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Risk Factors of New Adjacent Compression Fracture after Percutaneous Vertebroplasty: Effectiveness of Bisphosphonate in Osteoporotic or Osteopenic Elderly Patients.

Dae Hyun SEO ; Si Hyuck OH ; Kyeong Wook YOON ; Jung Ho KO ; Young Jin KIM ; Jee Young LEE

Korean Journal of Neurotrauma.2014;10(2):86-91. doi:10.13004/kjnt.2014.10.2.86

OBJECTIVE: The purpose of this study is to investigate the incidence of new compression and to analyze factors that influence the fractures in adjacent levels after percutaneous vertebroplasty (PVP). METHODS: This retrospective study examined 206 patients who had undergone PVP for single level osteoporotic or osteopenic compression fractures during the last seven years in our department. After PVP, the patients were observed for at least over one year, and 29 patients showed new additional compression fractures in adjacent levels. One hundred seventy seven patients who did not show additional compression fractures were analyzed as the control group. Statistical comparisons were performed between the groups, in terms of age, gender, bone mineral density, whether bisphosphonate (BPP) was treated, preoperative kyphosis, preoperative wedge angle, change in wedge angle, amount of bone cement, existence of intradiscal bone cement leakage, and initial fracture levels. RESULTS: The statistically significant factors that influence new compression fractures in adjacent levels after PVP were as follows: being female, initial thoracolumbar junction fracture, preoperative large kyphotic, preoperative large wedge angle, change in wedge angle, administration of BPP in osteopenia group, and intradiscal cement leakage. CONCLUSION: This study identified many factors that influence newly developed compression fractures in adjacent levels after PVP. Interestingly, the administration of BPP in osteopenia group had positive influence on new fractures in this study. Therefore, we recommend early administration of BPP to patients with osteopenia.
Aged* ; Bone Density ; Bone Diseases, Metabolic ; Diphosphonates ; Female ; Fractures, Compression* ; Humans ; Incidence ; Kyphosis ; Retrospective Studies ; Risk Factors* ; Spinal Fractures ; Vertebroplasty*

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Influence of Gender on Occurrence of Chronic Subdural Hematoma; Is It an Effect of Cranial Asymmetry?.

Jae Sang OH ; Jai Joon SHIM ; Seok Mann YOON ; Kyeong Seok LEE

Korean Journal of Neurotrauma.2014;10(2):82-85. doi:10.13004/kjnt.2014.10.2.82

OBJECTIVE: Chronic subdural hematoma (CSDH) is a condition mostly present in older people. Men are more commonly affected than women. Several theories about male predominance could not enough to explain the reason for male predominance on CSDH. The purpose of this study is to find out whether there were any differences in the anatomy of cranium, which may contribute the pathogenesis or risk factors of CSDH. METHODS: The study population was consisted of 87 patients with CSDH and 100 patients with transient ischemic attack (TIA) from 2006 to 2013. We classified into four groups; group A (CSDH male 47), group B (CSDH female 40), group C (TIA male 50), and group D (TIA female 50). We measured the size of the cranium in the computed tomography scans, retrospectively. We define the difference of cranium (Dc), which is difference between the right and left radiuses. RESULTS: The Dc was significantly higher in patients with CSDH (group A and B)(p=0.03). The mean Dc was 3.49 mm in CSDH group (group A and B) and 2.14 mm in TIA group (group C and D). The mean Dc of CSDH group was significantly larger than that of TIA group (by t-test, p<0.01). CONCLUSION: Size and asymmetry of the cranium may be a risk factor of CSDH. Gender differences in the anatomy of cranium may contribute pathogenesis of CSDH.
Craniocerebral Trauma ; Female ; Hematoma, Subdural, Chronic* ; Humans ; Ischemic Attack, Transient ; Male ; Radius ; Retrospective Studies ; Risk Factors ; Skull

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The Efficacy of Titanium Burr Hole Cover for Reconstruction of Skull Defect after Burr Hole Trephination of Chronic Subdural Hematoma.

