• Journal of Korean Neurosurgical Society
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• 제40권4호
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• pp.273-276
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• 2006

Although cavernous angioma itself is not rare, the epidural spinal localization is uncommon and makes preoperative differential diagnosis difficult. An extraordinary case of a thoracic epidural cavernous angioma in very young age, causing sudden paraplegia is presented. Only 79 cases have been reported in the literatures and among them, this kid was the youngest. A 23-month-old boy was referred to us with a 2-day history of sudden both lower limb weakness. Two days before admission, he got up at morning and was unable to stand and even to move the legs. MRI revealed an epidural mass surrounding spinal cord associated with cord compression at the level of the C5 through T3. Through posterior approach with exposure of C6 to T3 level, the hematomatous mass was removed subtotally due to intraoperative bleeding and its ventral location. After the first operation, the weakness of bilateral lower extremities was improved so as to move gainst the gravity. But the next day, the limb weakness was aggravated as same as preoperative status due to mass effect of new hematoma. The second operation was performed to remove the hematoma and to control the bleeding focus. Several weeks later, the limb weakness was improved and he was able to walk. The literatures about spinal cavernous angioma are reviewed.

• Journal of Korean Neurosurgical Society
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• 제60권5호
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• pp.534-539
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• 2017

Objective : Patients with hematological malignancies frequently encounter spine-related symptoms, which are caused by disease itself or process of treatment. However, there is still lack of knowledge on their epidemiology and clinical courses. The purpose of this article is to review clinical presentations and surgical results for spinal involvement of hematologic malignancies. Methods : From January 2011 to September 2014, 195 patients (98 males and 97 females) suffering from hematological malignancies combined with spinal problems were retrospectively analyzed for clinical and radiological characteristics and their clinical results. Results : The most common diagnosis of hematological malignancy was multiple myeloma (96 patients, 49.7%), followed by chronic myeloid leukemia (30, 15.2%), acute myeloid leukemia (22, 11.2%), and lymphoma (15, 7.56%). The major presenting symptoms were mechanical axial pain (132, 67.7%) resulting from pathologic fractures, and followed by radiating pain (49, 25.1%). Progressive neurologic deficits were noted in 15 patients (7.7%), which revealed as cord compression by epidural mass or compressive myelopathy combined with pathologic fractures. Reconstructive surgery for neurologic compromise was done in 16 patients. Even though surgical intervention was useful for early paralysis (Frankel grade D or E), neurologic recovery was not satisfactory for the progressed paralysis (Frankel grade A or B). Conclusion : Hematological malignancies may cause various spinal problems related to disease progression or consequences of treatments. Conservative and palliative treatments are mainstay for these lesions. However, timely surgical interventions should be considered for the cases of pathologic fractures with progressive neurologic compromise.

• Neurospine
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• 제15권4호
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• pp.368-375
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• 2018

Objective: To evaluate the results of operative management of subaxial spine injuries managed with 2-level anterior cervical corpectomy and fusion with a cervical locking plate and autologous bone-filled titanium mesh cage. Methods: This study included 23 patients with a subaxial spine injury who matched the inclusion criteria, underwent 2-level anterior cervical corpectomy and fusion at our institution between 2013 and 2016, and were followed up for neurological recovery, axial pain, fusion, pseudarthrosis, and implant failure. Results: According to Allen and Ferguson classification, there were 9 cases of distractive extension; 4 of compressive extension; 3 each of compressive flexion, vertical compression, and distractive flexion; and 1 of lateral flexion. Sixteen patients had a score of 6 on the Subaxial Injury Classification system, and the rest had a score of more than 6. The mean follow-up period was 19 months (range, 12-48 months). Neurological recovery was observed in most of the patients (78.21%). All patients experienced relief of axial pain. None of the patients received a blood transfusion. Twenty-one patients (91.3%) showed solid fusion and 2 (8.69%) showed possible pseudarthrosis, with no complications related to the cage or plate. Conclusion: Two-level anterior cervical corpectomy and fusion, along with stabilization with a cervical locking plate and autologous bone graft-filled titanium mesh cage, can be considered a feasible and safe method for treating specific subaxial spine injuries, with the benefits of high primary stability, anatomical reduction, and direct decompression of the spinal cord.

