• Journal of Korean Neurosurgical Society
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• v.57 no.2
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• pp.100-107
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• 2015

Objective : To report a minimally invasive treatment option using percutaneous pedicle screw fixation with adjuvant treatment for metastatic thoraco-lumbar and lumbar spinal tumors. Methods : This is a retrospective study of charts of patients with spinal metastases. All were older than 18 years of age and were considered to have more than 3 months of life expectancy. The patients had single or two level lesions, and compression fracture or impending fracture. Exclusion criterion was metastasis showing severe epidural compression with definite neurological symptoms. Usually spinal segments from one level above to below pathology were stabilized. Visual analog scale (VAS) score for pain assessment and Frankel scale for neurological deficit were used, while pre- and post-operative performance status was evaluated using the Eastern Cooperative Oncology Group (ECOG). Results : Twelve patients (nine men, three women; median age 54.29 years) underwent surgery. All patients presented with back pain with/without radicular pain. There were no early complications and perioperative mortalities. Following surgery, a significant difference between average pre- and post-operative VAS scores was found (p=0.003). Overall, 91.8% of patients (11/12) experienced improvement in their ECOG score post-operatively. The mean ambulation time was 196.9 days [95% confidence interval (CI), 86.2-307.6 days; median, 97 days]. During follow-up, nine patients died and the mean overall survival time in enrolled twelve patients was 249.9 days (95% CI, 145.3-354.4 days; median, 176 days). Conclusion : Minimally invasive treatment using percutaneous pedicle screw fixation with adjuvant treatment is a good alternative treatment option for potential instability of the thoraco-lumbar and lumbar spinal metastasis.

• Journal of Korean Neurosurgical Society
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• v.63 no.6
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• pp.794-805
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• 2020

Objective : Teriparatide is known as an effective anabolic agent not only for severe osteoporosis but also for bone healing and union. We explored the possibility of teriparatide as an alternative treatment option for osteoporotic thoracolumbar (TL) burst fracture. Methods : This retrospective study enrolled 35 female patients with mean age of 73.77±6.71 years (61-88) diagnosed as osteoporotic TL burst fracture with ≥4 of thoracolumbar injury classification and severity (TLICS) score and no neurological deficits. All patients were treated by teriparatide only (12 of group A), teriparatide plus vertebroplasty (12 of group B), or surgical fixation with fusion (11 of group C), and followed up for 12 months. Radiological outcomes were evaluated using radiological parameters including kyphotic angle (KA), segmental vertebral kyphotic angle (SVKA), compression ratio (CR), and vertebral body height (anterior [AH], middle [MH], posterior [PH]). Functional outcomes were evaluated using visual analog scale (VAS) and Macnab classification (MC). Results : There were no statistical significant differences in age, bone mineral density (-3.36±0.73), and TLICS score (4.34±0.48) among the three groups (p>0.05). Teriparatide was administered during 8.63±2.32 months in group A and B. In 12-month radiological outcomes, there were significant restoration in SVKA, CR, AH, and MH of group B and KA, SVKA, CR, AH, and MH of group C compared to group A with no radiological changes (p<0.05). All groups showed similar significant improvements in 12-month functional outcomes, although group B and C showed a better 1-month VAS, 1-month MC, 3-month MC compared to group A (p<0.05). Conclusion : Non-surgical treatment with teriparatide showed similar 12-month functional outcomes compared to surgical fixation with fusion. The additional vertebroplasty to teriparatide and surgical fixation with fusion were more helpful to improve short-term functional outcomes with structural restoration compared to teriparatide only.

• Korean Journal of Veterinary Service
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• v.46 no.1
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• pp.87-92
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• 2023

A 7-year-old dog weighing 3.9 kg visited the hospital with symptoms of inability to stand and quadriparesis. There were seizure symptoms 2 months before admission to the hospital, and the symptoms of stiffness and rigidity appeared. Radiographs showed normal vertebrae in cervical vertebral column. Magnetic resonance imaging (MRI) and computed tomography (CT) were performed immediately to diagnose vertebral lameness. As a result of the CT, it was possible to observe the fracture of the odontoid process of the axis, and the exact location of the damage was identified. The odontoid process was fractured and separated from the body of the 2^nd cervical vertebra (axis), and fragment of the process was observed inside the vertebral arch of the first cervical vertebra (atlas), and the body of the axis was lifted to the dorsal side. The MRI examination reflected the CT findings and confirmed severe spinal cord compression due to the fracture of the odontoid process. The patient was applied by neck brace and medical management including Mycophenolate mofetil administration was performed. The patient was able to move legs and tail after 2 weeks, and was able to voluntarily defecate, urinate and stand up after 4 weeks of administration.

