OBJECTIVE: To compare the visibility and procedural parameters between a standard spinal needle and a new laser-etched needle (LEN) in real-time ultrasonography guided lumbar medial branch access in a phantom of the lumbosacral spine. METHODS: We conducted a prospective single-blinded observational study at a rehabilitation medicine center. A new model of LEN was manufactured with a standard 22-gauge spinal needle and a laser etching machine. Thirty-two inexperienced polyclinic medical students performed ultrasonography-guided lumbar medial branch access using both a standard spinal needle and a LEN with scanning protocol. The outcomes included needle visibility score, needle elapsed time, first-pass success rate, and number of needle sticks. RESULTS: The LEN received significantly better visibility scores and shorter needle elapsed time compared to the standard spinal needle. First-pass success rate and the number of needle sticks were not significantly different between needles. CONCLUSION: A new LEN is expected to offer better visibility and enable inexperienced users to perform an ultrasonography-guided lumbar medial branch block more quickly. However, further study of variables may be necessary for clinical application.
Humans ; Needles* ; Needlestick Injuries ; Observational Study ; Phantoms, Imaging ; Prospective Studies ; Rehabilitation ; Spine ; Students, Medical ; Ultrasonography ; Zygapophyseal Joint

No abstract available.
Braces*

In cases of L4-5 spinal fusions, L5-S1 segment used to be included in the fusion traditionally for fear of progressive deterioration of the lumbosacral motion segment after fusion above. The purpose of this study was to evaluate the advisability of extension to L5-S1 segment in cases of L4-5 fusion for an isolated pathologic condition in L4-5 sement. A retrospective review of 72 patients with spinal fusion for an isolated pathologic condition in L4-5 segment was undertaken to compare the clinical results and adverse effects in two groups. One group consisted of 39 patients with floating L4-5 fusion(SF), and the other group consisted of 33 patients with L4-S1 fusion(LSF). The age, pathologic condition at L4-5, and the fusion method(lateral fusion) were matched in two groups. The mean follow-up period was 43.6 months(ranging 24-69 months). Comparisons were made for operative problems, post-operative complications, the amount of changes in angular motion at the adjacent segments to fusion at the last follow-up compared to the pre-operative motion, and the clinical results of treatment. The LSF group took 38 more minutes and lost 245 grams of more blood in averages to complete the additional surgical procedures compared with those in SF group. Several considerable post-operative complications were one deep infection in SF group and three metal failures of sacral fixation with subsequent two fusion failures in LSF group which were mostly concerned with the sacral fixations. The changes of angular motion at follow up compared to pre-operative motion in SF group were 1.5° gain in average (ranging 3° loss-6° gain) in L3-4 segment and 0.6° gain in average (ranging 5° loss-5° gain) in the L5-S1 segment. Those in L3-4 segment of LSF were 2.8° gain in average (ranging 2°-loss 9° gain). Therefore the higher stress and subsequent degeneration are more likely expected above the L4-S1 fusion rather than below the L4-5 fusion. The satisfactory clinical results were 89.7% in SF group and 87.9% in LSF group without significant difference between two groups. In conclusion there is no need to include the L5-S1 segment in the L4-5 fusion when the pathology is limited to L4-5 segment.
Follow-Up Studies ; Humans ; Pathology ; Retrospective Studies ; Spinal Fusion

The major cause of early dislocation after total hip arthroplasty is malposition of acetabular cup. Therefore, radiographic evaluation of acetabular cup placement is essential in determining the postsurgical prognosis. The purpose of this study was to establish principles which would aid in checking the radiography. We evaluated 33 patients who were treated with total hip arthroplasty between Jan. 1988 and Aug. 1993 and investigated the methods of measuring the position of the acetabular cup on radiography using pelvic skeleton and acetabular cup. The results were analyzed as followings. l. After the total hip arthroplasty, the inclination of the acetabular cup shows average 37.1 degress in pelvis AP, 36.4 degrees in hip AP and 43.4 degrees in femur AP. This result means that the more X-ray beam focus is far from the acetabular cup, the more inclination of acetabular cup on radiography is incerased. 2. After the total hip arthroplasty, the difference of acetabular cup angle between pelvis AP and hip AP is average 0.7 degree, 6.4 degrees between pelvis AP and femur AP and 7.1 degrees between hip AP and femur AP. This result means that the more X-ray beam focus is far from acetabular cup, the larger difference between acetabular cup angle on radiography is.3. In experimental study with pelvic rotation, acetabular cup angle on radiography is average 45.7 degrees in neutral position, 42.8 degrees in 10 degree rotation, and 39.6 degrees in 20 degree rotation. This result means that the more rotation of pelvic bone is increased, acetabular cup angle on radiography is reversely diminished. 4. In experimental study with pelvic flexion-extension, acetabular cup angle on radiography is average 45.7 degrees in neutral position, 56.4 degrees in 20 degree pelvic flexion, and 32.3 degrees in 20 degree pelvic extension. This result means that when the pelvis is flexed, acetabular cup angle on radiography is increased, and when the pelvis is extended, acetabular cup angle is decreased than normal acetabular cup angle. 5. In experimental study with X-ray beams, acetabular cup angle on radiography is average 45.7 degrees in pelvis AP, 45.5 degrees in femur AP and 50.4 degrees femur AP. This result means that the more X-ray beam focus is far from acetabular cup, the more inclination of acetabular cup on radiography is increased. As the result of the study, radiographs which focus centered on hip demonstrated a nearly true representation of acetabular cup angle.
Acetabulum ; Arthroplasty, Replacement, Hip ; Dislocations ; Femur ; Hip ; Humans ; Pelvic Bones ; Pelvis ; Prognosis ; Radiography ; Skeleton

