Calcium Pyrophosphate Deposit Disease of Cervical Spine Mimicking Ossification of the Yellow Ligament / 대한정형외과학회잡지

Calcium pyrophosphate deposition disease is deposited mainly in the knee joint or the cartilage of the wrist joint and rarely in the spine, but the transverse ligament invasion of the atlas is most common. A patient with gait disturbance showed spinal cord compression caused by thickening of the yellow ligament of the subaxial cervical spine. This paper reported two cases of calcium pyrophosphate deposition disease associated with Crown dens syndrome on a computed tomography scan of the atlantoaxial joint.

Adhesive Arachnoiditis of the Lumbar Spine after Endoscopic Discectomy - A Case Report -

Objective@#We present a rare case of adhesive arachnoiditis that occurred after percutaneous endoscopic discectomy.Summary of Literature Review: Adhesive arachnoiditis can be caused by infection, trauma, surgery, and other iatrogenic injuries.Material and Methods: A 60-year-old man presented with acute onset of lower back pain, radiating to the right leg. His symptoms had developed 10 days previously without any trauma. He had a history of L4-5 percutaneous endoscopic discectomy 10 months ago. There was no evidence of infection in an examination of cerebrospinal fluid obtained from a spinal tap. However, magnetic resonance imaging showed peridural fibrosis, clumping of the nerve roots of the cauda equina with the pia mater, and dural enhancement at the L4-5 level. @*Results@#His symptoms disappeared after steroid pulse therapy. @*Conclusions@#Even minimally invasive surgery, such as endoscopic discectomy, can lead to adhesive arachnoiditis of the lumbar spine.

Multiple Fractures in Thoracic Vertebrae after Epilepsy / 대한정형외과학회잡지

The musculoskeletal system can be damaged by massive contractions of the muscles in the case of systemic attacks by epilepsy. Several studies or case reports of multiple thoracic vertebrae fractures following generalized seizures without underlying diseases or falls have been reported, but there are few domestic studies or case reports. This paper reports the case of a 42-year-old male patient without any specific underlying disease, who was diagnosed with multiple fractures of the thoracic vertebrae caused by generalized myoclonic epilepsy during sleep.

Comparison of the Clinical Outcomes of an Ultrasound-Guided and C-Arm Guided Cervical Nerve Root Block / 대한정형외과학회잡지

PURPOSE@#This paper compares the clinical outcomes of patients who were treated with a cervical nerve block by ultrasound and C-arm and reports the complication.@*MATERIALS AND METHODS@#A total of 97 patients were treated with an ultrasound-guided nerve root block from May 1, 2015 to February 8, 2018. On the other hand, 94 patients were treated with a C-arm guided nerve root block. The consequences of the cervical pain and the radiating pain before and after the procedures were reviewed using the verbal numeric rating scale (VNRS). In addition, the complications related to the procedures from the daily notes from the chart were inspected.@*RESULTS@#Sixty-six cases out of 97 cases of ultrasound-guided nerve root block were enrolled in the study. The average age of the patients was 57 years, including 41 males and 25 females. Seventy seven out of 94 cases by a C-arm guided root block were included in the study. The average age of the patients was 55 years, including 40 males and 37 females. Before the nerve root block, the mean numeric rating pain scale (NRS) of the cervical pain in ultrasound-guided block decreased from 5.4 points to 2.7 points at three weeks and 1.4 points at six weeks (p=0.0023, p<0.001), and 3.1 points in the C-arm (p<0.001, p<0.001) at three weeks and 1.5 points at six weeks (p<0.001, p<0.001). In the case of radiating pain, the mean NRS in the ultrasound-guided nerve root block group improved from 6.3 points after the procedure to 2.8 points at three weeks and 1.5 points at six weeks (p<0.001, p<0.001). In the C-arm guided nerve root block group, the NRS improved from 7.4 points after the procedure to 3.3 points at three weeks and 1.9 points at six weeks. In the case of complications, Horner's syndrome and propriospinal myoclonus were observed in one case of C-arm guided block group.@*CONCLUSION@#The clinical results of the patients who underwent ultrasound-guided cervical nerve root block were not significantly different from those who underwent a C-arm guided cervical nerve root block.

