Clinical Features of Percutaneous Hemivertebroplasty in Patients with Osteoporotic Vertebral Compression Fractures / 대한신경손상학회지

OBJECTIVE: Unilateral percutaneous vertebroplasty is a widely accepted treatment for osteoporotic vertebral compression fractures (VCFs). However, bone cement may fail to fill both hemivertebra from the single needle. We assessed the radiographic and clinical outcome of hemivertebroplasty (HVP) and evaluated the factors that affect subsequent VCFs after HVP. METHODS: Fifty two patients who underwent HVP were reviewed. VCFs were identified based on clinical and radiological findings. The patients were grouped into two groups: 1) no subsequent VCFs, 2) subsequent VCFs. We evaluated the association between age, sex, body mass index (BMI) and bone mineral density (BMD) and subsequent VCFs. We also assessed the impact of location, type and grade of fracture, endplate fracture, burst fracture, bone cement volume on subsequent VCFs. We analyzed the compression ratio, wedge angle, kyphotic angle, and visual analogue scale (VAS) score in both groups. RESULTS: There were no significant differences in age, gender, BMI, and BMD between two groups. No significant difference was also found in pre-existing VCF, location, type and grading of fracture, endplate fracture, burst fracture, amount of bone cement, and radiological findings such as compression ratio, wedge angle, and kyphotic angle between two groups. The final mean VAS scores of patients with or without subsequent VCFs were 3.11 and 4.02, respectively. CONCLUSION: No major risk factors for the subsequent VCFs after HVP were found. However, we identified adjacent fractures, refractures, and remote fractures after HVP in chronological order. Therefore, long-term follow-up is necessary to evaluate the effectiveness of HVP to osteoporotic VCFs.

The Differences of Radiological Results after Percutaneous Vertebroplasty according to the Degree of Preoperative Canal Encroachment due to Bony Fragments / 대한신경손상학회지

OBJECTIVE: Anterior wedge compression fractures and burst fractures have different clinical features, treatment methods and risks of neurologic deficits. The aim of this study was to evaluate the radiological differences and postoperative risk due to cement leakage after vertebroplasty. METHODS: From January 2007 to December 2008, we retrospectively analyzed the radiological features of 43 patients. We divided the patients into three groups by the degree of the displaced bony fragments into the spinal canal. The change of the compression ratio, the kyphotic angle, the presence of cement leakage and the occurrence of major complications were investigated. RESULTS: The immediately postoperative improvement of the compression ratio was significantly better in the anterior wedge compression fracture group than that in the burst compression group (p-value: 0.022). Cement leakage was more common in the burst fracture group even though this was not statistically significant (p-value: 0.114), but cement leakage into spinal canal did not occur. There was no major complication, including embolism and additional neurologic deficit, after vertebroplasty in all the patients. CONCLUSION: Vertebroplasty was the more effective method for treating an anterior wedge fracture than a burst fracture, and especially for achieving an improved compression ratio. Even though the risk of cement leakage may be higher for a burst fracture, vertebroplasty may be also carefully applied to burst fracture patients with no neurologic deficits at admission.

The Proper Volume and Distribution of Cement Augmentation on Percutaneous Vertebroplasty

OBJECTIVE: The purpose of this study was to determine the optimal volume of injected cement and its distribution when used to treat vertebral compression fractures, and to identify factors related to subsequent vertebral fractures. METHODS: A retrospective analysis of newly developing vertebral fractures after percutaneous vertebroplasty was done. The inclusion criteria were that the fracture was a single first onset fracture with exclusion of pathologic fractures. Forty-three patients were included in the study with a minimum follow up period of six months. Patients were dichotomized for the analysis by volume of cement, initial vertebral height loss, bone marrow density, and endplate-to-endplate cement augmentation. RESULTS: None of the four study variables was found to be significantly associated with the occurrence of a subsequent vertebral compression fracture. In particular, and injected cement volume of more or less that 3.5 cc was not associated with occurrence (p = 0.2523). No relation was observed between initial vertebral height loss and bone marrow density (p = 0.1652, 0.2064). Furthermore, endplate-to-endplate cement augmentation was also not found to be significantly associated with a subsequent fracture (p = 0.2860) by Fisher's exact test. CONCLUSION: Neither volume of cement, initial vertebral height loss, bone marrow density, or endplate-to-endplate cement augmentation was found to be significantly related to the occurrence of a subsequent vertebral compression fracture. Our findings suggest that as much cement as possible without causing leakage should be used.

High Grade Myxofibrosarcoma in the Paravertebral Muscle: A Case Report

Many different abnormalities, such as, neoplasm, infection, traumatic hematoma, or congenital or immune myopathy, may be found in the paravertebral muscles. However, neoplasms of paravertebral muscle are an uncommon cause of back pain. Such neoplasms may arise from local lesions or due to metastatic spread from a distant malignancy. The differential diagnoses of a primary soft tissue malignancy and metastatic spread from a skeletal muscle tumor are important. In cases of soft tissue sarcoma, histopathological findings and surgical margins are both related to local recurrence and metastasis, therefore, percutaneous needle biopsy may be helpful before surgical excision. A degree of surgical excision is decided based on considerations of muscular function and histopathological findings.