A most common site for the isthmic spondylolisthesis is at fifth lumbar vertebra(L5) and far less at fourth(L4). The pathogenic lesion in the pars interarticularis is essentially the same in LA and L5 isthmic spondylolisthesis, but the clinical characteristics may differ each other according to their anatomical and biomechanical differences. A retrospective review of 24 patients of LA(study group) and 27 patients of L5(control group) isthmic spondylolisthesis was undertaken for their medical records and radiographs to compare the clinical characteristics in each groups. Included in each groups were all patients who were surgically treated during the same period and followed for more than two years after surgery. In the study group, 18 of 24 patients were females having an average age of 42.5 years(ranging 34-65), while in the control group, 17 of 27 patients were males having an average age of 38,1 years (ranging 13-59). The symptoms were severe leg pain in most of the study group, but in the control group, the leg pain and back pain were equally complained. The degrees of slip were similar in two groups, but a narrowing of dise space at slip segment was more prominent in study group. The lateral radiographs taken in flexion and extension revealed more changes of slip in study group (4.7mm in study group vs 2.8mm in control group in averages), and more angular motion at slip segment in study group unless the dise space is not severely narrowed. A spinal stenosis in CT findings was disclosed in almost all patients of study group and in 18 patients of control group. The sizes of L5 transeverse process were bigger than twice as those of L4 in 17(70.8%) patients including 9(37.5%) sacralizations of L5 in suty group, while in control group they were only 8(29.6%) patients with no sacralization. The heights of intercreastal line revealed no difference in two groups. The surgical procedures in study group were fusion only in two and decompression with fusion in 22(91.7%) patients and those in control group were fusion only in 11 and decompression with fusion in 16(59.3%) paticnts. The satisfactory results of treatment were in 21(87.5%) patients of study group and 25(92.6%) patients of control group without significant difference between two groups. In conclusion, the L4 spondylolytic spondylolisthesis compared to L5 lesion was more unstable and developed spinal stenosis more often. The surgical treatment and decompression procedure were also more needed in L4 lesions particularly in agend women.
Back Pain ; Decompression ; Female ; Humans ; Leg ; Male ; Medical Records ; Retrospective Studies ; Spinal Stenosis ; Spondylolisthesis

PURPOSE: To establish the interobserver and intraobserver reliability of the Coonrad classification for an idiopathic coronal curve pattern. MATERIALS AND METHODS: Radiographs of 257 idiopathic scoliosis patients that had a rib humping of more than 1 cm and a Cobb angle of more than 10 were reviewed. The interobserver and intraobserver reliability was assessed by a comparison of the classification of the curves between four observers. RESULTS: In the Coonrad classification, a 1A type-curve occurred in 37 cases, the 1B type-curve occurred in 27 cases, the 2A type-curve occurred in 70 cases, a 2B type-curve occurred in 22 cases, a 3 type-curve occurred in 44 cases, a 4 type-curve occurred in 6 cases, a 5 type-curve occurred in 15 cases, a 6 type-curve occurred in 22 cases, a 7 type-curve occurred in 13 cases and a 8 type curve occurre in 1 case. The interobserver reliability for the Coonrad classification was 0.60 and the intraobserver reliability was 0.71. CONCLUSION: The Coonrad classification proved to be relatively reliable, but revealed some confusion, particularly between type 2A and type 3. Also, there seemed to be no advantage in using this method of determining the treatment modality compared with the conventional scoliosis classification system.
Adolescent* ; Classification* ; Humans ; Ribs ; Scoliosis*

