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Cervical Epidural Abscess: Rare Complication of Bacterial Endocarditis with Streptococcus Viridans: A Case Report.

Jae Sang OH ; Jai Joon SHIM ; Kyeong Seok LEE ; Jae Won DOH

Korean Journal of Spine.2015;12(1):22-25. doi:10.14245/kjs.2015.12.1.22

Although many patients with infective endocarditis (IE) complain of joint, muscle, and back pain, infections at these sights are rare. The incidence of spinal abscess in cervical spine complicating endocarditis is very rare. Although the surgical management is the mainstay of treatment, conservative treatment can get success in selected patients. We report a patient with cervical epidural abscess due to Streptococcus viridans endocarditis. Both epidural abscess and IE were managed conservatively with intravenous antibiotics for 8 weeks, with recovery. It is important to remind spinal epidural abscess can occur in those patients with bacterial endocarditis.
Abscess ; Anti-Bacterial Agents ; Back Pain ; Endocarditis ; Endocarditis, Bacterial* ; Epidural Abscess* ; Humans ; Incidence ; Joints ; Spine ; Spondylitis ; Viridans Streptococci*

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Spontaneous Remission of a Big Subligamentous Extruded Disc Herniation: Case Report and Review of the Literature.

Veli CITISLI ; Muhammet IBRAHIMOGLU

Korean Journal of Spine.2015;12(1):19-21. doi:10.14245/kjs.2015.12.1.19

Spontaneous Regression of a Big Subligamentous Extruded Disc Herniation: Case Report And Review of The Literature The most efficient method for the treatment of lumbar disc herniation is still controversial. The most important aspect is the application of the suitable conservative or surgical treatment to the right patient at the right time. In lumbar disc herniation patients, one must not precipitate except for cases that require surgical indications as in cauda equina syndrome, evolutive motor deficit and persistence of pain in spite of the narcotics. However, the spontaneous regression mechanism has not been completely determined yet. The proposed hypotheses are; dehydration, retraction of the disc to the hernia in the annulus fibrosis, enzymatic catabolism and phagocytosis. In this study, the case of a patient with huge lumbar disc hernia regressing by itself has been presented and the potential mechanisms of disc regression have been discussed.
Dehydration ; Fibrosis ; Hernia ; Humans ; Magnetic Resonance Imaging ; Metabolism ; Narcotics ; Phagocytosis ; Polyradiculopathy ; Remission, Spontaneous*

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Spinal Teratoma Concomitant with Intracranial Lipid Droplet Dissemination.

Hyung Sug OH ; Tae Wan KIM ; Kwan Ho PARK

Korean Journal of Spine.2015;12(1):15-18. doi:10.14245/kjs.2015.12.1.15

A teratoma is a neoplasm that contains tissues originating from three germ cell layers at ectopic sites. The embryology of teratomas remains unclear. Teratomas are usually composed of cystic and solid components, and they are usually associated with syringomyelia. Cystic lesions of teratomas may rupture in a spontaneous, iatrogenic, or traumatic manner. Lipid droplets in the ventricles and subarachnoid space are rare. We managed a case of a spinal teratoma in the lumbar region in a 67-year-old man. He complained of nocturia, frequent urination, and difficulty in walking for 2 months. Radiographic imaging revealed a lumbar spinal intradural mass. Intracranial lipid droplets dissemination was also existed. The patient underwent surgery, and a diagnosis of mature teratoma was confirmed histopathologically. During the operation, the cystic portion of the intradural mass ruptured. During the hospital stay, the patient's mental status declined. On radiological examination, slightly enlarged ventricle size was observed. Dissemination of lipid droplets within ventricles occurs because of spontaneous, iatrogenic, or traumatic rupture. Additional lipid droplet dissemination to the intracranial space associated with neurologic deterioration after a spinal teratoma surgery should be considered when iatrogenic rupture of the cyst portion occurs.
Aged ; Diagnosis ; Embryology ; Germ Cells ; Humans ; Length of Stay ; Lumbosacral Region ; Nocturia ; Rupture ; Spine ; Subarachnoid Space ; Syringomyelia ; Teratoma* ; Urination ; Walking

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Posterior Epidural Migration of an Extruded Lumbar Disc Mimicking a Facet Cyst: A Case Report.

