I have examined the effects of a growth factor, transforming growth factor(TGF)-B 1, on the rates of proteoglycan synthesis, aggregation potenital, and phenotypic expression of proteoglycans from human cervical intervertebral discs maintained in a cell culture system. A cell culture system for transitional and nuclear regions of degenerated human cervical intervertebral disc disc was devised to assess the biosynthetic response, assayed by 35S-sulfate incorporation into proteoglycan and protein synthesis assayed by 35S-methionine incorporation. And I had the data as the TGF-B 1 has an effect on the proteoglycan synthesis in quantitative and qualitative analysis in the cell culture system of the human intervertebral disc. TGF-B 1 may be used as a therapeutic alternative to degenerated disc disease.
Cell Culture Techniques ; Humans ; Intervertebral Disc ; Proteoglycans ; Transforming Growth Factors

We report a case of bacteriologically proven salmonella infection on the thoracic vertebra in a patient with previous history of pulmonary tuberculosis, in the non-endemic area with no history of sickle cell disease and typhoid fever. A forty-three years old female patient was admitted because of severe back pain, chest pain, lower extremity weakness and intermittent high fever elevation. On plain X-ray there was narrowing of T11-12 disc space with adjacent vertebral body destruction localized centrally around the disc and paravertebral abscess. She had an old history of pulmonary tuberculosis and treated with antituberculosis medication twenty years ago. We treated this patient by abscess drainage, anterior curettage and iliac corticocancellous strut bone graft over the T11 to T12 by anterior transthoracic approach. Histopathological diagnosis was chronic vertebral osteomyelitis with chronic inflammatory reaction. Pus culture reported to have grown salmonella typhi group D, sensitive to ampicillin, chloramphenicol, gentamicin and tetracycline. We could establish the diagnosis and effectively treat the disease with early surgical intervention.
Abscess ; Ampicillin ; Anemia, Sickle Cell ; Back Pain ; Chest Pain ; Chloramphenicol ; Curettage ; Diagnosis ; Drainage ; Female ; Fever ; Gentamicins ; Humans ; Lower Extremity ; Osteomyelitis ; Salmonella Infections ; Salmonella typhi ; Salmonella* ; Spine* ; Spondylitis* ; Suppuration ; Tetracycline ; Transplants ; Tuberculosis, Pulmonary ; Typhoid Fever

PURPOSE: To evaluate the degree of injury of the spinal cord in relation with the space available for the spinal cord at the level of injury, the sagittal diameter of the spinal canal at the uninjured levels, and the Pavlov ratio at the uninjured levels in fractures and dislocations of the lower cervical spine. MATERIALS AND METHODS: We retrospectively reviewed the records and radiographs of patients who had sustained an acute fracture or dislocation of the cervical spine from 1990 to 1995. We collected patients from Orthopedic and Neurosurgical department of Chonbuk University Hospital and at Orthopedic department of Presbyterian Medical Center. Of the 69 patients analyzed, twelve had no neurological deficit, eleven had an isolated nerve-root injury, twenty-two had an incomplete injury of the spinal cord, and twenty-four had a complete injury. We measured above three parameters from the plain lateral radiographs and assessed the difference by one-way ANOVA and unpaired t-test. RESULTS: 1. The mean space available for the spinal cord at the level of injury was 12.9 millimeter for the complete injury of the spinal cord,13.8 millimeter for the incomplete injury, 14.7 millimeter for an isolated nerve-root injury, and 15.7 millimeter for no neurological deficit group. The overall difference among the groups was significant (F=6.98, P=0.0004). The patients who had a complete injury of the spinal cord and those who had an incomplete injury of the spinal cord were significantly different from the patients who had an isolated nerve-root injury and those who had no neurologic deficit (P=0.002). 2. The mean sagittal diameter of the canal at the proximal and distal uninjured level was 14.3 and 14.6 millimeter for the complete injury of the spinal cord, 14.9 and 14.9 millimeter for the incomplete injury, 15.5 and 16.6 millimeter for an isolated nerve-root injury, and 16.9 and 16.5 millimeter for no neurological deficit group. The patients who had a complete injury of the spinal cord and those who had an incomplete injury of the spinal cord were significantly different from the patients who had an isolated nerve-root injury and those who had no neurologic deficit (P=0.001). 3. The mean Pavlov ratio at the proximal and distal uninjured level was 0.90 and 0.86 for no neurologic deficit group, 0.85 and 0.87 for an isolated nerve-root injury, 0.76 and 0.75 for the incomplete injury of the spinal cord, and 0.76 and 0.76 for the complete injury. The patients who had a complete injury of the spinal cord and those who had an incomplete injury of the spinal cord were significantly different from the patients who had an isolated nerve-root injury and those who had no neurologic deficit (P=0.001). CONCLUSIONS: The patients who sustained a permanent injury of the cord usually had had a narrower sagittal diameter (<14mm) and a lower Pavlov ratio (<0.80) of the spinal canal before injury. Patients who had a large sagittal diameter of the canal may be more likely to be spared a permanent injury of the spinal cord following a fracture or dislocation of the cervical spine compared with patients who have a narrow canal. These findings demonstrated that the severity of the injury of the spinal cord was in part associated with the space available for the cord (at risk:<13mm) after the injury, as measured on plain lateral radiographs.
Dislocations* ; Humans ; Jeollabuk-do ; Neurologic Manifestations ; Orthopedics ; Protestantism ; Retrospective Studies ; Spinal Canal ; Spinal Cord* ; Spine*

