Non-traumatic Atlanto-axial Rotatory Subluxation: A Case Report

STUDY DESIGN: A case report. OBJECTIVES: To report a case of diagnostic, clinical and radiologic follow-up of a non-traumatic atlanto-axial rotatory subluxation. SUMMARY OF LITERATURE REVIEW: Atlanto-axial rotatory subluxation, caused by a non-traumatic inflammation or infectious diseases, has been branded as "Grisel's syndrome". However, the pathophysiology of the syndrome has not been clearly understood, and its diagnostic criteria and appropriate treatment plans are not established. MATERIALS AND METHODS: The patient suffering from antlanto-axial subluxation without any neurological symptoms was treated with halter traction and Miami J brace. RESULTS: The patient maintained a normal reduction state, and a normal cervical movement was observed after undergoing 4 weeks of non-surgical treatment. CONCLUSION: Early detection and treatment are essential and critical in avoiding catastrophic outcomes. It requires a combination of clinical assessment and appropriate radiographic imaging.

Efficiency of Implant Removal for Treatment of the Thoraco-lumbar Unstable Fractures: Multi Segments Fixation, Single Segment Fusion

STUDY DESIGN: A retrospective study. OBJECTIVES: To evaluate the safety and usefulness of implant removal based on fusion by radiological change analyses and non-fused segment motion angle after open reduction, multi-segment fixation, and single segment fusion. SUMMARY OF LITERATURE REVIEW: There have been reports that discuss possible fracture of fixator, loss of reduction, or failure of fixation in certain cases of single segment fixation consistent with thoracolumbar fracture. MATERIALS AND METHODS: We analyzed 83 patients who had undergone treatment by fixation of the top 2 segments and the bottom segment. The posterolateral fusions were performed for the top segment for thoracolumbar fractures. The mean follow-up was 21.3 months. Wedge and local kyphotic angles, anterior, and posterior heights of the vertebral body were measured on plain radiograph. The range of motion of each segment was recorded by flexion-extension lateral radiographs at 6 month after the removal of implants. RESULTS: Radiologic assessments performed on 83 patients demonstrated preoperative mean wedge angle, kyphotic angle, mean anterior body height of 20.1degrees, 18.5degrees and 62.0%, respectively, and, postoperatively, these were corrected by 9.0degrees, 9.3degrees and 24.6%, respectively. In the 44 cases that had the implants removed, the correction losses were 0.4degrees(P=0.258) and 3.7degrees(P=0.000), 0.5%(P=0.756), and at the last follow-up, compared to measurements prior to the removal. There was no statistical significance in wedge angle or anterior body height. The range of motion measured on the non-fused segment was 3.9degrees on average at 6-months after the hardware removal. CONCLUSIONS: The multi-segments fixation and single-segment fusion for the thoracolumbar fracture can preserve correction and the motion of non-fusion segment. Although the implant removal after union can sustain motion, further studies regarding degenerative change of the non-fused segment are necessary.

Efficiency of Anterior Interbody Fusion using Cage Packed with DBM in the Distractive Flexion Injury of Cervical Spine: Demineralized Bone Matrix vs Autoiliac Cancellous Bone

STUDY DESIGN: This is a retrospective study. OBJECTIVES: We wanted to evaluate the effectiveness and safety of a PEEK cage filled with DBM in patients with a distractive flexion injury of the cervical spine. SUMMARY OF LITERATURE REVIEW: AIF of the cervical spine using an autoiliac bone graft and plate fixation is known to be an effective treatment for traumatic injuries. However, the complications arising from the donor site are troublesome, and so fusion with cage is an alternative treatment. MATERIALS AND METHODS: We analyzed 32 cases (22 males and 10 females) with distractive flexion injury of the cervical spine. They underwent anterior decompression and interbody fusion with a PEEK cage and anterior plate fixation. In 18 patients, the cage was filled with autogenous iliac bone (Group I), and for the other 10 the cages were filled with DBM (Group II). RESULTS: All the cases in Group I and Group II achieved fusion except for one case of nonunion in group II. The anterior and posterior vertebral heights of the fused segments of group II were decreased more than those of group I, resulting a statistical difference (p=0.003). The changes of segmental lordosis (p=0.69) and the neurologic status (p=0.22) showed no statistical difference between the two groups. CONCLUSIONS: AIF using a PEEK cage filled with DBM and plate fixation showed no significant clinical differences compared to the case of iliac bone autografting. However, from a radiologic perspective, the time to achieve union was extensive and a case of nonunion was also observed. Therefore, many considerations are necessary when using DBM as a replacement for iliac bone autografting and further research should be done on this subject.

Efficiency of Anterior Interbody Fusion using Cage and Plate in the Distractive Flexion Injury of Cervical Spine : Cage vs Tricortical Autoiliac Bone / 대한척추외과학회지

