No abstract available.
Classification*

Long segmental fixation with TSRH posterior instrumentation for 19 patients who had unstable thoracolumbar fracture was performed between October 1992 and April 1995. The patients were followed for an average of 22 months. Measurements of the deformity angle, kyphosis, vertebral height, and the intervertebral angle were made. The patients were divided into 2 groups according to configurations of instruments for lower segmental fixation. For one group, only hooks were used, and for the others group pedicular screws and lateral offset hooks were used together at the same segment. Therefore, the purpose of this study is to anlyze the correctability following long segmental fixation and to compare one segmental fixation using both screws and lateral offset hook systems with two segmental fixation using hook systems for distal fixation. There was an overall correction of kyphosis at follow-up of 6.9degrees (27.1%) after a loss of 4.3degrees from operative correction. Overall correction of deformity angle was 8.2degrees (32.2%). Loss of vertebral height at final follow-up was 4.4%. And loss of intervertebral angle was 2.0degrees at follow-up. There was no difference of overall results between the hook group and the pedicular screw with lateral offset hook group. However, there was a significant improvement of the correction of kyphosis and restoration of vertebral height in patients who underwent operation within 7 days after injury, as compared to delayed operation. Therefore, the timing of surgery is the most important factor in order to correct the deformity caused by unstable thoracolumbar fractures. There was no significant loss of correction and no metallic failure. Therefore, rodding long with the method of one segment distal fixation using screws and lateral offset hook together can provide excellent correctability, maintenance of correction, preservation of distal lumbar joints, prevention of implant failure and complication.
Congenital Abnormalities ; Follow-Up Studies ; Humans ; Joints ; Kyphosis

PURPOSE: To determine the radiological, functional, and subjective outcome after stabilization in adult patients with severe scoliosis. MATERIALS AND METHODS: Eighteen adult patients with severe scoliosis underwent surgical correction. The radiological outcome was assessed by coronal and sagittal Cobb's angle, apical vertebral translation, and trunk deviation. The functional outcome was assessed by physical ability, locomotion, activities of daily living, and use of both hands. The subjective outcome was assessed by cosmetic satisfaction and costo-pelvic pain. RESULTS: Radiologically, mean correction of coronal curves were 28.7% in thoracic curves and 30.2% in lumbar. Average correction of sagittal curves were 29.4% and 16.8%, retrospectively. Mean correction of apical vertebral translation were 35% and 52.3%, retrospectively. Average correction of trunk deviation was 42.8%. In functional outcome, feeding ability and function of both extremities were improved significantly. 94.4% and 88.9% of patients were satisfactory significantly in cosmetic features and pain sensation. CONCLUSIONS: In this series, the surgical correction and stabilization of adult severe scoliosis resulted in much improvement in balancing of the trunk, improving function of upper extremities, and subjective satisfaction in the aspect of costo-pelvic pain and cosmesis.
Activities of Daily Living ; Adult ; Extremities ; Hand ; Humans ; Locomotion ; Retrospective Studies ; Scoliosis* ; Sensation ; Upper Extremity

