PURPOSE: Recently, MRI has been routinely used in detection and treatment of metastatic spine tumors, but no previous study on prediction and prevention of vertebral body collapse was done using MRI. This study was done to analyze the risk factors of collapse and to define criteria of impending collapse using MRI. MATERIALS AND METHODS: Ninety-five vertebrae of 69 patients with metastatic lesions were evaluated using ratio of involved axial area, sagittal area, costovertebral joint, pedicle, facet joint and uncovertebral joint involvement as independent variables. We defined collapse when there was a fracture of the end plate and loss of vertebral body height over 10%, and degree of collapse was measured as ratio of the body height to the mean of the height of adjacent bodies. The ratio of the involved area was measured on T1-weighted images which showed the largest area of tumor involvement. RESULTS: There noted collapse of the bodies in 11 of 14 cervical vertebrae, 24 of 48 thoracic vertebrae and 15 of 33 lumbar vertebrae. Metastatic involvement on axial images was considered as a significant risk factor regardless of the vertebral level, while costovertebral joint destruction and axial involvement were significant risk factors in the thoracic spine. The criteria of impending collapse were: 51-60% axial involvement of the vertebral body in the cervical and lumbar spine; 61-70% axial involvement of the vertebral body with no destruction of other structures, 21-30% involvement of the vertebral body with destruction of one costovertebral joint or destruction of both costovertebral joints regardless of body involvement in thoracic spine. CONCLUSIONS: Using the above criteria with consideration of the patient s general condition and biologic behavior of the primary tumor, prophylactic stabilization can be performed to prevent ver-tebral body collapse which results in severe pain or paralysis.
Body Height ; Cervical Vertebrae ; Female ; Humans ; Joints ; Lumbar Vertebrae ; Magnetic Resonance Imaging* ; Paralysis ; Risk Factors* ; Spine* ; Thoracic Vertebrae ; Zygapophyseal Joint

PURPOSE: This study was undertaken to increase the knowledge of the intra- and extra-spinal alignments and to help recovery of sagittal alignment in operation by measuring the normal values of the spinal alignment in relation to hip axis as well as those of the thoracic, thoracolumbar junction, lumbar and lumbosacral junction of sagittal alignment and their correlation. MATERIALS AND METHODS: Whole spine standing lateral radiographs were taken in young 100 adults without spinal abnormalities clinically and radiographically. Intraspinal alignment was measured with angles of thoracic kyphosis, lumbar lordosis, maximum thoracic kyphosis, maximum lumbar lordosis, angle of the thoracolumbar junction, sacral inclination, segmental angles and disc angles respectively with special emphasis on lumbar lordosis. Extraspinal alignment was measured with sacropelvic angle, spinopelvic balance and spinal balance in relation to hip axis. Correlations among these parameters were analyzed. RESULTS: Lumbar lordosis and thoracic kyphosis were measured -49 degree(-22 - -79 degree) and 32 degree(6 degree-56 degree), respectively. Slight amount of kyphosis in thoracolumbar junctional area was considered normal. Lumbar lordosis had significant correlation with thoracic kyphosis and sacral inclination. However, there was no correlation between thoracic kyphosis and sacral inclination. Lowest two lumbar segments comprised 71% of total lordosis. Lumbar lordosis usually started at L1-2 and gradually increased at each level caudally to the sacrum. Sacropelvic angle, spinopevlic balance and spinal balance were measured -11 degree(-6 degree - 24 degree), -4 cm (-10 - 2 cm), and -2 cm (-7 - 4 cm) respectively with C7 positioned posterior to hip axis mostly. CONCLUSIONS: There was a wide range of normal sagittal alignment of the thoracic and lumbar spines, and normal values of these alignments were not easily defined. Therefore, normal patterns of sagittal curvature and sagittal balance should be more emphasized.
Adult ; Animals ; Axis, Cervical Vertebra ; Hip ; Humans ; Kyphosis ; Lordosis ; Reference Values ; Sacrum ; Spine*

This article was withdrawn by the authors' request.

This article was withdrawn by the authors' request.