Young Sun YOO ; Chang Il JU ; Seok Won KIM ; Dong Min KIM

Korean Journal of Spine.2015;12(1):12-14. doi:10.14245/kjs.2015.12.1.12

Dorsal extradural migration of extruded disc material is clinically uncommon. We report a rare case of posterior epidural migration of an extruded lumbar disc mimicking a facet cyst. A 32-year-old man was admitted to our institute with a 2-week history of severe low back pain and radiating pain in the left leg. The magnetic resonance (MR) images revealed a dorsally located, left-sided extradural cystic mass at the L2-3 level. The initial diagnosis was an epidural facet cyst because of the high signal intensity on MR images and its location adjacent to the facet joint. Intraoperatively, an encapsulated mass of soft tissue adherent to the dural sac was observed and excised. The pathological diagnosis was degenerated disc material. After surgery, the patient experienced complete relief from leg pain.
Adult ; Diagnosis ; Humans ; Leg ; Low Back Pain ; Zygapophyseal Joint

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Experiences and Conceptualisation of Spinal Intramedullary Tuberculoma Management.

Manish JAISWAL ; Ashok GANDHI ; Achal SHARMA ; Radhey Shyam MITTAL

Korean Journal of Spine.2015;12(1):5-11. doi:10.14245/kjs.2015.12.1.5

OBJECTIVE: Spinal intramedullary tuberculoma (SIMT) is rare, accounting for 2/100,000 cases of tuberculosis and only 0.2% of all cases of central nervous system(CNS) tuberculosis. We share our experiences of 11 cases of this entity for improving diagnosis and conceptualize the management of this rare disease. METHODS: The clinical profile, radiological data and management of 11 cases of SIMT which were managed either conservatively or by surgical intervention during last 27 years (1987-2014) were analysed. RESULTS: Male:female ratio was 1.75:1. Five cases had associated pulmonary Koch's. Most common site was thoracic cord. Two cases had concurrent multiple intracranial tuberculoma. Most common presentation was paraparesis. X-ray myelography was performed in two patients in the initial period of study suggesting intramedullary pathology. In the subsequent nine cases who had magnetic resonance imaging (MRI), seven showed typical "target sign" and conglomerate ring lesion. Out of 8 surgically managed patients, 6 cases improved rapidly and in 2 patients gradual improvement was seen in follow-up. Most common indication of surgical excision was rapid neurological deterioration followed by diagnosis in doubt. Histopathology confirmed tuberculous etiology of the intramedullary lesion in all. Clinical and radiological improvement was seen in all 3 conservatively managed patients in follow-up. CONCLUSION: MRI findings of SIMT were specific and proven histologically correct. Surgical intervention may be indicated if there is no response to chemotherapy, the diagnosis is in doubt, or there is a rapid deterioration in neurological function because surgical outcome is good in these circumstances.
Diagnosis ; Drug Therapy ; Follow-Up Studies ; Humans ; Magnetic Resonance Imaging ; Myelography ; Paraparesis ; Pathology ; Rare Diseases ; Tuberculoma* ; Tuberculoma, Intracranial ; Tuberculosis

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An Innovative Universal Screw Removal Instrument.

Mehmet ELMADAG ; Yunus GUZEL ; Gokcer UZER ; Mehmet Ali ACAR

Korean Journal of Spine.2015;12(1):1-4. doi:10.14245/kjs.2015.12.1.1

OBJECTIVE: To present the clinical benefits of an instrument designed to facilitate removal of polyaxial screws during revision surgery. METHODS: All polyaxial screws can be removed without additional materials or a large amount of debridement using our newly designed instrument. Forty-two screws were removed from five patients without any complications using this instrument. RESULTS: We removed the cap screws and rods from the 42 polyaxial screws in five patients and made them monoaxial using the new screw removal apparatus. The screws and rods were removed quickly in a minimally invasive way with no complications. No damage to the pedicle or surrounding soft tissue occurred during screw removal. No neurogenic changes developed during revision surgery after changing the screws. CONCLUSION: This newly designed screw removal instrument was used safely and effectively to remove all polyaxial and monoaxial pedicle screws.
Debridement ; Equipment Failure ; Humans ; Spinal Fusion ; Spine

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Determination of the Effect of Diameter of the Sac on Prognosis in 64 Cases Operated for Meningomyelocele.

