• Journal of the Korean Orthopaedic Association
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• v.54 no.2
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• pp.187-191
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• 2019

Spinal epidural hematoma (SEH) can occur naturally or traumatically and is most common in patients with an underlying disease of the vascular structure or coagulation disorder. Most SEHs occur naturally for no apparent reason, and epidural hematoma caused by trauma is less common, comprising 1.0%-1.7% of total spinal injuries. Few reports of SEH induced cauda equine syndrome resulting from low-energy injury caused by osteoporotic vertebral compression fractures are available. The authors experienced a case of delayed SEH after hemorrhage due to a low-energy injury in an elderly patient. No cases in Korea have been reported; therefore, this case is reported with a review of the relevant literature.

• Investigative Magnetic Resonance Imaging
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• v.20 no.3
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• pp.181-184
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• 2016

Short inversion time inversion recovery (STIR) is widely used for spinal magnetic resonance imaging (MRI) because the pulse sequence of STIR is insensitive to magnetic field inhomogeneity and can be used to scan a large field of view. In this case report, we present a case of spinal epidural hematoma with unexpected signal decrease on a STIR image. The MRI showed an epidural mass that appeared with high signal intensity on both T1- and T2-weighted images. However, a signal decrease was encountered on the STIR image. This nonspecific decrease of signal in tissue with a short T1 relaxation time that is similar to that of fat (i.e., hemorrhage) could lead to a diagnostic pitfall; one could falsely diagnose this decrease of signal as fat instead of hemorrhage. Awareness of the nonselective signal suppression achieved with STIR pulse sequences may avert an erroneous diagnosis in image interpretation.

• Journal of Physiology & Pathology in Korean Medicine
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• v.16 no.6
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• pp.1302-1307
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• 2002

We experienced a case of patient of incomplete spinal cord injury following slipping off his clothes. He had complications : both leg paresisㆍboth arm weaknessㆍurine disturbanceㆍboth leg & arm sensory disorder . We could treat these complications with the methods of medical treatments ; acupunctureㆍmoxa therapyㆍherb-medicationㆍelectro-acupuncture & muscle exercises. We obtained results that motor grade and muscle atrophy were improved.

• The Korean Journal of Pain
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• v.18 no.2
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• pp.214-217
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• 2005

Spinal cord stimulation (SCS) was first attempted by Shearly et al for the relief of intractable pain. A spinal cord stimulator has traditionally been used for failed back surgery syndrome (FBSS) angina pectoris, complex regional pain syndrome (CRPS) and ischemic pain in the extremity. However, the complications associated with the use of a spinal cord stimulator, such as wound infection, hematoma, lead migration and device malfunction; make its long term application difficult. Here, our experience of an interesting case, in which intractable right leg pain was controlled using a spinal cord stimulator placed in the left epidural space, is reported, with a review of the literature.

• Neurospine
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• v.15 no.4
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• pp.338-347
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• 2018

Objective: Patients with extradural spine tumors are at an increased risk for intraoperative cerebrospinal fluid (CSF) leaks and postoperative wound dehiscence due to radiotherapy and other comorbidities related to systemic cancer treatment. In this case series, we discuss our experience with the management of intraoperative durotomies and wound closure strategies for this complex surgical patient population. Methods: We reviewed our recent single-center experience with spine surgery for primarily extradural tumors, with attention to intraoperative durotomy occurrence and postoperative wound-related complications. Results: A total of 105 patients underwent tumor resection and spinal reconstruction with instrumented fusion for a multitude of pathologies. Twelve of the 105 patients (11.4%) reviewed had intraoperative durotomies. Of these, 3 underwent reoperation for a delayed complication, including 1 epidural hematoma, 1 retained drain, and 1 wound infection. Of the 93 uncomplicated index operations, there were a total of 9 reoperations: 2 for epidural hematoma, 3 for wound infection, 2 for wound dehiscence, and 2 for recurrent primary disease. One patient was readmitted for a delayed spinal fluid leak. The average length of stay for patients with and without intraoperative durotomy was 7.3 and 5.9 days, respectively, with a nonsignificant trend for an increased length of stay in the durotomy cases (p=0.098). Conclusion: Surgery for extradural tumor resections can be complicated by CSF leaks due to the proximity of the tumor to the dura. When encountered, a variety of strategies may be employed to minimize subsequent morbidity.

• The Korean Journal of Pain
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• v.14 no.2
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• pp.253-256
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• 2001

One of the most serious complications of regional anesthesia is a neurological deficit. Although such a problem is very rare, obstetric patients may develop paresthesia and motor dysfuntion during the postoperative period in association with number of other factors, including direct nerve trauma, equipment problems, adhesive arachnoiditis, anterior spinal artery syndrome, epidural hematoma or abscess and adverse drug effect. We experienced a case of unilateral paraparesis following epidural anesthesia with 20 ml of 0.75% ropivacaine and $25{\mu}g$ of fentanyl in an obstetric patient.