Results of Decompression Alone in Patients with Lumbar Spinal Stenosis and Degenerative Spondylolisthesis: A Minimum 5-Year Follow-up

Background@#Surgical treatment consisting of decompression and fusion is generally known to produce good clinical results for lumbar spinal stenosis with degenerative spondylolisthesis. However, the clinical outcome of decompression alone, without fusion, remains unclear, and long-term follow-up results are scarce. This study aimed to retrospectively analyze the 5-year clinical results of decompression only in patients with lumbar spinal stenosis and degenerative spondylolisthesis. @*Methods@#Among the patients diagnosed as having lumbar spinal stenosis with degenerative spondylolisthesis, 36 patients who underwent decompression without fusion and were followed up for minimum 5 years were included in this study. The average follow-up period was 7.2 years, and the mean age of patients was 63.2 years. Visual analog scale (VAS) score and Oswestry disability index (ODI) were investigated pre- and postoperatively, and also radiologic displacement and instability were measured. In addition, patients who needed fusion or redecompression at the decompression site postoperatively were also investigated. @*Results@#VAS score and ODI improved from an average of 7.8 points and 57 points preoperatively, respectively, to 1.4 points and 19 points at 5 years postoperatively, respectively. The degree of radiologic displacement increased from an average of 5.1 mm preoperatively to 6.4 mm at the final follow-up. Radiological instability was detected in five patients. Two patients (9.5%) required fusion. @*Conclusions@#The long-term follow-up results revealed that satisfactory clinical outcomes were obtained with decompression alone, without fusion, for patients with lumbar spinal stenosis and degenerative spondylolisthesis.

Erratum: Radiological Results of the Double-Balloon Inflation Technique during Kyphoplasty

Correction of funding statement.

Radiological Results of the Double-Balloon Inflation Technique during Kyphoplasty

OBJECTIVES@#We analyzed the radiological results of the double-balloon inflation technique in terms of its ability to reduce cement leakage, to increase bone cement bonding, and to promote anterior column height recovery.SUMMARY OF LITERATURE REVIEW: Various methods, such as the egg-shell technique, have been proposed to prevent leakage of cement during kyphoplasty in cases of osteoporotic compression fracture.@*MATERIALS AND METHODS@#This study analyzed 18 patients diagnosed with osteoporotic compression fracture of the lumbar spine who underwent the double-balloon inflation technique after April 2015, and 30 consecutive patients with the same diagnosis who were treated using the conventional method prior to April 2015. We analyzed the radiological results on immediate postoperative simple X-rays in the anteroposterior and lateral views, 6-week postoperative lateral X-rays, and 6-month postoperative lateral X-rays to detect changes in anterior vertebral height and the cement leakage rate.@*RESULTS@#The average anterior vertebral height increased by 7.58 mm in the double-balloon inflation group, and by 5.8 mm in the conventional group on the immediate postoperative radiographs (p=0.044). On average, a decrease of 3.08 mm was observed at 6 weeks postoperatively in the double-balloon inflation group, in contrast to a decrease of 4.68 mm in the conventional group (p=0.149). At the 6-month postoperative follow-up, an average decrease of 1.45 mm was found in the double-balloon inflation technique group, while a decrease of 1.40 mm was found in the conventional group (p=0.9110). The cement leakage rate was 22% in the double-balloon inflation group and 27% in the conventional group (p=0.730).@*CONCLUSIONS@#Compared to the conventional method, the double-balloon inflation technique can be done more safely, and also promotes a greater recovery of anterior vertebral height.

Erratum: Radiological Results of the Double-Balloon Inflation Technique during Kyphoplasty

Correction of funding statement.

