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Open Reduction without Fusion of Bilateral Jumped Lumbosacral Facet Dislocation Associated with Symphysis Pubis Separation and Cauda Equina Syndrome: Case Report.

Sang Bong KO ; Sang Wook LEE

Asian Spine Journal.2010;4(2):128-131. doi:10.4184/asj.2010.4.2.128

This paper reports a rare case of a lumbosacral dislocation associated with symphysis pubis separation and cauda equina syndrome. A 39-year-old male who diagnosed traumatic lumbosacral dislocation underwent an open reduction without fusion. After an open reduction and internal fixation of a symphysis pubis separation, a missed lumbosacral dislocation was diagnosed and an open reduction was performed without fusion. Due to the symphysis pubis separation, the patient was not allowed weight bearing for 3 months, which then began from wheel chair ambulation. At the 6-month follow up evaluation, there was no back pain but the patient reported mild S1 nerve root sensory symptoms. Lumbosacral dislocation is common in high energy polytrauma patients and can be misdiagnosed. However, prompt reduction without fusion is a good alternative treatment.
Adult ; Back Pain ; Cauda Equina ; Dislocations ; Follow-Up Studies ; Humans ; Male ; Polyradiculopathy ; Walking ; Weight-Bearing ; Wheelchairs

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The Acute Calcific Prevertebral Tendinitis: Report of Two Cases.

Dong Eun SHIN ; Chang Soo AHN ; Jung Pil CHOI

Asian Spine Journal.2010;4(2):123-127. doi:10.4184/asj.2010.4.2.123

Acute calcific prevertebral tendinitis, which is also known as retropharyngeal calcific tendinitis and longus colli tendinitis, is an under-recognized cause of acute cervical pain produced by an inflammation of the longus colli muscle. The typical characteristics of this entity are calcifications at the superior insertion of the longus colli tendons at the C1-C2 level and fluid collection in the retropharyngeal space. The differential diagnosis includes a retropharyngeal abscess, infectious spondylitis or traumatic injury. Knowledge of the clinical and imaging findings can prevent a misdiagnosis and inappropriate attempts at surgical drainage.
Diagnosis, Differential ; Diagnostic Errors ; Drainage ; Inflammation ; Muscles ; Neck Pain ; Retropharyngeal Abscess ; Spondylitis ; Tendinopathy ; Tendons

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Delayed Spinal Epidural Hematoma after En Block Spondylectomy for Vertebral Ewing's Sarcoma.

Boram KIM ; Seong Hwan MOON ; Sun Yong KIM ; Ho Joong KIM ; Hwan Mo LEE

Asian Spine Journal.2010;4(2):118-122. doi:10.4184/asj.2010.4.2.118

We report here on a case of a 23-year-old male who received en block spondylectomy for a vertebral Ewing's sarcoma at our hospital. Nine days after surgery, he presented with severe back pain and motor weakness of the lower extremities. Based on the physical examination and the computed tomography scan, he was diagnosed with acute cauda equina syndrome that was caused by compression from an epidural hematoma. His neurological functions recovered after emergency evacuation of the hematoma. This case showed that extensive surgery for a malignant vertebral tumor has a potential risk of delayed epidural hematoma and acute cauda equina syndrome and this should be treated with emergency evacuation.
Back Pain ; Emergencies ; Hematoma ; Hematoma, Epidural, Spinal ; Humans ; Lower Extremity ; Male ; Physical Examination ; Polyradiculopathy ; Sarcoma, Ewing ; Spine ; Young Adult

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Reliability and Validity of Thoracolumbar Injury Classification and Severity Score (TLICS).

