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Effective Response of Methotrexate for Recurrent Idiopathic Hypertrophic Spinal Pachymeningitis.

Tae Joon PARK ; Won Deok SEO ; Sang Young KIM ; Jae Hoon CHO ; Dae Hyun KIM ; Ki Hong KIM

Korean Journal of Spine.2016;13(4):200-203. doi:10.14245/kjs.2016.13.4.200

Idiopathic hypertrophic spinal pachymeningitis (IHSP) is a chronic progressive and diffuse inflammatory fibrosis of the spinal dura mater. Though treatment of IHSP is surgical decompression with steroid therapy, treatment for recurrent IHSP is controversial. Our patient was diagnosed with IHSP based on magnetic resonance imaging (MRI) and underwent laminectomy for decompression following steroid pulse therapy. Despite maintenance of steroid therapy, the patient experienced 3 recurrences. As an alternative immunosuppressant medication, methotrexate was introduced with low-dose steroid. Fortunately, the symptom was resolved, and a decrease of dura thickening was revealed on MRI. We present the case and suggest that methotrexate might be an effective treatment modality for recurrent IHSP.
Decompression ; Decompression, Surgical ; Dura Mater ; Fibrosis ; Humans ; Laminectomy ; Magnetic Resonance Imaging ; Meningitis* ; Methotrexate* ; Recurrence

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Synovial Chondromatosis of Dorsal Spine: Case Report of Rare Pathological Entity and Review.

Raviraj S GHORPADE ; Yadhu K LOKANATH

Korean Journal of Spine.2016;13(4):196-199. doi:10.14245/kjs.2016.13.4.196

Synovial chondromatosis is an uncommon benign condition of metaplastic and focal formation of cartilage in the intimal layer of synovial membrane of joints with extremely low risk of malignant potential. Disease process is typically monoarticular predominantly involving large joints and spinal involvement being a very rare event. We report 31-year-old male patient who presented with history of low backache, left lower limb pain, difficulty in micturition since 8 months and difficulty in walking since 2 months .Magnetic resonance imaging of spine revealed D10-11 extradural lesion arising from left facet joint. Lesion was excised completely by posterior approach with resolution of symptoms. Literature reveals fourteen cases of spinal variant of synovial chondromatosis which has been published and this report represents the fifteenth case.
Adult ; Cartilage ; Chondromatosis, Synovial* ; Humans ; Joints ; Low Back Pain ; Lower Extremity ; Magnetic Resonance Imaging ; Male ; Spine* ; Synovial Membrane ; Urination ; Walking ; Zygapophyseal Joint

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Safety and Efficacy of Mini Open Transforaminal Lumbar Interbody Fusion.

Mohamed M MOHI ELDIN ; Ehab M EISSA ; Haitham M ELMORSY

Korean Journal of Spine.2016;13(4):190-195. doi:10.14245/kjs.2016.13.4.190

OBJECTIVE: Mini-transforaminal lumbar interbody fusion (Mini-TLIF) and other minimally invasive approaches introduced for the purpose of treating lumbar degenerative disc disease and instability are achieving high success and safety rates as the conventional approaches. Moreover, it has less soft tissue damage, minimal blood loss, and less hospital stay. METHODS: A prospective study was conducted from 2012 to 2014 on 28 patients who were subjected to Mini-open TLIF combined with transpedicular screw fixation for spondylolisthesis and degenerative disc disease. Two paramedian approaches were done, 4 cm for each, to insert the pedicular screws, along with inserting unilateral TLIF cage with autologous bone graft. Decompression was done either unilateral or bilateral according to the patient side of radiculopathy. Sixteen patients (57.2%) were diagnosed with degenerative spondylolisthesis, 7 patients (25%) were diagnosed with isthmic type spondylolisthesis, and 5 patients (17.8%) were diagnosed with degenerative disc disease, 2 of them(7.1%) had previous operations at the same level. Twenty patients (71.4%) were operated at the L4/5 level, and 8 patients (28.6%) at the L5/S1 level. RESULTS: All patients were able to ambulate the next day of surgery. The mean estimated blood loss was 251.79mL. The average hospital stay was 4.14 days. The average follow-up was 9 months. The mean visual analog scale was 1.86 at discharge, 1.68 after 3 months, and 1.38 after 6 months. After 6 months of the operation, MacNab's criteria were good in 23 patients and excellent in 5 patients. We had one case with transient weakness, 2 cases of screw malposition without clinical manifestations, and one case of infection. CONCLUSION: Mini-TLIF approach is an efficient and safe approach for treating instability and degenerative diseases of the lumbar spine. The clinical outcome is encouraging and it may be an operation of choice for lumbar spinal fusion in selected patients.
Decompression ; Follow-Up Studies ; Humans ; Length of Stay ; Prospective Studies ; Radiculopathy ; Spinal Fusion ; Spine ; Spondylolisthesis ; Transplants ; Visual Analog Scale

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Predictors of Reoperation after Microdecompression in Lumbar Spinal Stenosis.