No abstract available.

STUDY DESIGN: Retrospective study of 72 patients treated for the acute lower cervical spinal injury with or without spinal cord injury. OBJECTIVES: We designed this study to evaluate the determining factors in the prognosis of the acute cervical spinal cord injury. We hypothesized as the prognosis is dependent on the severity of injury, not by time-related for the initiation of the treatment. SUMMARY OF BACKGROUND DATA: There is still controversies in the management of the acute cervical spinal cord injury. And the prognosis is generally considered to depend on the severity of trauma to the spinal cord. METHODS: We divided neurologic status into 4 groups; complete, incomplete, root injury and no neurologic deficit group. And there were complete cord injury in 12, incomplete cord injury in 34, single root injury in 14 and no neurologic deficit in 12 patients. The time to operation since injury was 24 hours in 7, 7 days in 32, 3 weeks in 15, 6 weeks in 8, and more than 6 weeks in 5 cases. The operation was indicated mainly for the patients with irreducible fracture-dislocation or for the patients with bony fragments, and disc materials impinging on the spinal cord. Surgical treatment were done in 67 cases with anterior cervical discectomy and fusion(ACDF), ACDF with anterior stabilizaiton, posterior wiring, and circumferential fusion. We statistically analyzed the relationship hetween the time to surgery after injury and the degree of neurologic recovery after surgical treatment by chi square test. RESULTS: There were no neurologic recovery in complete cord injury. There were incomplete cord injury in 34 patients, 8 anterior cord syndrome had no neurologic recovery, among 24 patients with central cord syndrome(CCS) 18(22/24 operated) had neurologic recovery in various degrees and 2 of Brown-Sequard syndrome showed significant neurologic recovery. In nerve root injury, all except l (1/12) patient had complete neurologic recovery. There were neurologic recovery in 2/2 CCS when operated within 24 hours, 8/10 CCS when operated between 2-7 days and 4/5 CCS when operated between 2-3 weeks. There were neurologic recovery in 3/3 CCS when operated between 4-6 weeks and 1/2 CCS when operated more than 7 weeks after injury. There was no significant difference in the relationship between the time to surgery after injury and the degree of neurologic recovery after operation(X2=2.48, df=4, P=0.65). CONCLUSION: Spinai cord injury is directly related with the magnitude of injury at the time of trauma, and the prognosis is determined entirely at the time of injury, And the prognosis is not altered hy time of the treatment.
Brown-Sequard Syndrome ; Diskectomy ; Humans ; Neurologic Manifestations ; Prognosis* ; Retrospective Studies ; Spinal Cord Injuries* ; Spinal Cord* ; Spinal Injuries

No abstract available.