PURPOSE: To identify the changes of bony landmarks with rotation and to compare the reliability and accuracy of Perdriolle's method before and after training on the exact bony landmarks. MATERIALS AND METHODS: Simple A-P radiographs were taken with rotation from 5 degree to 50 degree at 5 degree interval using 10 dry human vertebrae (2 sets of T3, T6, T9 8 L3) with no bony abnormality. Axial rotation was measured before and after training on the exact bony landmarks by three observers, twice for each radiographs. Repeated measures of ANOVA were used for inter- < intraobserver variance and regression analysis for root mean square error and deviation of differences. RESULTS: Mamillary process, inner margin of lamina, proximal and distal costovertebral joints, upper margin of concave pedicle and tip of the transverse process on the convex side confused the exact outline of the pedicle, while neural foraminal margin was helpful in identifying the location of the indistinct convex pedicle and concave vertebral border. Of the 660 measurements before and after training 372 and 397 errors were made, respectively, of which 88.9% and 88.5% were within +/-5 degree(P > 0.05). Incidence of error greater than 5 degree was high at upper thoracic vertebra and 20 degree-40 degree of rotation regardless of training. The effects of training, however, was greatest at T3 and 20 degree-40 degree of rotation. Inter- < intraobserver variance was diminished at T3 and at the rotation between 20 degree-40 degree after training. CONCLUSIONS: We could conclude that training on the exact bony landmarks did not reduce the overall error incidence. Accuracy and reliability, however, was increased at T3 after training and the efficacy of training was more evident in moderate vertebral rotation than in small or large vertebral rotation.
Humans ; Incidence ; Joints ; Spine

Between 1982 and 1991, 33 cases(47 patients) with Ficat stage I and II avascular necrosis of the femoral head which had decompression with fibular strut grafting were followed up for average 62 months ranging from 36 to 136 months, The authors analyzed the results by Harris Hip Score(H.H.S) clinically and according to Ficat stage progression radiologically and evaluated the effectivencess of this procedure in the early stage of atraumatic avascular necrosis of the femoral head. The results were as follows. 29 hips were mon, 4 hips were women and 11 patients were bilateral. The ages ranged from 26 to 75 years and the mean age was 46.6 years. By the radiological classification of Japnese Investigation Committee, 23 hips(79%) of stage II showed diffuse involvement of the femoral heads(type 1-C, 2, 3-B). By Ficat stage, stage I were 4(12%) and stage II were 29(88%). At follow up, 2 hips were in stage I(6%), 15 hips were in stage II(46%), 11 hips were in stage III(33%) and 5 hips showed stage IV (15%). Two hips were converted to total hip arthroplasty due to failure. Preoperative Harris Hip Score was 84 points in average and at most recent follow up, the score was 89 points in average. The clinical surccess rate was 73% and radiological success rate was 52%, but 83% of the patients were satisfied with the procedure subjectively. There noted some disparity between the clinical and raiological results, but the effect of the decompression with fibular strut grafting will be known if more long term follow up is available.
Arthroplasty, Replacement, Hip ; Classification ; Decompression ; Female ; Follow-Up Studies ; Head ; Hip ; Humans ; Necrosis ; Transplants

There are some controversies on the mechanism of the lumbar disc degeneration and disc prolapse. But,it is clear that many factors are related to the disc degeneration. Configurations of the lower lumbar and lumbosacral spine have long been proposed as one of the important factors of disc degeneration in these areas. To look for the configurational risk factors and the probability of disc degeneration by the combinations of these factors, we analyzed simple radiographs and MRI of 73 patients who complaints of low back pain and are between 20 years and 39 years of age. We performed chi-square test and multivariate logistic regression analysis: L4-5 disc degeneration and L5-Sl disc degeneration as dependent variables and lumbar lordosis, sacral inclination, height of intercrest line, transitional vertebra and facet joint asymmetry as independent variables. We could not find any of these variables significantly related to the L4-5 intervertebral disc degeneration. For L5-S1 disc degeneration, only the presence of transitional vertebra was signicantly related. When there is no transitional vertebra, the probability of disc degeneration is 9 times(8.889) as large as that of presence of transitional vertebra. The probability of L4-5 disc degeneration without the degeneration of L5-S1 is 3 times as large as that of degeneration of both of L4-5 and L5-S1 disc in case of the presence of transitional vertebra.
Animals ; Humans ; Intervertebral Disc Degeneration* ; Logistic Models ; Lordosis ; Low Back Pain ; Magnetic Resonance Imaging ; Prolapse ; Risk Factors ; Spine* ; Zygapophyseal Joint

