PURPOSE: The purpose of this study was to evaluate the radiologic features of juxtafacet cyst and determine the correlation between these features and clinical outcome. MATERIALS AND METHODS: We analyzed a total of 23 patients. The degree of facet joint degeneration was classified using the Fujiwara method. The facet joint angles were measured with an magnetic resonance imaging to determine whether there was a difference between the cystic lesion that was occupied and the cystic lesion that was not occupied. Disc degeneration was measured by the Pfirrmann classification method. The clinical result was evaluated using the Oswestry disability index score and visual analogue scale. RESULTS: The L4–5 level of juxtafacet cyst was mostly affected, as found in previous studies. Facet joint arthritis was more severe within the side with the cystic lesion. Significant correlation was found between disc degeneration and juxtafacet joint cyst. All patients underwent wide decompression and fusion. Clinical result was excellent. No patients had signs of recurrence during the follow-up periods. CONCLUSION: Juxtafacet cyst has a significant correlation with facet joint degeneration. Therefore, aggressive surgical treatment—not just simple cyst excision—should be considered as the treatment option for juxtafacet cyst associated with degenerative lumbar disease.
Arthritis ; Classification ; Decompression ; Follow-Up Studies ; Humans ; Intervertebral Disc Degeneration ; Joints ; Magnetic Resonance Imaging ; Methods ; Recurrence ; Zygapophyseal Joint

PURPOSE: Spinopelvic dissociation which occurs by high energy trauma with associated fractures is rare. Treatment is difficult and only a few studies on treatment of spinopelvic dissociation have been reported. Therefore we evaluated spinopelvic dissociation patients treated with iliac screw. MATERIALS AND METHODS: We analyzed patients who underwent surgery using an iliac screw from 2005 to 2010. Preoperative radiologic classification was performed using the level of the transverse fracture line of the sacrum, shape of the fracture, and Roy-Camille classification. Neurologic evaluation was performed using Gibbons classification. Eleven patients underwent surgery with a pedicle screw in 1 level (L5 to S1) and bilateral iliac screws were added. RESULTS: A total of 11 patients were included in this study. The level of the transverse fracture line of the sacrum was mainly at S2, and there were mostly type 3 or 4 in Roy-Camille classification. Bony union was checked in 11 patients without metal failure. Six of 7 patients were treated by posterior decompression. Among them, 5 patients recovered from neurological deficit and 1 patient still had a sensory disorder on both lower legs. CONCLUSION: The more displacement of fracture, the more neurologic deficit occurred. In addition, we think that aggressive surgical treatment for spinopelvic dissociation should be considered, because a good clinical result was achieved with 1 level (L5 to S1) fixation and bilateral iliac screw fixation.
Classification ; Decompression ; Humans ; Hylobates ; Leg ; Neurologic Manifestations ; Pedicle Screws ; Sacrum ; Sensation Disorders

STUDY DESIGN: Retrospective study. OBJECTIVES: To explore the risk factors and the factors associated with the neurological improvement after operation in the spontaneous spinal epidural hematoma. SUMMARY OF LITERATURE REVIEW: The cause of the spontaneous spinal epidural hematoma is unknown. The objective risk and prognostic factors are still controversial. MATERIALS AND METHODS: From January 2006 to December 2014, a total of 12 patients with spontaneous epidural hematoma were evaluated. The risk and prognostic factors analyzed were sex, age, underlying diseases, medications, neurologic status, level and extent of hematoma, cord edema, and interval from onset to surgery. We analyzed the correlation between each factor and neurologic recovery. The neurologic status was analyzed using the American Spinal Injury Association impairment scale (AIS) at the first and the last neurologic examination. RESULTS: The average age of the patients was 68.6 years. Seven patients were treated with anticoagulation therapy, and two were advised to switch to a healthier diet. The initial neurologic status of the patients was AIS A in 2 cases, B in 5 cases, C in 4 cases, D in 1 case, and in two patients, cord edema was revealed on magnetic resonance imaging (MRI). The interval of time from onset to surgery was less than 24 hours in 6 cases, 24-48 hours in 4 cases, and more than 48 hours in 2 cases. CONCLUSIONS: The prognostic factors associated with spontaneous spinal epidural hematoma were found to be initial neurologic status, cord edema on MRI, and interval from onset to surgery. We found no correlation between anticoagulation therapy or healthy diet and spontaneous spinal epidural hematoma, but anticoagulation therapy cannot be excluded as a risk factor.
Diet ; Edema ; Hematoma ; Hematoma, Epidural, Spinal* ; Humans ; Magnetic Resonance Imaging ; Neurologic Examination ; Retrospective Studies ; Risk Factors* ; Spinal Injuries