No abstract available.
Angiotensin II* ; Angiotensins* ; Animals ; Hemorrhage* ; Rats*

Eosinophilic myelitis (EM) or atopic myelitis is a rare disease characterized by a myelitic condition in the spinal cord combined with allergic process. This disease has specific features of elevated serum IgE level, active reaction to mite specific antigen and stepwise progression of mostly the sensory symptoms. Toxocariasis can be related with a form of EM. This report describes two cases of cervical eosinophilic myelitis initially considered as intramedullary tumors. When a differential diagnosis of the intramedullary spinal cord lesion is in doubt, evaluation for eosinophilic myelitis and toxocariasis would be beneficial.
Diagnosis, Differential ; Eosinophils ; Hypersensitivity ; Immunoglobulin E ; Mites ; Myelitis ; Rare Diseases ; Spinal Cord ; Toxocariasis

Clinical observation was performed on the 71 hips of 52 patients which were replaced by total hip arthroplasty, who were treated at department of Orthopedic Surgery, College of Medicine, Kyungpook National University, from 1980 to 1985. The follow up period of each case varied from 2 to 7 years. The results obtained were as follows : 1. The peak age incidence ranged from 40 to 49 years, which was comprised 55.8%(29 patients) of total cases. Male was predominant(46 patients of total cases). 2. The cause of hip diseases were ; 49 cases of idiopathic avascular necrosis, which comprised highest incidence, 15 posttraumatic avascular necrosis, 4 osteoarthritis, 3 old pyogenic hip. 3. The lesion site were ; 23 right side, 10 left side and 19 both sides. All cases were Muller type which performed the Watson-Jones approach. 4. Seversl complications were developed; 1 subtrochanteric spiral fracture, 1 perforation of acetabulum, 1 perforation of femur shaft, 1 perforation of lesser trochanter of femur, 1 nerve palsy during the operation, post-operative superficial wound infection in 1 case, deep seated infection in 1 case, and wire breakage in 6 cases. 5. Preoperative and post-operstive functional evaluation by the Harris method was done ; 1) Average improvement was 49 points from 38.2 to 87.2 points. 2) Relief of pain was the most prominent effect of the total replacement surgery.
Acetabulum ; Arthroplasty, Replacement, Hip ; Femur ; Follow-Up Studies ; Gyeongsangbuk-do ; Hip ; Humans ; Incidence ; Male ; Methods ; Necrosis ; Orthopedics ; Osteoarthritis ; Paralysis ; Wound Infection

The subtrochanteric fracture of the femur is often comminuted because the subtrochanteric area is composed mainly of cortical bone and high compression force biomechanically and its proximal fragment is severely displaced by adjacent strong muscles. Therefore, it is difficult to maintain accurate reduction and rigid fixation and delayed or nonunion, limb shortening, varus deformity, metal failure, and many other problems can be encountered. Although various devices of internal fixation have been developed to solve these problems, we found many problems to select the fixation device in different fracture type properly. We studied 40 subtrochanteric fractures treated with various devices at our hospital from 1981 to Feb. 1987. The results were obtained as follows: 1. Male (28 patients, 70%) was predominant. The majority of patients (representing 55%) were between 31 and 60 years of age. While 10 of 12 female patients were after 50 years of age. 2. In 36 of 40 patients, the fracture resulted from high energy trauma, traffic accident or fall from height. 3. Pelvic bone fracture (4 cases)and head trauma (3 cases) were the most common associated injuries. 4. Fielding's type II(19 cases) fracture and Seinsheimer's type IV (10 cases) & V (9 cases) fractures were most common. 5. Of the 40 cases, 38(95%) were treated by open reduction and internal fixation. Of fixation devices, a Jewett nail was most commonly used in 23 cases (60.5%) 6. The average time from operation to partial weight bearing was 12.2 weeks. 7. The mean duration of bony union was 25 weeks. And more longer period was needed in union as fractures goes distally 8. Of the 40 cases, 4 (10%) complications occured, those are : metal failure and fixation screw loosening (2 cases), infection (1 case), varus deformity (1 case). 9. From these series, these fractures should be treated as rigid internal fixation and Jewett nail or many other devices such as compression hip screw, condylar plate, or Judet plate could be applied successfully for the rigid fixation of subtrochanteric fractures of the femur according to the fracture displacement and stability.
Accidents, Traffic ; Clinical Study ; Congenital Abnormalities ; Craniocerebral Trauma ; Extremities ; Female ; Femur ; Hip ; Hip Fractures ; Humans ; Male ; Muscles ; Pelvic Bones ; Weight-Bearing