Perioperative Complications of Lumbar Total Disc Replacement / 대한정형외과학회잡지

PURPOSE: To investigate the perioperative complications and their effect on the clinical outcomes after a lumbar total disc replacement (TDR). MATERIALS AND METHODS: Forty-three patients (18 men and 25 women) who had undergone a lumbar TDR from May 2002 and May 2004 were reviewed. Subgroup analysis was performed to determine if age, gender, previous discectomy, multilevel, learning curve of operator, or the difference between preoperative and postoperative disc height were associated with the development of intraoperative or postoperative complications. The patients rated their low back pain on a visual analogue scale and completed an Oswestry disability index (ODI) at the preoperative and postoperative follow-up. RESULTS: There were 4 cases of intraoperative complications (2 major vein injuries and 2 peritoneal rupture) and 8 cases of postoperative complications (6 radicular pains, 1 subsidence of implant, and 1 dissociation of endplate and polyethylene core). There were no significant differences in the incidence of complications according to age, gender, prior surgery, multilevel, learning curve, or disc height difference (p>0.05). In addition, there were no significant differences in the VAS and ODI between the complication and non-complication groups. CONCLUSION: The authors experienced a relatively high rate of complications (11/43 patients) following TDR and statistical analysis did not reveal any associated risk factors.

Significance of Brain MRI in the Diagnosis of Fat Embolism Syndrome / 대한정형외과학회잡지

The fat embolism syndrome is a complication which encounters rarely after fractures of pelvis and long bones of lower extremity of severe injury of soft tissue, and may results in microinfarctions in lungs, brain, heart, kidneys and other important organs when fat globules flow from bone marrow into small vessels. And that is the one of the main cause of death within 72 hours after major trauma of long bones. Diagnosis of fat embolism syndrome was made by clinical criteria by Gurd, but, majority of cases didn't show characteristic clinical symptoms or signs. Recently CT and MRI of the brain are adopted to the diagnosis of FFS as a new method. Authors experiences six cases of fat embolism syndrome from Mar. 1991 to Mar. 1994 and analyzed the brain MRI findings. We concluded that the brain MRI findings such as diffuse brain swelling, petechial hemorrhage and microinfarctions were helpful to diagnose clinically apparent or subclinical fat embolism syndrome.