Intervertebral disc degeneration is main cause of various spinal degenerative conditions, and results in a significant socio-economic burden and morbidity to those affected. Intervertebral disc degeneration is a multifactorial process that has no known curative method. Hence, various factors that cause intervertebral disc degeneration, especially biochemical ones, were discussed in this study.
Intervertebral Disc Degeneration* ; Intervertebral Disc* ; Regeneration*

Congenital absence of a lumbar pedicle is an uncommon anomaly, and most cases are asymptomatic and discovered incidentally. A 72-year-old man presented with lower back pain that radiated to his bilateral lower extremities. Physical examination revealed no neurological deficits. Plain radiographs of the lumbar spine revealed absence of the left L4 pedicle, along with hypertrophy and sclerosis of the contralateral pedicle. Magnetic resonance imaging showed stenosis of the L3-4 neural canal. Computed tomography revealed absence of the left L4 pedicle associated with hypertrophy and sclerosis of the right L4 pedicle and facet joint. The symptoms of the patient were resolved after posterior decompression without fusion. Here, we report one case of congenital absence of an L4 pedicle detected in a spinal stenosis patient who need to undergo a decompressive surgery for the spinal stenosis caused by contralateral facet hypertrophy.
Aged ; Constriction, Pathologic ; Decompression ; Humans ; Hypertrophy ; Low Back Pain ; Lower Extremity ; Magnetic Resonance Imaging ; Neural Tube ; Physical Examination ; Sclerosis ; Spinal Stenosis* ; Spine ; Zygapophyseal Joint

May-Thurner syndrome, compression of the left common iliac vein by the right common iliac artery, or intimal hypertrophy of the vein resulting from chronic pulsatile force of the right common iliac artery, may results in deep vein thrombosis on the left lower extremity. A patient presented to our facility with deep vein thrombosis caused by May-Thurner syndrome, and showed post-operative fever, pain, and tenderness over the left leg, showing severe lumbar disc herniation with acute cauda equina syndrome. This syndrome should be considered as one of the causes of deep vein thrombosis in the left lower extremity.
Cauda Equina* ; Fever ; Humans ; Hypertrophy ; Iliac Artery ; Iliac Vein ; Leg ; Lower Extremity ; May-Thurner Syndrome* ; Polyradiculopathy* ; Veins ; Venous Thrombosis*

Epidural abscess is a rare disease that can cause severe neurological complications or death if it is not recognized and treated early. Authors report a case of panspinal epidural abscess, which is diagnosed by MRI and treated with surgical drainage and antibiotics.
Anti-Bacterial Agents ; Drainage ; Epidural Abscess* ; Magnetic Resonance Imaging ; Rare Diseases

In recent years, percutaneous vertebroplasty has frequently been used to treat osteoporotic compression fractures. This procedure is generally known to be safe because of the rare occurrence of complications. However, it is accompanied by the risk of cement leakage, and the cement can be easily removed using a surgical technique. Most neurological complications occurred due to extravasation of cement into the spinal canal. Comparatively, there were no reports of neurological complications due to the extravasation of cement into the paravertebral area. Here, we report a case of right-exiting L1 spinal root compression after percutaneous vertebroplasty with polymethylmethacrylate (PMMA). We proceeded to cement removal and nerve root decompression by a paraspinal open microsurgical technique in the event of neurological complication.
Decompression ; Fractures, Compression ; Polymethyl Methacrylate* ; Spinal Canal ; Spinal Nerve Roots ; Vertebroplasty*

