Spinal epidural hematoma(SEH) is not common in lumbar spine disorders and can be developed spontaneously without direct trauma. According to the neurologic deficit and clinical condition of patient, surgical intervention can be required. Authors report a case of spontaneous lumbar SEH resolved spontaneously without surgery. A 59-year-old man had suffered back pain and left leg pain for three weeks without trauma while working on his farm. Magnetic resonance imaging MRI demonstrated a lumbar epidural hematoma at L3/4 level. After 3 months of conservative treatment, his clini- cal symptoms were disappeared completely without neurologic deficit, and the follow-up myelocomputed tomogram(CT) showed complete resolution of the SEH. The primary treatment modality of SEH is surgical evacuation of hema- toma in case of neurologic deterioration, but conservative treatment may be considered if the patient has no neurologic deficit.
Back Pain ; Follow-Up Studies ; Hematoma ; Hematoma, Epidural, Spinal ; Humans ; Leg ; Magnetic Resonance Imaging ; Middle Aged ; Neurologic Manifestations ; Spine

We describe a 75-year-old man with a cervico-thoraco-lumbar spinal epidural abscess was extended to the psoas muscle. The patient complained high fever and back pain, followed by weakness of the lower extremities. He had received multiple epidural injections in a local pain clinic just few days before the onset of fever. The multi-segmental epidural abscess which was demonstrated by MRI compressed dural sac and cord. The best way to recommend him was to undergo a surgical decompression, but he refused the surgery. Next, we chose nonsurgical treatment such as longstanding parenteral antibiotic therapy and percutaneous drainage of psoas abscess. We could cultivate a causative organism and chose appropriate antibiotics. The patient experienced immediate relief of fever and the improvement of laboratory findings, gradual relief of back pain and full neurological recovery.
Aged ; Anti-Bacterial Agents ; Back Pain ; Decompression, Surgical ; Drainage ; Epidural Abscess ; Fever ; Humans ; Injections, Epidural ; Lower Extremity ; Pain Clinics ; Psoas Abscess ; Psoas Muscles

Spinal extradural cavernous angiomas(CAs) are apparently rare lesions. The author report a 67 year old man with an epidural CA at T9-10 space presenting with progressive leg weakness. Magnetic resonance imaging showed a thoracic epidural lesion appearing as isointense on T1-weighted with strong contrast enhancement and hyperintense on T2-weighted images. A moderate hyperdensity and foraminal widening was found on computed tomography. Hemilaminectomy was performed to relieve the spinal cord compression. A highly vascular tumor without bony involvement was observed in the epidural space. Histopathology of the lesion revealed a typical CA. The patient's symptoms resolved after treatment. Clinical aspect, radiological features, and surgical treatment of this rare entity will be reviewed.
Caves ; Epidural Space ; Leg ; Magnetic Resonance Imaging ; Spinal Cord Compression ; Spine

Myxopapillary ependymoma is a distinctive subtype of glioma that occurs almost exclusively in the conus medullaris and filum terminale. Though magnetic resonance(MR) imaging is an effective diagnostic tool for the diagnosis of these tumors, there are no definite correlations between the preoperative radiological images and histopathologic findings. A 30-year-old man with low back pain and leg pain was presented. MR images demonstrated a well-defined intradural extramedullary mass at the L3-4 with strong homogenous enhancement. Based on radiological features, our tentative diagnosis was a nerve sheath tumor. However, the histopathologic report confirmed it as myxopapillary ependymoma.
Adult ; Cauda Equina ; Conus Snail ; Ependymoma ; Glioma ; Humans ; Leg ; Low Back Pain ; Magnetics ; Magnets

OBJECTIVE: Decompression and/or fusion have traditionally been used to treat the spinal stenosis and spondylosis. Recently, several devices for dynamic posterior stabilization have been developed in treatment of lumbar spinal stenosis and degenerative spine diseases. This special technique of dynamic posterior stabilization of the lumbar spine may be defined as a system that would alter favorably the movement and load transmission of a spinal motion segment, without the fusion. At present, the 'interspinous U' has been using as one of favor device for dynamic posterior stabilization. METHODS: From January 2003 to November 2004, we have used the 'interspinous U' for 48 patients with lumbar spinal stenosis with mild segmental instability, after bilateral foraminotomy. All patients were checked the follow-up simple X-ray stress view after more than 12 months and evaluated the stability and the outcome of the patients. RESULTS: The patients were consisted of 26 men and 22 women, and mean ages was 55.3 years. The average follow- up period was approximately 22 months. The clinical outcomes were evaluated as excellent 15, good 19, fair 12 and poor 2. Especially, the patient group of unsatisfactory outcome(fair and poor) mainly complained the sudden burst back pain with the position change and this symptom was aggravated more and more during follow-up periods. In the flexion/extension lateral X-ray view, the evidence of bony absorption of the spinous process at the contacting side with 'interspinous U' device was found in 15 cases and also the minor instability was seen. CONCLUSION: 'interspinous U' is harder than any other ones for dynamic posterior stabilization, it is difficult to act like the "shock-absorber" and so the power to clamp the spinous process might be weak in spacer. Our preliminary results suggest that the late complications of the 'interspinous U' device in posterior dynamic stabilization may be the bone absorption of spinous process and minor instability, that is bone-implant interface failure.
Absorption ; Back Pain ; Decompression ; Female ; Follow-Up Studies ; Foraminotomy ; Humans ; Male ; Spinal Stenosis ; Spine ; Spondylosis