STUDY DESIGN: This is a retrospective study OBJECTIVES: We wanted to evaluate the effectiveness and safety of anterior interbody fusion (AIF) using cage and plate fixation for treating distractive flexion injury of the cervical spine according to the radiological and clinical outcomes. SUMMARY OF THE LITERATURE REVIEW: AIF of the cervical spine using autoiliac bone and plate fixation is known as an effective method for treating not only degenerative disease, but also trauma as well. However, the problem lies in the complications that occur at the donor site. To avoid these complications, the fusion method using a cage is becoming more frequently used, but there are not many reports on using a cage and plate for treating trauma in the cervical spine. MATERIALS AND METHODS: We retrospectively analyzed 47 patients with distractive flexion injury of the cervical spine and who underwent anterior decompression and interbody fusion with a autoiliac bone graft and plate fixation (Group I, 32 patients) or who underwent anterior decompression and interbody fusion with cage and plate fixation (Group II, 15 patients). We statistically analyzed the changes of the segmental lordosis, the fused segmental body height, the fusion rate on plain radiography and the neurologic recovery with using an ASIA scoring system. RESULTS: All the cases were fused by 12.6+/-2.5weeks after operation. The changes of segmental lordosis shows no statistical difference between the two groups (p=0.69). The anterior and posterior vertebral heights of the fused segments of Group I were more decreased than those of Group II, and there was a statistical difference between the two groups (p=0.03, 0.04). The initial and last follow up neurologic statuses were not statistically difference between the two groups (p=0.11) CONCLUSIONS: For the treatment of fracture-dislocation injury in the cervical spine, AIF using a PEEK cage filled with autoiliac bone and plate fixation is an effective method with the least possibility of complications at the donor site, and at the same time, this surgical method shows equally satisfactory results, both radiologically and clinically, as fusion with using a tricortical autoiliac bone graft.

Cervical Spondylolysis with Dysplasia: A Case Report / 대한척추외과학회지

Cervical spondylolysis is defined as a corticated cleft between the superior and inferior articular facets of the articular pillar, which is the cervical equivalent of pars interarticularis in the lumbar spine. It is very important to avoid confusion with more clinically significant abnormalities, such as fracture or dislocation. This case report describes bilateral spondylolysis and associated dysplasia of C6. We describe the radiographic presentation of this anomaly, stressing the importance of computed tomography and magnetic resonance imaging for a correct diagnosis. A review of the literature on this interesting abnormality and a complete differential diagnosis are presented.

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.

Total Hip Arthroplasty with Hydroxyapatite-Coated Anatomic Femoral Stem / 대한정형외과학회잡지

PURPOSE: To evaluate minimum 5-year results of total hip arthroplasty using a hydroxyapatite (HA)-coated anatomic femoral stem. MATERIALS AND METHODS: Fifty hips in 46 patients, received total hip arthroplasty using a HA-coated anatomic femoral component, between March 1992 and April 1995, 39 hips (36 patients) were available for this study. RESULTS: The mean preoperative Harris hip score of 55.2 points increased to 91.5 points at one year, but reduced to 81.9 points at the last follow-up. Radiolucency was seen in 5 hips (12.8%) on the last follow-up radiograms. Femoral osteolysis occurred in 7 hips (17.9%) on the last follow-up radiograms. Four femoralstems (10.3%) were revised due to femoral osteolysis and loosening. The average duration between index operation and revision was 123 months. CONCLUSIONS: The HA-coated anatomical femoral stem gave an increased Harris hip score and lowered the incidence of thigh pain, however it did not prevent osteolysis due to polyethylene wear.

Changes of Adjacent Segment in Anterior Cervical Fusion / 대한척추외과학회지

STUDY DESIGN: A retrospective radiographic and medical record analysis of 36 patients. OBJECTIVES: To describe the incidence and consequence of the distribution of sagittal plane motion, across the adjacent cervical motion segment, after cervical fusion. Furthermore, to find the cause of the progression of degenerative changes in intervertebral discs adjacent to the fused segment. SUMMARY OF LITERATURE REVIEW : Anterior cervical fusion has been widely used in the treatment of degenerative cervical spine. An increased incidence of degenerative disease may exist at the levels immediately adjacent to a cervical fusion. However, the frequency of these complications is probably overestimated, and their effect on clinical outcome remains unknown. MATERIALS AND METHODS: From 1990 to 1996, 36 patients who underwent anterior cervical spine fusion for degenerative disorders were reviewed retrospectively with an average follow up of 6.9 years. Lateral views in neutral position, in flexion, and in extension of the preoperative cervical roentgenograms were analyzed in comparison with the last follow-up films in the range of motion of the neck, and in the intervertebral angular mobility and anteroposterior displacement of the vertebral bodies, and finally to quantify the incidence of the spinal instability. RESULTS: Degenerative change in adjacent intervertebral level was observed in 16 of the 36 patients (44.4%), above the fusion in 10, below the fusion in 4, and both above and below the fusion in 2 cases. In addition, degenerative change in adjacent intervertebral level was observed in 68% of cases of loss of lordosis of the fused segment, and degenerative change occurred more frequently in younger patients to a statistically significant extent. CONCLUSIONS: Loss of lordosis of the fused segment and young age are two factors promoting degenerative changes in adjacent intervertebral levels after anterior cervical fusion.

Treatment of Posterior Facet Fracture-Dislocation in Lumbar Spine / 대한척추외과학회지

STUDY DESIGN: Retrospective study. OBJECTIVES: The purpose of this study is to compare the outcomes of short segment fusion and long segment fusion in posterior facet fracture-dislocation in the lumbar spine. SUMMARY OF LITERATURE REVIEW: There are many controversies exist about the treatment of fracture-dislocation in lumbar spine. MATERIAL AND METHODS: Sixteen patients with lumbar fracture-dislocation were studied retrospectively. The patients divided two groups; group one treated with one level above and below the fracture segment fixation, group two treated with two level above and below the fracture segment fixation. Two groups were compared with neurologic recovery, bladder function recovery and radiologic changes of deformities. RESULTS: The neurologic deficit in two groups was improved more than one Frankel grade at last follow up. Patients who showed intact dura were neurologically improved significantly than the patients whose dura was ruptured. Radiologic changes were not a sinificant difference in two groups. CONCLUSION: In lumbar fracture-dislocation treatment, one level above and below the fracture segment fixed with pedicle screw fixation system was an effective treatment method which preserved the mobile segment lumbar spine.