STUDY DESIGN: Retrospective clinical study. OBJECTIVES: To assess the efficacy of a cortical bone trajectory pedicle screw (CBT-PS) for the treatment of lumbar pyogenic spondylodiscitis. SUMMARY OF LITERATURE REVIEW: Pedicle screws were used for surgical treatment of pyogenic spondylodiscitis to prevent instability and deformity. CTB-PS are typically inserted from the inferomedial to superolateral direction of the pedicle and have yielded satisfactory results in degenerative or osteoporotic spinal disorders. MATERIALS AND METHODS: Eight patients with single segment lumbar pyogenic spondylodiscitis were analyzed. At first, anterior debridements and interbody fusions were perfomed with autogenous strut bone grafts, followed by posterior fixations and fusions with CBT-PS. The lordotic angles of operated levels were checked at the preoperative, postoperative, and final follow-ups. Visual analogue scales (VAS) were checked at the preoperative and final follow-ups. RESULTS: Lesion sites were found at four L3-4, three L4-5, and one L2-3. Follow-ups were held at 26.13±8.23 months. The lordotic angles at preoperative, postoperative, and final follow-ups were 12.13±3.09°, 14.63±3.16°, and 12.75±3.99°, retrospectively. There were significant differences between results from the preoperative-postoperative and postoperative-final follow ups. There was no difference in the preoperative-final follow up. There was a significant difference between the VAS at the preoperative and final follow-ups (8.13±0.83 and 2.38±0.92, retrospectively). Complete bony unions of were observed at the final follow-up in all cases. CONCLUSIONS: The advantages of using a CBT-PS for lumbar pyogenic spondylodiscitis included the ability to minimize damage from the screw for both the posterior structure damage and the operated anterior area to prevent instability and deformity, and to achieve rigid bone union. CBT-PS is a potential surgical option for pyogenic spondylodiscitis.
Clinical Study ; Congenital Abnormalities ; Debridement ; Discitis* ; Follow-Up Studies ; Humans ; Pedicle Screws* ; Retrospective Studies ; Transplants ; Weights and Measures

No abstract available.
Ossification of Posterior Longitudinal Ligament* ; Spine*

To assess the prognostic factors of the femoral neck fractures in patients with CVA, we compared the survival rates in 12 cases of CVA group with 12 cases of non-CVA group and evaluated the various clinical factors of CVA group affect the mortality. All of the patients both CVA group and non- CVA group were treated hemiarthroplasty for femoral neck fractures between June 1990 and June 1992. The mean age was 68.9 years old in the CVA group and 69.3 years old in the non-CVA group. The mean follow-up periods were 32.8 months in the CVA group and 33.6 months in the non-CVA group. The results were as follows; 1. The incidence of the femoral neck fracture with CVA was 15%(12 cases among SO femoral neck fractures). 2. The survival rates in the CVA group at l-year, 2-year, and 3-year were 83.3%, 66.7%, and 58.3% respectively. In the non-CVA group, the survival rates were 83.3%, 75.0%, and 62.5%. 3. In the CVA group, serum total protein, nutritional index, hypertension, lung disease, and cardiac disease may be valuable prognostic factors. In conclusion, the pretraumatic patient's general physical condition could affect the mortality of femoral neck fracture in the CVA patients rather than CVA itself or postoperative status.
Femoral Neck Fractures ; Femur Neck ; Follow-Up Studies ; Heart Diseases ; Hemiarthroplasty ; Humans ; Hypertension ; Incidence ; Lung Diseases ; Mortality ; Nutrition Assessment ; Stroke ; Survival Rate

Isolated acute monoarticular septic arthritis of the sternoclavicular joint is a extremely rare disorder, and is usually associated with predisposing factors such as contiguous foci of infection, heroin addiction, rheumatoid arthritis, diabetes mellitus and maintenance hemodialysis. This case occurred in healthy adult. The etiological agent was staphylococcus aureus. Good result wads achieved by applying appropriate antibiotic therapy combined with an adequate drainage.
Adult ; Arthritis, Infectious ; Arthritis, Rheumatoid ; Causality ; Diabetes Mellitus ; Drainage ; Heroin Dependence ; Humans ; Renal Dialysis ; Staphylococcal Infections ; Staphylococcus aureus ; Sternoclavicular Joint

Osteoid osteoma is a relatively common benign tumor that most commonly affect the cortex of the long bone, Adolescent and young adult males are most frequently affected. It causes aching pain that worsens at night and commonly is relieved by aspirin. The typical radiographic appearance is a lucent nidus with surrounding dense cortical thickening. If the lesion is located in intra-articular cancellous bone, an osteoid osteoma may present with clinical findings that are more indicative of an inflammatory synovitis, and with atypical radiographic findings such as lack of both surrounding sclerosis and a lucent nidus. Therefore intra-articular osteoid osteoma may pose a diagnostic difficulty. Recently, we experienced 3 cases of intra-articular osteoid osteoma(2 humeral haed, 1 femoral head) and present them in detail.
Adolescent ; Aspirin ; Humans ; Male ; Osteoma, Osteoid ; Sclerosis ; Synovitis ; Young Adult

