Diagnosis and Prognosis of Adult Post-traumatic Cervical Cord Injury Without Radiographic Evidence of Trauma Using Magnetic Resonance Imaging / 대한척추외과학회지

STUDY DESIGN: This is a retrospective review of 10 consecutive patients with spinal cord injury without radiographic evidence of abnormalities (SCIWORA) and 17 spinal cord injury patients without radiographic evidence of trauma (SCIWORET). OBJECTIVES: We wanted to assess the MRI and clinical findings, the prognosis and effect of anterior decompression of the spinal cord in SCIWORET patients. SUMMARY OF THE LITERATURE REVIEW: SCIWORET is not uncommon among middle-age and elderly people. It is less reported in adults as compared with children. There are no studies on the method for the treatment or the effectiveness of anterior decompression of the spinal cord. MATERIALS AND METHODS: From February 1994 to December 2005, this study included 27 patients who had cervical spinal cord injury without radiographic evidence of trauma on the plain roentgenography and MRI. Ten patients had no spinal cord compression (SCIWORA patients, group 1) and 17 had their spinal cord compressed from the anterior (SCIWORET patients, group 2), We conservatively treated the group 1 patients and 10 of the group 2 patients, and anterior decompression and fusion were done for 7 of the group 2 patients. Neurological evaluation was performed initial and at last follow up using an ASIA motor score and the Frankel grade. RESULTS: The patients who had spinal cord edema on MRI had a better prognosis than those who had contusion (p=0.06). There is no statistical difference between the two groups for the neurologic changes at the initial period and the last follow up period (p=0.06, 0.61). Decompression of the spinal cord anteriorly was not effective for the neurologic recovery (p=0.25) and the involved segments were not related to the neurologic changes (p=0.34, 0.25). CONCLUSIONS: It was presumed that patients with edema of the spinal cord had a better prognosis than those with contusion of the spinal cord. There was no difference between the SCIWORA and SCIWORET groups for the neurologic changes and anterior decompression was not effective for the recovery of neurologic symptoms. This study was limited by its retrospective nature and the small number of patients, so a multi-center study is needed.

Spinal Cord Injury without Radiographic Abnormality in Adults / 대한척추외과학회지

STUDY DESIGN: This is a retrospective study. OBJECTIVES: This study examined the MRI findings, injury mechanism, clinical findings, and prognosis of a spinal cord injury without radiographic abnormality (SCIWORA) in adults with a normal spinal canal. SUMMARY OF LITERTURE: Most reports on SCIWORA deal with the pediatric age group. However, there are few reports on the MRI findings, clinical features and outcomes in adult patients with cervical SCIWORA. MATERIALS AND METHODS: The hospital records of 753 patients, who were treated for cervical spine injury between February 1, 1994 and July 31, 2004, were reviewed. This study included the 10 subjects with no fractures or dislocation on the plain roentgenograms or cord compression caused by degenerative change or disc herniation on MRI corresponding to the location of the cord lesion. All the patients had at least a 2-year follow-up evaluation. The relationships between the MRI findings, neurological findings and outcomes were evaluated. RESULTS: The MRI findings revealed 7 cases with cord contusion, 3 cases with cord edema, 3 cases with gliosis and 3 cases with syrinx formation at the follow-up. The injury mechanism was hyperextension and hyperflexion in 7 and 3 cases, respectively. The initial motor function scores of ASIA in the edema and contusion groups was 60.7 and 43.9, respectively. At the last follow-up, the motor function scores of ASIA in the edema and contusion groups were 90 and 70.3, respectively. The Frankel grade improved by 1.3 and 1.1 in the edema and contusion groups, respectively. CONCLUSIONS: In patients with SCIWORA, the MRI findings correlated well with the clinical picture and were of prognostic significance. The cord edema group showed better clinical features than the contusion group, and prognosis was relatively good in both groups. A further careful evaluation, such as MRI, is still needed to determine the appropriate treatment for spinal cord injuries without radiographic abnormalities.

Postoperative Complications in Patients over 65 years of Age with Lumbar Spinal Stenosis and its Influencing Factors / 대한척추외과학회지

STUDY DESIGN: This is a retrospective study. OBJECTIVES: The purpose of this study is to decrease the frequency of the postoperative complications and to improve the postoperative clinical outcomes for the elderly patients with lumbar spinal stenosis. Summery of Literature REVIEW: Many controversies exist about postoperative complication and its influencing factors in the elderly patients suffering with lumbar spinal stenosis. MATERIALS AND METHODS: We reviewed the hospital records of 213 patients who underwent decompression and posterolateral fusion between February 1, 1998 and December 31, 2003 to treat their degenerative lumbar spinal stenosis. This study was performed, to assess and compare the postoperative complications and clinical outcomes of surgical management for the patients over 65 years (Group A) and the patients between 50-64 years (Group B). All the patients had at least a 1-year follow-up evaluation. The factors that could have influenced the complications that resulted within 12 weeks after the operation were evaluated and statistically analyzed. RESULTS: Postoperative complications occurred in 62 patients of Group A and in 40 patients of Group B, of which the major complications occurred in 10 patients of Group A and in 1 patient of Group B and minor complications occurred in 52 patients of Group A and in 39 patients of Group B. A statistical relationship between diabetes and major complications was observed in Group A (p=0.005). While any relationship between age and the frequency of complication in each group was not found, Group A had a higher frequency of major complication than did Group B (p=0.004). CONCLUSIONS: Surgeon should be vigilant about postoperative complications in elderly patients suffering with diabetic mellitus.Elderly patients with diabetic mellitus should be made aware that they are at an increased risk for postoperative complications because of their fragility.

