Traumatic spinal subdural hematoma associated with intracranial subdural hematoma is a rare condition. Herein, we report the case of a 62-year-old man with lower back pain, radiating pain, and numbness in both lower extremities, without motor weakness, for 2 weeks. Lumbar magnetic resonance imaging (MRI) revealed high signal intensity on T1-weighted image (WI), and low signal intensity on T2-WI from L2 to L5. Two weeks after conservative management, follow-up lumbar MRI did not show the hematoma and his symptoms were relieved and there was no neurological deficit; therefore, he was discharged. However, subsequently, intracranial subdural hematoma increased and upper extremity motor weakness appeared. This was treated surgically. If there is no neurological deficit, conservative treatment may be a good option. Follow-up evaluation for asymptomatic cranial subdural hematoma is necessary.
Follow-Up Studies ; Hematoma ; Hematoma, Subdural ; Hematoma, Subdural, Intracranial* ; Hematoma, Subdural, Spinal* ; Humans ; Hypesthesia ; Low Back Pain ; Lower Extremity ; Magnetic Resonance Imaging ; Middle Aged ; Spinal Cord Injuries ; Upper Extremity

OBJECTIVE: Unilateral percutaneous vertebroplasty is a widely accepted treatment for osteoporotic vertebral compression fractures (VCFs). However, bone cement may fail to fill both hemivertebra from the single needle. We assessed the radiographic and clinical outcome of hemivertebroplasty (HVP) and evaluated the factors that affect subsequent VCFs after HVP. METHODS: Fifty two patients who underwent HVP were reviewed. VCFs were identified based on clinical and radiological findings. The patients were grouped into two groups: 1) no subsequent VCFs, 2) subsequent VCFs. We evaluated the association between age, sex, body mass index (BMI) and bone mineral density (BMD) and subsequent VCFs. We also assessed the impact of location, type and grade of fracture, endplate fracture, burst fracture, bone cement volume on subsequent VCFs. We analyzed the compression ratio, wedge angle, kyphotic angle, and visual analogue scale (VAS) score in both groups. RESULTS: There were no significant differences in age, gender, BMI, and BMD between two groups. No significant difference was also found in pre-existing VCF, location, type and grading of fracture, endplate fracture, burst fracture, amount of bone cement, and radiological findings such as compression ratio, wedge angle, and kyphotic angle between two groups. The final mean VAS scores of patients with or without subsequent VCFs were 3.11 and 4.02, respectively. CONCLUSION: No major risk factors for the subsequent VCFs after HVP were found. However, we identified adjacent fractures, refractures, and remote fractures after HVP in chronological order. Therefore, long-term follow-up is necessary to evaluate the effectiveness of HVP to osteoporotic VCFs.
Body Mass Index ; Bone Density ; Follow-Up Studies ; Fractures, Bone ; Fractures, Compression ; Humans ; Needles ; Osteoporotic Fractures ; Risk Factors ; Vertebroplasty

OBJECTIVE: Anterior wedge compression fractures and burst fractures have different clinical features, treatment methods and risks of neurologic deficits. The aim of this study was to evaluate the radiological differences and postoperative risk due to cement leakage after vertebroplasty. METHODS: From January 2007 to December 2008, we retrospectively analyzed the radiological features of 43 patients. We divided the patients into three groups by the degree of the displaced bony fragments into the spinal canal. The change of the compression ratio, the kyphotic angle, the presence of cement leakage and the occurrence of major complications were investigated. RESULTS: The immediately postoperative improvement of the compression ratio was significantly better in the anterior wedge compression fracture group than that in the burst compression group (p-value: 0.022). Cement leakage was more common in the burst fracture group even though this was not statistically significant (p-value: 0.114), but cement leakage into spinal canal did not occur. There was no major complication, including embolism and additional neurologic deficit, after vertebroplasty in all the patients. CONCLUSION: Vertebroplasty was the more effective method for treating an anterior wedge fracture than a burst fracture, and especially for achieving an improved compression ratio. Even though the risk of cement leakage may be higher for a burst fracture, vertebroplasty may be also carefully applied to burst fracture patients with no neurologic deficits at admission.
Embolism ; Fractures, Compression ; Humans ; Neurologic Manifestations ; Retrospective Studies ; Spinal Canal ; Spinal Cord Compression ; Vertebroplasty