Young Do KOH ; Dong Jun KIM ; Young Won KOH

Asian Spine Journal.2010;4(2):109-117. doi:10.4184/asj.2010.4.2.109

STUDY DESIGN: A new classification system for throacolumbar spine injury, Thoracolumbar Injury Classification and Severity Score (TLICS) was evaluated retrospectively. PURPOSE: To evaluate intrarater and interrater reliability of newly proposed TLICS schemes and to estimate validity of TLICS's final treatment recommendation. OVERVIEW OF LITERATURE: Despite numerous literature about thoracolumbar spine injury classifications, there is no consensus regarding the optimal system. METHODS: Using plain radiographs, computed tomography scanning, magnetic resonance imaging, and medical records, 3 clssifiers, consisting of 2 spine surgeons and 1 senior orthopaedic surgery resident, reviewed 114 clinical thoracolumbar spine injury cases retrospectively to classify and calculate injury severity score according to TLICS. This process were repeated on 4 weeks intervals and the scores were then compared with type of treatment that patient ultimately received. RESULTS: The intrarater reliability of TLICS was substantial agreement on total score and injury morphology, almost perfect agreement on integrity of the posterior ligament complex (PLC) and neurologic status. The interrater reliability was substantial agreement on injury morphology and integrity of the PLC, moderate agreement on total score, almost perfect agreement on neurologic status. The TLICS schems exhibited satisfactory overall validity in terms of clinical decision making. CONCLUSIONS: The TLICS was demonstrated acceptable intrarater and interrater reliability and satisfactory validity in terms of treatment recommendation.
Consensus ; Decision Making ; Humans ; Injury Severity Score ; Ligaments ; Magnetic Resonance Imaging ; Medical Records ; Reproducibility of Results ; Retrospective Studies ; Spine

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Comparison of Kyphoplasty and Lordoplasty in the Treatment of Osteoporotic Vertebral Compression Fracture.

Sang Bum KIM ; Taek Soo JEON ; Woo Suk LEE ; Jae Young ROH ; Jae Young KIM ; Won Ki PARK

Asian Spine Journal.2010;4(2):102-108. doi:10.4184/asj.2010.4.2.102

STUDY DESIGN: A retrospective study. PURPOSE: To compare the level of restoration of the vertebral height, improvement in the wedge and kyphotic angles, and the incidence of complications in osteoporotic compression fracture in patients treated with either kyphoplasty or lordoplasty. OVERVIEW OF LITERATURE: Kyphoplasty involves recompression of the vertebral bodies. Recently, a more effective method known as lordoplasty was introduced. METHODS: Between 2004 and 2009, patients with osteoporotic thoracolumbar vertebral compression fractures were treated by either kyphoplasty (n = 24) or lordoplasty (n = 12) using polymethylmethacrylate (PMMA) cement, and the results of the two interventions were compared. A visual analogue scale was used to measure the pain status. Preoperative and postoperative radiographs were analyzed to quantify the anterior vertebral height restoration and the wedge and kyphotic alignment correction. RESULTS: All patients in both groups reported a significant decrease in pain. The anterior heights increased 24.2% and 17.5% after the lordoplasty and kyphoplasty procedures, respectively (p < 0.05). Three months after the procedures, there was a larger decrease in the loss of anterior vertebral height in the kyphoplasty group (12.8%) than in the lordoplasty group (6.3%, p < 0.05). The wedge angles decreased after both procedures. The wedge angle in the lordoplasty group maintained its value after 3 months (p < 0.05). The kyphotic angular correction was 11.4 and 7.0degrees in the lordoplasty and kyphoplasty groups, respectively (p < 0.05). Both kyphotic deformities worsened to a similar degree of 5degrees after 3 months. CONCLUSIONS: Lordoplasty is more useful than kyphoplasty in terms of the improved anatomic restoration and postoperative maintenance.
Congenital Abnormalities ; Fractures, Compression ; Humans ; Incidence ; Kyphoplasty ; Polymethyl Methacrylate ; Retrospective Studies ; Vertebroplasty

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Changes of Sagittal Spinopelvic Parameters in Normal Koreans with Age over 50.

Kyu Bok KANG ; Youngjung J KIM ; Nasir MUZAFFAR ; Jae Hyuk YANG ; Youngbae B KIM ; Eui Dong YEO

Asian Spine Journal.2010;4(2):96-101. doi:10.4184/asj.2010.4.2.96

STUDY DESIGN: A prospective comparative study. PURPOSE: To describe the changes in the spinopelvic parameters on normal Koreans more than 50 years of age. OVERVIEW OF LITERATURE: There are differing opinions regarding the changes in the thoracic kyphosis, lumbar lordosis, C7 plumb with age in the elderly population. METHODS: Sagittal standing radiographs of the whole spine including the pelvis in 132 Korean adult male volunteers more than 50 years of age were evaluated prospectively. Volunteers with a history of spine operation, spinal disease, pain in their back or legs, scoliosis, spondylolisthesis, monosegment disc space narrowing, or compression fracture in radiographs were excluded. The following parameters were included: thoracic kyphosis (T5 upper end plate [UEP]-T12 lower end plate [LEP]), thoracolumbar kyphosis (T10 UEP-L2 LEP), lumbar lordosis (T12 LEP-S1 UEP), lower lumbar lordosis (L4 UEP-S1 UEP), sacral slope, pelvic incidence, and the distances from the C7 plumb to the posterosuperior endplate of S1. These parameters in the 6th, 7th and 8th decade groups were compared and the changes in these parameters according to age were examined. RESULTS: The thoracic kyphosis demonstrated significant differences in the in the three age groups (p = 0.019), and increased with age (r = 0.239, p < 0.006). The other parameters did not show any significant difference or correlation. CONCLUSIONS: Similar global sagittal balances and spinopelvic parameters may be observed in Korean males older than 50 years, with a trend towards increasing thoracic kyphosis with age.
Adult ; Aged ; Animals ; Fractures, Compression ; Humans ; Incidence ; Kyphosis ; Leg ; Lordosis ; Male ; Pelvis ; Prospective Studies ; Scoliosis ; Spinal Diseases ; Spine ; Spondylolisthesis

