No abstract available.
Humans

STUDY DESIGN: This is a retrospective study analyzing survivorship of pedicle screw fixation in various spinal lesions. OBJECTIVES: To determine the survivorship of pedicle screw fixation and to assess the risk factors for the death of system. SUMMARY OF LITERATURE REVIEW: The previous reports of ten years survival rate of pedicle screw instruments was about eighty percent and the factors which influenced were bone quality, strength of instruments, design of instruments and compliance of patients. MATERIALS AND METHODS: Three hundred and thirty-eight patients(178 males and 160 females), treated by pedicle screw fixation from May 1988 to Dec. 1997, were analysed. Follow-up averaged 26.8months(3 to 116 months). The survival rates according to spinal lesions which caused spinal fixation, types of instruments, level of fusion and methods of fusion were predicted by life table method. The criteria of death were 1)breakage of screw or rod 2)gross bending of screw >5 degree 3)screw pullout and 4)dissociation of rod-screw coupling mechanism. RESULTS: Death of instrumentation was identified in twenty-six patients(7.7%). Of the 1,827 screws used, forty-three screws(2.4%) in twenty patients had broken(28) or bent(15). Thirty-nine Cotrel-Dubousset screws(3.5%) and four Diapason screws(1.6%) had involved. Four patients showed pullout of screws and two had dissociation of rod and screw. There was no rod broken. Life table calculations predicted the survivorship of instrumentation would be 88.7% at 10 years of follow-up. Single segment fixation showed higher survival rate than more than three segments fixation(93.3% vs 83.4%). Fracture had the lowest survival rate(78.3%). Screw failure was not influenced by the method of fusion. Suspected causes of death were collapse of disc space(12 patients), increased kyphosis(6), forceful reduction of fracture(3), infection(2), nonunion(2) and trauma(1). CONCLUSIONS: Ten year survival rate of pedicle screw fixaion was 88.7%. The survival rate was influenced by 1)number of fixed segments 2)cause of fixation .
Cause of Death ; Compliance ; Follow-Up Studies ; Humans ; Life Tables ; Male ; Retrospective Studies ; Risk Factors ; Survival Rate*

STUDY DESIGN: This is a retrospective study comparing the radiologic results of sacral fixation using anteromedially directedsingle screw and triangulated double sacral screws. OBJECTIVES: To know whether the single screw fixation is enough for short level lumbosacral fusion. SUMMARY OF LITERATURE REVIEW: Method of sacral fixation is one of a hot issue in spinal instrumentation because of high complication rate. So, many kinds of sacral fixation methods were developed for long level spinal instrumentation. But, it is unclear whether we should use the special sacral fixation techniques instead of simple single screw fixation for the short level lumbosacral fusion. MATERIALS AND METHODS: Inclusion criteria of this study were fixation down to sacrum or sacralized L5, less than three segments fixation and minimum radiologic follow-up for one year. Of those patients treated with lumbosacral fixation using pedicle screw instrumentation from March 1989 to June 1998, forty-four patients met these criteria. They were divided into two groups according to the method of sacral fixation, Group I for single screw fixation and Group II for double screw fixation. Number of patients were 37 in Group I and 7 in Group II. The mean follow-up was 36.5 and 66.6 months, respectively. The radiologic results were evaluated by metal failure, change of lumbar lordosis, change of lumbosacral angle and change of L5-S1 disc space height. RESULTS: metal failure were identified in five patients(13.5%), all in sacral screws of Group I. There were 4 screw breakages and 1 screwrod dissociation. The change of lumbar lordosis was averaged 2.3 degrees(-17~38) in Group I and -4.0 degrees(-25~17) in Group II(p=0.194). The change of lumbosacral angle was averaged 2.3 degrees(-7~12) and 3.7 degrees(-1~12), respectively(p=0.596). The change of disc height was 5.6%(-13~33) and 8.8%(-5~16), respectively(p=0.381). CONCLUSIONS: Group I has much higher rate of instrumentation failure than Group II and all the instrumentation failures were occured at sacral screws. Other radiologic measurements were not statistically significant between the two groups. Stable fixation of the sacrum is necessary to prevent instrumentation failure at the sacrum even though the fusion is less than three levels.
Animals ; Follow-Up Studies ; Humans ; Lordosis ; Retrospective Studies ; Sacrum