PURPOSE: To evaluate the difference of clinical and radiological findings for patients who underwent surgery for lumbar HNP in adolescents and adults MATERIALS AND METHODS: We studied 70 patients ; 35 adolescents(below 20 years of age), 35 adults(21 to 40 years of age) retro-spectively from May 1992 through July 1999, whom we were able to follow up for more than one year after surgery. Patients with spinal instability and stenosis were excluded. RESULTS: By the JOA score, preoperative radiating pain of the lower leg was 1.0 point in adolescents, 0.6 point in adults, showing a statistically significant difference(p<0.05). Mean value was excellent as 9.5 points in adolescents and 9.3 points in adults at last follow-up of the JOA score, and there was no significant difference. Degree of disc degeneration was of higher grade in adults, but disc degeneration was not related to lower back pain in either group. In adolescents, severity of preoperative sensory or motor dysfunction affected duration of postoperative sensory or motor recovery respectively, while in adults, severity of either preoperative sensory or motor dysfunction affected that of both sensory and motor postoperative neurologic recovery(p<0.05). The longer the time of suffering from radiating pain, the lower the points of last follow-up JOA score in adolescents. The longer the time of lower back pain, the lower the points in adults(p<0.05). CONCLUSION: Preoperative radiating pain was more severe in adults, and no other clinical difference was seen between the two groups. In adolescents, severity of preoperative sensory or motor dysfunction affected duration of postoperative sensory or motor recovery respectively, while in adults, severity of either preoperative sensory or motor dysfunction affected that of both sensory and motor postoperative neurologic recovery. Duration of radiating pain in adolescents, and lower back pain in adults, can be used to predict prognosis.
Adolescent* ; Adult* ; Constriction, Pathologic ; Follow-Up Studies ; Humans ; Intervertebral Disc Degeneration ; Leg ; Low Back Pain ; Prognosis

STUDY DESIGN: We have analyzed vertebral fractures caused by osteoporosis to find the clinical correlations with fracture types, level of lesion sites, numbers of involved vertebrae, age of patients, and the degree of osteoporosis. OBJECTIVES: To analyze osteoporotic vertebral fractures clinically and it help us to increase our understandings of osteoporotic vertebral fractures and treat the patients more effectively. SUMMARY OF BACKGROUND DATA: There are increasing number of patients with osteoporotic vertebral fractures. However, there are few articles analyzing patients according to their correlating factors. MATERIALS AND METHODS: We evaluated sixty-three patients who were diagnosed and treated conservatively with osteoporotic compression fractures from January 1995 to June 1997. Plain radiographs and DEXA were taken to compare wedge compression ratio, biconcavity ratio, crush ratio according to fracture pattern, level of injury, number of injured vertebral body, and bone mineral density(BMD). All datas were statistically analyzed. RESULTS: There were no significant differences among fracture pattern, level of injury and BMD. However, BMD was more sig-nificantly decreased in patients who was fractured their back at thoracic spine. BMD was lowered at multiply(3 or more vertebral bodies)injured, continuously involved(2 level or more) vertebral bodies. CONCLUSION: We have concluded that careful observation and the efforts to differentiate osteoporotic compression fractures according to fracture pattern, injury level, BMD, and any objective clinical datas would be needed to manage these osteoporotic patients effectively.
Follow-Up Studies* ; Fractures, Compression ; Humans ; Osteoporosis ; Spine

STUDY DESIGN: A retrospective study. OBJECTIVES: To analyze the clinical features of spinal metastasis, and to evaluate what is the most appropriate treatment. SUMMARY OF LITERATURE REVIEW: Severe pain and neurological compromise induced by metastatic spine tumors deteriorates the quality of life. Surgical treatment may improve the quality of life effectively. MATERIALS AND METHODS: Between January 1995 and May 1999, we studied 61 patients diagnosed for spinal metastasis, and followed for more than 1 year or to their death. They were divided into three groups, such as surgery group, radiotherapy group, and other conservative therapy group. The results were evaluated with Turgut classification for functional status, WHO analgesics cascade for pain grading, and Frankel classification for neurological symptoms. RESULTS: Forty nine patients were followed to death. The average of survival time was 15 months, and it depends on the histology of primary tumor. In the review of treatment methods, non-operative treatment was preferred by medical oncologist in majority of cases. Eleven patients were treated surgically, and their pains and neurological symptoms were improved in varing degrees. But in case of posterior decompression alone, pain was not relieved. Surgical decompression with stabilization was effective for pain and neurological symptoms. In 50 patients, radiotherapy or other conservative therapy was applied, but results were not satisfactory. CONCLUSION: In view of the quality of life, surgical treatment should be considered in more cases of patients suffering from severe pain and neurological symptoms caused by metastatic spine tumor.
Analgesics ; Classification ; Decompression ; Decompression, Surgical ; Humans ; Neoplasm Metastasis ; Quality of Life ; Radiotherapy ; Retrospective Studies ; Spine*