Radiological Results of the Double-Balloon Inflation Technique during Kyphoplasty

STUDY DESIGN: Retrospective case-control study. OBJECTIVES: We analyzed the radiological results of the double-balloon inflation technique in terms of its ability to reduce cement leakage, to increase bone cement bonding, and to promote anterior column height recovery. SUMMARY OF LITERATURE REVIEW: Various methods, such as the egg-shell technique, have been proposed to prevent leakage of cement during kyphoplasty in cases of osteoporotic compression fracture. MATERIALS AND METHODS: This study analyzed 18 patients diagnosed with osteoporotic compression fracture of the lumbar spine who underwent the double-balloon inflation technique after April 2015, and 30 consecutive patients with the same diagnosis who were treated using the conventional method prior to April 2015. We analyzed the radiological results on immediate postoperative simple X-rays in the anteroposterior and lateral views, 6-week postoperative lateral X-rays, and 6-month postoperative lateral X-rays to detect changes in anterior vertebral height and the cement leakage rate. RESULTS: The average anterior vertebral height increased by 7.58 mm in the double-balloon inflation group, and by 5.8 mm in the conventional group on the immediate postoperative radiographs (p=0.044). On average, a decrease of 3.08 mm was observed at 6 weeks postoperatively in the double-balloon inflation group, in contrast to a decrease of 4.68 mm in the conventional group (p=0.149). At the 6-month postoperative follow-up, an average decrease of 1.45 mm was found in the double-balloon inflation technique group, while a decrease of 1.40 mm was found in the conventional group (p=0.9110). The cement leakage rate was 22% in the double-balloon inflation group and 27% in the conventional group (p=0.730). CONCLUSIONS: Compared to the conventional method, the double-balloon inflation technique can be done more safely, and also promotes a greater recovery of anterior vertebral height.

Relative Risk of Operation between Lumbar Far Lateral Disc Herniation and Posterolateral Disc Herniation: A Retrospective Cohort Study / 대한정형외과학회잡지

PURPOSE: We reported relative risk of operation between patients who were diagnosed with lumbar far lateral disc herniation and posterolateral disc herniation after transforaminal epidural block. MATERIALS AND METHODS: A retrospective cohort study was performed on 295 patients (131 male and 164 female) who underwent transforaminal epidural block for unilateral radiculopathy caused by lumbar intervertebral disc herniation. Among these 295 patients, 34 patients were diagnosed with far lateral disc herniation and 261 patients with posterolateral disc herniation. The median follow-up period was 23.9 months, with an average age of 55.7 years. RESULTS: Fifty-one patients underwent surgical treatment. Among them, 38 patients had posterolateral disc herniation and 13 patients had far lateral disc herniation. Patients with far lateral disc herniation, when compared with posterolateral disc herniation, had a relative risk of operation of 2.67 (1.59-4.48, 95% confidence interval) with statistical significance (p=0.0002). At the final follow-up, the average visual analogue scale (VAS) score for radicular pain in the surgical and non-surgical groups was 0.69 and 1.50, respectively; the average Korean-Oswestry Disability Questionnaire (K-ODI) score was 11.7 and 9.6, respectively. The difference of average VAS score showed a statistical significance (p=0.035), however, that of K-ODI showed no statistical significance (p=0.266). CONCLUSION: In the case of far lateral disc herniation, the relative risk of surgery after transforaminal epidural block was 2.67, which is higher than that of posterolateral disc herniation. Therefore, we should consider surgical treatment more aggressively.

Change in Neural Tube Size for a Lumbar Spinal Stenosis Patient on Axial Loading Magnetic Resonance Imaging / 대한정형외과학회잡지

PURPOSE: A conventional magnetic resonance imaging (MRI) was conducted in supine position, showing a slight different from that conducted in upright position. Therefore, we simulated the upright position by applying the axial load on a lumbar spinal stenosis patient and measured the change of neural tube size in axial load and standardized the data. MATERIALS AND METHODS: We compared the axial loading MRI obtained from spinal stenosis patients who visited Wonkwang University Hospital outpatient clinic between October 2010 and May 2011 showing radiologic and physical symptoms. RESULTS: Neural tube sizes by conventional MRI were as follows: 195.57 mm² and 203.20 mm² on average between the left and right sides in L3/4; 194.64 mm² and 211.43 mm² on average in L4/5; and 199.38 mm² and 203.04 mm² on average in L5/S1. Neural tube sizes by axial loading MRI were as follows: 166.43 mm² and 174.27 mm² on average between the left and right sides in L3/4; 154.81 mm² and 158.67 mm² on average in L4/5; and 148.48 mm² and 157.19 mm² on average in L5/S1. Changes of neural tube sizes in L3/4, L4/5, and L5/S1 had a significant correlation (p<0.05). CONCLUSION: The axial loading device was an excellent tool in simulating the upright position for spinal stenosis patients, and the change of neural tube sizes reproduced for the upright position was statistically significant. This is thought to be meaningful for clinical applicability.

