Objective: Autologous bone grafting for cranioplasty is associated with a high infection rate and bone absorption. Synthetic implant materials for cranioplasty have been developed. In this study, we evaluated the efficacy of titanium mesh-type patient-specific implants (PSIs) for patients with skull defects using the dice similarity coefficient (DSC), clinical outcomes, and artifacts caused by implants. Methods: This retrospective study included 40 patients who underwent cranioplasty with a titanium mesh PSI at our institution. Based on preoperative and postoperative computed tomography scans, we calculated DSC and artifacts. Results: The calculated DSC of 40 patients was 0.75, and the noise was 13.89% higher in the region of interest (ROI) near the implanted side (average, 7.64 hounsfield unit [HU]±2.62) than in the normal bone (average, 6.72 HU±2.35). However, the image signal-to-noise ratio did not significantly differ between the ROI near the implanted side (4.77±1.78) and normal bone (4.97±1.88). The patients showed no significant perioperative complications that required a secondary operation. Conclusion Titanium mesh-type PSIs for cranioplasty have excellent DSC values with lower artifacts and complication rates.

OBJECTIVE: To study risk factors of secondary lumbar discectomy (LD) for recurrent herniated lumbar disc (HLD) and identify methods to lower the rate of recurrence.METHODS: Data from 160 patients who underwent primary LD were collected retrospectively. Demographic features, radiologic findings including Pfirrmann disc degeneration, and surgical information were analyzed to compare risks between revision and non-revision patients.RESULTS: The revision rate was 15% (24 patients), and the mean follow-up was 28.3 months. HLD recurrence was not related to any demographic characteristics. Primary and secondary LD were most common at the L4–5 level, but the level of operation was not significantly associated with revision. Primary LD most commonly had a Pfirrmann disc degeneration grade of 3, followed by 4. For recurrent HLD, Pfirrmann grade 4 was most common and was statistically significant (p<0.05). A body mass index (BMI) over 30 was considered obese and was significantly related with HLD revision (p<0.05).CONCLUSION: Patients with high BMI or severe disc degeneration should be informed of HLD revision.
Body Mass Index ; Diskectomy ; Follow-Up Studies ; Humans ; Intervertebral Disc Degeneration ; Recurrence ; Reoperation ; Retrospective Studies ; Risk Factors

OBJECTIVE: Chronic subdural hematoma (CSDH) is common in elderly patients. So, with an increasing number of elderly people in the general population, there is a need to investigate risk factors which increase recurrence rate. In this study, factors affecting the postoperative recurrence are investigated based on the reoperative CSDH cases. METHODS: Total of ninety-seven patients was enrolled in this study who had have operation for CSDH. In all patients, one burr hole trephination and drainage was the method of choice for the initial treatment of CSDH. We retrospectively evaluated several factors which affect to recurrence of CSDH. RESULTS: Retrospective analysis was performed in 97 patients. Sixteen patients experienced reoperation within 3 months (16/97, 16.5%) for recurrence of CSDH. And, when hematoma was divided by internal architecture, heterogeneous density group seems to be have close relationship with recurrence more significantly than homogeneous density group (p=0.002). Hypertension, diabetes mellitus, early removal of drainage tube, bilaterality of hematoma also have significant relationship with recurrence. CONCLUSION: Recurrence rate of CSDH treated with one burr hole drainage is related with some various factors. There was statistically significant difference between recurred group and non-recurred group. Not only demographic factors but also internal architecture on preoperative brain computed tomography is a significant predicting factor of recurrence in CSDH patients who underwent a surgery. In this study, heterogeneous type hematoma have significantly related with recurrence of CSDH. We should give attention to these predicting factors for more effective care.
Aged ; Brain ; Demography ; Diabetes Mellitus ; Drainage* ; Hematoma ; Hematoma, Subdural, Chronic* ; Humans ; Hypertension ; Recurrence* ; Reoperation ; Retrospective Studies ; Risk Factors ; Trephining

