Gunshot wounds are rare in Korea, but they have tended to increase recently. We experienced an interesting case of penetrating gunshot injuries to the cervical spine with migration the fragments of the bullet within the dural sac of the cervical spine,so discuss the pathomechanics, treatment and complications of gunshot wounds to the spine and present a review of the literature. A 38-year-old man who had tried to commit suicide with a gun was admitted to our hospital with a penetrating injury to the anterior neck. the patient had quadriplegia. A Computed tomography (CT) scan and 3-dimensional CT of the spine showed destruction of the left lateral mass and lamina of the 5th cervical vertebra; the bullet and fragments were found at the level of the 5th cervical vertebra. The posterior approach was done. A total laminectomy and removal of the lateral mass of the 5th cervical vertebrae were performed, and bone fragments and pellets were removed from the spinal canal, but an intradurally retained pellets were not totally removed. A dural laceration was noted intraoperatively, and CSF leakage was observed, so dura repair was done watertightly with prolene 6-0. The dura repair site was covered with fibrin glue and Tachocomb(R) Immediately, a lumbar drain was done. Radiographs included a postoperative CT scan and X-rays. The postoperative neurological status of the patient was improved compared with the preoperative neurological status. however, the patients developed symptoms of menigitis. He received lumbar drainage(200~250 cc/day) and ventilator care. After two weeks, panperitonitis due to duodenal ulcer perforation was identified. Finally, the patient died because of sepsis.
Adult ; Cervical Vertebrae ; Duodenal Ulcer ; Female ; Fibrin Tissue Adhesive ; Humans ; Korea ; Lacerations ; Laminectomy ; Neck ; Polypropylenes ; Quadriplegia ; Sepsis ; Spinal Canal ; Spine ; Suicide ; Ventilators, Mechanical ; Wounds, Gunshot

PURPOSE: Cervical dislocations with locked facets account for more than 50% of all cervical injuries. Thus, investigating a suitable management of cervical locked facets is important. This study examined factors of close reduction failure in traumatically locked facets of the subaxial cervical spine patients to determine suitable surgical management. METHODS: We retrospectively analyzed of the case histories of 28 patients with unilateral/bilateral cervical locked facets from Nov. 2004 to Dec. 2010. Based on MRI evaluation of disc status at the injury level, we found unilateral dislocations in 9 cases, and bilateral dislocations in 19 cases, The patients were investigated for neurologic recovery, closed reduction rate, factors of the close reduction barrier, fusion rate and period, spinal alignment, and complications. RESULTS: The closed reduction failed in 23(82%) patients. Disc herniation was an obstacle to closed reduction (p=0.015) and was more frequent in cases involving a unilateral dislocation (p=0.041). The pedicle or facet fracture was another factor, although some patients showed aggravation of neurologic symptoms, most patients had improved by the last follow up. The kyphotic angle were statistically significant (p=0.043). Sixs patient underwent anterior decompression/fusion, and 15 patients underwent circumferential fusion, and 7 patients underwent posterior fusion. All patients were fused at 3 months after surgery. The complications were 1 case of CSF leakage and 1 case of esphageal fistula, 1 case of infection. CONCLUSION: We recommend closed reduction be performed as soon as possible after injury to maximize the potential for neurological recovery. Patients fot whom closed reduction of the cervical locked facets have a higher incidence of anatomic obstacles to reduction, including facet fractures and disc herniation. Immediate direct open anterior reduction or circumferential fixation/fusion of locked cervical facets is recommended as a treatment of choice for traumatic locked cervical facet patients after closed reduction failure.
Dislocations ; Fistula ; Follow-Up Studies ; Humans ; Incidence ; Neurologic Manifestations ; Retrospective Studies ; Spine

Hirayama disease usually selectively involves lower cervical myotomes (C8, T1). Thus, patients usually manifest with atrophy and weakness of small hand muscle. Predominant isolated involvement of proximal arm is rarely reported in Hirayama disease. Here, we report a case of Hirayama disease who had focal weakness and wasting, mainly confined to right biceps brachii muscle, with prominent shifting of dural sac in C4-5 segment by dynamic flexion magnetic resonance imaging (dfMRI), which may explain this unusual distribution of the disease.
Amyotrophy, monomelic

