• 대한정형외과학회지
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• 제55권4호
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• pp.348-353
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• 2020

68세 남자 환자가 허리의 피부에서 고름을 동반한 욕창으로 내원하였다. 초진시 일반 방사선상 제4요추체의 광범위한 파괴 소견과 자기공명영상 촬영에서 제4요추 척추체의 결손 부위에 고인 조영 증강된 많은 양의 액체가 양측 요근 및 후관절까지 확장된 소견을 보였다. 신경병성 척추병증으로 일차 진단하였으나 농양을 동반한 감염성 척추염을 배제할 수 없어 정맥 항생제를 2주 투여하였다. 자기공명영상을 재촬영한 결과 농양의 크기는 줄어 들지 않아 수술적 치료로 진행하였다. 샤르코 척추 관절병증은 광범위한 척추체 파괴를 일으켜 감염성 척추염과 유사한 소견을 보일 수 있으며 특히 척추체 불안정으로 인한 경막 파열로 뇌척수액이 축적되면 감별이 어려울 수 있어 이 증례를 보고하는 바이다.

• Journal of Trauma and Injury
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• 제35권1호
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• pp.56-60
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• 2022

The most common cause of foot drop is lumbar degenerative disc herniation, particularly at L4/5. We present a rare case of spinal cord injury accompanied by a thoracolumbar lesion that presented with bilateral foot drop. A 69-year-old male patient presented with sudden-onset severe bilateral leg pain and bilateral foot drop. Radiologic findings revealed T12 spondylitis compressing the conus medullaris. He had undergone vertebroplasty for a T12 compression fracture after a fall 6 months before. A physical examination showed bilateral foot drop, paresthesia of both L5 dermatomes, increased deep tendon reflex, and a positive Babinski sign. An acute bilateral L5 root lesion and a conus medullaris lesion were suspected based on electromyography. A surgical procedure was done for decompression and reconstruction. After the operation, bilateral lower extremity muscle strength recovered to a good grade from the trace grade, and the patient could walk without a cane. The current case is a very rare report of bilateral foot drop associated with T12 infectious spondylitis after vertebroplasty. It is essential to keep in mind that lesions of the thoracolumbar junction can cause atypical neurological symptoms. Furthermore, understanding the conus medullaris and nerve root anatomy at the T12-L1 level will be helpful for treating patients with atypical neurological symptoms.

• Journal of Korean Neurosurgical Society
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• 제56권6호
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• pp.517-520
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• 2014

Cauda equina syndrome (CES) associated with dural ectasia is a rare neurologic complication in patients with longstanding ankylosing spondylitis (AS). We report a 68-year-old male with a 30-year history of AS who presented a typical symptom and signs of progressive CES, urinary incontinence and neuropathic pain of the lumbosacral radiculopathy. Computed tomography (CT) and magnetic resonance imaging (MRI) findings showed the unique appearances of dural ectasia, multiple dural diverticula, erosion of posterior element of the lumbar spine, tethering of the conus medullaris and adhesion of the lumbosacral nerve roots to the posterior aspect of the dural ectasia. Considering the progressive worsening of the clinical signs, detethering of the conus medullaris through resection of the filum terminale was performed through a limited laminectomy. However, the urinary incontinence did not improve and there was a partial relief of the neuropathic leg pain only. The possible pathogenetic mechanism of CES-AS and the dural ectasia in this patient with longstanding AS are discussed with a literature review.

• 대한의용생체공학회:의공학회지
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• 제14권3호
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• pp.235-242
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• 1993

In the early stage of sacroilitis, it is'difficult to detect sacroiliac(Sl) abnormalities by conventional plain X-ray even though there are characteristic symptoms of ankylosing spondylitis. 3 dimensional volume rendering from the CT image was performed to make an early de tection of the structural changes of Sl joint. 2 cases who had clinical impression of ankylosing spondylitis without sacroilitis in plane X-ray and 1 case of typical ankylosing spondylitis as well as 1 case of normal control were studied. The Sl Joints were separated and each joint surface of sacrum and ilium was independently reconstructed by a special 3D manipulation program. All 2 patiant who complained of inflammatory lower back pain with no abnormal findings in the plain X-ray showed structural changes in 3 dimensionally reconstructed surface Image of the Sl joint compared to the normal control. Authors tried several parameters, such as fourler analysis of each surface and the mean and variance of Sl joint gap. We couldn't tell the statistical significance because of the limited number of cases. However, the parameters showed difference according to the progression of disease.

• Imaging Science in Dentistry
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• 제30권3호
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• pp.217-222
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• 2000

A 31-year-old male with the complaint of severe limitation of mouth opening was referred to our department of Chonbuk National University Hospital. The physical status of the patient was hyposthenic. Extraoral examination showed no condylar movement of the both temporomandibular joints, no pain, no facial swelling or paresthesia. Intraoral examination showed several cervical caries on the upper anterior teeth, and gingival swelling on the whole dentition. Transcranial view showed no condylar movement, and narrowing of joint spaces. Chest P-A view showed straightening of thoracic, lumbar spine, and squaring of vertebrae of the same spines. Conventional lateral radiograph of cervical spine showed calcification of the intervertebral ligament. Computed tomograph showed extensive bone formation between temporal bone and the condylar head at both sides. Laboratory findings showed positive reaction on HLA-B27 histocompatibility antigen and increased level of IgA, IgG, ESR. Based on the clinical, radiographic, and the laboratary findings, final diagnosis was made as bony ankylosis of the both temporomandibular joints secondary to ankylosing spondylitis.