• Journal of Korean Neurosurgical Society
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• 제64권5호
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• pp.677-692
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• 2021

Many studies have focused on pre-operative sagittal alignment parameters which could predict poor clinical or radiological outcomes after laminoplasty. However, the influx of too many new factors causes confusion. This study reviewed sagittal alignment parameters, predictive of clinical or radiological outcomes, in the literature. Preoperative kyphotic alignment was initially proposed as a predictor of clinical outcomes. The clinical significance of the K-line and K-line variants also has been studied. Sagittal vertical axis, T1 slope (T1s), T1s-cervical lordosis (CL), anterolisthesis, local kyphosis, the longitudinal distance index, and range of motion were proposed to have relationships with clinical outcomes. The relationship between loss of cervical lordosis (LCL) and T1s has been widely studied, but controversy remains. Extension function, the ratio of CL to T1s (CL/T1s), and Sharma classification were recently proposed as LCL predictors. In predicting postoperative kyphosis, T1s cannot predict postoperative kyphosis, but a low CL/T1s ratio was associated with postoperative kyphosis.

• Radiation Oncology Journal
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• 제12권3호
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• pp.393-399
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• 1994

최근 혈액암에 있어서 적극적인 복합항암요법및 골수이식등으로 장기 생존자의 수가 증가함에 따라 과거에 흔하지 않았던 합병증, 특히 척추 신경의 침범으로 인한 압박증상을 보이는 환자들의 수가 점차 증가하고 있다. 혈액종양과 고형종양간에 방사선 감수성의 현저한 차이가 있음에도 불구하고, 척수압박증상에 관한 대부분의 보고들이 혈액종양을 따로 구분하여 분석하지 않았으며, 충분한 수의 혈액종양환자를 대상으로 한 보고가 드문 실정이다. 이에 저자들은 1988년부터 1993까지 척수압박으로인해 응급방사선치료를 받은 32명의 혈액종양 환자를 대상으로 후향적 분석을 시행하여 치료결과 및 예후인자를 알아보고자하였다. 신경학적 진찰이나 방사선학적 검사 (척수조영술, 전산화단층촬영, 자기공명영상촬영)로 진단된 경우가 27례 이었고, 환자가 호소하는 증상 을 중심으로 'high index of suspicion' 으로 진단한 5례를 포함하였다. 발병당시 조직학적 진단이 없어 수술을 시행한 1례를 제외한 모든 환자가 방사선 단독으로 치료받았으며, 조사량의 범위는 800 cGy 에서 4000 cGy로 중앙값은 2000 cGy 이었다. 혈액종양의 방사선 감수성을 고려하여 200 cGy이하의 분할조사량이 사용되었으며, 신경학적 증상의 진행속도_가 빠른 13례에 있어서는 치료초기 2회 내지 3회에 걸쳐 250 cGy 이상의 고분할선량이 사용되었다. 전체환자의 $50\%$에서 좋은 반응을 보였고, $37.5\%$에서 부분반응을 보였으며, $12.5\%$는 치료에 반응이 없었다. 이러한 반응율은 문헌에 보고된 고형암에 비해 높았으며, 혈액종양만을 대상으로한 다른 보고들과 유사하였다. 진단당시 신경학적증상의 정도가 치료결과에 영향을 미치는 가장 중요한 예후인자였고, 증상의 출현에서 치료시작까지 소요된 기간도 치료결과에 유의한 영향을 미치는 것으로 나타났다. 반면에 조직학적 진단의 종류, 총방사선량, 초기고분할선량의 사용여부등에 따른 치료결과의 차이는 관찰되지 않았다.

