OBJECTIVE: To evaluate the diagnostic value of computed tomography-myelography (CTM) compared to that of magnetic resonance imaging (MRI) in patients with lumbar radiculopathy. METHODS: The study included 91 patients presenting with radicular leg pain caused by herniated nucleus pulposus or lateral recess stenosis in the lumbar spine. The degree of nerve root compression on MRI and CTM was classified into four grades. The results of each imaging modality as assessed by two different observers were compared. Visual analog scale score for pain and electromyography result were the clinical parameters used to evaluate the relationships between clinical features and nerve root compression grades on both MRI and CTM. These relationships were quantified by calculating the receiver-operating characteristic curves, and the degree of relationship was compared between MRI and CTM. RESULTS: McNemar's test revealed that the two diagnostic modalities did not show diagnostic concurrence (p<0.0001). Electromyography results did not correlate with grades on either MRI or CTM. The visual analog pain scale score results were correlated better with changes of the grades on CTM than those on MRI (p=0.0007). CONCLUSION: The present study demonstrates that CTM could better define the pathology of degenerative lumbar spine diseases with radiculopathy than MRI. CTM can be considered as a useful confirmative diagnostic tool when the exact cause of radicular pain in a patient with lumbar radiculopathy cannot be identified by using MRI. However, the invasiveness and potential complications of CTM are still considered to be pending questions to settle.
Constriction, Pathologic ; Electromyography ; Humans ; Leg ; Magnetic Resonance Imaging* ; Myelography ; Pain Measurement ; Pathology ; Radiculopathy* ; Spine ; Visual Analog Scale

Since the launch of cervical total disc replacement (CTDR) in the early 2000s, many clinical studies have reported better outcomes of CTDR compared to those of anterior cervical discectomy and fusion. However, CTDR is still a new and innovative procedure with limited indications for clinical application in spinal surgery, particularly, for young patients presenting with soft disc herniation with radiculopathy and/or myelopathy. In addition, some controversial issues related to the assessment of clinical outcomes of CTDR remain unresolved. These issues, including surgical outcomes, adjacent segment degeneration (ASD), heterotopic ossification (HO), wear debris and tissue reaction, and multilevel total disc replacement (TDR) and hybrid surgeries are a common concern of spine surgeons and need to be resolved. Among them, the effect of CTDR on patient outcomes and ASD is theoretically and clinically important; however, this issue remains disputable. Additionally, HO, wear debris, multilevel TDR, and hybrid surgery tend to favor CTDR in terms of their effects on outcomes, but the potential of these factors for jeopardizing patients' safety postoperatively and/or to exert harmful effects on surgical outcomes in longer-term follow-up cannot be ignored. Consequently, it is too early to determine the therapeutic efficacy and cost-effectiveness of CTDR and will require considerable time and studies to provide appropriate answers regarding the same. For these reasons, CTDR requires longer-term follow-up data.
Cervical Vertebrae ; Diskectomy ; Female ; Follow-Up Studies ; Humans ; Intervertebral Disc Degeneration ; Ossification, Heterotopic ; Prognosis ; Radiculopathy ; Spinal Cord Diseases ; Spine ; Surgeons ; Total Disc Replacement

In surgical treatments of degenerative lumbar disc disease, arthrodesis is well known to be a gold standard; however various disadvantages related to elimination of the segmental motion and the procedures of fusion surgery have become a matter of concern. To this end, total disc replacement (TDR) was recently highlighted as one of alternative surgical modalities and being used widely. However, although it has been almost 10 years since lumbar TDR was int- roduced and actively used in the clinic, its clinical usefulness is still in dispute. The authors review and put together the history, biomechanics, and currently available prostheses of lumbar TDR in the present study. Some of the recent preliminary, mid-term and long-term clinical results of lumbar TDR in degenerative lumbar spine diseases are also reviewed. Lastly, we look out over the future prospect of lumbar TDR.
Arthrodesis ; Biomechanics ; Dissent and Disputes ; Intervertebral Disc Degeneration ; Intervertebral Disc Displacement ; Prostheses and Implants ; Spine ; Total Disc Replacement

