• Journal of Korean Neurosurgical Society
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• 제51권6호
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• pp.388-390
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• 2012

There has been no report of bilateral pedicle stress fractures involving two vertebrae. The authors describe a unique case of spondylolisthesis accompanying a bilateral pedicle stress fracture involving two vertebrae. De novo development of spondylolisthesis at the L5-S1 vertebrae accompanying a bilateral pedicle stress fracture at L4 and L5 was observed in a 70-year-old woman. The patient's medical history was unremarkable and she did not have any predisposing factors except severe osteoporosis. Interbody fusion with bone cement augmented screw fixation was performed. Surgical treatment resulted in good pain management and improved functional recovery.

• Journal of Korean Neurosurgical Society
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• 제57권6호
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• pp.484-486
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• 2015

Unilateral pedicle stress fracture accompanying spondylolytic spondylolisthesis is rare even in the elderly. Most are associated with major trauma, previous spine surgery, or stress-related activity. Here, the authors describe an unique case of unilateral pedicle fracture associated with spondylolytic spondylolisthesis at the L5 level, which was successfully treated by posterior lumbar interbody fusion with screw fixation at the L5-S1 level. As far as the authors' knowledge, no such case has been previously reported in the literature. The pathophysiological mechanism of this uncommon entity is discussed and a review of relevant literature is included.

• Journal of Korean Neurosurgical Society
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• 제37권2호
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• pp.154-156
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• 2005

We present a case of chondroblastoma in the thoracic vertebra. A 40-year-old patient with upper back pain and lower extremity weakness was admitted to our clinic. On neurological examination, the patient exhibited lower extremity spastic paraparesis. Magnetic resonance imaging revealed a mass infiltrating the 7th thoracic vertebra and its adjacent structures with concomitant compression of the epidural space. After right upper lung tuberculoma was resected through the transthoracic approach, T7 total corpectomy was done with anterior stabilization using a MESH cage and T7 rib bone graft. Two weeks after the first operation, remained part of vertebra was removed and posterior stabilization was performed using a pedicle screw fixation and cross linkage bar with the assistance of the navigation system. The final pathologic diagnosis of the vertebral lesion was benign chondroblastoma.

• Journal of Korean Neurosurgical Society
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• 제47권2호
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• pp.134-136
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• 2010

Bow hunter's stroke is a rare symptomatic vertebrobasilar insufficiency in which vertebral artery (VA) is mechanically occluded during head rotation. Various pathologic conditions have been reported as causes of bow hunter's stroke. However, bow hunter's stroke caused by facet hypertrophy of C1-2 has not been reported. A 71-year-old woman presented with symptoms of vertebrobasilar insufficiency. Spine computed tomography showed massive facet hypertrophy on the left side of C1-2 level. A VA angiogram with her head rotated to the right revealed significant stenosis of left VA. C1-2 posterior fixation and fusion was performed to prevent serious neurologic deficit from vertebrobasilar stroke.

• Journal of Trauma and Injury
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• 제21권1호
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• pp.66-69
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• 2008

Traumatic bilateral abducens nerve palsy is rare and is associated with intracranial, skull and cervical spine injuries. We report a case of bilateral abducens nerve palsy in a 40-month-old patient with a skull base fracture. The injury mechanism was associated with direct nerve injury caused by a right petrous bone fracture and indirect injury by frontal impact on the abducens nerve at the point of fixation to the petrous portion and Dorello's canal. The emergency physician should be aware of injuries and the mechanism of abducens nerve palsy in head trauma.

• Journal of Korean Neurosurgical Society
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• 제30권sup1호
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• pp.55-60
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• 2001

