• Journal of Korean Neurosurgical Society
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• 제43권1호
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• pp.5-10
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• 2008

Objective : To evaluate the surgical outcomes of ventral interbody grafting and anterior or posterior spinal instrumentation for the treatment of advanced spondylodiscitis with patients who had failed medical management. Methods : A total of 28 patients were evaluated for associated medical illness, detected pathogen, level of involved spine, and perioperative complications. Radiological evaluation including the rate of bony union, segmental Cobb angle, graft- and instrumentation-related complications, and clinical outcomes by mean Frankel scale and VAS score were performed. Results : There are 14 pyogenic spondylodiscitis, 6 postoperative spondylodiscitis, and 8 tuberculous spondylodiscitis. There were 21 males and 7 females. Mean age was 51 years, with a range from 18 to 77. Mean follow-up period was 10.9 months. Associated medical illnesses were 6 diabetes, 3 pulmonary tuberculosis, and 4 chronic liver diseases. Staphylococcus was the most common pathogen isolated (25%), and Mycobacterium tuberculosis was found in 18% of the patients. Operative approaches, either anterior or posterior spinal instrumentation, were done simultaneously or delayed after anterior aggressive debridement, neural decompression, and structural interbody bone grafting. All patients with neurological deficits improved after operation, except only one who died from aggravation as military tuberculosis. Mean Frankel scale was changed from $3.78{\pm}0.78$ preoperatively to $4.78{\pm}0.35$ at final follow up and mean VAS score was improved from $7.43{\pm}0.54$ to $2.07{\pm}1.12$. Solid bone fusion was obtained in all patients except only one patient who died. There was no need for prolongation of duration of antibiotics and no evidence of secondary infection owing to spinal instrumentations. Conclusion : According to these results, debridement and anterior column reconstruction with ventral interbody grafting and instrumentation is effective and safe in patients who had failed medical management and neurological deficits in advanced spondylodiscitis.

• Tuberculosis and Respiratory Diseases
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• 제63권4호
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• pp.372-377
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• 2007

척추결핵은 경과가 느리고 서서히 진행하며 특이한 증상이 없으므로 임상적으로 의심하지 않으면 병이 상당히 진행된 후에야 진단되기 쉽다. 또한 침범된 부위가 척추결핵이 흔하지 않은 상부흉추, 경추, 천추부라면 진단은 더욱 늦어질 수 있다. 저자들은 국립의료원 결핵과에서 발열과 약 5개월간 지속된 상부 배부 통증으로 입원한 폐결핵환자에서 MRI 촬영으로 T5-6의 압박골절까지 초래한 상부흉추결핵을 진단하고 신경학적 이상이 생기기 전에 수술을 시행하고 항결핵약제의 치료로 좋은 결과를 얻었기에 이에 보고하는 바이다.

• Tuberculosis and Respiratory Diseases
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• 제69권5호
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• pp.389-391
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• 2010

Spinal epidural emphysema is rare and has been described secondary to following medical intervention, such as lumbar puncture and epidural analgesia, pneumothorax or pneumomediastinum, degenerative disk disease, epidural abscess, and trauma. Rarely, it occurs after chest tube placement. We report a case of spinal epidural emphysema incidentally noted on HRCT after chest tube placement.

• Investigative Magnetic Resonance Imaging
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• 제12권2호
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• pp.201-205
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• 2008

경막내 척수외 결핵종은 척추 결핵의 드문 형태로, 몇몇 증례들이 보고되었다. 저자들은 최근 흉추에 발생한 광범위한 경막내 척수외 결핵종 2예를 경험하였기에 문헌고찰과 함께 보고하고자 한다.

• Journal of Korean Neurosurgical Society
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• 제44권1호
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• pp.36-39
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• 2008

Although tuberculosis of the central nervous system is well known, the incidence of intramedullary tuberculomas is low and a combination of intramedullary with intracranial tuberculomas is extremely rare. We report a case of disseminated tuberculoma involving brain and spine with miliary pulmonary tuberculosis in a 66-year-old woman initially presenting with fever, general weakness, back pain and motor weakness of both lower extremities. Despite medical therapy, she developed progressive motor weakness of both lower extremities with muscle strength 1/5 in both lower extremities. Urgent surgical intervention was followed and her muscle power and motor functions were improved gradually. The anti-tuberculous drugs were continued and the follow-up magnetic resonance imaging (MRI) of brain and spine showed that the lesions had become smaller or disappeared.

• Journal of Korean Neurosurgical Society
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• 제56권1호
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• pp.21-27
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• 2014

