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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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Granulocytic Sarcoma Presenting as Epidural Mass in Lumbosacral Spine: A Case Report.

Ji Woong KWON ; Ki Jeong KIM ; Sang Ki CHUNG ; Hyun Jib KIM

Korean Journal of Spine.2008;5(3):230-233.

Granulocytic sarcoma, as known as chloroma, is a localized solid tumor consisting of immature myeloid cells. It is a infrequent extramedullary manifestation of acute or chronic leukemias and can often precede their bone marrow involvement. Spinal involvement of granulocytic sarcoma is very rare. A 17-year-old man presented with low back pain, gluteal pain and perianal numbness for 1 month. Lumbar spine magnetic resonance imaging (MRI) was taken under impression of herniated lumbar intervertebral disc and showed an epidural mass at the lumbosacral spinal canal. Leukocytosis, thrombocytopenia and anemia were found on blood cell count. Excisional biopsy of mass was done and the histopathologic examination confirmed the diagnosis of granulocytic sarcoma. Subsequent bone marrow biopsy revealed myelodysplastic syndrome. He had received anti-leukemic chemotherapy and the size of lumbosacral mass was markedly decreased. As a granulocytic sarcoma of spinal column is uncommon, high index of suspicion is inevitable to diagnose it. Therefore it must be included as a differential diagnosis of spinal epidural mass.
Adolescent ; Anemia ; Biopsy ; Blood Cell Count ; Bone Marrow ; Diagnosis, Differential ; Humans ; Hypesthesia ; Intervertebral Disc ; Leukemia ; Leukocytosis ; Low Back Pain ; Magnetic Resonance Imaging ; Myelodysplastic Syndromes ; Myeloid Cells ; Sarcoma, Myeloid ; Spinal Canal ; Spine ; Thrombocytopenia

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Utilization of Three-dimensional Reconstruction Computed Tomography as a Diagnostic Tool for Adult Unilateral Primary Cervical Spondylolysis: Report of Two Cases.

Sun Joo RHEE ; Sung Il HA ; Myoung Soo KIM ; Seung Jun LEE

Korean Journal of Spine.2008;5(3):225-229.

Primary spontaneous cervical spondylolysis is a rare anomaly, and is often diagnosed as a traumatic lesion such as a fracture or a locked facet; alternatively, it may be overlooked. A literature review revealed one report that addresses the usefulness of three-dimensional reconstruction computed tomography (CT) imaging in the diagnosis of cervical spondylolysis. We have experienced two cases of subaxial cervical spondylolysis. One patient was transferred to our institute due to trauma, and the other patient was referred from a local hospital without trauma history. In this second patient symptoms occurred spontaneously and showed insidious progression. Both cases typically involved the right side of the C6 vertebra. The author utilized three-dimensional (3-D) reconstruction computed tomography (CT) for diagnosis and evaluation. Among those issued in Korea, this is the first report of primary subaxial cervical spondylolysis evaluated using 3-D CT.
Adult ; Cervical Vertebrae ; Female ; Humans ; Imaging, Three-Dimensional ; Korea ; Spine ; Spondylolysis

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Intramedullary Epidermoid Cyst in Thoracolumbar Junctiont: A Case Report.

Jun Ho LEE ; Jun Jae SHIN ; Yong Soon HWANG ; Tae Hong KIM ; Hyung Shik SHIN ; Sang Keun PARK

Korean Journal of Spine.2008;5(3):219-224.

Intramedullary epidermoid cysts of the spinal cord are a rare disease. Around the world, there are few reported cases that involve the true intramedullary location. In this paper, we report a case of intramedullary epidermoid cyst which is not associated with congenital anomalies of the thoracolumbar region. A 53-year-old man suffered from lower extremity weakness, spasticity and fecal incontinence for 8 months. Magnetic resonance imaging revealed a 4 cm sized intradural intramedullary mass at the T11-L1 level. The tumor was resected through the posterior approach and complete removal of the mass was performed. Intraoperative and histological findings revealed an epidermoid cyst in the intramedullary region of the spinal cord. Although epidermoid cysts are very rare, these lesions should be considered in the differential diagnosis when an MRI is suggestive of an intradural, intramedullary mass. With early detection and complete resection, the patient had a good neurological outcome.
Diagnosis, Differential ; Epidermal Cyst ; Fecal Incontinence ; Humans ; Lower Extremity ; Magnetic Resonance Imaging ; Middle Aged ; Muscle Spasticity ; Rare Diseases ; Spinal Cord

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A Lumbar Disc Herniation Misdiagnosed as A Neurofibromatosis Type I: A Case Report.