Tae Seop IM ; Yoon Soo LEE ; Sang Jun SUH ; Jeong Ho LEE ; Kee Young RYU ; Dong Gee KANG

Korean Journal of Neurotrauma.2014;10(2):76-81. doi:10.13004/kjnt.2014.10.2.76

OBJECTIVE: Although burr hole trephination is a safe and effective surgical option to treat patients with chronic subdural hematoma (CSDH), it often results in a small but undesirable scalp depression from burr hole defect. This study is to evaluate the efficacy of titanium burr hole cover (BHC) for reconstruction of skull defects in these patients. METHODS: A hundred and ninety-six cases of burr hole trephinations for CSDHs between January 2009 and December 2013 were assigned into two groups; Gelfoam packing only (GPO) and reconstruction using titanium BHC group, according to the modalities of burr hole reconstructions. The incidences and depths of scalp depressions and incidences of postoperative complications such as infections or instrument failures were analyzed in both groups. We also conducted telephone surveys to evaluate the cosmetic and functional outcomes from patient's aspect. RESULTS: Significantly lower incidence (p<0.0001) and smaller mean depth (p<0.0001) of scalp depressions were observed in BHC than GPO group. No statistical differences were seen in postoperative infection rates (p=0.498) between the two groups. There were no instrument failures in BHC group. According to the telephone surveys, 73.9% of respondents with scalp depressions had cosmetic inferiority complexes and 62.3% experienced functional handicaps during activities of daily life. CONCLUSION: Titanium BHC is highly effective for reconstruction of skull defect after burr hole trephination of CSDH, and provides excellent cosmetic and functional outcomes without significant complications.
Surveys and Questionnaires ; Depression ; Gelatin Sponge, Absorbable ; Hematoma, Subdural, Chronic* ; Humans ; Incidence ; Postoperative Complications ; Scalp ; Skull* ; Telephone ; Titanium* ; Treatment Outcome ; Trephining*

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Burst Fractures as a Result of Attempted Suicide by Jumping.

Do Young KIM ; Hong June CHOI ; Jeong Yoon PARK ; Kyung Hyun KIM ; Sung Uk KUH ; Dong Kyu CHIN ; Keun Su KIM ; Yong Eun CHO ; Byoung Ho JIN

Korean Journal of Neurotrauma.2014;10(2):70-75. doi:10.13004/kjnt.2014.10.2.70

OBJECTIVE: Jumping from high place for the purpose of suicide results in various damages to body area. A burst fracture of vertebrae is representative of them and we reviewed eight patients who were diagnosed with spinal burst fracture following suicide falling-down. The demographics, characteristics, performed operation, combined injuries, psychological past histories of the patients were analyzed. METHODS: A retrospective study was made of patients who are diagnosed with vertebral burst fracture from falling-down with the purpose of suicide admitted to department of neurosurgery of the author's hospital, covering the period between 2003 and 2012. RESULTS: Total eight patients were suicidal jumper. There were eleven vertebral burst fractures in eight patients and mean age was 26.5 years old. Seven patients already had psychological past history and there were various combined injuries except vertebrae burst fracture. The ankle fracture such as calcaneus, talus, navicular and malleolus was the most common injury and there were also various combined injury. CONCLUSION: Suicidal jumper is different from incidental faller in some aspects because of different injury mechanism. For managing suicidal jumper, physician had to consider patients' age, affected site, psychiatric problem and combined injuries. Each department related to the injuries of patient have to cooperate each other with departments of psychiatry and rehabilitation from beginning to end.
Ankle Fractures ; Calcaneus ; Demography ; Humans ; Neurosurgery ; Rehabilitation ; Retrospective Studies ; Spinal Fractures ; Spine ; Suicide ; Suicide, Attempted* ; Talus

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Clinical Features of Post-Traumatic Syringomyelia.