Arteriovenous Malformation on the Medial Plantar Area of the Foot: A Case Report / 대한족부족관절학회지

Arteriovenous malformation (A-V malformation) is defined as an abnormal connection between arteries and veins that lead to A-V shunting with an intervening network of vessels. A-V malformation is a rare condition, and spontaneous regression is also rare. A-V malformation becomes symptomatic when the surrounding tissue and osseous structures are negatively affected. A-V malformation has a high recurrence rate and is relatively hard to treat. In this case, a huge mass with pulsatile and bruit on the medial plantar area were observed. With the diagnosis of A-V malformation in accordance with the results from ultrasonography, magnetic resonance imaging and computed tomography angiography, and mass excision with feeding vessel ligation through plantar midfoot approach was completed successfully.

Clinical Outcomes of a Zero Profile Implant for Single-Level Anterior Cervical Discectomy and Fusion

STUDY DESIGN: A retrospective study. OBJECTIVES: To evaluate and compare the clinical results of a zero profile implant with a conventional stand-alone cage. SUMMARY OF LITERATURE REVIEW: A new zero-profile interbody fusion implant named Zero-P was developed in order to avoid plate-related complications. MATERIALS AND METHODS: Twenty-three patients with cervical degenerative disc disease were enrolled. Twelve of these were implanted with a stand-alone cage, and 11 patients received a Zero-P. The mean follow-up time was 16.7 months, ranging from 12 to 34 months. Intraoperative parameters, clinical outcomes (Korean Neck Pain Disability Index [K-NDI], visual analog scale [VAS] score for neck/arm pain), dysphagia scores, and device-related complications were recorded. RESULTS: At the 6-week, 3-month, 6-month, and 12-month follow up, the K-NDI and VAS scores significantly improved in both groups. Dysphagia scores in both groups have no significant differences (p>0.05). However, the cage subsidence rate was significantly higher in the stand-alone cage group (p<0.05). CONCLUSIONS: Clinical outcomes of ACDF with the Zero-P were satisfactory. The incidence of cage subsidence was lower than with the conventional stand-alone cage.

Clinical Outcomes of Coccygectomy for Chronic Coccygodynia

STUDY DESIGN: Retrospective study. OBJECTIVES: To confirm the clinical outcomes of coccygectomy for intractable chronic coccygodynia. SUMMARY OF LITERATURE REVIEW: Coccygectomy has been reported to be one of the good options for the failure of conservative treatment. MATERIALS AND METHODS: A retrospective review was conducted, including nine patients who underwent coccygectomy for intractable chronic coccygodynia. RESULTS: Improvements in the mean visual analogue scale (VAS) scores, from 5.6 to 2.1, were observed. As for patient satisfaction, there were four cases with excellent outcomes, three with good outcomes, one with a fair outcome, and only one with a poor outcome. Surgical complications, such as wound infection, did not occur in any of the cases. CONCLUSIONS: Irrespective of the causes, coccygectomy for chronic coccygodynia, for which nonsurgical management, including cushions, nonsteroidal anti-inflammatory drugs, and corticosteroid injections, has no effect, is considered a useful method because it brings definite pain relief and leads to high patient satisfaction.

