Percutaneous endoscopic lumbar discectomy is a widely used procedure. In addition to the surgical techniques, the proper selection of the patients and appropriate approaching portal is important improving the clinical results. The choice of the approaching portal is related to the distance of migration and spinal canal encroachment in addition to the type of herniation type. In addition, it is essential to know the anatomic characteristics at each level of the lumbar spine in addition to the indications of the various approaching portals.
Diskectomy* ; Humans ; Spinal Canal ; Spine

Tumoral calcinosis is a rare disease involving the ectopic calcifications in the major juxtaarticular sites that was first described by Inclan Alberto in 1943. The etiology of tumoral calcinosis is still obscure. A disturbance of the phosphate metabolism in the kidney has been considered a major cause. However, some patients have no laboratory abnormalities. Tumoral calcinosis in the spine has not been reported in Korea. Recently, we encountered a case of tumoral calcinosis in the lumbar region. The clinical and pathological findings are discussed with a review of the relevant literature.
Calcinosis* ; Humans ; Kidney ; Korea ; Lumbosacral Region* ; Metabolism ; Rare Diseases ; Spine

Two percent of neurological complications after spine surgery for various reasons have been reported. Most are static or improve with time. We encountered two cases of newly developed, progressive neurological deficits with severe pain radiating along the exiting root after posterior decompression, adhesiolysis, posterior lumbar interbody fusion (PLIF) with a cage for spinal stenosis after previous lumbar spine surgery. When explored, the severely tightened and less movable, edematous exiting root was entrapped by a pedicle without evidence of pedicle violation, direct injury, epidural hematoma or iatrogenic foraminal stenosis. A wider decompression with a resection of the pedicle reduced the root course and made it more movable. Immediately, the severe radiating pain subsided and the neurological deficit recovered. A progressive neurological deficit after spinal surgery for spinal diseases with foraminal stenosis can develop as a result of the inordinate manipulation of the root, which may provoke root edema, root self-entrapment around a pedicle and local ischemia. An image test and exploration should be performed immediately in cases of progressive single root neurological deficits immediately after spine surgery. Total decompression, even with a pedicle resection, should be considered to resolve the neurological deficits.
Constriction, Pathologic ; Decompression* ; Edema ; Hematoma ; Ischemia ; Neurologic Manifestations* ; Spinal Diseases ; Spinal Stenosis ; Spine*

Patients with ankylosing spondylitis are susceptible to fractures, which usually occur in the cervical spine. However, upper spinal fractures, particularly dens fracture-nonunion complicating ankylosing spondylitis, are quite rare. We encountered one such case. The patient was treated with posterior fusion followed by a halovest, which resulted in good conditions.
Humans ; Spinal Fractures ; Spine ; Spondylitis, Ankylosing*

A mesenchymal chondrosarcoma is a rare malignant tumor occurring in both the bone and soft tissues, and has the characteristics of a malignant nature. Since its original description in 1959, several reports of this tumor occurring in the maxilla, mandible, rib and spine have been published. We report a case of a mesenchymal chondrosarcoma that occurred in the posterior part of C7, T1 and T2 and adjacent muscles in a 31-year-old man who was treated with a wide marginal excision.
Adult ; Chondrosarcoma, Mesenchymal* ; Humans ; Mandible ; Maxilla ; Muscles* ; Ribs ; Spine

A fracture of the posterior arch of the atlas is a rare complication of Halifax clamp fixation for atlantoaxial fusion. To the best of our knowledge, there is only one case reported reporting the English literature. Revision for this condition is challenging because of the difficulty in the surgical approach, internal fixation, and fusion. We report a case of bilateral fractures and nonunion of the posterior arch of the atlas and atlantoaxial nonunion after an atlantoaxial fusion procedure using Halifax clamp fixation, which resulted in persistent atlantoaxial instability and progressive myelopathy. Segmental screw fixation was performed using C1 lateral mass screws and C2 subarticular screws, along with intraarticular and extraarticular atlantoaxial inter-facet fusion.
Spinal Cord Diseases

STUDY DESIGN: A retrospective study. OBJECTIVES: The aim of this study was to analyze the long term follow-up results of the isthmic spondylolisthesis patients who had been treated with pedicle screw fixation and fusion, and were followed up for more than 5 years. An attempt was made to determine the differences between posterior lumbar interbod fusion(PLIF) and posterolateral fusion (PLF). SUMMARY OF LITERATURE REVIEW: The surgical treatment of isthmic spondylolisthesis has developed markedly after the introduction of spine fusion and pedicle screw fixation. However, the long-term prognosis after such treatments has not been investigated sufficiently. MATERIALS AND METHODS: Among 53 patients, 38(72%) patients were examined more than 5 years after surgery. The clinical results were evaluated according to Kim's criteria. Radiologically, the degree of slippage and disc height was measured. The changes in the adjacent segments were also observed. RESULTS: PLIF was performed in 26 patients and PLF was performed in 12 patients. In the PLIF group, the clinical results were 'excellent' in 15 patients, 'good' in 8, 'fair' in 2, and 'poor' in 1. In the PLF group, the results were 'excellent' in 8 patients, 'good' in 2, 'fair' in 1, and 'poor' in 1. According to the fusion method, a satisfactory outcome was obtained in 89% of patients in the PLIF group, and 83% in the PLF group, without any statistically significant differences. Radiological analysis was available in 28 (52.8%) patients. There were no statistically significant differences between the PLIF and PLF groups in terms of the reduction and maintenance of slippage and the disc height. CONCLUSIONS: The clinical result of isthmic spondylolisthesis patients who were treated with pedicle screws and fusion were satisfactory in 87% of patients. The clinical and radiological comparison of the fusion methods showed no significant differences between the PLIF and PLF groups.
Follow-Up Studies ; Humans ; Prognosis ; Retrospective Studies ; Spine ; Spondylolisthesis*