Efficacy of Microdecompression with Microscope and Tubular Retractor in Lumbar Foraminal Stenosis: Surgical Technique and Clinical Outcomes

OBJECTIVE: The objective of this study is to evaluate the efficacy of microdecompression (MD) with microscope and tubular retractor in lumbar foraminal stenosis (FS) and to analyze the clinical outcomes. METHODS: From January 2006 to December 2007, 22 patients with symptomatic lumbar FS underwent conventional decompressive surgery (CDS) and MD was performed in other 20 patients. Clinical outcome was measured using a Visual Analogue Scale (VAS) and Macnab?fs criteria. Spinal instability was determined by radiologic assessment of flexion-extension radiographs. RESULTS: The CDS group included 14 men and 8 women. The MD group included 14 men and 6 women. The mean age was 66.2 years (range, 46-80 yrs) in the CDS group and 65.4 years (range, 59-74 yrs) in the MD group. Average follow-up periods were 18.6 months in the CDS group and 16.5 months in the MD group. Mean operating time was 126 minutes in the CDS group and 168 minutes in the MD group. The mean VAS of back pain decreased from 2.68 to 1.36 in the CDS group and from 2.85 to 1.25 in the MD group. The mean VAS score of leg pain decrea- sed from 6.68 to 1.48 in the CDS group and from 6.65 to 1.40 in the MD group. The success rate of CDS group was 86.3 % (19/22), compared with 85.0% (17/20) for MD group. Radiologically, there was no spinal instability. CONCLUSION:MD could achieve neural decompression and offer an effective treatment of lumbar FS. However it was a technically demanding procedure and effective in limited operative indications. We need to consider long-term follow-up.

Differential Expressions of Genes in Colorectal Cancer with Liver Metastasis by using a cDNA Microarray Chip: A Pilot Study

PURPOSE: Liver metastasis is the most common type of failure in the treatment of colorectal cancer. The identification of differential expressions of genes in colorectal cancer and liver metastasis is important to differentiate the genetic mechanism of carcinogenesis and liver metastasis from that of a normal mucosa. The aim of this study is to find candidate genes playing roles in liver metastasis of colorectal cancer by using cDNA microarray. METHODS: We screened a group of genes differentially expressed in a normal mucosa and in cancer and liver metastasis by using a 4.7 K cDNA microarray chip in 8 patients with far advanced colorectal cancer from Jan 2003 to May 2004 at Kyungpook National University Hospital. RESULTS: A comparison of mRNA expressions of genes in normal mucosa vs. cancer, normal mucosa vs. liver metastasis, and cancer vs. liver metastasis, 76 and 27 known and unknown genes were significantly over-expressed in cancer and liver metastasis, respectively. Also 62 and 26 genes were down- regulated in cancer and liver metastasis. Among those genes, TIMP-1, SRY-box9, Rattus norvegicus fibronectin 1, mitotic check point regulator, etc. were constantly up- regulated in cancer or metastasis, and hsgk, etc. were down-regulated in cancer or liver metastasis. CONSLUSIONS: The cDNA microarray chip technique could be a useful for robust screening of candidate genes involved in carcinogenesis or metastasis of colorectal cancer.

Retrospective Analysis of Re-operated Patients after Chronic Subdural Hematoma Surgery

OBJECTIVE: The aim of this study is to analyze the clinical symptoms, radiological changes, interval from first operation to symptom recurrence and to propose the proper treatment method for re-operated patients following chronic subdural hematoma surgery. METHODS: Between January 1992 and April 2003, 18 of 138patients of chronic subdural hematoma repeatedly underwent surgical treatment. The symptoms, mental status by Bender grade, radiological hematoma size and midline shifting, interval from symptom onset to diagnosis, surgical method and prognosis by Glasgow outcome scale(GOS) between the first attack and the recurrence were compared. RESULTS: The symptoms at the time of recurrence were nearly the same as with the first attack, but two patients(2/18, 11.1%) showed a more declined mentality. In addition, the recurred hematoma sizes were the same or large than those previously found. Many patients were recurred within two weeks(13/18, 72.2%). Most patients were operated on using the previous burr hole, with the exception of one patient who recurred at a different site. All patients had a good prognosis more than GOS 4(GOS 4: 4 , GOS 5: 12), but two died due to extracranial complication and infection. CONCLUSION: These results suggest that the early diagnosis and treatment are important, mostly recurred same symptoms within two weeks. Re-operation using the previous burr hole site is a good method.

