• The Korean Journal of Pain
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• v.10 no.2
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• pp.301-303
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• 1997

A 35-year-old female patient was referred to our hospital with neurologic symptoms after continuous epidural block performed 2 days earlier. She die not have any prior no previous lumbar surgery or experience trauma, intraspinal hemorrhage, infections or other known causative factors to associate with neurologic symptoms. Continuous epidural block is widely used for postoperative pain control. Complications can occur with this block including postduralpuncture headache, epidural abscess and rare cases of arachnoiditis etc. We experienced such a case of spinal arachnoiditis after continuous epidural block. Neurologic examination revealed painful bilateral hypoesthesia below $S_2$ level dermatomes, urinary and fecal incontinence and various degrees of leg weakness. The following day, the patient was noted to have bilateral sacral radiculopathies and lesion on proximal portion of both tibial nerve. CSF study reported: protein 264 mg/dl, sugar 64 mg/dl, WBC $7/mm^3$. L-spine MyeloCTscan results were unremarkable. She was discharged after a month of hospitalization and has regular checkups but her neurologic symptoms show no signs of improvement.

• Childhood Kidney Diseases
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• v.2 no.1
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• pp.90-94
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• 1998

Hinman syndrome is a condition representing urinary voiding dysfunction in the neurologically intact child. The syndrome is probably caused by acquired behavioral and psychosocial disorders manifested by bladder and/or bowel dysfunction mimicking neurologic disease. Clinically, the symptom complex may include day and night time enuresis, encopresis, constipation, and recurrent urinary tract infections. Cystoscopy frequently demonstrates normal vesicourethral anatomy. Voiding films usually demonstarate a carrot-shaped proximal urethra with a persistent narrowing at the external sphincter. The bladder is large and often appears trabeculated with a thickened wall and significant postvoid residual. A 13-year-old male child was admitted due to fever, urinary tract infection, enuresis and flank pain. His neurologic examination was normal. Renal sonograms showed moderate hydronephrosis. Voiding cystourethrograms showed a huge, trabeculated bladder without vesicourethral reflux and urethral valves. No abnormal findings was found in spinal MRI.

• Journal of Korean Neurosurgical Society
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• v.29 no.6
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• pp.763-771
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• 2000

Objectives : Thoracolumbar burst fractures(TBLF) result in not only compressive deformity of vertebral body but also spinal cord compression by bony fragments. Many thoracolumbar burst fractures demand both anterior decompression and intervertebral fusion. Most of spinal surgeons use anterior instrumentation for anteior intervertebral bony fusion. The use of Z-plate has been increased recently, however there has been only a few reports regarding its clinical long-term strength. We studied nineteen patients with TBLF to find out the long-term stability of Z-plate. Methods : We have operated 19 patients from March 1996 to August 1998. They were treated with anterior decompression through either a transthoracic, retroperitoneal extrapleural or retroperitoneal approach. Retropulsed bony fragments were removed completely by corpectomy. Iliac bone graft was used for interbody fusion in all of the cases. They were evaluated by plain X-ray films including flexion and extention lateral films. Cobbs angle was used to evaluate kyphotic and lateral wedging deformity. Results : Burst fractured sites were T11 in two, three T12, nine L1, and five L2. Mean follow-up duration was fifteen months. Preoperative average kyphotic angle was 23.7 degree. Immediate postoperative kyphotic angle was 10.2 degree. Follow-up resluts of average kyphotic angles revealed 14 degrees. Four patients(21%), including two spinal 3-column injury, showed increasement of kyphotic angle more than 5 degree or breakage of intrumentation. Two patients showed the difference of kyphotic angle more than 3 degree. Five patients(26%) revealed lateral wedging deformity more than 3 degrees. Postoperative complications were two meralgia parestheticas, one pulmonary atelectasis and two donor site infections. Four of the eight patients, who initially showed incomplete spinal cord deficits, were nerologically improved by Frankel's grade. Conclusion : Z-plate fixation and iliac bone graft after anterior decompression in thoracolumbar burst fractures is a safe and easy method. Immediate postoperative results revealed excellent correction of posttraumatic kyphosis, but long-term follow-up evalution showed insufficient strength. Therefore we believe that use of Z-plate should be carefully decided, especially in the case of large lumbar fracture or 3-column injury.

