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

STUDY DESIGN: A review of the literature regarding neurophysiologic mechanism of pain. OBJECTIVES: To review and discuss neurophysiologic mechanism of pain, including neuropathic pain. SUMMARY OF LITERATURE REVIEW: The neurophysiology of pain has been established at the cellular and molecular biology level through many studies. Also, multiple modalities to manage pain have been developed. MATERIALS AND METHODS: A literature review. RESULTS: Pain develops by actions of multiple receptors, ion channels and neurotransmitters along the pain pathway. Pathologic states, such as persistent pain, allodynia, and hyperalgesia, arise from alteration of the pain pathway. Especially, neuropathic pain results from nerve injury and its pathology is rather different from the neuroplasty of normal individuals. CONCLUSION: Multiple modalities, including individualized pain treatment based on pain phenotype, are introduced. However, optimal treatment is uncertain, therefore, further studies are needed.
Hyperalgesia ; Ion Channels ; Molecular Biology ; Neuralgia ; Neuronal Plasticity ; Neurophysiology ; Neurotransmitter Agents ; Pathology ; Phenotype

Apoptosis is responsible for the loss of thyrocytes in autoimmune thyroiditis. Recent investigations into the pathogenesis of apoptosis have revealed that the important roles of suicide molecules expression on both thyrocytes and cytotoxic T-lymphocytes. To study the mechanism of thyrocyte loss in various forms of thyroiditis, we evaluated in situ expression patterns of CD40, Fas, and Fas-L on thyrocytes and infiltrating inflammatory cells by immunohistochemical staining of thyroid samples obtained from 49 patients (Graves' disease, n=10 : Hashimoto's thyroiditis, n=14; nonspecific lymphocytic thyroiditis, n=11; subacute granulomatous thyroiditis, n=11; normal, n=3). The role of cytotoxic T-lymphocytes was also evaluated by analyzing the expression of granzyme B along with their phenotypic characteristics. CD40 was not expressed on thyrocytes of normal controls while they showed a diffuse expression of Fas and a scattered focal expression of Fas-L. The plump thyrocytes proximal to the inflammatory infiltrates showed more intense expressions of these three molecules in various forms of thyroiditis and a close correlation was found between CD40 and Fas-L expression on thyrocytes. Unlike Fas, which was expressed on infiltrating lymphocytes in all groups, Fas-L was not expressed on infiltrating lymphocytes, except those in subacute granulomatous thyroiditis. Granzyme B expressing activated cytotoxic T-lymphocytes occupied a negligible proportion of CD8+ T-lymphocytes in various forms of thyroiditis, and no difference was found in terms of their proportions according to the type of thyroiditis. These results show the acquisition of CD40, Fas and Fas-L molecules on thyrocytes proximal to inflammatory cell aggregates and the negligible expression of granzyme B and Fas-L on the infiltrating lymphocytes, and suggest that Fas and Fas-L mediated apoptosis of thyrocytes (fratricide) may be more important than T cell-mediated cytotoxicity in various forms of thyroiditis.
Antigens, CD40/*metabolism ; Antigens, CD95/metabolism ; Apoptosis/*physiology ; Graves' Disease/*metabolism/pathology ; Human ; Membrane Glycoproteins/metabolism ; Reference Values ; Thyroiditis, Autoimmune/*metabolism/pathology

Spondylodiscitis is very rare complication caused by Klebsiella pneumoniae. Among those, few cases of spondylodiscitis concomitant with epidural abscess due to Klebsiella pneumoniae have been reported. We present a case of lumbar pyogenic spondylodiscitis with epidural abscess caused by Klebsiella pneumoniae that successfully treated with administration of cefotaxime, surgical drainage and intermittent closed continuous saline irrigation.
Cefotaxime ; Discitis ; Drainage ; Epidural Abscess ; Klebsiella ; Klebsiella pneumoniae ; Spondylitis

Objectives: To evaluate and compare the clinical outcomes of cervical transforaminal epidural block (CTEB) using local anesthetics with or without a steroid for cervical spondylotic radiculopathy (CSR).Summary of Literature Review: The typical mixture for a CTEB is a combination of local anesthetics with a non-particulate steroid.However, there are potential complications related to steroid injections such as steroid-induced osteoporosis, hypothalamus-pituitaryadrenal gland axis suppression, and hyperglycemia. Materials and Methods: From January 2018 to October 2019, 35 patients who underwent CTEB for CSR were enrolled in this study.Cases with arm pain over 4 on a visual analog scale (VAS) were included. In the first 19 cases, a combination of 1 mL of 1% lidocaine and 1 mL of dexamethasone was used (group A), and in the next 16 cases, 1 mL of 1% lidocaine mixed with 1 mL of normal saline was used (group B). Arm pain VAS and the Neck Disability Index (NDI) were obtained perioperatively. Results: Baseline characteristics were not significantly different between the two groups. In both groups, the arm pain VAS significantly decreased at 30 minutes, 2 weeks, and 6 weeks post-injection compared to pre-injection values. However, the arm pain aggravated 12 weeks post-injection. The NDI of both groups significantly improved 6 weeks post-injection compared to pre-injection. The clinical outcomes of arm pain VAS and NDI at 30 minutes, 2 weeks, and 6 weeks post-injection, as well as the amounts of change, were not significantly different between both groups. Conclusions CTEB for CSR without a steroid improved symptoms by 6 weeks. The degree of improvement was similar to when CTEB was performed with a steroid in terms of VAS and NDI.