STUDY DESIGN: A retrospective study about the efficacy of bridge reconstruction of donor iliac defect utilizing resected rib dur-ing surgical approach of thracolumbar vertebrae. OBJECTIVES: To evaluate the outcome in clinical aspect for cosmesis and pain, and radiological aspect for incorporation of rib with crest. SUMMARY OF LITERATURE REVIEW: Many iliac donor site problems were reported such as pain, deformity, fracture etc. Filling the bone defect with bone, cement, or artificial bone seems to reduce the donor site problems. MATERIALS AND METHODS: In fourteen patients who underwent anterior fusion of vertebrae, bridge reconstructions of iliac crest using resected rib for thoracoabdominal approach to vertebral body were performed. Postoperatively, donor site pain, residual deformity, and radiologic finding of the union between rib and iliac crest were evaluated. RESULTS: No patients had significant pain on donor iliac crest. Acceptable pain was complained by five patients after 1 month postoperatively and by three patients after 2 months postoperatively. After 3 months, no patients had pain problem at iliac donor site. Two patients presented palpable step-off on iliac crest, but external contours of iliac crest were satisfactory in all patients. Radi-ologic union of the rib-crest junction was confirmed within 6 months postoperatively in all cases. CONCLUSIONS: Bridge reconstruction of iliac crest defect using resected rib is a simple and effective method that can minimize residual donor site problems in anterior spinal surgeries of thoracic and upper lumbar vertebrae.
Congenital Abnormalities ; Humans ; Lumbar Vertebrae ; Retrospective Studies ; Ribs* ; Spine* ; Tissue Donors*

STUDY DESIGN: This is a retrospective study analyzing the results of posterior lumbar interbody fusion(PLIF) with TPM cages in spondylolisthesis OBJECTIVES: The purpose of this study was to evaluate the clinical, radiologic results & affecting factors of PLIF with TPM cages in spondylolisthesis. SUMMARY OF LITERATURE REVIEW: The ordinary PLIF has 86-98% of radiologic union rate and clinical satisfactory rate. The problems of ordinary PLIF were graft breakage, donor site morbidity, limited bone resources, high failure rate using only transpedicular screw fixation. MATERIALS AND METHODS: From October 1995 to January 1999, 108 consecutive patients with spondylolisthesis were treated by PLIF with TPM cages, in which morcellized bone chips salvaged from posterior neural arch applied, and pedicle screw fixation. RESULTS: Preoperative Low Back Pain score(total 100 points) was improved from 47.4 points to 88.7 points at last follow-up. 10 point visual analogue scale was reduced to 1.5 point at last follow-up. In the end results, Ninty-two percent of patients rated as excellent or good. The preoperative value of slippage, 18.6% was achieved to 5.5% at last follow-up. The anterior intervertebral disc space height was increased from 10.0 to 16.2mm postoperatively. Fusion occurred in all patients except one. Groups below 60-year-old patient at the time of surgery showed better clinical results than those above 60 (p<0.05). No clear correlations were noted between sex, the types of spondylolisthesis, bone mineral density, smoking habits and obesity in clinical, radiologic results. CONCLUSION: PLIF with TPM cages is appeared to be a recommended procedure of choice to treat lumbar spondylolisthesis and this operation should be performed with a caution in aged patients.
Bone Density ; Follow-Up Studies ; Humans ; Intervertebral Disc ; Low Back Pain ; Middle Aged ; Obesity ; Retrospective Studies ; Smoke ; Smoking ; Spondylolisthesis* ; Tissue Donors ; Transplants