With an aging population, osteoporotic vertebral collapse is an increasingly common condition. This compression fractures has been considered a benign entity, quite responsive to conservative treatment. In a rare patients, however, a major neurologic complication and painful kyphosis despite conservative treatment can develop. Therefore, the purpose of this present study is to analyze the surgical results of 14 patients with severe back pain, an increasing kyphosis and neurologic deficits caused hy osteoporotic vertebral collapse following minor trauma, who were treated surgically. Presenting signs and symptoms included severe back pain with progression of kyphosis in 6 patients and increasing neural deficit in 8 patients. Of 14 patients, eight patients had an intravertebral cleft sign (vacuum sign). Indications for surgery included increasing kyphotic deformity, intractable pain, or increasing neurologic deficit. There was no correlation between intravertebral cleft sign and neurologic deficit. However, patients who had intravertebral cleft sign had not well respond to conservative treatment. As treatments, combined anterior and posterior fusion in 8, anterior fusion in 4, posterior instrumentation, and wide decompressive laminectomry in one patient, respectively, were carried out. The final correction of the deformity averaged 0.3 degrees. Therefore. correction of kyphosis was not favorably maintained because of variable surgical methods, and sinking of graft bone or instrumentation into the osteoporotic vertebral bodies. However, pain was reduced significantly in all patients. In addition neurological symptoms improved in 7 patients. One patient underwent reoperation with nnterior inierbody tusion together with anterior instrument because of an increasing kyphosis, neurologic. iymptoms and scvcre hack pain following wide decompressive laminectomy. There was no complication relatecl to instruments. The authors strongly helieved that surgical intervention has highly satisfactory results in patients who have intravertehral cleft sign with persistent back pain despite conservative treatment, and proressive or persistent neurologic deficits following osteoporotic vertebral collapse.
Aging ; Back Pain ; Congenital Abnormalities ; Fractures, Compression ; Humans ; Kyphosis ; Laminectomy ; Neurologic Manifestations ; Osteoporosis ; Pain, Intractable ; Reoperation ; Transplants

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

One of various decompression methods in treatment of spinal stenosis is the indirect instrumental decompression. Theoretically, the distraction of the disc space can widen the intervertebral foramen of the stenotic segment and even increase the canal diameter by distracting the posterior annulus as well as reduce the extent of decompressive laminectomy site. The indirect instrumental decompression, however, was not guaranteed to maintain the restored discal height because of the loss of fixation strength between rod and screw, viscoelasticity of vertebra itself, bone density, type of screw and rod, and operative technique. As well the magnitude of the stresses on the instrumentation particularly at the rod-screw interface may depend on rod-contouring in order to make mormal sagittal curvature of the lumbar spines. Therefore, the aim of this experimental study was to evaluate the effect of different rod-contour on the axial sliding strength in Compact Cotrel-Dubousset (CCD) instrumentation. Axial sliding strength was tested by Universal Test Machine (Instron). Test was performed for 3 groups of different rodcontouring on the biomechanical axial strength: straight rod (no contour), 10 and 20 contouring rod. The length of contact surface between rod and screw was measured with Fuji pressure sensitive film. The study was performed using 6.5 mm open body screws and 7 mm rods of CCD instrumentation. Axial sliding strength of straight rod was 2518.6N, 1871.8N in 10 and 1528.8N in 20 contouring rod. The length of contact surface between rod and screw significantly decreased according to degree of rod contouring; 9.88mm in straight rod, 9.08mm in 10 and 8.57mm in 20 contouring rod. There was a statistically significant linear correlation (R=0.96) between failure load and length of contact surface. Therefore, this study has shown that excessive contour of the rod in order to make normal sagittal curvature of the lumbar spine using CCD instrumentation cannot provide sufficient axial sliding strength. That may be a cause of loss of restored disc space height after surgery.
Bone Density ; Decompression ; Laminectomy ; Spinal Stenosis ; Spine

