• 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.52 no.4
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• pp.339-345
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• 2012

Objective : The purpose of this study was to investigate the patterns and the risk factors of newly developed vertebral compression fractures (VCFs) after percutaneous vertebroplasty (PVP). Methods : We performed a retrospective review of the 244 patients treated with PVP from September 2006 to February 2011. Among these patients, we selected 49 patients with newly developed VCFs following PVP as the new VCFs group, and the remaining 195 patients as the no VCFs group. The new VCFs group was further divided into 2 groups : an adjacent fractures group and a nonadjacent fractures group. The following data were collected from the groups : age, gender, body weight/height, body mass index (BMI), bone mineral density (BMD) score of the spine and femur, level of initial fracture, restoration rate of anterior/middle vertebral height, and intradiscal cement leakage, volume of polymethylmethacrylate (PMMA). Results : Age, gender, mean body height/weight, mean BMI and volume of PMMA of each of the group are not statistically significantly associated with fractures. In comparison between the new VCFs group and the no VCFs group, lower BMD, intradiscal cement leakage and anterior vertebral height restoration were the significant predictive factors of the fracture. In addition, new VCFs occurrence at the adjacent spines was statistically significant, when the initial fracture levels were confined to the thoracolumbar junction, among the subgroups of new VCFs. Conclusion : Lower spinal BMD, the greater anterior vertebral height restoration rate and intradiscal cement leakage were confirmed as risk factors for newly formed VCFs after PVP.

• Journal of Korean Neurosurgical Society
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• v.63 no.2
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• pp.218-227
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• 2020

Objective : To evaluate and compare the clinical and radiographic features of 25 patients with infectious spondylitis treated with anterior debridement and reconstruction using autogenous bone grafts vs. a metal cage with allogenic bone grafts. Methods : The study analyzed 25 patients diagnosed with infectious thoracolumbar spondylitis who underwent anterior radical debridement and reconstruction. Autogenous bone grafts were used in 13 patients (group 1), and a metal cage with allogenic bone grafts was used in 12 patients (group 2). Clinical outcomes were assessed by the visual analogue scale (VAS) scores and neurological status. Additionally, the serological results and the radiographic results using the sagittal Cobb angle were compared. Fusion was evaluated by computed tomography (CT) imaging at 24 months postoperatively. Results : Both groups showed a significant decrease in the postoperative mean VAS scores; however, only, group 1 patients showed a significantly higher VAS score than group 2 patients, 1 month postoperatively (p=0.002). The postoperative neurological status significantly improved. Elevated C-reactive protein levels and erythrocyte sedimentation rate values returned to normal limits at the 2-year follow-up without recurrent infection. No significant intergroup difference was observed in Cobb angle. Bony fusion was confirmed in all patients at CT 24 months postoperatively. Conclusion : Although the use of a metal cage with allogenic bone grafts for anterior column reconstruction remains controversial, our results suggest that it can be considered as an effective treatment of option for anterior column reconstruction in patients with infectious spondylitis.

• Journal of Yeungnam Medical Science
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• v.34 no.2
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• pp.247-253
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• 2017

Approximately 10-15% of pheochromocytomas are malignant. There are insufficient histologic criteria for the diagnosis of malignant pheochromocytoma. Thus, the term malignant pheochromocytoma is restricted to tumors with local invasion or distant metastases. We experienced a case of malignant pheochromocytoma recurred with spinal metastasis 4 years after the surgery for huge benign pheochromocytoma. A 68-year-old female was admitted for trunk and back pain. The patient had a history of surgery 4 years ago for a $10.0{\times}9.5{\times}7.5cm$ sized benign pheochromocytoma at the left adrenal gland. A thoracolumbar magnetic resonance imaging showed a tumor in the 7th thoracic vertebral body and a 24-hour urinary norepinephrine increased, suggesting metastatic recurrence of malignant pheochromocytoma. After metastasectomy in the 7th thoracic vertebral body, urine catecholamine was normalized and pain also disappeared. However, a metastatic lesion was found in the paraaortic area on a follow-up abdominal computed tomography scan and an additional metastasectomy was performed. The pathology confirmed the diagnosis of metastatic pheochromocytoma in the paraaortic lymph nodes. She is supposed to be treated with adjuvant iodine 131-meta-iodobenzylguanidine therapy. In our experience, a close follow-up should be considered in patients who had a huge benign pheochromocytoma due to the possibility of malignant metastases.

