STUDY DESIGN: A prospective, non-randomized study OBJECTIVES: To evaluate the early clinical results of percutaneous endoscopic lumbar discectomy (PELD) and microdiscectomy (MD) using a tubular retractor. SUMMARY OF THE LITERATURE REVIEW: There are few reports comparing the clinical results of different minimal invasive surgical procedures for disc herniation. MATERIALS AND METHODS: Out of 41 patients who underwent a discectomy at the L4-5 level, 16 patients (Group I) underwent PELD and 25 patients (Group II) underwent MD. The surgical techniques were based on the patient's selection. The characteristics of the operation(operation time, time for C-arm, amount of removed disc) were compared with the clinical outcomes by evaluating the SLR (straight leg raising test), leg VAS (visual analogue scale), ODI (Oswestry Disability Index), hospital day, changes in disc height. RESULTS: Group I showed a larger amount of disc removed and exposure time for the C-arm than group II (p<0.05). However, the hospital day was shorter in group I than in group II (p<0.05). There were no differences in the leg VAS, ODI, the change in disc height and surgery time between the two groups at the last follow up. One case in group I had a neuropraxia of the L5 root that had recovered fully at postoperative 3months. In group II, there was one case of a postoperative hematoma and 2 cases of a dural tear. CONCLUSION: Although the early clinical outcomes were similar in both groups, group I showed a larger amount of disc removed and more exposure time to radiation but a shorter hospital stay.
Diskectomy ; Follow-Up Studies ; Hematoma ; Humans ; Leg ; Length of Stay ; Prospective Studies ; Tears

STUDY DESIGN: This is a retrospective study OBJECTIVES: This study compared the clinical outcomes of posterior lumbar interbody fusion (PLIF) using hydroxyapatite blocks with PLIF using a metal or poly-ether-ether-ketone (PEEK) cage. SUMMARY OF THE LITERATURE REVIEW: There are few reports on the clinical outcomes of PLIF using a hydroxyapatite block for treating lumbar degenerative disease. MATERIALS AND METHODS: The 27 PLIF cases (62 units, HA block) that were followed up for 1-year were compared with 13 cases using a metal cage and 13 cases using a PEEK cage. Pedicle screw fixation was performed for all the cases. If the local bone is deficient, then an additional bone graft with autogeous iliac bone or bone substitute was used. The visual analog scale(VAS) for low back pain and radiating pain, the Oswestry disability index (ODI), the intervertebral height and the halo sign around the cages and pedicle screws were comparatively analyzed. RESULTS: The mean VAS score for low back pain before PLIF and using the HA block, the metal cage and the PEEK cage was 7.5, 8.3 and 6.2, respectively, and this was 3.3, 2.9 and 4.8 after PLIF (P<0.05 with using the HA block and the metal cage (Wilcoxon test). The mean VAS score for radiating pain before PLIF was 7.9, 8.3 and 8.5, respectively, and the VAS score was 3.5, 3.1 and 3.9, respectively, after PLIF (P<0.05 for all cases, Wilcoxon test). For the ODI, the means before PLIF were 60.3, 51.2 and 53.8, respectively, and they changed to 30.5, 24.9 and 29.7, respectively, after PLIF (P<0 .05 for all cases, Wilcoxon test). On the X-ray images, there was no halo sign greater than 2 mm near the pedicle screws or greater than 1 mm near the cages and no breakage of the HA block. No additional bone graft was needed for the PLIF using the HA block and local bone. There was no statistically significant differences among the groups (P>0.05, One-way ANOVA). CONCLUSION: PLIF using a HA block showed improvements, including the back pain, and the ODI was satisfactory and this didn't fall below those ODIs of using metal or PEEK cages. Although a HA block may have higher tendency to break, there was no breakage at the 1-year follow up.
Back Pain ; Bone Substitutes ; Durapatite ; Follow-Up Studies ; Ketones ; Low Back Pain ; Polyethylene Glycols ; Retrospective Studies ; Transplants

