OBJECTIVE: To elucidate postoperative clinical and radiologic efficacy of unilateral kyphoplasty compared for percutaneous bilateral vertebroplasty. METHODS: One hundred patients with osteoporotic compression fracture at thoracolumbar junction were enrolled in this study. The kyphotic angle and reduction rate were measured to evaluate the vertebral restoration. Visual analog scale (VAS) for pain and short form-36 (SF-36) and Oswestry Disability Index (ODI) for functional outcome were recorded by 1 year postoperatively. Cement extravasation and adjacent vertebral fractures were monitored. RESULTS: Visual analog scale for pain was not statistically different through the follow up in both groups (p=0.38). The preoperative SF-36 and ODI scores were similar (p>0.05) but the difference in ODI score and standardized physical component scale reached statistical significance (p=0.04, p=0.03) and unilateral kyphoplasty group was getting better functional status. Reduction rate of vertebral body was 42.5+/-7.8% for the vertebroplasty group and 66.3+/-8.1% for the unilateral kyphoplasty group (p<0.001) and loss of reduction was 4.5+/-3.5% and 1.7+/-2.5% (p<0.0001) respectively. There were six complications of cement extraosseous leakage into the spinal canal in vertebroplasty only. CONCLUSION: Unilateral kyphoplasty in compare with vertebroplasty is safer for cement leakage and immediately reduces back pain and restore kyphotic deformities in addition to the prevention of subsequent compression fracture.
Back Pain ; Congenital Abnormalities ; Follow-Up Studies ; Fractures, Compression ; Humans ; Kyphoplasty ; Osteoporotic Fractures ; Spinal Canal ; Vertebroplasty

No abstract available.
Hematoma*

Fungal infections of the spine are relatively uncommon. Moreover, cervical spondylodiscitis due to Candida albicans in non-immunocompromised patient is very rare. We report a case of Candida spondylodiscitis in a 64-year-old woman who complained of neck pain. The clinical feature and treatment option are presented with a review of pertinent literatures.
Candida ; Candida albicans ; Discitis ; Female ; Humans ; Middle Aged ; Neck Pain ; Spine

OBJECTIVE: Intraoperative ventriculostomy is widely adopted to make the slack brain. However, there are few reports about hemorrhagic or parenchymal injuries after ventriculostomy. We tried to analyze and investigate the incidence of these complications in a consecutive series of patients with aneurysmal subarachnoid hemorrhage (SAH). METHODS: From September 2006 to June 2007, 43 patients underwent surgical clipping for aneurysmal SAH at our hospital. Among 43 patients, we investigated hemorrhagic or parenchymal injuries after intraoperative ventriculostomy using postoperative computed tomographic scan in 26 patients. After standard pterional craniotomy, ventriculostomy catheter was inserted perpendicular to the cortical surface along the bisectional imaginary line from Paine's point. RESULTS: Hemorrhagic injuries were detected in 12 of 26 patients (46.2%). Mean systolic blood pressure during anesthesia was with in statistically significant parameter related to hemorrhage (p = 0.006). On the other hand, parenchymal injuries were detected in 11 of 26 patients (42.3%). Female and the amount of infused mannitol during anesthesia showed statistically significant parameters related to parenchymal injury (p = 0.005, 0.04, respectively). However, there were no ventriculostomy-related severe complications. CONCLUSION: In our series, hemorrhagic or parenchymal injuries after intraoperative ventriculostomy occurred more commonly than previously reported series in aneurysmal SAH patients. Although the clinical outcomes of complications are generally favorable, neurosurgeon must keep in mind the frequent occurrence of brain injury after intraoperative ventriculostomy in the acute stage of aneurysmal SAH.
Anesthesia ; Aneurysm ; Blood Pressure ; Brain ; Brain Injuries ; Catheters ; Craniotomy ; Female ; Hand ; Hemorrhage ; Humans ; Incidence ; Mannitol ; Subarachnoid Hemorrhage ; Surgical Instruments ; Ventriculostomy

OBJECTIVE: We aimed to investigate the correlation between the success of recanalization and a modified version of the Qureshi grading system in acute ischemic stroke patients. METHODS: We retrospectively analyzed the intra-arterial thrombolysis (IAT) records of 37 patients who were evaluated by Thrombolysis in Myocardial Infarction (TIMI) and a modified version of the Qureshi grading systems as follows : 1) post-IAT Qureshi grade, 2) modified Delta Qureshi grade : pre-IAT group grade - post-IAT group grade (grade 1 : Qureshi grades 0-2 and grade 2 : Qureshi grade 3-5) and 3) Delta Qureshi grade (post-IAT Qureshi grade - pre-IAT Qureshi grade). Successful recanalization was defined as follows : 1) post-IAT TIMI grades 2 and 3, 2) post-IAT Qureshi grade 0-2, 3) modified Delta Qureshi grade=1, and 4) Delta Qureshi grade of > or =2 and/or post-IAT Qureshi grade=0. We investigated the correlation between the post-IAT TIMI grade and the modified Qureshi grade and also compared the various grading systems with modified Rankin Scale scores for evaluating the clinical outcome at 3 months. RESULTS: The post-IAT Qureshi grade and Delta Qureshi grade and/or post-IAT Qureshi grade were significantly correlated with the TIMI grade (gamma=0.976 and, 0.942, respectively). Further, post-IAT Qureshi grade and Delta Qureshi grade and/or post-IAT Qureshi grade showed a significantly stronger association with clinical outcome than did the post-IAT TIMI grade (p=0.001 and, 0.000 vs. 0.083, respectively). CONCLUSION: Our preliminary results suggest that the modified Qureshi grading system is a useful tool for assessing the success of recanalization after IAT.
Humans ; Myocardial Infarction ; Retrospective Studies ; Stroke

