Radiological Considerations of Posterior Cervical Lateral Mass Fixation Using Plate and Screw

The aim of this study is to determine whether the posterior cervical fusion methods with the plate-screw system applied to the lateral mass of cervical spine are radiologically safe to patients. The lateral cervical X-rays and CT scans were done on 40 normal adults without cervical problem. Based on Roy-Camille and Magerl's method, the theological trajectory of screw was shown on films and the parameters were measured. The study based on Roy-Camille's method showed less than one percent chance of injury on the facet joint and the mean depth of the screw to be 10.5+/-1.4mm. On the other hand, Magerl's method showed the mean depth of screw to be 11.9+/-1.5mm which is slightly larger than that of Roy-Camille's method and no chance of facet injury occurred. A reduced lateral angle of screw (19.6+/-3.5 degrees) performed with the concept based on Magerl's method resulted a longer depth of screw (13.5+/-2.1mm). Both Roy-Camille and Magerl's methods seemed to be radiologically safe to normal persons. However, the authors recommend the reduced lateral angle (19.6+/-3.5 degrees) of screw based on the Magerl's method more than an original Magerl's methods.

Clinical Application and Surgical Results of Hollow Cage(RABEA(TM)) without Bone Graft in the One-Segment Cervical Spinal Interbody Fusion

OBJECTIVE: The authors report a result of application of cervical hollow cage(RABEA(TM)) without bone graft to the patients of one-level cervical spondylosis or acute cervical disc herniation to fill and stabilize a vacant space following anterior decompression. METHODS: Twenty-one patients from May 1999 to April 2001 had been taken procedure with cervical hollow cage system following anterior decompression and there had been no additional bone graft or screw fixation or fusion. Pain relief and clinical outcome were evaluated, and the intervertebral disc height and segmental angle for radiological assessment were examined. All patient were followed up for 12 months at least. RESULTS: The result was excellent in 14 cases(66.7%), good in 6 cases(28.6%) and poor in 1 case(4.8%). In the lateral projection, the mean of preoperative disc height and segmental angle were significantly improved after surgery and maintained during follow-up periods. No abnormal displacement were recorded at dynamic flexion and extension lateral X-ray and no cage rotation or retropulsion was noted in follow-up periods. Three patients(14.3%) was observed to subside of disc height on the postoperative periods and only one of their patients was dissatisfied with surgery. CONCLUSION: Cervical hollow cage is simple to perform and reduces the operation time. Besides clinical improvement, it improves mechanical stability and radiological profile as the physiologic level. The cervical hollow cage might be an alternative to traditional cervical interbody fusion with bone graft.

Concurrence of Traumatic Spinal Epidural and Subdural Hematoma without Spine Injury at Occipitocervical Junction: A Cases Report

Spinal epidural and subdural hematomas are uncommonly recognized conditions. These conditions can result in severe irreversible neurologic deficits, if left untreated. Like intracranial lesions, these hematomas can expand rapidly and cause sudden spinal cord and/or cauda equina compression. This case is very rare in which is a concurrence of cervical spinal epidural and subdural hematoma after motor vehicle accident without spine fracture. The pathophysiology of these entities are discussed and the radiologic diagnosis focused on MR findings are reviewed. The importance of prompt surgical treatment is emphasized to facilitate good postoperative outcome.

The Effect of Caudal Block with Morphine Sulfate on Postoperative Pain Levels in Lumbar Spinal Surgery

In 38 of 70 patients who underwent lumbar spinal surgery, we performed a randomized, prospective double-blind study of the effect of caudal block with morphine sulfate on postoperative pain levels. Age, sex, clinical features, postoperative analgesic consumption, pain score, adverse effects and patient satisfaction on discharge were recorded. The consumption of parenteral analgesics on the 1st, 2nd and 3rd days was significantly lower in the morphine sulfate group(p<0.05), than in the control group. Caudal block with morphine sulfate also led to marked reductions in pain levels and thus increases patients satisfaction during the postoperative period(p<0.05). Transient respiratory depression occurred in three of 38 patients(7.9%), but further treatment was not needed. Seventeen patients(44.7%) developed urinary retention, but this recovered spontaneously. The present study demonstrates that caudal block with morphine sulfate leads to a highly significant reduction in pain during postoperative periods and a corresponding reduction in the need for additional postoperative analgesics, in addition, patients are more satisfied.

