No abstract available.
Spondylitis, Ankylosing*

STUDY DESIGN: A case report is presented of destructive lesion involuting intervertebral disc space and adjoing vertebral bodies in association with ankylosing spondylitis. OBJECTIVE: To report unusual clinical and radiological presentation of spondylodiscitis and its treatment wi th anterior interbody fusion. SUMMARY OF BACKGROUND DATA: Althought there is some mention in the literature of pathogenesis, diagnosis and treatment of spondylodiscitis in ankylosing spondylitis, we think that its occurrence is frequent enough to warrant this condition and we should differentiate it from other infectious or tumorous condition. RESULTS: Anterior debridement and anterior interbody fusion with structural bone graft were performed. The microscopic study showed nonspecific chronic inflammation and extensive necrosis. CONCLUSION: It was suggested that primary spondylodiscitis or pseudoarthrosis resulted from mechanical trauma be related to this condition rather than infectious spondylitis.
Debridement ; Diagnosis ; Discitis ; Inflammation ; Intervertebral Disc ; Necrosis ; Pseudarthrosis ; Spondylitis ; Spondylitis, Ankylosing* ; Transplants

Many believe the reduction in the number of mobile segments causes an increased strain in the unfused segments, predisposing them to early degeneration. This degeneration of the adjacent segment could be a cause of low back pain after spinal fusion. The clinical manifestations supporting the increased stress of the unfused segments are the significant incidence rates of spondylolisthesis, spondylolysis acquisita and spinal stenosis. However, there was a paucity of reports in the literature on the histological observation at the adjacent, unfused sgements. Therefore, the purpose of this study was to observe the histological changes of the unfused, mobile segments following fixation in the cat spine. The cat lumbar spines from L6 to L7 were fixed posteriorly with acrylic cement and wires. Histological and histochemical observation of the upper adjacent segment were performed after H-E, trichrome, reticulin and Safranin-O staining at postoperative 6 and 12 months, respectively. The results were as follows: 1. There were mild degenerative changes in the intervertebral disc, but no evidence of definitive degeneration in the articular cartilage of the facet joints at postoperative 6 months in the spinal fixation group. 2. The marked degenerative changes of the intervertebral disc were shown at postoperative 12 months in the spinal fixation group. Of 5 cats sacrificed at 12 months, 3 cats had irregular configuration of the fiber's arrangement of the annulus fibrosus. 3. At postoperative 12 months in the spinal fixation group, marked degeneration was noted on the articular cartilage of the adjacent facet joints. Through this study, it is clarified that degenerativce changes of the intervetebral disc and facet joint at the adjacent segments will develop after certain period of time following spinal fusion. Especially the facet joints of the adjacent, unfused segment were found to be most vulnerable to the adverse effects. This may be responsible for the back pain in the future after spine fusion.
Animals ; Back Pain ; Cartilage, Articular ; Cats* ; Incidence ; Intervertebral Disc ; Low Back Pain ; Reticulin ; Spinal Fusion ; Spinal Stenosis ; Spine* ; Spondylolisthesis ; Spondylolysis ; Zygapophyseal Joint

Complete plantar dislocation of the metatarsal head of the 2nd toe, irreducible by closed methods, is a rare injury. As with similar lesion in the hand, closed reduction is impossible because of interposition of volar plate. So author describes a case treated at Armed Forces Hospital by open reduction after failure of closed reduction, and anatomy of the 2nd M-P joint and pathomechanics of this rare dislocation are described.
Arm ; Dislocations ; Hand ; Head ; Joints ; Metatarsal Bones ; Toes

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

In general, soft tissue and bone tumors are diagnosed clinically by physical findings, laboratory data, and X-ray findings with only limited reliability, and a definite diagnosis must be supported by histopathological evidence. For this purpose, open biopsy routinely has been carried out, but there have been many disadvantages and sometimes followed by surgical complications. The present study was undertaken to compare the cytologic findings of soft tissue and bone lesions with the histological findings. The specimen were obtained by fine needle aspiration and Franklin-Silverman needle. For cytodiagnosis Stormby's cell block of aspirates were utilized. For histological diagnosis small tissue fragments obtained by the Franklin-Silvermans cutting needle were used. Then, the diagnostic accuracy of 3 different methods were compared, and the clinical applicability of those methods as adjunctive diagnostic procedures in the diagnosis of the soft tissue and bone tumors were assessed. The results obtained were as follows: l. In 15 out of the 20 cases (75%) in which clinically and roentgenologically the soft tissue and bone tumors were suspected, sufficient material was aspirated to enable detailed cytological diagnosis possible by fine needle aspiration. ln 13 out of the 15 cases, diagnosis could be made by cytologic findings, which was similar to histologic findings of tissue obtained by Franklin-Silverman needle. 2. In 6 out of the 20 cases, sufficient tissue fluid for cell block preparation were obtained from the tumor tissues. In 5 cases, cytologic findings of cell blocks were consistent with that ot the tissue obtained by Silverman needle. But in one case malignancy was susupected by cytodiagnostic method, and definite diagnosis could not be made. Finally the lesion was found to be malignant schwannoma through the histological study of tissue specimen obtained by Franklin-Silverman needle biopsy. 3. In 19 out of the 20 cases, diagnosis could be made by Franklin-Silverman needle biopsy. 4. Diagnostic accuracy of the lesions by clinical and roentgenological method was 75%, which overall diagnostic accuracy of 3 methods were 86.7% in aspiration cytology, 83.3% in cytodiagosis of cell block and 95% of histodiagnosis of tissue specimen obtained by Franklin-Silverman needle. Through this study it is found that cytodiagnostic method of aspirates and histodiagnosis of the small tissue specimen by Franklin-Silverman needle are very useful adjunctive methods in enhancing the diagnostic accuracy of the soft tissue and bone lesion prior to open biopsy trial.
Biopsy ; Biopsy, Fine-Needle ; Biopsy, Needle ; Cytodiagnosis ; Diagnosis ; Methods ; Needles ; Neurilemmoma