Chang Hyun OH ; Hyeong Chun PARK ; Chong Oon PARK ; Seung Hwan YOON

Korean Journal of Spine.2008;5(3):215-218.

We describe a rare case of an extradural disc herniation mimicking an extradural spinal tumor radiologically. It is often quite difficult to differentiate a sequestered disc from an extradural tumor when the discal fragments are migrated away from the origin. Distinguishable features of clinical and radiological characteristics between sequestered discs and benign intraspinal tumors were discussed. Although a well enhancing spherical mass in the spinal canal is routinely diagnosed as tumors, a free sequestered disc fragment also should be taken into consideration. This case demonstrates the role and the importance of contrast magnetic resonance imaging and of a clinical history in the diagnosis of disc herniation.
Magnetic Resonance Imaging ; Neurofibromatoses ; Neurofibromatosis 1 ; Spinal Canal

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Rapid Recurrence of Spinal Idiopathic Hypertrophic Pachymeningitis: A Case Report.

Hong June CHOI ; Do Heum YOON ; Dong Yeop LEE ; Poong Gee AHN ; Moon Sool YANG ; Seong YI ; Yoon HA ; Keung Nyun KIM ; Se Hoon KIM ; Dong Ah SHIN

Korean Journal of Spine.2008;5(3):211-214.

Idiopathic hypertrophic pachymeningitis is a rare inflammatory disorder of the dura mater. Spinal involvement is extremely rare and there are few case reports. We present a 36 year-old female of idiopathic hypertrophic spinal pachymeningitis compressing thoracic spinal cord which showed rapid recurrence.
Dura Mater ; Female ; Humans ; Meningitis ; Recurrence ; Spinal Cord ; Spine

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Dysphagia Caused by Anterior Cervical Osteophytes: Different Surgical Outcomes in Three Cases.

Eun Kyung PARK ; Suk Hyung KANG ; Seung Chul RHIM ; Sung Woo ROH ; Sang Ryong JEON

Korean Journal of Spine.2008;5(3):207-210.

Dysphagia is a common symptom in elderly individuals, and anterior cervical osteophytes have been implicated as a rare, but surgically correctible cause of dysphagia. In previous studies, surgical treatment of such cases has been associated with immediate symptomatic relief. The surgical outcome of three cases was reviewed retrospectively. A 74-year-old male with progressive dysphagia and aspiration pneumonia attributed to diffuse ossification of anterior longitudinal ligaments (OALL) from C3 to T1 was treated by standard anterior approach and subtotal resection was done. The second case was a 64-year-old male with dysphagia due to diffuse idiopathic skeletal hyperostosis (DISH) underwent anterior DISH resection. The last was a 79-year-old male with progressive dysphagia and aspiration pneumonia due to OALL treated with osteophyte resection. Symptomatic relief was achieved immediately in the first two cases, however, recurrence occurred after seven years in the first case and osteophyte regrowth without symptom in the second case after 33 months follow up. The last case did not have any symptomatic improvement and mechanical obstruction was noted intraoperatively within esophagus. Surgical complication resulting emergency hematoma evacuation and tracheostomy occurred in the second case with complete recovery. Surgical complications, reossification with symptomatic recurrence, and possible plural or mixed causes of dysphagia are all reasons for caution prior to the decision to intervene surgically in such cases.
Aged ; Cervical Vertebrae ; Deglutition Disorders ; Emergencies ; Esophagus ; Female ; Follow-Up Studies ; Hematoma ; Humans ; Hyperostosis, Diffuse Idiopathic Skeletal ; Longitudinal Ligaments ; Male ; Middle Aged ; Osteophyte ; Pneumonia, Aspiration ; Recurrence ; Retrospective Studies ; Tracheostomy

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Clinical Results of Anterior Cervical Discectomy and Fusion with Prefilled Cage in Patient with Traumatic Cervical Injury.

Jae Joon LIM ; Hoon KIM ; Sung Won KANG ; Se Hyuk KIM ; Ki Hong CHO ; Sang Hyun KIM

Korean Journal of Spine.2008;5(3):203-206.