• Journal of Korean Foot and Ankle Society
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• v.3 no.1
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• pp.26-32
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• 1999

Fractures of the tibial pilon are the severe injuries to the ankle joint resulted from axial compression, shear and/or rotational forces. The pilon fractures have been difficult in management due to the severe comminution of articular surface and frequent soft tissue problem. Among many treatment options, limited internal fixation of the tibia with long screws and multiple pins augmented with external fixation or casting provide adequate stabilization without soft tissue compromise. Among the patients of pilon fracture admitted to our hospital from March 1993 to March 1997 who treated by limited internal fixation and external fixation or casting, 25cases are included who could be follow up for more than 10months. According to Ruedi and Allgower, typeI 3cases, typeII 14cases, typeIII 8cases. The authors analyzed the clinical and radiological results of the tibial pilon fractures according to Magnusson. The results were as follow. 1. 10cases at Ruedi-Allgower typeII were obtained above fair and 5cases at Ruedi-Allgower typeIII were obtained above fair. 2. The postoperative complications were skin problem(3cases) and infection(2cases), which were treated by antibiotics and flap surgery.

• Journal of Biomedical Engineering Research
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• v.25 no.3
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• pp.171-182
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• 2004

This study investigates the biomechanical efficacies of vertebroplasty which is used to treat vertebral body fracture with bone cement augmentation for osteoporotic patients using image and finite element analysis. Simulated models were divided into two groups: (a) a vertebral body, (b) a functional spinal unit(FSU). For a vertebral body model, the maximum axial displacement was investigated under axial compression to evaluate the effect of structural integrity. The stiffness of each FE model simulated was normalized by the stiffness of intact model. In the case of FSU model, 3 types of compression fractures were formulated to assess the influence on spinal curvature changes. The FSU models were loaded under compressive pressure to calculate the change of spinal curvature. The results according to the various factors suggest that vertebroplasty has the biomechanical efficacy of the increment of structural reinforcement in a patient who has relatively high level of BMD and a patient with the amount of 15％, PMMA injection of the cancellous bone volume. The spinal curvatures after compression fracture simulation vary from 9$^{\circ}$ to 17$^{\circ}$ of kyphosis compared to that the spinal curvature of normal model was -2.8$^{\circ}$ of lordosis. These spinal curvature changes cause the severe spinal deformity under the same loading. As the degree of compressive fracture increases the spinal deformity also increases. The results indicate that vertebroplasty has the increasing effect of the structural integrity regardless of the amount of PMMA or BMD and the restoration of decreased vertebral body height may be an important factor when the compressive fracture caused the significant height loss of vertebral body.

• Journal of Korean Neurosurgical Society
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• v.42 no.1
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• pp.6-10
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• 2007

Objective : The purpose of this study was to determine the effect of bone cement augmentation of pedicular screwing in severe osteoporotic spondylolisthetic patients. Methods : Twenty patients with spondylolisthesis (8 : spondylolytic spondylolisthesis 12 : degenerative spondylolisthesis) who had undergone pedicular screwing and interbody fusion for osteoporotic lumbar spine (T-score on bone mineral density<-3.0) from 2002 to 2005 were reviewed. Mean age was 62.3 years with 3 male and 17 female patients. Average follow-up period was 14 months. Average T-score on bone mineral density (BMD) was -3.62. After decompression of neural elements, about 6cc of polymethylmethacrylate (PMMA) was injected into the each vertebral body through transpedicular route. All patients underwent one level interbody fusion and pedicular screw fixation. Clinical outcome was assessed using Oswestry Disability Index (ODI) on the last clinical follow-up. In addition, a modified MacNab's grading criteria was used to objectively assess patient's outcome postoperatively. Radiographic analysis of sagittal contour was assessed preoperatively, immediately postoperatively, and at final follow-up including fusion rate. Results : Eighteen of 20 patients were graded as excellent or good according to the modified MacNab's criteria. An significant improvement of ODI was achieved in both groups. Mean sagittal angle at the preoperative state, postoperative state and at the last follow-up state was $11.0^{\circ},\;20.1^{\circ}$ and $18.3^{\circ}$, respectively, with mean sagittal angle correction gain $7.3^{\circ}$. Firm fusion was achieved in all patients. There were one compression fracture above the fused segment after 6 months follow-up and one case of seroma. But there were no postoperative complications related to bone cement leakage and pedicular screwings such as screw pullout or screw cut-up. Conclusion : Bone cement augmentation of pedicular screwing can be an effective procedure for osteoporotic lumbar spine in spondylolisthetic patients.