Posterior Interbody Fusion with TFC in Degenerative Lumbar Diseases

Surgical treatment for chronic back pain in degenerative lumbar spine has been still complicated. Several kinds of devices for spine fusions have been developed, but they have had both some advantages and disadvantages. Recently, the TFC(Threaded fusion cage) instrument has been introduced in treating lumbar spinal disorders associated with degenerative changes. The authors analysed 15 cases of lumbar degenerative disease treated with adequate decompression and TFC instrumentation between October 1993 and March 1994 at Ewha Womans University Mokdong Hospital. There were 10 females and 5 males. The main surgical indication was serious limitation of daily activity, which was not treated conservatively. The preoperative diagnoses were 6 degenerative stenosis with disc, 6 degenerative spondylolisthesis, 2 spondylosis and spondylolytic spondylolisthests, and 1 FBSS. We observed that 93% of patients(14 of 15) had more than good results and preoperative back pain was markedly reduced. Intervertebral disc space was well restored, and the reduction was possible in spondylolisthesis patients. In our opinion, TFC instrument will be one of good surgical modality in the treatment of degenerative lumbar spine.

Attenuated release of atrial natriuretic peptide and vasorelaxation in streptozotocin-induced diabetic rats

The present study was aimed at investigating the atrial natriuretic peptide (ANP) and urinary responses to acute perturbations in fluid balance and the vascular function in diabetes mellitus (DM). DM was induced in rats by treatment with streptozotocin (50 mg/kg, i.p.). Ten weeks later, the plasma ANP concentration measured in the conscious state was significantly higher in DM group (27.5 +/- 3.9 pg/mL) than in the control (15.4 +/- 2.6 pg/mL), while the atrial tissue contents of ANP were lower. In response to acute extracellular volume expansion (VE), amounting up to 5% of body weight over 45 min, under thiopental anesthesia (50 mg/kg, i.p.), the magnitude of increase in plasma ANP was lower in the DM group than in the control (56.8 +/- 25.2 vs. 189.1 +/- 53.6% increases over the basal). Urinary sodium excretion during VE was also lower in the DM group. Acetylcholine-induced relaxation of the isolated aortic rings was attenuated in the DM group, which was partially restored by L-arginine-supplementation (2 g/L in drinking water). These results suggest that body fluid homeostasis and vascular functions are unfavorably altered in DM.

Posterior Lumbar Interbody Fusion with Threaded Fusion Cage(TFC)

Of all fusion techniques in the lumbar spines, posterior lumbar interbody fusion(PLIF) has the best theoretical opportunity to achieve fusion by way of compression loading of the bone graft between the well vascularized vertebral bodies. Even though the rationale for the PLIF is quite reasonable, it has been a very technically demanding procedure and frequent problems have been reported which include protrusion of bone grafts, settling of the interspace and pseudoarthrosis. A new deice, Threaded Fusion Cage(TFC) seems to be an ideal solution for the various technical problems which hindered greater success of PLIF in the past. Maintenance of stability and absence of loss of disc height are assured due to the threaded metal tube concept. We have operated PLIF with TFC in 60 patients since last December. The preoperative diagnoses were 27 degenerative disc diseases, 25 degenerative spondylolisthesis, 7 spondyloysis & listhesis and 1 FBSS. Our initial experience with the clinical results show that the most of the patient have marked improvement of low back pain and reduction is possible in almost cases of the spondylolisthesis. Long term follow up is needed as to the future of the threaded cage, but it would appear that once they have been in a stable position and fusion with the patients' own bone has occurred. In our opinion, the use of TFC in the future will be widely spread and represents an ideal method for the treatment of chronic low back pain and spinal instability.

Posterior Lumbar Interbody Fusion with Threaded Fusion Cage(TFC)

Of all fusion techniques in the lumbar spines, posterior lumbar interbody fusion(PLIF) has the best theoretical opportunity to achieve fusion by way of compression loading of the bone graft between the well vascularized vertebral bodies. Even though the rationale for the PLIF is quite reasonable, it has been a very technically demanding procedure and frequent problems have been reported which include protrusion of bone grafts, settling of the interspace and pseudoarthrosis. A new deice, Threaded Fusion Cage(TFC) seems to be an ideal solution for the various technical problems which hindered greater success of PLIF in the past. Maintenance of stability and absence of loss of disc height are assured due to the threaded metal tube concept. We have operated PLIF with TFC in 60 patients since last December. The preoperative diagnoses were 27 degenerative disc diseases, 25 degenerative spondylolisthesis, 7 spondyloysis & listhesis and 1 FBSS. Our initial experience with the clinical results show that the most of the patient have marked improvement of low back pain and reduction is possible in almost cases of the spondylolisthesis. Long term follow up is needed as to the future of the threaded cage, but it would appear that once they have been in a stable position and fusion with the patients' own bone has occurred. In our opinion, the use of TFC in the future will be widely spread and represents an ideal method for the treatment of chronic low back pain and spinal instability.