• 한국임상수의학회지
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• 제27권5호
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• pp.546-552
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• 2010

대부분 척수손상 모델에서의 척수 손상 정도 평가는 자기공명 영상 등을 통한 유발 후 평가를 실시하고 있으며, 유발 전 평가를 위해 풍선 카테타에 주입된 공기 양을 기준한 예가 있으나 종 특이성과 개체 차이를 고려하지 못하는 단점이 있다. 이러한 단점을 극복한 척수손상 기준모델을 제시하기 위해 본 실험을 실시하였다. 방사선 평가를 통해 요추 1 번 척수강 높이가 8 mm로 측정된 임상적으로 건강한 비글견 8 마리를 풍선카테타의 직경과 척수 압박시간을 기준으로 4개 군 (4 mm/3 시간, 4 mm/6 시간, 4 mm/12 시간 그리고 6 mm/3 시간)으로 구분하였다. 손상 정도는 행동 관찰, 자기공명영상 해석, 체성감각유발전위평가 그리고 병리조직검사를 실시하여 평가하였다. 실험결과, 행동평가와 체성감각유발전위평가는 단지 손상 유발 여부만 지시할 뿐 정도 평가에는 유용하지 못하였다. 자기공명영상 평가에서 척수손상 부위는 단시간반전회복영상과 T2강조영상에서 불균질한 고신호강도 영역으로 관찰되었다. 고신호강도 영역은 삽입된 풍선 직경과 압박시간 증가에 따라 보다 확장되어 관찰되었으며, 이러한 소견은 공포화 등의 손상부위 증가와 카스파제-3 및 PARP 면역반응 세포의 수적 증가로 나타난 병리조직검사 결과와 일치하였다. 이러한 결과로 미루어 정형화된 척수손상 모델 유발을 위한 척수강 직경과 풍선카테타 직경 그리고 압박시간의 변수 이용과 손상 정도 평가를 위해 자기공명영상은 매우 유용할 것으로 판단된다.

• 한국임상수의학회지
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• 제27권6호
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• pp.713-717
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• 2010

추간판 탈출증은 개에서 일반적인 신경학적 질병이다. 수의 신경학 임상에서 흉요추 추간판 탈출증의 비수술적 치료 또는 수술적 치료의 결과는 잘 보고되어 있다. 그러나 경추 추간판 탈출증의 비수술적 치료 또는 수술적 치료의 결과에 대해서는 상대적으로 적게 알려져 있다. 우리의 목적은 경추 추간판 탈출증을 가진 개에서의 수술적 치료와 비수술적 치료후의 결과에 대해 체계적으로 조사하는 것이다. 수술적 치료를 실시한 개의 치료 성공률(100%, 25/25) 이 비수술적 치료를 실시한 개의 치료 성공률(51.4%, 18/35) 에 비해 유의적으로 높았다. 비수술적 치료군에서 치료 성공률과 척수 압박률과는 부정적인 상관관계가 있음을 확인하였다. 본 연구에서는 경추 추간판 탈출증을 가진 개에서의 수술적 치료는 비수술적 치료에 비해 더 효과적이었다. 또한 CT 또는 MRI 상에서 확인된 척수압박의 정도는 비수술적 치료에서 유용한 예후의 지표가 되었다.

• 대한방사선기술학회지:방사선기술과학
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• 제29권3호
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• pp.157-165
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• 2006

자기공명영상에 의해 진단된 척추질환에 대하여 성별 및 나이별 발생빈도, 발생부위 등 임상적 특성을 분석하여 임상에서 참고 자료로 활용할 수 있도록 하였다. 수도권 소재의 B대학병원에서 2004년 1월부터 12월까지 척추 자기공명영상 검사를 하여 척추질환 유소견자로 진단된 총 1,291명을 대상으로 하였고, 수집된 자료는 SPSS WIN 11.5 프로그램을 이용하여 분석하였으며, 그 결과는 다음과 같다. 1. 연구의 조사대상자에 대한 일반적 특성은 총 1,291명 중 남자가 53.5%, 여자 46.5%이었다. 2. 척추질환의 부위별 발생빈도는 요추 65.6%, 경추 27.3%, 흉추 7.0% 순으로 나타났다. 3. 척추질환의 빈도가 높은 상위 10개 질환은 다음과 같다. 1) posterior bulging disc 65.8%. 2) narrowing of neural foramen 23.8% 3) herniated intervertebral disc (HIVD) 22.4% 4) spinal stenosis 16.7% 5) osteochondrosis 6.4% 6) compression fracture 6.4% 7) facet joint arthropathy 6.2% 8) spondylolisthesis 6.0% 9) spinal cord tumor 3.5% 10) inter body fusion 2.6%