• Journal of Biomedical Engineering Research
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• v.23 no.1
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• pp.17-26
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• 2002

The purpose of this study was to investigate the important Parameters of the Pedicle screw by estimating the mechanical characteristics of screws under static and dynamic loads. Methodology for estimating Parameters under static load was proposed. It was also shown that the fatigue life of the one-level system could be increased by changing the shape of screws. Load parameters of the single pedicle screw were friction force. bending moment. and holding force. The test results of the one-level system could be inferred from teat results of the sin91e screw under bending force Fatigue life of the one-level system with flexible rod was longer than that of the upper Part test without rod . Considering the drop of flexibility of the rod due to muscles and ligament, fatigue life of the one-level system could be estimated b? that of the single screw.

• Radiation Oncology Journal
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• v.4 no.2
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• pp.107-113
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• 1986

Radiation myelitis is a rather rare, but irreversible fatal complication. Etiology, pathologic change, clinical symptoms and the method of diagnosis have been studied with animal experiments and human necropsies. In spite of massive studies, pathogenesis of post-irradiation myelitis and the level of tolerance dose still remain controversial. Thoracolumbar spine of 110 hybrid mice were irradiated with orthovoltage x-ray machine. Mild capillary congestion and axonal swelling were observed in 1,000 rad irradiated specimens. Focal necrosis in 3,500 rad specimens, fragmentation of neural tissue in 4,000 rad specimens were also observed. These results suggest that 5,000 rad is not a completely safe tolerable dose which have been accepted and we cannot exclude direct radiation damage to news tissue as the causative pathology of radiation myelitis in addition to blood vessel damage.

• The Journal of Churna Manual Medicine for Spine and Nerves
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• v.5 no.2
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• pp.113-125
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• 2010

Objectives: We have evaluated the effects of conservative treatment on one patient who was diagnosed to thoraco-lumbar junction and lumbo-sacral junction transitional zone syndrome. so, we investigate thoraco-lumbar junction and Jumbo-sacral junction tranzitional zone syndrome that was suggested by Maigne R. Methods : One patient was diagnosed as T12-L1 herinated intervetebral disc through MRI. We diagnosed the patient to transitional zone syndrome by symptoms and physical examination and used Acupuncture therapy, Cox technique to the patient. We measured Visual Analog Scale(VAS) before and after treatment. Results: After treating Acupuncture therapy, Cox technique in the case, We find out that the patient was improved. VAS score changed from 7 to 2 and physical examinations are improved. Conclusions: We improved the patient who had thoraco-lumbar junction and lumbo-sacral junction transitional zone syndrome by Cox technique and Acupuncture therapy, and we found that thoraco-lumbar junction related lumbo-sacral junction.

• Nuclear Medicine and Molecular Imaging
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• v.40 no.3
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• pp.148-154
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• 2006

Purpose: Although radionuclide cisternography (RNC) is an useful study to detect cerebrospinal fluid (CSF) leakage in the patient with spontaneous intracranial hypotension (SIH), it sometimes fails to demonstrate the site of CSF leakage. The aim of the study is to improve the detection of leakage site of CSF and to reduce time for the study in RNC using modified protocol (m-RNC). Materials & methods : The study consists of 8 studies of 7 patients ($38{\pm}8$ years, M:F=2:5) with SIH, who underwent m-RNC following administration of 185-222 MBq of $^{99m}Tc$-DTPA into the lumbar subarachnoid space. Sequential images were obtained the whole spine with the head including urinary bladder at 10 minute, 30 minute, 1 hour, 2 hour, 4 hour and 6 hour. Radioactivity of extradural space and urinary bladder was evaluated. Results: Leakage site of CSF was identified in all 8 cases by m-RNC. Leakage site was cervicothoracic junction (CTJ, n=3), CTJ with C1-2 (n=2), CTJ with thoracic spine, thoracolumbar spine and lumbar spine (each n=1). All cases presented leakage sites within 1 hour and multiple sites, where CTJ was included in 6 cases. Only one case presented additional site in 6 hour image. Early radioactivity within the urinary bladder was noted in 6 cases, but that was fellowing after identification of the leakage site. Conclusion: Radionuclide cisternography is sensitive to detect the leakage site of CSF and is expected to improve the detection of CSF leakage site and reduce time for the study using modified protocol.

