No abstract available.
Longitudinal Ligaments*

No abstract available.
Fatigue* ; Sciatica*

No abstract available.

Vertebroplasty was introduced in 1987 for painful cervical hemangioma. Since then, there has been an explosion of interest in this remarkable procedure, which can be useful for the majority of vertebral fractures throughout the spinal column. This procedure is indicated for painful vertebral compression fracture(VCF) due to osteoporosis or malignancy, and for painful hemangiomas. Vertebroplasty is the injection of bone cement, generally polymethylmethacrylate (PMMA), into a vertebral body (VB). Kyphoplasty is the placement of balloons into the VB, followed by an inflation/deflation sequence to create a cavity prior to the PMMA injection. These procedures are most often performed in a percutaneous fashion under local anesthesia. Although these methods are minimally invasive procedure, numerous complications can occur. The common complications include bleeding at the puncture site, PMMA leakage, local infection, and adjacent vertebral body fracture. A grave complication, which is rarely reported, is pulmonary embolism by PMMA leakage. These procedures can reduce pain in about 90% of patients with osteoporotic VCFs. Additionally, improvements in mobility and in activities of daily living occur. The success rate is slightly less in patients with metastatic VCFs than osteoporotic VCFs. Much evidence favors the use of these procedures for pain associated with the aforementioned disorders. The risk/benefit ratio appears to be favorable in carefully selected patients. This article summarizes the indications, techniques, complications and outcomes for the vertebroplasty and kyphoplasty.
Activities of Daily Living ; Anesthesia, Local ; Explosions ; Hemangioma ; Hemorrhage ; Humans ; Kyphoplasty ; Osteoporosis ; Polymethyl Methacrylate ; Pulmonary Embolism ; Punctures ; Spine ; Vertebroplasty

Acute subdural hematoma (ASDH), chronic subdural hematoma (CSDH) and subdural hygroma (SDG) occur in the subdural space, usually after trauma. We tried to find a certain relationship among these three traumatic subdural lesions in 436 consecutive patients. We included all subdural lesions regardless of whether they were main or not. We evaluated the distribution, age incidence and interval from injury to diagnosis of these lesions, and the frequency of new subdural lesions in each lesion. ASDH constituted 68.6%, SDG 15.8%, and CSDH 15.6%, Age incidence of CSDH was similar to that of SDG, but differed from that of ASDH. Mean interval from injury to diagnosis was 0.4 days in ASDH, 13.4 days in SDG, and 51.6 days in CSDH. Focal brain injuries accompanied in 37.5% of ASDH, 5.8% of SDG, and no CSDH. In ASDH, 2 recurrent ASDHs, 17 SDGs and 9 CSDHs occurred. In SDG, 3 postoperative ASDHs and 8 CSDHs occurred. In CSDH, 2 postoperative ASDHs, 2 SDGs and 1 CSDH occurred. These results suggest that the origin of CSDH is not only ASDH, but also SDG in upto a half of cases. SDG is produced as an epiphenomenon by separation of the dural border cell layer when the potential subdural space is sufficient. A half of CSDHs may originate from ASDHs. ASDH may occur in CSDH by either a repeated trauma or surgery. Such transformation or development of new lesions is a function of a premorbid condition and the dynamics between the absorption capacity and expansile force of the lesion.
Adolescent ; Adult ; Age Factors ; Aged ; Brain Injuries/complications/pathology ; Child ; Female ; Glasgow Coma Scale ; Hematoma, Subdural/etiology/*pathology/therapy ; Human ; Male ; Middle Age ; Subdural Space/*pathology ; Tomography Scanners, X-Ray Computed

The authors have experienced 62 cases of chronic subdural hematoma from Jan. 1987 to May 1992 at National Medical Center. In these cases, 58 cases of chronic subdural hematoma were treated with burr hole and closed draninage, 4 cases were managed with conservative management. Male was predominant to female with the ratio of 6:1 and common age was 50-60 years old. Most common causes was head injury and there was cases of chronic subdural hematoma developed after shunt operation. Common symptom was mental change and headache. Brain expansion was delayed in old age group(over 50 years old), Brain CT was available in diagnosis but brain MRI was useful in diagnosis of scantly chronic subdural hematoma. Surgical outcome was related to preoperative neurologic grade and time interval of diagnosis. In this study, clinical improvement rates was 88% in surgically treated cases.
Brain ; Craniocerebral Trauma ; Diagnosis ; Female ; Headache ; Hematoma, Subdural, Chronic* ; Humans ; Magnetic Resonance Imaging ; Male