• Journal of Yeungnam Medical Science
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• 제30권2호
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• pp.116-119
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• 2013

A burnt-out prostate cancer tumor is a very rare clinical entity. The term 'burnt-out' refers to a primary tumor that has spontaneously and nearly completely regressed without treatment. Since metastasis of prostate cancer is usually encountered in the presence of advanced disease, distant metastasis with an undetectable primary tumor is very rare. We report herein a case of a burnt-out prostate cancer tumor that metastasized to the thoracic (T) spine and caused cord compression. A 66-year-old man visited the Emergency Department due to weakness of both legs for the past two days. His blood and urine tests were normal at the time. His spine magnetic resonance imaging (MRI) scans looked like bone metastasis that involved the T-7 vertebral body and a posterior element, and caused spinal cord compression. Other images, including from the brain MRI, neck/chest/abdomino-pelvic computed tomography (CT) scan and 18F-fluorodeoxyglucose (FDG)-positron emission tomography (PET) and endoscopy, revealed no lesions that suggested malignancy. After total corpectomy T-7 and screw fixation/fusion at T5 to T10, the pathology report revealed a metastatic carcinoma that was strongly positive for prostate-specific antigen (PSA). The serum PSA value was 1.5 ng/mL. The transrectal 12-core prostate biopsy and ultrasonography showed no definitive hypoechoic lesion, but one specimen had slight (only 1%) adenocarcinoma with a Gleason score of 6 (3+3). The final diagnosis was burned-out prostate cancer with an initial normal PSA value. Although metastatic disease with an unknown primary origin was confirmed, a more aggressive approach in seeking the primary origin could provide a more specific treatment strategy and greater clinical benefit to patients.

• 대한한방체열의학회지
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• 제1권1호
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• pp.28-37
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• 2002

Stable Compression Fractures(SCF hereafter) are most often caused by trauma such as traffic accidents. These SCFs usually occur in the thoracic and lumbar regions of the spinal cord. Human life spans have increased as a result of medical advances, which in turn has led to an increase in the elderly population. SCFs are divided into the categories of stable and unstable. The categories are determined through X-rays and P/Ex tests. The D.I.T.I. is then used to diagnose the severity and prognosis of the fracture injuries, and it allows an objective evaluation of the symptoms. This author researched 40 patients who were treated at Wonkwang University Oriental Medical Center from October 1995 to December 1996. The patients were diagnosed by X-ray as having SCFs and treated primarily with acupuncture. Both the changes in D.I.T.I. and patients' self-diagnoses of their conditions before and after treatment yielded the meaningful results which have been presented here. 1. 75% of those who suffer from Stable Compression Fractures are 60 years of older. Of those, the ratio of male to female is 1 to 4. This is due in part to the fact that many elderly women seek Oriental medicine treatment for conditions associated with advanced age. 2. 53.3% of these injuries occurred between T11 and L2. 3. 65% of patients were hospitalized for 10 to 29 days, and then able to be treated on an outpatiens basis. 4. The D.I.T.I. results showed 50% below $0.2^{\circ}C$, 30% between 0.3 and $0.5^{\circ}C$, 10% between 0.5 and $0.7^{\circ}C$, 10% between 0.7 and $0.9^{\circ}C$, and 0% over $0.9^{\circ}C$. 5. The results of treatment using Modified Evaluation System in Thoracolumbar Vertebral Fractures Method showed that 55% of patients achieved excellent recovery and 40% achived good recovery. After comparing the D.I.T.I. results before and after treatment, we found 50% of patients showed excellent recovery $({\Delta}T{\leq}0.2)$ and 40% showed good recovery$(0.2<{\Delta}T{\leq}0.5)$.