Accepted methods of treatment of lumbar burst fractures include conservative therapy, posterior reduction and instrumentation, and anterior decompression and instrumentation. Surgery aims at the correction of the kyphotic deformity and at the decompression of the spinal cord thereby reducing pain and allowing early patient mobilization. Posterior-only procedures usually rely on ligamentotaxis or manual tamping of bone fragments for decompression of the spinal canal. Transpedicular corpectomy allow for circumferential surgery through a single posterior approach. The authors use an expandable cage to restore the normal spinal curvature and to prevent the kyphotic deformity.
Congenital Abnormalities ; Decompression ; Humans ; Spinal Canal ; Spinal Cord ; Spinal Curvatures

The authors analyzed a series of 49 cases of spinal cord tumor confirmed by operation and biopsy at Presbyterian Medical Center, Jeonju, from Jan. 1977 to Dec. 1981. Histologically vertified spinal cord tumors wereneurofibroma(36.7%: 18/49), meningioma(22.5%; 11/49), ependymoma(18.5%; 9/49), metastasis(10.2%; 5/49),astrocytoma(6.1%; 3/49), epidermoid (2.0%;1.49), glioblastoma multiforme(2.0%;1/49), and diffuse non-Hodgkin'slymphoma(2.0%;1.49). The results were as follows; 1. The most frequently encountered tumor was the intraduralextramedulary tumor(55.1%;27/49). The other tumors, in descending order, were intramedullary tumor(26.5%; 13/49),extradural extradural extramedullary tumor(10.2%;5/49), and intra-&extradural extramedullary tumor(8.2%;4/49).The most frequently encoutered tumor was neurofibroma(36.7%; 18/49). Four of the 18 neurofibroma were intra-&extradural extramedullary tumor, and three(3/4) were dumbbell type of neurofibroma. 2. Only 3 cases occurred under20 years of age. They were glioblastoma multiforme, neurofibroma and epidermoid. 3. No sex predominance of spinalcord tumor was seen, but the majority of the meningiomas occurred in females(81.8%). 4. The most frequent site oftumors was the thoracic region(53.1%;26/49). The order sites were the cervical regions(2.0%;1/49) . 5. Thirteencases (26.5%) showed bony changs on preliminary roentgenograms of the spine. None showed bony changes inextradural extramedullary tumor. 6. As a rule, the myelographic deformities produced by intramedullary tumorshowed fairly long fusiform dilatation of the contrast column without displacement of the spinal cord; theextradural extramedullary tumor showed coarse transverse serrated block of the contrast column; and the intraduralextramedullary tumor showed cup defect of the contrast column.
Biopsy ; Congenital Abnormalities ; Dilatation ; Glioblastoma ; Jeollabuk-do ; Meningioma ; Neurofibroma ; Protestantism ; Spinal Cord Neoplasms ; Spinal Cord ; Spine

STUDY DESIGN: A literature review regarding the correlation between a kyphotic neck and its clinical outcomes. OBJECTIVES: This review examines normal cervical alignment, methods for assessing alignment, a specific correlation between kyphotic neck and clinical outcomes, and indications and methods of surgical treatment. SUMMARY OF LITERATURE REVIEW: Cervical kyphotic deformity is problematic in terms of HRQOL due to nerve damage or loss of horizontal gaze. MATERIALS AND METHODS: Review of the literature. RESULTS: Cervical kyphosis can be caused by postlaminectomy, degenerative disc disease, and trauma, and the symptoms exhibit diverse clinical progression including compensatory mechanisms, adjacent segment disease, changes in quality of life, and cervical myelopathy. Given the serious complications of cervical surgery, we need a deep understanding of spine anatomy, preoperative planning, and correction methods. CONCLUSIONS: It is vital to investigate cervical sagittal alignment and to perform intensive treatment and corrective surgery to achieve better clinical outcomes.
Congenital Abnormalities ; Kyphosis ; Neck* ; Quality of Life ; Spinal Cord Diseases ; Spine

Rigid cervical deformities are difficult problems to treat. The goals of surgical treatment include deformity correction, achieving a rigid fusion, and performing a thorough neural decompression. In stiff and ankylosed cervical spines, osteotomies are required to restore sagittal and coronal balance. In this chapter, we describe the clinical and radiographic workup for patients with cervical deformities, and delineate the various factors that must be considered when planning surgical treatment. We also describe in detail the various types of cervical osteotomies, along with their surgical technique, advantages, and potential complications.
Congenital Abnormalities ; Decompression ; Humans ; Kyphosis ; Osteotomy* ; Spinal Cord Diseases ; Spine*