OBJECTIVE: Posterior accessed lumbar interbody fusion (PALIF) has a clear objective to restore disc height and spinal alignment but surgeons may occasionally face the converse situation and lose lumbar lordosis. We analyzed retrospective data for factors contributing to a postoperative flat back. METHODS: A total of 105 patients who underwent PALIF for spondylolisthesis and stenosis were enrolled. The patients were divided according to surgical type [posterior lumbar inter body fusion (PLIF) vs. unilateral transforaminal lumbar interbody fusion (TLIF)], number of levels (single vs. multiple), and diagnosis (spondylolisthesis vs. stenosis). We measured perioperative index level lordosis, lumbar lordosis, pelvic tilt, sacral slope, pelvic incidence, and disc height in standing lateral radiographs. The change and variance in each parameter and comparative group were analyzed with the paired and Student t-test (p<0.05), correlation coefficient, and regression analysis. RESULTS: A significant perioperative reduction was observed in index-level lordosis following TLIF at the single level and in patients with spondylolisthesis (p=0.002, p=0.005). Pelvic tilt and sacral slope were significantly restored following PLIF multilevel surgery (p=0.009, p=0.003). Sacral slope variance was highly sensitive to perioperative variance of index level lordosis in high sacral sloped pelvis. Perioperative variance of index level lordosis was positively correlated with disc height variance (R2=0.286, p=0.0005). CONCLUSION: Unilateral TLIF has the potential to cause postoperative flat back. PLIF is more reliable than unilateral TLIF to restore spinopelvic parameters following multilevel surgery and spondylolisthesis. A high sacral sloped pelvis is more vulnerable to PALIF in terms of a postoperative flat back.
Animals ; Constriction, Pathologic ; Diagnosis ; Humans ; Incidence ; Lordosis ; Pelvis ; Postoperative Complications ; Retrospective Studies ; Spinal Curvatures ; Spinal Fusion ; Spondylolisthesis

A 69-year-old man, suffering from diabetes, presented with drowsiness and general weakness is reported. Brain computed tomography revealed low density subdural lesion in the left hemisphere. A single burr hole was trephined and purulent material with liquified hematoma was drained to reveal Klebsiella pneumoniae from the specimen culture. Due to the unexplained postoperative mental deterioration and high fever, the patient underwent abdominal sonography to reveal liver abscess and the same pathogen was also cultured from the liver abscess. This case was very rare in that Klebsiella pneumoniae implanted into the vascularized capsule of the chronic subdural hematoma by hematogenous bacteremia. When chronic subdural hematoma is present in an immunocompromised or in old age patient, the infected subdural hematoma might be considered as one of the differential diagnosis.
Aged ; Bacteremia ; Brain ; Diagnosis, Differential ; Empyema, Subdural ; Fever ; Hematoma ; Hematoma, Subdural* ; Hematoma, Subdural, Chronic ; Humans ; Klebsiella pneumoniae ; Liver Abscess ; Sleep Stages

OBJECTIVE: There are various surgical approaches to far-lateral lesions in the L5-S1 intervertebral space. Of these is the validity of a paramedian tangential approach is being investigated in this study. METHODS: A retrospective study was conducted on 25 patients who had been diagnosed as having a far-lateral L5-S1 disc herniations, osteophyte, costal process hypertrophy, and had undergone a paramedian tangential approach from November 1999 through December 2003. The degree of symptoms and improvement were compared via the visual analog pain scale, before and after surgery. RESULTS: This study included 4 males and 21 females with a mean age of 62+/-11.8 years old. The average follow-up period after surgery was 8.2+/-2.7 months. The visual analog pain scale taken before surgery was 6.7+/-1.1 points, while the post-surgical scale was 2.4+/-0.9 points showing a significant decrease (p<0.05). There were no complications that developed during surgery. CONCLUSION: A paramedian tangential approach is less invasive in the soft tissue than that of the median approach. This approach may effectively reduce nerve root compression and expand intervertebral foramens, and is devoid of the risk of spinal instability after surgery. The authors suppose that a paramedian tangential approach is quite an effective technique to relieve compression in the far-lateral L5-S1 intervertebral space.
Female ; Follow-Up Studies ; Humans ; Hypertrophy ; Male ; Osteophyte ; Pain Measurement ; Radiculopathy ; Retrospective Studies

Currently, endovascular treatment of carotid cavernous fistula (CCF) is widely accepted and performed. However, a graft stent is rarely used for the treatment of high-flow CCF. Here we describe our experience using a graft stent to treat CCF and discuss the indications for its use.
Caves ; Fistula ; Stents ; Transplants

Bilateral traumatic abducens nerve palsy is a rare condition. We report a case associated with Hangman's fracture without skull fracture. Seventeen cases of bilateral traumatic nerve palsy were found in the literature and only four cases had bilateral traumatic abducens nerve palsy associated with cervical spine fracture without skull fracture. In case of head and neck injury, the abducens nerve may be damaged at the point of fixation to the dura mater. The pathogenesis, the clinical conditions and the radiological findings are presented.
Abducens Nerve Diseases* ; Abducens Nerve* ; Dura Mater ; Head ; Neck Injuries ; Paralysis ; Skull Fractures ; Spine