Herpes Zoster Confused with Radiculopathy / 대한정형외과학회잡지

PURPOSE: To describe the clinical features of herpes zoster that can be easily misdiagnosed as cervical or lumbar radiculopathy. MATERIALS AND METHODS: We retrospectively reviewed the medical records and diagnostic studies of 7 patients with herpes zoster-related arm or leg pain. RESULTS: Except one immunocompromised patient with suspected postherpetic neuralgia or sequelae of herpetic myelitis, the other 6 patients with herpes zoster complained of very severe initial pain of sudden onset. Three patients did not show skin lesions on initial examination, and 2 of 5 patients with an MRI of the cervical or lumbar spine had findings consistent with their arm or leg pain and may have been confused with radiculopathy. Conservative treatment, including antiviral agents, improved the symptoms of all patients except the immunocompromised one. Selective nerve root blocks of the corresponding dermatomes were performed in 5 patients and extremity pain decreased over 50% in 4 of them. CONCLUSION: Herpes zoster can be confused with radiculopathy in patients with arm or leg pain if the typical skin lesions have not been developed. Unnecessary treatments including surgery should be avoided by early, correct diagnosis through prudent history taking and physical examination.

Scoliosis Correction with Thoracic Pedicle Screws: Posteroanterior C-arm Rotation Method / 대한정형외과학회잡지

Purpose: This study evaluated a practical, safe and accurate method of thoracic pedicle screw insertion for the surgical treatment of scoliosis using the posteroanterior C-arm fluoroscopy rotation method. Materials and Methods: A total of 611 thoracic pedicle screws were inserted in 45 patients using the posteroanterior (PA) C-arm rotation method. CT scans were taken postoperatively in the transverse and sagittal sections to evaluate the pedicle screw placement. Results: A mean preoperative curve of 57.7o was corrected to 17.1o (range, 3o-45o) in the coronal plane. The postoperative CT scans revealed that 10 screws (1.6%) had penetrated the medial cortex by a mean distance of 3.0 mm and 56 screws (9.2%) penetrated the lateral cortex by a mean distance of 3.5 mm. No screw penetrated the inferior or superior cortex in the sagittal plane. However, 21 screws (3.4%) penetrated the anterior cortex. No neurological or vascular complications were encountered, and none of the screws required replacement. Conclusion: Thoracic pedicle screw insertion in scoliosis patients using the posteroanterior C-arm rotation method is a practical, simple and safe technique that allows the en face visualization of both pedicles by rotating the C-arm to compensate for the rotational deformity.

Thoracic Pedicle Screw Insertion in Scoliosis Using Posteroanterior C-arm rotation Method / 대한척추외과학회지

STUDY DESIGN: A prospective study of the accuracy of thoracic pedicle screws inserted in scoliotic patients. OBJECTIVES: To evaluate and present a practical, safe and accurate method for thoracic pedicle screw insertion in the surgical treatment of scoliosis using the posteroanterior c-arm fluoroscopy rotating method. SUMMARY OF LITERATURE REVIEW: Previous studies have emphasized the clinical importance, yet difficulty, of accurate thoracic pedicle screw insertion in scoliotic patients. Three-dimensional alterations in the pedicle orientation of scoliotic patients makes the accurate insertion challenging. No reports exist on the accuracy and benefits of posteroanterior c-arm fluoroscopy, which is rotated to allow visualization from en face, in real patients. MATERIALS AND METHODS: A total of 350 thoracic pedicle screws were inserted in 29 patients, including 24 with idiopathic scoliosis, using the posteroanterior (PA) c-arm rotation method. The smallest patient weighed 14 kg, and the next smallest 17 kg. The average preoperative curve was 60.9 degrees(range, 45 degrees~101 degrees). CT scans were taken, postoperatively, in the transverse and sagittal sections to evaluate the pedicle screw placement. RESULTS: The mean preoperative curve of 60.9 degrees was corrected to 15.4 degrees(range, 3 degrees~45 degrees) in the coronal plane, a correction of 74.7%. A mean of 12.1 thoracic screws were inserted per patient. On analysis of the postoperative CT scans, 39(11.1%) of the 350 screws penetrated the medial or lateral pedicle cortices, 8(2.3%) into the medial cortex and 31(8.9%) into the lateral cortex, by mean distances of 3.3 and 3.6 mm, respectively. No screws penetrated the inferior or superior cortices in the sagittal plane, but 16(4.6%) penetrated the anterior cortex. No neurological or vascular complications were encountered, and none of the screws required subsequent replacement. CONCLUSIONS: Thoracic pedicle screw insertion in scoliotic patients, using a posteroanterior c-arm rotation method, allows the en face visualization of both pedicles by rotating the c-arm to compensate for rotational deformity, which makes it a practical, simple and safe method.

