Clinical Analysis of Posterior Lymbar Apophyseal Ring Fractures in Young Adults

Lumbar apophyseal ring fracture occurs between the vertebral ring apophyses and the cartilaginous rim of the superior or inferior margins of the vertebral end plates. This fracture is an unusual disease that if typically seen in adolescents or young adults. We analyzed the clinical records and neuroradiologic imagings of 49 patients who were less than 29 years old diagnosed with posterior lumbar apophyseal ring fractures in regards to the age, trauma history, the type and distribution of the fracture, clinical presentation, and postoperative outcome. The posterior lumbar apophseal ring fractures were detected in 29(9.2%) out of 533 young adult patients with herniated lumbar discs. There was trauma history in 37(75.5%) out of the 49 patients. The main presenting symptoms in most of the patients were low back pain and radiating leg pain. In patients who presented with symptoms, thirty-five patients(75.5%) had a positive straight leg-raising test. According to classification by Takata, they were type I in 12 cas es(24.0%), type II in 9 cases(18.0%), and type III in 29 cases(58.0%). The type III with trauma history was more common than with non-trauma history(p<0.01). Twenty-one patients(42.0%) had bony fragments projecting into the spinal canal from the upper border of S1. Partial hemilaminectomy(18 patients) and total laminectomy(3 patients) were performed. We could easily remove the bony fragments in all of the surgical cases. Chemonucleolysis were done in three patients. The overall results were good. We conclude that knowledge of this entity and correct radiographic diagnosis will help to facilitate the operative planning.

Primary Spinal Epidural Ewing's Sarcoma: Report of 1 Case

Ewing's sarcoma, originating primarily in the spinal epidural space is exceptionally rare. There are only 6 case reports in English literature until 1986. We experienced a case of epidural Ewing's sarcoma originated in thoracic spinal canal at T6~T7 level with myelopathy. Initial neural decompression was very effective and complete recovery was achieved. But local recurrence occurred in relatively short follow up period(8 months). Subsequent radiotherapy showed us dramatic tumor regression and improvement of neurologic deficit. The problems that concerned in this tumor are its accurate diagnosis and appropriate therapeutic modality. We reviewed the literatures that deal with exceptional locations of Ewing's sarcoma and current therapeutic approaches with their outcomes.

Surgical Experience of Transpedicular Screw Fixation of the Lumbar Spine

Transpedicular screw fixation of the lumbar spine has evolved rapidly and become one of the reliable methods to application. We treated 42 cases of lumbar spine disease using above method from October, 1987, to Febuary, 1993. The disease entities were spondylolisthesis 24 cases(58%), spondylolysis 14 cases(33%), fracture and dislocation 3 cases(7%), postsurgical instability 1 case(2%). The most frequent clinical symptom and sign was low back pain with radiating pain accompanying limitation of straight leg raising, which clinical outcome was excellent with wide laminectomy. The transpedicular screw fixation allow adequate neural decompression, short segment fixation and prevention of motion limitation of lumbar spine. But one of the important complication driven with this method was root injury which must be prevented by surgen's throught knowledge to pedicular anatomy and meticulous operative technique. The instrument failure is also the troublesome problem. The appropriate bone fusion will be the acceptable strategy to overcome the eventual possibility of instument failure.