Brown-Sequard syndrome may be the result of penetrating injury to the spine, but many other etiologies have been described. This syndrome is most commonly seen with spinal trauma and extramedullary spinal neoplasm. A herniated cervical disc has been rarely reported as a cause of this syndrome. We present a case of a 28-year-old male patient diagnosed as large C3-C4 disc herniation with spinal cord compression. He presented with left hemiparesis and diminished sensation to pain and temperature in the right side below the C4 dermatome. Microdiscectomy and anterior cervical fusion with carbon fiber cage containing a core of granulated coralline hydroxyapatite was performed. After the surgery, rapid improvement of the neurologic deficits was noticed. We present a case of cervical disc herniation producing acute Brown-Sequard syndrome with review of pertinent literature.
Adult ; Brown-Sequard Syndrome ; Carbon ; Ceramics ; Durapatite ; Humans ; Hydroxyapatites ; Male ; Neurologic Manifestations ; Paresis ; Sensation ; Spinal Cord Compression ; Spinal Neoplasms ; Spine

Sacral insufficiency fractures are usually known to develop in elderly patients with osteoporosis without definite trauma history. It is difficult to diagnose the sacral insufficiency fracture at an early stage because lower lumbar diseases, concurrently or not, may also be presented with similar symptoms and signs. We report a rare case of sacral insufficiency fracture who was not diagnosed initially but, instead, showed progressively worsening of clinical symptoms and radiological findings after decompression surgery for upper level lumbar stenosis.
Aged ; Constriction, Pathologic ; Decompression ; Fractures, Stress ; Humans ; Osteoporosis ; Sacrum

OBJECTIVE: To evaluate the clinical characteristics and surgical outcomes of the patients with cervical spondylotic myelopathy associated with athetoid cerebral palsy. METHODS: The authors reviewed the clinical and neurodiagnostic findings, surgical managements and outcomes in six consecutive patients with cervical spondylotic myelopathy associated with athetoid cerebral palsy who had been treated with surgical decompression and fusion procedures between January 1999 and December 2005. The mean age of the 6 patients (four women and two men) at the time of surgery was 42.8 years (range, 31-55 years). The mean follow-up period was 56.5 months (range, 17-112 months). The neurological outcome was evaluated before and after operations (immediately, 6 months after and final follow-up) using grading systems of the walking ability, brachialgia and deltoid power. RESULTS: At immediate postoperative period, after 6 months, and at final follow-up, all patients showed apparent clinical improvements in walking ability, upper extremity pain and deltoid muscle strength. Late neurological deterioration was not seen during follow-up periods. There were no serious complications related to surgery. CONCLUSION: Surgical decompression and stabilization in patients with cervical spondylotic myelopathy associated with athetoid cerebral palsy have been challenging procedure up to now. Our results indicate that early diagnosis and appropriate surgical procedure can effectively improve the clinical symptoms and neurological function in patients with cervical spondylotic myelopathy and athetoid cerebral palsy, even in those with severe involuntary movements.
Cerebral Palsy ; Decompression ; Decompression, Surgical ; Deltoid Muscle ; Dyskinesias ; Early Diagnosis ; Female ; Follow-Up Studies ; Humans ; Postoperative Period ; Spinal Cord Compression ; Spinal Cord Diseases ; Upper Extremity ; Walking