Hee Jong HWANG ; Hyung Ki PARK ; Gwang Soo LEE ; June Young HEO ; Jae Chil CHANG

Korean Journal of Spine.2016;13(4):183-189. doi:10.14245/kjs.2016.13.4.183

OBJECTIVE: The risk factors of reoperation after microdecompression (MD) for lumbar spinal stenosis (LSS) are unclear. In this study, we presented the outcomes of MD for degenerative LSS and investigated the risk factors associated with reoperation. METHODS: A retrospective review was conducted using the clinical records and radiographs of patients with LSS who underwent MD. For clinical evaluation, we used the Japanese Orthopedic Association (JOA) scoring system for low back pain, body mass index, and Charlson comorbidity index. For radiological evaluation, disc height, facet angle, and sagittal rotation angle were measured in operated segments. Also the Modic change and Pfirrmann grade for degeneration in the endplate and disc were scored. RESULTS: Forty-three patients aged 69±9 years at index surgery were followed for 48±25 months. The average preoperative JOA score was 6.9±1.6 points. The score improved to 9.1±2.1 points at the latest follow-up (p<0.001). Seven patients (16.3%) underwent reoperation. Clinical and radiological factors except operation level and Pfirrmann grade showed a p-value >0.1. Patients with Pfirrmann grade IV and lower lumbar segment had a 29.1% rate of reoperation (p=0.001), whereas patients without these factors had a 0% rate of reoperation. CONCLUSION: Moderate disk degeneration (Pfirrmann IV) in lower lumbar segments is a risk factor of disk herniation or foraminal stenosis requiring reoperation after MD in LSS.
Asian Continental Ancestry Group ; Body Mass Index ; Comorbidity ; Constriction, Pathologic ; Follow-Up Studies ; Humans ; Intervertebral Disc Degeneration ; Laminectomy ; Low Back Pain ; Orthopedics ; Reoperation* ; Retrospective Studies ; Risk Factors ; Spinal Stenosis*

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The Change of Range of Motion at Anterior Compression of the Cervical Cord after Laminoplasty in Patients with Cervical Spondylotic Myelopathy.

Yongjae CHO

Korean Journal of Spine.2016;13(4):177-182. doi:10.14245/kjs.2016.13.4.177

OBJECTIVE: Degenerative diseases of the spine, such as cervical spondylotic myelopathy (CSM), are increasing among the old age population, and surgical treatment of CSM is becoming more and more common. The aim of this study was to investigate how functional recovery can be influenced by anterior compression of the spinal cord (ACS) after laminoplasty for treatment of patients with CSM. METHODS: We retrospectively analyzed 32 patients admitted to Ewha Womans Mok-Dong Hospital with CSM who underwent open-door laminoplasty from January 2012 to December 2014. We divided patients into 2 groups according to whether ACS was or not preoperatively. Each group was analyzed clinical and radiological parameters which were Japanese Orthopedic Association (JOA) scores and its recovery rate, sagittal alignment and range of motion (ROM). RESULTS: The mean duration of symptom was 11.2 months (range, 6-22 months). A significant difference in recovery rate of the total JOA score was shown between the 2 groups, especially upper extremity motor function. No difference in preoperative JOA score between the 2 groups, but recovery rate of each group was 20.05%±18.1%, 32.21%±25.4%, statistically significant (p<0.005). Upper motor and sensory function was not significantly different in the 2 groups. Preoperative, postoperative and preservation of ROM was 44.3°±10.1°, 41.8°±15.7°, 87.9%±35.4% each at ACS (-) group. A significant difference in postoperative ROM was identified between ACS (-) and ACS (+) group. Postoperative anterior compression of the spinal cord was recognized 14 cases which were classified from its causes. CONCLUSION: Cervical ROM decreased significantly after laminoplasty, but 85.3% of the preoperative ROM was preserved. The postoperative reduction of ROM in group with anterior compression of spinal cord was identified.
Asian Continental Ancestry Group ; Cervical Cord* ; Female ; Humans ; Laminoplasty* ; Orthopedics ; Range of Motion, Articular* ; Retrospective Studies ; Sensation ; Spinal Cord ; Spinal Cord Diseases* ; Spine ; Spondylosis ; Upper Extremity

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Repeated Vertebral Body Fracture at Different Levels due to Sagittal Imbalance.