STUDY DESIGN: A case report. OBJECTIVES: To report a case of spinal extradural arachnoid cyst. SUMMARY OF LITERATURE REVIEW: Extradural arachonid cysts of the spine are a rare cause of spinal cord and nerve root compression. There are few reports about it, and the etiology remains unclear. MATERIALS AND METHODS: The authors performed a clinical and radiographic case review. RESULTS: A 56-year-old male patient presented with both lower extremity radiating pain and tingling sensation in both feet for four years. His MRI revealed a large, well-demarcated extradural lesion, isointense to cerebrospinal fluid from L1 to L3. We performed dural repair and laminectomy for partial resection of the cyst. The outcome was good in the immediate postoperative period, and the patient made a full recovery without complications. CONCLUSIONS: Surgical treatment should be considered for large spinal extradural arachnoid cysts with neurologic symptoms when conservative treatment does not work.
Arachnoid Cysts ; Arachnoid* ; Cerebrospinal Fluid ; Foot ; Humans ; Laminectomy ; Lower Extremity ; Magnetic Resonance Imaging ; Male ; Middle Aged ; Neurologic Manifestations ; Postoperative Period ; Radiculopathy ; Sensation ; Spinal Cord ; Spine

STUDY DESIGN: Cross-sectional study. OBJECTIVES: Sagittal imbalance cannot be predicted depending on the degree of lumbar lordosis. Thus, we tried to evaluate the necessity of whole spine standing lateral radiograph through comparison of the spinal and pelvic parameter between supine lumbar lateral radiograph and whole spine standing lateral radiograph. SUMMARY OF LITERATURE REVIEW: No studies in the literature compare supine lumbar lateral radiograph and whole spine standing lateral radiograph. MATERIALS AND METHODS: We randomly selected 50 males and 50 females among the patients over the age of 50 who visited our hospital for outpatient due to degenerative lumbar disease. Lumbar lordosis (sLL/wLL), sacral slope (sSS/wSS), and pelvic tilt (sPT/wPT) were measured and compared respectively by supine lumbar lateral radiograph and whole spine standing lateral radiograph. We categorized as group AI (sLL<30degrees) and group AII (sLL> or =30degrees) by supine lumbar lateral radiograph and analyzed them. We also categorized as group BI (SVA< or =5 cm) and group BII (SVA>5 cm) by whole spine standing lateral radiograph and analyzed them. RESULTS: There were no statistical difference in lumbar lordosis (sLL/wLL: 35.1degrees/37.7degrees) and pelvic parameter (sSS/wSS: 32degrees/31.7degrees, sPT/wPT: 24.3degrees/24.2degrees. sPI/wPI: 56.3degrees/58.2degrees) between supine lumbar lateral radiograph and whole spine standing lateral radiograph, and there were also no statistical difference between two groups (group AI & AII) in SVA, lumbar lordosis and pelvic parameter. Pelvic parameter compared by supine lumbar lateral radiograph and whole spine standing lateral radiograph based on sagittal balance was no significant difference, but lumbar lordosis appeared statistical difference. CONCLUSION: Sagittal imbalance appears quite a lot in patients with degenerative lumbar disease and supine lateral radiograph can't reflect the whole sagittal imbalance. So, whole spine standing lateral radiograph should be performed routinely to analyze the sagittal alignment.
Adult* ; Animals ; Cross-Sectional Studies ; Female ; Humans ; Lordosis ; Male ; Outpatients ; Spine*

STUDY DESIGN: A retrospective-based study. OBJECTIVES: To evaluate the usefulness of iliac screws in the surgical correction of sagittal imbalance by changes of spinopelvic parameters. SUMMARY OF LITERATURE REVIEW: Although reports exist regarding the fusion rates on lumbosacral fusion by iliac screws, no previous studies address the issue of changes of spinopelvic parameters on surgical correction of sagittal imbalance by iliac screws. MATERIALS AND METHODS: We analyzed a total of 23 patients who were operated on by pedicle subtraction osteotomy and posterior fusion on sagittal imbalance. Patients were divided into two groups: 1) non-iliac screw fixation and; 2) iliac screw fixation. The two groups were compared during the preoperative and postoperative stages, and the last follow-up spinopelvic parameters of two groups. RESULTS: Spinopelvic parameters, except for pelvic incidence, were corrected after surgery; some corrected values of spinopelvic parameters were lost during follow-up. There was a statistically significant difference in the last follow-up period between lumbar lordosis and pelvic tilt. Values of postoperative lumbar lordosis and pelvic tilt was similar to each other; however, during the follow-up period corrected values of spinopelvic parameters of non-iliac screw fixation group were more lost. There were no statistically significant changes in postoperative and last follow-up sacral slope and pelvic incidence. CONCLUSIONS: Sagittal imbalance could be corrected by pedicle subtraction osteotomy, and corrected values of lumbar lordosis and pelvic tilt of iliac screw fixation group could be maintained well compared to non-iliac screw fixation. Iliac screw fixation could be useful for maintenance of corrected values of spinopelvic parameters in surgical correction of sagittal imbalance.
Animals ; Follow-Up Studies ; Humans ; Incidence ; Lordosis ; Osteotomy

