OBJECTIVE: The authors evaluate the differences in the pedicle screw pull-out strength between an unaugmented screw and a screw augmented by high pressurized PMMA in an embalmed human lumbar cadaveric spine. METHODS: Pedicle screws were inserted in the 50 pedicles of cadaver lumbar spine after measuring the bone mineral density(BMD) of the specimens. The pedicle screw was inserted without augmentation on the left pedicle and with augmentation by a vertebral reconstruction with high pressurized PMMA on the right side. The pedicle screw was inserted before the hardening of bone cement on the right side. A computed tomographic scan was done to evaluate the location of the PMMA and PMMA/ screw interface. After that, a screw pullout strength test was performed. RESULTS: There were positive correlations between the pull-out strength and BMD in the control group (r=0.7339). The average pull-out strength of the augmented group was 168% greater than that of the control group(p<0.05). The pull-out strength of the augmented group was correlated with in the volume of the PMMA. CONCLUSION: A pedicle screw that is augmented with PMMA will provide a more rigid fixation than that of an unaugmented screw, especially in the low BMD group of the specimens.
Cadaver* ; Humans ; Polymethyl Methacrylate ; Spine

No abstract available.
Leukemia, Myeloid, Acute* ; Sarcoma, Myeloid*

OBJECTIVE: The authors describe four patients in whom we performed a single stage, pedicle subtraction and extension wedge osteotomy for the correction of sagittal imbalance by creating lumbar lordosis. METHODS: One patient presented with congenital hemivertebra, one with post-laminectomy kyphosis, and two with lumbar degenerative kyphosis. All patients suffered from back pain and were unable to walk due to forward stooping of the trunk. We performed a single stage, pedicle subtraction and extension wedge osteotomy for the correction of sagittal imbalance. RESULTS: The angles of correction were 37, 44, 45, and 49 degrees. No case had any neurologic complication. All patients reported complete relief of back pain and were able to upright standing. CONCLUSION: Single-level wedge osteotomy and reduction provide excellent sagittal correction of rigid kyphotic deformities in the lumbar lesion without neurologic compromise.
Animals ; Back Pain ; Congenital Abnormalities* ; Humans ; Kyphosis ; Lordosis ; Osteotomy* ; Spine*

No abstract available.
Neoplasm Metastasis* ; Vertebroplasty*

Sagittal imbalance in adult population has a significant impact on health-related quality of life. Successful surgical treatment of sagittal plane deformities is crucial because it can significantly improve patient's quality of life. However, this reconstructive surgery for deformity is challenging for both patient and physician. Osteoporosis and systemic disease are important considerations in preparation of the surgery because they may be associated with the relatively high rate of complications. Therefore, careful planning of the meticulous surgical technique and vigilant postoperative follow-up may help in minimizing the occurrence of complications and optimizing the patients' out- comes.
Adult ; Congenital Abnormalities ; Follow-Up Studies ; Humans ; Osteoporosis ; Quality of Life

We report a case of 21-year-old woman with atypical form of spinal tuberculosis. The patient had simultaneous involvement of C2, T4, T10, T11, L1-3 and S2, which resembles spinal malignancies. In this patient, pulmonary tuberculosis was not detected. However, biopsy revealed tuberculosis. The patient was treated successfully with surgery followed by anti-tuberculosis therapy. It is important to be aware that spinal tuberculosis may resemble spinal malignancy.
Biopsy ; Female ; Humans ; Tuberculosis ; Tuberculosis, Pulmonary ; Tuberculosis, Spinal* ; Young Adult

Intramedullary epidermoid tumors are rare. To our knowledge, this is the first description of a multiple intraspinal epidermoid tumor, including the intramedullary conus medullaris and an intradural lesion in the lumbar spine. The authors report the case of a 43-year-old woman presenting with progressive paraparesis. A thoraco-lumbar lesion was confirmed as an epidermoid cyst from histopathology. The clinical, radiological and surgical features, as well as a brief critical review of the literature are included.
Adult ; Conus Snail* ; Epidermal Cyst* ; Female ; Humans ; Paraparesis ; Spine*

