No abstract available.
Fatigue* ; Sciatica*

No abstract available.

Development of new surgical devices and approaches for management of injuries to the cervical spine has offered various methods of treatment available. Making it is not easy in choosing the most suitable method of treatment. We present our experience and results of 90 operations performed during the past eight-year-period(1986-1993) including 10 halo-vest applications. The timing of operation was within 7 days posttrauma in 34.2%, 8-14 days in 27.4%, 15-28 days in 1.0%, and over 28 days in 27.4%. In 18 cases of upper(C1-3) cervical spine injuries, 23 operations were performed, all approached from the posterior. In 5 cases of lower(C4-7) cervical spine injuries, 67 operations were performed, the anterior approach used in 33 patients and the posterior approach in 18 patients. Halo-vest was applied in 6 patients with upper cervical spine injuries and in 4 patients with lower cervical spine injuries. The halo-vest was inadequate in maintaining the stability of the injured spine in 5 out of 0 cases. The complication rate was 23.3% in postrior approaches and 32.4% in anterior approaches. Overall, 27 complications(0%) occurred in 90 operations, and the reoperation rate was 16.4%(85 operations for 73 patients, except for the halo-vest applications). Internal fixation with a variety of devices has become a popular procedure for ervical spine injuries. Despite the popular and wide usage of such devices, the occurrence of complications and the need to reoperate has rendered the procedure to be applied with much caution regarding its technical aspects and possible problems it may pose. In our study, the rate of reoperation and complications following such procedures were quite high. We conclude that in choosing the most proper surgical approach for ervical spine injuries with minimal occurrence of any complications, a stringent criteria should be adhered to rather then easily select the more fashionable, new of fancy devices over the traditional techniques.
Humans ; Reoperation ; Spine*

We present a retrospective study on the results of posterior instrumentation with various devices after thoracolumbar spinal injuries. From Jaunary 1985 to December 1990, we operated 61 patients in Soonchunhyang University Chonan Hospital. Fourty-six patients were followed at least three months(three to 40 months). Rod system was used in 21 patients and pedicle screw system was used in 27 patients. In two patients, both systems were used. We divided them into two group ; Group A for the patients operated with rod system and Group B for the patients operated with pedicluar screw system. We analysed and compared the results of these two groups. There were no significant differences in the age, sex, causes of injury, levels and types of injury, and the incidence of cord injury. The final wedge deformity was less severe in Group B than A(P<0.02). However, the final angular deformity did not significantly differ in two groups. The mean hospital stay of Group B was shorter than that of Group A, but the difference was not statistically significant. Although there was no statistical significance, the final wedge deformity was severe in patients who were older than 40 years of age, who follwed up for more than 300 days, and who had cord injury. The final wedge deformity and angular deformity were severe in patients whose preoperative deformity was great(P<0.05 and P<0.02, respectively). The angular deformity was also severe Group A, in patients who had cord injury, who followed up for more than 300 days, and who were younger than 40 years of age, but these differences lack the statistical significance. Although the rate of complication in Group B(40.7%) was higher than Group A(28.6%), this diference was not significant. The most common complication was rod displacement in Group A and screw fracute in Group B. Pedicle screw system was superior to the rod system in this study. Improving the instruments and accumulating clinical experiences, pedicle screw system will be an effective method for thracolumbar stabilization.
Chungcheongnam-do ; Congenital Abnormalities ; Humans ; Incidence ; Length of Stay ; Retrospective Studies ; Spinal Injuries

Acute subdural hematoma (ASDH), chronic subdural hematoma (CSDH) and subdural hygroma (SDG) occur in the subdural space, usually after trauma. We tried to find a certain relationship among these three traumatic subdural lesions in 436 consecutive patients. We included all subdural lesions regardless of whether they were main or not. We evaluated the distribution, age incidence and interval from injury to diagnosis of these lesions, and the frequency of new subdural lesions in each lesion. ASDH constituted 68.6%, SDG 15.8%, and CSDH 15.6%, Age incidence of CSDH was similar to that of SDG, but differed from that of ASDH. Mean interval from injury to diagnosis was 0.4 days in ASDH, 13.4 days in SDG, and 51.6 days in CSDH. Focal brain injuries accompanied in 37.5% of ASDH, 5.8% of SDG, and no CSDH. In ASDH, 2 recurrent ASDHs, 17 SDGs and 9 CSDHs occurred. In SDG, 3 postoperative ASDHs and 8 CSDHs occurred. In CSDH, 2 postoperative ASDHs, 2 SDGs and 1 CSDH occurred. These results suggest that the origin of CSDH is not only ASDH, but also SDG in upto a half of cases. SDG is produced as an epiphenomenon by separation of the dural border cell layer when the potential subdural space is sufficient. A half of CSDHs may originate from ASDHs. ASDH may occur in CSDH by either a repeated trauma or surgery. Such transformation or development of new lesions is a function of a premorbid condition and the dynamics between the absorption capacity and expansile force of the lesion.
Adolescent ; Adult ; Age Factors ; Aged ; Brain Injuries/complications/pathology ; Child ; Female ; Glasgow Coma Scale ; Hematoma, Subdural/etiology/*pathology/therapy ; Human ; Male ; Middle Age ; Subdural Space/*pathology ; Tomography Scanners, X-Ray Computed