STUDY DESIGN: We retrospectively reviewed the cervical myelopathy patients who underwent anterior or posterior surgery. OBJECTIVES: This study was undertaken to analyze the preoperative radiologic evaluation and the results of the treatment of cervical myelopathy. SUMMARY OF LITERATURE REVIEW: The surgical treatment of cervical myelopathy consisted of anterior/posterior or combined surgery according to lesion site, symptoms, number of involved sequents or prevalence of the surgeon. Material and METHODS: We reviewed the clinical and radiological aspects of 28 patients Preoperative plain radiographs and MRI were evaluated with clinical symptoms. Postoperative clinical evaluation was performed according to the Robinson's criteria. RESULTS: On plain lateral radiographs, spinal canal diameter were 13.4+/-2.6/12.5+/- 1.7mm, Pavlovratios were 0.78+/-0.09/0.66+/-0.08, spondylosis indices were 1.70/1.80mm, and the antero-posterior compression ration of spinal cord were 42.4+/-8/44.0+/-6% for anterior surgery and posterior surgery group each. The results of 15 patients who received anterior decompression and interbody fusion were excellent in 11, good in 2, and fair in 2 cases. The results of 13 patients who underwent laminoplasty were excellent in 9, good in 3, and fair in one case. CONCLUSIONS: The patients who have Pavlov ratio less than 0.8 and spondylosis index more than 1.5mm on plain radiograph are vulnerable to developing myelopathy. It is better to do anterior decom pression and interbody fusion in patients who have one or two segments involved and kyphotic deformity of the cervical spine. Otherwise, patients who involve more than 3 segments and narrow spinal canal can be managed using laminoplasty posteriorly.
Congenital Abnormalities ; Decompression ; Humans ; Magnetic Resonance Imaging ; Prevalence ; Retrospective Studies ; Spinal Canal ; Spinal Cord ; Spinal Cord Diseases* ; Spine ; Spondylosis

STUDY DESIGN: This is a case report. OBJECTIVE: We report here on three cases of late spinal cord compression without bone cement leakage after kyphoplasty from the view point of the common characteristics, the suspected etiologies and the performed treatments, and we propose a technique to prevent this kind of complication. SUMMARY OF THE LITERATURE REVIEW: Kyphoplasty is widely accepted as an effective and safe treatment for osteoporotic vertebral compression fracture (VCF). Complicated compression fractures and even bursting fractures with a compromised spinal canal are currently indicated for kyphoplasty. The wide spread application of kyphoplasty may be mainly due to reducing the complication rates associated with cement leakage and possible restoration, even though partially, of a vertebral kyphotic deformity. MATERIALS AND METHODS: we experienced three cases of newly emerged complications that caused delayed neurologic compromise after uneventful kyphoplasty without any immediate neurologic deficits. MR imaging was done to find the pathologic regions and surgical treatment was performed. RESULTS: Refracture of an augmented vertebra at the conus medullaris level can cause late occurring spinal cord compression without compromising the spinal canal. Posterior instrumentation and posterior fusion with posterior decompression were effective treatments. CONCLUSION: The anatomical peculiarity of the conus medullaris and the dynamic irritation of the spinal cord by a bone cement mass after refracture of an augmented vertebral body can be the causes of late spinal cord compression after kyphoplasty. The neurologic symptoms were treated by posterior decompression and fusion. This kind of complication can be prevented by injecting a sufficient amount of bone cement with a shape to support both endplates.
Congenital Abnormalities ; Conus Snail ; Decompression ; Fractures, Compression ; Kyphoplasty ; Neurologic Manifestations ; Spinal Canal ; Spinal Cord ; Spinal Cord Compression ; Spine

Spinal dysraphism is a common birth defect that causes different kinds of secondary impairments, including joint deformities, reduced mobility, and bowel or bladder dysfunction. Various dysraphic spinal abnormalities result in tethered cord syndrome, a progressive form of neurological deterioration that results from spinal cord tethering. The surgery and management of children who have spinal dysraphism require multidisciplinary care and long-term follow-up by multiple specialists in birth defects. This article reviews the clinical presentation, pathophysiology, diagnostic strategies, and therapeutic management of spinal dysraphism in infancy.
Child ; Congenital Abnormalities ; Humans ; Joints ; Neural Tube Defects ; Specialization ; Spinal Cord ; Spinal Dysraphism ; Urinary Bladder