OBJECTIVE: The authors conducted this study to investigate the safety and efficacy of decompressive surgery alone in the treatment of lumbar spinal stenosis in the elderly population. METHODS: All charts and records of 323 patients aged 65 years or older who underwent lumbar spinal decompressive surgery without fusion for lumbar spinal stenosis in the period from September 2003 to August 2007 were reviewed. RESULTS: A total of 323 patients were identified. Mean age among patients were 72.6years. 197 patients(60.9%) underwent wide decompression, 95 patients(29.4%) had microscopic partial decompression, and 31 patients(9.5%) underwent bilateral decompression via unilateral approach. Perioperative morbidity seen was among 16 patients(4.9%). There were 5 patients(1.5%) reoperated for hematoma formation. Another 5 patients(1.5%) developed wound infection. Cerebrospinal fluid(CSF) leakage were noted among 3 patients(0.9%). 2 patients(0.6%) had urinary difficulty, and Steven Johnson syndrome developed in one patient(0.3 %). Clinical outcome was evaluated using Macnab's classification. 40 patients(12.4%) had excellent results, 241 patients(74.8%) had good results, 34 patients(10.3%) had fair results and 8 patients(2.5%) had poor outcome. CONCLUSION: Decompressive laminectomy alone is a relatively safe and effective treatment option for the elderly.
Aged ; Decompression ; Hematoma ; Humans ; Laminectomy ; Spinal Stenosis ; Wound Infection

OBJECTIVE: The minimally invasive spine surgery has become popular to reduce approach-related injury associated with the traditional spine surgery. The unilateral laminetomy and bilateral decompression(ULBD) using a microscopic tubular retractor system preserves interpedicular portion of the lamina, the spinous processes, supraspinous and interspinous ligamentous complex, contralateral facet and paraspinal musculature. The aim of this study is to evaluate the effectiveness of ULBD with microscope and tubular retractor system. METHODS: We retrospectively analyzed 24 patients who was diagnosed with lumbar spinal stenosis and treated with ULBD. The visual analogue scale(VAS) and oswestry disability index(ODI) to pain were checked for clinical assessment. We postoperatively observed a presence of spinal instability in flexion-extension radiographs. The cross sectional area (CSA) of dural sac was measured in the preoperative and postoperative magnetic resonance(MR) images. The mean follow up period was 18 months. RESULTS: The subjects were composed of 16 men and 8 women and average age was 67.4 years. Clinical improvement was assessed with VAS and ODI scale at last follow-up. The average VAS score of back pain was decreased from 3.6+/-1.3 to 1.7+/-0.9 after surgery(p<0.01). The average VAS score of leg pain also was decreased from 6.9+/-0.9 to 2.1+/-1.0 after surgery(p<0.01). Average ODI was decreased from 49.0+/-7.3 to 23.2+/-6.2(p<0.01). No patient developed spinal instability after operation on the flexion-extension radiographs. Postoperative CT and MR images showed bila- teral decompression by unilateral laminectomy. The mean dural CSA was significantly increased from 50.8+/-13.5mm2 to 130.5+/-16.5mm2(p<0.01). Complications were detected in two patients(dural tear in one and transient dysesthesia in 1 subject). CONCLUSIONS: ULBD using the microscopic retractor tubular system minimized trauma to posterior lumbar component with favorable clinical outcome. ULBD could be considered to be useful and effective technique for lumbar spinal stenosis.
Back Pain ; Decompression ; Female ; Follow-Up Studies ; Humans ; Laminectomy ; Leg ; Ligaments ; Magnetics ; Magnets ; Male ; Paresthesia ; Retrospective Studies ; Spinal Stenosis ; Spine

