Preoperative Gadolinium-enhanced Magnetic Resonance Images on Infectious Spondylitis

OBJECTIVE: The purpose of this study is to analyze the patterns of intervertebral disc enhancement seen in infectious spondylitis, differentiate between two groups(tuberculous vs pyogenic spondylitis). METHODS: Between January 1994 and December 2002, 83patients underwent operative procedure with confirmed to histopathologic evaluation. Magnetic resonance(MR) images were obtained in all patients and were analyzed retrospectively. 57patients had tuberculosis and 26patients were infected by pyogens. The patterns of gadolinium enhancement of disc were classified into 4 types(post's classification): Type I, non-enhancing; Type II, enhancement of the peripheral rim; Type III, Type II with central area and partial endplate; Type IV, general enhancement. RESULTS: The enhancement patterns observed were as follows: Common pattern of tuberculous spondylitis was Type II, and pyogenic spondylitis was Type III.(p<0.01) This difference may result from pathophysiologic varieties of organisms. CONCLUSION: Careful preoperative MR analysis of the patterns of disc enhancement occuring in infectious spondylitis can be useful for differentiating between the tuberculous and pyogenic spondylitis.

The Surgical Results of Traumatic Subdural Hygroma Treated with Subduroperitoneal Shunt

OBJECTIVE: The detection rate of traumatic subdural hygroma(TSH) has increased after the development of computed tomography and magnetic resonance imaging. The treatment method and the mechanism of development of the TSH have been investigated, but they are still uncertain. This study is performed to evaluate the effectiveness of subduroperitoneal shunt in traumatic subdural hygroma. METHODS: Five hundred thirty six patients were diagnosed as TSH from 1996 to 2002, among them, 55 patients were operated with subduroperitoneal shunt. We analyzed shunt effect on the basis of clinical indetails, including the patient's symptoms at the diagnosis, duration from diagnosis to operation, changes of GCS, hygroma types. We classified the TSH into five types (frontal, frontocoronal, coronal, parietal and cerebellar type) according to the location of the thickest portion of TSH. RESULTS: The patients who have symptoms or signs related to frontal lobe compression (irritability, confusion) or increased intracranial pressure (headache, mental change), had symptomatic recovery rate above 80%. However, the patients who have focal neurological sign (hemiparesis, seizure and rigidity), showed recovery rate below 30%. The improvement rate was very low in the case of the slowly progressing TSH for over 6weeks. We experienced complications such as enlarged ventricle, chronic subdural hematoma, subdural empyema and acute SDH. CONCLUSION: Subduroperitoneal shunt appears to be effective in traumatic subdural hygroma when the patients who have symptoms or signs related to frontal lobe compression or increased ICP and progressing within 5weeks.

Changes of Both Palmar Temperature and Blood Flow after Limited Upper Thoracoscopic T2 Sympathicotomy

OBJECTIVE: Thoracoscopic T2 sympathicotomy for palmar hyperhidrosis has been recognized as an effective treatment. This study is performed to evaluate the changes in both palmar temperatures and blood flow after the thoracoscopic T2 sympathicotomy. METHODS: From January 2001 to April 2002, eighteen patients were treated by video-assisted endoscopic T2 sympathicotomy. All patients were treated for excessive sweating on palms with 2mm endoscopic sympathicotomy. The patients were evaluated for preoperative and postoperative temperature change on the finger. Preoperative and postoperative blood flows were measured by the Doppler examination on digital artery and radial artery. RESULTS: There were no operative deaths but some complications existed. (four pneumothorax and one subcataneous emphysema). The temperature difference between preopration and postoperation was 1.7degrees C on right hand and 1.8degrees C on left hand(P<0.05). Blood flow increased significantly. CONCLUSION: T2 sympathicotomy for palmar hyperhidrosis is a safe and effective treatment. Ipsilateral palmar temperature and blood flow increased due to the sympatholytic vasodilatation.

Effect of the Mixture of Thrombin Powder and Gelfoam Powder on Control of Exposed Cancellous Bone Bleeding

No abstract available.

Partial Pediculectomy for Spondylolisthesis with Radicular Pain Combined with Severe Osteoporosis

No abstract available.

Clinical Analysis of Patients with Thoraco-lumbar Spinal Lesions Managed by Vertebrectomy, Interbody Fusion and Stabilization using Kaneda Device

Among the 98 patients who underwent operations for thoracolumbar spinal lesions from May 1989 to September 1994, the authors performed clinical analysis of 72 patients who were followed-up for more than 12 months. There were 52 cases of trauma, 18 cases of tuberculous spondylitis, and 2 cases of metastatic tumor. After partial or toal vertebrectomy, interbody fusion was performed using autogenous iliac bone or autogenous ribs which were taken while approaching the thoracic spine, and stabilized using Kaneda devices. Complete neural decompression was possible under direct vision in all cases. Neurologic deficits improved to an average of 1.7 grades using a modified Frankel scale. Patients with tuberculous spondylitis did not show recurrence or any evidence of increased risk of secondary infection caused by instrumentation. Loosening or breakdown of instruments occurred in 4 patients, and spinal deformity in 7 patients, but reoperation was not needed in any of these patients. By anterior decompression, interbody fusion and stabilization using Kaneda device in thoracolumbar spinal lesions, we could obtain satisfactory neurologic improvement as well as immediate firm stability and high fusion rate involving only a minimum(usually two) number of motion segments as compared with the posterior approach.

Surgical Management of Patients with Isthmic Spondylolisthesis with Transpedicular Screw Fixation and Posterior Lumbar Interbody Fusion using Posterior Movable Segment

Twenty three patients with isthmic spondylolisthesis were operated on from December 1993 to June 1995. There were 14 female and 9 male patients and the average age of the patients was 50(ranging 20-67) years old. Symptoms in the lower extremities had been present for 3 months to 10 years, although varying degrees of back pain had existed for longer periods. Disability was caused mainly by claudication in 20 patients. Diagnostic studies included plain films, tomography, CT scaning, and MRI. Single interspace was involved in 18 patients, and in five patients, two interspaces were involved. After wide decompression and discectomy, stabilization was reestablished by segmental pedicular screw fixation device(Diapason(R) pedicular system) and interbody fusion using posterior movable segment as graft material. Between 6 to 24 months postoperatively, all patients exhibited radiographic fusion. The results were excellent in 12 cases, good in 8 cases and fair in 3 cases. The authors believe that full four nerve roots decompression, pedicular screw fixation. Posterior lumbar interbody fusion using movable segment as graft material, and prevention of nerve root traction injury during insertion of graft bone are important points to get good post-operative results.

Clinical Analysis of Postoperative Patients with Electrocardiographic Abnormalities Associated with Aneurysm

Preoperative assessment of electrocardiographical(EKG) abnormalities in the patients with subarachnoid hemorrhage(SAH) is importment. Authors analyzed 58 SAH patients who had EKG abnormalities of neurogenic origin. EKG abnormalities consisted of T wave abnormality, arrhythmia, ST segment change, QT prolongation and U wave. Five patients were dead in this study because of brain swelling(3 cases) and cerebral spasm(2 cases). EKG abnormalities were normalized 13 days after aneurysmal SAH. Radioactive nuclear(99mTc-pyrophosphate) scan of myocardial revealed normal findings in the patients with EKG abnormalities of neurogenic origin. It is concluded that life-saving surgical intervention need not be delayed in the patients with EKG abnormalities of neurogenic origin. On the other hand, patients who had cardiac origin EKG abnormalities need a careful and detailed preanesthetic cardiac evaluation.