Objective : The purpose of the present study was to examine neurologic changes, fusion rate and degree of kyphosis from the surgical results of those patients who underwent multi-level anterior interbody fusion and internal fixation. Methods : Among 63 cases of the patients who received multi-level anterior interbody fusion and internal fixation in 5 years between 1995 to 1999 at the neurosurgery department, we performed a retrospective study in 52 cases that could be followed up with dynamic view imaging ; the results were compared and analyzed. The analysis was based on the results of history taking, physical findings and radiologic findings, and Odom criteria were used to classify those cases with neurologic changes. Results : Among those 52 cases in whom the follow-up was possible for at least a year and dynamic view imaging was possible, bone fusion was seen in 93% of the trauma cases and 95% in the non-trauma cases and overall bone fusion was observed in 94% of the cases. Bone fusion was seen in 93% of the autobone cases, 95% of the allobone cases, and 94% of the Mesh cases. Radiologic changes were observed by comparing the lateral view after surgery ; kyphosis was seen in 53% of the autobone cases, in 70% of the allobone cases, and in 35% of Mesh cases ; in 45% and 60% of the non-trauma cases and trauma cases, respectively ; and in 55% of the 2 level fusion cases and 46% of the 3 level fusion cases. Neurologic changes classified according to Odom criteria showed excellent result in 48% of all the cases, good in 23%, fair in 4%, and poor in 25%. Conclusion : Even those cases with multi-level fusion, a high fusion rate could be obtained by performing anterior interbody fusion and internal fixation ; those cases with kyphosis were related more with the presence or absence of posterior compartment injury rather than the fusion level ; and those trauma cases showed not much difference in the fusion rate compared with non-trauma cases but had a high possibility of kyphosis.

• Journal of Korean Neurosurgical Society
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• 제30권11호
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• pp.1314-1319
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• 2001

Objects : Because of the nonspecific nature of symptoms in tuberculous spondylitis, a delay in the diagnosis can result in progressive neurologic deficits. The authors evaluate the clinical and the radiological results of the 10 cases of surgically treated tuberculous spondylitis. Clinical materials & Methods : We retrospectively analyzed the medical records of 10 patients with tuberculous spondylitis who were treated between February 1996 and March 2000. Six patients were female, and four were male. Mean age was 43 years old, and mean follow-up period was 20.5 months. All patients were treated with 12 months of antituberculous medication postoperatively, and were followed by complete blood count, ESR, spine X-ray and MRI. Results : The lumbar spine was involved in 5 patients, the thoracic in 4, and the thoracolumbar in one. The infected vertebral bodies were 2.8 in average. The associated lesions were pulmonary tuberculosis in 3 cases, and renal tuberculosis in one. Five patients were treated by anterior debridement and fusion with bone graft using anterior instrumentation, 2 with anterior debridement and fusion with bone graft(Hong Kong procedure only), 1 with Hong Kong procedure with posterior spinal instrumentation, and 2 were managed with posterior debridement and posterior spinal instrumentation. All patients improved after operation, and the average kyphotic angle decreased postoperatively. Postoperatively, one patient had a fistula at the operative site. Conclusion : The debridement and minimal level fusion of motion segment with instrument fixation is one of surgical option for tuberculous spondyltis to preserve the spine motion segment as much as possible. Spine instability and kyphosis were prevented by anterior and posterior spinal instrumentation. But, large number of cases and longer period follow-up study in future will be needed to confirm the long term results.

• 대한관절경학회지
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• 제10권1호
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• pp.26-32
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• 2006

목적: 경골극 골절에서 관절경을 이용한 골편의 정복 및 고정 후 골절편의 정복 정도와 전방 불안정성에 대한 결과를 알아보고자 하였다. 대상 및 방법: 경골극 골절로 관절경적 치료를 받은 32예를 대상으로 하였으며 평균 추시 기간은 18개월(12개월-48개월)이었다. 수술 후 평가는 Lachman 검사 및 회전 불안정성 검사와 KT-2000 관절측정기를 이용한 건측과의 전방전위차이(SSD)를 측정하였다. 방사선 사진 상 골편의 완전 정복, 전방 거상 및 정복 실패로 나누었고, 골편의 정복 정도에 따른 전방 불안정성 정도를 조사하였다. 결과: 골편의 완전 정복, 전방 거상, 정복 실패는 각각 23예(71%), 8예(25%), 1예(4%)였고 pull-out 방법 28예 중 8예(29%)에서 전방 거상이 있었다. 완전 정복군과 전방 거상군의 SSD는 각각 2.0 mm와 2.8mm로 의미 있는 차이는 없었으나 Lachman 0등급 비율(P=0.021)과 3 mm 미만의 SSD의 비율(P=0.048)은 의미 있게 정복군이 높았다. 결론: 심하게 전위된 골절일수록 골편의 정확한 정복이 술 후 전방 동요를 줄이는데 중요할 것으로 생각되며, 봉합사를 이용한 pull-out 방법에 의한 고정은 수술 후 골편 전방부의 거상을 유발할 수 있으므로 세심한 주의가 필요 할 것으로 생각된다.