BACKGROUND AND PURPOSE: Freezing of gait (FOG) is a frustrating problem in Parkinson's disease (PD) for which there is no effective treatment. Our aim was to find brain stimulation areas showing greater responses for reducing FOG. METHODS: Twelve PD patients with FOG were selected for inclusion. We explored the therapeutic effect of repetitive transcranial magnetic stimulation (rTMS) in the supplementary motor area (SMA) and the motor cortex (MC). We measured the number of steps, completion time, and freezing episodes during the stand-walk-sit test before and after rTMS treatment. We also tested freezing episodes in two FOG-provoking tasks. RESULTS: There was a trend for a greater reduction in freezing episodes with SMA stimulation than MC stimulation (p=0.071). FOG was significantly improved after SMA stimulation (p < 0.05) but not after MC stimulation. CONCLUSIONS: Our study suggests that the SMA is a more-appropriate target for brain stimulation when treating PD patients with FOG. This study provides evidence that stimulating the SMA using rTMS is beneficial to FOG, which might be useful for future developments of therapeutic strategies.
Brain ; Freezing* ; Gait* ; Humans ; Motor Cortex* ; Parkinson Disease* ; Transcranial Magnetic Stimulation ; Weather

A case of acute quadriplegia resulting from reduction of atlantoaxial subluxation due to os odontoideum is rare. Patient with os odontoideum are at a greater risk for atlantoaxial instability and resultant spinal cord compression. In our case, the patient exhibited mild myelopathic symptoms before the onset of acute quadriplegia. Owing to the clinical presentations, the spinal cord not only seemed to suffer a mechanical compression but also an insufficiency of blood supply to the spinal artery and its branches. No other report has described the findings from magnetic resonance imaging before and after the onset of acute myelopathy after surgery. The aim of our case report is to highlight the pathophysiology and appropriate management strategy of a patient with severe progressive spinal cord myelopathy after surgery, secondary to chronic atlantoaxial subluxation due to os odontoideum. This case depicts the presence of this rare yet possible complication, and emphasizes the importance of preoperative evaluation in cases with chronic progressive myelopathy. Moreover, urgent postoperative treatment and rehabilitation are important for the recovery of neurological symptoms.
Arteries ; Humans ; Magnetic Resonance Imaging ; Quadriplegia ; Rehabilitation ; Spinal Cord ; Spinal Cord Compression ; Spinal Cord Diseases

OBJECTIVE: Self-expanding stents are increasingly used for the treatment of complex intracranial aneurysms. The purpose of this study was to evaluate the usefulness and safety of a self-expanding nitinol stent (Enterprise) in the treatment of wide-necked intracranial aneurysms. METHODS: This was a retrospective study of 39 patients with 40 wide-necked intracranial aneurysms who were enrolled in a single-center registry of patients treated with the Enterprise between June 2009 and December 2011. Thirty patients were asymptomatic, four had cerebrovascular accident sequelae, and five had suffered subarachnoid hemorrhage. One aneurysm had reopened after prior coil embolization, while 39 had not been treated. Clinical charts, procedural data, and angiographic results, including both immediate post-procedural angiograms and follow-up imaging, were reviewed. RESULTS: The mean neck size of the aneurysms was 5.58 mm (range 3-15.1 mm). Embolization was successful in all patients. There were five procedure-related events. There were no fatalities, but one procedure-related morbidity was noted. The immediate angiographic results included eight complete occlusions (20%), six remnant necks (15%), and 26 remnant sacs (65%). At angiographic follow-up (mean: 11.3 months), out of 18 of the aneurysms treated with stent-assisted coiling, there were 13 (72.2%) complete occlusions, four (22.2%) remnant necks, and one recanalization (5.6%). CONCLUSION: Stent-assisted coiling using the Enterprise is effective for the treatment of wide-necked intracranial aneurysms. Further angiographic and clinical follow-up investigation will be needed for evaluation of the long-term outcomes.
Aneurysm* ; Embolization, Therapeutic ; Follow-Up Studies ; Humans ; Intracranial Aneurysm* ; Neck ; Retrospective Studies ; Stents* ; Stroke ; Subarachnoid Hemorrhage

Desmoid fibromatosis is a locally aggressive myofibroblastic neoplasm. In this study, we report a case of desmoid fibromatosis in the paraspinal muscle that was misdiagnosed as intramuscular schwannoma through incisional biopsy at another hospital. We performed total excision of the mass lesion with a clear margin. We found that for an accurate diagnosis, magnetic resonance imaging, incisional biopsy and excisional biopsy were required.

