Post-traumatic kyphosis is generally recognized as the result of failure of initial treatment in injured spine. The purposes of this study are to find out the surgical indications in residual post-traumatic kyphosis and to analysis the result of operative correction in post-traumatic kyphosis. The authors analyzed 14 cases of post-traumatic kyphosis, operated from Jan. 1992 to Mar. 1996. Their injuries were estimated initially compression fracture in 12 cases, hurst fracture in 2 cases. Their initial treatments were conservative method in 12 cases, anterior fusion in 1case & laminectomy in 1 case. The results of this study are as follows: 1) By standard Cobb lateral measurement, the mean preoperative kyphosis of 32.9degrees was reduced to 14.2 degrees(56.8% correction ratio). 2) Symptomatic improvement was definite, stooping with fatigue pain, mid back pain and accompanied claudication were improved in all cases. And low hack pain due to compensatory lordosis was improved in 5 of 6 cases. 3) We acquired bone union in all cases. We concluded that some thoraco-lumhar fractures could be underestimated in supine X-ray and needed more meticulous evaluation and follow-up. In addition, preexisting symptomatic lumhar degeneration below fracture should be considered in initial surgical decision making of post-traumatic kyphosis.
Animals ; Back Pain ; Decision Making ; Fatigue ; Follow-Up Studies ; Fractures, Compression ; Kyphosis* ; Laminectomy ; Lordosis ; Spine

In recent years, the rate of the thracolumbar and lumbar fractures rends to be increasing as the traffic accidents and industrial accidents frequently occurs. The purpose of this study is to review the results of conservative treatment for 73 patients with thoracolumbar and lumbar fractures and to review the failed 6 cases after conservative treatment, who were admitted and treated at National Medical Center during the period the period from January 1986 to June 1992. The following results were obtained: 1. Among the 65 cases of compression fracture, we performed hyperextension body cast in patient with height loss more than 30% and bed rest & brace in patient with height loss less than 30%, And in 63 cases, it showed good results. But two cases treated by bed & brace showed complaint such as radicular pain and persisdent back pain. 2. Among the 6 cases of burst fracture without neurological involvement, two cases treated by casting showed good result, but four cases treated by bed rest & brace showed complaint such as claudication and persistent back pain. 3. All cases of Chance fracture treated by casting showed good result. 4. There was no correlation between loss of correction of kyphotic angle and overall result. 5. Among the cases of poor result, we operated four cases which included two cases of instability & two cases of spinal stenosis and their results were good.
Accidents, Occupational ; Accidents, Traffic ; Back Pain ; Bed Rest ; Braces ; Fractures, Compression ; Humans ; Spinal Stenosis ; Spine

The purposes of this clinical study are to observe the clinical findings of the high lumbar disc herniation, to analyze the of the posterior approach and to define the surgical indications of the high lumbar disc herniation. We analyzed the 13 cases which were treated at the Deparment of the Orthopaedic Surgery, National Medical Center from March 1988 to December 1992(Mean follow up rate : 17. 2 months). 1. We operated 10 cases by posterior approach and 1 case by anterior approach due to marked degenerative osteophyte. 2. We evaluated the post-operative results by modified Macnab criteria, the 2 cases showed no symptomatic improvement because of respectively associated high lumbar osteophyte and lower lumbar spinal stenosis. 3. On conclusion, suspicion is important in cases of incompatible clinical symptoms and signs of the intervertebral disc herniation. MRI is the most recommended diagnostic tool, because it can provide the high lumbar levels with saggital section image and differentiate herniation from degenerative osteophyte. As for the surgical indications of high lumbar disc herniations, we suggest marked dural compression by disc or sequestered disc materials in MRI, definite neurological complications such as ankle clonus, increased DTR, weakness of quadriceps and hip flexor muscle and severe radiating pain on the anterior thigh. We recommended the posterior approach for the surgical intervention of high lumbar disc herniation except cases marked degenerative osteophytes.
Ankle ; Clinical Study ; Follow-Up Studies ; Hip ; Intervertebral Disc ; Magnetic Resonance Imaging ; Osteophyte ; Spinal Stenosis ; Thigh

No abstract available.
Sinus of Valsalva*

No abstract available.
Esophageal Fistula* ; Tuberculosis, Spinal*

No abstract available.