• Journal of Korean Neurosurgical Society
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• 제50권1호
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• pp.54-56
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• 2011

Ankylosing spondylitis (AS) is frequently associated with inflammatory lesions of the spine and continuous fatigue stress fractures; however, an association with an intraspinal synovial cyst has not been previously reported. A 55-year-old man with a five year history of AS who presented with back pain and a right radiculopathy was admitted to the hospital. Five years previously, he underwent a percutaneous vertebroplasty for an osteoporotic L1 compression fracture, and was diagnosed with AS at that time. Plain radiographs showed aggravated kyphosis and a stress fracture through the ossified posterior element, below the prior vertebroplasty. Magnetic resonance images revealed a right foraminal cystic lesion at the L2-L3 level with effacement of the nerve root. A 1.6 cm cystic lesion that appeared to arise from the L2-L3 facet joint without direct communication was excised from the L2-L3 foramen. Pathological examination confirmed synovial cyst. The patient's symptoms resolved immediately after surgery except for a mild dysesthesia of the right leg. We report herein a rare case of foraminal synovial cyst associated with AS accompanying posterior element fracture with a review of literature.

• Journal of Korean Neurosurgical Society
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• 제50권5호
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• pp.460-463
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• 2011

There are few reported cases of post-operative spondylitis caused by $Mycobacterium$ $Intracellulare$. A 75-year-old female presented to our hospital with low back pain and paraparesis after a fall. The radiologic examination revealed compression fractures of L1, L3 and L4 and an epidural hematoma compressing the spinal cord. The dark-red epidural hematoma was urgently evacuated. Four weeks post-operatively, neurologic deficits recurred with fever. On magnetic resonance image, an epidural abscess and osteomyelitis were detected in the previous operative site. Five weeks post-operatively, revision was performed with multiple biopsies. The specimen were positive for acid-fast bacilli and traditional anti-tuberculous medications were started. Because the Polymerase Chain Reaction for non-tuberculous mycobacterium (NTM) was positive, the anti-tuberculous medications were changed to anti-NTM drugs. However, the neurologic deficits did not improve and persistent elevation of erythrocyte sedimentation rate and C-reactive protein were noted. Eight weeks after the revision, $Mycobacterium$ $Intracellulare$ was detected in the specimen cultures. Despite supportive care with medication, the patient died due to multiple organ failure.

• Maxillofacial Plastic and Reconstructive Surgery
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• 제34권6호
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• pp.455-461
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• 2012

Ankylosing spondylitis (AS) is a chronic autoimmune disease mainly involving the axial skeleton. The pathology of the disease is usually found at the sacroiliac joint, and half of the patients experience cervical spine invasion, but eventually, the whole spine is affected. The involvement of the temporomandibular joint (TMJ) in AS has not been investigated very well. A review of the literature revealed that there are only a few studies of TMJ involvement in AS that combined clinical and radiographic examinations. These studies show widely different results, ranging between 4% and 32%. We experienced Bilateral osseous ankylosis of the jaw treated by total alloplastic joint replacement in AS, and offer a case report.

• The Korean Journal of Pain
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• 제20권2호
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• pp.219-223
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• 2007

Vertebroplasty and kyphoplasty are well-known, useful techniques for the treatment of painful vertebral compression fractures. Although the risk associated with these procedures is low, serious complications can occur. Of these complications, infection is even rarer, however, when it does occur, it is difficult to manage and can become life-threatening. We describe here a case of infectious spondylitis with epidural inflammation that occurred after performing kyphoplasty in a patient who had a thoracic vertebra compression fracture. We reviewed other case and literatures. Extreme asepsis of the operating theater, screening and treatment for systemic infection prior to the procedure, as well as the use of appropriate antibiotic prophylaxis are strongly recommended when conducting kyphoplasty to prevent infection.

• Genomics & Informatics
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• 제15권2호
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• pp.65-68
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• 2017

Ankylosing spondylitis (AS) is a chronic autoinflammatory disease that affects the spine and sacroiliac joints. Regarding its etiology, although HLA-B27 is known to be the strongest genetic factor of AS, much evidence suggests the potential contribution of non-MHC genes to the susceptibility to AS. Most of these non-MHC genes have been discovered in non-Asian populations; however, just some of them have been validated in Koreans. In this study, we aimed to identify additional AS-associated single-nucleotide polymorphism (SNP) candidates by replicating the candidate SNPs in Korean AS patients and healthy controls. For this, we selected three SNPs (rs11249215 in RUNX3, rs6556416 in IL12B, and rs8070463 in TBKBP1), which were previously reported as risk factors of AS but have not been studied in Koreans, and performed genotyping assays using a total of 1138 Korean samples (572 AS patients and 566 healthy controls). Of the three SNP candidates, one SNP in RUNX3 (rs11249215) was significantly associated with the risk of AS (odds ratio, 1.31; 95% confidence interval, 1.02 to 1.68, p = 0.03). These results will be helpful in elucidating the pathogenesis of AS and may be useful for developing AS risk prediction models in Koreans.