Purpura fulminans is a potentially disabling and life-threatening disorder characterized by acute onset of progressive cutaneous hemorrhage and necrosis on distal extremities, and disseminated intravascular coagulopathy. We experienced a case of purpura fulminans due to Streptococcus pneumoniae. A 42-year-old women presented with skin petechiae, ecchymosis and gangrene on distal extremities with laboratory evidence of DIC. The latex agglutination test with CSF was positive at Streptococcus pneumoniae. To our knowledge, this is the first report of purpura fulminans caused by Streptococcus pneumoniae in Korea.
Adult ; Dacarbazine ; Ecchymosis ; Extremities ; Female ; Gangrene ; Hemorrhage ; Humans ; Korea ; Latex Fixation Tests ; Necrosis ; Purpura Fulminans* ; Purpura* ; Sepsis ; Skin ; Streptococcus pneumoniae* ; Streptococcus*

OBJECTIVE: Kyphoplasty performed in the middle thoracic spine presents technical challenges that differ from those in the lower thoracic or lumbar region due to small pedicle size and angular severity for thoracic kyphosis. The purpose of this study was to evaluate the efficacy of balloon kyphoplasty through extrapedicular approach for the treatment of intractable osteoporotic compression fractures in the middle thoracic spine. METHODS: The patients who were performed with one level balloon kyphoplasty through extrapedicular approach due to painful osteoporotic compression fractures at T5-T8 from June 2003 to July 2005 were retrospectively analyzed. Imaging and clinical features were analyzed including involved vertebrae level, vertebral height, injected cement volume, clinical outcome and complications. RESULTS: Eighteen female patients (age ranged from 60 to 77 years old) were included in this study. The average amount of the implanted cement was 4.2+/-1.5 cc. The mean cobb angle and compression rate were improved from 12.1+/-6.5 degrees to 8.5+/-7.2 degrees and from 30% to 15%, respectively. The mean pain score (visual analogue scale) prior to kyphoplasty was 7.9 and it decreased to 3.0 after the procedure. Cement leakage to the adjacent disc (2 cases) and paravertebral soft tissues (1 case) were seen but there were no major complications such as pneumothorax, segmental artery injury, pulmonary embolism, or epidural leakage. CONCLUSION: Balloon kyphoplasty through extrapedicular approach is considered as a safe and effective in treating the middle thoracic regions with low complication rate.
Arteries ; Embolism ; Female ; Fractures, Compression* ; Humans ; Kyphoplasty* ; Kyphosis ; Lumbosacral Region ; Lung Injury ; Pneumothorax ; Retrospective Studies ; Spine

We present a case of an acute psoas muscle hematoma following percutaneous endoscopic lumbar discectomy. A 60-year-old female who presented with far lateral lumbar disc herniation underwent endoscopic discectomy on the right side at the L4-5 level. On the second postoperative day, the patient complained of severe right flank and leg pain and her blood pressure decreased. A computed tomography scan showed a large acute psoas muscle hematoma at right L4-5 level. The patient was transfused with packed red blood cells and placed at absolute bed rest. After observing the patient in intensive care, the severe flank and leg pain subsided, but the mild back pain persisted. Although percutaneous endoscopic lumbar discectomy is an effective minimally invasive surgical technique for the treatment of lumbar disc herniation, this case highlights the inherent risks of acute lumbar segmental vessel injury.
Back Pain ; Bed Rest ; Blood Pressure ; Diskectomy ; Erythrocytes ; Female ; Glycosaminoglycans ; Hematoma ; Humans ; Critical Care ; Leg ; Middle Aged ; Psoas Muscles

Unilateral pedicle stress fracture accompanying spondylolytic spondylolisthesis is rare even in the elderly. Most are associated with major trauma, previous spine surgery, or stress-related activity. Here, the authors describe an unique case of unilateral pedicle fracture associated with spondylolytic spondylolisthesis at the L5 level, which was successfully treated by posterior lumbar interbody fusion with screw fixation at the L5-S1 level. As far as the authors' knowledge, no such case has been previously reported in the literature. The pathophysiological mechanism of this uncommon entity is discussed and a review of relevant literature is included.
Aged ; Fractures, Stress ; Humans ; Spine ; Spondylolisthesis* ; Spondylolysis