Kyeong Bo CHOI ; Jee Soo JANG ; Sang Ho LEE

Korean Journal of Spine.2010;7(1):41-45.

The authors report a case of repeated vertebral body fracture at different levels due to sagittal imbalance resulting from long level spinal fusion after thoracic discectomy. A 69-year-old woman with severe cord compression at T9-T10-T11 due to calcified herniated discs underwent an anterior thoracotomy via the left transpleural approach followed by discectomy of T9-T10-T11. Six weeks later, she complained of severe thoracic and right flank pain after falling over. A newly developed burst fracture resulting in sagittal imbalance was detected, so the authors performed posterior fusion from T8 to L2 and pedicle screw fixation. Unfortunately, 4 months after the second ope- ration the patient revisited our hospital complaining of severe back and right leg pain. The whole spine lateral view revealed a newly developed bursting fracture of L3 and more aggravated sagittal imbalance accompanied with junctional kyphosis at the L2-L3 level. The authors performed a third operation composed of anterior lumbar inter- body fusion at the L5-S1 level and L3 closing wedge osteotomy with fixation for better sagittal balance and nerve decompression. The patient showed no evidence of postoperative neurological compromise. Her back and leg pain improved over time, and she was completely pain-free at 4 months after the surgery
Aged ; Decompression ; Diskectomy ; Female ; Flank Pain ; Humans ; Intervertebral Disc Displacement ; Kyphosis ; Leg ; Osteotomy ; Oxalates ; Spinal Fusion ; Spine ; Thoracotomy

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Post-augmentation Burst Fracture at the Same Fractured Vertebra.

Jaewoo CHUNG ; Hyoung Joon CHUN ; Hyeong Joong YI ; Koang Hum BAK ; Young Soo KIM ; Yong KO

Korean Journal of Spine.2010;7(1):37-40.

A 56-year-old woman was admitted for management of low back pain from compression fracture on L3 vertebral body. Vertebroplasty was performed, and she discharged without any neurologic deficit. She revisited our institute with low back pain with sciatica but without myelopathy after three months. At admission image studies revealed fractured bony particles caused canal encroachment on the same level vertebrae. Surgical management was perfor- med including wide posterior decompression and transpedicular screw fixation on L2, L3, and L4 with posterolateral bony fusion. Authors present a rare case of post-augmentation fracture led to spinal fusion. Additionally, we suggest that filling material for vertebroplasty or kyphoplasty should be, as much as possible, inserted into the posterior half of vertebral body to prevent the refracture or burst fracture.
Decompression ; Female ; Fractures, Compression ; Humans ; Kyphoplasty ; Low Back Pain ; Middle Aged ; Neurologic Manifestations ; Sciatica ; Spinal Cord Diseases ; Spinal Fusion ; Spine ; Vertebroplasty

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Spontaneous Regression of Lumbar Herniated Intervertebral Disc.

Jin Sang KIL ; Ki Seong EOM ; Jong Tae PARK ; Seong Keun MOON ; Tae Young KIM

Korean Journal of Spine.2010;7(1):34-36.

Although the spontaneous regression of herniated intervertebral disc(HIVD) is well documented, the most useful and effective treatment protocol for symptomatic HIVD remains controversial. Here, we present a rare case of spon- taneous regression of lumbar HIVD. A 43-year-old woman presented with a pain in her lower back and right lower limb radiating from the buttock to the calf. Straight-leg raising test was positive at 30 degrees on the right side. Magnetic resonance imaging(MRI) revealed right-sided extrusion of an L5-S1 disc fragment with caudal migration; the disc fragment compressed the dural sac and nerve root at this level. The patient refused surgery and was, therefore, managed with conservative therapy comprising bed rest, epidural block, muscle relaxants, and nonsteroidal anti- inflammatory drugs(NSAIDs) for 45 days. At a follow-up after 45 days of this therapy, all the initial symptoms of the patient disappeared completely and a follow-up MRI showed regression of the disc fragment. The exact mecha- nism that prompted this regression is still unclear. However, as shown in our case, lumbar HIVD may spontaneously regress, implying that conservative treatment should be given additional importance in the treatment of HIVD.
Adult ; Bed Rest ; Buttocks ; Clinical Protocols ; Female ; Follow-Up Studies ; Humans ; Intervertebral Disc ; Lower Extremity ; Magnetic Resonance Spectroscopy ; Muscles

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Instrumented Fusion of Same-Level Lamina and Transverse Process for the Treatment of Lumbar Spondylolysis: A Preliminary Report.

