There are several modalities of surgical treatment in lumbar herniated nucleus pulposus (HNP), derangement of lumbar intervertebral disk (DLID), spondylolysis, spondylolisthesis and degenerative spinal stenosis with scoliosis, such as laminectomy, laminectomy and diskectomy, laminectomy with diskectomy and posterolateral fusion, laminectomy with diskectomy and posterior lumbar intebody fusion, anterior diskectomy and interbody fusion, modification with cage instrumentation and decompression with instrumentation and posterolateral fusion. Low back pain due to the instability resulting from the removal of the nucleus pulposus was not infrequent in clinical practice. The purpose of the study was to determine the factors affecting clinical results by evaluating fusion rate, fusing pattern, measurement of spinal canal, correction of deformity. Five hundred and twenty eight cases of lower lumbar spinal diseases including 2S6 cases of lumbar HNP and DLID, 189 cases of spondylolysis and spondylolisthesis and 53 cases of spinal stenosis with scoliosis were studied respectively. The cases were admitted to Severance Hospital department of Orthopaedic Srugery from January 1970 through December 1994, and followed the patients from two years up to 15 years with an average of 2.9 years. It was reviewed clinical records and radiographs. The radiological study included plain x-ray, dynamogram, tomogram, myelography, computed axial tomography and/or MRI. It was evaluated the fusion rate, fusing pattern, area of spinal canal, correction of deformity and clinical results. The rate of solid fusion was 89.5% in lumbar HNP and DLID, 77.3% in spondylolysis and spondy-lolisthesis, and 86.7% in spinal stenosis with scoliosis. The most common type of the fusing pattern was type I in lower lumbar diseases. The satisfying clinical result was 82.6% in lumbar HNP and DLID, 76.7% in spondylolysis and spondylolisthesis and 58.5% in spinal stenosis with scoliosis. Spinal canal measurement was done in 23 cases and the increase of A-P diameter of spinal canal was 0.50+/-0.29mm and it was correlated with satisfying clinical result. Correction of the deformity was evaluated in 53 cases of spinal stenosis with scoliosis and of them 67.9% was corrected and it was correlated with satisfying clinical result. In conclusion the factors affecting the satisfying clinical results in the lower lumbar spinal diseases treated by diskectomy and anterior interbody fusion are solid union, restoration of disk height, correction of the deformity and increment of area of dural sac. Anterior diskectomy and interbody fusion have shown to be a good method of treatment for lower lumbar spinal diseases.
Congenital Abnormalities ; Decompression ; Diskectomy ; Hospital Departments ; Humans ; Intervertebral Disc ; Laminectomy ; Low Back Pain ; Magnetic Resonance Imaging ; Myelography ; Scoliosis ; Spinal Canal ; Spinal Diseases* ; Spinal Stenosis ; Spondylolisthesis ; Spondylolysis

Reiters syndrome is a clinical triad of arthritis, urethritis and conjunctivitis, but the characteristic mucocutaneous lesions occur frequently enough to be included in this syndrome. This applies to the initial stage of the disease, in which the arthritis usually, but by no means invariably, comes triad, i.e. after the urethritis and conjunctivitis have made their apperance. In most instances the arthritisis is of subacute onset, reaching its full intensity within a few weeks. Some 50% of the patients suffer from recurrences of the arthritis. The chronic progressive polyarthritis occuring in Reiters syndrome has severe functional and anatomical repercussions. Here we report a case of Reiters syndrome in a 14 year old middle school boy. He had classical characteristic triad of arthritis, nonspecific urethritis and conjunctivitis. He had pyuria in first fewdays after onset and the arthritis of acute onset, reaching its full intensity within two weeks and then followed by conjunctivits. A review of literature was included.
Arthritis ; Conjunctivitis ; Humans ; Male ; Pyuria ; Recurrence ; Urethritis