We designed this study to analyze the causes of repeat surgery in the low back disorder after primary procedure, to evaluate the risk factors and to suggest the rational approachs can prevent and solve the problems related with repeat surgery. We retrospectively reviewed the medical record and radiographs of 24 patients who had sustained persistent or recurrent pain, failed to extended conservative therapy, showing abnormal myelogram and/or CT scan with nerve root compression, and with segmental instability consistent with patients symptom and sign after the primary procedures. We evaluated the functional outcome according to Kims(1986) criteria. The causes of remained or recurrent pain with neurologic symptom were persistent or aggravated lumbar spinal stenosis in 10 cases(42%), recurrent disc herniation in 4 cases(17%), infection in 3 cases(12%), instability in 2 cases(8%) and others in 5 cases(20%). Satisfactory outcome was recorded in 79%(19/24) of patients. The characteristics of the patients associated with satisfactory outcome were those who operated by recurrent disc herniation, instability, retained disc, metal malposition, and nerve root compression by bone chip. But the characteristics of the patients associated with unsatisfactory outcome were those who operated by infection, lumbar spinal stenosis aggravated by degenerative spondylosis and multiple herniated disc, inadequate decompression of lateral and/or foraminal stenosis in aged patients. The most common lesion site was on L4-5 disc, and unsatisfactory result was expected at the upper lumbar spine involvement. Favorable outcome could be expected in the presence of a pain-free interval more than 1 year from the date of the previous operation or persistent symptoms immediately after the initial operaion. We were expected the risk factors leading to repeat surgery were old aged(more than 60) patients, upper lumbar spine involvement and multiple lumbar disc herniation. Postoperative diskitis or osteomyelitis, pain free interval more than 1 month or less than 1 year, and those who had a revision on the lumbar spine previously could be considered as a poor prognostic indicators. When surgery is indicated for degenerative lumbar spinal disorders, adequate diagnostic tests and the execution of appropriate procedures based upon this information should be carried out to prevent the repeat surgery in the low back disorders. Adequate postoperative management can reduce the occurrence of failed back surgery syndrome and in cases necessitating repeat surgery, thorough analysis of causes following proper surgical stabilization can reduce the operative morbidity with early return to daily life.
Constriction, Pathologic ; Decompression ; Diagnostic Tests, Routine ; Discitis ; Failed Back Surgery Syndrome ; Humans ; Intervertebral Disc Displacement ; Medical Records ; Neurologic Manifestations ; Osteomyelitis ; Radiculopathy ; Reoperation* ; Retrospective Studies ; Risk Factors ; Spinal Stenosis ; Spine ; Spondylosis ; Tomography, X-Ray Computed