OBJECTIVE: To evaluate the efficiency of carbon fiber composite frame and polyetheretherketone(PEEK) cages in the interbody fusion for surgical treatment of cervical disc diseases, we analyzed fusion time and subsidence rate. METHODS: From March 2004 to February 2007 fifty patients with cervical disc diseases underwent anterior discectomy and interbody fusion in 60 levels. The subjects were 26 men and 24 women with a mean age of 57.2 years ranging from 29 to 67. Among them 25 patients underwent operations using carbon fiber composite frame cages (Osta-Pek(R), Co-Ligne, Zurich, Switzerland) in 30 levels, and 25 patients using PEEK cages(Cornerstone(R), Medtronic, TN, USA) in 30 levels. The cages were packed with allograft bone or bone substitute(demineralised bone matrix). On lateral flexion-extension radiographs anterior disc height and posterior disc height were measured at preoperative time, postoperative 1, 3, 6 and 12 month respectively. Segmental stability(lordotic angle) was measured at postoperative 3, 6, and 12 months in all 60 levels for fusion time. RESULTS: The anterior disc height and posterior disc height were 4.87+/-1.36mm and 3.25+/-0.73mm at preoperative time, 7.32+/-1.41mm and 4.77+/-0.80mm at postoperative 1month, and 5.87+/-1.47mm and 3.22+/-0.93mm at posto- perative 12 months respectively in carbon fiber composite frame cage group(30 levels). The anterior disc height and posterior disc height were 4.88+/-1.18mm and 3.75+/-0.75mm at preoperative time, 7.26+/-1.17mm and 5.27+/-0.55mm at postoperative 1month, and 6.23+/-1.16mm and 3.96+/-0.69mm at postoperative 12months respectively in PEEK cage group(30 levels). The angular motion at the fused segment was measured in carbon fiber composite frame cage and PEEK group for segmental stability(two degrees or less flexion-extension range of motion at the fusion site). The carbon fiber composite frame cage group was stabilized between postoperative 3 months and 6 months, but PEEK cage group was stabilized between 6 months and 9 months. This result was statistically significant(p-value =0.003)(Fig. 2). Fusion rate of carbon composite frame cage group was 28%, 67% and 83% at 3, 6, 12 months after operation, and that of PEEK cage group was 24%, 48% and 86% at postoperative 3, 6 and 12 months respe- ctively. Complications included transient hoarseness, cage migration and subsidence. There was no persistent hoar- seness or Horner syndrome. We have observed severe subsidence(above 3mm) in two cases(6.7%) of carbon fiber composite frame cage group only. Anterior cage migration was shown in each one case(3.3%) of carbon fiber composite frame and PEEK cage group. CONCLUSION: The carbon fiber composite frame cage group showed a tendency of earlier fusion than PEEK cage group but both cages were same in the fusion rate at postoperative 1 year. But, restoration or maintenance of inter- vertebral height was much better in PEEK cage group than carbon fiber composite frame cage group. Subsidence rate was higher in carbon fiber cage group rather than PEEK cage group.
Carbon ; Diskectomy ; Female ; Hoarseness ; Horner Syndrome ; Humans ; Ketones ; Male ; Polyethylene Glycols ; Range of Motion, Articular ; Transplantation, Homologous

Thoracolumbar paraspinal myonecrosis can be developed with various etiologies. It can induce compartment syndrome of spinal muscles and cause elevated pressure on back muscles, resulting in severe back pain. Thoracolumbar paraspinal myonecrosis is a very rare disease. There are only a few studies about paraspinal myonecrosis. Here we report a case of a spontaneous thoracolumbar paraspinal myonecrosis in a patient who had asymptomatic abdominal aortic dissection. Through this case, etiologies, clinical features, radiologic findings, and treatment options for thoracolumbar paraspinal myonecrosis are discussed.
Back Muscles ; Back Pain ; Compartment Syndromes ; Humans ; Muscles ; Rare Diseases

We report a case of cervicomedullary compression by an anomalous vertebral artery treated using microsurgical decompression with intraoperative monitoring. A 68-year-old woman presented with posterior neck pain and gait disturbance. MRI revealed multiple abnormalities, including an anomalous vertebral artery that compressed the spinal cord at the cervicomedullary junction. Suboccipital craniectomy with C1 laminectomy was performed. The spinal cord was found to be compressed by the vertebral arteries, which were retracted dorsolaterally. At that time, the somatosensory evoked potential (SSEP) changed. After release of the vertebral artery, the SSEP signal normalized instantly. The vertebral artery was then lifted gently and anchored to the dura. There was no other procedural complication. The patient's symptoms improved. This case demonstrates that intraoperative monitoring may be useful for preventing procedural complications during spinal cord microsurgical decompression.
Abnormalities, Multiple ; Aged ; Decompression* ; Evoked Potentials, Somatosensory ; Female ; Gait ; Humans ; Laminectomy ; Magnetic Resonance Imaging ; Microvascular Decompression Surgery ; Monitoring, Intraoperative* ; Neck Pain ; Spinal Cord ; Vertebral Artery*