STUDY DESIGN: This is a retrospective study analyzing early problems of open discectomy for lumbar intervertebral disc herniation. OBJECTIVES: To analyse the incidence of intraoperative and postoperative problems developed within six weeks and their relationship with reoperation and prognosis. MATERIALS AND METHODS: Hundred and ninty-four patients with intervertebral disc herniation, treated by open discectomy from April 1987 to December 1997, were assessed for intraoperative and postoperative problems. The problems were classified into three degrees : major, moderate and minor problem. when the problem was related to readmission, reoperation and prolonged admission for more than six weeks, it was classified as major problem. When the problem was related to prolongation of duration of admission for two to six weeks, it was classified as moderate problem. When the problem was not related to any prolongation of duration of admission, it was classified as minor one. RESULTS: Seven intraoperative and twenty-three postoperative problems were developed in twenty-seven patients. There were seven major problems : three recurrence of symptom and four suspicious deep infections. Nine moderate problems : six remained radiating pain, two serous discharge from operative wound and one urinary tract infection. and remained fourteen were minor problems : two recurrent symptom, two persistent pain, three serous discharge and seven intraoperative complications. CONCLUSIONS: The early major problems of open discectomy were recurrence of intervertebral disc herniation and deep infections. Problems with remainded radiating pain usually don't need reoperation and those symptoms were relieved with time goes. The prognosis was not influenced by minor problems.
Diskectomy* ; Humans ; Incidence ; Intervertebral Disc* ; Intraoperative Complications ; Prognosis ; Recurrence ; Reoperation ; Retrospective Studies ; Urinary Tract Infections ; Wounds and Injuries

STUDY DESIGN: A case report and review of the literature. OBJECTIVES: To discuss the iatrogenic intradural-extramedullary epidermoid cyst and review the literatures. SUMMARY OF LITERATURE REVIEW: Intradural epidermoid cyst has two types of lesions, congenital and iatrogenic. The former is fre-quently associated with bone or skin malformations(spina bifida. etc) and the latter resulting from lumbar puncture, due to direct implantation of epithelial cell by puncture needle. MATERIALS AND METHODS: A 13-year-old boy had pain radiating down to the right lower extremity and hypoesthesia on the anterolateral aspect of right thigh. Straight leg raising was markedly limited. T1 weighted image reveals round intradural mass on L3-4, which was not enhanced by gadolinium. He had the history of spinal tapping two and a half years ago for the work-up of headache. RESULTS: The mass was excised through posterior approach and midline durotomy. It was whitish ovoid mass, measuring 2x1.5x1.5cm in size and histologically diagnosed as epidermoid cyst consisting of keratinous material and cholesterol. All the symptoms were completely relieved at 16 months follow-up. CONCLUSIONS: A case of iatrogenic epidermoid cyst was successfully treated by excision. Epidermoid cyst must be ruled out if space occupying lesion exists in lumbar spine and patients complaining of lower back pain.
Adolescent ; Cholesterol ; Epidermal Cyst* ; Epithelial Cells ; Follow-Up Studies ; Gadolinium ; Headache ; Humans ; Hypesthesia ; Leg ; Low Back Pain ; Lower Extremity ; Male ; Needles ; Punctures ; Skin ; Spinal Puncture ; Spine ; Thigh

