The incidence of low back pain as shown in the literature indicates that approximately 65~80% of the population at one time or another have had significant trouble. Low back pain causes one to lose time from work or other activity if an attack is significant, and it is also an universal problem in all economic and social brackets. The vast majority of etiological causes of low back trouble comes from discogenic origin, such as degenerative change of the intervertebral lumbar disc. Disc degeneration should be interpreted as a more or less physiological process which begins at about the age of 20 and continues throughout life. As disc degeneration proceeds, the normal physiologic biomechanics of low back can be transformed to pathomechanics of the spine as a causes of disability. Clinically plain radiography has been routinely used to substantiate the diagnosis of disc degeneration. The typical radiological abnormalities of degeneration are those of marginal spur, narrowing of disc space, Schmorls nodule and sclerosis of the opposing surfaces of the vertebral bodies, etc. However, these changes generally appear somewhat later when degeneration has eventually progressed and in the early stage are generally considered to be negative. Attention is directed to detection of pathomechanical abnormalities of disc degeneation with radiograms being taken in the standing dynamic position rather than in the supine non-dynamic position. The purpose of the study was to investigate some sigificant evidence of dynamograms to evaluate the changes in motion of the lumbar intervertebral joints, and to obtain comparison of the mobility of the joint involved with that of adjacent joints in the same spine. The case material consisted of one hundred and nine patients with discogenic low back pain. In clinical classification, the cases were separated into groups of lumbar insufficiency, intervertebral disc herniation and degenerative spondylosis for the purpose of analysis. Although this was an investigation of the significance in pathologic spines, ten normal subjects with no symptoms, between the ages of twenty and twenty five years, were included in the study as a control to interpret the findings. Non-dynamograms in the non-weight bearing supine position and dynamograms in the weight bearing standing position were made in each case. Non-dynamograms were taken with antero-posterior and lateral projections of the cases. Dynamograms were taken with antero-postericr and lateral projections, and additional lateral views in flexion and extension of spine. The focal film distance was eighty centimeters with the central ray at the third lumbar vertebra. Roentgenograms were analysed by comparison of non-dynamograms and dynamograms, and of groups of patients classified. The results of the study are as follows. 1. Early degenerative change such as abnormal mobility or primary instability was observed by dynamograms. 2. Dynamograms were helpful to detect the level of disc degeneration involved. 3. By dynamograms it has been found possible to deduce severity of disc degeneration. 4. Flexion-extension radiograms have appeared worthwhile to predict the level at which disc protrusion has occurred. In conclusion it is to be expected that there will be a valuable for dynamoradiological assessment in clinical application not only for diagnostic purposes in which it is possible to detect confirmatory evidence of early degeneration, and to predict the level and severity of disc degeneration, but also in the therapeutic aspect where one has to decide how to manage the lesion when it has occurred.
Classification ; Diagnosis ; Humans ; Incidence ; Intervertebral Disc ; Intervertebral Disc Degeneration ; Joints ; Low Back Pain ; Physiological Processes ; Posture ; Radiography ; Sclerosis ; Spine ; Spondylosis ; Supine Position ; Weight-Bearing

No abstract available.
Animals ; Calcitonin* ; Female ; Osteoporosis* ; Ovariectomy* ; Rats* ; Tamoxifen*

The first myelography with air was carried out by Walter Dandy in 1919, and the myelography with positive contrast medium was done by Sicard and Forestier in 1922. Since Pantopaque was adopted as a contrast material by University of Rochester group in 1944, it has been rapidly popularized. Although higher diagnostic accuracy has been made with a development of the diagnostic aids such as electromyography, discography, epidural venography and computerized tomography, myelography has been popularized in our country with electromyography. The authars have seen and studied 107 cases of herniated lumbar disc with respect to the diagnostic accuracy of myelographic examination from January, 1976 to December, 1981 at the department of Orthopedic Surgery, Yonsei University College of Medicine. The results were as follows: l. Of the 107 cases, 59 were found in the age of 20 to 40 years and the ratio of male and female was 2:l. 2. Fifty eight cases (54.2%) had no history of back injury, but 40 cases (37.4%) had sprain of the back and 9 cases had direct trauma history. 3. In all cases, plain X-ray and myelogram were taken. Among them 55 cases showed narrowing of intervertebral space in plain film, and 100 cases showed positive myelographic findings such as lateral indentation of dural sac (41 cases), hour-glass defect (30 cases), root sleeve defect (12 cases), block defect (10 cases) and combined defects (7 cases). 4. Sixty one cases which confirmed by operation, the most frequent level of disc herniation was in L4-5 space. Clinical diagnosis was correct in 57.4%, and myelographic accuracy was coincided with operative finding in 80.3%. 5. Twelve (19.7%) of the 61 cases showed discrepancy between myelographic and operative findings, and these 12 cases consisted of 5 cases of level discrepancy, 3 cases of false positive and 4 cases of false negative.
Back Injuries ; Clinical Study ; Diagnosis ; Electromyography ; Female ; Humans ; Iophendylate ; Male ; Myelography ; Orthopedics ; Phlebography ; Sprains and Strains