Metehan ESEOĞLU ; Ahmet EROĞLU ; Serkan KEMER ; Mehmet ARSLAN

Korean Journal of Spine.2017;14(1):7-10. doi:10.14245/kjs.2017.14.1.7

OBJECTIVE: To examine the effect of meningomyelocele sac size on prognosis by retrospective review of 64 cases operated for meningomyelocele between January 2009 and December 2012. METHODS: We evaluated newborn babies operated for meningomyelocele by retrospectively reviewing their files for head circumference, location and with of the defect, accompanying anomalies, treatments administered, drugs that mother used during pregnancy. Based on the defect size, 3 patient groups were created as 0–24 cm² (group I), 25–39 cm² (group II), and 40 cm² and above (group III). RESULTS: Throughout the study, 64 babies were evaluated. Mean head circumference was 37.4 cm (range, 30.7–50 cm). Based on their location, 49 of the defects (76.5%) were lumbar, 7 (10.9%) were thoracolumbar, 4 (6.2%) were thoracic, 3 (3.1%) were sacral, 1 (1.5%) was cervical. Mean size of the meningomyelocele sac was 4.7 cm×5.8 cm (range, 1 cm×1 cm—10 cm×8 cm), 13 of the babies (20.3%) had skin defect requiring flap. According to accompanying anomalies, 47 of the babies (73.4%) had hydrocephalus, 7 (10.9%) had club foot, 1 (1.5%) had diastematomyelia, 1 (1.5%) had tethered cord. Thirty-nine of the babies (60.9%) had paraplegia, 10 (15.6%) had paraparesis, 8 (12.5%) had monoplegia; neurological examination in the remaining 7 babies was normal. CONCLUSION: In our study, increased diameter of meningomyelocele sac was associated with greater amount of neural tissue within the sac, which worsens the prognosis. Sac localization was not changing prognosis but infection rates, hospitalization duration were increased in babies with bigger diameter of sacs.
Foot ; Head ; Hemiplegia ; Hospitalization ; Humans ; Hydrocephalus ; Infant, Newborn ; Meningomyelocele* ; Mothers ; Neural Tube Defects ; Neurologic Examination ; Paraparesis ; Paraplegia ; Pregnancy ; Prognosis* ; Retrospective Studies ; Skin

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Assessment of Clinical Symptoms in Lumbar Foraminal Stenosis Using the Japanese Orthopaedic Association Back Pain Evaluation Questionnaire.

Yawara EGUCHI ; Munetaka SUZUKI ; Hajime YAMANAKA ; Hiroshi TAMAI ; Tatsuya KOBAYASHI ; Sumihisa ORITA ; Kazuyo YAMAUCHI ; Miyako SUZUKI ; Kazuhide INAGE ; Hirohito KANAMOTO ; Koki ABE ; Yasuchika AOKI ; Masao KODA ; Takeo FURUYA ; Kazuhisa TAKAHASHI ; Seiji OHTORI

