Comparison of Posterior Lumbar Interbody Fusion and Posterolateral Lumbar Fusion in Monosegmental Vacuum Phenomenon within an Intervertebral Disc

STUDY DESIGN: Retrospective. PURPOSE: To compare the clinical and radiological outcomes of posterolateral lumbar interbody fusion (PLIF) and posterolateral lumbar fusion (PLF) in monosegmental vacuum phenomenon within an intervertebral disc. OVERVIEW OF LITERATURE: The vacuum phenomenon within an intervertebral disc is a serious form of degenerative disease that destabilizes the intervertebral body. Outcomes of PLIF and PLF in monosegmental vacuum phenomenon are unclear. METHODS: Monosegmental instrumented PLIF and PLF was performed on 84 degenerative lumbar disease patients with monosegmental vacuum phenomenon (PLIF, n=38; PLF, n=46). Minimum follow-up was 24 months. Clinical outcomes of leg and back pain were assessed using visual analogue scales for leg pain (LVAS) and back pain (BVAS), and the Oswestry disability index (ODI). The radiographic outcome was the estimated bony union rate. RESULTS: LVAS, BVAS, and ODI improved in both groups. There was no significant difference in the degree of these improvements between PLIF and PLF patients (p>0.05). Radiological union rate was 91.1% in PLIF group and 89.4% in PLF group at postoperative 24 months (p>0.05). CONCLUSIONS: No significant differences in clinical results and union rates were found between PLIF and PLF patients. Selection of the operation technique will reflect the surgeon's preferences and patient condition.

Preliminary study of vacuum phenomenon in pediatric hip joint / 国际儿科学杂志

Objective To find the accurate incidence of vacuum phenomenon in the hip and the best projection position produced the vacuum phenomenon on plain radiograph of hip in children.Methods All pediatric anteroposterior view and frog-leg position plain radiographs of hip joints were retrieved in our hospital between January 2003 and March 2013.All subjects was between 0 and 14 years old (mean age,4.2 years old).All the plain radiographs showing the crescent,linear,and irregular lucency between the femoral head and acetabulum were included in the present study.Results A total of 16 749 cases,including 12 422 cases (5 912 boys and 6 510 girls) only taken AP view plain radiographs and 4 327 cases (1 537 boys and 2 790 girls) taken both AP view and frog-leg position plain radiographs,were taken in our hospital between January 2003 and March 2013.None of AP view plain radiographs of hips could find the vacuum phenomenon.Two hundred and fifty-eight cases (321 hips) with vacuum phenomenon of the hips were found only in the frog-leg position plain radiographs of 4 327 cases,and the constituent ratio of vacuum phenomenon in the hip joint is 5.96％ in frog-leg position plain radiographs.One thousand seven hundred and thirty-eight normal children were included in 4 327 frog-leg position radiographs,and 150 cases of vacuum phenomenon were included in 1 738 normal children,and incidence of vacuum phenomenon in normal children is 8.63％.Two thousand three hundred and sixty children with developmental dysplasia of the hip (DDH) were included in 4 327 frog-leg position radiographs,and 98 cases of vacuum phenomenon were included in 2 360 children with DDH,and incidence of vacuum phenomenon in children with DDH is 4.15％.258 cases with vacuum phenomenon included 150 cases of normal hips (58.14％),98 cases of developmental dysplasia of the hip (37.98％),5 cases of Legg-Calvé-Perthes disease (1.94％),and 1 each in solitary eosinophilic granuloma of ischium,polyostotic fibrous dysplasia of the bilateral proximal femur,hereditary multiple exostoses,congenital coxa vara and fracture of femoral neck after surgery.Three hundred and twenty-one hips in 258 cases were classified into complete type (121 hips,37.69％) and partial type (200 hips,62.31％) according to the proportion of lucency area in the hip joints and linear (159 hips,49.53％),crescent (151 hips,47.04％) and irregular (11 hips,3.43％) lucency according to the shape of lucency area in the hips.Conclusion Vacuum phenomenon of the hip in children is not very rare in frog-leg position plain radiograph.It is easier to find the vacuum phenomenon in normal hip compared to that of developmental dysplasia of the hip.The frog-leg position plain radiograph is a better projection position to obtain the vacuum phenomenon of the hip in children compared to the anteroposterior view plain radiograph.