OBJECTIVE: Although endoscopic procedures for lumbar disc diseases have improved greatly, the postoperative outcomes for high grade inferior migrated discs are not satisfactory. Because of anatomic limitations, a rigid endoscope cannot reach all lesions effectively. The purpose of this study was to determine the feasibility of endoscopic transforaminal suprapedicular approach to high grade inferior-migrated lumbar disc herniations. METHODS: Between May 2006 and March 2008, a suprapedicular approach was performed in 53 patients with high grade inferior-migrated lumbar disc herniations using a rigid endoscope and a semi-rigid flexible curved probe. One-to-four hours after surgery, the presence of remnant discs was checked with MRI. The outcomes were evaluated with the visual analogue scale (VAS) score and the Oswestry Disability Index (ODI) one week after surgery. RESULTS: The L2-3 level was involved in 2 patients and the L3-4 level was involved in 14 patients, while the L4-5 level was involved in 39 patients. There were single piece-type in 34 cases and a multiple piece-type in 19 cases. Satisfactory results were obtained in all cases. The mean preoperative VAS for leg pain was 9.32+/-0.43 points (range, 7-10 points), whereas the mean ODI was 79.82+/-4.53 points (range, 68-92 points). At the last follow-up examination, the mean postoperative VAS for leg pain was 1.78+/-0.71 points and the mean postoperative ODI improved to 15.27+/-3.82 points. CONCLUSION: A high grade inferior migrated lumbar disc is difficult to remove sufficiently by posterolateral endoscopic lumbar dscectomy using a rigid endoscope. However, a satisfactory result can be obtained by applying a transforaminal suprapedicular approach with a flexible semi-rigid curved probe.
Endoscopes ; Follow-Up Studies ; Humans ; Leg

Juxtafacet cysts are implicated in neural compression. Thus far, it is known that surgical removal is the definitive treatment for symptomatic juxtafacet cyst because spontaneous regression is rare, and the failure rate of conservative treatment is high. We have reported a rare case of right-sided juxtafacet cyst development after the spontaneous resolution of contralateral left-sided facet cyst. The left-sided facet cyst resolved spontaneously without surgical treatment, but a juxtacyst developed on the contralateral facet on the right side, as illustrated on 4-year follow-up magnetic resonance images. To the best of our knowledge, this is the first report of newly developed contralateral juxtafacet cyst after spontaneous regression. Herein, we have discussed the natural history and the management of this rare case.
Follow-Up Studies ; Natural History

We report a rare case of delayed cement displacement after balloon kyphoplasty in patient with Kummell's desease. A 78-year-old woman with Kummell's desease at T12 level received percutaneous balloon kyphoplasty. Two months after surgery, the patient complained of progressive severe back pain. Computed tomographic scans revealed a breakdown of the anterior cortex and anterior displacement of bone cement. Although this complication is very rare, it is likely to occur in treatment of Kummell's desease accompanying anterior cortical defect.
Aged ; Back Pain ; Displacement (Psychology) ; Female ; Humans ; Kyphoplasty

Bilateral pedicle stress fracture is a rare entity and few cases have been reported in the literature. Furthermore, the majority of these reports concern previous spine surgery or stress-related activities. Here, the authors report ankylosing spondylitis as a new cause of bilateral pedicle stress fractures accompanying spondylolysis. The reported case adds to the literature on bilateral pedicle stress fracture and spondylolysis by documenting that ankylosing spondylitis is another cause of this condition.
Fractures, Stress ; Humans ; Spine ; Spondylitis, Ankylosing ; Spondylolysis

It is well known that spinal instability should be evaluated in the standing lateral position. Standing dynamic flexion and extension radiographs are usually used to assess spinal instability. Here, we report a patient who experienced distraction instability while in the supine position rather than the standard standing position. To our knowledge, this is the first report of lying-down instability undetected on standing dynamic flexion and extension radiographs. We discuss the pathophysiological mechanism of this uncommon but possible entity and provide a review of the literature.
Deception* ; Humans ; Supine Position

Sparganosis is not a common disease, and its rarity makes it difficult to distinguish from other disease. Most cases of sparganosis are found in subcutaneous or adipose tissue of the abdominal, thoracic wall, and inguinal regions, but are rarely found in the breast. We experienced a case of sparganosis in the breast of a 65-year-old female by using an excisional biopsy. A sparganum should be considered in the differential diagnosis of benign breast disease.
Adipose Tissue ; Aged ; Biopsy ; Breast Diseases ; Breast* ; Diagnosis, Differential ; Female* ; Humans ; Sparganosis* ; Sparganum ; Thoracic Wall