The incidence of the spondylolysis is very low before five years but during the adolescence the incidence increase. The etiologic factors of spondylolisthesis are congenital and acquired. The acquired factors are traumatic and stress fracture. Then there are many congenital properties of the etiologic factors for the spondylolisthesis because several congenital anomalies are combined with spondyolysis or isthmic spondylolisthesis. But there are few articles about relationship between the spondylolysis or isthmic spondylolisthesis and the congenital anomalies around the lumbosacral area. The purpose of this particular study is to search the etiologic factors that increase the degree of the vertebral slippage and relationship between the spondylolysis or ishtmic spondylolisthesis around the lumbosacral area. The plain X-ray and computed tomograms were taken in the 48 patients and the 26 control group that have not chronic low back pain previously. The patients were divided into three groups, such as the spondylolysis, grade I spondylolisthesis, and grade II spondylolisthesis. The parameters measured from the plain X-ray were the incidence of congenital anomalies and degree of vertebral slippate. The parameters measured from the computed tomograms were fact angles and the degree of pseudodisc. Tropism were present for 5 cases, and 16 cases at L3-4 facets, 12 cases, and 22 cases at L4-5 facets, 10 cases, and 28 cases at L5-S1 facets in control and patients group. There was no correlation between the presence or absence of tropism and the vertebral slippage. The sacralization was related with the vertebral slippage but other congenital anomalies were not related to the degree of vertebral slippage. There was a increment of vertebral slippage according to the increase of facet angle, but the linear correlation was absent on regression analysis. So statistical significance was absent among the control group and 3 patients groups. And the vertebral slippage was not significantly different among the groups that were divided according to the difference of facet angle. There was a linear correlation between the degree of the pseudodisc and the degree of vertebral slippage of square=0.60 on regression analysis. At present study, there was a trend of increase of vertebral slippage according to increase of facet angle and presence of the sacralization. And there was a linear correlation between the degree of the pseudodisc and the vertebral slippage.
Adolescent ; Fractures, Stress ; Humans ; Incidence ; Low Back Pain ; Spondylolisthesis ; Spondylolysis ; Tropism ; Zygapophyseal Joint

The effect of radiation therapy, either alone or combined with surgery or chemotherapy is accepted well in the treatment of metastatic carcinoma, multiple myeloma, reticulum cell sarcoma and Ewing's sarcoma. But its effect on osteosarcoma and chondrosarcoma is less clear. The authors reviewed 90 patients treated with radiation therapy, 62 cases with primary bone tumor and 28 cases with multiple myeloma, from 1969 to 1988. There were 20 Ewing's sarcoma, 12 osteosarcoma, 12 chondrosarcoma, 9 Histiocytosis-X and 3 reticulum cell sarcoma among 62 primary bone tumors. And 40 patients with more than three months follow-up were analyzed for the primary response of tumor three months after radiation therapy and the long term effect of the radiation therapy. When the radiation therapy was done alone, the primary response was poor in osteogenic sarcoma, chondrosarcoma, Ewing's sarcoma and reticulum cell sarcoma. But with the multimodal therapy, the primary response was rslatively good in reticulum cell sarcoma and chondrosarcoma. In 15 patients, more than one year follow-up was done. The status of these patients at the last follow-up was poor in all cases trearted with radiation therapy alone than the multimodal therapy except Histiocytosis-X. In multiple myeloma, the effect of radiation therapy for the relief of pain was analyzed. There were complete relief of pain in 14.3%, partial relief in 71.4% and no relief in 10.7%.
Chondrosarcoma ; Drug Therapy ; Follow-Up Studies ; Histiocytosis, Langerhans-Cell ; Humans ; Lymphoma, Non-Hodgkin ; Multiple Myeloma ; Osteosarcoma ; Sarcoma, Ewing

Low back pain and sciatica is one of the troublesome problems in the orthopedic field. Many authors reported the pathogenesis of the low back pain and sciaticadue to disc prolapse. Prior to 1934, when the connection between sciatica and disc prolapse was established, non-surgical management was almost always the therapy of choice. The surgical alternative, was established in the middle of the 1930's by the work of Mixter and Barr and others. Even if many patients obtained symptomatic relief from discectomy alone, many authors proposed intervertebral fusion to prevent aggravation of segmental instability. We reviewed the cases of 60 patients who underwent anterior lumbar spine fusion for herniated lumbar disc, and were followed for 10 months to 9 years from January 1975 to December 1984. We results were as follows. l. Among 60 patients, 45(75%) were successful, and 56(93.3%) were effective. 2. Fifty-eight patients(96.7%) showed bony union which took place in 7.9 months on an average. 3. Ambulation started with Knight-Kim type back brace in 10.2 days on an average after operation, and discharged in 11.5 days on an average. 4. When duration of symptoms was less than 6 months, and the involved level was confined in one level and was L4 intervertebral disc, the results were good. 5. Postoperative wound infection was noted in 5%, and 22 patients(36.7%) complained of postsympathectomy symptoms.
Arthrodesis ; Braces ; Diskectomy ; Humans ; Intervertebral Disc ; Low Back Pain ; Orthopedics ; Prolapse ; Sciatica ; Spine ; Surgical Wound Infection ; Walking