Although the prevalence of infectious disorders has been decreased, tuberculous infections are still common in this country. Therefore epidemiological data for the correct diagnosis of some spinal infections and proper selection of susceptible antibiotics are necessary. We presented a series of 40 patients with primary spinal infection dated from January 1990 to December 1994. Tuberculosis was the most common infection constituting 85% of this series, while pyogenic infection constituted only 10%, and primary discitis shared 5%. In a half of the tuberculous spondylitis, there were histories of previous tuberculosis except the vertebrae. We could identify the pathogenic organisms in only 47.5% o the cases(in 4 of 6 pyogenic infection and 15 of 34 tuberculous infection). Since it is difficult to differentiate the pyogenic and tuberculous infections by clinical or radiological features alone, some pyogenic infections might have been regarded as tuberculous, although the pyogenic spinal infections are rare. Nevertheless the tuberculous spinal infection outnumbered pyogenic ones in this country, which is similar to the patterns of other third-world countries. Therefore, correct identification of the microbial agent is important not only for the proper treatment but also to evaluate the patients of primary spinal infections in this country.
Anti-Bacterial Agents ; Developing Countries ; Diagnosis ; Discitis ; Epidemiology ; Humans ; Prevalence ; Spine ; Spondylitis ; Tuberculosis

It is never easy to assess the rate of disability from spinal injuries objectively. One reason is that the pain is an unmeasurable subjective symptom, and the other is that the disability is usually not confirmed by or correlated with radiological or laboratory examinations. The disability is an essentially subjective inconvenience or limitation, which is hard to measure objectively. However, compensation or reparation requires a scale to measure this unmeasurable disability, even with a universal validity and equity. There are several guidelines or criteria for a quantitative assessment of the disability. They differ from each other and have their own advantages and disadvantages. This difference may cause confusion or inequity. To improve the validity and equity, we propose a new design for the disability evaluation in patients with spinal injuries. We reviewed the Korean law for compensation in industrial accidents, McBride's disability table, the guideline proposed by American Medical Association, and a impairment rating table. Disabilities resulting from spinal injuries were classified into three types, i.e., morphologic sequelae(deformity), functional sequelae(dysfunction), and others. Only objective findings were considered as criteria for rating the disability. Disability resulting from deformity were rated from 0 to 20% by the degree of compression. Dysfunction can be rated by the number of lost motion segment from 10 to 60%. Disability from other compensable spinal pain were rated by objective physical findings or neurologic deficit from 0 to 25%. By eliminating the subjective or intentional complaints, this design can be a useful method minimizing the differences from the multiple examiners.
Accidents, Occupational ; American Medical Association ; Compensation and Redress ; Congenital Abnormalities ; Disability Evaluation ; Humans ; Jurisprudence ; Neurologic Manifestations ; Spinal Injuries*

