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Anterior Lumbar Interbody Fusion with Percutaneous Pedicle Screw Fixation for the Treatment of Postoperative Pyogenic Spondylodiscitis.

Sang Keun KOO ; Byeong Wook HWANG ; Sang Ho LEE

Korean Journal of Spine.2010;7(4):276-279.

Deep wound infection is a serious surgical complication. The majority of patients with pyogenic spondylodiscitis can be treated non-surgically with antibiotics and immobilization. However, although surgical management of pyogenic spondylodiscitis continues to evolve, no consensus has yet been reached regarding the best surgical approaches and techniques. Anterior lumbar interbody fusion (ALIF) followed by percutaneous pedicle screw fixation (PPF) is an effective surgical option for treating postoperative pyogenic spondylodiscitis (PPS). In this report, we describe a case of PPS in a 64-year-old man who underwent ALIF with PPF.
Anti-Bacterial Agents ; Consensus ; Discitis ; Humans ; Immobilization ; Middle Aged ; Wound Infection

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Anterior Cervical Disc Herniation Presenting as Instability and Minimal Dysphagia: A Case Report.

Dae Yong KIM ; Yong Seok PARK ; Ju Ho JEONG

Korean Journal of Spine.2010;7(4):272-275.

Few symptomatic anterior cervical disc herniations have been found in the literatures. We describe a rare case of an anterior cervical disc herniation presenting as instability and minimal dysphagia. A 62-year-old man presented with a 3-months history of axial neck pain and minimal dysphagia that did not respond to a conservative treatment. Preoperative plain X-rays of the cervical spine revealed loss of normal lordotic curvature with no definite narrowing of the disc spaces. Flexion/extension radiographs of the cervical spine revealed segmental instability as angular motion greater than 11 degree between adjacent segment at C5-6. Cervical magnetic resonance (MR) imaging revealed a 1.7 x 0.8 cm extruded disc in the left anterior aspect of the C5-6 disc space on axial T2-weighted images and an anteriorly extruded disc with the base at the C5-6 disc, which displaced the esophagus anteriorly on sagittal T2-weighted images. The patient underwent on a cervical disc removal, followed by stabilization of the C5 and C6 via the anterior approach. Preoperative complaints were resolved completely after the surgery. He remained symptom-free 9 months after the surgery.
Deglutition Disorders ; Esophagus ; Humans ; Intervertebral Disc Displacement ; Magnetic Resonance Spectroscopy ; Middle Aged ; Neck Pain ; Spine

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High Grade Myxofibrosarcoma in the Paravertebral Muscle: A Case Report.

Dong Hyuk NAM ; Tae Wan KIM ; Kwan Ho PARK ; Jae O KIM

Korean Journal of Spine.2010;7(4):268-271.

Many different abnormalities, such as, neoplasm, infection, traumatic hematoma, or congenital or immune myopathy, may be found in the paravertebral muscles. However, neoplasms of paravertebral muscle are an uncommon cause of back pain. Such neoplasms may arise from local lesions or due to metastatic spread from a distant malignancy. The differential diagnoses of a primary soft tissue malignancy and metastatic spread from a skeletal muscle tumor are important. In cases of soft tissue sarcoma, histopathological findings and surgical margins are both related to local recurrence and metastasis, therefore, percutaneous needle biopsy may be helpful before surgical excision. A degree of surgical excision is decided based on considerations of muscular function and histopathological findings.
Back Pain ; Biopsy, Needle ; Diagnosis, Differential ; Hematoma ; Muscle, Skeletal ; Muscles ; Muscular Diseases ; Myxosarcoma ; Neoplasm Metastasis ; Recurrence ; Sarcoma

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O-arm(R) Imaging System Coupled with Navigation Guided Posterior Atlantoaxial Screw Fixation in the Patient with Ponticulus Posticus, an Anatomical Variation of Atlas.

Sang Mok KIM ; Kyeong Sik RYU ; Hong Jae LEE ; Chun Kun PARK

Korean Journal of Spine.2010;7(4):265-267.