BACKGROUND/AIMS: Until recently, only indirect procedures were available to provide images of the small bowel. Double-balloon enteroscopy (DBE) has the ability to obtain tissue for diagnosis and endoscopic interventions. This study was designed to determine the usefulness of DBE in patients with small bowel diseases by evaluating diagnostic yields and the impact on treatment. METHODS: From November, 2004 to November, 2006 a total 81 patients with suspected small bowel disease were investigated by DBE. We analyzed the diagnostics and therapeutics rates according to the indications of DBE. RESULTS: A total of 114 DBE procedures were performed. Gastrointestinal bleeding (64.2%) was the most common indication, followed by chronic abdominal pain/diarrhea (29.6%). A diagnosis was obtained in 44 of 52 patients with gastrointestinal bleeding and 17 of 24 patients with chronic abdominal pain/diarrhea. DBE resulted in therapeutic intervention in 17 patients with gastrointestinal bleeding and 13 patients with chronic abdominal pain/ diarrhea. DBE was diagnostic in 75.3% of the patients and played a role in the subsequent treatment of 37.0% of the patients. CONCLUSIONS: DBE was a useful and safe method for diagnosis and treatments in patients with small bowel diseases.
Diarrhea ; Double-Balloon Enteroscopy ; Hemorrhage ; Humans

STUDY DESIGN: This is a retrospective study. PURPOSE: We wanted to investigate the clinical relevance of the lumbar high intensity zone (HIZ) on magnetic resonance imaging (MRI) and the relationship of trauma history to internal disc disruption (IDD). OVERVIEW OF LITERATURE: HIZs on lumbar spine (L-spine) MRI have been suggested as a reliable marker of IDD by some authors. The prevalence and type of spinal trauma in IDD have not yet been carefully analyzed. METHODS: L-spine MRIs of 737 patients with low back pain with or without associated leg pain were reviewed for the presence of HIZs. HIZs on T2-weighted MR images were determined according to the Aprill and Bogduk criteria. A review of medical records and a telephone interview were performed for further analyses of pain. RESULTS: HIZs were found in 117 patients and 153 discs among a total of 737 patients who met the inclusion criteria. Both a medical record review and a telephone interview were possible with 99 patients. Among these, 42 patients had had an episode of trauma. Seventeen of these had a relatively high-energy injury such as a traffic accident or a fall. Regarding back pain, 27 patients complained of typical discogenic back pain. Only 11 patients had both a trauma history and typical discogenic pain and 41 patients (42%) had neither a trauma history nor typical natural pain. CONCLUSIONS: Given the low incidence of discogenic pain, a HIZ on an L-spine MRI appears less meaningful than often assumed as a specific marker of IDD. Trauma, such as a traffic accident, seems unlikely to be the main cause of IDD.
Accidents, Traffic ; Back Pain ; Humans ; Incidence ; Interviews as Topic ; Leg ; Low Back Pain ; Magnetic Resonance Imaging* ; Medical Records ; Prevalence ; Retrospective Studies ; Spine

OBJECTIVE: Computed tomography angiography (CTA) has recently been used for detecting cerebral aneurysm because of the accuracy of the images and the large supply of high-resolution CT scanners, and there is no need to perform cerebral digital subtraction angiography (DSA) when performing CTA. In contrast with DSA, CTA is unable to show the realtime cerebral blood flow. The aim of the present study is to find an appropriate aneurysm clipping method to reduce the risk during operation, and we did this by comparing the performance of CTA for detecting ruptured cerebral aneurysm with that of DSA. METHODS: We performed a systemic review of patients suffering from ruptured anterior communicating artery aneurysm. We report here on the results obtained from November 2002 to March 2006. We reviewed a total of 37 patients who had undergone both CTA and DSA before surgery. RESULTS: With performing CTA, 15 patients (40.5%) were observed to have the same thickness of both sides of the A1 (group A); there were 2 patients with right dominance (group B), and 20 patients with left dominance (group C). The total numbers of patients with an anomalous artery was 3 (12.5%). Two of them were in Group A and one of them was in Group B. Two of them (one in Group A and the other in Group B) were accessory A2 patients and the other was an azygous A2 patient. Also, there was no difference between CTA and DSA for the patients with an abnormal artery. CONCLUSION: In the case of observing a severe hypoplastic A1 or an anomalous artery in the patients with anterior communicating artery aneurysm seen on the CTA, it is expected that checking the accurate structure and status of their aneurysm and the surrounding artery through performing DSA and also checking the contralateral carotid artery compression may help prepare the strategy for the operation and reduce the risk during operation.
Aneurysm ; Angiography* ; Angiography, Digital Subtraction* ; Anterior Cerebral Artery ; Arteries* ; Carotid Arteries ; Humans ; Intracranial Aneurysm

