A Prospective Randomized Clinical Trial Comparing Bone Union Rate Following Anterior Cervical Discectomy and Fusion Using a Polyetheretherketone Cage: Hydroxyapatite/B-Tricalcium Phosphate Mixture versus Hydroxyapatite/Demineralized Bone Matrix Mixture

STUDY DESIGN: Prospective randomized noninferiority trial. PURPOSE: To evaluate whether the union rate of anterior cervical discectomy and fusion (ACDF) using a polyetheretherketone (PEEK) cage filled with a mixture of hydroxyapatite (HA) and demineralized bone matrix (DBM) is inferior to that of a mixture of beta-tricalcium phosphate (beta-TCP) and HA. OVERVIEW OF LITERATURE: There have been no clinical trials investigating the outcomes of a mixture of HA and DBM in a PEEK cage in ACDF. METHODS: Eighty-five eligible patients were randomly assigned to group B (n=43), in which a PEEK cage with a mixture of HA and DBM was used, or group C (n=42), in which a PEEK cage with a mixture of HA and beta-TCP was used. The primary study endpoint was the fusion rate, which was assessed with dynamic radiographs and computed tomography (CT) scans. Secondary endpoints included pain intensity using a visual analogue scale, functional outcome using a neck disability index score, laboratory tests of inflammatory profiles, and the infection rate. RESULTS: Seventy-seven patients (38 in group B and 39 in group C) were included in the final analysis. One year postoperatively, bone fusion was achieved in 87% of group B patients and 87% of group C patients on dynamic radiographs, and 87% of group B patients and 72% of group C patients on CT scans (p=1.00 and 0.16, respectively). There were also no between-groups differences with respect to the secondary endpoints. CONCLUSIONS: A HA/DBM mixture inside a PEEK cage can provide noninferior outcomes compared to a HA/TCP mixture in ACDF.

A comparative study on the fracture behavior of zironia, glass infiltrated alumina and PFM full crown system / 대한치과보철학회지

PURPOSE: The purpose of this study was to compare the fracture behavior of Zironia, glass infiltrated Alumina and PFM full crown system. MATERIALS AND METHODS: Fifteen crowns for each of 3 experimental groups (Zironia, glass infiltrated Alumina and PFM full crown) were made by the conventional method. The crowns mounted on the testing jig were inclined in 30 degrees to the long axis of the tooth and the universal testing machine was used to measure the fracture strength. RESULTS: 1. The mean fracture strengths were 588.3 +/- 49.6 MPa for zirconia system, 569.1 +/- 61.8 MPa for PFM system and 551.0 +/- 76.5 MPa for glass-infiltrated alumina system (P>.05). 2. The mean shear bond strengths were 25.5 +/- 5.6 MPa for zirconia system, 38.9 +/- 5.0 MPa for Ni-Cr alloy system and 39.4 +/- 5.1 MPa for glass-infiltrated alumina system. 3. The chemical bonding was observed at interfaces between PFM or glass-infiltrated alumina and veneering porcelain, however, no chemical bonding was observed at interface between zirconia and veneering porcelain. CONCLUSION: With the study, the fracture strengths of PFM crown system had a higher fracture strength than conventional zirconia system crown and glass-infiltrated alumina crowns. and than the shear bond strengths glass-infiltrated alumina system had a higher shear bond strength than conventional PFM system and zirconia system.