Mortality after cervical spine injury is reportes as high as 15~30%, and it is intimately related to the initial cardiopulmonary function. We analysed the cause of death and initial cardiopulmonary function in 30 patients who expired at Soonchunhyang University Chonan Hospital after cervical spine injury between 1986 and 1993. Overall 42 patients(20.5%) expired in 205 patients with cervical spine injuries. Except 12 cases with concomitant fatal head injury and/or multiple systemic injuries, the mortality rate of cervical spine injury was 15.5%. It was 28.9% in cases with cord injury, and 2.1% in cases without cord injury. Male to female ratio was 5 : 1. Fifth to seventh decades constituted 63.3%. Common causes of spinal injury were in-car accident(46.7%) and fall/slip(36.7%). The level of spinal injury was above C5(upper cervical group ; UCG(55.6%) than the LCG(25.0%). Associated injuries were found in 66.7%, and the head injury was the most common one. The injury severity score was over 25 in 93.3%. The higher the score, the earlier the patients expired(Fisher's test, P<0.05). On arrival, hypotension(systolic blood pressure below 70 mmHg), bradycardia(less than 60/min), and respiratory arrest was found in 23.3%, 26.7%, and 16.7%, respectively. The episode of bradycardia was found in 56.7%. It was more common in cases of the early death(69.2%) than those of the late death(47.1%). Hypoxia, hypercarbia, and acidosis was observed in 19.2%, 7.7% and 5.38%, respectively. Respiratory failure was responsible for the majority(86.7%) of death. In UCG and cases of the early death, primary respiratory dysfunction was the main cause of death, while in LCG and cases of the death, pulmonary complication was the major reason(Fisher's test, P<0.01, respectively.
Acidosis ; Anoxia ; Blood Pressure ; Bradycardia ; Cause of Death* ; Chungcheongnam-do ; Craniocerebral Trauma ; Female ; Humans ; Injury Severity Score ; Male ; Mortality ; Respiratory Insufficiency ; Spinal Injuries ; Spine*

The following is our report a series of 220 patients who visited the neurosurgical out-patient department from January 1994 to June 1994 complaining of low back pain. We investigated how they were treated and what was the outcome on December 1995. Three certified neurosurgeons had managed these patients. Although the patients were not significantly different in terms of age, sex, and the duration of pain, the diagnostic methods(p<0.005), impression(p<0.01), and the methods of treatment(p<0.01) differred from doctor to doctor. The rates of admission and operation were 11.8% and 7.3%, respectively, and found to be consistent among doctors. We conducted telephonic interviews of 123 patients during December 1995 with the following outcome : improved in 69.1%, unchanged in 22.0%, and aggravated in 4.1%, together with six(4.9%) deaths. The cause of death was cancer in four cases, respiratory failure in one, and unknown in one. Sixteen patients underwent surgery in this hospital, while the other 12 patients were operated on in other hospitals. The outcome was favorable when 1) the patients were female, 2) the age was 21-40 years old, 3) presence of sciatica, 4) the duration was 1 week to 3 months, 5) the diagnostic impression was herniated lumbar disc, 6) drugs were not prescribed, and finally 7) managed by senior doctor. However, these differences were statistically not significant(p>0.1). Although low back pain is a very common complaint, there was enormous ambiguity with respect to its diagnosis and management. Neverthless, the outcomes were not significantly different. Despite the above, we still feel that low back pains should be more systematically classified and precisely dignosed. Also the therapeutic efficacies of different modalities of treatment should be critically reviewed.
Cause of Death ; Diagnosis ; Female ; Humans ; Low Back Pain* ; Outpatients* ; Respiratory Insufficiency ; Sciatica

Low back pain is one of the most common symptoms in medical practice. Differential diagnosis of back pain is complicated, however. Self-reported pain intensity and disability may affect on the decision for diagnosis or therapy. Exaggerated symptoms may cause unnecessary investigations or even surgical interventions. Self-reported pain intensity and disability are not in proportion to the objective physical findings. We investigated the relationship between self-reported pain intensity or disability and sleep disturbance or fatigue. The study was conducted as a survey using a questionnaire from November 1997 to March 1998. The survey included consecutive 368 patients who visited the neurosurgical out-patient department complaining of low back pain. Pain intensity was measured by visual analog scale, and disability was assessed by Waddell's chronic disability index. By multiple regression analysis, self-reported pain intensity corresponded best with the sleep disturbance. Age and fatigue were also related to the pain intensity. There was no good agreement between pain intensity and region or duration of the pain, appetite or indigestion. Disability corresponded best with the sleep disturbance. Fatigue, appetite, and indigestion were also related to the disability. There was no good relationship between disability and region or duration of the pain, or age. Self-reported pain intensity and disability are related to the psychological distress represented as sleep disturbance, fatigue, poor appetite or indigestion. Inquiring about sleep or fatigue is important to understand the underlying psychological condition, which may exaggerate pain intensity and disability.
Appetite ; Back Pain ; Diagnosis ; Diagnosis, Differential ; Dyspepsia ; Fatigue* ; Humans ; Low Back Pain ; Outpatients ; Surveys and Questionnaires ; Spine ; Visual Analog Scale