• Journal of Korean Neurosurgical Society
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• v.50 no.6
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• pp.528-531
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• 2011

Although posterior segmental fixation technique is becoming increasingly popular, surgical treatment of craniovertebral junctional disorders is still challenging because of its complex anatomy and surrounding critical neurovascular structures. Basilar invagination is major pathology of craniovertebral junction that has been a subject of clinical interest because of its various clinical presentations and difficulty of treatment. Most authors recommend a posterior occipitocervical fixation following transoral decompression or posterior decompression and occipitocervical fixation. However, both surgical modalities inadvertently sacrifice C0-1 and C1-2 joint motion. We report two cases of basilar invagination reduced by the vertical distraction between C1-2 facet joint. We reduced the C1-2 joint in an anatomical position and fused the joint with iliac bone graft and C1-2 segmental fixation using the polyaxial screws and rods C-1 lateral mass and the C-2 pedicle.

• Journal of Trauma and Injury
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• v.19 no.2
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• pp.164-172
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• 2006

Background: The authors conducted a retrospective study to evaluate the mechanism of injury, the surgical techniques, the clinical features, the combined injuries, the treatment results, and the surgical complications in patients with atlantoaxial fracture/subluxations. Methods: The authors reviewed 71 cervical fracture/dislocations during a four-year period from September 2002 to August 2006. Among them, there were twenty one C1,2 fracture/subluxations. There were thirteen men (mean age : 43.5 years) and eight women (mean age : 50 years). Their follow-up period was at least 6 months, and the mean follow-up period was 9.6 months. Gardner-Wells tongs traction was used in all patients immediately on presentation. Surgical treatment was performed, depending on the pathologic conditions. Results: Of all 21 cases, 14 cases were injured in motor vehicle accidents, 5 were falls, and 2 were miscellaneous. There were four C1 fracture (5.6%), fourteen C2 fracture (66.7%), one C1 and 2 combined fracture (4.8%), and one C1-2 subluxation (4.8%). The C1 fractures in our series were classified as two Jefferson's fractures and two C1 lateral mass fracture. The C2 fractures were classified as one odontoid type I fracture, two odontoid type II fractures, five odontoid type III fractures, one hangman's fracture, and four C2 body tear-drop fractures. Atlantoaxial fractures were associated with six (28.6%) head injuries, four (19.0%) other spinal injuries, two (9.5%) chest injuries, and three (14.3%) spinal cord injuries. Surgical treatment was performed in nine cases, which included anterior odontoid screw fixation in two cases, transarticular screw fixation with iliac bone graft in one case, posterior fixation by using C2 pedicle screw and C3 lateral mass screw in three cases, lateral mass screw fixation C1-2 with iliac bone graft in one case, O(occipito)-C1-3-4 screw fixation in one case, posterior C2-3 wiring with allograft in one case, and halo vest in six cases. Conservative management was used in the rest of the patients in our trials. Bone fusion was complete in all cases. There were no operation-related complication, except one pin site infection in the case of halo vest. Conclusion: In this study, the choice of appropriate treatment according to the fracture types resulted in safe and effective management of unique atlantoaxial fracture/subluxations.

• Journal of the Korean Association of Oral and Maxillofacial Surgeons
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• v.47 no.4
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• pp.321-326
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• 2021

Hemangioma is a benign tumor characterized by the proliferation of blood vessels. Although it often appears in soft tissues, its occurrence in bone tissue, particularly the mandible, is extremely rare. A 32-year-old female sought attention at the dental clinic complaining of a painless swelling in the posterior region of the left side of the mandible. A panoramic radiograph and computed axial tomography scan were taken, showing honeycomb and sunburst images, respectively, in the affected area. The patient underwent a biopsy, which led to the diagnosis of intraosseous hemangioma. Having assessed the characteristics of the lesion, it was decided to perform complete excision including safety margins, followed by an iliac crest bone graft to reconstruct the mandible. Awareness of the possible clinical and radiographic presentations of intraosseous hemangioma is considered important, as non-diagnosis could have severe consequences given its possible relation to dental structures.

• Journal of Korean Neurosurgical Society
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• v.49 no.5
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• pp.267-272
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• 2011

Objective : Although iliac crest autograft is the gold standard for lumbar fusion, the morbidity of donor site leads us to find an alternatives to replace autologous bone graft. Ceramic-based synthetic bone grafts such as hydroxyapatite (HA) and b-tricalcium phosphate (b-TCP) provide scaffolds similar to those of autologous bone, are plentiful and inexpensive, and are not associated with donor morbidity. The present report describes the use of Polybone$^{(R)}$ (Kyungwon Medical, Korea), a beta-tricalcium phosphate, for lumbar posterolateral fusion and assesses clinical and radiological efficacy as a graft material. Methods : This study retrospectively analyzed data from 32 patients (11 men, 21 women) who underwent posterolateral fusion (PLF) using PolyBone$^{(R)}$ from January to August, 2008. Back and leg pain were assessed using a Numeric Rating Scale (NRS), and clinical outcome was assessed using the Oswestry Disability Index (ODI). Serial radiological X-ray follow up were done at 1, 3, 6 12 month. A computed tomography (CT) scan was done in 12 month. Radiological fusion was assessed using simple anterior-posterior (AP) X-rays and computed tomography (CT). The changes of radiodensity of fusion mass showed on the X-ray image were analyzed into 4 stages to assess PLF status. Results : The mean NRS scores for leg pain and back pain decreased over 12 months postoperatively, from 8.0 to 1.0 and from 6.7 to 1.7, respectively. The mean ODI score also decreased from 60.5 to 17.7. X-rays and CT showed that 25 cases had stage IV fusion bridges at 12 months postoperatively (83.3% success). The radiodensity of fusion mass on X-ray AP image significantly changed at 1 and 6 months. Conclusion: The present results indicate that the use of a mixture of local autologous bone and PolyBone$^{(R)}$ results in fusion rates comparable to those using autologous bone and has the advantage of reduced morbidity. In addition, the graft radiodensity ratio significantly changed at postoperative 1 and 6 months, possibly reflecting the inflammatory response and stabilization.

