Separation of the Symphysis Pubis during Childbirth / 대한정형외과학회잡지

PURPOSE: To describe our experience concerning clinical features, methods of treatment and outcomes of separation of the symphysis pubis during childbirth. MATERIALS AND METHODS: We experienced 26 cases during a period of 6 years from March 1992 to January 1998. Retrospectively, we analysed 23 cases which could be followed up for more than a year, each with separation of the symphysis pubis associated with childbirth. Method of treatment was pelvic sling and absolute bed rest in 18 cases of 23 cases, the others were treated with bed rest and early mobilization. RESULTS: Clinical symptoms and physical findings were similar in all cases. The duration of symptom was from 3 weeks to a year (mean=3.2 months), the size of the gap on simple X-ray ranged from 6 mm to 28 mm (mean=16 mm) initially and from 3 mm to 11 mm (mean=4.7 mm) finally. Outcomes were good in all cases with conservative treatment, although final radiologic fingings were normalized, widening, sclerosis, erosion or osteophytes. CONCLUSION: Separation of the symphysis pubis during childbirth was treated well with conservative treatments, although variable radiologic findings were noted in final X-ray finding.

Cauda Equina Syndrome in the Lumbar Disc Herniation / 대한척추외과학회지

STUDY DESIGN: A retrospective analysis of the patients who had cauda equina syndrome caused by a herniated lumbar disc. OBJECTIVES: To assess the clinical debates concerning the diagnosis, treatment, and results of treatment. SUMMARY OF LITERATURE REVIEW: This syndrome has been considered as an absolute indication of surgical treatment in the herniated lumbar disc and poor prognosis after surgery were reported. Although there are debates on the timing of surgery, early recognition early surgical treatment are recommended for a better results of treatment. MATERIALS AND METHODS: 23 consecutive patients having a cauda equina syndrome caused by herniated lumbar disc were reviewed retrospectively. They were 14 males and 9 females having ages of 41.6 in average. The incidence of this syndrome was 3.8% of the patients who had surgical treatment of herniated lumbar disc. RESULTS: All patients had bladder dysfunction in addition to the low back pain and radicular pain in the leg, but five patient did not recognize their urinary retention which were shaded by severe leg pain. A surgical treatment were performed for all patients at 6.8 days in average after onset of the bladder dysfunction. At follow-up of 3 years and 3 months in average after surgery, 20 patients(86.9%) had satisfactory resolution of the low back pain and leg pain, and all patients had complete recovery of motor weakness except one patients who had residual foot drop. Bladder function recovered satisfactorily in 18 patients (78.3%), but 4 patients had some difficulty of urination and one patient needed a sphinterotomy for urination. CONCLUSIONS: The cauda equine syndrome in herniated lumbar disc was often not recognized early and a poor result of treatment was not rare, particularly in the patients who had acute onset and severe bladder dysfunction. So, early diagnosis and active surgical treatment are recommended for a better results of treatment.

Fixation Failure of Instrumentation for the Spinal Fusion in Lumbar Region / 대한척추외과학회지

STUDY DESIGN: A retrospective review of the patients who have a fixation failure of instrumentalion for the spinal fusion in lumbar region. OBJECTIVES: To assess the incidence and different types of the mechanical failure of fixation and to evaluate their managements and their influences on the progression of a spinal fusion and to the clinical outcomes. SUMMARY OF LITERATURE REVIEW: Most of the spine surgeons have been experiencing the mechanical failures after instrumentations for a spinal fusion, eden though the incidence is decreasing with a modification of the implants. Reports on this problem are sporadic in conjunction with the other topics, rarely focusing on their management and their influences on the final outcomes. MATERIALS AND METHODS: 338 consecutive patients who had a lateral fusion in the lumbar region with an instrumentation of pedicle screws and rods, mostly with decompression, were reviewed to analyse the fixation failures of instrumentation after surgery. RESULTS: There were 26 patients (7.7%) who had the fixation failures of instrumentation, in terms of loosening around the pedicle screws in 18 patients (5.3%), the breakage of the pedicle screws in fide patients (1.5%), and the migration of a rod in three patients (0.9%). They were managed by prolonged use of brace and ergonomic back cares. Even with the fixation failures, 19 patients (73.1%) disclosed solid union uneventfully, but one patient had re-operation to obtain solid fusion. The final outcomes were satisfactory in 22 patients (84.6%), including four of six patients who had pseudoarthrosis. CONCLUSIONS: The fixation failure of instrumentation after a spinal fusion in lumbar region was not rare, but the progression of a spinal fusion usually quite well achieved and the final outcomes were not so bad, even with the implant failures and pseudoarthrosi s. Except for the persistently symptomatic pseudoarthrosis, only a prolonged use of brace and the ergonomic back cares are recommended for symptomatic patients.

Surgical treatment of spondylolytic spondylolisthesis in adults / 대한정형외과학회잡지

No abstract available.