Hyun Gon KIM ; Han San OH ; Tae Wan KIM ; Kwan Ho PARK

Korean Journal of Neurotrauma.2014;10(2):66-69. doi:10.13004/kjnt.2014.10.2.66

OBJECTIVE: The purpose of this study was to analyze the clinical manifestations, radiological findings, treatment results, and clinical significance of post-traumatic syringomyelia (PTS). METHODS: We retrospectively reviewed the medical charts of nine surgical patients with symptomatic PTS between 1992 and 2012. RESULTS: The most common clinical manifestation was development of new motor weakness. The mean interval between the initial injury and the onset of new symptoms 21.9 years. The mean length of the syringes observed on preoperative magnetic resonance images was 7.8 spinal levels. Shunting procedures were performed in five patients. Four patients underwent arachnoidolysis and duraplasty. Patients developed mechanical shunt failure. Postoperatively, one patient showed clinical improvement, four patients were stable, and four patients showed deterioration. CONCLUSION: PTS is a disabling sequelae of spinal cord injury, which develops months to years after spinal injury. We have to consider that patients with PTS may have poor long-term outcome.
Humans ; Retrospective Studies ; Spinal Cord Injuries ; Spinal Injuries ; Syringes ; Syringomyelia*

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Midline Splitting Cervical Laminoplasty Using Allogeneic Bone Spacers: Comparison of Fusion Rates between Cervical Spondylotic Myelopathy and Ossification of Posterior Longitudinal Ligament.

Jae Jon SHEEN ; Sang Ryong JEON

Korean Journal of Neurotrauma.2014;10(2):60-65. doi:10.13004/kjnt.2014.10.2.60

OBJECTIVE: To analyze factors associated with fusion using allogeneic bone spacers for midline splitting cervical laminoplasty (MSCL). METHODS: During April 2012 and September 2013, seventeen patients with cervical spondylotic myelopathy (CSM) or ossification of posterior longitudinal ligament (OPLL) underwent MSCL with allogeneic bone spacers by a single surgeon. Mean follow up periods was 11.3 months (range, 6-19 months). Clinical outcomes were evaluated by the Japanese Orthopedic Association (JOA) scores at preoperative and postoperative 6 months. Simple cervical X-rays were taken preoperatively, immediate postoperatively, 3, and 6 months after operation. Computed tomography (CT) scans were performed preoperatively, immediate postoperatively and 6 months postoperatively. The differences between two diseases were analyzed on cervical lordosis, canal dimension, anteroposterior (AP) distance, fusion between lamina and allogeneic bone spacer and affecting factors of fusion. RESULTS: All surgeries were performed on 59 levels. There were no significant differences on the changes of lordosis (p=0.602), canal dimension (p=0.554), and AP distance (p=0.924) as well as JOA scores (p=0.257) between CSM and OPLL groups. Overall fusion rate was 51%. Multivariate analysis on the factor for the fusion rates between lamina and spacers showed that the immediate postoperative contact status between lamina and spacers in CT as significant factor of fusion (p=0.024). CONCLUSION: The present study suggests that CSM and OPLL did not show difference of surgical outcome in MSCL using allogeneic bone spacer. In addition, we should consider the contact status between lamina and bone spacer for the better fusion rates for this surgery.
Allografts ; Animals ; Asian Continental Ancestry Group ; Follow-Up Studies ; Humans ; Lordosis ; Multivariate Analysis ; Orthopedics ; Ossification of Posterior Longitudinal Ligament* ; Spinal Cord Diseases* ; Spinal Fusion ; Spondylosis

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Chronic Subdural Hematomas: Comparison between Unilateral and Bilateral Involvement.