OBJECTIVE: Transpedicular screw fixation has some disadvantages such as postoperative back pain through wide muscle dissection, long operative time, and cephalad adjacent segmental degeneration (ASD). The purposes of this study are investigation and comparison of radiological and clinical results between interspinous fusion device (IFD) and pedicle screw. METHODS: From Jan. 2008 to Aug. 2009, 40 patients underwent spinal fusion with IFD combined with posterior lumbar interbody fusion (PLIF). In same study period, 36 patients underwent spinal fusion with pedicle screw fixation as control group. Dynamic lateral radiographs, visual analogue scale (VAS), and Korean version of the Oswestry disability index (K-ODI) scores were evaluated in both groups. RESULTS: The lumbar spine diseases in the IFD group were as followings; spinal stenosis in 26, degenerative spondylolisthesis in 12, and intervertebral disc herniation in 2. The mean follow up period was 14.24 months (range; 12 to 22 months) in the IFD group and 18.3 months (range; 12 to 28 months) in pedicle screw group. The mean VAS scores was preoperatively 7.16+/-2.1 and 8.03+/-2.3 in the IFD and pedicle screw groups, respectively, and improved postoperatively to 1.3+/-2.9 and 1.2+/-3.2 in 1-year follow ups (p<0.05). The K-ODI was decreased significantly in an equal amount in both groups one year postoperatively (p<0.05). The statistics revealed a higher incidence of ASD in pedicle screw group than the IFD group (p=0.029). CONCLUSION: Posterior IFD has several advantages over the pedicle screw fixation in terms of skin incision, muscle dissection and short operative time and less intraoperative estimated blood loss. The IFD with PLIF may be a favorable technique to replace the pedicle screw fixation in selective case.
Back Pain ; Follow-Up Studies ; Humans ; Incidence ; Intervertebral Disc ; Muscles ; Operative Time ; Skin ; Spinal Fusion ; Spinal Stenosis ; Spine ; Spondylolisthesis

OBJECTIVE: Various procedures have been introduced for anterior interbody fusion in degenerative cervical disc disease including plate systems with autologous iliac bone, carbon cages, and cylindrical cages. However, except for plate systems, the long-term results of other methods have not been established. In the present study, we evaluated radiologic findings for cylindrical cervical cages over long-term follow up periods. METHODS: During 4 year period, radiologic findings of 138 patients who underwent anterior cervical fusion with cylindrical cage were evaluated at 6, 12, 24, and 36 postoperative months using plain radiographs. We investigated subsidence, osteophyte formation (anterior and posterior margin), cage direction change, kyphotic angle, and bone fusion on each radiograph. RESULTS: Among the 138 patients, a minimum of 36 month follow-up was achieved in 99 patients (mean follow-up : 38.61 months) with 115 levels. Mean disc height was 7.32 mm for preoperative evaluations, 9.00 for immediate postoperative evaluations, and 4.87 more than 36 months after surgery. Osteophytes were observed in 107 levels (93%) of the anterior portion and 48 levels (41%) of the posterior margin. The mean kyphotic angle was 9.87degrees in 35 levels showing cage directional change. There were several significant findings : 1) related subsidence [T-score (p=0.039) and anterior osteophyte (p=0.009)], 2) accompanying posterior osteophyte and outcome (p=0.05). CONCLUSION: Cage subsidence and osteophyte formation were radiologically observed in most cases. Low T-scores may have led to subsidence and kyphosis during bone fusion although severe neurologic aggravation was not found, and therefore cylindrical cages should be used in selected cases.
Carbon ; Follow-Up Studies ; Humans ; Kyphosis ; Osteophyte

OBJECTIVE: The safety and efficacy of various fusion substitutes in pyogenic osteomyelitis has not been investigated. We evaluated and compared the cadaveric allograft and titanium cages used to reconstruct, maintain alignment and achieve fusion in the management of pyogenic spinal infection. METHODS: There were 33 patients with pyogenic osteomyelitis underwent fusion in this study. Fifteen of the 33 patients were operated on by fusion with allografts (cadaveric patella bones) and 18 of those were operated with titanium mesh cages filled with autologous cancellous iliac bone. After the affected disc and vertebral body resection with pus drainage, cadaveric allograft or titanium cages were inserted into the resected space. Posterior transpedicular screw fixation and rod compression in resected space, where cadaveric allograft or titanium cages were inserted, was performed to prevent the malposition in all patients except in 1 case. Recurrent infection was identified by serial erythrocyte sedimentation rate and cross reactive protein follow-up. Osseous union and recurred infection available at a minimum of 2 years following operation was identified. The amount of kyphosis correction and the subsidence were measured radiographically. RESULTS: Spinal fusion was achieved in 29 of 33 patients. In the cadaveric allograft group, 93.3% of patient (14 of 15) showed the osseous union while 83.3% of patient (15 of 18) in the titanium cage group showed union. Subsidence was noted in 12 of the patients. Twelve patients (36.3%) showed unsettling amounts of subsidence postoperatively whereas 46.6% of patients in the cadaveric allograft group and 37.7% of patients in the titanium cage group showed similar subsidence, respectively. There were statistical difference in the fusion rate (p=0.397) and subsidence rate (p=0.276) between the two groups. There was significant statistical difference in the postoperative improvement of segmental kyphosis between the two groups (p=0.022), that is the improvement in sagittal alignment was greater in the titanium cage group than in the cadaveric allograft group. There was no case of recurred infection. CONCLUSION: The cadaveric allograft and titanium cages are effective and safe in restoring and maintaining sagittal plane alignment without increased incidence in infection recurrence in pyogenic osteomyelitis. The postoperative improvement of segmental kyphosis was better in the cage group.
Blood Sedimentation ; Cadaver ; Drainage ; Follow-Up Studies ; Humans ; Incidence ; Kyphosis ; Osteomyelitis ; Patella ; Recurrence ; Spinal Fusion ; Suppuration ; Titanium ; Transplantation, Homologous