In this study, author tried to clarify the chronological and histological change of the growing spine after posterior cement fixation in dogs. The material used for the study consisted of 24 male mongrel dogs, aged 8 weeks. Lumbar spines, from 3rd to 5th were fixed posteriorly with bone cement (Zimmer Co. U.S.A.). After posterior spinai fixation with bone cement, there dogs at a time were sacrificed every 4 weeks up to 32 weeks, and histologic changes of intervertebral disc, growth plate and the vertebral bodies were observed after hematoxylin & eosin stainning with light microscope. The results obtained were as follows: 1. Thinning of the growth plate and distortion of the cartilage columns developed gradually after posterior cement fixation of the spine, but premature closure of the growth plate did not develop and the growth of the vertebral body continued till 32 weeks after operation. 2. Intervertebral disc thinned posteriorly and widened anteriorly without any changes in subchondral cortices, though there is some bony atrophy in the body which is represented by the thinning and coarseness of bony spicules. 3. At 16 weeks the cartilage layer of the vertebral end plate became thinner, and at 32 weeks there were profound degenerative changes in the cartilages. 4. After fixation of the spine, the nucleus pulposus gradually degraded and was replaced by fibrous tissues, and began to adhere to the vertebral end plate at 24 weeks and completely adhered to it at 32 weeks after fixation. 5. The direction of the horizontally arranged annulus fibrosus began to derange from 24 weeks after fixation, and at 32 weeks all the fibers of the annulus fibrosus were vertically arranged completely. Through this study it is found that posterior spinal fixation with bone cement affects growths of the vertebral growth plate, and end plate slightly, but there were no cessation of cartilaginous growth which might later cause the vertebral deformity. Also it is clarified that posterior fixation of e spine with cement develops noticeable degenerative changes in the intervertebrai disc and thereby develops the lordotic curve of the cemented segment of the spine.
Animals ; Atrophy ; Cartilage ; Congenital Abnormalities ; Dogs ; Eosine Yellowish-(YS) ; Growth Plate ; Hematoxylin ; Humans ; Intervertebral Disc ; Male ; Spine

Since Palmer's introduction of the torn medial collateral ligament, many clinical and anatomical studies were performed. But any reconstructive procedure of the medial collateral ligament of the knee known to us, has not solved the problem completely yet. The purpose of present study is to describe a technique of reconstruction, socalled Tatsuzawa's tenodesis surgery of transposed semitendinosus tendon, and is to report the clinical results of 45 cases treated by his procedure between April 1976 and June 1981. In addition, significance of the procerdure was compared with the result of primary closure group of the torn ligament. Tatsuzawa's procedure consists of reinforcement surgery of the repaired or unrepaired torn medial collateral ligament with forwardly transposed semitendinosus. The semitendinosus tendon was brought forward to lie adjacent to deep layer of the medial collateral ligament. The transposed part of the tendon was sutured throughout its length to the medial collateral ligament and to the medial aspect of the tibia and femoral condyle. Because the direction of transposed tendon as similar to the direction of fibers of medial collateral ligament, the procedure was very simple and anatomical one, and had some functional advantages. In this series some old cases are treated only with tendon reinforcement operation without repairing the laxed torn ligament. The results of the surgery were evaluated by the Asais modification of the Feltons evaluation criteria. Results obtained were as follows: 1. In semitendinosus tenodesis with or without primary repair of the torn ligament, satisfactory results were obtained (excellent and good) in 33 cases (73.3%). But in 20 cases of the primary repair group, the satisfactory results were obtained in 11 cases (55%). More satisfactory results were obtained with the semitendinosus tendon reinforcement operation of the torn ligament than only with primary repair. 2. In 29 cases with fresh injury of the medial collateral ligament in which the primary repair together with the tendon reinforcement procedure was performed, satisfactory (excellent and good) results were obtained in 72.4% (21 cases), and in 16 untreated old cases in which only the tendon reinforcement procedure were done, satisfactory results were obtained in 75%. 3. In 5 cases having medial collateral and anterior cruciate ligaments tear, excellent results were obtained in 3. This explains that semitendinosus tendon reinforcement procedure is the key one of the reconstructive operative procedures. It is thought that the procedure is also effective for the anterior cruciate tear to provide the anterior instability.
Anterior Cruciate Ligament ; Clinical Study ; Collateral Ligaments ; Knee ; Ligaments ; Surgical Procedures, Operative ; Tears ; Tendons ; Tenodesis ; Tibia

