STUDY DESIGN: Case report OBJECTIVES: To report a case of Brown-Séquard syndrome after blunt cervical trauma. SUMMARY OF LITERATURE REVIEW: Brown-Séquard syndrome is a rare disease characterized by hemisection of the spinal cord, and it shows the best prognosis of the various types of incomplete spinal cord injuries. MATERIALS AND METHODS: A patient with Brown-Séquard syndrome that occurred after a traffic accident was followed up for 2 years and 6 months. RESULTS: We observed normal recovery of motor strength, but sensory impairment and deep tendon hyperreflexia remained. CONCLUSIONS: Brown-Séquard syndrome is known to have a good prognosis, but in this case, the neurological abnormality did not fully recover; therefore, we report this rare case and present a review of the literature.
Accidents, Traffic* ; Cervical Vertebrae ; Female ; Humans ; Prognosis ; Rare Diseases ; Reflex, Abnormal ; Spinal Cord ; Spinal Cord Injuries ; Tendons

A diagnosis of gout is often straightforward because gout has well known clinical presentations, laboratory analyses, and radiologic features. On the other hand, gout can mimic other diseases by showing a range of atypical clinical manifestations. This paper reports a 35-year-old male with no prior history of gout who developed tophaceous gout at his previously repaired Achilles tendon 11 years after surgery. He was initially misdiagnosed with cellulitis because of his atypical clinical features. This case is presented with a review of the relevant literature.

STUDY DESIGN: Retrospective study. PURPOSE: This study was conducted to compare vertebral body height restoration rate in rheumatoid arthritis (RA) patients who had undergone percutaneous balloon kyphoplasty (KP) with that of control group who had matched age, sex, body mass index, and bone mineral density. OVERVIEW OF LITERATURE: There is no report on result of KP in RA patients. METHODS: Postoperative height restoration rate of RA group consisting of 15 patients (18 vertebral bodies) who had undergone KP due to osteoporotic vertebral compression fracture with a 30% or higher vertebral compression rate between May 2005 and January 2013 were compared to control group consisting of 38 patients (39 vertebral bodies) who had matched age, sex, body mass index, and bone mineral density. RESULTS: No statically significant difference in age (p=0.846), sex (p=0.366), body mass index (p=0.826), bone mineral density (p=0.349), time to surgery (p=0.528), polymethylmethacrylate injection time (p=0.298), or amount (p=0.830) was found between the RA group and the control group. However, preoperative compression rate in the RA group was significantly (p=0.025) higher compared to that in the control group. In addition, postoperative height restoration rate showed significant correlation with the RA group (p=0.008). Although higher incidence of recollapse occurred in the RA group compared to that in the control group, the difference was not statistically significant (p=0.305). CONCLUSIONS: Compared to the control group, RA patients showed higher compression rate and higher vertebral restoration rate after KP, indirectly indicating weaker bone quality in patients with RA. Higher incidence of recollapse occurred in the RA group compared to that in the control group, although it was not statistically significant.
Arthritis, Rheumatoid ; Body Height ; Body Mass Index ; Bone Density ; Fractures, Compression* ; Humans ; Incidence ; Kyphoplasty* ; Polymethyl Methacrylate ; Retrospective Studies

STUDY DESIGN: A case report. OBJECTIVES: To report a rare case of minimally invasive spine surgery after sublaminar wiring fixation with Luque rods. SUMMARY OF LITERATURE REVIEW: In the past, sublaminar wiring fixation with Luque rods was believed to be an effective fixation method; however, the development of transpedicular fixation resulted in the discontinuation of this method. Currently, instead of classical surgery using a broad incision, minimally invasive spine surgery is performed, which has a multitude of advantages. MATERIALS AND METHODS: Initially, the patient underwent Luque sublaminar wiring and posterolateral fusion. After 25 years, minimally invasive TLIF and percutaneous transpedicular fixation were performed for the adjacent segmental spinal stenosis. RESULTS: A good bone union is developing with an excellent clinical outcome, 14 months after the surgery. CONCLUSIONS: We report a very rare case of a patient who underwent Luque sublaminar wiring and then, 25 years later, had spine surgery with minimally invasive techniques.
Humans ; Spinal Stenosis* ; Spine*

Lumbosacral fracture-dislocation is very rare because of the characteristic anatomical features, and various displacements by injury mechanisms have been reported. Most of the reports were displaced by flexion, distraction, compression and rotation. Complete reduction and appropriate treatment can be difficult or impossible in the case of delayed diagnosis. We report a case of lumbosacral fracture & dislocation that occured in horizontal shear and flexion, which was correctly diagnosed and treated successfully with partial corpectomy, open reduction, posterior interbody fusion and transpedicular fixation with posterolateral fusion by posterior approach only.
Delayed Diagnosis ; Dislocations ; Lumbosacral Region ; Spine

