Direct Internal Fixation for Unstable Atlas Fractures

Purpose@#To investigate the radiologic and clinical outcomes of direct internal fixation for unstable atlas fractures. @*Materials and Methods@#This retrospective study included 12 patients with unstable atlas fractures surgically treated using C1 lateral mass screws, rods, and transverse connector constructs. Nine lateral mass fractures with transverse atlantal ligament (TAL) avulsion injury and three 4-part fractures with TAL injury (two avulsion injuries, one TAL substance tear) were treated. Radiologic outcomes included the anterior atlantodental interval (AADI) in flexion and extension cervical spine lateral radiographs at 6 months and 1 year after treatment. CT was also performed to visualize bony healing of the atlas at 6 months and 1 year. Visual Analog Scale (VAS) scores for neck pain, Neck Disability Index (NDI) values, and cervical range of motion (flexion, extension, and rotation) were recorded at 6 months after surgery. @*Results@#The mean postoperative extension and flexion AADIs were 3.79±1.56 (mean±SD) and 3.13±1.01 mm, respectively. Then mean AADI was 3.42±1.34 and 3.33±1.24 mm at 6 months and 1 year after surgery, respectively. At 1 year after surgery, 11 patients showed bony healing of the atlas on CT images. Only one patient underwent revision surgery 8 months after primary surgery due to nonunion and instability findings. The mean VAS score for neck pain was 0.92±0.99, and the mean NDI value was 8.08±5.70. @*Conclusion@#C1 motion-preserving direct internal fixation technique results in good reduction and stabilization of unstable atlas fractures. This technique allows for the preservation of craniocervical and atlantoaxial motion.

Posterior Device Fixation Using Pedicle Screws in Patients with Degenerative Spine Disease:A Prospective, Single-Group, Therapeutic Pilot Study

Objectives@#To evaluate the effectiveness and safety of posterior interbody fusion with a new type of pedicle screws after posterior decompression for degenerative spinal disease.Summary of Literature Review: There are no reports of surgical treatment results using the new type of pedicle screw (LumFix™) analyzed herein. We report the results of posterior interbody fusion with this new type of pedicle screw. @*Materials and Methods@#Ten patients underwent surgical treatment for degenerative spinal disease and were followed up for at least 1 year. In all cases, fixation using pedicle screws and posterior interbody fusion were performed after posterior decompression. Visual analogue scale (VAS) and Oswestry Disability Index (ODI) scores were measured before surgery, at 3 months postoperatively, and at 12 months postoperatively. Bone union was investigated through simple radiographs and computed tomography (CT) at 12 months postoperatively. In addition, blood inflammation levels and basic vital signs were investigated preoperatively and at the last follow-up. @*Results@#In all cases, preoperative symptoms improved, and the back pain VAS improved from 7.30±1.49 preoperatively to 2.70±1.64 at 3 months postoperatively and 1.80±1.40 at the final follow-up. Leg pain was 7.40±1.17 preoperatively and 2.60±2.17 at 3 months postoperatively. At the last follow-up, it improved to 2.40±1.96 (p<0.001). The ODI improved from 28.80±4.89 preoperatively to 15.60±5.04 at 3 months postoperatively and 16.90±6.61 (p=0.002) at the final follow-up. Bone union was achieved in all cases. Inflammation levels and vital signs were within the normal range both preoperatively and at 12 months postoperatively. @*Conclusions@#The LumFix™ pedicle screws used in this study were fused in 100% of patients with degenerative spinal diseases. No complications were observed, and the VAS of back and leg pain and ODI of the lumbar spine significantly improved. There were no abnormal findings in blood tests or vital signs, demonstrating biocompatibility. Therefore, the type of new pedicle screw analyzed in this study can be used in fusion surgery for degenerative spinal diseases.

Posterior Device Fixation Using Pedicle Screws in Patients with Degenerative Spine Disease:A Prospective, Single-Group, Therapeutic Pilot Study