Risk Factors of New Compression Fractures in Adjacent Vertebrae after Percutaneous Vertebroplasty

STUDY DESIGN: Retrospective study. PURPOSE: To evaluate risk factors related to the development of new fractures in adjacent vertebrae after percutaneous vertebroplasty. OVERVIEW OF LITERATURE: Recent reports indicate that undue numbers of new fractures in adjacent vertebral bodies occur after percutaneous vertebroplasty. METHODS: One hundred four of 369 patients who underwent percutaneous vertebroplasty were followed for over 1 year. Fifty-four patients (51.9%) subsequently suffered from adjacent vertebral fractures. Age, lumbar lordotic angle, sacral slope, pelvic tilt, pelvic incidence, bone mineral density, amounts of cement injected, the restoration of vertebral height, kyphotic angle differences preexisting fracture, and intradiscal cement leakage were noted. RESULTS: Average bone mineral density was -3.52 in the fracture group and -2.91 in the fracture-free group; the risk of adjacent vertebral fracture increased as bone mineral density decreased (p < 0.05). Intradiscal cement leakage occurred in 18 patients (33.3%) in the fracture group, indicating that the risk of adjacent vertebral fracture increased with intradiscal cement leakage. In addition, 36 patients (66.7%) in the fracture group had a pre-existing fracture; thus, the presence of a preexisting fracture was found to be significantly associated with an increased risk of an adjacent vertebral fracture (p < 0.05). Higher restoration rates are associated with a greater likelihood of developing adjacent vertebral fractures (p < 0.05). CONCLUSIONS: The factors found to contribute significantly to new fractures in adjacent vertebral bodies after percutaneous vertebroplasty were a lower bone mineral density, a greater restoration rate of vertebral height, a pre-existing fracture, and intradiscal cement leakage.

Comparison of the Outcomes on Second-Look Arthroscopy after Anterior Cruciate Ligament Reconstruction Using a Hamstring Autograft or a Tibialis Anterior Allograft

PURPOSE: We wanted to evaluate the status and changes of the reconstructed anterior cruciate ligament (ACL) graft by performing second-look arthroscopy after arthroscopic reconstruction of the ACL with a hamstring autograft or a tibialis allograft. MATERIALS AND METHODS: From June 2003 to February 2007, second look arthroscopy was performed on 58 cases and a hamstring autograft was used in 36 cases and a tibialis allograft was used in 22 cases. Second-look arthroscopy was conducted at an average of 19.1 (12~42) months after reconstruction. We measured the graft tension using displacement by probing and the synovial coverage by visual analysis at the time of second-look arthroscopy. The Lysholm score, the Lachman test and a KT-2000 arthrometer were used to evaluate the status of the reconstructed ACL. RESULTS: The hamstring tendon autograft group showed normal tension in 25 cases, lax tension in 7 cases and partial tear in 4 cases. The tibialis anterior allograft group showed normal tension in 12 cases, lax tension in 5 cases and partial tear in 5 cases. In the hamstring tendon autograft group, the synovial coverage was good in 23 cases, there was half coverage in 8 cases and it was pale in 5 cases. In the tibialis anterior allograft group, the synovial coverage was good in 10 cases, there was half in 7 cases and it was pale in 5 cases. There were no significant differences between the two groups on the clinical examination, but on second look arthroscopy, the synovial coverage was better in the hamstring tendon autograft group than that for the tibialis anterior allograft group. CONCLUSION: The hamstring autograft group had superior synovial coverage compared to that of the other group on second look arthroscopy. But there were no significant difference of the clinical outcomes between the groups.

Comparison of Bone Mineral Density in Elderly Patients over 65 Years according to Presence and Types of Hip Fracture

PURPOSE: We measured the BMD of elderly patients with osteoporotic hip fracture in order to understand the relationship between BMD of each sites and hip fracture occurrence or the types, and also to suggest a reference point for starting an osteoporosis treatment program. MATERIALS AND METHODS: From July 2007 to February 2010, we investigated total 147 elderly osteoporotic hip fracture patients over 65 years. For control group, 80 patients who were over 65-year-old and did not have any fracture were selected. BMD was compared at each site between each groups statistically. RESULTS: In the comparison of femur intertrochanter and neck fracture groups, BMD of femur neck and trochanter areas and L2, L3 areas were significantly less in intertrochanteric fracture group. In the analysis according to the classification of intertrochanteric fracture, BMD of intertrochanter and Ward's triangle area were significantly less in unstable fracture group than stable one. Each of the fracture threshold of intertrochanteric and neck fracture group was -1.10 and -1.36 of the T-score in proximal femur, and -1.40 and -1.40 of the T-score in lumbar vertebrae. CONCLUSION: To examine the BMD of both proximal femur and lumbar vertebrae areas is helpful to predict the hip fracture occurrence and the type of hip fracture. And for the prevention of hip fracture in elderly patients over 65 years, we propose that the aggressive treatment of osteoporosis should be started to prevent fracture for patients with a T-score less than -1.40.