OBJECTIVE: Korea Institute of Drug Safety and Risk Management works for signal detection and safety information generation by analyzing spontaneous adverse event reports database. As the number of reports and detected signals of aripiprazole by each data mining indices were more than other drugs, aripiprazole was selected as a subject of study. METHODS: 1989-2012 spontaneous reporting database was analyzed and the model drug ingredient was aripiprazole. We estimated proportional reporting ratio, reporting odds ratio, and information component for data mining. Then we assessed the causality through review of local and foreign drug labels and literatures. RESULTS: In reconstructed 1989-2012 spontaneous reporting database, there were 2,062 reports on aripiprazole and 2,565 aripiprazole-adverse events pairs. As a result of data mining analysis and signal prioritization, 78 adverse events were detected, 20 adverse events of them were not included in drug label. After literature review, back pain, epistaxis, xerophthalmia and ejaculation disorder were generated as novel safety information on aripiprazole. CONCLUSION: Those 4 novel safety informations of Aripiprazole, back pain, epistaxis, xerophthalmia and ejaculation disorder had become listed on the local label in April 2013.
Back Pain ; Data Mining ; Ejaculation ; Epistaxis ; Korea ; Male ; Odds Ratio ; Risk Management ; Xerophthalmia ; Aripiprazole

PURPOSE: The aim of this study was to evaluated biphasic calcium phosphate applied in surgically created 1-wall periodontal intrabony defects in dogs by histometrical analysis. MATERIAL AND METHOD: Critical sized(4 mm x 4 mm), one wall periodontal intrabony defects were surgically produced at the proximal aspect of mandibular premolars in either right and left jaw quadrants in four canines. The control group was treated with debridement alone, and experimental group was treated with debridement and biphasic calcium phosphate application. The healing processes were histologically and histometrically observed after 8 weeks. RESULTS: In biphasic calcium phosphate group, more new bone and cementum formation, less epithelium and connective tissue attachment were observed compared to other groups. But there was no statistical significance. CONCLUSION: Though the statistically significant difference could not be found, it seemed that there was more new bone and cementum formation with applying biphasic calcium phosphate in 1 wall intrabony defects in dogs by preventing junctional epithelium migration.
Animals ; Bicuspid ; Calcium ; Connective Tissue ; Debridement ; Dental Cementum ; Dogs ; Epithelial Attachment ; Epithelium ; Hydroxyapatites ; Jaw

STUDY DESIGN: A case report and review of the literature. OBJECTIVES: To discuss the chondroblastoma of the lumbar spine and review the literatures. MATERIALS AND METHODS: A 36-year-old woman had back pain and pain radiating to the left lateral abdomen. Straight leg rais-ing was not limited. Plain roentgenograms show a small round radiolucent area in left L1 vertebral pedicle and expansile sclerotic margin in L1 vertebral body. T1-weighted MR images show the lesion displaying low signal intensity, T2-weighted images show high signal intensity, Gadolinium enhanced images show a necrotic area with low signal intensity in the lesion. RESULTS: The mass of left L1 transverse process and pedicle was excised through posterior approach and pedicle screws were inserted T12 and L2 pedicle. L1 vertebral body was excised through anterior approach and a titanium mesh was inserted. It was a ovoid mass, measured 2.3 x 2 x 1.5 cmcm in size and histologically diagnosed as chondroblastoma consisting of chondroid matrix and chondroblast. Soft tissue nodule shows chicken-wire calcification. All the symptoms were relieved at 14 months follow-up and no evidence of recurrence on follow-up roentgenogram and bone scan. However, the patient had persistent lower back pain. CONCLUSIONS: A case of chondroblastoma in L1 vertebral body was successfully excised by combined anterior and posterior approach and stabilized with a titanium meh.
Abdomen ; Adult ; Back Pain ; Chondroblastoma* ; Chondrocytes ; Female ; Follow-Up Studies ; Gadolinium ; Humans ; Leg ; Low Back Pain ; Recurrence ; Spine* ; Titanium