• Journal of the Korean Society of Radiology
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• v.85 no.1
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• pp.36-53
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• 2024

As the number of spinal surgeries being performed expands, the number of medical imaging procedures such as radiography, CT, and MRI is also increasing, and the importance of their interpretation is becoming more significant. Herein, we present the radiological findings of a variety of complications that can occur after spinal surgery and discuss how effectively and accurately they can be diagnosed through imaging. In particular, this study details the characteristic imaging findings specific to the early and long-term postoperative periods. Early complications of spinal surgery include improper placement of surgical instruments (instrument malpositioning), seromas, hematomas, pseudomeningoceles, and infections in the region surrounding the surgical site. Conversely, long-term complications may include osteolysis around surgical instruments, failure of fusion, adjacent segment disease, and the formation of epidural fibrosis or scar tissue. A precise understanding of the imaging assessments related to complications arising after spinal surgery is crucial to ensure timely and accurate diagnosis, which is necessary to achieve effective treatment.

• Preventive Nutrition and Food Science
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• v.8 no.1
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• pp.24-28
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• 2003

There is evidence to suggest that cranberry juice supplements improve the health of the urinary tract by inhibiting the binding of fimbriated uropathogenic E. coli to the bladder mucosa. In patients with neurogenic bladders, urinary tract infections (UTI) are particularly common and often poorly managed by antibiotic treatment. A double-blind, randomized, placebo-controlled trial was undertaken on 29 geriatric and spinal cord injured patients with dysfunctional bladders. They received three times daily at mealtimes a 4 oz bottle of cranberry juice (Ocean Spray Cranberries, USA) or a specially prepared synthetic placebo drink. Two episodes of UTI arose in week one of cranberry intake and none thereafter, compared to four episodes of UTI in 4 placebo patients in weeks four, six and 10. Mean bacterial adhesion counts on bladder cells of the patients rose during the first month of treatment in 71 % of the placebo patients compared to only 31 % of cranberry patients (p < 0.001). The difference persisted to some extent for the second and third months. Bacterial adhesion levels correlated with culture findings (higher adhesion and higher viable counts in urine) (p < 0.001), positive leukocyte nitrite tests (136$\pm$131 bacteria per cell versus 52$\pm$86 in negative tests) (p < 0.001), and higher white blood cell counts (> 10) per high power field (126$\pm$125 versus 48$\pm$85 bacteria per cell) (p<0.001). E. coli was the most frequently isolated organism (40% samples) followed by K. pneumoniae (17%) and a number of other uropathogens. Group B Streptococci, and coagulase negative Staphylococcus were recovered from urine in 4 samples but were not associated with any red blood cell presence. The daily intake of cranberry juice, in amounts which are not detrimental to long term compliance, appeared to have a role in reducing the risk of bladder colonization and infection in a highly susceptible patient population.

• Journal of Korean Neurosurgical Society
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• v.47 no.4
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• pp.295-297
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• 2010

Candida is a relatively rare cause of spinal infections that commonly affects immunocompromised patients. A 70-year-old woman, who underwent a lumbar discectomy on L5-S1 two months earlier, was admitted to our department complaining of persistent back and leg pain. Magnetic resonance imaging showed irregular enhancing mass lesion in L5-S1 intervertebral space, suggest of pyogenic discitis with epidural abscess. The surgery was performed via retroperitoneal approach and the infected material at L5-S1 intervertebral space was removed. The histological examination of the specimen revealed chronic inflammation involving the bone and soft tissue, and a culture of the excised material was positive for Candida parapsilosis. The patient received intravenous fluconazole for 4 weeks after surgery and oral fluconazole 400 mg/day for 3 months after surgery. The patient made a full recovery with no symptoms 6 months after surgery. We present a rare case of spondylodiscitis after a lumbar discectomy due to Candida parapsilosis and discuss treatment option with a review of the literatures.