Korean Journal of Spine.2017;14(1):1-6. doi:10.14245/kjs.2017.14.1.1

OBJECTIVE: It is important to develop an easy means of diagnosing lumbar foraminal stenosis (LFS) in a general practice setting. We investigated the use of the Japanese Orthopaedic Association Back Pain Evaluation Questionnaire (JOABPEQ) to diagnose LFS in symptomatic patients. METHODS: Subjects included 13 cases (mean age, 72 years) with LFS, and 30 cases (mean age, 73 years) with lumbar spinal canal stenosis (LSCS) involving one intervertebral disc. The visual analogue scale score for low back pain and leg pain, the JOABPEQ were evaluated. RESULTS: Those with LFS had a significantly lower JOA score (p<0.001), while JOABPEQ scores (p<0.05) for lumbar dysfunction and social functioning impairment (p<0.01) were both significantly lower than the scores in LSCS. The following JOABPEQ questionnaire items (LFS vs. LSCS, p-value) for difficulties in: sleeping (53.8% vs. 16.6%, p<0.05), getting up from a chair (53.8% vs. 6.6%, p<0.001), turning over (76.9% vs. 40%, p<0.05), and putting on socks (76.9% vs. 26.6%, p<0.01) such as pain during rest, and signs of intermittent claudication more than 15 minutes (61.5% vs. 26.6%, p<0.05) were all significantly more common with LFS than LSCS. CONCLUSION: Results suggest that of the items in the JOABPEQ, if pain during rest or intermittent claudication is noted, LFS should be kept in mind as a cause during subsequent diagnosis and treatment. LFS may be easily diagnosed from LSCS using this established patient-based assessment method.
Asian Continental Ancestry Group* ; Back Pain* ; Constriction, Pathologic* ; Diagnosis ; General Practice ; Humans ; Intermittent Claudication ; Intervertebral Disc ; Leg ; Low Back Pain ; Methods ; Spinal Canal

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Spontaneous Cervical Spondylodiscitis and Epidural Abscess Caused by Klebsiella Pneumonia-single Stage Operation with Decompressive Corpectomy and Autologous Bone Fusion.

Min Seok KIM ; Dae Chul CHO ; Joo Kyoung SUNG

Korean Journal of Spine.2008;5(3):237-240.

We present a very rare case of spontaneous cervical spondylodiscitis and epidural abscess caused by Klebsiella pneumonia. A 45-year-old man presented with severe posterior neck pain radiating down both arms with decreased range of motion of the neck. He also complained of paresthesia of the upper extremities and a subjective weakness of his right arm. Magnetic resonance imaging (MRI) revealed spondylodiscitis and epidural abscess on the C5 and C6. In order to obtain adequate drainage of the abscess and complete removal of granulation tissues we performed a total decompressive corpectomy of C5 and C6. After drainage of the abscess, single stage autologous iliac bone graft was performed. The patient was followed by three months with antibiotic treatment confirmed to be sensitive to the organism. Klebsiella pneumonia was cultured postoperatively from the surgical biopsy samples. The patient recovered with no complications and the postoperative MRI showed improvement of the lesions.
Abscess ; Arm ; Biopsy ; Decompression ; Discitis ; Drainage ; Epidural Abscess ; Granulation Tissue ; Humans ; Klebsiella ; Magnetic Resonance Imaging ; Middle Aged ; Neck ; Neck Pain ; Paresthesia ; Pneumonia ; Range of Motion, Articular ; Transplants ; Upper Extremity

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Aneurysmal Bone Cyst Arising from Iliac Bone Mimicking Liposarcoma.

Jae Gyun CHOE ; Sang Hyuk KIM ; Whan EOH

Korean Journal of Spine.2008;5(3):234-236.

Aneurysmal bone cysts (ABCs) are benign, non-neoplastic, expansile lesions. We present a case of a male patient aged 46 presented with 4-month history of left hip and low back pain and left hip swelling. Lumbosacral magnetic resonance imaging (MRI) and computed tomography (CT) demonstrated a large multi-loculated hemorrhagic lumbosacral and retroperitoneal mass with spinal dysraphism and tethered cord. Curettage and Biopsy were performed with partially resected cystic wall which was histological confirmed with aneurismal bone cyst. Large cystic mass of the vertebrae, sacrum, and pelvic bone must be considered with ABCs.
Aged ; Aneurysm ; Biopsy ; Bone Cysts ; Bone Cysts, Aneurysmal ; Curettage ; Hip ; Humans ; Liposarcoma ; Low Back Pain ; Magnetic Resonance Imaging ; Male ; Pelvic Bones ; Sacrum ; Spinal Dysraphism ; Spine

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