No abstract available.
Peripheral Arterial Disease*

No abstract available.
Spine*

Forty six cases of Legg-Calve-Perthes disease were reviewed clinically and roentgenographically in order to determine a satisfactory method of assessing the prognosis and to correlate the clinical and roentgenographical results. 1. The patients were children 3 to 12 years of age, with the peak at 6 years. The average age of visit (or diagnosis) was 6.7 years and that of onset was 6.4 years. 2. The total number of hips involved were 49, three cases being bilateral (6. 5%). Boys predominated girls by a ratio of 4.7:1 3. End results in children below 6 years of age were better than those in children above 6 years. The end results of treatment with the containment method were better than those with the noncontainment method. 4. The hips with excellent result had an average of 2.5mm. of uncovering of the femoral head at the time of diagnosis. The degree of uncovering increased as the roentgenographical result deteriorated, in the poor hips the average uncovering being 9mm. The average for the normal side was 2mm. The uncovering at onset is an accurate guide to the likely end result. 5. The Catterall assessment was of reliable prognostic value. In the excellent group, the majority of the hips belonged to Groups 1 and 2, In the poor group, there were no hips in Group 1 and increasing number of hips belonged to Groups 2,3 and 4. 6. The head at risk judged by Gage's sign, calcification of lateral epiphysis, lateral subluxation of the femoral head, and presence of a horizontal epiphyseal line indicated poor prognosis. 7. There was a close correlation between the severity of clinical features and the severity of residual roentgenographic findings.
Child ; Clinical Study ; Containment of Biohazards ; Diagnosis ; Epiphyses ; Female ; Head ; Hip ; Humans ; Legg-Calve-Perthes Disease ; Methods ; Prognosis

A primary infection of the intervertebral disc in adult is an uncommon entity. Usually these patients are not actually ill and their symptoms have been present for some months. Pyogenic infection of the intervertebral disc in children was well documented by a number of authors,but this condition was less well recognized in the adult. We analysed 12 cases of discitis in adults which were treated at the Department of Orthopedic Surgery of Severance Hospital for 10 years from January 1975 to March 1984 by curettage and autogenous iliac bone graft through anterior approach. The results obtained from this study were as follows: 1. The average duration of symptoms before diagnosis was 9.6 months. 2. The lumbar spine was involved in 83% and next in thoracic spine. 3. The most prominent symptoms and signs are backache and local tenderness at the site of the lesion. 4. Ten patients had the preceding disease or definile past history of previous back surgery, myelogram, abscess, urinary tract infection, heavy lifting and back trauma. 5. The white cell count was of little value in the initial investigation, but the E.S.R. was raised in 67%. 6. Positive cultures from the intervertebral disc were obtained in 8 cases(67%). The causative organisms were 5 Staphylococcus, 2 E-coli, and 1 Pseudomonas aeruginosa. 7. The most common radiological finding on admission was narrowing of the intervertebral disc space, and the tomogram showed the most reliable finding for the preoperative diagnosis. 8. In the treatment, focal curettage or diskectomy and anterior fusion with autogenous iliac bone graft was done in all cases. Antibiotics were administrated for 4 to 10 weeks (average 5.5 weeks) after operation and the cast or brace was applied for immobilization. 9. Over-all clinical result were as follows; eight patients (67%) excellent, 3 patients good, 1 patient fair, and no recurrence.
Abscess ; Adult ; Anti-Bacterial Agents ; Back Pain ; Braces ; Cell Count ; Child ; Clinical Study ; Curettage ; Diagnosis ; Discitis ; Diskectomy ; Humans ; Immobilization ; Intervertebral Disc ; Lifting ; Orthopedics ; Pseudomonas aeruginosa ; Recurrence ; Spine ; Staphylococcus ; Transplants ; Urinary Tract Infections

Tuberculosis of the bones and joints is not an uncommon condition in Korea, but extraosseous tuberculosis of the soft tissue is relatively rare. A few reports of extraosseous tuberculosis, tuberculous tenosynovitis and bursitis, hsve been published in the literature, but there have been no reports concerning soft tissue tuberculosis in other than the tendon, synovium and bursa. We reviewed 7 cases of soft tissue tuberculosis of the lower back at the Department of Orthopedic Surgery, Yonsei University College of Medicine from Jan. 1984 to Sept. 1986. Five cases had received steroid injection to the lumbosscral region, and two had undergone acupuncture, thus all seven cases had experienced injections to the lumbosacral region. We think that a possible route of infection is the hematogenous one, at an area of decreased local resistance after steroid injection, And that direct inoculation of the tuberculous bacilli was result of artificial injection and acupuncture. But, further studies are needed to support the proposal that the hematogenous route following steroid injection and direct inoculation by artifical puncture is the source of soft tissue tuberculosis. These results indicate that steroid injections into the soft tissue should be performed limitedly under sterile conditions.
Abscess ; Acupuncture ; Bursitis ; Joints ; Korea ; Lumbosacral Region ; Orthopedics ; Punctures ; Synovial Membrane ; Tendons ; Tenosynovitis ; Tuberculosis

No abstract available.
Constriction, Pathologic*

Paget's disease is classified, according to location, as mammary or extramammary disease. Extramammary Paget's disease especially in the vulva is extremely rare. Several hundred cases have been described worldwide. Patients with Paget's disease of the vulva are usually white and postmenopausal. The cause of which remains elusive. A case of vulva Paget's disease is presented with brief review of literature.
Humans ; Paget Disease, Extramammary ; Vulva