OBJECTIVE: The purpose of this study was to determine the optimal volume of injected cement and its distribution when used to treat vertebral compression fractures, and to identify factors related to subsequent vertebral fractures. METHODS: A retrospective analysis of newly developing vertebral fractures after percutaneous vertebroplasty was done. The inclusion criteria were that the fracture was a single first onset fracture with exclusion of pathologic fractures. Forty-three patients were included in the study with a minimum follow up period of six months. Patients were dichotomized for the analysis by volume of cement, initial vertebral height loss, bone marrow density, and endplate-to-endplate cement augmentation. RESULTS: None of the four study variables was found to be significantly associated with the occurrence of a subsequent vertebral compression fracture. In particular, and injected cement volume of more or less that 3.5 cc was not associated with occurrence (p = 0.2523). No relation was observed between initial vertebral height loss and bone marrow density (p = 0.1652, 0.2064). Furthermore, endplate-to-endplate cement augmentation was also not found to be significantly associated with a subsequent fracture (p = 0.2860) by Fisher's exact test. CONCLUSION: Neither volume of cement, initial vertebral height loss, bone marrow density, or endplate-to-endplate cement augmentation was found to be significantly related to the occurrence of a subsequent vertebral compression fracture. Our findings suggest that as much cement as possible without causing leakage should be used.
Bone Marrow ; Follow-Up Studies ; Fractures, Compression ; Fractures, Spontaneous ; Humans ; Retrospective Studies ; Vertebroplasty

OBJECTIVE: The objective of this study is to evaluate the efficacy of microdecompression (MD) with microscope and tubular retractor in lumbar foraminal stenosis (FS) and to analyze the clinical outcomes. METHODS: From January 2006 to December 2007, 22 patients with symptomatic lumbar FS underwent conventional decompressive surgery (CDS) and MD was performed in other 20 patients. Clinical outcome was measured using a Visual Analogue Scale (VAS) and Macnab?fs criteria. Spinal instability was determined by radiologic assessment of flexion-extension radiographs. RESULTS: The CDS group included 14 men and 8 women. The MD group included 14 men and 6 women. The mean age was 66.2 years (range, 46-80 yrs) in the CDS group and 65.4 years (range, 59-74 yrs) in the MD group. Average follow-up periods were 18.6 months in the CDS group and 16.5 months in the MD group. Mean operating time was 126 minutes in the CDS group and 168 minutes in the MD group. The mean VAS of back pain decreased from 2.68 to 1.36 in the CDS group and from 2.85 to 1.25 in the MD group. The mean VAS score of leg pain decrea- sed from 6.68 to 1.48 in the CDS group and from 6.65 to 1.40 in the MD group. The success rate of CDS group was 86.3 % (19/22), compared with 85.0% (17/20) for MD group. Radiologically, there was no spinal instability. CONCLUSION:MD could achieve neural decompression and offer an effective treatment of lumbar FS. However it was a technically demanding procedure and effective in limited operative indications. We need to consider long-term follow-up.
Back Pain ; Constriction, Pathologic ; Decompression ; Female ; Follow-Up Studies ; Humans ; Leg ; Male

BACKGOUND: Platelet-derived growth factor (PDGF) is a widely expressed growth factor with both mitogenic and chemotactic activities in many connective tissue cell types. There are four members of PDGF family; PDGF-A, PDGF-B, PDGF-C, PDGF-D. Their biological effects are mediated via two tyrosine kinase receptors, PDGF receptor-alpha and PDGF receptor-beta, and PDGF-mediated signaling is critical for development of many organ systems and acquired disease. The aims of this study were to determine the changes of PDGF-A, PDGF-C and PDGF receptor (PDGFR)-alpha expression in ischemia reperfusion acute renal failure model. METHODS: We examined the expression and localization of PDGF-A, PDGF-C and PDGF receptor-alpha protein using Western blot analysis and immunohistochemistry and PDGF-C mRNA using RNase protection assay after ischemia reperfusion renal failure model. RESULTS: PDGF-A expression showed no change after ischemia reperfusion injury. Proliferating cell nuclear antigen expression increased at day 2 after ischemia reperfusion injury. PDGF-C expression increased at day 2 after ischemia reperfusion injury, and was localized in tubular epithelial cells of outer medulla. PDGFR-alpha increased at day 2 after ischemia reperfusion injury, and was localized in tubular interstitium of outer medulla. CONCLUSION: These results indicated that PDGF-C and PDGF receptor-alpha may have an important role in the renal regeneration after ischemia reperfusion renal injury.
Acute Kidney Injury ; Blood Platelets* ; Blotting, Western ; Connective Tissue Cells ; Epithelial Cells ; Humans ; Immunohistochemistry ; Ischemia* ; Platelet-Derived Growth Factor* ; Proliferating Cell Nuclear Antigen ; Receptor Protein-Tyrosine Kinases ; Receptors, Platelet-Derived Growth Factor ; Regeneration ; Renal Insufficiency* ; Reperfusion Injury ; Reperfusion* ; Ribonucleases ; RNA, Messenger

