Method of management of the spine injury should be determined, based on the status of neurological injury as well as on the presence of traumatic instability. At the thoracic and lumbar spine, patterns of neurological injury are different from the cervical spine due to their neuro-anatomical characteristics. Especially, at the thoracolumbar junction, neurological injury patterns with their respective prognosis vary from the complete cord injury or conus medullaris syndrome to the cauda equina syndrome according to the injury level. The concept of Holdsworth's instability based on the posterior ligament complex theory has evolved into the current 3-column theory of Denis. Flexion-rotation injury and fracture-dislocation are well known to be unstable that surgical fixation is frequently needed for these injuries. However, there have been some controversies for the stability of burst fractures and their treatment, such as indirect or direct decompression and anterior or posterior approach. In this article, current concepts and management of traumatic instabilities at the thoracic and lumbar spine have been reviewed and summarized.
Decompression ; Ligaments ; Polyradiculopathy ; Prognosis ; Spinal Cord Compression ; Spine*

The disc internal disruption syndrome is not well known to us, but the following hypothesis is widely accepted in clinical practice. The disc internal disruption syndrome may develop intractable back pain with aggravated of pain, loss of spinal motion with any physical exercise, leg pain, loss of energy, marked weight loss, and profound depression. The patient with this syndrome will be found to have normal plain roentgenograms, myelograms, CT scans, results of blood examination and neurologic findings. For these reasons, this syndrome was frequently diagnosed by abnormal discographic findings. We had experience with two cases of disc internal disruption syndrome with clinical, roentgenographic and discographic evaluations. Thus we present these case with a brief review of the concerned literature.
Back Pain ; Depression ; Exercise ; Humans ; Leg ; Neurologic Manifestations ; Tomography, X-Ray Computed ; Weight Loss

PURPOSE: To evaluate the clinical outcome and reliability of mixed bone in the process of posterior spinal fusion for the treatment of thoracolumbar spine fractures. In order to eliminate donor site morbidity which is linked to the use of autogenous bone graft, a new surgical procedure mixing autogenous bone chips that were obtained from local decortication of the posterior element of the spine with highly purified calf bone (Lubboc) is studied. MATERIALS AND METHODS: We followed up 9 patients who had undergone autogenous bone graft and 9 patients who had undergone mixed bone graft for more than 12 months out of 33 patients who underwent posterior spinal fusion for thoracolumbar spine fractures between July 1993 and July 1997. RESULTS: Radiographic results indicated solid bony union in 17 of 18 cases regardless of the graft materials. Based on each follow-up evaluation, it was found that the increase in kyphotic angle was related to elapsed time rather than to the type of graft materials. CONCLUSIONS: It appears that the new surgical method of bone graft with highly purified calf bone can be a reliable alternative for achieving stable posterior spinal fusion as long as bone chips large enough to fill the interlamina space can be obtained.
Follow-Up Studies ; Heterografts* ; Humans ; Spinal Fusion* ; Spine* ; Tissue Donors ; Transplants*

A clinical analysis was done on 23 patients (24 hips) with fracture of the femoral neck, who had been admitted and treated at our Orthopedic department during the period of 4 years, from Jan. 1984 to May 1988. The results were as follows 1. 23 patients were comprised of 4 males and 19 females, and 11 patients were over 65 years old. 2. 18 cases of 24 cases were due to minor traumas such as slipping down, and for over 65 years old, all cases were due to simple minor traumas, 8 cases were showed a severe osteoporosis, below grade 3 of the Singh's index. 3. 14 cases of 24 cases were displaced subcapital fractures, and 6 cases displaced transcervical fractures. Only 4 cases were the undisplaced transcervical fractures. 4. In treatment of fractures internal fixations after manipulation were performed in 14 cases and primary arthroplasties in 10 cases. Secondary arthroplasties were done in complicated 4 cases of 14 cases treated with internal fixations. 5. Complications after internal fixation were developed in 7 cases out of 14 cases, avascular necrosis in 6, nonunions in 2, pin migrations in 3, and metal failure in 1 case. 6. In 14 arthroplasty immediate surgical fitness of femoral stem were related to late loosening of femoral stem (correlation coefficient γ=–0.68, p<0.01).
Arthroplasty ; Clinical Study* ; Female ; Femoral Neck Fractures* ; Femur Neck* ; Femur* ; Humans ; Male ; Necrosis ; Orthopedics ; Osteoporosis

No abstract available.
Aneurysm, False* ; Aorta*

Since the introduction of MRI, the arachnoiditis could easily haute been diagnosed by confirming the abnormal distribution of the roots in the dural sac. But the arachnoiditis-like pattern of nerve root distribution in a degenerative disc disease has been regarded as a an incorrect diagnosis of arachnoiditis. The arachnoiditis has been one of the most serious complication in the failed back surgery syndrome. MR images of 32 patients with acute or chronic radicular pain syndrome were investigated by a radiologist and a orthopedc surgeon. 17 patients had lumbar disc herniation; 13 patients, pure spinal stenosis; 2 patients, spondylolisthesis. The discriminant analysis was used to calculate the cutting point of clumping for the abnormal nerve root distribution and to assess the relationship between the arachnoiditis-like pattern of nerve root distribution and other factors According to the result of calculation, the cutting point of clumping In spinal stenosis was 9mm and that in a disc herniation was 6mm. Central clumping of nerve roots in the durn is considered as a characteristic finding at the constricted level of the lumbar degenerative disease. However, the appearance is not a differentiating factor between the adhesive arachnoiditis and constriction in the lumbar degenerative disease. Clinically, the adhesive arachnoiditis should be suspected in the lumbar degenerative disease with the nerve root clumping at multiple level, not associated with remarkable constriction of spinal canal. In the disc herniation with their sagittal diameter over 6mm, the clumping seems to imply the possibility of association with adhesive arachnoiditis.
Adhesives ; Arachnoid ; Arachnoiditis ; Constriction ; Diagnosis ; Failed Back Surgery Syndrome ; Humans ; Magnetic Resonance Imaging ; Spinal Canal ; Spinal Stenosis ; Spondylolisthesis

