No abstract available.
Longitudinal Ligaments*

No abstract available.
Fatigue* ; Sciatica*

No abstract available.

Vertebroplasty was introduced in 1987 for painful cervical hemangioma. Since then, there has been an explosion of interest in this remarkable procedure, which can be useful for the majority of vertebral fractures throughout the spinal column. This procedure is indicated for painful vertebral compression fracture(VCF) due to osteoporosis or malignancy, and for painful hemangiomas. Vertebroplasty is the injection of bone cement, generally polymethylmethacrylate (PMMA), into a vertebral body (VB). Kyphoplasty is the placement of balloons into the VB, followed by an inflation/deflation sequence to create a cavity prior to the PMMA injection. These procedures are most often performed in a percutaneous fashion under local anesthesia. Although these methods are minimally invasive procedure, numerous complications can occur. The common complications include bleeding at the puncture site, PMMA leakage, local infection, and adjacent vertebral body fracture. A grave complication, which is rarely reported, is pulmonary embolism by PMMA leakage. These procedures can reduce pain in about 90% of patients with osteoporotic VCFs. Additionally, improvements in mobility and in activities of daily living occur. The success rate is slightly less in patients with metastatic VCFs than osteoporotic VCFs. Much evidence favors the use of these procedures for pain associated with the aforementioned disorders. The risk/benefit ratio appears to be favorable in carefully selected patients. This article summarizes the indications, techniques, complications and outcomes for the vertebroplasty and kyphoplasty.
Activities of Daily Living ; Anesthesia, Local ; Explosions ; Hemangioma ; Hemorrhage ; Humans ; Kyphoplasty ; Osteoporosis ; Polymethyl Methacrylate ; Pulmonary Embolism ; Punctures ; Spine ; Vertebroplasty

The authors have experienced 62 cases of chronic subdural hematoma from Jan. 1987 to May 1992 at National Medical Center. In these cases, 58 cases of chronic subdural hematoma were treated with burr hole and closed draninage, 4 cases were managed with conservative management. Male was predominant to female with the ratio of 6:1 and common age was 50-60 years old. Most common causes was head injury and there was cases of chronic subdural hematoma developed after shunt operation. Common symptom was mental change and headache. Brain expansion was delayed in old age group(over 50 years old), Brain CT was available in diagnosis but brain MRI was useful in diagnosis of scantly chronic subdural hematoma. Surgical outcome was related to preoperative neurologic grade and time interval of diagnosis. In this study, clinical improvement rates was 88% in surgically treated cases.
Brain ; Craniocerebral Trauma ; Diagnosis ; Female ; Headache ; Hematoma, Subdural, Chronic* ; Humans ; Magnetic Resonance Imaging ; Male

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

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*

Two hundreds and four consecutive patients who sustained proven spontaneous subarachnoid hemorrhage with conservative treatment were studied retrospectively. The reasons for conservative treatment were poor condition for surgery, difficulties in surgery and operation refusal. Comparative study was done in proven 47 cases of aneurysmal SAH, 27 cases of SAH with negative angiography and 130 cases of SAH without angiography about age, aneurysm site & size, neurologic grade mortality & morbidity, etc. Death had occurred in 2 weeks after attack predominantly. Rebleeding was most common cause of mortality(64%, 68/107). Survivals had good quality of life(73%, 19/26).
Aneurysm ; Angiography ; Disulfiram ; Follow-Up Studies* ; Humans ; Mortality ; Retrospective Studies ; Subarachnoid Hemorrhage

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*

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