• Journal of Korean Foot and Ankle Society
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• v.1 no.2
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• pp.102-111
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• 1997

The tibial Pilon fracture, which is defined as a comminuted intraarticular fracture of the distal tibia, is difficult to manage because high axial compression and rotational forces to the ankle joint result in impaction, severe comminution, metaphyseal disruption and soft tissue damage. There are variable methods of treatment such as manipulation and cast, calcaneal traction and cast, external fixation, pin and plaster, limited open reduction and external fixation, and open reduction and rigid internal fixation. Though most of authors reported better result after a surgical treatment. than that of conservative treatment, many complications such as posttraumatic arthritis and soft tissue problem still remain troublesome. We have reviewed 19 cases of the tibial Pilon fractures in 18 patients which were treated with limited open reduction and internal fixation from September 1993 to May 1996. The results were as follows: 1. The fractures were classified into five types according to the system of Ovadia and Beals, and the most frequent type was type 3 (53%). The most common cause of injury was traffic accident (47%). 2. All of the cases of type 1 and 2, in which the injury of the ankle joint was less severe, revealed good or excellent clinical results. But in type 4 and 5, because the injury is much severe and accurate reduction is difficult, the clinical results were unsatisfaetory. 3. The most frequent complication was posttraumatic osteoarthritis, and which developed in second frequent complication, was developed m the three cases of type 3 in which the radiographic results were less than fair, but there were no correlation with the clinical results. 4. We could markedly reduce the complications related to the soft tissue problem of Pilon fracture by treatment with limited open reduction and internal fixation, and consider that this is a good method of treatment of Pilon fracture when the injury is less severe and accurate reduction is possible.

• Journal of Trauma and Injury
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• v.29 no.4
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• pp.204-208
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• 2016

For an orthopaedic surgeon, the critical decisions to either amputate or salvage a limb with severe crushing injury with progressive ischemic change due to arterial rupture or occlusion can become a clinical dilemma at the Emergency Department (ED). And reperfusion injury is one of the fetal complications after vascular reconstruction. The authors present a case which was able to save patient's life by rapid vessel ligation at bedside to prevent severe reperfusion injury. A 43-year-old male patient with no pre-existing medical conditions was transported by helicopter to Level I trauma center from incident scene. Initial result of extended focused assessment with sonography for trauma (eFAST) was negative. The trauma series X-rays at the trauma bay of ED showed a multiple contiguous rib fractures with hemothorax and his pelvic radiograph revealed a complex pelvic trauma of an Anterior Posterior Compression (APC) Type II. Lower extremity computed tomography showed a discontinuity in common femoral artery at the fracture site and no distal run off. Surgical finding revealed a complete rupture of common femoral artery and vein around the fracture site. But due to the age aspect of the patient, the operating team decided a vascular repair rather than amputation even if the anticipated reperfusion time was 7 hours from the onset of trauma. Only two hours after the reperfusion, the patient was in a state of shock when his arterial blood gas analysis (ABGA) showed a drop of pH from 7.32 to 7.18. An imminent bedside procedure of aseptic opening the surgical site and clamping the anastomosis site was taken place rather than undergoing a surgery of amputation because of ultimately unstable vital sign. The authors would like to emphasize the importance of rapid decision making and prompt vessel ligation which supply blood flow to the ischemic limb to increase the survival rate in case of profound reperfusion injury.

• Journal of Korean Neurosurgical Society
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• v.56 no.2
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• pp.141-145
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• 2014

Vertebral artery (VA) injuries usually accompany cervical trauma. Although these injuries are commonly asymptomatic, some result in vertebrobasilar infarction. The symptoms of VA occlusion have been reported to usually manifest within 24 hours after trauma. The symptoms of bilateral VA occlusions seem to be more severe and seem to occur with shorter latencies than those of unilateral occlusions. A 48-year-old man had a C3-4 fracture-dislocation with spinal cord compression that resulted from a traffic accident. After surgery, his initial quadriparesis gradually improved. However, he complained of sudden headache and dizziness on the 5th postoperative day. His motor weakness was abruptly aggravated. Radiologic evaluation revealed an infarction in the occipital lobe and cerebellum. Cerebral angiography revealed complete bilateral VA occlusion. We administered anticoagulation therapy. After 6 months, his weakness had only partially improved. This case demonstrates that delayed infarction due to bilateral VA occlusion can occur at latencies as long as 5 days. Thus, we recommend that patients with cervical traumas that may be accompanied by bilateral VA occlusion should be closely observed for longer than 5 days.

• Journal of Chest Surgery
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• v.10 no.1
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• pp.38-43
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• 1977

With the adevance of widespread mechanization and high-speed era, the incidence of traumatic rupture of the tracheobronchial tree has been increased considerably. We have experienced these diseased of the 3 cases in our department. The first case was a 25 year old male who was severe dyspneic and subcutaneous emphysema, hemoptysis, and hemopneumothorax of both side were noted. During tracheostomy, it was found that the 2net ring of the trachea was ruptured. No definitive procedure was made on admission. Corrective surgery was performed with end-to-end anastomosis on 31 post-traumatic day. The second case was a 43 year old female who received multiple stab wounds on the anterior neck and it was found that the cricoid cartilage was transected partially. The injured cartilage was approximated with interrupted suture of No. 600 wire. The third case was a 19 year old male who had sustained a compression chest injury without external wound or rib fracture. At five days after trauma, he had suffered from dyspnea, and obstruction of the left main bronchus due to traumatic bronchial rupture was confirmed by means of bronchoscopy and bronchography at two weeks after the trauma. End-to-end anastomosis of the bronchus was performed and the left lung was aerated well. Mild postoperative stenosis of trachea was remained in the first case. Others were uneventful.