STUDY DESIGN: A retrospective study. OBJECTIVES: To describe the surgical procedure and assess the results of an unilateral transpedicular screw and contralateral translaminar facet screw fixation in degenerative lumbar stenosis. SUMMARY OF LITERATURE REVIEW: A drawback of conventional lumbar fusion is the extensive soft-tissue destruction that is essential when inserting a screw and preparing the fusion bed. The development of a procedure that minimizes the tissue trauma without compromising the effectiveness of the conventional posterior lumbar interbody fusion (PLIF) should be pursued in lumbar spinal stenosis. MATERIALS AND METHODS: From August 2004 to November 2005, PLIF was performed on 25 consecutive patients who had lumbar spinal stenosis. Among them, 10 patients underwent with unilateral transpedicular screw and contralateral translaminar facet screw fixation (Group 1), and 15 patients underwent traditional bilateral transpedicular screw fixation (Group 2). The clinical and radiological results in the two groups were compared. RESULTS: The mean follow-up was 17.6 and 20.5 months in Groups 1 and 2, respectively. Group 1 had less blood loss, fewer transfusion requirements (P.0.05) in the surgical procedure, and less postoperative back pain (P.0.05). There was no significant difference between the two groups in the clinical results such as the VAS score for back pain and the Kirkadly-Willis criteria at the last follow-up, and the radiological results such as the changes in the disc height and interbody fusion. CONCLUSION: The PLIF with unilateral transpedicular screw and contralateral translaminar facet screw fixation in lumbar spinal stenosis has advantages over conventional PLIF of less soft tissue injury, and produces good clinical results.
Back Pain ; Constriction, Pathologic ; Follow-Up Studies ; Humans ; Retrospective Studies ; Soft Tissue Injuries ; Spinal Stenosis*

STUDY DESIGN: A prospective radiological assessment was performed using computerized tomography measurements. OBJECTIVES: The aim of this study was to assess the changes in the dimensions of the neural foramen after anterior interbody fusion with posterior fixation in spondylolisthesis. SUMMARY OF LITERATURE REVIEW: Anterior lumbar interbody fusion distracts the height and width of the neural foramen. MATERIALS AND METHODS: Anterior interboody fusion with posterior fixation was performed in twenty-five patients. The sagittal parameters were the height and area of the neural foramen. The fused lumbar segments was imaged in the direct sagittal projections in a CT (SOMATOM Senstaion; SIMENS, Germany) and 1-mm slice thickness before surgery and after solid fusion. Computer digitation was used for the measurements independently by three different observers. Statistical analysis was performed using a Wilcoxon signed test and a paired T-test to determine the correlation between the measurements, and Pearson correlation to determine the level of interobserver and intraobserver agreement. RESULTS: After anterior interbody fusion and posterior fixation, the height and the area of the neural foramen had increased significantly by 15.5+/-14.0%(p.0.001) and 23.2+/-17.7%(p.0.001). There was a significant confidence in interobserver (0.9466~0.9996) and intraobserver(0.8896~0.9991) agreement. CONCLUSIONS: Anterior interbody fusion significantly increased the changes in the dimensions of the neural foramen. Anterior distraction and decompression with anterior interbody fusion increased the area of the neural foramen This study shows that anterior interbody fusion can be used to decompress the neural foramen in the spondylolisthesis.
Decompression ; Humans ; Prospective Studies ; Spondylolisthesis*

STUDY DESIGN: A retrospective study OBJECTIVES: To compare the radiological and clinical results of the unipedicular and bipedicular approach of kyphoplasty for osteoporotic vertebral compression fractures. SUMMARY OF LITERATURE REVIEW: A unipedicular rather than a bipedicular technique has been suggested to decrease the risks associated with surgical procedures. MATERIALS AND METHODS: Between July 2005 and May 2006, 136 vertebrae of 97 patients, who underwent kyphoplasty for osteoporotic vertebral compression fractures, were analyzed. Group 1, with the bipedicular approach, consisted of 86 vertebrae of 67 patients with a mean age of 72.2 years. Group 2, with unipedicular approach, consisted of 50 vertebrae of 30 patients with mean age of 73.4 years. The plain radiographs, MRI and surgical records were reviewed. RESULTS: The mean operation time of the single vertebral body in group 2 was statistically lower than in group 1(p<0.05). There was more disruption of the medial wall of the pedicle in group 2 than in group 1(p<0.05). In the aspect of the volume of cement injected in the thoraco-lumbar junctional vertebrae, group 2 used significantly less cement than group 1(p<0.05). There were no significant differences in the cement leakage, vertebral height restoration, kyphotic deformity correction, admission time and VAS scores between groups 1 and 2(p>0.05). CONCLUSION: There were no significant differences in clinical satisfaction and radiological results between the unipedicular and bipedicular kyphoplasty. The advantage of a unipedicular approach is the shorter procedure time than the bipedicular approach. This is particularly useful in multi-level compression fractures. The rate of the unipedicular approach in upper and mid thoracic spine is higher because of the higher convergence of the pedicle and the lower volume of vertebral body despite the disadvantages of instrument insertion through the medial pedicle wall.
Congenital Abnormalities ; Fractures, Compression* ; Humans ; Kyphoplasty* ; Magnetic Resonance Imaging ; Osteoporosis ; Retrospective Studies ; Spine