Jae Hyeon LIM ; Jeong Hyun PARK ; Seong Il HA ; Young Keun KIM ; Joong Won YANG ; Il Tae JANG

Korean Journal of Spine.2010;7(1):28-33.

OBJECTIVE: There were many instruments introduced for direct repair of spondylolysis. But those instruments were not designed for direct repair of spondylolysis originally. Dynesys implants consist of pedicle screws and cords or laminar hooks that were designed for lumbar dynamic stabilization. We used pedicle screws and cord or laminar hook of Dynesys spinal system for repairment of spondylolysis. METHODS: July 2005 to March 2009, Six patients with lumbar spondylolysis were treated with a new technique using a pedicle screw with a u-shaped rod or laminar hook combined with bone grafting of the transverse process and lamina of the same level, bypassing the spondylolytic defect. There were 5 males and 1 female. Ages ranged from 18-48 years(average of 34.5 years). A total of 8 vertebral levels were fused(one patient had spondylolytic defects at 3 levels). Five defects were at L5, two at L4, and one at L3. The patients had low back pain that was unimproved after 3-6 months of conservative management. None demonstrated spondylolisthesis or instability, disc degeneration on MRI, nor radiculopathy. All symptoms resolved after isthmus block. The patients were followed-up for a period of 3-27 months(average of 14.8 months). The authors compared pre-operative and post-operative clinical symptoms and radiographic findings retrospectively. Success of the procedure was determined by the following criteria: impro- vement of clinical symptoms(VAS score), absence of isthmic motion on plain radiographs, and evaluation for the presence of a bone mass bridging the transverse processes and laminae using plain radiographs and reconstruction CT scan. RESULTS: All patients demonstrated improvement in pain scores(average of 8.3 to an average of 3.2). A fusion rate of 87.5% was achieved(7 out 8 levels). No complications were noted. The authors were able to demonstrate a potential benefit in using this new technique for the treatment of lumbar spondylolysis. CONCLUSION: Direct repair of spondylolysis with Dynesys spinal system is technically easy and fixes strongly biome- chanically.
Bone Transplantation ; Female ; Humans ; Intervertebral Disc Degeneration ; Low Back Pain ; Male ; Radiculopathy ; Retrospective Studies ; Spondylolisthesis ; Spondylolysis

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The Effects of Epidural Anesthesia in Elderly Patients during Single-Level Lumbar Microdiscectomy.

Sung Bae PARK ; Moon Chul KIM ; Seong Il HA

Korean Journal of Spine.2010;7(1):24-27.

OBJECTIVE: To analyze the effect of epidural anesthesia in elderly patients with single-level lumbar discectomy. METHODS: Medical records of 28 patients aged between 60 and 90 years who had undergone single-level lumbar microdiscectomy by two surgeons from January 2004 to December 2008 were retrospectively reviewed. Patients were divided into 2 groups: Group I was comprised of patients with lumbar discectomy under epidural anesthesia and Group II was comprised of patients with lumbar discectomy under general anesthesia. Factors taken into account when comparing the effects of epidural and general anesthesia were surgical time, anesthetic time, starting time of ambulation after surgery, hospital stay, postoperative headache, nausea, vomiting, urinary difficulty, back pain and patient satisfaction. The score on the visual analogue scale(VAS) for back pain was measured after surgery. RESULTS: 15 patients(Group I) underwent discectomy under epidural anesthesia. The mean age of patients in Group I and II were 65+/-6.1 years and 67+/-6.7 years, respectively. 19 patients had underlying co-morbidities, such as cardiovascular, pulmonary, cerebrovascular diseases and cancer. Demographically, there was no statistical diffe- rence between the two groups. Surgical time, anesthetic time, starting time of ambulation after surgery and hospital stay were longer in patients in Group II. The incidences of urinary difficulty and VAS score for back pain were significantly lower in Group I. The incidences of headache, nausea and vomiting and patient satisfaction were not different between Group I and II. CONCLUSION: Epidural anesthesia was as efficacious and as safe as general anesthesia. Elderly patients who need to undergo single-level lumbar discectomy could be offered epidural anesthesia.
Aged ; Anesthesia, Epidural ; Anesthesia, General ; Back Pain ; Diskectomy ; Headache ; Humans ; Incidence ; Length of Stay ; Medical Records ; Nausea ; Operative Time ; Patient Satisfaction ; Retrospective Studies ; Vomiting ; Walking

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