Giant cell tumor is an uncommon neoplasm, arising from the mesenchymal cells of bone marrow. The lesion was first described by Sir Astley Cooper in 1818. Levert in 1845 gave a detailed delineation of this tumorous condition. Paget in 1853 provided an excellent description of what remains a guiding treatise. In 1940, Jaffe, Lichtenstein, and Portis identified it as an entity with distinctive roentgenographic, hiatological, and clinical characteristics. Since then, frequent detailed reports analyzing the treatment and prognosis were published by many authors. The classic grading system is that of Jaffe, Lichtenstein, and Portis. Grade I,II, and III correspond respectively to insignificant, moderate, and marked atypism of the nuclei of the stromal cells. Tumors of Grade III are considered to be frankly malignant. While Dahlin and associates and Goldenberg and his co-workers found the grading of no prognostic value, Lichtenstein, in 1972, still claimed that in his experience the grading of giant cell tumor is of practical value. Twenty seven cases of giant cell tumor were seen and treated at Severance Hoepital during the 18 years from July 1960 to June 1978. The tumors were mostly diatributed 55% in the 21 to 40 years group and mostly located around the knee (52%). According to the pathologlcal grading, these casosbelonged to Grade I and Grade III in 19% each and to Grade Il in 62%. The treatment consisted of curettage and bone graft in 14 cases, amputation in 4 cases, en bloc excision in 3 cases, partial resection and fusion, curettage and bone graft with radiotherapy in 2 cases each, curettage and bone cement, and en bloc excision and endoprosthsis in one case each. On following up the end results, the over all recurrence rate was 18.5% (5 cases) and the malignant change rate was 3.7% (1 case). In this study one case was changed into malignant degeneration in Grade II and a pulmonary metastasis was found. Among our cases, 5 were of recurrences, primarily treated by curettage and bone graft in to cases, partial excision with fusion in one case, and curettage, and bone graft with radiotherapy in one case. The recurrence rate seems not to be correlated with the grade. In the treatment of this tumor, surgical treatment if pcssible is recommended. The definitive procedures for removal of the tumors in this series were curettage-and bone graft, excision or resection with or without bone graft, and amputation. Resection and prosthesis replacement was employed in our cases for one lesion in the proximal end of humerus. A new alternative in the choice of surgery has been tried in many authors. This alternative is a thorough curettage of the tumor and filling with bone or acylic bone cement. In our series bone cement filled up the lesion of the distal end of tibia. Tumors located around the knee and distal radius showed higher recurrence than other sites. The results obtained from this study led us to conclude that: 1) The highest incidence was in the age group from 21 to 40 years in 15 cases (55%) and sex distribution was almost equal 2) The most frequent sites of this tumor are the lower end of the femur, upper end of tibia, and lower end of the radius (18 cases, 67%). 3) The pathological grading in this series showed 5 cases in Grade I, 17 cases in Grade II, and 5 cases in Grade III. 4) Recurrence rate was 18.5% and all cases recurred within 2 years after first surgery. 5) A case who is in Grade II in pathological finding was changed into malignant degeneration and pulmonary metastasis. 6) Tumors located around the knee and distal radius were higher in recurrence than at other sites.
Amputation ; Bone Marrow ; Curettage ; Femur ; Giant Cell Tumors ; Giant Cells ; Humans ; Humerus ; Incidence ; Knee ; Neoplasm Metastasis ; Prognosis ; Prostheses and Implants ; Radiotherapy ; Radius ; Recurrence ; Sex Distribution ; Stromal Cells ; Tibia ; Transplants

