Comparative Analysis of Pre- & Post-operative Change in Thoracolumbar Compression Fracture, as seen on 3-dimensional Computed Tomography

Conventional radiographs and simple CT scans fail to provide accurate information about the structural integrity of a fracture site. In recent years, special 3-dimensional CT scanning has been progressively developed, and we applied this technique to thoracolumbar compression fractures. Posterolateral spinal fusion with iliac bone graft was attempted in all patients; Comparative pre- and post-operative change in these fractures was then an-alysed, using 3-dimensional CT. The results of this study suggest that this imaging is a useful non-invasive technique to assess compression fracture and determine prognosis.

Prognostic Factors in Patients with Hypertensive Basal Ganglionic - Thalamic Intracerebral Hemorrhage

The authors carried out various treatment modalities in 74 consecutive patients with hypertensive basal ganglionic-thalamic intracerebral hemorrhage and were admitted to the Department of Neurosurgery. Konkuk University Hospital, from Jan. 1991 to Dec. 1993. A variety of prognostic factors that influence mortality were observed. The locaton of hematoma was at the basal ganglia in 47 cases and at the thalamus in 27 cases. The prognosis gets poorer as the hematoma extended wider and deeper. The prognosis was unfavorable when the hematoma was over 30cc(P<0.001). The mortality rate was higher in cases with IVH than in cases without IVH(P<0.005). In cases with IVH, 19 cases(26%) showed dilated 4th ventricular hemorrage and higher mortality rate(P<0.001). Cases in which the GCS were less than 9 on admission showed higher mortality rate(P<0.0001). The mortality rate was also higher if the midline shift was more than 10mm on the initial brain CT scan(P<0.005). THe group where the unilateral or bilateral pupillary light reflex was unreactive(35cases) showed poorer prognosis than the group where the bilateral pupillary light reflex was reactive(P<0.0001). The ventriculocranial ratio(VCR), hydrocephalus, surrounding edema edema around the heamtoam, and treatment modality were not related to the prognosis. The significant prognostic factors in patients with hypertensive basal ganglionic-thalamic intracerebral hemorrhage were location and type of hematoma, whether or not the volume of hematoma is more than 30cc, IVH, dilated 4th ventricular hemorrhage, Graeb's score of more than 7, GCS of less than 9, midline shift of more than 10mm, and reactivity of pupillary light reflex.

Stereotactic Surgery for the Nail-Gun Injury of the Head: Case Report

The authors report a rare case of gunshot injury to the head by a nail-gun which was treated by stereotactic surgery. In the case, a 23-year-old male patient, presented with semicomatose mentality and decerebrated rigidity. The large nail was located in the 3rd ventricular area in the mid-line with vertical stature. The entry point was identified 1cm anterior to the coronal suture line and just lateral to the sagittal suture line. The foreign body was removed stereotactically with the guidance of gluoroscope. But the died of initial severe brain damage.

A Case of Recurrence of Spinal Tuberculosis Treatment with Posterior Approach and Followed by Successful Anterior Fusion on the Lumbosacral Spine

In the treatment of spine tuberculosis, anterior spinal fusion has been a widely accepted procedure since Hodgson and Stock in 1956 bacause of its many advantages. Posterior approch is a simplier & safer procedure. However the destructed vertebral body can not be removes completely by this procedure. A 50 years old female patient was admitted with lumbosacral tuberculosis showing massive destruction of the L5 & S1 vertebral body and abscess formation. We initially performed a curettage and debridement by the posterior approach, combined with chemotheraphy. A anterior fusion was a more risky procedure to the patient with poor general condition, severe adhesion and long destruction of the entire L5 & upper S1 vertebral body. Occurred 35 days after first operation. Curettage and debridement were again undertaken by the posterior approach on the second operation. However 45 days late, it recurred again. Therefore, we performed the anterior fusion as the third procedure and had a successful outcome. We believe that in some cases, the advantages of posterior approach and fusion may be a pitfall and should be carefully applied in the treatment of spine tuberculosis.

Clinical Significance of Intracranial Hematoma in Ruptured Aneurysms

The intracranial hematoma following cerebral aneurysmal rupture makes patient's clinical status and outcome worse by pressure effect on the brain structure. It's incidence has varied with authors between 5-30% of patients with ruptured cerebral aneurysms. Several authors emphasized the importance of early operation to obtain better results by early removal of hematoma and reducing intracranial pressure. The authors retrospectively evaluated seventy-six patients with intracranial hematomas in 370 patients with ruptured aneurysms from Jan. 1987 to Dec. 1992. The incidence of hematoma resulting from ruptured aneurysm was 20.5%. The most frequent site of aneurysm which was accompanied by intracranial hematoma was the middle cerebral artery, and the next was the anterior cerebral artery. The amount of hematoma and/or evidence of midline shift were the important factors in predicting the clinical outcome. The most favorable outcome was found in cases with intracerebral hematoma only, and the worst was in cases with intracerebral hematoma associated with intraventricular hemorrhage. Fifty out of 76 patients with intracranial hematomas were operated on. Their outcomes were more favorable than in the patients who were not operated on. Aggressive surgical intervention was especially effective in patients with poor Hunt & Hess grades(IV or V) .

A Clinical Analysis of Degenerative Supondylolisthesis

The auther has studied 60 patients of degenerative spondylolisthesis diagnosed and operatively treated at Hanyang University Hospital from January 1987 to June 1992, and analized the outcome. The results were summarized as followings: 1) Male to female ratio was 1:4, showing female predominance. Average peak ages were 5th and 6th decades. 2) "Pedicle-Facet Angle" and the degree of slipping had directly proportional relationship(Y=0.58X+110). The wider the angle is, the more slipping develops. 3) The significant symptom and sign were neurogenic intermittent claudication and negative straight-leg-raising test. 4) The degenerative spondylolisthesis developed most frequently at L4-5 level(74%), L5-S1(15%), L3-4(8%), 57 cases(95%) fell into Grade by Meyerding classification. 5) Complete or incomplete block on myelogram was present in 59%, and pseudodisc and lumbar spinal stenosis were noticed on CT. 6) Laminectomy with P.L.I.F. were done in 50 cases(83%) and total laminectomy and medial facetectomy and foraminotomy were done in only 4 cases(7%). In the comparision on the slipping degree before & after operation, in 55 cases(92%), slipping degrees showed no great change less than 2mm, but the almost showed exellent & good results. So we considered decom pression & fusion without excessive reduction was sufficient. 7) Threaded fusion cage(T.F.C) had the several benefits that 1) stability was good, 2) osteosynthesis through threaded was possible and 3) postoperative ambulation was possible earlier. Therefore recently, P.L.I.F. using T.F.C in the treatment of degenerative spondylolisthesis were used in many cases and further evaluation for T.F.C. should be considered.