PURPOSE: We designed this study to evaluate the incidence of spinal cord injury and the results of surgical treatment of lower cervical spine injury, and to suggest a rational treatment guideline according to the stages of Allen's mechanistic classification of the lower cervical spine injury. MATERIALS AND METHODS: We reviewed the medical records and roentgenograms of 66 patients (49 men and 17 women), who were treated surgically for acute fracture and dislocation of the lower cervical spine since March. 1991 to March. 1996. These patients ranged in age from 17 to 68 years (average age- 38 years). We used Allen's mechanistic classification to analyze fractures in the lower cervical spine injury. We divided neurologic status by complete, incomplete, root injury and no neurologic deficit group, Surgical treatment was performed for those with unstable fracture/dislocation, progressive neurologic deficit with conservative care, neurologic deficit with spinal cord compression by fracture fragment or extruded disc material. Surgical approach was determined according to the site of lesion. We analyzed the surgical treatment results according to neurologic recovery, radiologic bone union and complications, We used chisquare test for statistical analysis of neurologic improvement between the different surgical treatments. RESULTS: Twenty-nine cases were distractive-flexion (DF) phylogeny, 19 cases were compressive-flexion (CF), 2 cases were vertical-compression (VC), 8 cases were compressive-extension (CE), and 8 cases were distractive-extension (DE) phylogeny. For definitive surgical treatments we performed anterior cervical discectomy and fusion (ACDF) in 25, ACDF with anterior stabilizaiton in 30, posterior fusion in 5, and circumferential fusion in 6. There was no neurologic recovery in complete cord injury. There were 32 cases of incomplete cord injury all 8 anterior cord syndromes had no neurologic recovery, among 22 patients with central cord syndrome 18 had neurolgic recovery in various degrees and 2 with Brown-Seguard syndrome showed significant neurologic recovery. In nerve root injury, all patients had complete neurologic recovery. There was no radiologic nonunion at all and it took 10.3 weeks in average for radiologic bone union. There were neurogenic bladder, bed sore, local kyphosis, duodenal ulcer, respiratory infection, persistent neck pain and superficial wound infection in complications. Summary and CONCLUSIONS: In extension (CE, DE) injuries with neurologic deficit, anterior approach should be recommended because the major pathology is located in the anterior structure of the cervical spine. In flexion (DF and CF) injuries with major posterior osteoligamentous disruption, posterior approach could fix the posterior structures. Anterior decompression and fusion should be followed whenever anterior pathology is compressing the spinal cord or nerve root. Posterior open reduction and fusion is necessary whenever there is unreduced facet joint dislocation with or with out neurologic deficit. To prevent the late local kyphosis and persistent neurologic deficit with neck pain after prolonged external immobilization with ACDF, anterior stabilization with a plate and screw system is necessary to augment the surgical treatment of the unstable lower cervical spine injury which necessitates anterior decompression.
Central Cord Syndrome ; Classification ; Decompression ; Diskectomy ; Dislocations ; Duodenal Ulcer ; Humans ; Immobilization ; Incidence ; Kyphosis ; Male ; Medical Records ; Neck Pain ; Neurologic Manifestations ; Pathology ; Phylogeny ; Pressure Ulcer ; Spinal Cord ; Spinal Cord Compression ; Spinal Cord Injuries ; Spine* ; Urinary Bladder, Neurogenic ; Wound Infection ; Zygapophyseal Joint

Fracture of the vertebral end plate in the lumbar spine has been reported as a rare lesion occurring in the adolescent period. It is characterized by variable degrees of sign and symtom related to the degree of block on myelogram and the level of end plate fracture. Trauma or strenuous sport activity seems to play an improtant role in the production of fracture of vertebral body in the adolescent period. We experienced three cases of fracture of lower lumbar vertebral end plate in teenaged patients, two males and one female. Two patients showed upper end plate fracture with severe neurologic deficit on the involved root level and a strong positive on straight leg raising test, and one patient showed lower end plate fracture with slight neurologic deficit. Two patients with upper end plate fracture were treated with partial laminectomy with removal of fracture fragment and one patient with lower end plate fracture was treated with bilateral laminectomy and posterolateral fusion. The method of treatment will depend upon the type of fracture and the degree of neurologic symptoms. We obtained satisfactory results with posterior decompressive laminectomy and removal of fracture fragment with or without fusion.
Adolescent ; Female ; Humans ; Laminectomy ; Leg ; Male ; Methods ; Neurologic Manifestations ; Spine ; Sports

The ankle is a complex structure supporting the entire musculoskeletal system during standing and walking. The injuries to the ankle joint result in a severe functional disturbance because of complex anatomical characteristics around the ankle joint. 69 patients(72 cases) of the ankle fracture that were treated in Orthopedic Dept. Chonbuk National University Hospital from Jan. 1979 to Dec. 1983 were analized in clinical and radiological aspects. The following results were obtained: 1. Among the 69 patients, male was 54 and female 15 with ratio of 3.5: 1.The average age was 32. 2. Main cause of fracture was traffic accident(58%). 3. The musculoskeletal system was injured most frequently associated with the ankle fracture(66%). 4. According to the ankle fracture classification, the most common type was Pronation-external rotation type in Lauge-Hansen classification, and the type C in Weber classification. 5.The average duration of cast immobilization was 8.8 weeks in closed reduction and 7.4 weeks in open reduction. 6. The lateral malleolar fracture involving the distal tibiofibular syndesmosis was very important in ankle stability so accurate anatomical reduction by internal fixation was necessary for satisfactory functional results. 7. In clinical and radiological analysis, the better results were obtained from open reduction.
Ankle Fractures ; Ankle Joint ; Ankle ; Classification ; Clinical Study ; Female ; Humans ; Immobilization ; Jeollabuk-do ; Male ; Musculoskeletal System ; Orthopedics ; Walking