STUDY DESIGN: The authors reviewed the dural tears in the thoracolumbar fractures treated surgically. OBJECTIVES: To evaluate the incidence and the predictive values for the presence of dural tears in the thoracolumbar fractures. SUMMARY OF LITERATURE REVIEW: Many authors reported that the dural tear was usually related to the thoracolumbar fractures especially with laminar fracture and neurologic deficit. The dural tears may lead complications such as the entrapment of spinal nerve root, delayed wound healing, cerebrospinal fluid fistula, and myelomeningocele. Previous reports emphasized posterior approach to confirm and treat the dural tears using laminectomy. So it is very important that surgeons should identify the presence of dural tear preoperatiyely to determine the surgical approach and treatment options. MATERIALS AND METHODS: The authors reviewed 22 patients of thoracolumbar fractures treated with posterior laminectomy, posterior decompression, posterolateral fusion, and instntmentation from August 1993 to August 1996. The follow-up period was minimally 12 months. We checked the canal compromise, the injury of the posterior column including laminar fracture and ligamental injury, and neurologic deficits as the predictive values. The statistical analysis was done to evaluate the relationship between the dural tear and the predictive values. RESULTS: The incidence of dural tear was 54.4% of the thoracolumbar fractures. The canal encroachment, the injury of the posterior column, and the neurologic deficits were not significantly related with the dural tears in statistical analysis. But we could find the tendency that is related to the dural tear and posterior column injury. CONCLUSION: The authors concluded that we could find the possible presence of dural tears in the severe thoracoiumbar which were needed the surgical treatment and we could suggest the injury of posterior column was a possible value that could predict the presence of dural tear.
Cerebrospinal Fluid ; Decompression ; Fistula ; Follow-Up Studies ; Humans ; Incidence ; Laminectomy ; Ligaments ; Meningomyelocele ; Neurologic Manifestations ; Spinal Nerve Roots ; Tears* ; Wound Healing

STUDY DESIGN: This is a retrospective and preliminary study. OBJECTIVES: We wanted to evaluate the characteristics of recompression of vertebral bodies without trauma after balloon kyphoplasty (KP) for treating osteoporotic vertebral compression fractures (VCF). SUMMARY OF THE LITERATURE REVIEW: KP has been used for fracture reduction, maintenance of vertebral height and relief of pain in VCF. Despite of numerous satisfactory results, several factors have been noted to affect the clinical results of KP. MATERIALS AND METHODS: Six patients with recompression of vertebral bodies without trauma after KP were reviewed. All the patients were female and their mean age was 75.9+/-4.1 years old. The follow-up period was 17.2+/-8.5 months. The compression rates of the operated vertebral bodies (CR) and the kyphotic angles (KA) were checked by using plain roentgenograms at the initial, postoperative and last follow-up periods. The preoperative MRIs were also reviewed. The clinical results were checked using the VAS. RESULTS: The CRs at the initial, postoperative and last follow-up periods were 33.7+/-14.8%, 13.4+/-7.6% and, 26.9+/- 9.9%, respectively. The KAs were 19.2+/-7.2degrees , 14.8+/-6.2degrees and 20.5+/-7.4degrees for each period, respectively. Statistically, the CR and KA at the initial-postoperative period and at the postoperative-last follow-up period showed significant differences (p < 0.05). Intervertebral clefts were found in all the cases on MRI. Normal bones superior or inferior to cement were also seen in all the cases after KP. The VAS scores were 8.5+/-0.5, 2.3+/-0.5 and 3.0+/-0.6, retrospectively, and there were significant differences between each periods (p<0.05). CONCLUSIONS: Recompression of a vertebral body without trauma after KP for treating VCF was observed in the cases with a intervertebral cleft seen on MRI and normal bones superior or inferior to the cement were observed after KP. The causes of recompression may be subsequent compression or resorption of the remaining vertebral body.
Female ; Follow-Up Studies ; Fractures, Compression ; Humans ; Kyphoplasty ; Retrospective Studies