Treatment of Acromioclavicular Joint Injuries Using Clavicle Hook Plates

PURPOSE: To analyze results of treating acromioclavicular injuries using clavicle hook plates. MATERIALS AND METHODS: Between February 2008 and April 2010, 18 patients with acromioclavicular joint injury treated by clavicle hook plates were reviewed. Using the Rockwood classification, 7 dislocations were classified as type III injuries and 11 as type V injuries. Implant removal was done at least 3 months from initial fixation. Simple X-rays were taken for comparing the state of reduction, and clinical outcomes were evaluated by the Korean Shoulder Scoring System and the American Shoulder Elbow Society score. The average follow-up period was 9 months. RESULTS: On weight bearing X-rays, the average coracoclavicular distance showed a 114% increase compared to the contralateral side at the time of injury. It decreased to 23% by the last follow-up. The mean Korean Shoulder Scoring System and the American Shoulder Elbow Society score were 80 and 74 at the last follow-up. CONCLUSION: The immediate stability these plates provide allows rapid rehabilitation. Clavicle hook plate fixation for acromioclavicular joint dislocation is considered an effective method for ensuring satisfactory results both radiologically and clinically.

Effect of Traumatic Brain Injury on Healing of Femur shaft Fracture / 대한정형외과연구학회지

PURPOSE: Among the fracture patients, there is a tendency to form more callus and get fracture united earlier in groups with traumatic brain injury. This retrospective study is to evaluate the factors that might accelerate the bone formation by comparing two groups in serologic tests, clinical and radiologic results. MATERIALS AND METHODS: From March 2001 to July 2009, femur shaft fracture patients were divided in two groups 1) without traumatic brain injury (32cases), 2) fracture with traumatic brain injury combined (30cases). We evaluated the routine serologic exams, amount of callus formations during the follow up period. RESULTS: There was no statistical difference in WBC, CRP, total calcium, LDH level between two groups, except Alkaline phosphatase level. Amount of callus formation on AP radiograph at the last follow up period was 74.9% in study, 42.6% in control group. Lateral radiograph showed 73.2% of callus formation rate in study group and 32.0% in control group. CONCLUSION: Two groups had no significant difference with the routine serologic exam except Alkaline phosphatase. Group with traumatic brain injury had much more amount of callus formation but there was no evidence of traumatic brain injury accelerate the fracture healing.

Percutaneous A1 Pulley Release of Locked Trigger Thumb in Children

PURPOSE: To report the clinical outcomes of percutaneous A1 pulley release for the surgical treatment of locked trigger thumb in children. MATERIALS AND METHODS: Twenty-six trigger thumbs in 24 patients with a average of 14.2 months follow-up after percutaneous release were enrolled. There were 15 females and 9 males with an average age of 39 months. The mean time from first presentation to surgery was 16 months. Procedures were performed under local anesthesia. Postoperative examinations at immediate, 3 months and 1-year recorded pain, triggering and range of motion and presence of complications. RESULTS: All thumbs had a satisfactory result without digital nerve injury. Eleven patients(46%) had a mean 14.3degrees extension loss of the interphalangeal joint and 12.0degrees hyperextension of the metacarpophalangeal joint of the thumb, compared to the contralateral thumb. At final follow-up, all but 1 patient were completely resolved. The duration of symptoms and age were higher in the group with thumb deformity (p<0.05). CONCLUSION: Temporary thumb deformity is possible after surgical treatment of trigger thumb in children with a long duration of symptoms. Percutaneous release can be a safe and satisfactory treatment option in pediatric trigger thumb.