STUDY DESIGN: This case report presents a rare case of Aspergillus osteomyelitis of the vertebra in an immunocompetent host. OBJECTIVES: To discuss the iatrogenic Aspergillus spondylitis after posterior instrumentation in an immunocompetent patient and review the pertinent literatures. SUMMARY OF BACKGROUND DATA: Aspergillus spondylitis is very rare especially in immunocompetent host. Treatment requires early debridement and continuous medication with antifungal drugs. RESULT: This report discusses a case that occured in an immunocompetent 60 year-old woman who had posterolateral fusion with posterior instrumentation for T12 burst fracture. After a few months of operation, she complained chronic back pain and progressive neurologic compromise. The MR imaging showed an epidural mass compressing the spinal cord, so hardware removal and curettage was done at neurosurgical department. Her symptoms were not improved after hardware removal, so anterior decompression and fusion was done again. The biopsy of the epidural mass showed septated hyphae which is the characteristic of Aspergillosis. With aggressive surgical debridement and continuous treatment with amphotericin B, follow-up examination at postoperative 2 years showed neurologic improvement about 2 grades by Frankel classification.
Amphotericin B ; Aspergillosis ; Aspergillus* ; Back Pain ; Biopsy ; Classification ; Curettage ; Debridement ; Decompression ; Female ; Follow-Up Studies ; Humans ; Hyphae ; Magnetic Resonance Imaging ; Middle Aged ; Osteomyelitis ; Spinal Cord ; Spine ; Spondylitis*

PURPOSE: To define possible mechanism of posture-dependent symptom of spinal stenosis by measuring the effect of low back motion on the morphologic change of intervertebral disc and spinal canal. MATERIALS AND METHODS: Twenty healthy young volunteers underwent magnetic resonance imaging (1.5T MR scanner, GE) while supine with their lumbar spine in neutral, flexed, extended, and right and left rotational positions. The axial MR images at the middle of the intervertebral disc of L3-4 and L4-5 were analyzed to measure the difference of the size and shape of the disc and spinal canal in each posture. RESULTS: Extension decreased the sagittal diameters and the cross-sectional areas of the dural sac and spinal canal and increased the thickness of ligamentum flavum, whereas flexion had the opposite effects. The gap between convex posterior disc margin and anterior margin of facet joint of each side, represented as subarticular sagittal diameter, increased with flexion and decreased with extension or rotation. The directions of the rotation did not result any asymmetry of the subarticular sagittal diameter, but right rotation resulted thickening of right ligamentum flavum. The shape and dimensions of disc did not significantly change according to the positions of low back. CONCLUSIONS: With extension or rotation, the thickness of ligamentum flavum increased and posterior margin of the intervertebral disc was approximated to facet joint secondary to posterior movement of upper vertebral body without any change of shape and size of the disc. These phenomena result decrease of the size of spinal canal and dural sac in extension or rotation posture in young healthy people and may explain the posture-dependent symptom of spinal stenosis.
Intervertebral Disc ; Ligamentum Flavum ; Magnetic Resonance Imaging ; Posture ; Spinal Canal* ; Spinal Stenosis ; Spine ; Volunteers ; Zygapophyseal Joint

There are several reports on the intervertebral vacuum phenomenon since Maldague s report in 1978. This disease is, however, considered as uncommon and miscellaneous entity. We performed retrospective review of 27 collapsed vertebral bodies of 21 osteoporotic patients to define the clinical, radiological and pathological characteristics of intravertebral vacuum phenomenon. Simple radiographs and MRIs were reviewed and the pathological findings from 6 specimens were matched with MRI. Intravertebral air shadows were shown in all cases either on A-P or lateral view, more definite on extension lateral views. Basically, it was considered as a burst fracture with loss of anterior and middle column height. The extent of collapse could be classified as complete or incomplete and the shape of spinal canal intrusion as bulging or local beak type. 12 cases of MRI findings were classified in to three types by T1, T2 and gadolinium enhancement patterns. The extent of spinal canal intrusion was less then 50% in all cases but neurolgic deficits were examined in 10 cases. Pathologically, necrotic trabeculae with fibrous granulation tissue was mixed with reactive new bone and callus formation in some area. This phenomenon is considered not so uncommon, which can be noticed easily in lateral flexion/extension view. Basically, this is a burst fracture with nonunion from ischemic necrosis and neurologic status should be carefully obserued.
Animals ; Beak ; Bony Callus ; Gadolinium ; Granulation Tissue ; Humans ; Magnetic Resonance Imaging ; Necrosis ; Pathology ; Retrospective Studies ; Spinal Canal ; Vacuum*