A 56-year-old woman was admitted for management of low back pain from compression fracture on L3 vertebral body. Vertebroplasty was performed, and she discharged without any neurologic deficit. She revisited our institute with low back pain with sciatica but without myelopathy after three months. At admission image studies revealed fractured bony particles caused canal encroachment on the same level vertebrae. Surgical management was perfor- med including wide posterior decompression and transpedicular screw fixation on L2, L3, and L4 with posterolateral bony fusion. Authors present a rare case of post-augmentation fracture led to spinal fusion. Additionally, we suggest that filling material for vertebroplasty or kyphoplasty should be, as much as possible, inserted into the posterior half of vertebral body to prevent the refracture or burst fracture.
Decompression ; Female ; Fractures, Compression ; Humans ; Kyphoplasty ; Low Back Pain ; Middle Aged ; Neurologic Manifestations ; Sciatica ; Spinal Cord Diseases ; Spinal Fusion ; Spine ; Vertebroplasty

Primary central nervous system (CNS) sarcomas are exceedingly rare, and, to the best of our knowledge, there has not yet been a report of intramedullary sarcoma. Here, we report a primary intradural intramedullary sarcoma of the spinal cord in a four-year-old boy who presented with low back pain and a radiculopathy involving both lower extremities. The tumor showed significant enhancement on magnetic resonance (MR) images due to its extreme vascularity. Gross total tumor removal was performed with microelectrical pulse recording, and the patient also received adjuvant radiotherapy and chemotherapy. After the operation, the patient's sensory deficits were improved. Because CNS dissemination is common, entire neuraxis evaluation is essential, although there was no evidence of dissemination in this case. The prognosis of primary CNS sarcoma is poor due to infiltrative nature and early CNS dissemination is common, and the treatment of choice is radical surgical resection. Adjuvant therapy is also beneficial with radiotherapy and chemotherapy.
Central Nervous System ; Humans ; Low Back Pain ; Lower Extremity ; Magnetic Resonance Spectroscopy ; Prognosis ; Radiculopathy ; Radiotherapy, Adjuvant ; Sarcoma ; Spinal Cord

Traumatic brainstem hemorrhage after blunt head injury is an uncommon event. The most frequent site of hemorrhage is the midline rostral brainstem. The prognosis of these patients is poor because of its critical location. We experienced a case of traumatic brainstem hemorrhage. A 41-year-old male was presented with drowsy mentality and right hemiparesis after blunt head injury. Plain skull radiographs and brain computerized tomography scans revealed a depressed skull fracture, epidural hematoma, and hemorrhagic contusion in the right parieto-occipital region. But, these findings did not explain the right hemiparesis. T2-weighted magnetic resonance (MR) image of the cervical spine demonstrated a focal hyperintense lesion in the left pontomedullary junction. Brain diffusion-weighted and FLAIR MR images showed a focal hyperintensity in the ventral pontomedullary lesion and it was more prominent in the left side. His mentality and weakness were progressively improved with conservative treatment. We should keep in mind the possibility of brainstem hemorrhage if supratentorial lesions or spinal cord lesions that caused neurological deficits in the head injured patients are unexplainable.
Adult ; Brain ; Brain Stem ; Brain Stem Hemorrhage, Traumatic ; Contusions ; Craniocerebral Trauma ; Head ; Head Injuries, Closed ; Hematoma ; Hemorrhage ; Humans ; Magnetic Resonance Spectroscopy ; Male ; Paresis ; Prognosis ; Skull ; Skull Fracture, Depressed ; Spinal Cord ; Spine

Disseminated superficial porokeratosis (DSP) is a specific disorder of keratinization. Genetic studies show that DSP is an autosomal dominant trait. Clinically, the lesions show a sharply demarcated and hyperkeratotic plaque with central atrophy. The lesions appear mainly in the extremities and generally develop with bilateral symmetry. Unusual cases of DSP accompanied by severe pruritus have been reported as "eruptive pruritic papular porokeratosis" or "inflammatory DSP." Histopathologically, inflammatory DSP is characterized by the presence of cornoid lamella with a dense infiltration of eosinophils and lymphocytes in the perivascular area of the upper dermis. Here we report a case of inflammatory DSP in a 84-year-old man with colon cancer who presented with multiple hyperpigmented atrophic macules.
Aged, 80 and over ; Atrophy ; Colon ; Colonic Neoplasms ; Dermis ; Eosinophils ; Extremities ; Humans ; Keratins ; Lymphocytes ; Porokeratosis ; Pruritus