The Effect of Vertebral Wedge Angle to the Change of Kyphotic Angle by the Posterior Instrumentation Method in Thoracolumbar Spine Fracture / 대한척추외과학회지

STUDY DESIGN: Retrospective study OBJECTIVES: To examine the effect of transpedicular screw fixation on fractured vertebrae about the vertebral wedge angle (VWA) after posterior instrumentation of the thoracolumbar fracture, determine the effect of reduced VWA on the change in the Kyphotic angle (KA), and minimize loss of reduction of KA. SUMMARY OF THE LITERATURE REVIEW: Maintenance of the KA of a thoracolumbar fracture after surgery is important for the radiologic and functional outcome. MATERIALS AND METHODS: Forty patients, who had undergone posterior instrumentation in a thoracolumbar fracture between February 2006 and February 2008 and followed-up for more than one year, were enrolled in this study. The patients were divided into two groups according to transpedicular screw fixation (Group A) or not (Group B) including fractured vertebrae. The evaluation was performed by measuring the changes in the KA and VWA taken after the injury, immediate after surgery and 1 year after surgery. RESULTS: There was correlation between groups A (transpedicular screw fixation on fractured vertebrae) and B (no transpedicular screw fixation on the fractured vertebrae) regarding the correction of the VWA and the loss of correction KA, (p<0.05). CONCLUSIONS: Reduction of the VWA is an important factor for preventing reduction loss of the KA, and transpedicular screw fixation including fractured vertebrae would help reduce the VWA. Therefore, the operator must pay attention to the increase in VWA to maintain the KA through short segment transpedicular screw fixation including fractured vertebrae.

The Quantitative Analysis of Back Muscle Degeneration after Posterior Lumbar Fusion: Comparison of Minimally Invasive and Conventional Open Surgery

STUDY DESIGN: Prospective controlled study. PURPOSE: The results of conventional open surgery was compared with those from minimally invasive transforaminal lumbar interbody fusion (MI-TLIF) for lumbar fusion to determine which approach resulted in less postoperative paraspinal muscle degeneration. OVERVIEW OF LITERATURE: MI TLIF is new surgical technique that appears to minimize iatrogenic injury. However, there aren't any reports yet that have quantitatively analyzed and proved whether there's difference in back muscle injury and degeneration between the minimally invasive surgery and conventional open surgery in more than 1 year follow-up after surgery. METHODS: This study examined a consecutive series of 48 patients who underwent lumbar fusion in our hospital during the period, March 2006 to March 2008, with a 1-year follow-up evaluation using MRI. There were 17 cases of conventional open surgery and 31 cases of MI-TLIF (31 cases of single segment fusion and 17 cases of multi-segment fusion). The digital images of the paravertebral back muscles were analyzed and compared using the T2-weighted axial images. The point of interest was the paraspinal muscle of the intervertebral disc level from L1 to L5. Picture archiving and communication system viewing software was used for quantitative analysis of the change in fat infiltration percentage and the change in cross-sectional area of the paraspinal muscle, before and after surgery. RESULTS: A comparison of the traditional posterior fusion method with MI-TLIF revealed single segment fusion to result in an average increase in fat infiltration in the paraspinal muscle of 4.30% and 1.37% and a decrease in cross-sectional area of 0.10 and 0.07 before and after surgery, respectively. Multi-segment fusion showed an average 7.90% and 2.79% increase in fat infiltration and a 0.16 and 0.10 decrease in cross-sectional area, respectively. Both single and multi segment fusion showed less change in the fat infiltration percentage and cross-sectional area, particularly in multi segment fusion. There was no significant difference between the two groups in terms of the radiologic results. CONCLUSIONS: A comparison of conventional open surgery with MI-TLIF upon degeneration of the paraspinal muscle with a 1 year follow-up evaluation revealed that both single and multi segment fusion showed less change in fat infiltration percentage and cross-sectional area in the MI-TLIF but there was no significant difference between the two groups. This suggests that as time passes after surgery, there is no significant difference in the level of degeneration of the paraspinal muscle between surgical techniques.