Hyun Seok PARK ; Eun Suk PARK ; Jun Bum PARK ; Soon Chan KWON ; In Uk LYO ; Min Ho KIM ; Hong Bo SIM

Korean Journal of Neurotrauma.2014;10(2):55-59. doi:10.13004/kjnt.2014.10.2.55

OBJECTIVE: Chronic subdural hematoma (CSDH) is a common intracranial hemorrhage, encountered in neurosurgical practice. Most CSDHs are unilateral, but some show bilateral involvement. However, the clinical characteristics of bilateral CSDH remain unclear. In this study, we investigated the clinical differences between bilateral and unilateral CSDH. METHODS: A retrospective study was performed on 120 patients with CSDH surgically treated at our institute from January 2008 to December 2012. Patients were divided into two groups: the bilateral CSDH and the unilateral CSDH groups. Clinical presentations, precipitating factors, computed tomography (CT) findings, postoperative complications, and outcomes of patients were analyzed. RESULTS: Bilateral CSDH was identified in 11 of 120 (10.9%) patients with CSDH. Patients with bilateral CSDH tended to have a lower rate of head injury compared to patients with unilateral CSDH (36.4% vs. 59.6%), but it had no statistical significance (p=0.201). The frequency of marked midline shift on CT scans was significantly greater in unilateral CSDH than in bilateral CSDH (p=0.010). Presenting symptoms, coexisting systemic diseases, postoperative complications, and clinical outcomes were not significantly different between the two groups. CONCLUSION: Bilateral CSDH has comparatively similar clinical features and precipitating factors as unilateral CSDH. Patients with bilateral CSDH have significantly lower incidences of midline shift on CT scans, and most patients with either bilateral or unilateral CSDH have good postoperative outcomes.
Craniocerebral Trauma ; Hematoma, Subdural, Chronic* ; Humans ; Incidence ; Intracranial Hemorrhages ; Postoperative Complications ; Precipitating Factors ; Prognosis ; Retrospective Studies ; Tomography, X-Ray Computed ; Treatment Outcome

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Clinical Characteristics of Bilateral versus Unilateral Chronic Subdural Hematoma.

Jungjun LEE ; Jae Hyo PARK

Korean Journal of Neurotrauma.2014;10(2):49-54. doi:10.13004/kjnt.2014.10.2.49

OBJECTIVE: Chronic subdural hematoma (CSDH) is a common intracranial hemorrhage that is associated with significant morbidity. Bilateral lesions are occasionally found in neurosurgical practice. The purpose of this study is to analyze clinical characteristics of bilateral CSDH compared with unilateral CSDH. METHODS: Between January 2005 and January 2013, the authors treated 114 surgical patients with CSDH. Clinical presentations, precipitating factors, computed tomography (CT) findings, postoperative complications, and outcomes of patients were retrospectively analyzed in the bilateral and unilateral CSDH groups. RESULTS: Bilateral CSDH was identified in 28 (24.6%) of the 114 CSDH patients. The mean age was 77.85 years in the bilateral CSDH group. The frequency of altered consciousness as a presenting symptom was significantly higher in the bilateral CSDH, and that of hemiparesis was significantly higher in the unilateral CSDH (p=0.015). Diabetes mellitus was more common in the bilateral CSDH (p=0.001). CT scans revealed significant differences in the degree of midline shift (p=0.001). The mean modified Rankin scale at discharge was 1.5 in the bilateral CSDH group and 0.6 in the unilateral group (p=0.019). CONCLUSION: Bilateral CSDH showed different clinical characteristics from unilateral CSDH. Bilateral CSDH is prone to occurrence in the patient of old and diabetics. The patients of bilateral CSDH seem to reveal worse mental status and neurologic sign than unilateral CSDH in both baseline and postoperative state.
Brain ; Consciousness ; Diabetes Mellitus ; Hematoma ; Hematoma, Subdural, Chronic* ; Humans ; Intracranial Hemorrhages ; Neurologic Manifestations ; Paresis ; Postoperative Complications ; Precipitating Factors ; Retrospective Studies ; Tomography, X-Ray Computed

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The Predicting Factors for Recurrence of Chronic Subdural Hematoma Treated with Burr Hole and Drainage.