Clinical Evaluation of Failed Back Surgery Syndrome(FBSS)

The authors experienced 186 cases of Failed Back Surgery Syndrome(FBSS), which were 2.5% of all admitted patients in authors' clinic from 1983 to 1992. Among them, 173 patients were referred cases from other hospital and 13 patients were authors' cases which was 0.2% of authors' back surgery. About 75% of all was come to our clinic within 2 years after initial operation. The common cause of FBSS was resulted form inadequate surgery or surgical complications (51%). In these cases, incomplete decompression at initial operation was seemed to be a major factor. The next causes was due to inadequate patient selection(26.3%) and the FBSS was more prevalent when the patient had only back pain without leg pain. The other causes of FBSS was post-operative adhesion(8.6%), discitis(4.3%), and inadequate diagnosis(4.3%). So about 80% of FBSS seem to have preventable causes. 66 of 186 cases was performed reoperation and 70% of them had improvement.

Chemonucleolysis at Out-patient Clinic

The Chemonucleolysis at out-patient clinic(OPD) is a new option in the treatment of lumbar disc herniation. The authors performed 39 cases of Chemonucleolysis with this method since Mar. 1992. All but 2 cases had excellent or good results without any complications. This OPD chemonucleolysis was thought to be a very useful method that gave various benefits to both of the patient and the hospital. To the patient, Socioeconomical and psychological benefits such as cost reduction and short hospital periods would be obtained. And to the hospital, Increasing outcome could be obtained by the improving hospital circulation of the patients who needed admission. For the best results, complete pre-operative evaluation and strict application of indication was essential. Proper home care guide was also needed because the home care was occasionally required from several days to a few months.

Intramedullary Spinal Hemangioblastoma Associated with Syringomyelia

Intrameduallary spinal hemangioblastoma is frequently associated with syringomyelia. It grows slowly and can be removed totally. Syringomyelia can be subcided by total removal of tumor and opening of syringomyelia. Two cases of intramedullary spinal hemangioblastomas associated with syringomyelia are reported. Intramedullary tumor and syrinx was easily diagnosed by magnetic resonance imaging(MRI). They are successfully managed by total removal of tumor and opening of syrinx. Patients showed improved neurological status after operations.

Iopamidol Myelography

In a comparative, prospective randomized study 200 patients underwent myelography using iopamidol (150 patients) or metrizamide (50 patients) as contrast medium. Adverse reactions were few, mild, and short in duration in iopamidol myelography compared to metrizamide myelography. Seizure occured in 2 patients with the use of metrizamide. Iopamidol appears to be superior to metrizamide for intrathecal administration.

Clinical Analysis of Aneurysmal Subarachnoid Hemorrhage

The authors analyzed 377 consecutive cases of aneurysmal subarachnoid hemorrhage admitted to the Department of Neurosurgery at Yonsei University Hospital from 1980 through 1984. The results of analysis were summarized as follows. 1) Mean age of the patients was 48.8 years. Aneurysmal SAH occured more frequently in female(201) than male(176). 2) Incidence of clinical vasospasm was 33.2%(125/377) and of rebleeding was 11.7%(44/377). 3) Surgery was done for 191 patients which accounts for 50.7% of all patients. Functional recovery was noted in 179 of these 191 surgically treated patients(93.7%). Operative mortality was 3.7%. 4) Conservative treatment was done for remaining 186 patients. Among them, 124 patients died or disabled : 40 from initial insult, 59 from vasospasm, 25 from rebleeding. Aneurysm could not be found on angiography in 19 cases. Remaining 43 patients refused surgery. Despite of dramatic improvement of surgical treatment for ruptured intracranial aneurysms, overall mortality and morbidity for ruptured cerebral aneurysm still remain unchanged over the past two decades. As shown in this study, most of the management mortality and morbidity came from the patients who didn't or couldn't receive surgical treatment. The authors suggest several directions to improve overall management outcome in all aneurysmal patients.

Calcified Pituitary Adenomas

Two cases of calcified pituitary adenoma are reported, which comprise 2.44% among a surgical series of 82 pituitary adenomas. Both patients had very high serum prolactin level, which suggested the possibility of hormonal influence in formation of the calcification. The tumors were removed by a subfrontal approach to prevent and reduce possible damage to the surrounding structures.

Stereotaxic Biopsy for Brain Tumors Using C-T Brain Scanning

Stereotaxic biopsy is an useful technique as an alternative to craniotomy for the tissue diagnosis of the intracranial tumors, especially such as deep seated tumor or malignant neoplasm in the dominant hemisphere. Such biopsy was more safe and lesser expensive than any other procedures and had high accuracy. For the purpose of more accuracy, the authors inserted small steel ball marker at the biopsy site and performed repeat C-T brain scanning immediately after the operation. We could confirm the marker in the tumor tissue on the C-T scans. The authors had experienced 4 cases of stereotaxic biopsy as follow; 2 cases of thalamic astrocytomas, 1 case of pineocytoma and 1 case of astrocytoma grade II in the dominant hemisphere. Neither mortality nor morbidity was noted.