Usefulness of Coronal MR Image in Diagnosis of Foraminal and Extraforaminal Disc Herniation / 대한척추외과학회지

STUDY DESIGN: This is a retrospective study OBJECTIVES: The coronal MR images were carefully evaluated to document the efficacy of diagnosing foraminal and extraforaminal disc herniations. SUMMARY OF LITERATURE REVIEW: Extraforaminal disc herniations constitute 1~11.7% of all disc herniations. The diagnosis of it demands great caution because it must be distinguished from intraspinal canal disc herniation. Diagnosing extraforaminal disc herniations can be neglected with using ordinary diagnostic methods. MATERIALS AND METHODS: A retrospective analysis was performed on 24 patients, (26 cases) that underwent lumbar spine MRI, with the T2 coronal images, for the evaluation of disc herniations from March 2006 to March 2007. Every MRI image of each patient who had foraminal or extraforaminal disc herniations was graded according to the Pfirrmann's classification of diagnostic efficacy by two spinal surgery specialists and two radiology specialists. RESULTS: There were 13 cases of foraminal disc herniation and 13 cases of extraforaminal disc herniation in all 26 cases that were diagnosed by MRI. The coronal and axial images were more effective than the sagittal images for the discrimination of a compressed root. Especially, for the extraforaminal disc herniation, all of the coronal images were graded as grade 3; on the other hand, all of the sagittal images were not helpful for the assessment and the axial images were graded as grade 2 for 38.5% of the and as grade 3 for 61.5%. So, the coronal images were most effective for making the diagnosis of extraforaminal disc herniation and this was statistically significant (p<0.05). CONCLUSION: For the accurate discrimination of the location and the grading of foraminal and extraforaminal disc herniation, MRI, and especially the coronal images, is an effective and useful method in addition to conducting a physical examination.

Surgical Treatment of Spontaneous Spinal Epidural Hematoma: A Case Report / 대한척추외과학회지

Spontaneous spinal epidural hematomas without any risk factors, such as spinal tap, trauma, pregnancy, bleeding diathesis, vascular malformations, hypertension, etc. are relatively rare clinical entities. In addition, the clinical suspicion is quite difficult because there are various clinical symptoms according to the size and location of hematoma. However, the speed of diagnosis and initiation of the appropriate treatment are important because the outcome for patients is usually determined by the location and degree of neurological deficits and the duration of dural compression. We report the diagnosis and treatment of spontaneous spinal epidural hematoma in this case with a review of the relevant literature.

A case of Crohn's Disease with Optic Neuritis and Wernicke's Encephalopathy

Neurological complications associated with Crohn's disease are infrequent and optic neuritis is extremely rare. We report a 20-year-old man showing optic neuritis and Wernicke's encephalopathy as complications of Crohn's disease. We suggest that nutritional deficiency caused Wernicke's encephalopathy and the immunologic abnormality of Crohn's disease induced the complication of optic neuritis. This patient is the first reported case showing optic neuritis and Wernicke's encephalopathy simultaneously as neurological complications of Crohn's disease in Korea.

Bouquet Pin Intramedullary Nail Technique of the 5th Metacarpal Neck Fractures

PURPOSE: To evaluate radiologic and clinical results of bouquet pin intramedullary nail technique for the 5th metacarpal neck fracture. MATERIALS AND METHODS: Between April, 2005 and February, 2006, 17 patients treated by bouquet pin intramedullary nail technique for the 5th metacarpal neck fracture were evaluated. All patients were reviewed clinically and radiologically after operation. RESULTS: All of 17 cases of fractures were completely united. In the anteroposterior radiographs, the average of preoperative angulation was corrected from 34.4° to 5.2°. Also, in the oblique radiographs, radiographic results of angulation correction were satisfactory which was corrected from 44.2° to 11.7°. Although, the averages of difference between postoperative and final follow-up angulations were 1.5° in the anteroposterior radiographs and 0.9° in the oblique radiographs, they were not statistically different. All patients were excellent clinically except 1 patient who has moderate joint stiffness after operation. CONCLUSION: Selecting of appropriate patients who is indicated, bouquet pin intramedullary nail technique for the 5th metacarpal neck fracture could be a good treatment method without complications.