Radicular Compression by Intraspinal Epidural Gas Bubble Occurred in Distant Two Levels after Lumbar Microdiscectomy

The authors report a case of symptomatic epidural gas accumulation 2 weeks after the multi-level lumbar surgery, causing postoperative recurrent radiculopathy. The accumulation of epidural gas compressing the dural sac and nerve root was demonstrated by CT and MRI at the distant two levels, L3-4 and L5-S1, where vacuum in disc space was observed preoperatively and both laminectomy and discectomy had been done. However, postoperative air was not identified at L4-5 level where only laminectomy had been done in same surgical field, which suggested the relationship between postoperative epidural gas and the manipulation of disc structure. Conservative treatment and needle aspiration was performed, but not effective to relieve patient's symptoms. The patient underwent revision surgery to remove the gaseous cyst. Her leg pain was improved after the second operation.

Symptomatic Epidural Gas-containing Cyst from Intervertebral Vacuum Phenomenon

Vacuum disc phenomenon is a collection of gas in the intervertebral disc space but rarely causes nerve compression. However, some rare type of vacuum phenomenon in the spinal canal may bring about posterior gas displacement within the epidural space. The authors describe two patients with symptomatic epidural gas-containing cyst that seem to be originating from vacuum phenomenon in the intervertebral disc, causing lumbosacral radiculopathy. Radiographic studies demonstrated intervertebral vacuum phenomenon and accumulation of gas in the lumbar epidural space compressing the dural sac and the nerve root. The nerve root in both patients was compressed by gas containing cyst that was surrounded by thin walled capsule separable from the gaseous degenerated disc space. The speculative mechanism of the nerve root compression is discussed. The possibility of gas containing cyst should be considered in case of the nerve root compression in which epidural gas is present.

CT Diagnostic Vlaue of Degenerative Lumbar Intervertebral Joint / 实用放射学杂志

Objective To improve recognition of the processus articularis arthropathy.Methods CT findings of the processus articularis arthropathy was analysed.Results According to the CT findings of the 94 cases processus articularis arthropathy,CT signs and the syndrome of this disease were summarized five types:①zygapophyseal hypertrophy and osteophyte formation;②stricture or asymmetry of articular space ;③vacuum phenomenon of articular space ;④pachynsis or calcification of articular capsule ;⑤articular instability.Conclusion The processus articularis arthropathy is a very high incidence of a disease.The CT scanning is very important significance to the disease.

Intravertebral Vacuum Phenomenon / 대한정형외과학회잡지

There are several reports on the intervertebral vacuum phenomenon since Maldague s report in 1978. This disease is, however, considered as uncommon and miscellaneous entity. We performed retrospective review of 27 collapsed vertebral bodies of 21 osteoporotic patients to define the clinical, radiological and pathological characteristics of intravertebral vacuum phenomenon. Simple radiographs and MRIs were reviewed and the pathological findings from 6 specimens were matched with MRI. Intravertebral air shadows were shown in all cases either on A-P or lateral view, more definite on extension lateral views. Basically, it was considered as a burst fracture with loss of anterior and middle column height. The extent of collapse could be classified as complete or incomplete and the shape of spinal canal intrusion as bulging or local beak type. 12 cases of MRI findings were classified in to three types by T1, T2 and gadolinium enhancement patterns. The extent of spinal canal intrusion was less then 50% in all cases but neurolgic deficits were examined in 10 cases. Pathologically, necrotic trabeculae with fibrous granulation tissue was mixed with reactive new bone and callus formation in some area. This phenomenon is considered not so uncommon, which can be noticed easily in lateral flexion/extension view. Basically, this is a burst fracture with nonunion from ischemic necrosis and neurologic status should be carefully obserued.