Clinical and Radiological Outcome of Unilateral Posterior Lumbar Interbody Fusion Using Cages

OBJECTIVE: The goal of study is the evaluation of clinicofunctional outcomes and fusion success rates of unilateral posterior lumbar interbody fusion(PLIF) using cages. METHODS: The authors conducted retrospective study of 81 patients who underwent unilateral PLIF using cages. The outpatient notes, standard hospital charts, and pre-and postoperative imaging studies were analyzed. In this study pre-and postoperative back pain, radiating pain, fusion success rates, pseudoarthrosis, clinicofunctional outcome, and complications were evaluated. Follow-up duration ranged from 3 to 8 years. RESULTS: Eighty-one patients underwent unilateral PLIF using 98 cages(TFC:37, CH cage:25, Novus cage 36). Two-level fusion was performed in 17 patients. There were 48 men(59%) and 33 women(41%). Seventh decade was most common(47%). The most common site of PLIF was at L4-5 space(69.4%) and left side(58%) was prevalent. Fusion was successful in 91 out of 98 levels(92.8%) and pseudoarthrosis was observed in five patients(7 level, 7%). The clinicofunctional results by Prolo scale were as follows:good(score 8-10):80.3%, moderate(score 6-7):14.8%, poor(score 5 or less 5):4.9%. Device migration was observed in six cases:5(20%) of 25 CH cages and 1(2.8%) of 36 Novus cages. CONCLUSION: Unilateral PLIF using cage is one of method to decrease the rates of iatrogenic complications in patient of unilateral symptomatic spinal instability while preserving normal anatomic structures with good fusion success rates and clinicofunctional results after surgery.

Nonsecretory Multiple Myeloma with Multiple Spine Fracture

A case of nonsecretory multiple myeloma in a 66 year-old-woman is reported. At first, she complained severe neck pain and radiologic finding showed C2 pathologic fracture. She complained severe low back pain 4 month later and L1 compression fracture was found. The lumbar MRI showed a 1.4cm-sized round enhancing lesion in the body of T12. Bone marrow aspiration biopsy at L1 spine showed a few polymorphous and small nests of mononuclear cell. L1 lamina bone biopsy showed many abnormal plasma cells. Pathologic diagnosis was multiple myeloma. However, plasma electrophoresis and protein immunoelectrophoresis of serum and urine of patient were normal. So, it is a nonecretory multiple myeloma case and the incidence of nonsecretory multiple myeloma is known to about 1% of all multiple myeloma.

Spinal Epidural Lipomatosis: Report of Four Cases

No abstract available.

A Case of Cerebral Paragonimiasis Combined with a Meningioma : A Case Report

No abstract available.

Cliniclal Analysis of Microsurgical Reoperation after Lumbar Disc Surgery

Repeated surgery of the lumbar spine after lumbar discectomy was not uncommon. Total 817 cases of lumbar disorders were carried out surgical intervention in author's clinic from Jan. 1993. to May 1997. Among them, 82 cases were reoperated cases after lumbar disc surgery. The causes, methods and outcome of reoperation were reviewed. The most common causes of reoperation was epidural adhesion, and the most frequent method of reoperation was the interbody fusion with adhesiotomy. Epidural fibrosis was the major problem and must be studied forward for preventing reoperaion.

A Case of Calvarial Tuberculosis

Tuberculosis is still remains an important cause of morbidity and mortality throughout the world. Calvarial tuberculosis is a rare entity and when the primary lesion is in the calvarium without any detectable pulmonary lesion, it is even exeedingly rare. The authors present a case of a 60-year-old female patient presenting with headache and an area of painful protrusion in the left parietal scalp. Plain skull radiographs, computerized tomography(CT) scan and magnetic resonance(MR) image of the brain revealed an osteolytic lesion in the left parietal bone with an outward growth of the outer table. Chest radiograph was normal. At operation, the osteolytic lesion of the skull and the abnormal soft tissue were removed completely. Histopathological report on the surgical specimen confirmed the tuberculosis of the calvarium.

Long-term Follow-up Results of Anterior Cervical Interbody Fusion with and without Cervical Plate

Eighty-four patients whose cervical lesions not associated with any trauma or tumor were operated for anterior cervical interbody fusion. The patients were separated into two groups, one group operated with a cervical plate and the other group, without the cervical plate. The mean follow-up duration in anterior cervical interbody fusion with cervical plate cases was 16 months(from 6 months to 30 months), without cervical plate 35 months(from 6 months to 84 months). Retrospective analysis of the two groups were done in order to compare the incidence of postoperative complications, clinical outcome, and radiological changes. The most notable postoperative complications of the group operated without the cervical plate were migration of the bone graft(3.3%) and angulation(3.3%), whereas of the group operated with the cervical plate were screw loosening(4.2%) and infection of the operative wound(4.2%). Comparative analysis of the postoperative clinical outcome and changes in radiological measurement of the intervertebral heights and angles showed no statistically significant difference between the two groups. The results of this study suggest that whether or not the cervical plate should be used for anterior cervical interbody fusions requires a decision made carefully and meticulously by the operator, so that the possibility of any postoperative complications can be minimized.

Surgical Treatment of Syringomyelia Secondary to Tuberculous Meningitis: Report of 4 Cases

The authors report our recent experience with 4 cases of syringomyelia that had developed secondary to tuberculous meningitis. Three cases of syringomyelia were treated by syringoperitoneal shunt and 1 case, by syringosubarachnoid shunt. Postoperatively, upper and lower extremity pain that had persisted in all the patients was relieved in all the patients, but improvement in limb sensation was noted in only 1 case. Improvement in limb motor power was noted in 3 cases. The clinical presentation, surgical consideration, and pathogenesis of syringomyelia is discussed together with a review of the literature.