Total Elbow Arthroplasty for the Fracture of Elbow Arthrodesis Site: A Case Report

Total elbow arthroplasty is a relatively rare procedure compared with total knee or total hip arthroplasty. Total elbow arthroplasty for bony ankylosis is even rarer, and the results are often unsatisfactory. We report a patient who gained good mobility of the elbow after total elbow arthroplasty for the treatment of fractured arthrodesis site with which the patient had lived with for 12 years.

The Effect of Different Wavelength of Low Power Laser on Fracture Healing / 대한정형외과연구학회지

PURPOSE: The purpose of this study is to evaluate the effect of different wave length of low power laser on early fracture healing. METHODS AND MATERIALS: Nine week old female English Hartley guinea pigs were used for this experiment. Sixty guinea pigs were divided into three groups, and then right femur was fractured and fixed with an intramedullary nail. The frequency of 632 nm and 830 nm semi-conductor laser machines were used. Finally, 46 guinea pigs were survived (including 14 cases in control group, 16 cases in 632 nm group and 16 cases in 830 nm group). Guinea pigs were sacrificed at 3 and 6 weeks separately. The gross, radiologic and histologic findings were assessed by the Modified Zorlu Scoring System. The statistical evaluation was done by repetitive measured ANOVA test. RESULTS: In the gross findings and radiologic findings, both of 632 nm and 830 nm radiation groups showed a greater amount of callus formation at postoperative 3 weeks with statistical significance (P0.05). The result of histological findings showed that an increase of osteoblastic proliferation in two radiation groups was greater than that in the control group at 3 and 6 weeks (P<0.01). Enhancement of osteoblastic proliferation was greater in 830 nm group compared to in 632 nm group at 3 weeks (P<0.05). The comparison between the experimental groups for wave length of 632 nm and 830 nm at 6 weeks showed significant difference (P<0.05). CONCLUSION: In this study, it became known that applying 632 nm and 830 nm wavelength laser to the fracture site accelerate bony union, and 830 nm wavelength laser showed earlier bony union than 630 nm wavelength laser.

Risk Factors of New Compression Fractures in Adjacent Vertebrae after Percutaneous Vertebroplasty

PURPOSE: To evaluate the risk factors related to the development of new fractures in adjacent vertebrae after vertebroplasty. MATERIALS AND METHODS: The study was conducted on 46 patients in whom 296 patients were performed during last 9 years. We were especially concerned with the restoration rate of vertebral height and kyphotic angle and estimated them on simple X-ray films. RESULTS: In patients experienced subsequent vertebral fractures and no subsequent vertebral fractures after vertebroplasty, the mean height restoration rate of treated vertebra were 16.7% and 7.07%, and the kyphotic angle difference were 2.53 degree and 4.2 degree. The greater degree of height restoration of the vertebral body, especially in middle vertebral height and the lesser degree of kyphotic angle difference increased the risk of adjacent vertebral fracture risk. This results were available statistically (all p<0.05, Logistic regression test, SPSS 13.0). CONCLUSION: It may be thought that the vertebral body height restoration rate will become risk factor of adjacent vertebral fractures.