Objective : Infectious spinal disease is regarded as an infection by a specific organism that affects the vertebral body, intervertebral disc and adjacent perivertebral soft tissue. Its incidence seems to be increasing as a result of larger proportion of the older patients with chronic debilitating disease, the rise of intravenous drug abuser, and the increase in spinal procedure and surgery. In Korea, studies assessing infectious spinal disease are rare and have not been addressed in recent times. The objectives of this study are to describe the epidemiology of all kind of spinal infectious disease and their clinical and microbiological characteristics as well as to assess the diagnostic methodology and the parameters related to the outcomes. Methods : A retrospective study was performed in all infectious spinal disease cases presenting from January 2005 to April 2010 to three tertiary teaching hospitals within a city of 1.5 million in Korea. Patient demographics, risk factors, clinical features, and outcomes were assessed. Risk factors entailed the presence of diabetes, chronic renal failure, liver cirrhosis, immunosuppressants, remote infection, underlying malignancy and previous spinal surgery or procedure. We comparatively analyzed the results between the groups of pyogenic and tuberculous spinal infection. SPSS version 14 statistical software was used to perform the analyses of the data. The threshold for statistical significance was established at p<0.05. Results : Ninety-two cases fulfilled the inclusion criteria and were reviewed. Overall, patients of tuberculous spinal infection (TSI) and pyogenic spinal infection (PSI) entailed 20 (21.7%) and 72 (78.3%) cases, respectively. A previous spinal surgery or procedure was the most commonly noted risk factor (39.1%), followed by diabetes (15.2%). The occurrence of both pyogenic and tuberculous spondylitis was predominant in the lumbar spine. Discs are more easily invaded in PSI. At initial presentation, white cell blood count and C-reactive protein levels were higher in PSI compared to TSI (p<0.05). Etiological agents were identified in 53.3%, and the most effective method for identification of etiological agents was tissue culture (50.0%). Staphyococcus aureus was the most commonly isolated infective agent associated with pyogenic spondylitis, followed by E. coli. Surgical treatment was performed in 31.5% of pyogenic spondylitis and in 35.0% of tuberculous spondylitis cases. Conclusion : Many previous studies in Korea usually reported that tuberculous spondylitis is the predominant infection. However, in our study, the number of pyogenic infection was 3 times greater than that of tuberculous spinal disease. Etiological agents were identified in a half of all infectious spinal disease. For better outcomes, we should try to identify the causative microorganism before antibiotic therapy and make every effort to improve the result of culture and biopsy.

• Tuberculosis and Respiratory Diseases
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• 제43권1호
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• pp.113-116
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• 1996

A previously healthy 59-year old male patient was admitted due to cough and abnormal chest x-ray. Cough started 5 months ago and persisted. Two months before admission, abnormality in chest PA was detected. He had no symptom other than cough. He was nonsmoker and physical examination revealed no abnormal finding. His chest X-ray showed ill-defined $2{\times}1\;cm$ ovoid infiltration in left middle lung field. On chest computed tomography, it was located in the subpleural region of posterobasal segment of left lower lobe. Mediastinal lymphadenopathy was absent. Blood test and sputum examination were not diagnostic. Fluoroscopy-guided percutaneous needle biopsy revealed pulmonary cryptococcosis. After central nervous system involvement was excluded by spinal tap, oral ketoconazole therapy was started. The lesion decreased in size after 8 weeks of therapy and almost disappeared on follow-up chest X-ray 4 months later.

• Tuberculosis and Respiratory Diseases
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• 제52권6호
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• pp.627-632
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• 2002

폐암 환자에서 척수에 대한 신경학적 증상이 발생할 경우, 척수 수질 내로의 전이를 고려해야 하며, 조기 진단이 예후에 중요한 영향을 미칠 것으로 사료된다. 자기공명영상 검사는 이러한 병변의 진단에 매우 민감한 검사이나, 임상증상과 원발병변, 타 장기로의 전이 등을 함께 고려하여야 하며, 가능하다면 조직검사를 시행하여 진단할 수 있다. 본 예는 임상양상 및 방사선 검사에 의해 매우 드문 비소세포 폐암의 척수 수질내 전이로 판단된 경우이기에 보고하는 바이다.

• Tuberculosis and Respiratory Diseases
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• 제49권3호
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• pp.372-375
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• 2000

척추 경막외 기종은 드문 질환으로 흉부 CT상 우연히 발견되는 경우가 많고, 고식적 치료로 완치되는 양성 질환이다. 저자들은 기종격동 및 경막외 기종까지 동반된 기관지 천식 1례를 치료하였기에 문헌고찰과 함께 보고하는 바이다.

• Asian Spine Journal
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• 제12권6호
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• pp.1069-1077
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• 2018

Study Design: A case study. Purpose: To assess the chronological changes of the disease-related kyphosis after chemotherapy alone, secondly to clarify the role of growth cartilage in the healed lesion on kyphosis change, and to define the accurate prediction time in assessing residual kyphosis. Overview of Literature: None of the previous papers up to now dealt with the residual kyphosis, stability and remodeling processes of the affected segments. Methods: One hundred and one spinal tuberculosis children with various stages of disease processes, age 2 to 15 years, were the subject materials, between 1971 to 2010. They were treated with two different chemotherapy formula: before 1975, 18 months of triple chemotherapy (isoniazid [INH], para-aminosalicylic acid, streptomycin); and since 1976, 12 months triple chemotherapy (INH, rifampicin, ethambutol, or pyrazinamide). The first assessment at post-chemotherapy one year and at the final discharge time from the follow-up (36 months at minimum and 20 years at maximum) were analyzed by utilizing the images effect of the remaining growth plate cartilage on chronological changes of kyphosis after initiation of chemotherapy. Results: Complete disc destruction at the initial examination were observed in two (5.0%) out of 40 cervical spine, eight (26.7%) out of 30 dorsal spine, and six (19.4%) out of 31 lumbosacral spine. In all those cases residual kyphosis developed inevitably. In the remainders the discs were partially preserved or remained intact. Among 101 children kyphosis was maintained without change in 20 (19.8%), while kyphosis decreased in 14 children (13.7%), and increased in 67 children (66.3%) with non-recoverably damaged growth plate, respectively. Conclusions: It could tentatively be possible to predict the deformity progress or non-progress and spontaneous correction at the time of initial treatment, but it predictive accuracy was low. Therefore, assessment of the trend of kyphotic change is recommended at the end of chemotherapy. In children with progressive curve change, the deformity assessment should be continued till the maturity.