Effectiveness of Selective Nerve Root Block for the Patient with a Single Level Lumbar Spinal Stenosis who is on the Operation Schedule

STUDY DESIGN: Retrospective study. OBJECTIVES: We reported the therapeutic usefulness of a selective nerve root block (SNRB) for patients with a single level spinal stenosis. SUMMARY OF LITERATURE REVIEW: Selective nerve root block for the radiculopathy due to lumbar disc herniation, spinal stenosis, and spondylolisthesis have been reported frequently. MATERIALS AND METHODS: We retrospectively examined 44 patients with single-level spinal stenosis, for whom surgical treatment was considered due to the failure of other conservative treatments from January 2005 to January 2010. All 44 patients were admitted for surgical decompression. Selective nerve root block was done just before a final decision of surgical procedure; patients with his or her 50% or more pain reduction could avoid surgery. RESULTS: In fourty-four cases, twenty-seven pateints underwent a surgical operation. Seventeen patients avoided surgical procedures by successful SNRB. As a result of a 3 year follow-up, the VAS score was significantly and continuously low on the operation group (p=0.02~0.03). K-ODI and Roland-Morris Disability scores were low in both groups until 1 year after the operation and SNRB procedure (p=0.026~0.042, p=0.03), but there was no statistically significant difference beteween the two groups after 2 years upon follow-up (p=0.072~0.14, p=0.06). Generally, the operation group had good results until 1 year after operation and had better tendency for improvement. The data displayed a high probability of surgical treatment among the patients with foraminal stenosis (p=0.039) highlight - this sentence says there is no difference after 1 year and there is still no difference after 2 years. If this is true, the sentence needs to be rewritten so that it says both times show no difference. If there is a difference between 1 year and 2 year then the sentence needs to be rewritten to make this more clear. The next sentence seems to say they are different. CONCLUSIONS: Selective nerve root block avoided the surgical intervention in 39% of the patients with the spinal stenosis refractory to the conservative treatment. Thus it is one of options for the refractory spinal stenosis.

Evaluation of the Back Muscle Exercise for the Lumbar Discectomy Patients

STUDY DESIGN: Retrospective study. OBJECTIVES: To identify the implementation of self-exercise therapy and analyze the effects of exercise therapy after lumbar discectomy. MATERIALS AND METHODS: Studied 47 patients who underwent partial lumbar discectomy and laminectomy from January, 2009 to December, 2009. They were instructed on 16 kinds of exercise therapy in total from postoperative 1day to postoperative 6weeks. Group A (n=25), whose frequency of outpatient clinic visit is above the average, and Group B (n=22), whose frequency of visit is relatively low;, below 5 times. We tested the visual analog scale (VAS scale) of back, Oswestry disability index and the strength of the two groups before surgery and at postoperative 3, 6, and 12 months. RESULTS: The degree of pain was significantly different (26.6+/-9.4 and 53.5+/-18.6) between group A and group B at postoperative 6 months. Function of daily life and strength test were significantly different (6.6+/-4.8 and 11.3+/-4.0 at group A, 3.6+/-0.9 and 3.0+/-1.1 at group B) between the two groups at postoperative 12 months. The characteristics of low compliance patients are low accessibility to the hospital and lack of knowledge on the importance of exercise according to the degree of pain. CONCLUSION: These results suggested that postoperative exercise program has significant effects on the pain, the function of daily life. It also increases flexibility and strengthens the muscle of patients with high compliance of outpatient clinic visit. The factors influencing the results are the age of patients, the willingness to exercise, and the environment in which each patient lives/resides.

Acute Sciatic Nerve Palsy after Sleeping in a Sitting Position: Case Report

STUDY DESIGN: A case report. OBJECTIVE: We wanted to present the clinical manifestation and imaging findings of a rare case of acute sciatic nerve palsy with a foot drop similar to lumbar disc herniation developed after sleeping for 8 hours in a sitting position in inebriated condition. SUMMARY OF LITERATURE REVIEW: Sciatic nerve palsy as a complication from being operated in a sitting position have been reported, but here have not been any reported cases of after-sleep sciatic nerve palsy. STUDY SUBJECT AND METHODS: Sixty eight year old male admitted to hospital due to acute onset of right foot drop, subsequent walking difficulty, and numbness of the right calf and foot. Symptoms began after 8 hours of sleeping in a sitting position. Pelvic MRI exam revealed sciatic neuropathy, and also electrophysiological exam revealed sciatic nerve palsy. RESULTS: The subject patient's conditions started improving after 6 weeks and he was able to walk again on his own. CONCLUSION: Sciatic nerve injury by prolonged pressure around the buttocks or posterior thighs, albeit rare, can develop and may cause foot drop, parethesia and sciatica.