The use of quinolone for treatment of rickettsial diseases remains controversial. Recent clinical studies suggest that quinolone is not as effective as others in patients with rickettsial diseases including scrub typhus, although the mechanism is not well understood. In this study, we evaluated the mutation in gyrA associated with quinolone resistance. We prospectively enrolled scrub typhus patients, collected blood samples and clinical data from October, 2010 to November, 2011. Among the 21 patients enrolled, one initially received ciprofloxacin for 3 days but was switched to doxycycline due to clinical deterioration. We obtained the gyrA gene of Orientia tsutsugamushi from 21 samples (20 Boryong strain, 1 Kato strain) and sequenced the quinolone resistance-determining region. All of 21 samples had the Ser83Leu mutation in the gyrA gene, which is known to be associated with quinolone resistance. This suggests that quinolones may be avoided for the treatment of serious scrub typhus.
Aged ; Aged, 80 and over ; Amino Acid Sequence ; Anti-Bacterial Agents/*therapeutic use ; Bacterial Proteins/*genetics ; Ciprofloxacin/*therapeutic use ; DNA Gyrase/*genetics ; Doxycycline/therapeutic use ; Drug Resistance, Bacterial ; Female ; Genotype ; Humans ; Male ; Middle Aged ; Molecular Sequence Data ; Mutation ; Orientia tsutsugamushi/classification/enzymology/*genetics ; Phylogeny ; Prospective Studies ; Scrub Typhus/*drug therapy ; Sequence Alignment ; Sequence Analysis, DNA

STUDY DESIGN: This is a retrospective study. OBJECTIVES: We analyzed the risk factors and the surgical results for adjacent segment disease after lumbar fusion. SUMMARY OF LITERATURE REVIEW: Many studies have been performed about the risk factors for adjacent segment disease, but the findings are still controversial. MATERIALS AND METHODS: This study was carried out on 35 (13 men, 22 women) of 50 patients who underwent lumbar fusion due to adjacent segment disease with a minimum of 2 year follow-up period from July 1999 to July 2006. The differences of the interval to revision (IR) were statistically analyzed by the examining preexisting degenerative change in the adjacent segments on MRI, the number of fused segments, the lumbar lordosis and the sagittal balance. The surgical outcomes of reoperation were assessed by Brodsky's criteria. RESULTS: Junctional stenosis as adjacent segment disease was seen in 21 cases (60%) and instability was seen in 14 cases (40%), including 2 iatrogenic flat backs and 2 cases of lumbar degenerative kyphosis. The average IR was 93 months for the cases that had less than 2 segment fusion (20 cases) and 62 months in those with more than 3 segment fusion (15 cases). As for lumbar lordosis, 25 cases (71%) had a normal range of angle as well as 101 months until the IR and 10 cases (29%) had an abnormal range of angle as well as 64 months until IR. Six cases were beyond the normal range of sagittal balance (17%) and their average IR value was 59 months. Otherwise, the cases with a normal range of sagittal balance had 109 months for the IR. The clinical outcome was excellent in 6 cases (17%) and good in 15 cases (43%). CONCLUSION: To decrease the adjacent segment disease, we should seriously consider the extent of lumbar fusion and we should restore the angle in lumbar lordosis to the physiological range and the sagittal balance during the initial operation.
Animals ; Constriction, Pathologic ; Ethylenes ; Follow-Up Studies ; Humans ; Kyphosis ; Lordosis ; Male ; Reference Values ; Reoperation ; Retrospective Studies ; Risk Factors