STUDY DESIGN: This is a retrospective study determining the surgical result of lumbar HIVD associated with spondylolysis. OBJECTIVES: To analyze the incidence of lumbar HIVD associated with spondylolysis and to compare the results of open discectomy for lumbar HIVD associated with spondylolysis to simple lumbar HIVD. SUMMARY OF LITERATURE REVIEW: Lumbar HIVD associated with spondylolysis need be treated by spinal fusion. MATERIALS AND METHODS: Nine patients(5 males and 4 females) who had lumbar HIVD with spondylolysis, no instability, fol-low-up period of 1yr were identified out of 273 patients with lumbar HIVD, treated by open discectomy from March 1989 to Feb. 1999. The type of HIVD and level of spondylolysis were evaluated, the clinical symptoms and signs including SLR, motor deficit, sensory deficit, change of DTR and severity of radiating pain were periodically followed up on the predesigned protocol. RESULTS: The incidence of lumbar HIVD associated with spondylolysis is 3.7%. The recovery of back pain was 2.1 to 2.1 by visu-al analogue scale, radiating pain was 7.6 to 0.8. The recovery rate of SLR was 100%, motor deficit; 100%, sensory deficit; 85%, change of DTR; 40%. The clinical evaluation was excellent(2), good(6), fair(1). CONCLUSIONS: According to the recovery rate of the clinical symptoms, the results of open discectomy for lumbar HIVD associ-ated with spondylolysis without spinal instability and simple HIVD was not different. Therefore, we conclude that lumbar HIVD associated with spondylolysis need not be treated by spinal fusion.
Back Pain ; Diskectomy ; Humans ; Incidence ; Male ; Retrospective Studies ; Spinal Fusion ; Spondylolysis*

STUDY DESIGN: Retrospective study on 12 cases of intradural extramedullary tumor. OBJECTIES : To analyze the clinical symptoms and the outcome of the treatments in the 12 patients who had intradural extramedullary tumors. SUMMARY OF LITERATURE REVIEW : In order to provide a good prognosis and achieve a satisfactory clinical outcome for the treatment of intradural extramedullary tumors, early diagnosis and careful surgical resection is necessary. MATERIALS AND METHODS: Twelve cases of intradural extradmedullary tumors were treated surgically from September 1990 to July 2000. Of the 12 cases, 7 were male and 5 were femal. Average follow-up period was 37 months. Mean age of the cases was 48.3 years. The followings were analyzed; 1)histopathologic diagnoses, 2)locations of tumors, 3)clinical findings, 4)duration of symptoms, and 5)radiologic findings. In addition, both changes of symptoms as well as neurologic findings during the preoperative stage and the postoperative follow-up were evaluated according to the Frankel's and Kim 's criteria. RESULTS: Histiopathologic results were as follows; 6 cases (50%) confirmed as schwannoma, 3 cases (25%) as meningioma, 1 case as epidermoid cyst, 1 case as neurofibroma, and 1 case as arachnoid cyst. Locations of tumors were as follows; 6 cases (50%) located in the thoracic region, 4 cases (33%) located in the lumbar, 1 case located in the cervical region, and 1 case located in the sacrum. Clinical findings were as follows: 6 cases complained of back pain and radiating pain to leg, 6 cases noticed motor weaknesses and sensory changes of varying degrees. The average duration from initial symptoms to admission was 57 months (23-140 months). Laminectomy and complete resection of tumors were performed in all cases. Posterior spinal fusion with instrumentation was necessary only in one case. The preoperative Frankel's grades were as follows; 6 cases were in grade C, 4 cases in grade D, and 2 cases in grade E. At the final follow-up, all cases were graded as E . CONCLUSION: The Early diagnosis and careful surgical resection for intradural extramedullary tumors provide for a good prognosis as well as a positive clinical outcome. Intradural tumors should be included in the differential diagnosis of spine diseases and considered as a subdivision of orthopaedic spine surgery.
Arachnoid ; Back Pain ; Diagnosis ; Diagnosis, Differential ; Early Diagnosis ; Epidermal Cyst ; Follow-Up Studies ; Humans ; Laminectomy ; Leg ; Male ; Meningioma ; Neurilemmoma ; Neurofibroma ; Neurologic Manifestations ; Prognosis ; Retrospective Studies ; Sacrum ; Spinal Fusion ; Spine