Long Term Results of LCS Mobile Bearing Knee System in Total Knee Arthroplasty

PURPOSE: To evaluate the long-term (over 10 years) clinical and radiologic results of LCS (low contact stress, Depuy, USA) total knee arthroplasty (TKA) retrospectively. MATERIALS AND METHODS: Out of 57 cases who underwent TKA with LCS knee system between June 1994 and August 1995, 33 cases could be analysed clinically and radiographically. Clinical analysis was performed according to flexion contracture, ROM, Knee Society Clinical Rating System (KSCRS) and Hospital for Special Surgery (HSS) score system. Radiographic analysis was performed according to the roentgenographic evaluation criteria of American Knee Society. Complications and survival rate were evaluated. RESULTS: Average flexion contracture was improved from 10.0degrees preoperatively to 3.7degrees at final followup and average ROM was improved from 104.0degrees preoperatively to 115.3degrees at final follow-up (p<0.05). Average HSS score was improved from 49.5 preoperatively to 80.1 at final follow-up and average KSCRS score was also improved from 77.2 to 152.5. Average tibio-femoral angle was changed from 3.3degrees varus preoperatively to 3.5degrees valgus at final follow-up. There were 4 complications, including infection in two cases and fracture dislocation of polyethylene implant in two cases respectively. Ten year survival rate was 94.1 percent. CONCLUSION: LCS TKA showed excellent results and good survival rate at more than ten years followup. However, more cases should be necessary for statistic significance.

Significance of Retinal Microvascular Changes in Patients with Ischemic Stroke

BACKGROUND: Retinal microvascular abnormalities reflect cerebral microvascular changes. However, there is few clinical data on the relationship between retinal microvascular changes and intracranial arterial stenosis or stroke subtypes. We examined the association between white matter changes (WMCs) or large artery stenosis and retinal microvascular changes, stroke subtypes. METHODS: We investigated demographic features, retinal microvascular changes, intracranial large arterial stenosis, WMCs and stroke subtypes in 100 acute ischemic stroke patients over 2 years who had taken retinal photography and underwent brain MRI with MR angiography. Retinal photography was evaluated for specific retinal microvascular change by grader using standardized protocol. Intracranial arterial stenosis was defined by MR angiography. WMCs were coded from 1 for normal to 8 for most severe degree. And we defined "White matter lesion" as grade 3 or more. Stroke subtypes were classified by TOAST criteria. RESULTS: Among the retinal microvascular changes, retinal hemorrhage, arteriovenous nicking, focal and generalized arteriolar narrowing and venous congestion were significantly correlated with intracranial large arterial stenosis. There was no relationship between the retinal microvascular changes and stroke subtypes. And only focal arteriolar narrowing was significantly correlated with WML. CONCLUSIONS: Retinal microvascular changes seen in patients with ischemic stroke were related to intracranial large arterial stenosis. We might suggest that the pathogenesis of retinal microvascular changes is related to that of large arterial atherosclerosis.

CT Guided Cervical Transforaminal Steroid Injection: 2 Months Follow-up / 대한통증학회지

BACKGROUND: A cervical transforaminal steroid injection is an effective therapeutic modality for radiculopathy of a herniated cervical disc or a cervical foraminal stenosis. However, there is some debate regarding the safety of the transforaminal approach under C-arm guidance compared with the posterior interlaminar approach. We report a new technique for cervical transforaminal steroid injection guided by MDCT. METHODS: Patients presenting with radiating pain on their shoulder or arm were diagnosed using CT or MRI of a cervical herniated disc or a foraminal stenosis. Each patient whose symptoms were compatible with the image scan was enrolled in this study. They received a cervical transforaminal steroid injection under CT guidance, and the effectiveness and complications of this technique were evaluated over a 2-month period. RESULTS: According to the CT scan, none of the participants had an internal jugular vein or a carotid artery invasion during the procedure. No vertebral artery injection was noted, and no patient developed a hematoma after the injection. The VAS score had improved significantly by 2, 4 and 8 weeks after the injection. CONCLUSIONS: While a conventional C-arm guided cervical transforaminal steroid injection does not appear to differentiate between the major vessels and structures in images, a CT guided approach is a more useful and safer technique for the precise placement of a needle.