It is never easy to assess the rate of disability from spinal injuries objectively. One reason is that the pain is an unmeasurable subjective symptom, and the other is that the disability is usually not confirmed by or correlated with radiological or laboratory examinations. The disability is an essentially subjective inconvenience or limitation, which is hard to measure objectively. However, compensation or reparation requires a scale to measure this unmeasurable disability, even with a universal validity and equity. There are several guidelines or criteria for a quantitative assessment of the disability. They differ from each other and have their own advantages and disadvantages. This difference may cause confusion or inequity. To improve the validity and equity, we propose a new design for the disability evaluation in patients with spinal injuries. We reviewed the Korean law for compensation in industrial accidents, McBride's disability table, the guideline proposed by American Medical Association, and a impairment rating table. Disabilities resulting from spinal injuries were classified into three types, i.e., morphologic sequelae(deformity), functional sequelae(dysfunction), and others. Only objective findings were considered as criteria for rating the disability. Disability resulting from deformity were rated from 0 to 20% by the degree of compression. Dysfunction can be rated by the number of lost motion segment from 10 to 60%. Disability from other compensable spinal pain were rated by objective physical findings or neurologic deficit from 0 to 25%. By eliminating the subjective or intentional complaints, this design can be a useful method minimizing the differences from the multiple examiners.
Accidents, Occupational ; American Medical Association ; Compensation and Redress ; Congenital Abnormalities ; Disability Evaluation ; Humans ; Jurisprudence ; Neurologic Manifestations ; Spinal Injuries*

Two hundreds and four consecutive patients who sustained proven spontaneous subarachnoid hemorrhage with conservative treatment were studied retrospectively. The reasons for conservative treatment were poor condition for surgery, difficulties in surgery and operation refusal. Comparative study was done in proven 47 cases of aneurysmal SAH, 27 cases of SAH with negative angiography and 130 cases of SAH without angiography about age, aneurysm site & size, neurologic grade mortality & morbidity, etc. Death had occurred in 2 weeks after attack predominantly. Rebleeding was most common cause of mortality(64%, 68/107). Survivals had good quality of life(73%, 19/26).
Aneurysm ; Angiography ; Disulfiram ; Follow-Up Studies* ; Humans ; Mortality ; Retrospective Studies ; Subarachnoid Hemorrhage

Although the prevalence of infectious disorders has been decreased, tuberculous infections are still common in this country. Therefore epidemiological data for the correct diagnosis of some spinal infections and proper selection of susceptible antibiotics are necessary. We presented a series of 40 patients with primary spinal infection dated from January 1990 to December 1994. Tuberculosis was the most common infection constituting 85% of this series, while pyogenic infection constituted only 10%, and primary discitis shared 5%. In a half of the tuberculous spondylitis, there were histories of previous tuberculosis except the vertebrae. We could identify the pathogenic organisms in only 47.5% o the cases(in 4 of 6 pyogenic infection and 15 of 34 tuberculous infection). Since it is difficult to differentiate the pyogenic and tuberculous infections by clinical or radiological features alone, some pyogenic infections might have been regarded as tuberculous, although the pyogenic spinal infections are rare. Nevertheless the tuberculous spinal infection outnumbered pyogenic ones in this country, which is similar to the patterns of other third-world countries. Therefore, correct identification of the microbial agent is important not only for the proper treatment but also to evaluate the patients of primary spinal infections in this country.
Anti-Bacterial Agents ; Developing Countries ; Diagnosis ; Discitis ; Epidemiology ; Humans ; Prevalence ; Spine ; Spondylitis ; Tuberculosis

The following is our report a series of 220 patients who visited the neurosurgical out-patient department from January 1994 to June 1994 complaining of low back pain. We investigated how they were treated and what was the outcome on December 1995. Three certified neurosurgeons had managed these patients. Although the patients were not significantly different in terms of age, sex, and the duration of pain, the diagnostic methods(p<0.005), impression(p<0.01), and the methods of treatment(p<0.01) differred from doctor to doctor. The rates of admission and operation were 11.8% and 7.3%, respectively, and found to be consistent among doctors. We conducted telephonic interviews of 123 patients during December 1995 with the following outcome : improved in 69.1%, unchanged in 22.0%, and aggravated in 4.1%, together with six(4.9%) deaths. The cause of death was cancer in four cases, respiratory failure in one, and unknown in one. Sixteen patients underwent surgery in this hospital, while the other 12 patients were operated on in other hospitals. The outcome was favorable when 1) the patients were female, 2) the age was 21-40 years old, 3) presence of sciatica, 4) the duration was 1 week to 3 months, 5) the diagnostic impression was herniated lumbar disc, 6) drugs were not prescribed, and finally 7) managed by senior doctor. However, these differences were statistically not significant(p>0.1). Although low back pain is a very common complaint, there was enormous ambiguity with respect to its diagnosis and management. Neverthless, the outcomes were not significantly different. Despite the above, we still feel that low back pains should be more systematically classified and precisely dignosed. Also the therapeutic efficacies of different modalities of treatment should be critically reviewed.
Cause of Death ; Diagnosis ; Female ; Humans ; Low Back Pain* ; Outpatients* ; Respiratory Insufficiency ; Sciatica