Comparison of Ultrasonography- and Fluoroscopy-Guided Facet Joint Block in the Lumbar Spine

STUDY DESIGN: Retrospective study. PURPOSE: Facet joint block is performed for diagnostic or therapeutic purposes and generally carried out under computerd tomography (CT) or radiologic fluoroscopy guidance. Ultrasonography-guided facet block has recently been attempted. So, we compared the results of ultrasonography-guided facet joint block with the results of fluoroscopy-guided facet joint block. OVERVIEW OF LITERATURE: Because fluoroscopic or CT guided facet joint block has been reported side effects, we performed spinal facet block using a fluoroscopy-guided method. METHODS: We selected 133 patients who had lumbar pain or referred pain. They were diagnosed as having spinal stenosis and hospitalized from January 2008 to June 2008. As the subjects, we selected 105 patients who had been follow-up for more than 6 months and carried out a prospective study. RESULTS: The procedure in group 2 averaged 4 minutes and 25 seconds, and in group 1, 4 minutes and 7 seconds. The coast was an average of 38,000 won in group 2 and 25,000 won in group 1. The VAS score was improved from an average of 7.5 (range, 5 to 9) to 2.8 (range, 2 to 6) in group 2 and from 7.8 (range, 4 to 10) to 2.7 (range, 2 to 5) in group 1. The Oswestry disability index was improved from an average of 32.3 (range, 28 to 41) to 23.5 (range, 17 to 26) in group 2 and from 34.2 (range, 29 to 43) to 24.8 (range, 18 to 28) in group 1. As for complications, worsening of lumbar pain, paresthesia, headache and allergic reaction were detected in 5 cases of group 2 and in 3 of group 1. Those symptoms were improved within several hours. One case of superficial infection that developed in group 2 was improved within several days. CONCLUSIONS: We should consider that ultrasonography-guided facet joint block is a minimal invasive procedure that is easily carried out without radiation exposure.

Cervical Prevertebral Hematoma - a Rare Complication of Acupuncture Therapy: A Case Report / 대한척추외과학회지

A 36-year old man with neck pain developed an acute cervical prevertebral hematoma after acupuncture therapy at an oriental medicine hospital. MR imaging demonstrated a fluid collection, and this suggested a diagnosis of retropharyngeal hematoma, and the patient was managed conservatively. We report here on a case of a retropharyngeal hematoma following acupuncture therapy and we review the relevant literature.

Clinical Analysis of Lumbar Herniation in the Elderly Patients / 대한척추외과학회지

STUDY DESIGN: A retrospective analysis of lumbar disc herniation in elderly patients. OBJECTIVES: To evaluate the clinical picture and surgical outcome of a lumbar disc herniation in elderly patients. SUMMARY OF LITERATURE REVIEW: Lumbar disc herniation is less common in older persons, but there has been an increasing concern in elderly patients. MATERIALS AND METHODS: A retrospective review evaluated 34 patients (men:12, female:22) over 65 years old or with a T score -2.5 or below below on the BMD and/or over 60 years old with systemic comorbid disease who underwent surgery for a lumbar disc herniation between January 1991 and June 2001. All patients had at least a 2-year follow-up evaluation. They were analyzed for their physical status, comorbid condition, preoperative, follow-up symptoms and signs, the long-term clinical outcome based on the ASA (American society of anesthesiology) class and operative findings. RESULTS: There were 7 ASA class I patients, 22 ASA class II patients, 5 ASA class III patients, and comorbidity was found in 20 patients. Higher rates of negative straight leg raising were observed in the elderly patients compared to the younger patients, and 8 patients had a neurological claudication history. 25 patients had excellent or good results and better results were obtained with the sequestration and extrusion type, respectively, as compared with protrusion type. However, there was no correlation between the ASA class, postoperative complications, and clinical outcome. CONCLUSIONS: Clinical picture of disc herniation in the elderly patients may be nonspecific. Therefore, it is believed that the surgical indication is different from young patients, and requires a proper examination and diagnosis.