BACKGROUNDS: Percutaneous radiofrequency neurotomy of posterior primary ramus has been in use as a treatment for persistent, mechanical low back pain for two decades. However, there has been limited studies regarding to prognostic factors related to outcome. We report our experience with at least 2-year follow up with special aftention on prognostic factors. METHODS: Of total 228 patients who underwent percutaneous radiofrequency neurotomy (PRN) of posterior primary ramus for refractory low back pain during last 3 years, 128 patients whose pain was considered to be originated from facets joints or their surrounding soft tissue and responded to temporary blocks were assigned to a group II. All patients had more than 6 months of pain. These patients were compared with 100 patients to whom PRN were provided for chronic nonspecific low back pain without all inclusion criteria (Group I). RF procedures were done under local anesthesia with C-arm intensifier guidance. Pain reliefs were estimated at 1week, 1month, 6months and 2 years using visual analog scale(VAS). For patients with more that 50% reduction of previous pain was regarded as positive responder. Various clinical variables such as age, sex, symptom duration, types of pain, bilaterality, and previous surgery were studied for prognostic factors. RESULTS: Positive responders were 56% at 1week, 46% at lmonth, 18% at 6months, and 13% at 2years after PRN in group I, and 78.9% at lweek, 75.4% at lmonth, 62.5% at 6months, and 54.7% at 2years in group II. Some variables were found to be significantly related to outcome including prominent local tenderness, percussion tenderness, combination of symptoms with pain on gefting up, extension, transitional movement, pain radiating to buttock and/or posterior thigh, and good immediate response. Age, sex, symptom duration, bilaterality, imaging study results, previous lumbar surgery, and degrees of pain relief from diagnostic block were not related to outcome. CONCLUSIONS: These results indicate that PRN of posterior primary ramus has a moderate overall long-term beneficial effect, with no morbidity in our series. But, the long-term good results will be anticipated only in properly selected patients with low back pain originating from facet joints and surrounding structures.
Anesthesia, Local ; Buttocks ; Follow-Up Studies ; Humans ; Joints ; Low Back Pain* ; Percussion ; Thigh ; Zygapophyseal Joint

No abstract available.
Fanconi Anemia*

Desmoplastic fibroma(DF) is a rare neoplasm of the bone, and is histologically benign but locally aggressive disease. A total of nine cases of DF involving skull have been reported in the literature, and among these eight are females. In this report, the clinical findings and histopathology of a case with DF of the skull in a male patient is presented with a review of the literature with an emphasis on treatment modalities. A 21-year-old man presented with headache. CT scan revealed a solitary and lytic skull lesion without brain invasion. DF was confirmed by histological evaluation. On immunohistochemical staining of the tumor was negative for estrogen or progesterone receptors. After total resection of tumor with wide surgical margin, there was no recurrence during the 35 months of follow-up period. Although longer follow up period maybe needed, treatment of this type of tumor with complete resection of tumor tissue along with a wide margin may provide long disease-free state compare to the high recurrence rates in DF of other sites.
Brain ; Estrogens ; Female ; Fibroma, Desmoplastic* ; Follow-Up Studies ; Headache ; Humans ; Male ; Parietal Bone ; Receptors, Progesterone ; Recurrence ; Skull ; Tomography, X-Ray Computed ; Young Adult

Spinal trauma produced from motor vehicle accidents, diving accidents, or falls occur at high rates of loading. This study was undertaken to reproduce clinically relevant cervical spine injuries under controlled conditions. Six isolated head-T2 human cadaveric preparations were tested using an electrohydraulic piston actuator at loading rates from 295 to 813 cm/sec. The Hybrid III head-neck was tested similarly at rates from 401 to 683 cm/sec. The input forces for specimen tests were of higher magnitude and shorter duration than the distally measured forces. In contrast, the Hybrid III head-neck revealed similar magnitude and duration force traces from input to output. The specimen preparations were analyzed kinematically at 1200 frame/sec with 20 to 30 retroreflective targets fixed to each level of the cervical spine. With this technique it is possible to temporally follow cervical damage as a function of applied forces. Wedge, burst, and anterior compression fractures were documented using CT and cryosectioning techniques. This pathology can be evaluated quantitatively using the target analysis. For example, a burst fracture occurred suddenly and 2.5 msec, whereas wedge fractures were progressive and took 4 to 5 msec to occur.
Cadaver* ; Cryoultramicrotomy ; Diving ; Fractures, Compression ; Humans* ; Motor Vehicles ; Pathology ; Spine

Cervical spondylosis is known to be one of the most common disorders involving bony and neural structures of cervical region and shows variety of clinical menifestation, namely radiculopathy, myelopathy, or both. Also, the outcome of the treatment of this disorder, whether surgical or nonsurgical, shows wide variations according to handful reports from different institutions. The purpose of this report is to assess the patients treated by our department for their spondylogenic symptoms. The results of treatments from 102 patients with cervical spondylotic radiculopathy and/or myelopathy were clinically assessed. Among them, thirty eight patients were undelwent operation and followed up for at least six to twelve month period. Remaining sixty four patients were treated conservatively for three weeks to three months. The results are as follows: 1) Among 102 patients, the most common type was combined myeloradiculopathy(57.8%). 2) Mean age was 52 tears with range between 31 to 74 years. Male to female ratio was about three to one. 3) Multiple level involvement was 52% and C5-6 was the most commonly involved level by single lesions. 4) Mean AP diameter of cervical canal of the spondylotic patients, as compared with the control group, was significantly narrowed(p<0.01). 5) Overall outcome by conservative treatment showed 65.3% improvement and 86.8% improvement by operative treatment. 6) Among various clinical factors studied(age, severity, duration of symptoms, multiple level involvement, methods of operation), only the degree of severity revealed statistically significant effect on outcome of both conservative and operative group. 7) There were three cases of mild transient neurological complications and one case of technical complication(graft extrusion).
Female ; Hand ; Humans ; Male ; Radiculopathy ; Spinal Cord Diseases ; Spondylosis