OBJECTIVE: Two findings easily found at coronal source images of MR myelography (MRM) were evaluated : dorsal root ganglion (DRG) swelling and running course abnormality (RCA) of L5 exiting root at foramen or extraforamen. We tried to find the sensitivity of each finding when root was compressed. METHODS: From 2004 July to 2006, one hundred and ten patients underwent one side paraspinal decompression for their L5 root foraminal or extraforaminal compression at L5-S1 level. All kinds of conservative treatments failed to improve leg symptom for several months. Before surgery, MRI, CT and MRM were done. Retrospective radiologic analysis for their preoperative MRM coronal source images was done to specify root compression sites and L5 root morphologic changes. RESULTS: DRG swelling was found in 66 (60%) of 110 patients. DRG swelling has statistically valuable meaning in foraminal root compression (chi-square test, p < 0.0001). Seventy-two (66%) in 110 patients showed abnormal alteration of running course. Abnormal running course has statistically valuable meaning in foraminal or extraforaminal root compression (chi-square test, p < 0.0001). CONCLUSION: Three-dimensional MRM provides precise thin sliced coronal images which are most close to real operative views. DRG swelling and running course abnormality of L5 exiting root are two useful findings in diagnosing L5 root compression at L5-S1 foramen or extraforamen. MRM is thought to provide additional diagnostic accuracy expecially in L5-S1 foraminal and extraforaminal area.
Decompression ; Diagnosis-Related Groups ; Ganglia, Spinal ; Humans ; Leg ; Myelography ; Retrospective Studies ; Running

A benign fibrous histiocytoma (BFH) is one of the fibrohistiocytic groups of soft-tissue tumors for which spinal involvement is extremely rare. To the best of our knowledge, most spine-originating BFHs are bone tumors. We report the first case of BFH occurring in the intraspinal extradural space on the lumbar spine. A 66-year-old female presented with severe claudication symptom. The preoperative magnetic resonance images showed a huge intraspinal, extradural, thecal-sac-compressing soft-tissue tumor that extended along the right L5 root to the neural foramen. The tumor was a relatively well-marginated, inhomogeneous soft-tissue mass with some fluid-containing cystic portions that were well enhanced by the gadolinium contrast dye. After a total facectectomy, the tumor was removed completely. The patient had a good neurological recovery without complications, and no recurrence was noted at the 6-month follow-up.
Aged ; Female ; Follow-Up Studies ; Gadolinium ; Histiocytoma ; Histiocytoma, Benign Fibrous ; Humans ; Lumbar Vertebrae ; Magnetic Resonance Spectroscopy ; Recurrence ; Soft Tissue Neoplasms ; Spine

OBJECTIVE: The goal of this study is to establish the anatomical criteria of the normal and stenotic lumbosacral extraforaminal tunnel, and also to determine the effect of the pathologic intervertebral disc on the size of extraforaminal tunnel in the lumbosacral spine. METHODS: MRI and CT scans were reviewed and classified into two groups: (1) 40patients with normal discs at L5-S1 (Group 1) and (2) 43 patients that had undergone successful decompression surgery for extraforaminal entrapment at the lumbosacral region(Group 2). In these two groups, the following parameters were compared are compared: the distance between the disc margin and the ala (lumbosacral tunnel) on the axial MRI, and the posterior disc height at L5-S1 on the mid-sagittal MRI. RESULTS: In the group 1, the mean distance of the lumbosacral tunnel on the axial MRI was 10.1+/-2.2mm. The mean posterior disc height at L5-S1 was 7.4+/-1.7mm on the mid-sagittal MRI. In the group 2, the mean distance between the disc margin and the ala (costal process) was 1.6+/-1.3mm on the axial MRI. The average posterior disc height was 4.4+/-1.5mm on the mid-sagittal MRI. The posterior disc height and the size of the lumbosacral tunnel between the two groups were statistically different on the paired t-test (p<0.0001). However, the posterior disc height was not positively correlated with the size of the extraforaminal tunnel for group 2 (p=0.909). CONCLUSION: The extraforaminal stenosis was correlated to pathologic disc. However, the posterior disc height was not correlated to the size of the of the extraforaminal tunnel.
Constriction, Pathologic ; Decompression ; Humans ; Intervertebral Disc ; Magnetic Resonance Imaging* ; Spine* ; Tomography, X-Ray Computed