Objectives@#To evaluate the effectiveness and safety of posterior interbody fusion with a new type of pedicle screws after posterior decompression for degenerative spinal disease.Summary of Literature Review: There are no reports of surgical treatment results using the new type of pedicle screw (LumFix™) analyzed herein. We report the results of posterior interbody fusion with this new type of pedicle screw. @*Materials and Methods@#Ten patients underwent surgical treatment for degenerative spinal disease and were followed up for at least 1 year. In all cases, fixation using pedicle screws and posterior interbody fusion were performed after posterior decompression. Visual analogue scale (VAS) and Oswestry Disability Index (ODI) scores were measured before surgery, at 3 months postoperatively, and at 12 months postoperatively. Bone union was investigated through simple radiographs and computed tomography (CT) at 12 months postoperatively. In addition, blood inflammation levels and basic vital signs were investigated preoperatively and at the last follow-up. @*Results@#In all cases, preoperative symptoms improved, and the back pain VAS improved from 7.30±1.49 preoperatively to 2.70±1.64 at 3 months postoperatively and 1.80±1.40 at the final follow-up. Leg pain was 7.40±1.17 preoperatively and 2.60±2.17 at 3 months postoperatively. At the last follow-up, it improved to 2.40±1.96 (p<0.001). The ODI improved from 28.80±4.89 preoperatively to 15.60±5.04 at 3 months postoperatively and 16.90±6.61 (p=0.002) at the final follow-up. Bone union was achieved in all cases. Inflammation levels and vital signs were within the normal range both preoperatively and at 12 months postoperatively. @*Conclusions@#The LumFix™ pedicle screws used in this study were fused in 100% of patients with degenerative spinal diseases. No complications were observed, and the VAS of back and leg pain and ODI of the lumbar spine significantly improved. There were no abnormal findings in blood tests or vital signs, demonstrating biocompatibility. Therefore, the type of new pedicle screw analyzed in this study can be used in fusion surgery for degenerative spinal diseases.

The Result of Repeat Discectomy for Ipsilateral Recurrent Lumbar Disc Herniation / 대한정형외과학회잡지

PURPOSE: To analyze the result of a repeat discectomy for ipsilateral recurrent lumbar disc herniation and to investigate the potential factors that influenced the outcomes for this surgery. MATERIALS AND METHODS: Fifty-nine patients, who underwent reoperation after lumbar discectomy with a minimum follow-up period of 2 years, were reviewed. The surgical outcome was assessed using the visual analogue scale (VAS) and Macnab classification, and the recovery rate was calculated in accordance with VAS. A statistical analysis was carried out by SPSS to evaluate the possible factors that may have influenced the outcomes of the reoperation. RESULTS: The rate of reoperation after lumbar disc surgery due to the recurrent disc herniation was 6.0% (59/983 cases). The average recovery rate of VAS from the 1st operation was approximately 77%, and from the 2nd operation was 71%. According to the Macnab criteria, the results were “excellent” or “good” in 96% of cases. Statistical analysis revealed that there was no difference of the average recovery rate (p<0.05). There is no additional instability after repeat discectomy. Factors, such as smoking, precipitating traumatic events, and diabetes mellitus did not have much influence on the average recovery rate after repeat discectomy for ipsilateral recurrent lumbar disc herniation. CONCLUSION: The outcomes of repeat discectomy were satisfactory. Moreover, factors, smoking, trauma history and diabetic mellitus, only had a minor impact on the outcomes of a repeat discectomy.

Neurolymphomatosis Involving Antebrachial Cutaneous Nerve / 대한정형외과학회잡지

The term neurolymphomatosis has included infiltration of the peripheral nervous system by lymphoma. In generally, direct invasion of the peripheral nervous system is rare. The difficulty in treatment of neurolymphomatosis is due to unclassified characteristic symptoms and diagnosis. We performed excision of mass on the antebrachial cutaneous nerve with no specific symptoms. After diagnosis of diffuse large B cell lymphoma, further treatment and observation were followed. However, recurrence of the lymphoma was found in the ipsilateral forearm ulnar nerve, therefore we described a case of neurolymphomatosis with a brief review of the literature.

More than 5-Year Follow-up Results of Two-Level and Three-Level Posterior Fixations of Thoracolumbar Burst Fractures with Load-Sharing Scores of Seven and Eight Points

BACKGROUND: The development of pedicle screw-based posterior spinal instrumentation is recognized as one of the major surgical treatment methods for thoracolumbar burst fractures. However, the appropriate level in posterior segment instrumentation is still a point of debate. To assesses the long-term results of two-level and three-level posterior fixations of thoracolumbar burst fractures that have load-sharing scores of 7 and 8 points. METHODS: From January 1998 to May 2009, we retrospectively analyzed clinical and radiologic outcomes of 45 patients with thoracolumbar burst fractures of 7 and 8 points in load-sharing classification who were operated on using two-level posterior fixation (one segment above and one segment below: 28 patients, group I) or three-level posterior fixation (two segments above and one segment below: 17 patients, group II). Clinical results included the grade of the fracture using the Frankel classification, and the visual analog score was used to evaluate pain before surgery, immediately after surgery, and during follow-up period. We also evaluated pain and work status at the final follow-up using the Denis pain scale. RESULTS: In all cases, non-union or loosening of implants was not observed. There were two screw breakages in two-level posterior fixation group, but bony union was obtained at the final follow-up. There were no significant differences in loss of anterior vertebral body height, correction loss, or change in adjacent discs. Also, in clinical evaluation, there was no significant difference in the neurological deficit of any patient during the follow-up period. CONCLUSIONS: In our study, two-level posterior fixation could be used successfully in selected cases of thoracolumbar burst fractures of 7 and 8 points in the load-sharing classification.