The distal tibial physeal plate is the second most frequently injured physis and the percentile incidence of its injury is reported to reach 11 percent of all physeal injuries. After physeal injuries, many complications may follow such as angulatory deformity, incongruity of the joint surface, and growth disturbance, which are well recognized. Therefore, for preventing these complications, we have to know mechanism of injury and position of foot in injury. There are several published articles about classification of these injuries. The first traumatological classification of ankle injuries in children is the one proposed by Bishop. Although there were many reports about classification since Bishop, those did not mention the position of foot in injury. Recently a modified classification by Dias and Tachdjian added the postiton of the foot during injury to the direction of the force as Lauge-Hansen did. There were only few reports about epiphyseal and physeal injuries of the ankle in Korea. Also, we could not find the reports which dealt with more than forty cases. The authors have made a clinical analysis on forty cases of childrens ankle fractures, and among them twenty-two could be followed over a year, who were treated at the Department of Orthopaedic Surgery, Kang-Nam St. Marys Hospital, from June 1981 to December 1986. Children were in age of 3 to 16 years. Forty cases were classified according to modified Dias and Tachdjians. 15 out of 40 cases (37.5%) had supination and external rotation injury, which is the most frequent mechanism of injury in this series. However, one case (2.5%) which was suspected to be axial compression type could not be accommodated to this classification. Twenty-seven cases were treated by gentle closed reduction and immobillization in a plaster cast, and thirteen by open reduction and internal fixation. Among the 22 cases who were followed over a year, five cases had complications, such as angulatory deformity, incongruity of the joint surface, and growth disturbance. Three cases out of these five cases had incongruity of the joint surface.
Ankle Fractures ; Ankle Injuries ; Ankle ; Casts, Surgical ; Child ; Classification ; Congenital Abnormalities ; Foot ; Humans ; Incidence ; Joints ; Korea ; Supination

The accepted radiographic method to determine cervical spinal stenosis is the direct measurement of the sagittal diameter of the spinal canal on the routine lateral view of the cervical spine. The reported normal and abnormal values for this measurement are inconsistent because of various methods of obtaining the roentgenograms and different body types which affect the size of the X-ray image. According to Pavlow, the ratio method of determining crevical spinal stenosis, in which the sagittal diameter of the spinal canal is divided by the sagittal diameter of the corresponding vertebral body, is independent of technical factor variables and is a reliable method for determining cervical spinal stenosis. In order to determine the Pavlov's ratio of normal Koreans, and compare it with that of radiculopathic group, we measured the diameter of cervicl canal in 47 normal persons(28 male, 19 female), and 32 patients( 9 male, 23 female) who had transient tingling sensation and radiculopathic symtom from the second to fifth decades. The results were as follows :1) The average Pavlov's ratio from C3 to C7 in normal Korean men are 0.906(0.70–1.13), 0.899 (0.070–1.13),0.948(0.70–1.67) and 0.948(0.67–1.17), respectively, and those of normal Korean women are 0.977(0.83–1.15), 1.021(0.83–1.13), 1.014(0.84–1.33) and 1.055(0.88–1.18), respectively. 2) The average Pavlov's ratio from C3 to C7 in radiculopathic Korean men are 0.88(0.65–1.12), 0.90(0.68–1.12), 0.95(0.79–1.12) and 0.95(0.78–1.06), respectively, and those of radiculopathic Korean women are 0.902(0.70–1.27), 0.905(0.69–1.27), 0.939(0.70–1.33) and 0.931(0.70–1. 18), respectively. 3) There are not statistically differences of the Pavlov's ratio between the control group and the radiculopathic group. 4) We believe that the Pavlov's ratio is an effective method in detection of cervical stenosis and is able to eliminate technical factor such as body position, target and object-to-film distanc.
Asian Continental Ancestry Group ; Constriction, Pathologic ; Female ; Humans ; Male ; Methods ; Sensation ; Somatotypes ; Spinal Canal ; Spinal Stenosis ; Spine