Late-Onset Candida Vertebral Osteomyelitis in Two Young Patients Who Underwent Heart Transplant Surgery / 대한정형외과학회잡지

Candida vertebral osteomyelitis (CVO) is a rare disease that is a complication of intravenous drug use, but recently it has been recognized as mostly an opportunistic infection. Because CVO appears to mimic pyogenic spondylodiscitis in terms of the clinical and radiologic presentations, it is often neglected in a usual clinical setting. The clinical, radiological, and biological characteristics of CVO are often used to make a differential diagnosis with vertebral osteomyelitis from other etiologies. Once an initial proper diagnosis was performed, the treatment relies on the prompt initiation of appropriate pharmacotherapy and serial monitoring of the clinical progress. This paper report late-onset CVO in two young patients who underwent a heart transplant surgery and had postoperative systemic candidiasis. These two cases are a good reminder of the potential of CVO in immunosuppressive patients treated with anti-fungal agents. This paper presents these two cases with a review of the relevant literature.

The Therapeutic Effect of Postganglionic Nerve Block for Symptomatic Schmorl Nodule: A Retrospective Case Series

OBJECTIVES@#We retrospectively evaluated the clinical efficacy of postganglionic nerve block in symptomatic Schmorl nodules (SNs).SUMMARY OF LITERATURE REVIEW: SNs are common lesions that are often asymptomatic. In certain cases, SNs have been reported to cause severe axial back pain, thereby considerably impacting patients' quality of life. No consensus currently exists on the treatment of symptomatic SNs.@*MATERIALS AND METHODS@#From October 2015 to October 2017, a total of 21 patients with symptomatic SNs diagnosed by magnetic resonance imaging (MRI) that did not respond to conservative treatment after 4 weeks were included in the study. All patients received postganglionic nerve block. We evaluated effective pain relief (improvement of back pain of more than 50% compared with before the intervention) and functional improvements, assessed by visual analogue scale (VAS) and Oswestry Disability Index scores obtained at 4 hours, 4 weeks, 8 weeks, 3 months, and 6 months after the procedure.@*RESULTS@#Symptomatic SNs were more common at the L2-3 level, and the lower end plate was more commonly involved than the upper end plate. Eighteen of the 21 patients (85.7%) showed effective pain relief, and no deterioration was observed within the follow-up period. Throughout the follow-up period, the VAS remained significantly improved compared to before the procedure (p < 0.05). Complications were not reported in any cases.@*CONCLUSIONS@#Postganglionic nerve block for symptomatic SNs that do not respond to conservative treatment is a non-invasive modality for pain relief.

The Therapeutic Effect of Postganglionic Nerve Block for Symptomatic Schmorl Nodule: A Retrospective Case Series

STUDY DESIGN: Retrospective case series. OBJECTIVES: We retrospectively evaluated the clinical efficacy of postganglionic nerve block in symptomatic Schmorl nodules (SNs). SUMMARY OF LITERATURE REVIEW: SNs are common lesions that are often asymptomatic. In certain cases, SNs have been reported to cause severe axial back pain, thereby considerably impacting patients' quality of life. No consensus currently exists on the treatment of symptomatic SNs. MATERIALS AND METHODS: From October 2015 to October 2017, a total of 21 patients with symptomatic SNs diagnosed by magnetic resonance imaging (MRI) that did not respond to conservative treatment after 4 weeks were included in the study. All patients received postganglionic nerve block. We evaluated effective pain relief (improvement of back pain of more than 50% compared with before the intervention) and functional improvements, assessed by visual analogue scale (VAS) and Oswestry Disability Index scores obtained at 4 hours, 4 weeks, 8 weeks, 3 months, and 6 months after the procedure. RESULTS: Symptomatic SNs were more common at the L2-3 level, and the lower end plate was more commonly involved than the upper end plate. Eighteen of the 21 patients (85.7%) showed effective pain relief, and no deterioration was observed within the follow-up period. Throughout the follow-up period, the VAS remained significantly improved compared to before the procedure (p < 0.05). Complications were not reported in any cases. CONCLUSIONS: Postganglionic nerve block for symptomatic SNs that do not respond to conservative treatment is a non-invasive modality for pain relief.

