STUDY DESIGN: This is a retrospective study analyzing 73 patients treated by decompression, pedicular screw instrumentation and posterior lumbar interbody fusion (PLIF) for lumbosacral spondylolithesis and symptomatic spinal stenosis. we used laminected laminar and spinous process instead of iliac bone. OBJECTIVES: This is to evaluate fusion rate and clinical results of PLIF with laminected laminar and spinous process. MATERIALS AND METHODS: PLIF in 73 patients with lumbosacral disorders who carried out at Pohang St. Mary's Hospital from March 1994 to January 1996. Fusion rate was evaluated by simple X-ray and dynamic view. Clinical effect was evaluated by Kirkaldy-Willis criteria. RESULTS: The solid fusion was achieved at 67 cases(91.8%) and the average period of fusion was 6.4 months. Complications were 2 cases of superficial skin infection and 3 cases of root irritation. The functional results by Kirkaldy-Willis were as follows ; excellent 40 cases, good 23 cases, fair 9 cases and poor 1 case. CONCLUSIONS: This PLIF procedure combined with transpedicular instrumentation showed sufficient fusion rate and excellent clinical results and improvement in vertebral alignment.
Decompression ; Gyeongsangbuk-do ; Humans ; Retrospective Studies ; Skin ; Spinal Stenosis

PURPOSE: We experienced six cases of late infection of the hydroxyapatite (HA) orbital implant treated with surgical procedures. METHODS: Exposures of the HA and pyogenic granulomas around conjunctival dehiscence helped us to confirm infections of the HA orbital implants. Infections were not controlled by medical therapies so the HA implants were exchanged by silicone implants in all cases. Finally, the silicone implants were replaced by Medpor(R) after the inflammation had been controlled. Dermis fat graft was also performed in two cases due to insufficient conjunctival sac. RESULTS: Infections of HA orbital implants occurred at 62 to 106 months postoperatively. Staphylococcus aureus and Pseudomonas aeruginosa were cultured from removed implants. All cases show successful outcomes during 12 to 42 months after Medpor(R) implantations. CONCLUSIONS: Infections of peg-inserted HA orbital implants occurred after five years due to exposure of HA orbital implants. To replace infected HA implants with Medpor(R) implants is considered a functionally and aesthetically effective therapeutic method.
Dermis ; Durapatite* ; Granuloma, Pyogenic ; Inflammation ; Orbit* ; Orbital Implants* ; Pseudomonas aeruginosa ; Silicones ; Staphylococcus aureus ; Transplants

Narcotic analgesics may be added to spinal anesthetics solution to improve the quality of sensorimotor blockade and to produce postoperative pain relief. The opioid-related side effects of respiratory depression, pruritus, nausea, and urinary retension also occur with intrathecal administration and the effects are dose-related. It is difficult to select morphine with spinal anesthetic solution due to fatal side-effect, respiratory depression. Intrathecal morphine dose used for our study was less than 1mg, thereby the risk of respiratory depression was decreased. There was no report that the addition of morphine affected the motor block produced by the local anesthetics in spinal anesthesia. But in our study, we found that 0.9 mg of intrathecal morphine produced prolongation of optimal condition for operation(more than 3 hours duration), and sufficient postoperative pain relief(for about 20 hours) without respiratory depression in 28 out of 30 spinal anesthesia cases. On the other hand, 0.5 mg or 0.7 mg of intrathecal morphine produced sufficient postoperative pain relief without respiratory depression(for about 20 hours), but insufficient prolongation of optimal condition for operation in each 30 cases of spinal anesthesia.
Anesthesia, Spinal* ; Anesthetics ; Anesthetics, Local ; Hand ; Morphine* ; Narcotics ; Nausea ; Pain, Postoperative ; Pruritus ; Respiratory Insufficiency ; Tetracaine*

Acute malperfusion syndrome is a serious complication of acute aortic dissection. A 76-year-old female patient was admitted with acute type B aortic dissection and developed renal malperfusion during medical therapy. We are reporting a clinically successful result from the thoracic endovascular aortic repair used for malperfusion syndrome that occurred by acute type B aortic dissection.
Aged ; Aorta ; Female ; Humans ; Stents ; Transplants

STUDY DESIGN: A retrospective study of patients with a posterolateral spinal fusion for an unstable thoracolumbar junction. OBJECTIVES: To evaluate the efficacy of a posterolateral spinal fusion for an unstable thoracolumbar junction. SUMMARY OF LITERATURE REVIEW: Posterolateral spinal fusions are well documented for their efficacy in the lumbar and lumbosacral spine, and have also been applied to the thoracolumbar junction in the lumbar area. The thoracolumbar junction, however, is a little different from the lumbar spine, in its anatomical and biomechanical aspects, and posterolateral fusions have not been well evaluated in these respects. MATERIALS AND METHODS: Fourteen consecutive patients, who had posterolateral spinal fusions, with instrumentation for an unstable condition, including T12-L1 segment, and followed for more than one year, were included. In 11 patients, all the fractures had been decompressed posteriorly, for degenerative conditions in 2, and for a neoplastic pathology in the other one. The radiographs concerning the lateral fusion mass were reviewed according to Lenke's classification, the change in the segmental sagittal angle of the fused segment and the fixation failure of the instrumentation. The medical records relating to the neurological recovery were reviewed using the modified Frankel grading, and the overall clinical results of treatment by the Kirkaldy-Willis criteria. RESULTS: All patients disclosed big, bilateral and solid fusion masses, with the exception of one patient who revealed a big, solid fusion mass on one side, and small, thin fusion mass on the other. No patient revealed more than 3 degrees of mobility on flexion-extension lateral radiographs, any evidence of fixation failure of the instrumentation. The neurological recovery, by the modified Frankel grading system, showed an average 1.3 improvement. The clinical results were excellent in 6, good in 6 and fair in 2 patients, with no poor results. CONCLUSIONS: A posterolateral spinal fusion can be effectively applied in an unstable thoracolumbar junction, such as in the lumbar and lumbosacral spine, provided there is precise preparation of the graft beds, enough bone grafts and correction of the excessive kyphotic angle by the compression fixation of the posterior instrumentation.
Classification ; Humans ; Medical Records ; Pathology ; Retrospective Studies ; Spinal Fusion ; Spine ; Transplants