The thoracolumbar spine is frequently involved in spinal injuries, with more than 50% of all vertebral body fractures. This fractures may cause injuries to the spinal cord or nerve roots. Therefore the appropriate management, including surgery of that lesion, is very important and can determine the long-term outcome of the treatment. The authors analyzed the surgical results of twenty-nine thoracolumbar spine fractures treated with anterior or posterior internal skeletal fixation from August. 1990 to December, 1995. The indications for surgery were based on the neurological state and radiological findings of the patients. The selection of surgical approach(anterior or posterior) depended on the presence of neural or canal compression, the initial radiological findings, and the extent of reducibility of the fractures. Of twenty-nine patients, 21 cases were operated via the anterolateral route with Kaneda or Z-plate. The others were operated through the posterior approach with Diapason transpedicular system. They were grouped into one of three categories according to the radiological findings by Gertzbein's classification. A type fractures were most common(12 cases), B was 11, and C was 6 cases. Surgical results were evaluated by neurological recovery and achievement of stable reduction. Postoperative neurologic recovery rate was 76.2% in the case of anterolateral approach and 50.0% in the case of posterior approach. The reduction of kyposis and compression in types of A and B was prominent(P<0.01) but in type C it was not. The authors conclude that the operation with anterior and posterior internal skeletal fixation for the treatment of unstable thoracolumbar fractures can improve neurological recovery and normalize anatomical deformities.
Classification ; Congenital Abnormalities ; Fracture Fixation* ; Humans ; Spinal Cord ; Spinal Injuries ; Spine*

The thoracolumbar spine is frequently involved in spinal injuries, with more than 50% of all vertebral body fractures. This fractures may cause injuries to the spinal cord or nerve roots. Therefore the appropriate management, including surgery of that lesion, is very important and can determine the long-term outcome of the treatment. The authors analyzed the surgical results of twenty-nine thoracolumbar spine fractures treated with anterior or posterior internal skeletal fixation from August. 1990 to December, 1995. The indications for surgery were based on the neurological state and radiological findings of the patients. The selection of surgical approach(anterior or posterior) depended on the presence of neural or canal compression, the initial radiological findings, and the extent of reducibility of the fractures. Of twenty-nine patients, 21 cases were operated via the anterolateral route with Kaneda or Z-plate. The others were operated through the posterior approach with Diapason transpedicular system. They were grouped into one of three categories according to the radiological findings by Gertzbein's classification. A type fractures were most common(12 cases), B was 11, and C was 6 cases. Surgical results were evaluated by neurological recovery and achievement of stable reduction. Postoperative neurologic recovery rate was 76.2% in the case of anterolateral approach and 50.0% in the case of posterior approach. The reduction of kyposis and compression in types of A and B was prominent(P<0.01) but in type C it was not. The authors conclude that the operation with anterior and posterior internal skeletal fixation for the treatment of unstable thoracolumbar fractures can improve neurological recovery and normalize anatomical deformities.
Classification ; Congenital Abnormalities ; Fracture Fixation* ; Humans ; Spinal Cord ; Spinal Injuries ; Spine*

Five cases of the spinal tuberculosis with severe kyphosis and paraplegia were treated with radical surgery at the Department of Orthopedic Surgery, Seoul National University Hospital. All the cases were involved at the thoracic spine and kyphosis were ranged 100 through 150 degrees. Severe fixed chest deformity and impaired pulmonary function were observed. By thoracotomy, aorta was seen to be adherent to the surrounding tissue and this was separated from the verterbral lesion with meticulous procedure. The focus was curetted radically exposing spinal cord which was decompressed with anterior transposition. Then the spine was stabilized with anterior interbody fusion. Postoperative intensive pulmonary care and antituberculous therapy are imperative for the good result. Spinal tuberculosi with severe kyphosis and paraplegia could be benefited with the radical surgery by the experienced surgeon.
Aorta ; Congenital Abnormalities ; Kyphosis ; Orthopedics ; Paraplegia ; Seoul ; Spinal Cord ; Spine ; Thoracotomy ; Thorax ; Tuberculosis, Spinal