No abstract available.
Bone Marrow* ; Fibrin* ; Transplants*

Chemonucleolysis is a significant innovation in the treatment of herniated lumbar disc disease. The prodedure is relatively safe and the results are highly acceptable, but in most studies, the failure rate is 20-25%. Computed tomography was performed from January, 1986 to June, 1987 at the Department of Orthopedic Surgery, Yonsei University on six patients with herniated lumbar discs who did not improve with chemonucleolysis. The results of this study are as follows : 1. The herniated lumbar disc remained unchanged in 4 cases and was reduced in 2 cases. 2. In 2 cases of hernia reduced, the development of a diffuse annular bulging was noted and compression of the dural sac unchanged. 3. Chemonucleolysis was carried out at two levels in 2 cases and the herniated lumbar disc was not changed in these cases. 4. Thickening of the ligament flavum was noted in 1 cases. 5. Computed tomography findings after chemonucleolysis were good correlation with the clinical results in failed cases. In the cases not relieved the symptoms over 3–6 months after chemonucleolysis, it is necessary follow up computed tomography to decide the further treatment.
Follow-Up Studies ; Hernia ; Humans ; Intervertebral Disc Chemolysis ; Ligaments ; Orthopedics

In recent years, the rate of the spine fracture tends to be on the increase year by year as rate of traffic and industrial accidents are increased. 111 patients with paralysis caused by thoracic, thoracolumbar, lumbar spine injuries were evaluated from January, 1979 to December, 1988 in our study. 1. In patients with paralysis caused by thoracic, thoracolumbar, lumbar spine injuries, most common site of injuries was “thoracolumbar junction” (47.7%) and most common cause was “fall down” (48.7% ). 2. “Burst fracture” was most common type of injuries which were classified by 3-column concept according to Denis & McAfee(52.3%) 3. In early 1980's the operation was performed with Harrington rod, anterior decompression & AIF, posterior decompression & PIF and from 1984, mainly Luque sublaminar wiring, and in 1988, SSI was commonly used. 4. There was no difference in neural recovery between conservative and operative treatments. 5. There was statistic significance in the incidence of complications between conservative and operative treatments(p <0.05). 6. The more severe neurologic damage at injury, the higher incidence in complication(p<0.05). Therefore, although there was no significant difference in neural recovery between conservative and operative treatments in the care of paralysed patients caused by thoracic, thoracolumbar, lumbar spine injuries, rigid internal fixation and rapid mobilization can be recommended for decreasing complications by prologed bed rest and active rehabilitation.
Accidents, Occupational ; Bed Rest ; Decompression ; Humans ; Incidence ; Paralysis ; Rehabilitation ; Spine

The treatment of Achilles tendon rupture is controversial between surgical repair and conservative cast treatment. This study was attempted to compare the biomechanical and morphological results between operative and nonoperative treatments of experimentally tenotomized rabbit Achilles tendon with the lapse of time. A total of 72 adult rabbits were used. After tenotomizing the Achilles tendons, the subjects were divided into 3 groups according to the time of the initiation of the treatment and each group was subdivided into 2 further subgroups according to the method of treatment; immediate operation and nonoperation, 1 week delayed operation and nonoperation, and 2 weeks delayed operation and nonoperation subgroups. Ten animals from each subgroup were sacrificed after four weeks of cast immobilization and the Achilles tendons were prepared for the gross, biomechanical and histological examinations. At the same time, two animals from each subgroup were examined by Microfil perfusion for microvascular changes in the healed tendons. On biomechanical examination, maximal loads were decreased with the lapse of time in each treatment method, and there were statistical significances between the immediate and 2 weeks delayed operation subgroups, 1 week and 2 weeks delayed operation subgroups, and immediate and 2 weeks delayed nonoperation subgroups. A maximal loads were higher in the operative treatment of each group but there was no statistical significances between operative and nonoperative treatment of each group. The results of absorption energy and stiffness were similar to those of maximal load. In conclusion, these results suggest that a rupture of the Achilles tendon should be treated as early as possible preferably within 1 week, in order to achieve a high tensile strength irrespective of the treatment method. In terms of rerupture, nonoperative treatment is comparable with surgical treatment if a rupture of Achilles tendon is managed within 2 weeks of injury.
Absorption ; Achilles Tendon ; Adult ; Animals ; Humans ; Immobilization ; Methods ; Perfusion ; Rabbits ; Rupture ; Silicone Elastomers ; Tendons ; Tensile Strength