STUDY DESIGN: This study is a prospective, clinical study for lumbar degenerative kyphosis. PURPOSE: To determine the factors affecting postoperative clinical outcomes in patients who undergo corrective osteotomy for lumbar degenerative kyphosis. OVERVIEW OF LITERATURE: Only a small number of studies have reported clinical results for surgery for lumbar degenerative kyphosis. There are almost no studies about prognostic factors that predict postoperative clinical results. METHODS: This study involved 25 patients who were diagnosed with lumbar degenerative kyphosis and who underwent corrective osteotomy following gait analysis. A pedicle subtraction osteotomy was done at the third lumbar vertebra (L 3). Regarding the fusion level, surgery was done within a range from T10 proximally to S1 distally. Of these, for rigid fixation of a distal part, an iliac screw was used. Pain was evaluated using a 10-point pain scale and a questionnaire about activities. We also evaluated cosmesis and subjective satisfaction using a modified version of the Scoliosis Research Society Outcome-22 (SRS-22) instrument. This assessment was done using a 5-point scale which was designed by us. We assigned patients to group A (good clinical outcomes) if their postoperative pain score was lower than 4 (of 10 points) and if scores indicating activity, cosmesis and subjective satisfaction were higher than 11 (of 15 points). All other patients were assigned to group B (poor clinical outcomes). RESULTS: Clinical outcomes were good in 64% of patients (16/25) and poor in 36% (9/25). Regarding cosmesis and subjective satisfaction, there were significant differences between the two groups. There were also significant differences in physical factors of individual patients such as body mass index (BMI): 23.78 +/- 2.79 in group A and 26.44 +/- 2.75 in group B. On gait analysis, there was a significant difference in the dynamic pelvic tilt: 7.5 +/- 3.3degrees in group A and 11.72 +/- 1.89degrees in group B. CONCLUSIONS: There is no correlation between preoperative degree of kyphotic deformity and clinical outcomes. The degree of anterior rotation of pelvic tilt does not change significantly; rather, compensatory mechanisms of the pelvis and BMI were found to have more influence. Because neither the degree of satisfaction with clinical outcomes nor the increased activity was relatively higher, a more sincere decision should be made before recommending corrective osteotomy for degenerative lumbar kyphosis.
Body Mass Index ; Congenital Abnormalities ; Gait ; Humans ; Kyphosis ; Osteotomy ; Pain, Postoperative ; Pelvis ; Prospective Studies ; Scoliosis ; Spine ; Surveys and Questionnaires

STUDY DESIGN: This is a retrospective study OBJECTIVES: We radiologically analyzed the correction of the sagittal imbalance and the proximal fusion level to prevent correction loss and the usefulness of iliac screws in LDK. SUMMARY OF THE LITERATURE REVIEW: Complications can be encountered during fixation and fusion as most of the LDK patients are aged, and the osteoporosis that causes fixation loss is known to affect the loss of correction. MATERIALS AND METHODS: We analyzed the cause of correction loss among 35 patients who underwent surgery and who were followed up for at least 1 year. All the patients had performed gait analysis before operation. The operative techniques were pedicle subtraction osteotomy and fixation to S1. For analyzing causes of correction loss, we analyzed the degrees of lumbar lordosis for the sagittal correction and the degrees of the preoperative thoracolumbar kyphosis for the proximal fusion range. For analyzing the usefulness of iliac screws, the subjects were divided into two groups: 1) the -iliac screw (23cases) group for the patients who were fixed without iliac screws and 2) the +iliac screw (12cases) group for the patients who were fixed with iliac screws. RESULTS: There were no patients who had marked anterior pelvic tilt. It is important to correct the lumbar lordosis over 20degrees compared with the preoperative thoracic kyphosis. There are 10 cases of preoperative thoracolumbar kyphosis > or = 10degrees and 25 cases of preoperative thoracolumbar kyphosis < 10degrees of the total 35 cases. Among 10 cases of preoperative thoracolumbar kyphosis > or = 10degrees, 4 cases that were fixed to T10 had no sagittal correction loss, and 2 of the 6 cases that were fixed to T11 or T12 had sagittal correction loss. For the 25 cases of preoperative thoracolumbar kyphosis < 10degrees, 5 cases that were fixed to T10 had no sagittal correction loss and 1 of the 20 cases that were fixed to T11 or T12 had sagittal correction loss (p<0.05). 6 cases (26%) in the -iliac screw group (23 cases total) and 1 case (8%) in the +iliac screw (12 cases total) showed sagittal correction loss (p<0.05). CONCLUSIONS: It is important to make the postoperative lumbar lordosis over 20degrees compared with the preoperative thoracic kyphosis for correcting sagittal imbalance, to decide on the proximal fixation level according to the preoperative thoracolumbar kyphosis and to fix with iliac screws.
Aged ; Animals ; Gait ; Humans ; Kyphosis ; Lordosis ; Osteoporosis ; Osteotomy ; Retrospective Studies