OBJECTIVES: This study is designed to evaluate the fusion rate of anterior cervical discectomy and fusion (ACDF) using prefilled cage, and clinical features in patients with traumatic cervical injury. METHODS: Sixteen trauma patients at a single institute who underwent ACDF with prefilled cage and rigid plate fixation were evaluated for radiographic fusion status postoperatively every 1 month, 3 month, and 6 month after the surgery. ACDFs were done in 9 patients at one level, 3 patients at two levels, 3 patients at three levels, and 1 patient at four levels. Fourteen patients had fracture and instability, and 2 patients had traumatic herniated cervical discs without fracture and instability. Plain radiographs and CT scan were done for evaluation of bone fusion in all patients. RESULTS: Bone fusion was recognized in all patients. Intervertebral disc height was well maintained during follow-up period. There was no patient with graft failure and instability. Even though the patients with fracture and instability, there was no patient who needed posterior stabilization. There was one case of subsidence without clinical symptom which was needed additional surgical treatment. CONCLUSION: In the treatment of the patients with traumatic cervical diseases, prefilled cage is very effective to achieve cervical spinal stability after ACDF, and to maintain intervertebral disc height. We can achieve immediate postoperative stability and prevent graft displacement by reinforcement with cervical plate and screws.
Diskectomy ; Displacement (Psychology) ; Follow-Up Studies ; Humans ; Intervertebral Disc ; Reinforcement (Psychology) ; Transplants

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Technical Strategies and Surgical Results of C1 Lateral Mass-C2 Pedicular Screw Fixation in Atlantoaxial Disorders.

Hong June CHOI ; Keun Su KIM ; Ki Seok PARK ; In Ho HAN ; Dong Kyu CHIN ; Byoung Ho JIN ; Yong Eun CHO

Korean Journal of Spine.2008;5(3):196-202.

OBJECTIVE: There are various posterior fusion techniques in managing C1-2 instability. The aim of this study is to evaluate surgical techniques and clinical results including complications of the C1 lateral mass and C2 pedicle screw fixation (C1-2 LMPSF) in atlantoaxial disorders. METHODS: From February 1997 to July 2008, 24 patients were performed C1-2 LMPSF due to C1-2 instability. Pathway of vertebral artery was classified into three groups by 3D-angiogram. Diameter of C1 lateral mass and C2 isthmus on the plain X-ray and CT was measured before operation. Surgical method was divided into four groups according to fixation site (bilateral or unilateral) and bone graft (with or without graft). Stability of C1-2 fixation was postoperatively evaluated by flexion and extension cervical lateral films. We reviewed clinical data, imaging studies and old chart retrospectively as sources for analysis. RESULTS: Among 24 patients, os odontoideum was the most common cause (16 out of 24). Four patients had anomalous vertebral artery. Mean diameters of C1 lateral mass was 9.9(range 4.2~16.4) mm at right side, 10.3 (range 3.4~14.2) mm at left side. Mean diameter of C2 isthmus was 5.8 (range 1.0~10.1) mm at right side and 5.8(range 2.1~8.2) mm at left side. Two patients showed very narrow C2 isthmus. As a result, unilateral C1-2 LMPSF was performed on 6 patients (4 for anomalous vertebral arteries and 2 for narrow C2 isthmus). 12 of 18 patients were with C1-2 interlaminar bone graft and 6 patients without bone graft. All patients showed stable C1-2 fixation by flexion and extension cervical lateral X-ray films taken at least 6 months after surgery. Five out of 8 patients who had preoperative radiculopathy only showed improved symptoms. However, Seven out of 8 patients who had myelopathy showed little neurological improvement . CONCLUSION: For C1-2 LMPSF, preoperative 3D CT-angiogram study is mandatory to identify abnormal vertebral artery and narrow C2 isthmus. Bilateral C1-2 LMPSF without bone graft is enough to obtain stable C1-2 fixation. If there is an abnormal vertebral artery or narrow C2 isthmus, unilateral C1-2 LMPSF with bone graft and wiring is alternative successful method.
Humans ; Radiculopathy ; Retrospective Studies ; Spinal Cord Diseases ; Transplants ; Vertebral Artery ; X-Ray Film

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