This study was performed to establish a radiological indication and contraindication of indirect decompression in the thoracolumbar burst fracture as well as to clarify an acceptable degree of the canal constriction to enhance neurologic recovery and to prevent the spinal stenosis. The canal diameter ratio (CDR) of the constricted level was determined using pre-and post-operative CAT images of 31 thoracolumbar burst fractures, decompressed indirectly. The acceptable CDR was decided by the lower limit of the 95% confidence interval of the post-operative CDR in cases without neurologic deficit associated with the canal constriction. A radiological indication and contraindication of indirect decompression was establish based on the calculation of the discriminant equation and linear regression equation respectively. The results were as followings. 1. The acceptable CDR was 46% at the cauda equina level and 37% at the conus medullaris level. 2. According to the result of calculation of the regression equation, the radiological contraindication of indirect decompression was the pre-operative CDR of 13% or less at the cauda equina level and 27% or less at the conus medullaris level. In conclusion, the radiological indication of indirect decompression was the pre-operative CDR of 34% at the cauda eqbina level and 42% at the conus medullaris.
Animals ; Cats ; Cauda Equina ; Constriction ; Conus Snail ; Decompression* ; Linear Models ; Neurologic Manifestations ; Spinal Stenosis

Since the term “facet syndrome” was introduced by Ghormley in 1933, arthropathy of the lumbar facet joint has long been recognized as an important source of low back pain, even sciatic pain. And facet joint injection has been helpful in the diagnosis and therapy for this facet syndrome. However, considering the possible complications such as infection, neurologic deficit and difficulty in locating the symptpmatic joint, and placebo effect, we have frequently doubted about clinical application of these procedures. This study is a retrospective review of 18 patients who got lumber facet joint injection for low back and leg pain with various previous indication that are not response to convential therapy for 2 months or more for therapeutic purpose. The response to facet joint injection was analyzed according to the entire spectrum of symptoms, physical findings, and X-ray findings. 13 or 15 patients with back pain with thigh or groin pain aggrevated by extension/rotation of trunk had successful response but patients with leg pain below the knee joint or pathology in the other structures in the spine got poor response. Strict diagnostic criteria through scoring system, provocation test, relief test and analysis of patient's signs and symptoms is needed to get higher degree of predictability and effectiveness of facet joint injection.
Back Pain ; Diagnosis ; Groin ; Humans ; Joints ; Knee Joint ; Leg ; Low Back Pain ; Neurologic Manifestations ; Pathology ; Placebo Effect ; Retrospective Studies ; Spine ; Thigh ; Zygapophyseal Joint

To observe the change in the status of stresses according to size of the meniscus, a 3-dimensional photoelasticity model of the knee joint was made of epoxy. Three kinds of meniscus models were made of rubber. Through the axial application of a vertical compressive load of 8kg equivalent to the joint reaction of 3,000N in the human knee joint, the peculiar patterns of the isochromatic fringes were observed and stresses around the knee joint were analyzed according to the size of the defect in the medial meniscus. Even distribution of the photoelasticity fringe patterns were observed in the normal knee joint model with both menisci intact. Stress concentration was increased at the margin of the medial side of the knee joint model with the medial menicus removed partially in about 30-50% of its central portion. In addition, the magnitude of stresses were also noted as increased in the lateral part of this type model. In the knee joint model with nearly all of the medial meniscus removed, strssess were concentrated markedly in the central portion of the knee joint just outside of both tibial spines. Stress was increased in its magnitude according to the size of the defect of the meniscus, and was focalized after menisectomy. In the model for partial menisectomy, the maximum stress concentration point of the removed side migrated to the margin of the same side of the joint. But in the model of total menisectomy, maximum stress concentration points of both side were more centralized. Not only an increment of stresses in magnitude but also centralization of the maximum stress concentration point in its location could contribute to the degenerative process of the knee joint after menisectomy. In addition, articular cartilage can be easily damaged with a relatively small amount of external force.
Cartilage, Articular ; Humans ; Joints ; Knee ; Knee Joint ; Menisci, Tibial ; Rubber ; Spine

Epidemilologic information about various syndromes in low back pain has been regarded by Vert Mooney as one of the important sources for establishing prognosis and providing a rationale for therapy. Several risk factors about low back pain and injuries were analyzed through a questionnaire filled out by 172 athletes of various kind of sports including students and professional players. The following results were obtained. 1. Types of sports were associated with the incidence of low back injuries and gymnastics were included in high risk groups (p<0.01). 2. Career is also associated with the incidence of low back injuries (p<0.05). 3. Pain pattern, such as anterior element pain or posterior element pain is also associated with the particular type of sport(p<0.001). 4. Over-use has been suspected as a main cause of sports injury in 37.8% of athletes. Neglect of warming-up, psychologic attitudes and chronic accumulation of micro-trauma have been also suspected (p<0.001). 5. Management of pain was expected to be received from physiotherapists by 34.2%, from coaches or fellow sportsmen by 24.6%, from an acupuncturist by 17.5%, from doctors by 9.7%, and from trainers by 14% of athletes. However 66.7% of the professional players wanted to receive management of pain from trainers (p<0.001).
Athletes ; Athletic Injuries ; Back Injuries ; Epidemiologic Studies ; Gymnastics ; Humans ; Incidence ; Low Back Pain ; Physical Therapists ; Prognosis ; Risk Factors ; Sports