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The Comparison of Bone Scan and MRI in Osteoporotic Compression Fractures.

Jung Hoon KIM ; Jong In KIM ; Bo Hoon JANG ; Jung Gook SEO ; Jin Hwan KIM

Asian Spine Journal.2010;4(2):89-95. doi:10.4184/asj.2010.4.2.89

STUDY DESIGN: Retrospective study. PURPOSE: To estimate the usefulness of bone scan and magnetic resonance imaging (MRI) for the diagnosis of new fracture in osteoporotic vertebral fractures. OVERVIEW OF LITERATURE: The diagnosis of new fractrure in osteoporotic vertebral fractures requires simple X-ray and supplementary studies. METHODS: We analyzed 87 vertebrae in 44 patients, who diagnosed with osteoporotic vertebral fractures using bone scan and MRI within 2 months interval between August 2001 and July 2008. We compared hot uptakes in bone scan with MRI findings such as new fractures, old fractures and degenerative lesions. RESULTS: Hot uptakes in bone scan was matched to 48 new fractures, 26 old fractures and 13 degenerative lesions in MRI findings. It was 55% of concordance between hot uptakes in bone scan and new fractures in MRI. The rate of new vertebral fractures confirmed by MRI according to 1 level hot uptakes in bone scan was 96%, 2 levels was 50% and 3 more levels was 36%. CONCLUSIONS: The diagnosis of new fracture in osteoporotic vertebral fractures requires simple X-ray and supplementary studies such as bone scan and MRI. We recommend more careful interpretation in multiple osteoporotic vertebral fracture patients about hot uptake lesions of bone scan.
Fractures, Compression ; Humans ; Magnetic Resonance Imaging ; Retrospective Studies ; Spine

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Comparison between Operated Muscular Dystrophy and Spinal Muscular Atrophy Patients in terms of Radiological, Pulmonary and Functional Outcomes.

Hyon Su CHONG ; Eun Su MOON ; Hak Sun KIM ; Nanda ANKUR ; Jin Oh PARK ; Jin Young KIM ; Phillip Anthony KHO ; Seong Hwan MOON ; Hwan Mo LEE ; Nam Hun SEUL

Asian Spine Journal.2010;4(2):82-88. doi:10.4184/asj.2010.4.2.82

STUDY DESIGN: Retrospective comparative study. PURPOSE: To study and compare the surgical outcomes of muscular dystrophy (MD) and spinal muscle atrophy (SMA). OVERVIEW OF LITERATURE: There are few reports that have evaluated and compared the surgical outcomes of MD and SMA patients. METHODS: The patients (n = 35) were divided into two groups: a MD group with 24 patients and a SMA group with 11 patients. The average follow-up period was 21 months. All patients were operated for scoliosis correction using posterior instrumentation and fusion. In the immediate postoperative period, all efforts were made to reduce the pulmonary complications using non-invasive positive pressure ventilation and a coughing assist devices. The patients were evaluated by radiograph in terms of the Cobb's angle, pelvic obliquity, T1 translation, thoracic kyphosis and lumbar lordosis. The pulmonary function and self-image satisfaction were also assessed. RESULTS: There was a lower correction rate in the MD group (41.5%) than in the SMA group (48.3%), even though the curves were smaller in the MD group. The correction in the pelvic obliquity was significantly better in the SMA group (p = 0.03). The predicted vital capacity showed a 4% reduction in the MD group 1 year after surgery, while the SMA group showed a 10% reduction. The peak cough flow and end tidal PCO2 did not deteriorate and were well maintained. The average score for the improvement in self-image satisfaction postoperatively was 3.96 and 4.64 for the MD and SMA groups, respectively. The total complication rate was 45.7%; 14.3% of which were respiratory-related. CONCLUSIONS: Surgical intervention for MD and SMA may be performed safely in patients with a very low forced vital capacity (< 30%) through aggressive preoperative and postoperative rehabilitation efforts.
Animals ; Cough ; Follow-Up Studies ; Humans ; Kyphosis ; Lordosis ; Muscular Atrophy ; Muscular Atrophy, Spinal ; Muscular Dystrophies ; Positive-Pressure Respiration ; Postoperative Period ; Retrospective Studies ; Scoliosis ; Vital Capacity

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Relationship between New Osteoporotic Vertebral Fracture and Instrumented Lumbar Arthrodesis.