OBJECTIVE: To investigate a suitable animal model for studies of male osteoporosis. Osteoporosis has a particularly high incidence in postmenopausal women, resulting in a substantial amount of research with respect to this disease in women. However, research on osteoporosis in men is still lacking. METHODS: Twenty 10-week-old male Sprague Dawley rats were used in this study, including 4 rats used to establish a baseline bone mineral density (BMD). The other 16 rats were divided into two groups: a sham surgery group (n=8), which underwent a sham operation, and an orchiectomized rat group (OCX) (n=8), which underwent bilateral OCX at 10 weeks of age. Bone mineral density was measured in 4 rats from both the sham surgery group and the OCX group 8 weeks after the surgery, while BMD in the remainder of the rats was measured 10 weeks post-surgery. RESULTS: Femoral BMD at 8 weeks post-surgery was found to be significantly lower in the OCX group compared to the sham group; a finding that was also similar 10 weeks post-surgery. CONCLUSION: 8 weeks after undergoing orchiectomy performed via a scrotal, white rats are a suitable model for studies of male osteoporosis.
Animals ; Bone Density* ; Female ; Femur ; Humans ; Incidence ; Male ; Models, Animal ; Multiple Endocrine Neoplasia Type 1 ; Orchiectomy* ; Osteoporosis ; Rats* ; Rats, Sprague-Dawley

OBJECTIVE: The purpose of this study was to evaluate the safety and efficacy of cervical midline-splitting French-door laminoplasty with a polyether ether ketone (PEEK) plate. The authors retrospectively analyzed the results of patients with cervical laminoplasty miniplate (MAXPACER(R)) without bone grafts in multilevel cervical stenosis. METHODS: Fifteen patients (13 males and 2 females, mean age 50.0 years (range 35-72)) with multilevel cervical stenosis (ossification of the posterior longitudinal ligament and cervical spondylotic myelopathy) underwent a combined surgery of midline-splitting French-door laminoplasty with or without mini plate. All 15 patients were followed for at least 12 months (mean follow-up 13.3 months) after surgery, and a retrospective review of the clinical, radiological and surgical data was conducted. RESULTS: The radiographic results showed a significant increase over the postoperative period in anterior-posterior diameter (9.4+/-2.2 cm to 16.2+/-1.1 cm), open angles in cervical lamina (46.5+/-16.0degrees to 77.2+/-13.1degrees), and sectional volume of cervical central canal (100.5+/-0.7 cm2 to 146.5+/-4.9 cm2) (p<0.001). The sagittal alignment of the cervical spine was well preserved (31.7+/-10.0degrees to 31.2+/-7.6degrees, p=0.877) during the follow-up period. The clinical results were successful, and there were no significant intraoperative complications except for screw displacement in two cases. The mini plate constructs did not fail during the 12 month follow-up period, and the decompression was maintained. CONCLUSION: Despite the small cohort and short follow-up duration, the present study demonstrated that combined cervical expansive laminoplasty using the mini plate is an effective treatment for multilevel cervical stenosis.
Cohort Studies ; Constriction, Pathologic ; Decompression ; Ether* ; Female ; Follow-Up Studies ; Humans ; Intraoperative Complications ; Longitudinal Ligaments ; Male ; Postoperative Period ; Retrospective Studies ; Spine ; Spondylosis* ; Transplants

OBJECTIVE: Epidural injection of hyaluronic acid may prevent adhesion formation after spine surgery, but the compounds used to stabilize hyaluronidase could interfere with its anti-adhesion effects. The present study was conducted as a clinical trial to evaluate the efficacy and safety of an experimental medical gel in preventing adhesion formation. METHODS: This study was designed as a multicenter, randomized, double-blind, and comparative controlled clinical trial with an observation period of 6 weeks. Subjects were randomly assigned into two groups: group A with sodium hyaluronate + 1,4-butanediol diglycidyl ether (BDDE) and group B with sodium hyaluronate + sodium carboxymethylcellulose (CMC). Visual analogue scale (VAS) of back and leg pain and the Oswestry disability index (ODI) and scar score ratings were assessed after surgery. RESULTS: Mean scar grade was 2.37+/-1.13 in group A and 2.75+/-0.97 in group B, a statistically significant difference (p=0.012). VAS of back and leg pain and ODI scores decreased significantly from baseline to 3 and 6 weeks postoperatively in both groups (p<0.001). However, VAS and ODI scores were not statistically different between groups A and B at baseline or at 3 and 6 weeks after operation (p>0.3). The number of adverse reactions related to the anti-adhesion gels was not statistically different (p=0.569), but subsequent analysis of nervous adverse reactions showed group B was superior with a statistically difference (p=0.027). CONCLUSION: Sodium hyaluronate with BDDE demonstrated similar anti-adhesion properties to sodium hyaluronate with CMC. But, care should be used to nervous adverse reactions by using sodium hyaluronate with BDDE.
Carboxymethylcellulose Sodium* ; Cicatrix ; Diskectomy* ; Ether* ; Gels ; Hyaluronic Acid* ; Hyaluronoglucosaminidase ; Injections, Epidural ; Leg ; Spine