• Journal of Korean Neurosurgical Society
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• v.30 no.4
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• pp.451-455
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• 2001

Objectives : There have been several studies documenting the changing level of the conus throughout infancy and childhood, but there is only a little detailed study that documents the range of conus positions in a living adult population, especially in Korean, without spinal deformity. Methods : we made a sequential study of magnetic resonance images of the lumbar spine to determine the variation in position of the conus medullaris in 650 living korean adults population without spinal deformity who checked MRI to identify the cause of low back pain. The study population consisted of patients over the age of 16 years. A T1-weighted, midline, sagittal image was reviewed for identifying the postion of conus. This location was recorded in relation to the upper, middle, or lower third of the adjacent vertebral body or the adjacent intervertebral disc. Results : The study group consisted of 305 men(47%) and 345 women(53%) with a mean age 45.9 years(range, 16-79 years). The conus existed commonly at the middle third of L1(131cases, 20.2%), at the L1-2 intervertebral space(129cases, 19.8%), and the lower third of L1(123cases, 18.9%). The mean position of conus was the lower third of L1(range, middle third of T12 to middle third of L3). Conclusions : The mean position of conus was at the lower third of L1(range, middle third of T12 to middle third of L3). This results was same as that of foreign study. Our results of living korean adult population could allow for safe clinical procedures such as lumbar puncture, spinal anesthesia, and help to explain the differences among observed neurologic injuries from fracture-dislocation at the thoracolumbar junction.

• Journal of Korean Neurosurgical Society
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• v.29 no.5
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• pp.664-667
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• 2000

Objective : Excessive bleeding from the exposed cancellous bone surface may cause serious problem such as hematoma formation, infection, transfusion reaction during operation and postoperative period. There are several kinds of bleeding control agent on the cancellous bone surface including bone wax, gelatin sponge ($Gelfoam^{(R)}$), oxidized cellulose($Oxycel^{(R)}$, $Surgicel^{(R)}$), thrombin, microfibrillar collagen($Avitene^{(R)}$) etc. In the past, bone wax was used to control bone bleeding but it is associated with increased infection rate and fusion failure. Recently, gelfoam paste has been used to control cancellous bone bleeding. We controlled the cancellous bone bleeding with the mixture of gelfoam powder and thrombin powder. Material and Methods : Seventeen patients of posterior fusion on the 4 motion segments of thoracolumbar spine were selected to compare the result of bone bleeding control. In the test group of 9 patients, the cancellous bone bleeding was controlled with the mixture of Gelfoam and thrombin powder during operation. In the control group of 8 cases, no chemical hemostatic agent was used to manage the bone bleeding during operation. We calculated the total amount of bleeding from cancellous bone surface during and after operation in the two groups and compared their statistic significance of the result which was judged by student t-test. Results : The average amount of intraoperative bleeding was 1825ml in control group, 811ml in test group(p<0.01). The amount of postoperative bleeding was 943ml in control group and 812ml in test group, there were no significant difference in the amount of bleeding during postoperative period between two groups(p>0.5). Total amount of blood was decreased in as much as 1150ml in test group(p<0.01). Conclusion : We concluded that the application of the mixture of thrombin and gelfoam powder on the cancellous bone surface is the effective control method of cancellous bone bleeding for multilevel posterior spinal fusion.