OBJECTIVE: The aim of this study is to analyze the clinical symptoms, radiological changes, interval from first operation to symptom recurrence and to propose the proper treatment method for re-operated patients following chronic subdural hematoma surgery. METHODS: Between January 1992 and April 2003, 18 of 138patients of chronic subdural hematoma repeatedly underwent surgical treatment. The symptoms, mental status by Bender grade, radiological hematoma size and midline shifting, interval from symptom onset to diagnosis, surgical method and prognosis by Glasgow outcome scale(GOS) between the first attack and the recurrence were compared. RESULTS: The symptoms at the time of recurrence were nearly the same as with the first attack, but two patients(2/18, 11.1%) showed a more declined mentality. In addition, the recurred hematoma sizes were the same or large than those previously found. Many patients were recurred within two weeks(13/18, 72.2%). Most patients were operated on using the previous burr hole, with the exception of one patient who recurred at a different site. All patients had a good prognosis more than GOS 4(GOS 4: 4 , GOS 5: 12), but two died due to extracranial complication and infection. CONCLUSION: These results suggest that the early diagnosis and treatment are important, mostly recurred same symptoms within two weeks. Re-operation using the previous burr hole site is a good method.
Diagnosis ; Early Diagnosis ; Hematoma ; Hematoma, Subdural, Chronic* ; Humans ; Prognosis ; Recurrence ; Retrospective Studies*

OBJECTIVE: The goal of study is the evaluation of clinicofunctional outcomes and fusion success rates of unilateral posterior lumbar interbody fusion(PLIF) using cages. METHODS: The authors conducted retrospective study of 81 patients who underwent unilateral PLIF using cages. The outpatient notes, standard hospital charts, and pre-and postoperative imaging studies were analyzed. In this study pre-and postoperative back pain, radiating pain, fusion success rates, pseudoarthrosis, clinicofunctional outcome, and complications were evaluated. Follow-up duration ranged from 3 to 8 years. RESULTS: Eighty-one patients underwent unilateral PLIF using 98 cages(TFC:37, CH cage:25, Novus cage 36). Two-level fusion was performed in 17 patients. There were 48 men(59%) and 33 women(41%). Seventh decade was most common(47%). The most common site of PLIF was at L4-5 space(69.4%) and left side(58%) was prevalent. Fusion was successful in 91 out of 98 levels(92.8%) and pseudoarthrosis was observed in five patients(7 level, 7%). The clinicofunctional results by Prolo scale were as follows:good(score 8-10):80.3%, moderate(score 6-7):14.8%, poor(score 5 or less 5):4.9%. Device migration was observed in six cases:5(20%) of 25 CH cages and 1(2.8%) of 36 Novus cages. CONCLUSION: Unilateral PLIF using cage is one of method to decrease the rates of iatrogenic complications in patient of unilateral symptomatic spinal instability while preserving normal anatomic structures with good fusion success rates and clinicofunctional results after surgery.
Back Pain ; Follow-Up Studies ; Humans ; Outpatients ; Pseudarthrosis ; Retrospective Studies

A case of nonsecretory multiple myeloma in a 66 year-old-woman is reported. At first, she complained severe neck pain and radiologic finding showed C2 pathologic fracture. She complained severe low back pain 4 month later and L1 compression fracture was found. The lumbar MRI showed a 1.4cm-sized round enhancing lesion in the body of T12. Bone marrow aspiration biopsy at L1 spine showed a few polymorphous and small nests of mononuclear cell. L1 lamina bone biopsy showed many abnormal plasma cells. Pathologic diagnosis was multiple myeloma. However, plasma electrophoresis and protein immunoelectrophoresis of serum and urine of patient were normal. So, it is a nonecretory multiple myeloma case and the incidence of nonsecretory multiple myeloma is known to about 1% of all multiple myeloma.
Biopsy ; Biopsy, Needle ; Bone Marrow ; Diagnosis ; Electrophoresis ; Fractures, Compression ; Fractures, Spontaneous ; Humans ; Immunoelectrophoresis ; Incidence ; Low Back Pain ; Magnetic Resonance Imaging ; Multiple Myeloma* ; Neck Pain ; Plasma ; Plasma Cells ; Spine*

Patients with bile duct stones usually present with biliary pain, obstructive jaundice, ascending cholangitis, or pancreatitis. When endoscopic retrograde cholangiopancreatography (ERCP) is performed, bile duct stones are usually movable and thus easily detected. If a stone in the bile duct presents unusually, it may pose some diagnostic challenges. Recently, we experienced a case of an impacted distal common bile duct (CBD) stone mimicking a tumor which resulted in performing a pylorus-preserving pancreaticoduodenectomy in an asymptomatic 56-year-old man. On ERCP, an obstructing distal CBD lesion did not move even by doing brush cytology. Moreover, the result of brush cytology was positive for atypical cells. A major resective surgery performed after recovery from severe post-ERCP pancreatitis confirmed the diagnosis. Interestingly, this stone caused erosion with acute and chronic inflammation and fibrosis containing foci of mild epithelial dysplasia. We herein report an unusual manifestation of gallstone disease with a review of the literature.
Bile Ducts ; Cholangiopancreatography, Endoscopic Retrograde ; Cholangitis ; Common Bile Duct* ; Diagnosis ; Fibrosis ; Gallstones* ; Humans ; Inflammation ; Jaundice, Obstructive ; Middle Aged ; Pancreaticoduodenectomy ; Pancreatitis