OBJECTIVE: The authors introduce a technique of direct repair of pars defects in symptomatic lumbar spondylolysis using pedicle screws and universal hooks. METHODS: From March 2001 to September 2001, six patients with symptomatic lumbar spondylolysis and positive pars injection test underwent this procedure. Patients with lumbar instability and discogenic pain were excluded. After posterior midline incision, clearing of fibrous, cartilaginous and sclerotic tissues in and around the defects of pars was done until healthy bone was exposed. Strips of cancellous bone were taken from adjacent laminae and packed into the defects of pars. After insertion of the pedicle screws, universal hooks were placed in the lower margin of the lamina of the involved vertebra. With gentle compression between the head of screw and universal hook, the nut was fixed. Same procedures were done on the contralateral side. RESULTS: Postoperatively, all six patients experienced clinical improvement and there was no complication related with operation. CONCLUSION: This new technique is considered useful for direct repair of the defects in symptomatic lumbar spondylolysis without significant injury in the normal structures.
Head ; Humans ; Nuts ; Spine ; Spondylolysis*

Effects of a M1 receptor antagonist, pirenzepine, a M2 receptor antagonist, AF-DX116, and a nicotinic receptor antagonist, mecamylamine on the pressor responses to preganglionic sympathetic nerve stimulation(PNS) and McN-A-343 and DMPP in spinal(pithed) rabbits were investigated in order to elucidate a functional role of M1, M2 and nicotinic receptors in ganglionic transmission. Pirenzepine and AF-DX116 selectively inhibited the McN-A-343-induced pressor reponse in chlorisondamine-treated rabbit and the BCh-induced bradycardia, respectively. Electrical stimulations of preganglionic sympathetic outflow at T8 level produced increases in blood pressure. Pirenzepine(3 microgram/kg) significantly inhibited the PNS-induced pressor response and the degree of inhibition was not changed by increasing the doses to 100 microgram/kg. AF-DX116(100 microgram/kg) had no effect on the PNS-induced pressor response. Mecamylamine inhibited the PNS-induced pressor response in a dose-dependent manner. The inhibitory action of mecamylamine was significantly augmented by combined-treatment with pirenzepine(30 microgram/kg) but AF-DX116(100 microgram/kg) did not affect the inhibitory action of mecamylamine. McN-A-343 and DMPP elicited pressor response in the spinal rabbit. Pirenzepine and AF-DX116 dose-dependently inhibited the McN-A-343-induced pressor response but they did not affect DMPP-induced pressor response. Mecamylamine inhibited both pressor responses induced by Mc-N-343- and DMPP. These results suggest that not only nicotinic receptors but also M1 receptors play a facilitatory role in ganglionic transmission but M2 receptors do not contribute the transmission in spinal(pithed) rabbits.
(4-(m-Chlorophenylcarbamoyloxy)-2-butynyl)trimethylammonium Chloride ; Blood Pressure ; Bradycardia ; Dimethylphenylpiperazinium Iodide ; Electric Stimulation ; Ganglia, Sympathetic* ; Ganglion Cysts ; Mecamylamine ; Pirenzepine ; Rabbits ; Receptors, Nicotinic*