STUDY DESIGN: We classified adult isthmic spondylolisthesis based on the findings of postmyelographic CT scanning. OBJECTIVES: To propose a new classification that could be used as a useful guideline when evaluating the patient with adult isthmic spondylolisthesis. SUMMARY OF LITERATURE REVIEW: Morphologic changes of the spinal canal and its neural contents in the adult patient with isthmic spondylolisthesis and their relations to radiological variables have not been well described in literature. MATERIALS AND METHODS: 32 adult patients with one level isthmic spondylolisthesis underwent myelography followed by CT scanning. Based on these findings, we classified each patient with four morphologic criteria; 1. dural station I or ll by the location of dural sac, 2. non-compression or compression type by the existence of lateral compression of dural sac. 3. root station I or ll by the location of nerve root, 4. hook or smooth type by the shape of spinal canal. Subsequent statistical analyses to assess the relationships between our newly developed classification and clinical variables were tested by SPSS software. RESULTS: Dural station correlated positively with percent slip(rpb=0.39; p=0.026). Patient age was closely related to the lateral compression(rpb=0.54, p<0.01) which consequently decreased transverse diameter of dural sac(rpb=-0.68, p<0.01). Both dural station and lateral compression were important in the prediction of the extent of the dural involvement. Root station of the smooth type correlated positively with percent slip(reb=0.47: p=0.038), while that of the hook type did not. Consequently, nerve root of the hook type entered neural foramen under the pedicle, whereas that of the smooth type entered at various locations depending on the degrees of percent slip. Depth of lateral recess was significantly less in the hook type than in the smooth type(p<0.01). Stretching of the nerve root, produced by posterior migration of the nerve root, was observed only in the smooth type. CONCLUSIONS: We strongly recommend the use of our classification because it is easy to apply and has a high correlation with radiological variables.
Adult* ; Classification* ; Humans ; Myelography* ; Spinal Canal* ; Spondylolisthesis* ; Tomography, X-Ray Computed*

We have experienced 109 cases of hypertensive intracerebral hemorrhage admitted to the Department of Neurosurgery of Catholic Medical Center from January 1973 to August 1976. We analized the result of treatment of hypertensive intracerebral hemorrhage and assessed prognostic factors affecting the results of surgical treatment of hypertensive intracerebral hemorrhage. 1. The age of the patients did not significantly influence on the mortality of operative or non-operative cases provided the age is below sixty. 2. The amount of hematoma did not directly related to the outcome of operated cases if the hematoma is less than 50ml, while the mortality was considerably increased if the clot was more than 50ml. 3. There was no specific difference in operative mortality between total evacuation and partial evacuation of hematoma in surgery of the hypertensive intracerebral hemorrhage, but total evacuation had better result than that of partial evacuation in the functional recovery. 4. The operative mortality of the hypertensive intracerebral hemorrhage was 43.6% and 55.7% in non-operative cases. Thalamic hemorrhage carried the highest mortality either operated or conservatively treated. 5. The surgical treatment carried better result than non-operative treatment in the case showing progressive change in consciousness following intracerebral hemorrhage. Conservative treatment obtained good result in the cases showed progressive improvement of conscious level following intracerebral hemorrhage. 6. The interval from the ictus to surgical intervention did not constantly influence on the result of surgery and it might be wise to decide the time of surgical intervention according to the progressive changes in conscious level and neurological status after bleeding. 7. The operative result was favorable in the patients who has shown progressive worsening of conscious level and neurologic status following clear conscious at hemorrhage (class II). We also noted that the patients were unconscious at ictus then became progressively stupor with increasing neurologic deficit showed better result with surgical treatment than non-operative care.
Cerebral Hemorrhage ; Consciousness ; Hematoma ; Hemorrhage ; Humans ; Intracranial Hemorrhage, Hypertensive* ; Mortality ; Neurologic Manifestations ; Neurosurgery ; Stupor

STUDY DESIGN: A retrospective analysis was performed on 40 patients who had had previous lux bar spine surgeries. OBJECTIVE: To determine what factors most influenced surgical outcome and to analyze results in a series of revision lumbar surgeries. SUMMARY OF BACKGROUND DATA: Satisfactory surgical outcome of the revision lumbar surgery range from 28% to 82% and are rarely comparable to primary surgery. Many factors predicting outcome from repeat lumbar surgery haute been listed. METHODS: Forty patients were analyzed who had had previous lumbar surgeries. The patients were classified into 5 groups according to diagnosis: 3 Infection,5 instability,8 nonunion, 14 HNP and 10 spinal stenosis. of 40 patients,33 patients(82.5%) underwent fusion with instrumentation for repeat surgery. Their clinical course was followed for a minimum of 1 year. The number of surgery on each mpatient was 1.3 times on an average. RESULTS: Overall, 80% of patients had a satisfactory result. Obviously extruded or sequestrated HNP in MRI findings, complete block of contrast with severe radiculopathy and/or myelopathy in spinal stenosis, complete decompression, neurolysi s and fusion with instrumentation, and longer than 6 month pain relief after precious surgery were correlated with satisfactory outcome. However, the number of precious operation, age, repair of pseudarthrosis , no abnormality at surgery and combined multiple degenerative joint disease were significantly correlated with poor surgical outcome. The most common complication during repeat surgery was dural tear in 5 cases(12.5%). CONCLUSIONS: Success rate of revision surgery was low as compared to primary operation. Therefore, erroneous diagnosis and faulty surgical technique understandably lead to failure, and precise attention to preoperative and intraoperative detail can minimize these sources of error.
Decompression ; Diagnosis ; Humans ; Joint Diseases ; Magnetic Resonance Imaging ; Pseudarthrosis ; Radiculopathy ; Reoperation ; Retrospective Studies ; Spinal Cord Diseases ; Spinal Stenosis ; Spine* ; Tears