• The Korean Journal of Pain
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• v.20 no.1
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• pp.74-77
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• 2007

The trigger point injection technique is widely used in pain clinics for the treatment of acute and chronic pain. Yet it has a variety of complications such asvasovagal syncope, total spinal anesthesia, paralysis, root block, pneumothorax, needle breakage, skin infection, and hematoma formation. Among them, the simultaneous occurrence of psoas and epidural abscesses is extremely rare. We report here on a patient who was diagnosed with epidural and psoas abscesses after paravertebral trigger point injection.

• Journal of Korean Neurosurgical Society
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• v.50 no.5
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• pp.460-463
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• 2011

There are few reported cases of post-operative spondylitis caused by $Mycobacterium$ $Intracellulare$. A 75-year-old female presented to our hospital with low back pain and paraparesis after a fall. The radiologic examination revealed compression fractures of L1, L3 and L4 and an epidural hematoma compressing the spinal cord. The dark-red epidural hematoma was urgently evacuated. Four weeks post-operatively, neurologic deficits recurred with fever. On magnetic resonance image, an epidural abscess and osteomyelitis were detected in the previous operative site. Five weeks post-operatively, revision was performed with multiple biopsies. The specimen were positive for acid-fast bacilli and traditional anti-tuberculous medications were started. Because the Polymerase Chain Reaction for non-tuberculous mycobacterium (NTM) was positive, the anti-tuberculous medications were changed to anti-NTM drugs. However, the neurologic deficits did not improve and persistent elevation of erythrocyte sedimentation rate and C-reactive protein were noted. Eight weeks after the revision, $Mycobacterium$ $Intracellulare$ was detected in the specimen cultures. Despite supportive care with medication, the patient died due to multiple organ failure.

• Journal of Trauma and Injury
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• v.23 no.2
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• pp.163-169
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• 2010

Purpose: Spinal epidural hematoma (EDH) is a rare condition requiring an urgent diagnosis and management. We describe here the clinical features, magnetic resonance image (MRI) findings, and outcomes of surgery in six patients with spinal EDH. Methods: We retrospectively analyzed six patients who underwent surgery for spinal EDH between April 2004 and May 2010. Preoperative MRI findings within 48 hours of symptom occurrence were analyzed for cord compression, extent of EDH, and presence of vascular abnormalities. Pre- and postoperative neurological status was also assessed comparatively. Results: Our six patients consisted of three men and three women, with a mean age of 70 years (range: 54-88 years), who presented with the back pain or motor weakness. The mean follow-up period was 34 months (range: 2-72 months). Two patients had cardiovascular disease and were taking warfarin, but the others had no history of medical comorbidity. Those two patients taking warfarin had a history of trauma, another one experienced symptoms during a strenuous effort, and the others developed spontaneously. Before surgery, motor power was grade III in three patients, grade 0 in two patients, and normal in one patient. Preoperative MRI showed no vascular abnormalities except for the EDH in any patient. At the last follow-up, all those five patients with motor weakness showed neurological improvement compared to their preoperative status. There were no complications related to surgery. All six patients were able to ambulate with or without an assistive device. Conclusion: Spinal EDH can occur in patients without trauma, bleeding diathesis, or combined vascular pathology. The surgical outcomes of spinal EDH seem to be satisfactory, even in quadriplegic patients.

• Journal of Korean Neurosurgical Society
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• v.65 no.1
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• pp.13-21
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• 2022

Objective : Nontraumatic subdural hematoma (SDH) is a common disease, and spinal cerebrospinal fluid (CSF) leakage is a possible etiology of unknown significance, which is commonly investigated by several invasive studies. This study demonstrates that heavily T2-weighted magnetic resonance myelography (HT2W-MRM) is a safe and clinically effective imaging modality for detecting CSF leakage in patients with nontraumatic SDH. Methods : All patients who underwent HT2W-MRM for nontraumatic SDH workup at our institution were searched and enrolled in this study. Several parameters were measured and analyzed, including patient demographic data, initial modified Rankin Scale (mRS) score upon presentation, SDH bilaterality, hematoma thickness upon presentation, CSF leakage sites, treatment modalities, follow-up hematoma thickness, and follow-up mRS score. Results : Forty patients were identified, of which 22 (55.0%) had CSF leakage at various spinal locations. Five patients (12.5%) showed no change in mRS score, whereas the remaining (87.5%) showed decreases in follow-up mRS scores. In terms of the overall hematoma thickness, four patients (10.0%) showed increased thickness, two (5.0%) showed no change, 32 (80.0%) showed decreased thickness, and two (5.0%) did not undergo follow-up imaging for hematoma thickness measurement. Conclusion : HT2W-MRM is not only safe but also clinically effective as a primary diagnostic imaging modality to investigate CSF leakage in patients with nontraumatic SDH. Moreover, this study suggests that CSF leakage is a common etiology for nontraumatic SDH, which warrants changes in the diagnosis and treatment strategies.