No abstract available.
Animals ; Lordosis* ; Spine*

No abstract available.

An automated percutaneous lumbar discectomy(APLD) have been apphed for contained lumbar disc herniation. But suggested that more exclusion criteria than disc containment was needed to improve success rate. The purposes of this study are to evaluate cIinical outcome of more than 4 years follow up of APLD, to analysis the cause of failure for longer follow up period, and to define prognostic factor of APLD. The l04 patients with contained lumbar disc herniation were treated with APLD from March 1990 to November 1992 in National Medical Center. The surgical candidates were contained focal disc herniation in MRI, sciatica than back pain, failure to conservative management at least 6 weeks and clinical and radiological correlation. And patient were excluded from this data if they had history of previous lumbar surgery and compensation claims. Among them 74 cases were followed up for over 4 years (Mean: 5.3 years). The results were accessed by questionnaire using telephone or OPD follow up. The overall success rate was 84% on 3 months follow up, but 68.9% on more than 4 years follow up by four subjective criterias (Onik, 1987). Causes of decreasing success rate were reoperation, recurrence without specific cause or after sprain and heavy work. 76% of failed cases occurred within 1 year and 40% of them underwent open discectomy. The patient sex, treated level, duration of symptom were not influenced on success rate, but age was factor related to success rate. In this study we can assess the effectiveness of APLD within 3 months in most cases and then change treatment option according to patients status, and it seems that we need more exclusion criteria than disc containment in MRI and refined patient selection in order to decrease the failures.
Back Pain ; Compensation and Redress ; Containment of Biohazards ; Diskectomy* ; Follow-Up Studies* ; Humans ; Magnetic Resonance Imaging ; Patient Selection ; Surveys and Questionnaires ; Recurrence ; Reoperation ; Sciatica ; Sprains and Strains ; Telephone

The transpedicular screw fixation is known to be capable of providing more secure correctional, force and rigid fixation to the spine. But it is often accompanied by various complications, including stress shield effects, loosening in osteoporotic spine, pseudoarthrosis, hardware problems and long-term change in motion behaviors at the adjacent motion segment and etc. The purpose of this study is to compare the flexible and rigid rods system in terms of complications and problems for various degenerative lumbar diseases. From September 1991 to November 1994, 41 patients were operated with the flexible rods system (group A) and 39 patients with the rigid rods system (group B). They were followed up for more than 4 years. The flexible rods system was composed of 41 cases of Wiltse system and the rigid rods system was composed of 29 cases of Diapason, 8 cases of TSRH and 2 cases of CD instrument. The resuits of the study were as follows: 1. By standard Cobb lateral measurement, 7 cases in group A and 10 cases in group B showed significant loss of sagittal angle (>4), post-operatively. 2. Hardware failure was noted in 7 cases in group A and 10 cases in group B. In group A, rod bending was seen in 4 cases, rod breakage in 2 and screw loosening in one. In group B, screw loosening was observed in 5 and screw-rod locking mechanism failure in 5 cases. 3. In spondylolisthesis patients, 10 cases in group A and 14 in group B, there was no statistically significant differences between the two groups in the reduction rate immediately after surgery and loss of reduction at the last follow up. 4. Clinical results were good to excellent in 85.4% of patients in group A and 82.1% of group B. No statistically significant differences between the two groups were found, 5. No statistically significant differences between the two groups were found with respect to degenerative changes at the adjacent motion segment to the fused level and pseudoarthrosis.
Follow-Up Studies ; Humans ; Pseudarthrosis ; Spine* ; Spondylolisthesis