Relationships between Posterior Ligament Complex Injury and Plain Radiograph in Thoracolumbar Spinal Fracture / 대한척추외과학회지

STUDY DESIGN: A prospective study of 100 patients with thoracolumbar spinal fractures. OBJECTIVES: To assess the relationships between a posterior ligament complex injury and plain radiograph in thoracolumbar spinal fractures. SUMMERY OF LITERATURE REVIEW: Some studies have reported the value of MRI for the evaluation of a posterior ligament complex injury. However, most of these did not evaluate the relationships between the posterior ligament complex and plain radiograph of the thoracolumbar spine fractures. MATERIALS AND METHODS: 100 patients with either a thoracolumbar compression or burst spinal fracture, from T11 to L2 levels, were evaluated by plain radiographs, taken in the supine position, and MRI taken within a week of the trauma. The wedge angle, Cobb's angle and anterior body height were measured on the plain radiographs, and the presence of posterior ligament complex injury on MRI was evaluated and analyzed. RESULTS: In the compression fracture group, the wedge angle, Cobb's angle and anterior body height loss were 19.9+/-1.4 degrees, 14.3+/-2.2 degrees and 35.6+/-3.6%, respectively, in the posterior ligament complex injury subgroup, but only the anterior vertebral body height loss was statistically significant (p=0.04). In the burst fracture group, the wedge angle, Cobb's angle and anterior body height loss were 26.4+/-2.0 degrees, 23.3+/-1.7 degrees and 57.4+/-5.2%, respectively, in the posterior ligament complex injury subgroup, which were all statistically significant (p=0.00, 0.02, 0.00). With a sensitivity of 75% or greater, the wedge angle, Cobb's angle and anterior body height loss in compression and burst fractures were more than 15 degrees, 10 degrees and 30% and 20 degrees, 20 degrees and 40%, respectively. CONCLUSIONS: When the values of wedge angle, Cobb's angle and anterior body height loss in the compression and burst fractures were more than 15 degrees, 10 degrees and 30% and 20 degrees, 20 degrees and 40%, respectively, and the sensitivity for the presence of a posterior ligament complex injury was more than 75%. Therefore, these values in the screening test are indicators for the presence of a posterior ligament complex injury. Further careful evaluations, such as MRI, are still required in deciding the appropriate treatment method.

Distractive Atlantoaixial Dislocation / 대한척추외과학회지

Atlantoaxial dislocations usually present with fatal brain injury, but rarely with clinical problems. With the development of newer imaging techniques, as well as improved preoperative and perioperative care, the likelihood of survival from an atlantoaxial dislocation has increased. Survivors usually suffer incomplete neurological deficits, including Brown-Sequard syndrome or central cord syndrome. The authors describe a distractive atlantoaxial dislocation, with neurological sequelae, in a younger patient who had been involved in a car accident. This case was treated surgically, but the patient suffered paraplegia due to thoracic myelopathy.

Dissociation of Sandwich Ceramic Liner: A Case Report / 대한정형외과학회잡지

In total hip replacement with a sandwich ceramic liner, liner dissociation is rare. We experienced one case of sandwich ceramic liner dissociation at 3 years 7 months after total hip replacement in avascular necrosis of the femoral head. The patient was treated by revisional total hip arthroplasty and a new sandwich liner and head were fitted. We describe this one rare case and review the literature.

Range of Motion of Cervical Spine in Normal Korean People / 대한척추외과학회지

STUDY DESIGN: A prospective study is to evaluate the cervical range of motion through the analysis of the plain films of the cer-vical spine. OBJECTIVE: To provide criteria validity for the cervical lordosis, range of motion and segmental motion of each segment using normal Korean adults, as guide lines for the radiographic diagnosis and treatment of cervical diseases. MATERIALS AND METHODS: One hundred and four healthy Korean adults were examined. Roentgenographic lateral views were taken in neutral, active flexion and extension positions. Measurement of the range of motion and segmental motion of the cer-vical spine, using the technique of Penning and Bakke, were independently made by two observers. RESULTS: The mean angle of the lordosis and the range of motion were 19.8degrees+/-8.4degrees and 63.1degrees+/-11.2degrees respectively, and the range of motion of each segment were 10.3degrees+/-2.9degrees, 9.2degrees+/-3.0degrees, 13.5degrees+/-7.2degrees 15.1degrees+/-4.3degrees, 15.6degrees+/-4.4degrees and 13.0degrees+/-5.0degrees and C1-2, C2-3, C3-4, C4-5, C5-6 and C6-7, respectively. There were no differences in the lordotic angle between the ages and genders. The range of motion decreased with increasing age, but there was no difference between genders. The segmental motion was no different between genders, but decreased significantly with increasing age on segments C1-2, C5-6 and C6-7. CONCLUSIONS: No significant differences were found in the range of cervical motion of each segment and the lordotic angle of the Korean population compared with those of other populations. The range of cervical motion also decreased with increasing age. These data provide guidelines in the dynamics of cervical spine and for the roentgenographic diagnosis and treatment of cervi-cal diseases.