Ponticulus posticus is an abnormal bony bridge of posterior arch of atlas. The resulting foramen contains the vertebral artery and has clinical significance in lateral mass screw insertion into the first cervical vertebra. The authors report an atlantoaxial subluxation case showing a ponticulus posticus, which was surgically treated with posterior atlantoaxial screw fixation under the guidance of O-arm(R) imaging system coupled with navigation.
Atlanto-Axial Joint ; Congenital Abnormalities ; Humans ; Spine ; Vertebral Artery

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Transection of the Spinal Cord Following Anterior Cervical Stab Injury: A Case Report.

Chang Min PARK ; Dae Yong KIM ; Ju Ho JEONG ; Yong Seok PARK

Korean Journal of Spine.2010;7(4):261-264.

Stab wounds to the neck with transection of the cervical spinal cord and complete paraplegia in combination with penetrating injury to the trachea and esophagus are extremely uncommon, and optimal treatment remains unclear. We report an unusual case of stab wound of the anterior neck with a penetrating injury to the trachea and esophagus and transection of the spinal cord at the C7-T1 level. Tracheoplasty and esophageal primary suture were performed by the thoracic surgeons. We regularly followed up the patient with the cervical spinal lesion, because there was neither definite mechanical spinal instability nor CSF leakage. Moreover, there was a possibility of the aggravation of mediastinitis. The postoperative course of the patient was uneventful without a CSF leak or a wound infection. Nineteen months after the operation, the patient had no complain of nuchal pain or the limitation of motion of the neck. There was no definite cervical instability. However, no neurological improvement has been reported either.
Esophagus ; Humans ; Mediastinitis ; Neck ; Paraplegia ; Spinal Cord ; Sutures ; Trachea ; Wound Infection ; Wounds, Stab

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A Chordoma of the Thoracic Spine: A Case Report.

Jae Sung PARK ; Kyeong Sik RYU ; Ki Yeol LEE ; Chun Kun PARK

Korean Journal of Spine.2010;7(4):258-260.

A 52-year-old woman presented with a thoracic chordoma at T1-3 level as abnormal sensations on the trunk and low extremities and both legs weakness. Almost total resection was possible through posterolateral costotransversectomy. The patient could ambulate at 3 days after the operation without any sequelae. Histologic study revealed a malignant chordoma with no sarcomatous differentiation.
Chordoma ; Extremities ; Female ; Humans ; Leg ; Middle Aged ; Sensation

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Brown-Sequard Syndrome Caused by Spinal Cord Infarction: A Case Report and Literature Review.

Hyeun Sung KIM ; Seok Won KIM ; Sung Myung LEE ; Ho SHIN

Korean Journal of Spine.2010;7(4):255-257.

Brown-Sequard syndrome is usually observed in patients with compressive myelopathy due to trauma, cord tumors, and degenerative spinal diseases. Brown-Sequard syndrome resulting from spinal cord infarction is rare. We report the case of a 46-year-old man who presented abruptly with left hemiparesis and diminished pain and temperature sensations on his right side below the C6 dermatome. Cervical spine magnetic resonance imaging revealed abnormally high signal intensity in the left lateral parenchyma of the spinal cord at the level of C4 and C6 on T2 weighted images. After excluding other possible causes, a clinical diagnosis of Brown-Sequard syndrome of probable vascular onset was made, associated with spinal cord infarction. The patient was managed conservatively with intravenous fluids and corticosteroids. However, his condition remained mostly unchanged after six months. Here, we present a rare case of spinal cord infarction causing acute Brown-Sequard syndrome, with a review of the literature.
Adrenal Cortex Hormones ; Brown-Sequard Syndrome ; Humans ; Infarction ; Magnetic Resonance Imaging ; Middle Aged ; Paresis ; Sensation ; Spinal Cord ; Spinal Cord Compression ; Spinal Diseases ; Spine

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Mini-Transthoracic Supradiaphragmatic Approach to the Thoracolumbar Junction.

Jae Chil CHANG ; Hyung Ki PARK ; Jae Won DOH ; Jon PARK

Korean Journal of Spine.2010;7(4):249-254.