Results of Non-fusion Method in Thoracolumbar and Lumbar Spinal Fractures / 대한척추외과학회지

STUDY DESIGN: A retrospective study of surgically managed patients. OBJECTIVES: To evaluate the results of posterior stabilization of a thoracolumbar fracture, without fusion, followed by the removal of metal implants within an appropriate period. Changes in the sagittal alignment and the restoration of segmental motion were also investigated. SUMMARY OF LITERATURE REVIEW: In managing unstable thoracolumbar and lumbar fractures, posterior fusion, using a transpedicular screw system, has been the treatment of choice, but results in the permanent loss of segmental motion. MATERIALS AND METHODS: Twelve patients with thoracolumbar and lumbar spine fractures, under 40 years of age (mean 28.4 years), were managed using this non-fusion method. Implants were removed at mean 9.2 months after the initial fixation of the fracture. For metal-fixed segments, the sagittal alignment, such as the angle of kyphosis, height of body, recovered motion range in flexion-extension and right-left bending view, were measured radiologically and compared with a control group. Clinical aspects, such as gross deformity and functional ability, were also investigated. RESULTS: The average sagittal angle at the time of injury was average 17.2 degrees, but became 1.7 degrees post-fixation, which increased after removal of the implants, reaching 9.8 degrees at the final follow up. The height of the fractured body was maintained until the final follow-up. The mean segmental motion measured in the sagittal and coronal planes were 11.7 and 9.5 degrees, respectively. Most patients were satisfied with the final gross appearance and functional outcomes. Only one patient showed considerable development of kyphotic angulation, but the functional outcome was good. CONCLUSION: The author's non-fusion method seems to be effective in achieving stability and sagittal alignment, as well as in regaining segmental motion of the fixed segments. The non-fusion method seems to be an effective method for managing thoracolumbar fractures, especially for young active persons.

Differences of Fracture Types and Associated Injuries in Thoracolumbar Fractures Caused by Fall from Height and by In-Car Accident

PURPOSE: To evaluate the differences of associated factors in thoracolumbar fractures according to the mechanism of injury, level and type of the fracture, associated injuries were investigated for comparison between injuries by fall from height and by in-car accident injury. MATERIALS AND METHODS: Medical records and X-ray findings of 249 patients with fractures of thoracolumbar spine were reviewed retrospectively. Among them, 169 patients were injured by the two main causes. McAfee classification was adopted to determine the type of fracture. Associated injuries were classified as head and neck, chest and abdomen, pelvis, proximal and distal extremity, and neurologic deficit. Statistical analysis using Chi-square method was used for comparison between the two groups. RESULTS: In overall patients, the most common cause of thoracolumbar fracture was fall from height (44.6%) followed by in-car accident (23.3%) and fall down (16.9%). In fall-from height gruoup, burst fracture was the most common (44.1%) while flexion-distraction injury was the most popular (39.7%) in in-car accident group (p=0.05). Comparison according to height of fall showed significant increase of multiple fractures (p=0.0326). Associated injuries of distal lower and upper extremities and pelvis were common in fall-from-height group, while injuries of head and neck, proximal part of upper extremity, chest and abdomen were common in in-car accident patients. CONCLUSION: Type of fracture and distribution of associated injuries were significantly different between the two main causes of thoracolumbar injury, which seemed to be useful for understanding the mechanical events of injury and detecting associated injuries in each victim.