Association Study of Fibroblast Growth Factor 2 and Fibroblast Growth Factor Receptors Gene Polymorphism in Korean Ossification of the Posterior Longitudinal Ligament Patients

OBJECTIVE: The aim of this study was to determine whether single nucleotide polymorphisms (SNPs) of fibroblast growth factor (FGF) 2 gene and fibroblast growth factor receptor (FGFR) genes are associated with ossification of the posterior longitudinal ligament (OPLL). METHODS: A total of 157 patients with OPLL and 222 controls were recruited for a case control association study investigating the relationship between SNPs of FGF2, FGFR1, FGFR2 and OPLL. To identify the association among polymorphisms of FGF2 gene, FGFR1, FGFR2 genes and OPLL, the authors genotyped 9 SNPs of the genes (FGF2 : rs1476217, rs308395, rs308397, and rs3747676; FGFR1 : rs13317 and rs2467531; FGFR2 : rs755793, rs1047100, and rs3135831) using direct sequencing method. SNPs data were analyzed using the SNPStats, SNPAnalyzer, Haploview, and Helixtree programs. RESULTS: Of the SNPs, a SNP (rs13317) in FGFR1 was significantly associated with the susceptibility of OPLL in the codominant (odds ratio=1.35, 95% confidence interval=1.01-1.81, p=0.048) and recessive model (odds ratio=2.00, 95% confidence interval=1.11-3.59, p=0.020). The analysis adjusted for associated condition showed that the SNP of rs1476217 (p=0.03), rs3747676 (p=0.01) polymorphisms in the FGF2 were associated with diffuse idiopathic skeletal hyperostosis (DISH) and rs1476217 (p=0.01) in the FGF2 was associated with ossification of the ligament flavum (OLF). CONCLUSION: The results of the present study revealed that an FGFR1 SNP was significantly associated with OPLL and that a SNP in FGF2 was associated with conditions that were comorbid with OPLL (DISH and OLF).

Lumbar Interbody Fusion Outcomes in Degenerative Lumbar Disease : Comparison of Results between Patients Over and Under 65 Years of Age

OBJECTIVE: To evaluate the clinical and radiological outcomes of lumbar interbody fusion and its correlation with various factors (e.g., age, comorbidities, fusion level, bone quality) in patients over and under 65 years of age who underwent lumbar fusion surgery for degenerative lumbar disease. METHODS: One-hundred-thirty-three patients with lumbar degenerative disease underwent lumbar fusion surgery between June 2006 and June 2007 and were followed for more than one year. Forty-eight (36.1%) were older than 65 years of age (group A) and 85 (63.9%) were under 65 years of age (group B). Diagnosis, comorbidities, length of hospital stay, and perioperative complications were recorded. The analysis of clinical outcomes was based on the visual analogue scale (VAS). Radiological results were evaluated using plain radiographs. Clinical outcomes, radiological outcomes, length of hospital stay, and complication rates were analyzed in relation to lumbar fusion level, the number of comorbidities, bone mineral density (BMD), and age. RESULTS: The mean age of the patients was 61.2 years (range, 33-86 years) and the mean BMD was -2.2 (range, -4.8 to -2.8). The mean length of hospital stay was 15.0 days (range, 5-60 days) and the mean follow-up was 23.0 months (range, 18-30 months). Eighty-five (64.0%) patients had more than one preoperative comorbidities. Perioperative complications occurred in 27 of 133 patients (20.3%). The incidence of overall complication was 22.9% in group A, and 18.8% in group B but there was no statistical difference between the two groups. The mean VAS scores for the back and leg were significantly decreased in both groups (p < 0.05), and bony fusion was achieved in 125 of 133 patients (94.0%). There was no significant difference in bony union rates between groups A and B (91.7% in group A vs. 95.3% in group B, p = 0.398). In group A, perioperative complications were more common with the increase in fusion level (p = 0.027). Perioperative complications in both groups A (p = 0.035) and B (p = 0.044) increased with an increasing number of comorbidities. CONCLUSION: Elderly patients with comorbidities are at a high risk for complications and adverse outcomes after lumbar spine surgery. In our study, clinical outcomes, fusion rates, and perioperative complication rates in older patients were comparable with those in younger populations. The number of comorbidities and the extent of fusion level were significant factors in predicting the occurrence of postoperative complications. However, proper perioperative general supportive care with a thorough fusion strategy during the operation could improve the overall postoperative outcomes in lumbar fusion surgery for elderly patients.