STUDY DESIGN: Surgical simulation using CT images and computer software. OBJECTIVES: We wanted to determine a new trajectory for the C2 screw, and then we wanted to evaluate its safety and accuracy. Summary of Literature REVIEW: There have been a few suggestions for trajectories of the C2 pedicle screws. However, their safety is somewhat unsatisfactory as all of them have some possibility of vertebral artery injury. MATERIALS AND METHODS: Using 1 mm-sliced CT scan images of 158 patients and an A-view spine surgery simulator 1.0, we determined a new trajectory for the C2 screw with which 4.0 mm screws can be inserted with a minimal number of breaches of the bone cortices. The percentage of cortical perforations by the suggested trajectory was compared with that by the pedicle screws by means of simulation. RESULTS: The medial angulation of the determined trajectory is the same as that of the pedicle on the axial CT images: it usually is between 30 and 40 degrees. The screw is angled toward the antero-superior end of the superior articular process of C2, as observed on lateral fluoroscopy. The entry point is 3 mm inferior to the posterior aspect of the superior articular surface, and this point should allows the screw (ED note: check this and it wasn't clear.)the screw to be inserted close to the superomedial border of the superior articular process. Using this trajectory, 2.5% (8/316) of the screws breached the vertebral grooves, while 6.0% (19/316) of the pedicle screws breached them (p=0.030, chi-square test). CONCLUSIONS: The subarticular screw has improved safety compared with the pedicle screws. However, there are still some casesin which screws can not be inserted without breaching the vertebral groove. Therefore, preoperative thin-slice CT scanning with three-dimensional reconstruction and/or three-dimensional CT-angiography is recommended.
Computer Simulation ; Fluoroscopy ; Humans ; Spine ; Tomography, X-Ray Computed ; Vertebral Artery

BACKGROUND: A primary central nervous system lymphoma (PCNSL) is a rare neoplasm with a poor prognosis. The treatment of PCNSL involves a combination of chemotherapy, intrathecal chemotherapy and radiotherapy. This study retrospectively evaluated the treatment outcomes and prognostic factors of Korean patients with PCNSL. METHODS: Between 1995 and 2003, 58 patients diagnosed with PCNSL from the multi-center hospitals were enrolled in this study. Among 56 patients who had received treatment, 16 patients were treated with radiotherapy alone, while 40 patients were treated with combined chemotherapy (CHOP; 9 cases, high-dose methotrexate; 31 cases) and radiotherapy. RESULTS: The median age of the patients was 58 years (range, 19-76). A diffuse large B-cell lymphoma was diagnosed in 56 cases (96.6%), while a peripheral T-cell lymphoma was diagnosed in 2 cases. Of the 47 patients who could be assessed for their response after treatment, a CR and PR was observed in 32 (68%) and 11 patients (23%), respectively, giving an overall response rate of 91% (95% CI, 82~100%). The estimated 3-year overall survival rate for all the patients was 67+/-7.9% and the 3-year disease free survival rate was 53+/-8.3%. The overall survival of the high-dose methotrexate group was superior to that of the CHOP group (77+/-10% versus 47+/-19%, p=0.05). Leukoencephalopathy was observed as a late complication in 9 patients (21%). No significant prognostic factors affecting survival were found by univariate analysis. CONCLUSIONS: Approximately half of the patients could have long-term survival after treatment in this study. High-dose methotrexate containing chemotherapy followed by radiotherapy was found to be an effective treatment.
Central Nervous System* ; Disease-Free Survival ; Drug Therapy ; Humans ; Leukoencephalopathies ; Lymphoma* ; Lymphoma, B-Cell ; Lymphoma, T-Cell, Peripheral ; Methotrexate ; Prognosis ; Radiotherapy ; Retrospective Studies* ; Survival Rate