Objective: This study aimed to determine whether absolute bed rest (ABR) is essential for the conservative treatment of osteoporotic vertebral compression fractures (OVCFs). Methods: This study included 115 patients diagnosed with OVCFs. The patients in group A were allowed to ambulate as soon as possible, while those in group B underwent ABR for at least 1 week. X-ray images at baseline and 1 week, 2 weeks, 1 month, 3 months, and 6 months after trauma were obtained from both groups for assessment. In each group, ABR-related complications including constipation, indigestion, Foley catheter insertion, urinary tract infection, cough/sputum, dizziness, and neurasthenia were investigated. Results: In both groups, the compression rates, Cobb angles, and visual analog scale scores did not differ significantly at baseline and the first, second, third, fourth, and fifth follow-ups. In terms of constipation, indigestion, dizziness, and neurasthenia, group A reported a significantly higher complication rate than group B (p<0.05). Conclusion The prognosis did not differ significantly between patients who underwent ABR for at least 1 week and those who started walking as soon as possible. The incidence of complications due to ABRs was lower in the early ambulatory group. Therefore, it may be helpful to start walking as early as possible during the conservative treatment of OVCFs.

A 65-year-old woman who underwent transforaminal lumbar interbody fusion at L4-5 for very severe spinal stenosis combined with a hard disc and instability presented with a headache on postoperative day (POD) 3 and cerebrospinal fluid (CSF) leakage on POD 5. Follow-up lumbar spine computed tomography (CT) was performed on POD 7, and fluid collection at the operation site was observed on CT images. Under the diagnosis of iatrogenic dural injury, absolute bed rest and lumbar drain catheter insertion at the L2-3 level were performed for three days, but the patient continued to complain of severe headache until POD 10. We reoperated on POD 10 and observed a dural defect with CSF leakage. The surgery was completed after ensuring that the CSF leakage was resolved by dural repair. However, 10 days after the reoperation, the amount of hemovac drainage still did not decrease and was measured to be more than 250 mL. There was no improvement in the patient’s symptoms. Twenty days after the first surgery, an epidural blood patch was applied to the epidural space at the site of dural injury, and the patient’s symptoms improved.

OBJECTIVE: Percutaneous pedicle screw fixation (PPSF) offers some of the advantages of minimally invasive surgery. However, an additional skin incision is necessary in order to gain these advantages. The author recently performed a modified PPSF through a single skin incision and it yielded good results. Here, we report the single incision percutaneous pedicle screw fixation (SIPPSF). METHODS: The medical records of 51 patients who underwent single segment transforaminal lumbar interbody fusion (TLIF) with pedicle screw fixation (PSF) between December 2009 and December 2011 were reviewed. The patients were divided into 3 groups according to the PSF technique used; conventional group (Group C), SIPPSF (Group S) and PPSF through multiple skin incisions (Group M). Operation time, estimated blood loss (EBL) and pain intensity before and after the operation using a numeric rating scale (NRS) were evaluated. RESULTS: The number of patients in Group S, Group C and Group M was 25, 17 and 9, respectively. The NRS demonstrated a reduction in pain intensity in all the patients, and there were no differences in NRS scoring between the three groups. Group S showed a reduction in the EBL compared to Group C (p=0.001) and a reduction in the operation time compared to Group M(p=0.003). CONCLUSION: The author supposes that the type of skin incision does not correlate significantly with the clinical results of TLIF with PPSF. However, it can be considered that SIPPSF offers the advantage of avoiding an additional paramedian skin incision.
Humans ; Imidazoles ; Medical Records ; Nitro Compounds ; Skin

OBJECTIVE: Percutaneous pedicle screw fixation (PPSF) offers some of the advantages of minimally invasive surgery. However, an additional skin incision is necessary in order to gain these advantages. The author recently performed a modified PPSF through a single skin incision and it yielded good results. Here, we report the single incision percutaneous pedicle screw fixation (SIPPSF). METHODS: The medical records of 51 patients who underwent single segment transforaminal lumbar interbody fusion (TLIF) with pedicle screw fixation (PSF) between December 2009 and December 2011 were reviewed. The patients were divided into 3 groups according to the PSF technique used; conventional group (Group C), SIPPSF (Group S) and PPSF through multiple skin incisions (Group M). Operation time, estimated blood loss (EBL) and pain intensity before and after the operation using a numeric rating scale (NRS) were evaluated. RESULTS: The number of patients in Group S, Group C and Group M was 25, 17 and 9, respectively. The NRS demonstrated a reduction in pain intensity in all the patients, and there were no differences in NRS scoring between the three groups. Group S showed a reduction in the EBL compared to Group C (p=0.001) and a reduction in the operation time compared to Group M(p=0.003). CONCLUSION: The author supposes that the type of skin incision does not correlate significantly with the clinical results of TLIF with PPSF. However, it can be considered that SIPPSF offers the advantage of avoiding an additional paramedian skin incision.
Humans ; Imidazoles ; Medical Records ; Nitro Compounds ; Skin