• The Korean Journal of Pain
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• v.9 no.1
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• pp.69-74
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• 1996

Background: Efficacy of spinal opioids for the treatment of intractable cancer pain has been reported by several authors. The epidural route seems to be a more reliable and effective method of pain control as compared to the intrathecal route which can lead to opioids by portal system. Methods: Medical records were reviewed of 18 patients who had been treated with epidural morphine via an implanted port-A-Cath from Mar. 1991 to Sep. 1994. Results: Patients were treated for a mean of 92 days. There were wide variation of dose requirements. The minimum daily dose ranged from 2 to 10mg, and maximum daily dose from 3 to 30 mg. Verbal rating scale were below moderate until 100th days after posrtal implantation. When 3 patients suffered from aggravated pain associated with vertebral metastasis. Five of 11 patients who were administered medication longer than 50 days reguired increased doses ranging from 3 mg to 25 mg which were higher as compared to initial doses. These patients also experienced pain due to vertebral metastasis. There were no report of epidural scarring, respiratory depression, epidural infections, meningitis, or catheter blockade. Conclusion: Continuous epidural morphine administration via Port-A-Cath is an effective method with minimal complication.

• The Korean Journal of Pain
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• v.33 no.3
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• pp.208-215
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• 2020

Zoster sine herpete (ZSH) is one of the atypical clinical manifestations of herpes zoster (HZ), which stems from infection and reactivation of the varicella-zoster virus (VZV) in the cranial nerve, spinal nerve, viscera, or autonomic nerve. Patients with ZSH display variable symptoms, such as neuralgia, however, different from HZ, ZSH show no zoster, which makes clinical diagnosis difficult. ZSH not only causes initial symptoms, such as neuropathic pain in the affected nerve, Bell palsy, and Ramsay Hunt syndrome, but also postherpetic neuralgia and fatal complications such as VZV encephalitis and stroke. The misdiagnosis of ZSH and tardy antiviral treatment may lead to severe ZSH sequelae. We review the publications related to ZSH, especially its diagnosis with VZV DNA and/or anti-VZV immunoglobulin (IgG and IgM). More work about ZSH, especially ZSH epidemiological survey and guidelines for its diagnosis and treatment, are needed because most of the present studies are case reports.

• Archives of Plastic Surgery
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• v.48 no.3
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• pp.254-260
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• 2021

Background Myelomeningocele is a frequently seen condition at tertiary care hospitals. Its treatment involves a variety of plastic reconstructive techniques. Herein, we present a series of myelomeningocele patients treated using keystone flaps. Methods We gathered information regarding soft tissue reconstruction and the use of bilateral keystone flaps to treat myelomeningocele patients. We obtained data from clinical records and recorded the demographic characteristics of mothers and children with the condition. The size, level of defect, and complications detected during the follow-up were analyzed. Results A series of seven patients who underwent bilateral keystone flaps for myelomeningocele closure was analyzed. There were no cases of midline or major dehiscence, flap loss, necrosis, surgical site infections, or cerebrospinal fluid leakage. No revision procedures were performed. Minor complications included one case with minimal seroma and three cases with areas of peripheral dehiscence that healed easily using conventional measures. Conclusions The use of keystone flaps is an adequate option for closure of dorsal midline soft tissue defects related to myelomeningocele. This technique offers predictable results with an acceptable spectrum of complications. Robust blood flow can be predicted based upon anatomical knowledge.

• Tuberculosis and Respiratory Diseases
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• v.60 no.3
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• pp.353-356
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• 2006

Acute transverse myelitis (TM) is a neurological syndrome caused by inflammation of the spinal cord. TM is rare but is frequently caused by viral or bacterial infections. TM caused by tuberculosis (TB) is extremely rare and there are no reports of TM caused by multidrug-resistant TB (MDR-TB). We report a case of acute TM due to MDR-TB in a 40-year-old man. The patient had been diagnosed with pulmonary TB and was started on the first-line anti-TB treatment. However, the chest radiographic findings were aggravated and neurological symptoms such as weakness in both lower extremities, sensory changes, and voiding difficulty were newly developed. The T2-weighted magnetic resonance image of the spine showed diffusely increased signal intensity in the spinal cord, particularly at the lower cervical and upper thoracic levels, without any definite evidence of myeloradicular compression, which is consistent with a diagnosis of TM. A drug susceptibility test revealed MDR and second-line anti-TB drugs were prescribed. The chest radiographic findings showed improvement after treatment, the mycobacterial culture converted to negative, the MRI findings improved, and there was partial improvement in the low extremity weakness. The patient has been prescribing second-line anti-TB medications for 14 months.