STUDY DESIGN: This retrospective study was designed to find the causes of adjacent-segment changes and to investigate the correlation between these changes and clinical results in long-term follow-up patients after instrumental lumbar fixation and posterolateral fusion. OBJECTIVE: To quantify how immobilization of a rigid spinal segment fixation effect the pre-existing degenerated adjacent-segment and to observe the adjacent-segment changes, contributing factors of adjacent-segment changes and to investigate the the correlation between clinical results and adjacent-segment changes. SUMMARY OF LITERATURE REVIEW: The reduction in the number of mobile lumbar segments with posterior instrumentation and fusion causes an increased stress in the unfused segment, predisposing them to early degeneration. In addition, the adjacent-segment above the rigid fixation is a particular problem in the previously degenerative spine, which accelerated degeneration at adjacent-segment Many clinical studies reported that stress of the adjacent-segment could develop the significant incidence of spondylolisthesis, spondylolysis and spinal stenosis. MATERIALS AND METHODS: Forty patients were retrospectively reviewed who underwent wide laminectomy and intertransverse fusion with posterior instrumentation. Inclusion in the study required minimum of 5 years of clinical and radiographic follow-up. Nineteen patients were diagnosed as degenerative spondylolisthesis, degenerative scoliosis in 8, pure spinal stenosis in 6 and lytic spondylolisthesis in 7. The most common fused segments were L4-5 in 16. Initial radiographs including plain radiogram, CT and MRI were classified with respect to presence of degeneration adjacent to fused segments. A preoperative spinal instability was diagnosed when any of the following conditions were noted at adjacent above the fusion: 1) >15degrees angulatory instability, 2) >3mm translation, 3) >5degrees lateral angulation, 4) >grade 1 rotational deformity, and postoperative adjacent changes were diagnosed 1) same as preoperative instability criteria, 2) fracture, 3) spinal stenosis, 4) spondylolysis. Clinical results were categorized as poor, fair, good and excellent. RESULTS: Of 40 patients, 16(40%) patients had significant adjacent-segment changes such as instability in six, fracture in aye, spinal stenosis in four and lysis in one. Incidence of adjacent- segment changes was significantly higher in more than 54-years old. Degenerative scoliosis had a higher adjacent-segment chanties and showed statistically significant between preoperative disease and adjacent-segment changes. Nine patients who had a preoperative instability showed significant adjacent-segment changes. Of remained 31 patients, only 7 patients had adjacent-segment changes. There was a statistically significant difference according to preexisting adjacent-segment degeneration. All five patients with grade 3 degeneration developed significant adjacent-segment changes. In overall clinical results, all 7 poor cases had significant adjacent-segment changes. Of them,5 patients should undergo reoperation. CONCLUSION: Inevitable compensatory mechanism occurs at adjacent segment, resulting from stress concentration and alteration in motion kinematics after fusion. The most important factors associated with adjacent-segment changes were age, pre-existing degeneration and preoperative instability. The adjacent-segment changes had a significant correlation with poor clinical results.
Biomechanical Phenomena ; Congenital Abnormalities ; Follow-Up Studies* ; Humans ; Immobilization ; Incidence ; Laminectomy ; Magnetic Resonance Imaging ; Middle Aged ; Reoperation ; Retrospective Studies ; Scoliosis ; Spinal Stenosis ; Spine ; Spondylolisthesis ; Spondylolysis

We found a mistake in our recently published article.

The gout is a hereditary condition of disturbed uric acid metabolism. There are medical and surgical management in tophaceous gout for prevention of recurrence of acute attack and creation of a negative uric acid balance. The surgical management is removal of tophaceous material in the soft tissue and osseous structure. Aditionally, the resection of bone and joint, arthrodesis and bone graft improve the functional capacity of the gouty patients. A 53 years old man was managed by removal of tophaceous materials in both prepatellar area, left olecranon area and both feet and arthrodesis of left first metatarsophalangeal joint with autogenous iliac bone graft and supportive medication with probenecid and indomethacine, and was followed up from March, 1986 to April, 1987. There was no significant difference in duration between the union of nonpathologic fracture and the union of arthrodesis area in this gouty patient. We found the progressive recovery of normal trabeculation in previous destructive bone lesions with drug therapy, but there was no specific change in the soft tissue lesions.
Arthrodesis ; Drug Therapy ; Foot ; Gout ; Humans ; Indomethacin ; Joints ; Metabolism ; Metatarsophalangeal Joint ; Olecranon Process ; Probenecid ; Recurrence ; Transplants ; Uric Acid

Fracture of the vertebral end plate in the lumbar and sacral spine has been reported as a rare lesion. Especially it is very rare that fractures are found at two levels simultaneously. To our knowledge, there has been only one reported case of this type of fracture in Korea3). We report a case of fractures of the vertebral end plates at two levels in adolescent patient.
Adolescent ; Humans ; Spine