Lymphocytic hypophysitis is a rare inflammatory disease of the pituitary gland that is one of the cause of hypopituitarism. The majority of cases occur in women during the peripartum period, and it is rare in men. Testicular feminization syndrome is a genetic disorder presenting a 46XY karyotype, but a normal female phenotype. We report a case of lymphocytic hypophysitis in a 23-year-old woman with testicular feminization syndrome.
Androgen-Insensitivity Syndrome* ; Female ; Humans ; Hypopituitarism ; Karyotype ; Male ; Peripartum Period ; Phenotype ; Pituitary Gland ; Young Adult

OBJECTIVE: The objective of this study is to establish an animal model of chronic paraspinal muscle injury in rat. METHODS: Fifty four Sprague-Dawley male rats were divided into experimental group (n=30), sham (n=15), and normal group (n=9). Incision was done from T7 to L2 and paraspinal muscles were detached from spine and tied at each level. The paraspinal muscles were exposed and untied at 2 weeks after surgery. Sham operation was done by paraspinal muscles dissection at the same levels and wound closure was done without tying. Kyphotic index and thoracolumbar Cobb's angle were measured at preoperative, 2, 4, 8, and 12 weeks after the first surgery for all groups. The rats were sacrificed at 4, 8, and 12 weeks after the first surgery, and performed histological examinations. RESULTS: At 4 weeks after surgery, the kyphotic index decreased, but, Cobb's angle increased significantly in the experimental group (p<0.05), and then that were maintained until the end of the experiment. However, there were no significant differences of the kyphotic index and Cobb's angle between sham and normal groups. In histological examinations, necrosis and fibrosis were observed definitely and persisted until 12 weeks after surgery. There were also presences of regenerated muscle cells which nucleus is at the center of cytoplasm, centronucleated myofibers. CONCLUSION: Our chronic injury model of paraspinal muscles in rats shows necrosis and fibrosis in the muscles for 12 weeks after surgery, which might be useful to study the pathophysiology of the degenerative thoracolumbar kyphosis or degeneration of paraspinal muscles.
Animals ; Cytoplasm ; Fibrosis ; Humans ; Kyphosis ; Male ; Models, Animal ; Muscle Cells ; Muscles ; Necrosis ; Paraspinal Muscles* ; Rats* ; Rats, Sprague-Dawley ; Spine ; Wounds and Injuries

OBJECTIVE: As a conservative treatment of compression fractures, absolute bed rest (ABR) for a certain period has been recommended, but no guideline on the period has yet been established. Considering that a long ABR period may adversely affect patients, the difference in prognosis according to the ABR period was investigated in this study. METHODS: A prospective study was conducted who were diagnosed with compression fracture. Groups A and B were put on ABR (one week for group A and two weeks for group B). X-ray images at baseline, 1, 2, 4, and 8 weeks were obtained from both groups, for assessment purposes. RESULTS: The compression rates of both groups were no significant difference at baseline, 1, 2, 4, and 8 weeks. The conditions of 25.9% and 21.2% of the subjects deteriorated in groups A and B, showing no significant difference. Between the groups of age and bone mineral densities (BMD), no significant difference was observed in the incidence of deterioration. In terms of complications development including constipation and other Gastrointestinal problems, voiding difficulty, etc., group A reported 57.4%, and group B, 84.8%, showing a significant difference (p-value=0.001). CONCLUSION: No significant difference in the conservative period was observed between the groups. Group B, however, reported a higher complications development rate than group A. Therefore, a short ABR period may be helpful in the early stage of conservative treatment.
Bed Rest* ; Bone Density ; Constipation ; Fractures, Compression* ; Humans ; Incidence ; Prognosis ; Prospective Studies