• Journal of Korean Neurosurgical Society
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• v.29 no.11
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• pp.1469-1475
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• 2000

Objective : The goal of this study was to evaluate the clinical outcome of the posterior C1-2 transarticular screw fixation without C1-2 sublaminar wiring in atlantoaxial instability. Methods : Between Apr. 1995 and Feb. 2000, we used this technique in treat randomly selected 17 patients (11 men, 6 women) who had atlantoaxial instability. The causes of instability were : type II-A odontoid process fracture(10 cases) ; type II-P odontoid process fracture(1 case) ; Os odontoideum(2 cases) ; transverse ligament laxity due to rheumatoid disease(1 case) ; and, transverse ligament injury without bone fracture(3 cases). All cases were operated with posterior C1-2 transarticular screw fixation with 3.5mm cortical screw and interlaminar iliac graft without sublaminar wire fixation. The mean follow-up period was 28 months(5 to 58 months) and the mean age at the time of operation was 41 years(15 to 68 years). All Patients were allowed to ambulate with Philadelphia neck collar on the first post-operation day. Results : Bony fusion was successfully achieved in all cases demonstrated at 3-month follow-up studies. There was no operative mortality or morbidity. Conclusion : The authors conclude that the posterior transarticular screw fixation without C1-2 sublaminar wiring provide adequate stability with high bony union rate in atlantoaxial instability of various causes.

• Journal of Korean Neurosurgical Society
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• v.37 no.3
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• pp.201-206
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• 2005

Objective: To evaluate the accuracy and safety of C1-C2 transarticular screw insertion, we retrospectively review surgical records and postoperative radiological findings. Methods: From January 2001 to October 2003, the C1-C2 transarticular screw fixation and posterior wiring with iliac bone grafts was performed in 16 patients. 6 patients had rheumatoid arthritis which caused cervical instability, 3 patients had os odontoideum, 3 patients had type 2 odontoid process fracture, 3 patients had traumatic transverse ligament injury and 1 patients who had been managed with C1-C2 wire fixation had psoriatic arthritis. Results: Osseous fusion was documented in 15 patients(93.8%). Only one patient was recorded screw loosening because of postoperative infection. One patient had only one screw placed because of abnormal anatomical structure, one patients was breakage of a Kirschner wire, and one screw was medial location to lateral mass of C1, but clinical results was excellent and radiological instability was not noted. Conclusion: The author's experience demonstrates that C1-C2 transarticular screw fixation with wired bone graft is a safe procedure with higher fusion rate but precaution is needed to avoid the neural damage, vertebral artery injury, and hardware failure.

• Journal of Korean Foot and Ankle Society
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• v.7 no.2
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• pp.238-249
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• 2003

Purpose: To report the clinical result of the intraarticular calcaneus fracture after open reduction and internal fixation with plate by lateral approach. Materials and Methods: Thirty-six calcaneal fractures of 33 patients(29 men and 4 women) were treated by open reduction and internal fixation using an lateral approach from March, 1997 to May, 2002 and were followed more than one year. The autogenous iliac bone graft was done in 2 cases but the others didn't. Radiographically B?hler angle and Gissane angle on simple lateral radiograph were measured and in the 15 cases, the step-off(gap) of posterior facet joint on post-operative CT images were followed. The Salama method was used for evaluation of clinical results. Results: According to Sanders classification, 19 cases of the 36 cases were classified as type II. Type III fracture were found in 12 cases and type IV in 5 cases. The following results were obtained: twenty-two cases(61.1%) out of 36 cases were estimated as good or excellent. The good results or more were obtained in 15 cases(78.9%) in type II and 7 cases(58.3%) in type ill, but no case in type IV. B?hler angles were improved from preoperative average 1.6?to postoperative average 23.4?, Gissane angle was improved from preoperative 107.2?to postoperative 122.8?, respectively. Among 36 cases, Computed tomography was carried out in 15 cases. The postoperative step-off (gap) of posterior facet joint on computed tomography was filled with cancellous bone. Satifactory results was obtained in 7 cases with 2mm gap or less and in 6 cases of 2-5mm. There were no satifactory results in 2 cases with 5mm gap or more. Conclusion: Open reduction and internal fixation for intra-articular fracture of calcaneus was thought to be a good treatment modality. It is thought that the lateral approach is one of the good one for surgical treatment, and that accurate reduction of the posterior facet, acceptable recovery of B?hler angle are more important to obtain best results.