Dae Hyo SONG ; Young Soo KIM ; Hyoung Joon CHUN ; Hyeong Joong YI ; Koang Hum BAK ; Yong KO ; Suck Jun OH

Korean Journal of Neurotrauma.2014;10(2):41-48. doi:10.13004/kjnt.2014.10.2.41

OBJECTIVE: Chronic subdural hematoma (CSDH) is common in elderly patients. So, with an increasing number of elderly people in the general population, there is a need to investigate risk factors which increase recurrence rate. In this study, factors affecting the postoperative recurrence are investigated based on the reoperative CSDH cases. METHODS: Total of ninety-seven patients was enrolled in this study who had have operation for CSDH. In all patients, one burr hole trephination and drainage was the method of choice for the initial treatment of CSDH. We retrospectively evaluated several factors which affect to recurrence of CSDH. RESULTS: Retrospective analysis was performed in 97 patients. Sixteen patients experienced reoperation within 3 months (16/97, 16.5%) for recurrence of CSDH. And, when hematoma was divided by internal architecture, heterogeneous density group seems to be have close relationship with recurrence more significantly than homogeneous density group (p=0.002). Hypertension, diabetes mellitus, early removal of drainage tube, bilaterality of hematoma also have significant relationship with recurrence. CONCLUSION: Recurrence rate of CSDH treated with one burr hole drainage is related with some various factors. There was statistically significant difference between recurred group and non-recurred group. Not only demographic factors but also internal architecture on preoperative brain computed tomography is a significant predicting factor of recurrence in CSDH patients who underwent a surgery. In this study, heterogeneous type hematoma have significantly related with recurrence of CSDH. We should give attention to these predicting factors for more effective care.
Aged ; Brain ; Demography ; Diabetes Mellitus ; Drainage* ; Hematoma ; Hematoma, Subdural, Chronic* ; Humans ; Hypertension ; Recurrence* ; Reoperation ; Retrospective Studies ; Risk Factors ; Trephining

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Cerebral Infarction after Traumatic Brain Injury: Incidence and Risk Factors.

Dong Hyeon BAE ; Kyu Sun CHOI ; Hyeong Joong YI ; Hyoung Joon CHUN ; Yong KO ; Koang Hum BAK

Korean Journal of Neurotrauma.2014;10(2):35-40. doi:10.13004/kjnt.2014.10.2.35

OBJECTIVE: Post-traumatic cerebral infarction (PTCI) is one of the most severe secondary insults after traumatic brain injury (TBI), and is known to be associated with poor outcome and high mortality rate. We assessed the practical incidence and risk factors for the development of PTCI. METHODS: We conducted retrospective study on 986 consecutive patients with TBI from the period May 2005 to November 2012 at our institution. The definition of PTCI was made on non-enhanced CT scan based on a well-demarcated or fairly discernible region of low attenuation following specific vascular territory with normal initial CT. Clinical and radiological findings that related to patients' outcome were reviewed and statistically compared. RESULTS: PTCI was observed in 21 (2.1%) patients. Of various parameters, age (p=0.037), initial Glasgow coma scale score (p<0.01), brain herniation (p=0.044), and decompressive craniectomy (p=0.012) were significantly higher in patients with PTCI than patients who do not have PTCI. Duration between accident and PTCI, patterns of TBI and vascular territory of PTCI were not specific. The mortality rates were significantly higher in patients with PTCI than without PTCI. CONCLUSION: The development of PTCI is rare after TBI, but it usually results in serious outcome and high mortality. Early recognition for risks and aggressive managements is mandatory to prevent PTCI.
Brain ; Brain Injuries* ; Cerebral Infarction* ; Craniocerebral Trauma ; Decompressive Craniectomy ; Glasgow Coma Scale ; Hernia ; Humans ; Incidence* ; Mortality ; Retrospective Studies ; Risk Factors* ; Tomography, X-Ray Computed

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