PURPOSE: This study is to analyze the prevalence of various intra-articular lesions in patients with traumatic recurrent anterior dislocation of shoulder over 40 years and suggest clinical implications for treatment. MATERIALS AND METHODS: We retrospectively studied 16 cases that underwent surgical treatment for recurrent anterior dislocation of shoulder from January 2001 to May 2009. There were 9 males and 7 females, and the mean age was 52.7years. We carried out arthroscopic exam for all patients based on standard protocol, which included labrum, capular lesion, cuff, bony lesions. RESULTS: All 16 cases showed Hill-Sachs lesion, 3 patients (19%) had bony Bankart lesion, 6 patients (38%) had labral tear. Capsular tear were found 15 patients (94%). Twelve (75%) had ruptured supraspinatus and 5 (31%) had subscapularis tear. Only one (6%) had SLAP lesion. CONCLUSION: There was relatively higher incidence of capsular and rotator cuff tears in patients over age 40 years. Preoperative planning to address these lesions is highly recommended.
Aged ; Dislocations ; Female ; Humans ; Incidence ; Male ; Prevalence ; Retrospective Studies ; Rotator Cuff ; Shoulder ; Shoulder Dislocation

STUDY DESIGN: Case Report. OBJECTIVES: The aim of this study was to report 2 cases of calcified spinal meningioma that displayed differences in appearance during resection, and to review the current literature on calcified and ossified spinal meningiomas. SUMMARY OF LITERATURE REVIEW: Calcified and ossified spinal meningiomas are rare, and tumor calcification is a risk factor for poor neurological outcomes resulting from the additional manipulations required to dissect the tumor. MATERIALS AND METHODS: We describe the clinical course and intraoperative findings of 2 female patients who presented with symptoms of myelopathy. Magnetic resonance imaging showed calcified spinal meningiomas of the thoracic spine. The type of tumor resection performed was dependent on the solidity and texture of the individual tumors. RESULTS: Pathologic evaluation revealed psammoma bodies, which suggested calcified meningioma. The patients' neurologic symptoms resolved with no neurologic sequelae. CONCLUSIONS: Although there are a few pathologic differences regarding the main type and pathogenesis of ossified and calcified meningioma, both are thought to have a poor prognosis. For these tumors, adequately accounting for the expected poor prognosis and performing a wide laminectomy in order to ensure an adequate surgical margin are important factors for achieving a favorable outcome.
Female ; Humans ; Laminectomy ; Magnetic Resonance Imaging ; Meningioma* ; Neurologic Manifestations ; Prognosis ; Risk Factors ; Spinal Cord Diseases ; Spine

STUDY DESIGN: We have studied anatomical dimension and shape of lumbar vertebrae and disc from MRI scan of lumbar spine of 467 patients. OBJECTIVES: In order to provide the basic information and understandings for appropriate spinal instrumentation, development and production of implant and diagnosis of disc disease. SUMMARY OF BACKGROUND DATA: There are few data on the anatomical demension and shape of lumbar vertebrae in Korean adults. METHODS: The MRI scan of lumbar spine of 467 patients were obtained from Oct. 1996 to Jul. 1998. According to Thompson's criteria, Grade I and II were considered as normal intervertebral disc. Anterior-posterior distance of the center of superior end plate surface, anterior-posterior distance of at edge of the spinal canal, distance between the edges of the spinal canal, transverse diameter of dura sac, surface area of superior end plate(cm(2)), shape of posterior margin of intervertebral disc, anterior and posterior height of intervertebral space and shape of the intervertebral disc were measured on T1 and T2 weighted image of MRI. RESULTS: Anteroposterior distance of L5 spine was longest but anteroposterior distance of S1 was 2.68cm. The difference between anterior and posterior height of intervertebral space was gradually increased to lower level of the lumbar spine as segmental lordosis was increased. The shapes of posterior margin of intervertebral disc were concave at L1-2 and L2-3, flat at L3-4, and convex at L4-5 and L5-S1. The shapes of the intervertebral disc space were mostly pot shape at L1-2 and L2-3, dish shape at L3-4 and L4-5, but at L5-S1, trapezoidal shape was most popular. There was no statistical significance between age and sex in Korean adults. CONCLUSIONS: There were some individual variance in anatomical dimension of lumbar vertebrae and intervertebral disc, it is necessary to understand details of anatomical structure when the surgeon choose proper implant and diagnose disc disease.
Adult* ; Animals ; Diagnosis ; Humans ; Intervertebral Disc ; Lordosis ; Lumbar Vertebrae* ; Magnetic Resonance Imaging ; Spinal Canal ; Spine

The arcade of Struthers has been described as a possible cause of ulnar nerve compression in the elbow. This paper reports two cases of ulnar neuropathy caused by the arcade of Struthers. These observations demonstrated the importance of evaluation of the arcade of Struthers in atypical high ulnar nerve palsy.
Elbow* ; Ulnar Nerve Compression Syndromes ; Ulnar Nerve* ; Ulnar Neuropathies*

The traumatic C1-C2 unifacetal joint dislocation associated with oblique fractures of the C2 body and arch is a rare injury that can be effectively treated with gentle closed reduction under fluoroscopic guidance followed by halo vest immobilization. To our knowledge, however, there are only a few reported cases of this injury. Recognition of associated conditions including vertebral artery compromise, concomitant cervical spine fractures, and life-threatening injuries is paramount to the successful treatment of these patients. A 29-year-old patient, who presented a unifacetal dislocation at C1-C2 with associated oblique fractures of the C2 body and arch, is reported. Closed reduction with Gardner-Wells tong and halo vest application was performed. After 3 months of application of halo vest, the fractures of C2 body and arch had the complete union and the C1-2 dislocation had the good reduction. He had no pain and discomfort in his neck for about 2 years after halo vest removal.
Adult ; Dislocations ; Humans ; Immobilization ; Joints ; Neck ; Spine ; Vertebral Artery