Aneurysmal bone cyst is an uncommon spinal tumor of vascular origin and represents less than 1% primary bone tumors. A case of 15-year-old girl who presented with low back pain and severe left leg pain. The lesion was expansile in nature involving anterior and posterior bony elements of the spine. It also showed expanision into the intraspinal canal and paraspinal soft tissue. Surgical treatment consisted of tumor excision and pedicle screw fixation via extracavitary approach. Postoperative course was uneventful and her symptoms and signs were improved. Extracavitary approach, as applied to our case, seemed to be an ideal surgical method in such cases because of its nature and extent of involvement.
Adolescent ; Aneurysm* ; Bone Cysts* ; Female ; Humans ; Leg ; Low Back Pain ; Spine

BACKGROUND: Small cell lung cancer (SCLC) disseminates early and has poor prognosis. However, SCLC is highly chemosensitive, thus chemotherapy has been established as the primary mode of treatment. This study evaluated the efficacy and toxicity of etoposide in combination with cisplatin in the treatment of extensive stage small cell lung cancer. METHODS: Thirty four patients (28 males, 6 females) with previously untreated extensive stage small cell lung cancer were treated with etoposide at a dose of 100 mg/m2, IV on days 1-3 with cisplatin at 100 mg/m2, IV on day 1. The median age was 63 (range 41~80). This combination chemotherapy was administered every 3-4 weeks. Response rate, response duration, survival, and toxicity were evaluated. RESULTS: The response rate was 50%. The median survival time was 29 weeks. The median response duration was 17.2 weeks in responders. The toxicity was acceptable. CONCLUSION: This study illustrated that the combination of etoposide and cisplatin is effective in the treatment of extensive stage small cell lung cancer, and can be administered with acceptable toxicity. Although this study was not designed to be a formal comparative trial, the efficacy and toxicity observed with this regimen were found to be comparable to previous reports.
Cisplatin* ; Drug Therapy ; Drug Therapy, Combination* ; Etoposide* ; Humans ; Male ; Prognosis ; Small Cell Lung Carcinoma*

OBJECTIVES: The craniopharyngioma is a benign tumor located at least in part in the suprasellar cistern. However, the symptoms and signs from this tumor may be determined not only by the location of the tumor but also by its size and the age of the patient. The objective of our study is to analyze retrospectively the clinical manifestations of craniopharyngiomas with regards to tumor characteristics in children and adults. MATERIALS AND METHODS: Twenty-three patients(16 adults, 7 children) treated for craniopharyngioma between 1990 and 1999 were studied to demonstrate the relationship of tumor size, growth pattern, and its invasiveness with clinical symptoms. As part of the assessment, 16 adults(M:F=8:8, mean age:43.7 years) and 7 children(M:F=5:2, mean age:10.1 years) underwent magnetic resonance(MR) imaging and computerized tomography(CT) scanning with a three-dimensional volume acquisition sequence. RESULTS: The three major cardinal signs were defined to increased intracranial pressure, endocrine dysfunction, and visual problems. The tumor size in child group was larger than that in adult group. Also, visual problems, symptoms of increased intracranial pressure and hydrocephalus were more frequently observed in child group. However, endocrine dysfunction and neuropsychological symptoms related with hypothalamic connections to the thalamus, pituitary, frontal lobe, and other cortical areas were more frequent in adult group. Conclusions: In our series, the tumor size and invasiveness of craniopharyngioma revealed to be relevent with initial symptoms of increased intracranial pressure and visual symptoms which were more frequent in child group. As for the growth pattern, we did not find major difference between adults and children.
Adult* ; Child* ; Craniopharyngioma* ; Frontal Lobe ; Humans ; Hydrocephalus ; Intracranial Pressure ; Retrospective Studies ; Thalamus

Osteochondromas make up about 30% to 40% of benign bone tumors. Most are solitary lesions but some are multiple, usually with autosomal dominant inheritance. From 1% to 4% of osteochondromas occur in the spine, where they can cause a variety of signs and symptoms, including those of spinal cord compression. Isolated osteochondromas are usually of little significance. However, if they are located near neural structures, they may cause irritation due to mechanical compression. In patients with hereditary multiple exostoses who present with neck or back pain, and particularly in those who have neurologic symptoms in the upper or lower extremities, a diagnosis of intracanalicular osteochondroma should be presumed until proven otherwise. Computerized tomography(CT) and MRI are the imaging procedures of choice. Prompt surgical excision affords the best prognosis for these patients who have spinal cord compression secondary to intracanalicular osteochondroma.
Back Pain ; Diagnosis ; Exostoses* ; Exostoses, Multiple Hereditary ; Humans ; Lower Extremity ; Magnetic Resonance Imaging ; Neck ; Neurologic Manifestations ; Osteochondroma* ; Prognosis ; Spinal Cord Compression ; Spine ; Wills

A case of AVM(Arteriovenous Malformation) harboring a large venous aneurysm is presented. The AVM was located in right temporo-parietal area. The pathology revealed a AVM and large venous aneurysm which was attached to nidus and drained into petrosal sinus. The authors reviewed the pathology of AVM and venous aneurysm.
Aneurysm* ; Arteriovenous Malformations* ; Pathology