Giant Thoracic Spinal Arteriovenous Fistula with Cord Compression: A Case Report / 대한정형외과학회잡지

A spinal arteriovenous fistula is a rare vascular disease that is characterized by abnormal connections between the vertebral artery or its branches and the neighboring veins. Bruit and back pain are common symptoms related to the fistula. Spinal cord dysfunction can also occur as a result of blood flow steal, venous hypertension, or mechanical compression of the nerve roots and spinal cord. We report a huge arteriovenous fistula in the spinal canal at the thoracic vertebra, which was characterized by a large azygous vein connected to the epidural vein causing osteolysis on the vertebral body and spinal cord compression symptoms. Staged embolization was performed using 80 coils.

Clinical Results of Autoiliac Cancellous Bone Graft Combined with Implantation of Autologous Bone Marrow Cells for Osteonecrosis of the Femoral Head / 대한정형외과학회잡지

PURPOSE: We prospectively analyzed the clinical results of auto-iliac cancellous bone graft with autologous bone marrow mononucleated cell implantation for osteonecrosis of the femoral head. MATERIALS AND METHODS: In a prospective evaluation, 45 hips in 37 patients with osteonecrosis of the hip were treated with auto-iliac cancellous bone graft after core decompression combined with implantation of autologous bone marrow cells. The average duration of clinical follow up of the patients was 32 months. Core decompression of the femoral head was performed and most of the necrotic part of the head was removed. Auto-iliac cancellous bone grafting was then done to fill up the defect, and this was followed by cell therapy with implantation of autologous monocytes isolated from the iliac bone marrow. RESULTS: The mean Merle d' Aubigne and Postel score improved from 11.6 points preoperatively to 15.5 points. Collapse of the femoral head developed in 13 hips, of which 12 hips showed an extensive lesion on the preoperative radiogram. Total hip replacement surgery was performed in 9 hips: 8 hips were due to progressive collapse of the femoral head with clinical deterioration, and 1 hip was due to postoperative bacterial infection. The preoperative stages of the 8 hips that were converted to THRA were stage II in 1 hip, stage III in 4 hips and stage IV in 3 hips. The head preservation rate according to the preoperative stage was 94.4% in stage II, 77.8% in stage III and 66.7% in stage IV. CONCLUSION: Auto-iliac cancellous bone grafting combined with implantation of autologous bone marrow cells after core decompression showed a good clinical results on the short term follow-up. Long term follow-up studies are still necessary to validate this point.

Postlaminectomy Spinal Stenosis after Lumbar Discectomy / 대한척추외과학회지

STUDY DESIGN: Retrospective study OBJECTIVES: To investigate the type of postsurgical spinal stenosis in patients who had undergone a primary laminectomy and discectomy for a herniated lumbar disc, and to evaluate the clinical outcomes of the revision operation. SUMMARY AND LITERATURE REVIEW: Spinal stenosis occurs frequently after a laminectomy and discectomy. Facet joint arthritis, hypertrophy of the ligamentum flavum, iatrogenic instability, postsurgical scarring or any combination of these conditions can cause spinal stenosis. MATERIALS AND METHODS: Twenty-four patients, who had postsurgical spinal stenosis were reviewed. Patients with a simple recurrent disc herniation without a spinal stenosis were excluded. The mean age was 52.5 years (range 31~70). There were 19 males and 5 females. The primary discectomy were performed at L4-5 in 21 patients, L5-1 in 2 patients, and both L4-5 and L5-1 in 1 patient. The mean interval between the first discectomy and revision surgery was 11.6 years (range 2.7~40). The anatomical site of the spinal stenosis, combined herniated disc, height of the disc space, segmental instability, hypertrophy of facet joint and thickening of the ligamentum flavum in radiographs was evaluated. The clinical outcome was measured using the Oswestry disability index. RESULTS: Lateral spinal stenosis was observed in all patients. Eight patients showed both central and lateral stenosis. The lateral stenosis was caused by hypertrophy of the facet joint in 20 patients and a thickening of the ligamentum flavum in 8 patients. Nineteen patients showed herniated lumbar disc, including disc protrusion in 8 patients, disc extrusion in 9 patients, and disc sequestration in 2 patients. A loss of disc height was observed in 12 patients, segmental instability in 5 patients, and spondylolisthesis in 3 patients. All the patients received posterior decompression and posterolateral fusion with pedice screw instrumentation. Eighteen patients received a discectomy simultaneously. The average Oswestry score at the last visit was 24.4. CONCLUSIONS: Postlaminectomy spinal stenosis resulted from a lateral spinal stenosis associated with facet joint hypertrophy. Recurrent disc herniation also contributed to the novel development of symptoms. A wide decompression and fusion provided good clinical outcomes.