Semi-Circumferential Decompression: Microsurgical Total en-bloc Ligamentum Flavectomy to Treat Lumbar Spinal Stenosis with Grade I Degenerative Spondylolisthesis

BACKGROUND: To describe and assess clinical outcomes of the semi-circumferential decompression technique for microsurgical en-bloc total ligamentum flavectomy with preservation of the facet joint to treat the patients who have a lumbar spinal stenosis with degenerative spondylolisthesis. METHODS: We retrospectively analyzed the clinical and radiologic outcomes of 19 patients who have a spinal stenosis with Meyerding grade I degenerative spondylolisthesis. They were treated using the "semi-circumferential decompression" method. We evaluated improvements in back and radiating pain using a visual analogue scale (VAS) and the Oswestry Disability Index (ODI). We also evaluated occurrence of spinal instability on radiological exam using percentage slip and slip angle. RESULTS: The mean VAS score for back pain decreased significantly from 6.3 to 4.3, although some patients had residual back pain. The mean VAS for radiating pain decreased significantly from 8.3 to 2.5. The ODI score improved significantly from 25.3 preoperatively to 10.8 postoperatively. No significant change in percentage slip was observed (10% preoperatively vs. 12.2% at the last follow-up). The dynamic percentage slip (gap in percentage slip between flexion and extension X-ray exams) did not change significantly (5.2% vs. 5.8%). Slip angle and dynamic slip angle did not change (3.2° and 8.2° vs. 3.6° and 9.2°, respectively). CONCLUSIONS: The results suggested that semi-circumferential decompression is a clinically recommendable procedure that can improve pain. This procedure does not cause spinal instability when treating patients who have a spinal stenosis with degenerative spondylolisthesis.

Epidural Gas-containing Pseudocyst in Lumbar Spine: A Case Report

STUDY DESIGN: Case report. OBJECTIVES: We report two cases regarding epidural air pseudocyst at the lumbar spine. SUMMARY OF LITERATURE REVIEW: Epidural air pseudocyst at the lumbar spine that provokes radiating pain and neurologic symptoms can be misdiagnosed as an epidural tumor or HIVD. Consequently, proper diagnosis and treatment of the epidural air pseudocyst at the lumbar spine is necessary. MATERIALS AND METHODS: We report on two patients with radiculopathy and neurologic symptoms resulting from epidural air pseudocysts. In one patient, the epidural air pseudocyst was found within the epidural ligament flavum area on an MRI, and fluoroscopic-guided FNA (fine needle aspiration) was performed. In the other, the epidural air pseudocyst was found behind the posterior longitudinal ligament and was accompanied by spinal stenosis. In this patient, we conducted open cystectomy and posterior decompression surgery. Results: After treatment, all patients have showed symptom improvement and they are currently living without discomfort. RESULTS: After treatment, all patients have showed symptom improvement and they are currently living without discomfort. CONCLUSIONS: Due to frequent misdiagnosis, the careful diagnosis of lumbar epidural air pseudocyst is necessary. Physicians should select a proper treatment plan concerning the patient's condition and the location of the lesion.

Effect of Pressurized Cement Insertion on Cardiopulmonary Parameters during Cemented Hip Hemiarthroplasty: A Randomized Prospective Study / 대한고관절학회지

PURPOSE: We aimed to investigate the cardiopulmonary effects of pressurized cement insertion in elderly patients undergoing cemented hip hemiarthroplasty. MATERIALS AND METHODS: We conducted a randomized prospective study on elderly patients undergoing cemented hip hemiarthroplasty. Patients were divided into pressurized and non-pressurized groups based on the pressure application during cement insertion. We measured mean arterial blood pressure (MAP), systolic blood pressure (SBP), diastolic blood pressure (DBP), heart rate (HR), arterial blood gases and serotonin concentration in blood. These variables were measured before bone cement insertion, and 3 and 5 minute after insertion. They were also measured immediately and 15 minutes after reduction. RESULTS: In cemented hip hemiarthroplasty, there were no significant change in MAP (P=0.92), SBP (P=0.85), DBP (P=0.98), HR (P=0.97) and serotonin concentration over time. There were no statistically significant difference between the two groups in MAP, SBP, DBP, HR, PO2, PaCO2, SaO2 and serotonin concentration, though three minutes after cement insertion, both groups showed decreases in SBP, DBP and MBP. CONCLUSION: The pressurization method in cemented hip hemiarthroplasty was not found to be related with development of bone cement syndromes in elderly patients.