Anterior reconstruction with instrumentation of the thoracolumbar junction (TLJ) offers: 1) the biomechanical advantage of immediate restoration of the load-bearing anterior column and 2) the ideal biological milieu for an optimal arthrodesis. The authors describe the mini-transthoracic supradiaphragmatic (MTTS) approach to the TLJ. Its technical feasibility is compared with that of the traditional transdiaphragmatic and thoracoscopic supradiaphragmatic approaches to this area of the spine. This technique was performed in 21 patients from 2004 to 2006. There were no surgical mortalities. The MTTS approach without the use of a thoracoscope was successfully employed in this study to treat patients with various lesions located at the TLJ. The diaphragmatic opening, even at its smallest diameter, provides excellent views of the operative field and avoids the significant morbidities associated with the traditional transdiaphragmatic approach.
Arthrodesis ; Diaphragm ; Humans ; Imidazoles ; Nitro Compounds ; Spine ; Stearates ; Thoracoscopes ; Weight-Bearing

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The Comparative Study for Clinical and Radiologic Results of Unilateral Kyphoplasty and Bilateral Vertebroplasty.

Byung Gwan MOON

Korean Journal of Spine.2010;7(4):242-248.

OBJECTIVE: To elucidate postoperative clinical and radiologic efficacy of unilateral kyphoplasty compared for percutaneous bilateral vertebroplasty. METHODS: One hundred patients with osteoporotic compression fracture at thoracolumbar junction were enrolled in this study. The kyphotic angle and reduction rate were measured to evaluate the vertebral restoration. Visual analog scale (VAS) for pain and short form-36 (SF-36) and Oswestry Disability Index (ODI) for functional outcome were recorded by 1 year postoperatively. Cement extravasation and adjacent vertebral fractures were monitored. RESULTS: Visual analog scale for pain was not statistically different through the follow up in both groups (p=0.38). The preoperative SF-36 and ODI scores were similar (p>0.05) but the difference in ODI score and standardized physical component scale reached statistical significance (p=0.04, p=0.03) and unilateral kyphoplasty group was getting better functional status. Reduction rate of vertebral body was 42.5+/-7.8% for the vertebroplasty group and 66.3+/-8.1% for the unilateral kyphoplasty group (p<0.001) and loss of reduction was 4.5+/-3.5% and 1.7+/-2.5% (p<0.0001) respectively. There were six complications of cement extraosseous leakage into the spinal canal in vertebroplasty only. CONCLUSION: Unilateral kyphoplasty in compare with vertebroplasty is safer for cement leakage and immediately reduces back pain and restore kyphotic deformities in addition to the prevention of subsequent compression fracture.
Back Pain ; Congenital Abnormalities ; Follow-Up Studies ; Fractures, Compression ; Humans ; Kyphoplasty ; Osteoporotic Fractures ; Spinal Canal ; Vertebroplasty

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Load Distribution in Functional Spinal Unit with SB Charite III(R) Artificial Disc; Finite Element Analysis.

Sang Hoon YOON ; Hyun Jib KIM

Korean Journal of Spine.2010;7(4):234-241.

OBJECTIVE: To evaluate the effects of SB Charite III(R) artificial disc implantation on the biomechanics of functional spinal units. METHODS: A nonlinear intact osteoligamentous three-dimensional finite element model of L4-L5 was developed using 1-mm CT scan data from a human volunteer, and the material properties of each element were determined. The model was validated using biomechanical data. A model that was implanted with SB Charite III(R) artificial discs via an anterior approach was also developed. The stresses and strains of the vertebral bodies and surrounding spinal ligaments were investigated. The implanted model was compared to the intact model in terms of range of motion, force on facet joints with flexion-extension, lateral bending, and axial rotation under 400 N preloading. RESULTS: There were no significant differences between the findings of this finite element study and other reports in the literature. Our analytical method proved useful method for the biomechanical evaluation of the effects of artificial disc implantation. The implanted model revealed an increased range of motion in flexion-extension, lateral bending, and axial rotation compared to the intact model. The stresses on facets were greater in the implanted model than in the intact model. CONCLUSION: The model that was implanted with artificial discs showed increased segmental motion and stress on the facet joints compared to the intact model. We hypothesize that the removal of the anterior longitudinal ligament is the major cause of increased segmental motion and stress on the facet joints in the implanted model. The development of new artificial discs should focus on compensating for these unwanted results.
Biomechanics ; Finite Element Analysis ; Human Experimentation ; Ligaments ; Longitudinal Ligaments ; Range of Motion, Articular ; Zygapophyseal Joint

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