Clinical Studies of Tuberculosis of the Spine

During the period from January 1967 to December 1977, 244 cases of tuberculosis of the spine were operated on at the Department of Orthopedic Surgery, Yonsei University College of Medicine, Seoul, Korea. We followed up 176 cases from 6 months to 10 years and the average period was one year and ten months. (Radical curettage and anterior interbody fusion 129 cases, posterior fusion 20 cases, curettage without bone graft 21 cases, and combined anterior and posterior fusion 6 cases.) The results of those studies are as follows: 1) The incidence of Pott's-parplegia was 25% (61 cases) of the total cases. 2) Almost 41 cases (66%) of the total cases of Pott's parplegia have recovered well enough to return after operation to their previous work. 3) In children (below 15 years of age) 50 cases (87.7%) had satisfactory results with bony fusion and in adults 93 cases (94.9%). 4) In children 44 cases (77%) had healing of radiological activity after operation and in adults 104 cases (87%). 5) The younger the spine, the lower the fusion rate. Combined anterior and posterior fusion is the choice of treatment for tuberculosis of the spine in children. 6) Postoperative complications occured in 38 cases (16%) including wound infection, postoperative pneumonia, postoperative pneoumothorax, postoperative atelectasis, paralytic ileus, meningitis, cystitis, and failure in bone graft.

A Clinical Study of the Thoraco-lumbar Spine Fractures and Fracture-dislocations / 대한정형외과학회잡지

In recent years the rate of the spine frecture tends to be on the increase year by year as the rate of traffic and industrial accidents are increased. Realignment of the displaced vertebral column should be achieved for two reasons. It provedes better neural decompression than a laminectomy in most instances and permits stabilization of the axial skeleton in a position of function. One hundred and nine thoraco-lumbar spine fractures and fracture-dislocations out of 102 patients were evaluated from January, 1972 to December, 1977 in our study. 1. Out of the 102 patients, there were 89 male and 13 female cases. The ratio between male and female was 6.8: 1. The majority(77.1%) of the spine fractures was found in the age group of 20 to 50 years. 54.2% of the cases was caused by industrial accident. 2. The most Common site of the lesion occured between T 12 and L 2 vertebrae (82.6%) and the simple anterior wedge fracture (69.7%) was most common. 3. Thirty one cases of the total were complicated by paraplegia, of which 77.4% was caused by rotational fracture-dislocation and most common site of the lesion was between T 12 and L 2 vertebrae (93.8%). 4. Prognosis for neurological recovery in initially complete lesions was poor, regardless of treatment. About 10% of initially complete lesions showed partial neural recovery compared to 62.5% of initially incomplete lesions. 5. All 6 patients on bladder training with intermittent catheterization became catheter free within 3 months.

Atlanto-axial Dislocation with the Fracture of the Odontoid Process: A Case Report / 대한정형외과학회잡지

Atlanto-axial dislocation with the fracture of the odontoid process has been considered as an uncommon lesion and a high incidence of nonunion of fractures of the odontoid process or high incidence of neurological involvement or death has been reported. With the advent of radiology, this fracture has been diagnosed early with increasing frequency. This paper is presented because very excellent result of union of the odontoid process treated with wiring and posterior atlanto-axial fusion by means of Brooks technic was obtained in our case.

Pyogenic Osteomyelitis of the Spine / 대한정형외과학회잡지

We analysed 26 cases of pyogenic osteomyelitis of the spine who were treaed at Younsei University Hospital during 25 years from January 1952 to August 1977 by operative or conaervative treatment. The diagnosis of pyogenic osteomyelitis of the spine is not easy and very confused. The cause and entry of the offending organism is mainly by venous drainage from the genitourinary and lower extremity circulation and the next is direct spreading from the adjacent focus. The typical clinical symptom is severe pain and tenderness over the lesion accompanied by febril history and the clinical course is relatively rapid than tuberculosis of the spine. In blood examination leukocytosis is uncommon but it showed relative increase of neutrophils in 62%, and erythrocyte sedimentation rate in 89%. Radiological findings are narrowing of joint space, erosion and/or destuctive change of vertebral body, vertebral marginal sclerotic change, and new bone formation and less frequently abscess shadow. The results obtained from this study were as follows, 1) The incidence of pyogenic osteomyelitis of the spine among total cases of the pyogenic osteomyelitis was 2.5% and the ratio of the pyogenic osteomyelitis of the spine to the spine tuberculosis was 2.8%. 2) The sexual incidence was in 11 and 15 each male and female. and the avrage, prevalent age was 34 years of age. 3) The pathogenic organism was isolated in 20 cases from the diseased focus during surgical procedure; stapyhloccus in 16 cases, pseudomonas in two and in a case of E.coli and proteus each. 4) The lumber vertebrae was mostly involved, i.e.lumbar in 11 cases, cervical in four, thoracic in nine, lumbosacral and sacrum in one each. 5) The operative treatment was performed in 23 cases and conservative in 3 cases with the satisfatory result in all cases. 6) We conclude that the focal curettage with anterior interbody fusion through anterior approach was better than the conservative treatment.

Cystic Hygroma: A Case Report / 대한정형외과학회잡지

Cystic hygroma is a rare, endothelial lined cystic lesion of lymphatic origin which is encountered most often in children, usually at birth or early in life. The tumor is usually found in the neck and axilla. It is a soft, nontender, semifluctuant freely movable tumor of varying size filled with lymphatic fluid. The mass is sometimes pedunculated and is uaually multilocular, althouh it may be monolocular. The cystic hygroma of the right axilla and the upper arm, in a 4 month-old female infant, is presented with a review of the literature.