Bung Hak KIM ; Dong Hyuk CHOI ; Seong Hun JEON ; Yong Soo CHOI

Asian Spine Journal.2010;4(2):77-81. doi:10.4184/asj.2010.4.2.77

STUDY DESIGN: Retrospective study. PURPOSE: To evaluate the relationship between a new osteoporotic vertebral fracture and instrumented lumbar arthrodesis. OVERVIEW OF LITERATURE: In contrast to the growing recognition of the importance of adjacent segment disease after lumbar arthrodesis, relatively little attention has been paid to the relationship between osteoporotic vertebral fractures and instrumented lumbar arthrodesis. METHODS: Twenty five patients with a thoracolumbar vertebral fracture following instrumented arthrodesis for degenerative lumbar disorders (study group) were investigated. The influence of instrumented lumbar arthrodesis was examined by comparing the bone mineral density (BMD) of the femoral neck in the study group with that of 28 patients (control group) who had sustained a simple osteoporotic vertebral fracture. The fracture after instrumented arthrodesis was diagnosed at a mean 47 months (range, 7 to 100 months) after the surgery. RESULTS: There was a relatively better BMD in the study group, 0.67 +/- 0.12 g/cm2 compared to the control group, 0.60 +/- 0.13 g/cm2 (p = 0.013). The level of back pain improved from a mean of 7.5 +/- 1.0 at the time of the fracture to a mean of 4.9 +/- 2.0 at 1 year after the fracture (p = 0.001). However, 12 (48%) patients complained of severe back pain 1 year after the fracture. There was negative correlation between the BMD of the femoral neck and back pain at the last follow up (r = - 0.455, p = 0.022). CONCLUSIONS: Osteoporotic vertebral fractures after instrumented arthrodesis contribute to the aggravation of back pain and the final outcome of degenerative lumbar disorders. Therefore, it is important to examine the possibility of new osteoporotic vertebral fractures for new-onset back pain after lumbar instrumented arthrodesis.
Arthrodesis ; Back Pain ; Bone Density ; Femur Neck ; Follow-Up Studies ; Humans ; Osteoporosis ; Retrospective Studies

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Antibiotic Microbial Prophylaxis for Spinal Surgery: Comparison between 48 and 72-Hour AMP Protocols.

Boram KIM ; Seong Hwan MOON ; Eun Su MOON ; Hak Sun KIM ; Jin Oh PARK ; In Je CHO ; Hwan Mo LEE

Asian Spine Journal.2010;4(2):71-76. doi:10.4184/asj.2010.4.2.71

STUDY DESIGN: This is a prospective randomized cohort study. PURPOSE: We intended to evaluate the efficacy of a 48 hour antibiotic microbial prophylaxis (AMP) protocol as compared with a 72 hour AMP protocol. OVERVIEW OF LITERATURE: The current guideline for the prevention of surgical site infection (SSI) suggests the AMP should not exceed 24 hours after clean surgery like spinal surgery. But there exist some confusion in real clinical practice about the duration of postoperative antibiotic administration because the evidence of the guideline was not robust. METHODS: The subjects were 548 patients who underwent spinal surgery at our department from April 2007 to December 2008. The patients were classified into two groups according to the prophylaxis protocol: group A, for which AMP was employed for 72 hours postoperatively and group B, for which AMP was employed for 48 hours postoperatively. Five hundred two patients out of 548 patients were followed until 6 months postoperatively. The incidence of SSI in the two groups was analyzed. RESULTS: The overall infection rate was 0.8%. There was no significant difference in infection rate between the two groups. The overall infection rate for the patients who underwent instrumented fusion was 0.9%. There was no significant difference in the infection rate between the patients of the two groups who underwent instrumented fusion. CONCLUSIONS: AMP for 48 hours is as efficient as AMP for 72 hours.
Anti-Bacterial Agents ; Cohort Studies ; Humans ; Incidence ; Prospective Studies ; Spine

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