The blood blister-like aneurysm (BBA) of the internal carotid artery (ICA) is a rare but clinically important cause of subarachnoid hemorrhage (SAH), which accounts for 0.5% of incidences of ruptured intracranial aneurysms. BBA is a thin-walled, broad-based aneurysm that lacks an identifiable neck and is one of the most difficult lesions to treat. In this paper, a case is presented of a 57-year-old woman with SAH. Her cerebral angiography demonstrated a small BBA on the dorsal wall of her right ICA. Endovascular treatment that consisted of a stent-within-a-stent was attempted, but the replacement of the second stent failed, and the aneurysm became bigger. Surgery was performed by clipping the BBA with a Sundt slim-line encircling graft clip. The patient completely recovered with no complications. This treatment may be a salvageable option for BBA, especially when endovascular treatment has failed.
Aneurysm ; Carotid Artery, Internal ; Cerebral Angiography ; Endovascular Procedures ; Female ; Humans ; Incidence ; Intracranial Aneurysm ; Middle Aged ; Neck ; Stents ; Subarachnoid Hemorrhage ; Transplants

OBJECTIVE: Epidural hematoma of posterior fossa is less common than epidural hematoma of supratentorial area, and there are not many articles about epidural hematoma of posterior fossa. This study investigated patients who underwent surgery of epidural hematoma of posterior fossa, and the relation between the clinical manifestation and postoperative outcome. METHODS: A retrospective analysis performed of 27 patients who underwent operation for acute traumatic epidural hematoma of posterior fossa from January 2004 to December 2011. Analyzed factors were gender, age, Glasgow Coma Scale (GCS) measured upon presentation to the hospital, preoperative GCS score, cause of trauma, time elapsed from the accident to the presentation to the hospital, time elapsed from the presentation to the hospital to the surgery, radiographic findings (brain CT findings), and Glasgow Outcome Scale (GOS). RESULTS: Two patients (7.4%) had GCS score on admission of 3-8, 11 (29.6%) had 9-12, and 17 (66.7%) had 13-15. In 1 (3.7%) patient, GCS score changed from 13 to 10, and preoperative GCS score was significantly correlated with GOS score (p<0.05). Mean thickness of hematoma was 19.3+/-7.5 mm, and was significantly correlated with GOS score (p<0.05). GOS score was 4-5 in 24 patients (88.9%), 3 (severe disability) in 1 patient (3.7%), and 1 (death) in 2 patients (7.4%). CONCLUSION: In the patients underwent surgery for epidural hematoma of posterior fossa, 88.9% had favorable outcome (in GOS score of 4 or more). Preoperative GCS score and thickness of hematoma on brain computed tomography are important determinants of prognosis.
Brain ; Cranial Fossa, Posterior ; Glasgow Coma Scale ; Glasgow Outcome Scale ; Hematoma ; Humans ; Prognosis ; Retrospective Studies

OBJECTIVE: Posterior cervical foraminotomy (PCF) is a motion-preserving surgical technique. The objective was to determine whether PCF alter cervical motion as a long-term influence. METHODS: Thirty one patients who followed up more than 36 months after PCF for cervical radiculopathy from January 2004 to September 2008 were enrolled in this study. The range of motion (ROM) of whole cervical spine, the operated segment, the cranial and the caudal adjacent segment were obtained. The clinical result and the change of ROMs were compared with those in the patients performed anterior cervical discectomy and fusion (ACDF) during the same period. RESULTS: In PCF group, the ROM of whole cervical spine had no significant difference in statistically at preoperative and last follow up. The operated segment ROM was significantly decreased from 11.02+/-5.72 to 8.82+/-6.65 (p<0.05). The ROM of cranial adjacent segment was slightly increased from 10.42+/-5.13 to 11.02+/-5.41 and the ROM of caudal adjacent segment was decreased from 9.44+/-6.26 to 8.73+/-5.92, however these data were not meaningful statistically. In ACDF group, the operated ROM was decreased and unlike in PCF group, especially the ROM of caudal adjacent segment was increased from 9.39+/-4.21 to 11.33+/-5.07 (p<0.01). CONCLUSION: As part of the long-term effects of PCF on cervical motion, the operated segment motions decreased but were preserved after PCF. However, unlikely after ACDF, the ROMs of the adjacent segment did not increase after PCF. PCF, by maintaining the motion of the operated segment, imposes less stress on the adjacent segments. This may be one of its advantages.
Diskectomy ; Follow-Up Studies ; Foraminotomy* ; Humans ; Radiculopathy ; Range of Motion, Articular ; Spine