OBJECTIVE: The IDET(Intradiscal electrothermal therapy) appears as a new therapeutic modality for intractable discogenic back pain. We carried out a prospective study to analyze and evaluate the therapeutic effects of IDET. METHODS AND RESULTS: During a six month period, we performed IDET in 39 patients with chronic low back pain using RITA Model 30 Electrosurgical device. The patients included 21 men and 18 women. The mean patient age was 50.2 years(range 21-73 years). All patients underwent preoperative plain radiography and MRI for excluding non-discogenic back pain. We conducted discography-CT to reveal painful discs in all patients. During the study, we measured intradiscal pressure subjectively. The area of annular tear, which identified with post-discography CT scan, was coagulated in 90degreesC of temperature for 15 minutes. Of the 17 patients who were followed up more than three months after surgery, the 10 patients(58.8%) experienced clinical improvement. Three patients had high intradiscal pressure on discography, other three patients had loss of disc height more than 30% of normal on plain radiography, and one patient suffered from postoperative epidural abscess. All of these patients were included in the remaining no improvement group(41.2%). CONCLUSION: The IDET procedure could be an alternative modality for discogenic back pain. It appears that a patient who has low intradiscal pressure on discography and intact disc height on plain radiography is considered a good candidate for IDET.
Back Pain ; Epidural Abscess ; Female ; Humans ; Low Back Pain* ; Magnetic Resonance Imaging ; Male ; Prospective Studies ; Radiography ; Tomography, X-Ray Computed

OBJECTIVE: Treatments of osteoporotic bursting vertebral body fracture(OBF) of thoracic and lumbar spines have been limited to conservative managements especially in the elderly patients. The authors correct kyphosis and stabilize the spine by the posterior approach with intraoperative polymethylmethacrylate(PMMA) vertebroplasty. METHODS: From March 1999 to June 2000, eight patients with OBF underwent posterior approach with intraoperative vertebroplasty. The patients included 7 women and 1 man aged 54-82 year. Average T-score on bone marrow density was -3.02. In the case of old fracture with sclerosis in the posterior wall, after laminectomy, the retropulsed posterior wall of the fractured spine was reduced with L-shaped micro-bone impactor through the lateral epidural spaces, in prone position. About 6cc of PMMA was injected into the fractured vertebral body via transpedicular route, and then, small amount of PMMA was also injected into each entry point of the screws. All patients underwent one above and one below short segment fixation followed by correction of kyphotic deformity. RESULTS: The preoperative clinical symptoms improved gradually in all patients. During postoperative follow-up for more than 7 months, there was no recurrence of the preoperative clinical symptoms, aggravation of kyphosis or instrumentation failure. CONCLUSIONS: It is suggested that posterior approach with short segment fixation and intraoperative PMMA vertebroplasty could be a new surgical modality for osteoporotic bursting fracture of the thoracic and lumbar spines especially in the aged.
Aged ; Bone Marrow ; Congenital Abnormalities ; Epidural Space ; Female ; Follow-Up Studies ; Humans ; Kyphosis ; Laminectomy ; Osteoporosis ; Polymethyl Methacrylate ; Prone Position ; Recurrence ; Sclerosis ; Spine* ; Vertebroplasty*

OBJECTIVE: This retrospective study was performed to evaluate the clinical and radiological results of anterior lumbar interbody fusion (ALIF) using two different stand-alone cages in the treatment of lumbar intervertebral foraminal stenosis (IFS). METHODS: A total of 28 patients who underwent ALIF at L5-S1 using stand-alone cage were studied [Stabilis(R) (Stryker, Kalamazoo, MI, USA); 13, SynFix-LR(R) (Synthes Bettlach, Switzerland); 15]. Mean follow-up period was 27.3 +/- 4.9 months. Visual analogue pain scale (VAS) and Oswestry disability index (ODI) were assessed. Radiologically, the change of disc height, intervertebral foraminal (IVF) height and width at the operated segment were measured, and fusion status was defined. RESULTS: Final mean VAS (back and leg) and ODI scores were significantly decreased from preoperative values (5.6 +/- 2.3 --> 2.3 +/- 2.2, 6.3 +/- 3.2 --> 1.6 +/- 1.6, and 53.7 +/- 18.6 --> 28.3 +/- 13.1, respectively), which were not different between the two devices groups. In Stabilis(R) group, postoperative immediately increased disc and IVF heights (10.09 +/- 4.15 mm --> 14.99 +/- 1.73 mm, 13.00 +/- 2.44 mm --> 16.28 +/- 2.23 mm, respectively) were gradually decreased, and finally returned to preoperative value (11.29 +/- 1.67 mm, 13.59 +/- 2.01 mm, respectively). In SynFix-LR(R) group, immediately increased disc and IVF heights (9.60 +/- 2.82 mm --> 15.61 +/- 0.62 mm, 14.01 +/- 2.53 mm --> 21.27 +/- 1.93 mm, respectively) were maintained until the last follow up (13.72 +/- 1.21 mm, 17.87 +/- 2.02 mm, respectively). The changes of IVF width of each group was minimal pre- and postoperatively. Solid arthrodesis was observed in 11 patients in Stabilis group (11/13, 84.6%) and 13 in SynFix-LR(R) group (13/15, 86.7%). CONCLUSION: ALIF using stand-alone cage could assure good clinical results in the treatment of symptomatic lumbar IFS in the mid-term follow up. A degree of subsidence at the operated segment was different depending on the device type, which was higher in Stabilis(R) group.
Arthrodesis ; Constriction, Pathologic ; Follow-Up Studies ; Humans ; Pain Measurement ; Retrospective Studies