A Occluded Posterior Communicating Artery Mimicking a Cerebral Aneurysm: A Case Report / 대한뇌혈관외과학회지

A 47-year-old man was admitted to the emergency department due to a sudden onset of headache during exercise. Brain computed tomography (CT) and CT angiography showed a subarachnoid hemorrhage (SAH) with a small sac in the left posterior communicating (pcom) artery and total obstruction in the proximal portion of the right middle cerebral artery (MCA). Catheter angiography revealed a protruding lesion in the left p-com artery and a total obstruction in the right MCA. It was difficult to differentiate the aneurysm from the occlusion of the pcom artery. We planned to confirm whether or not the protruded lesion was an aneurysm. Intraoperatively, the aneurysmal opacification seen on the preoperative catheter angiography proved it to be the occluded p-com artery filled with thrombus. The possibility of a vascular stump should be considered when diagnosing a protruding vascular lesion at the p-com artery.

Total En Bloc Lumbar Spondylectomy of Follicular Thyroid Carcinoma

The presence of distant metastases from differentiated thyroid carcinoma decreases the 10-year survival rates of patients by 50%. This is a report of a 61-year-old female with follicular thyroid carcinoma who presented initially with low back pain. 2-deoxy-2-[18F] fluoro-D-glucose whole-body positron emission tomography/computed tomography (PET/CT) demonstrated a hypointensity lesion in the left thyroid gland with malignant uptake in L1 vertebra and magnetic resonance images revealed paravertebral and epidural extension of mass in L1 vertebra. After thyroidectomy, histopathological study showed a follicular carcinoma. We performed L1 total en bloc spondylectomy with expandable cage for long-term local control. The technical details of total en bloc spondylectomy in follicular carcinoma are described herein.

Delayed Neurological Deficit in a Patient with a Compression Fracture of the Thoracic Spine: Coexistence of Ankylosing Spondylitis and Diffuse Idiopathic Skeletal Hyperostosis

Ankylosing spondylitis(AS) and diffuse idiopathic skeletal hyperostosis(DISH) increase the risk of spinal fracture after minor trauma in an ankylosed spine. There are few reports on a spinal fracture in people with both conditions. A 67-year-old man visited our emergency room with moderate back pain developed after slipping. No neurological deficit was noted. On physical examination, direct tenderness was noted in the back at the level of the thoracolumbar(TL) junction. Radiological evaluations showed the compression fracture of ankylosed spine and the coexistence of AS and DISH. Vertebroplasty was performed in fractured spine due to persistent back pain. Several weeks later, neurological deficits were developed. Finally, decompressive laminectomy and posterior screw fixations were performed. After operation, neurological deficits were fully recovered and patient was discharged. Patient who had a fracture of an ankylosed spine in association with coexisting AS and DISH could be considered the early surgical treatment.

Gamma Knife Radiosurgery for Growth Hormone-secreting Pituitary Adenoma following Trans-sphenoidal Approach

OBJECTIVE: The results of gamma knife radiosurgery(GKRS) for growth hormone(GH)-secreting pituitary adenoma are investigated to identify the role of adjuvant GKRS for remnant or recurrent tumor following transsphenoidal approach(TSA). METHODS: From March 1992 to December 2001, 20 patients treated by GKRS for GH-secreting pituitary adenoma following TSA were followed up more than 3 years and evaluated their symptomatic, hormonal and radiological changes after radiosurgery. RESULTS: There were 6 men and 14 women and the mean age was 40.2 years (range 24-58 years). The maximal dose was 32 to 60Gy (mean 46.2Gy) and the marginal dose was 12.8 to 36Gy (mean 25.5Gy). The mean follow-up time was 5.9 years (range 3-10years). Normalization of GH level (below 2ng/ml) was achieved in 10 of 20 patients (50.0%), and the normalization of IGF-I was in 8 of 15 patients (53.3%). On follow up MR imaging, the tumor control rate was 100% and the tumor volume reduction rate was 25~50% in 4 patients, 50~75% in 13 patients and 75~100% in 3 patients. CONCLUSION: In the treatment of GH-secreting pituitary adenoma, tumor control rate and improvement of clinical symptom show good outcome without major complication after adjuvant GKRS following TSA, though the rate of normalization of GH level is unsatisfactory. The optimal marginal dose for GH-secreting pituitary adenoma is more than 25Gy, and secondary GKRS can be considered in the failed cases to achieve effective hormonal normalization after the first adjuvant GKRS.