In a thoracolumbar fracture, accurate diagnosis of spinal stability is necessary in deciding on appropriate treatment options and for prevention of complications that can subsequently occur. In various reports for spinal stability, rupture of the posterior ligament complex is generally accepted as a very important factor of spinal stabiliby. In cases of conservative treatment for unstable thoracolumbar fractures, the progressive kyphotic deformity can cause chronic pain and functional disability, and neurologic deterioration in severe cases. Therefore, the concept of surgical treatment for unstable thoracolumbar fracture has been well established. We report on two cases of neglected three column injury in the thoracolumbar spine, which were treated conservatively due to misdiagnosis at other hospitals, and finally underwent delayed operation in our hospital because of chronic back pain and progressive kyphotic deformity.
Back Pain ; Chronic Pain ; Congenital Abnormalities ; Diagnostic Errors ; Ligaments ; Rupture ; Spine

A 49-year-old male was found unconscious at his accommodation and visited the emergency room. He was on antipsychotic and antidepressant drugs (vortioxetine hydrobromide, mirtazapine, sertraline hydrochloride, quetiapine, and alprazolam) for schizophrenia and major depression. At the time of discovery there were signs of overdose of the drugs around the patient. A physical examination revealed, pain, pallor, and edema in the left buttocks and lateral thigh. Active ankle movements below the left ankle were not possible and sensations in the tibia and peroneal nerves were lost. The pressure in the buttock compartment was measured at 42 mmHg. Magnetic resonance imaging revealed edema and high intensity signals in the left hip muscles and surrounding soft tissue. An emergency fasciotomy was performed and partial restoration of the lower extremity sensation and muscle strength were achieved after 24 hours.

A lumbar juxtafacet cyst is a rare disease that causes low back pain, radiculopathy and neurological claudication by compressing the nerve roots. A 34-year-old male complained of severe low back pain and radicular pain in the right lower extremity. Magnetic resonance images revealed a cyst at the lateral recess of the spinal canal between the L3-4 disc and posterior facet joint that extended to the L4 body level. Under the guidance of an image intensifier, needle aspiration of the cyst was performed, which extracted 1.5 ml of serous, yellowish colored fluid. After the aspiration, the symptoms subsided dramatically. The follow-up magnetic resonance images showed no recurrence of the cyst. To the best of the author’s knowledge, there are no reports of lumbar juxtafacet cyst treated with needle aspiration in Korea. This case is reported with a review of the relevant literature.

Osteoporosis associated with pregnancy and lactation is a rare disease that can cause osteoporotic vertebral compression fracture (OVCF).Patients usually complain of severe back pain, which is easily mistaken for pain due to pregnancy, childbirth, and lactation, making a rapid diagnosis and treatment difficult. The authors diagnosed OVCF related to pregnancy and lactation through a physical examination, simple radiography, whole-body bone scan, magnetic resonance image, bone marrow density, and blood tests in a 29-year-old female patient and a 31-year-old female patient who presented with low back pain. This paper reports two cases of symptom improvement through a teriparatide injection, wearing thoracic lumbar sacral orthosis and taking calcium and vitamin D with a review of the literature.

This study was carried out to elucidate the cytokine mRNAs expression and morphological features according to a microglial proliferation and apoptosis in a rat lumbar spinal cord, after a right sciatic nerve transection. The control group was composed of 5 rats (Spraque-Dawley) and the experimental group was composed of 70 rats. On post operation day (pod) 1, 2, 3, 5, and 7 eight rats were sacrificed on those days. On pod 10 five rats were sacrificed as well as five rats sacrificed on post operation weeks 2, 3, 4, 5, and 6. On light microscopy, activated microglia were often found in a perineuronal position around motoneurons in the ventral gray matter and more randomly distributed throughout the neuropil in the dorsal gray matter of lumbar spinal cord. GSA I-B4-positive microglia began to increase from 1 day after transection, and reached peak at 2~3 days and it persisted at 5~7 days and decreased thereafter. TUNEL-positive microglia was not observed in control group and began to increase from 5 days after transection and increased gradually until 3 weeks and decreased thereafter. On in situ RT-PCR, the positive signal for IL-1alpha and IL-6 mRNA was found mainly in the cytoplasm of the activated microglia and astrocytes at 1 day after transection and showed stronger signal at 3 days and decreased gradually until 10 days. TNF-alpha mRNA was detected 1 day after transection and remained for 7 days and localized to activated microglia as well as probably some astrocytes. The signal intensity of IL-1alpha and IL-6 mRNA was generally stronger than TNF-alpha mRNA. On transmission electron microscopy, there were chromatin condensation with margination toward nuclear membrane and condensation of cytoplasm at 3 days after transection. Apoptotic bodies were found after 5 days and increased gradually until 3 weeks. According to the above findings, it is concluded that apoptosis appears to be one mechanism by which activated microglia are gradually eliminated and cytokine expression seems to played an active role in the microglial turnover.
Animals ; Apoptosis* ; Astrocytes ; Chromatin ; Cytokines ; Cytoplasm ; Interleukin-6 ; Microglia ; Microscopy ; Microscopy, Electron, Transmission ; Neuropil ; Nuclear Envelope ; Rats* ; RNA, Messenger ; Sciatic Nerve* ; Spinal Cord* ; Tumor Necrosis Factor-alpha