• 대한의용생체공학회:의공학회지
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• 제25권1호
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• pp.71-76
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• 2004

척추 측만증 교정 시 유합 범위에 따른 수술 후 의 효과를 분석하기 위하여 King-Moe type II 형태의 척추 측만증 환자를 대상으로 이에 대한 수학적 유한 요소 모델을 개발하였다. 유한 요소 모델을 이용하여 척추경 나사못을 이용한 고정 및 강봉 감염술 형태의 수술모사를 수행하였으며, 유합 범위를 각기 달리하여 수술 시뮬레이션 후의 척추계의 변화 즉 Cobb 각도, 첨추체 축회전, 흉추 후만각 그리고 늑골고의 변화를 정량적으로 계산하였다. 해석 결과 강봉 감염술의 경우에서 보다 강봉을 척추경 나사못에 연결시키는 과정에서 훨씬 더 많은 Cobb각도의 변화를 얻을 수 있었다. 강봉 감염술 과정에서는 약간의 Cobb각도 감소를 유발시킬 수 있었으나 오히려 척추체 축회전과 늑골 돌출고의 증가를 나타내었다 아울러 강봉과 척추경 나사못의 체결 과정이 척추 후만각 유지에도 큰 역할을 하고 있음을 알 수 있었다. 유합 범위를 변곡 발생 추체의 위치 보다 한 단계씩 길게(T4-12) 하여 60o의 강봉 감염술을 시행하였을 경우 Cobb 각도를 두 배 감소시킬 수 있었으나 급격한 늑골고와 첨추체 축회전량의 증가가 유발되었다. 해석 결과 유합 범위는 만곡 흠추체에서 변곡이 발생되는 위치 보다 한 레벨씩 작게 선정하는 것이 최적의 유합 범위임을 알 수 있었다.

• Asian Spine Journal
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• 제12권6호
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• pp.1060-1068
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• 2018

Study Design: Retrospective study. Purpose: Lumbar intervertebral disc degeneration is an important cause of low back pain. Overview of Literature: Spinal fusion is often reported to have a good course for adolescent idiopathic scoliosis (AIS). However, many studies have reported that adjacent segment degeneration is accelerated after lumbar spinal fusion. Radiography is a simple method used to evaluate the orientation of the vertebral column. magnetic resonance imaging (MRI) is the method most often used to specifically evaluate intervertebral disc degeneration. The Pfirrmann classification is a well-known method used to evaluate degenerative lumbar disease. After spinal fusion, an increase in stress, excess mobility, increased intra-disc pressure, and posterior displacement of the axis of motion have been observed in the adjacent segments. Methods: we retrospectively secured and analyzed the data of 15 patients (four boys and 11 girls) with AIS who underwent a spinal fusion surgery. We studied the full-length view of the spine (anterior-posterior and lateral) from the X-ray and MRI obtained from all patients before surgery. Postoperatively, another full-length spine X-ray and lumbosacral MRI were obtained from all participants. Then, pelvic tilt, sacral slope, curve correction, and fused and free segments before and after surgery were calculated based on X-ray studies. MRI images were used to estimate the degree to which intervertebral discs were degenerated using Pfirrmann grading system. Pfirrmann grade before and after surgery were compared with Wilcoxon signed rank test. While analyzing the contribution of potential risk factors for the post-spinal fusion Pfirrmann grade of disc degeneration, we used generalized linear models with robust standard error estimates to account for intraclass correlation that may have been present between discs of the same patient. Results: The mean age of the participant was 14 years, and the mean curvature before and after surgery were 67.8 and 23.8, respectively (p<0.05). During the median follow-up of 5 years, the mean degree of the disc degeneration significantly increased in all patients after surgery (p<0.05) with a Pfirrmann grade of 1 and 2.8 in the L2-L3 before and after surgery, respectively. The corresponding figures at L3-L4, L4-L5, and L5-S1 levels were 1.28 and 2.43, 1.07 and 2.35, and 1 and 2.33, respectively. The lower was the number of free discs below the fusion level, the higher was the Pfirrmann grade of degeneration (p<0.001). Conversely, the higher was the number of the discs fused together, the higher was the Pfirrmann grade. Conclusions: we observed that the disc degeneration aggravated after spinal fusion for scoliosis. While the degree of degeneration as measured by Pfirrmann grade was directly correlated by the number of fused segments, it was negatively correlated with the number of discs that remained free below the lowermost level of the fusion.