Experinece in the management of 74 patients with delayed traumatic intracranial hemorrhage(DTICH) of 474 head injury from January 1996 to December 1996 is poresented with emphasis on the incidence, occurring time, risk factors and outcome. The incidence of DTICH was 15.6% of all hospitalized head-injury patients. After an injury, every patient had an immediate computerized tomography(CT) scan to diagnose intracranial pathology and then CT follow-up was carried out according to intial CT finding and reurological deficit. The lesion was almost occurred in patients with initial abnormal CT finding(85.1%). 82.4% of DTICH were noted within 72 hours after injury. The delayed epidural hematoma and intracerebral hemorrhage were almost noted in first 72 hours(>90%), but the delayed subdural hemorrhage was found after a time interval varying from 6 hours to 10 days. So we strongly recommend CT follow-up in 4-8hour, 24-72hour, and then 7th day after head injury, especially in patients with initial abnormal CT findings. The risk factor of the delayed lesion was not hypotension, hypoxia, and consciousness level, but age of patients and the initial CT finding. The development of DTICH was not heralded by neurological deterioration. The prognosis of DTICH was not worse than non-DTICH. The patient with delayed subdural hemorrhage was better than the patient with non-delayed lesion(including hemorrhage and normal CT finding).
Anoxia ; Cerebral Hemorrhage ; Consciousness ; Craniocerebral Trauma* ; Follow-Up Studies ; Head* ; Hematoma ; Hematoma, Subdural ; Hemorrhage ; Humans ; Hypotension ; Incidence ; Intracranial Hemorrhages* ; Pathology ; Prognosis ; Risk Factors

We report a rare complication of iatrogenic spinal intradural following minimally invasive extradural endoscopic procedues in the lumbo-sacral spines. To our knowledge, intradural cyst following epiduroscopy has not been reported in the literature. A 65-year-old woman with back pain related with previous lumbar disc surgery underwent endoscopic epidural neuroplasty and nerve block, but her back pain much aggravated after this procedure. Postoperative magnetic resonance imaging revealed a large intradural cyst from S1-2 to L2-3 displacing the nerve roots anteriorly. On T1 and T2-weighted image, the signal within the cyst had the same intensity as cerebrospinal fluid. The patient underwent partial laminectomy of L5 and intradural exploration, and fenestration of the cystic wall was accomplished. During operation, the communication between the cyst and subarachnoid space was not identified, and the content of the cyst was the same as that of cerebrospinal fluid. Postoperatively, the pain attenuated immediately. Incidental durotomy which occurred during advancing the endoscope through epidural space may be the cause of formation of the intradural cyst. Intrdural cyst should be considered, if a patient complains of new symptoms such as aggravation of back pain after epiduroscopy. Surgical treatment, simple fenestration of the cyst may lead to improved outcome. All the procedures using epiduroscopy should be performed with caution.
Back Pain ; Endoscopes ; Epidural Space ; Female ; Humans ; Laminectomy ; Magnetic Resonance Imaging ; Nerve Block ; Spine ; Subarachnoid Space