Cauda Equina Syndrome by Facet Synovial Pseudocyst Secondary to Epidural Injection / 대한정형외과학회잡지

A 77-year-old woman presented with bilateral leg weakness, accompanied by severe axial back and radicular pain, after a L4–5 epidural injection. She had been receiving misappropriated epidural injections for the last few months. A contrast-enhanced magnetic resonance image showed rim enhancing, spinal canal compromising cystic lesion at the posterior epidural space of L4–5. During surgery, a severely central compromised non-communicating cystic lesion located at posterior epidural space was resected. A histological report of this lesion confirmed a pseudocyst containing a degenerated synovial tissue. Herein, we report our experience of cauda equine syndrome after epidural injection with successful treatment.

Influence of Recombinant Human Bone Morphogenetic Protein-2 on the Remodeling of Subchondral Bone and Cartilage Healing in the Articular Cartilage Defect of the Rabbit / 대한정형외과학회잡지

PURPOSE: The purpose of this study is to evaluate the effects of recombinant human bone morphogenetic protein-2 (rhBMP-2) after microfracture on the remodeling of subchondral bone and cartilage healing in a model of full-thickness articular cartilage injury in a rabbit. MATERIALS AND METHODS: A full thickness articular cartilage defect of 6x3-mm-size was created in the trochlear groove of the right femur in 24 rabbits. The defect was left empty in six rabbits, and microfracture was done in 18 rabbits. After microfracture, no treatment was done in six rabbits, defect was filled with fibrin glue in six rabbits, and with fibrin glue and rhBMP-2 in six rabbits. The effect of rhBMP-2 after microfracture was evaluated based on histological analysis and real-time polymerase chain reaction (PCR) for analysis of collagen type at 8 weeks after surgery. RESULTS: The score of histological grade scale of six rabbits in which the defect was filled with fibrin glue and rhBMP-2 was better than that of others and real-time PCR also showed a higher amount of collage type 1 and collage type 2 in these six rabbits. CONCLUSION: We consider that fibrin glue and rhBMP-2 after microfracture may accelerate cartilage healing in an articular cartilage defect and maybe helpful in healing the articular cartilage defect into more closely native hyaline cartilage.

Carpal Tunnel Syndrome / 대한정형외과학회잡지

Carpal tunnel syndrome is the most common peripheral nerve entrapment syndrome. The elevated pressure in the carpal tunnel causes compression of median nerve. Although the diagnostic criteria for carpal tunnel syndrome are not clear, the diagnosis is based on the patient history and physical examination and may be confirmed by electrodiagnosis with nerve conduction test or ultrasonography. Nonsurgical treatments are generally recommended for early carpal tunnel syndrome and surgical treatments are preferred for failed nonsurgical treatment, however there is controversy regarding the optimal time when the surgery should be performed. Results of surgical treatment are usually satisfactory, however there are also complications after surgical treatment. In order to achieve good results without complications, normal anatomy around the median nerve and its anatomical variations should be thoroughly understood before the operation and careful surgical technique is absolutely required.

Operative Treatment in the Delayed Diagnosed Fracture and Dislocation of Hamatometacarpal Joint

PURPOSE: The purpose is to evaluate and report the results that treated with open reduction and internal fixation in delayed diagnosed fracture and dislocation of the hamatometacarpal joint. MATERIALS AND METHODS: We evaluated 12 cases that had been treated with open reduction and internal fixation in delayed diagnosed fracture and dislocation of the hamatometacarpal joint. The mean interval between injury and operation was 34 days (21~60 days), the mean age of 12 cases was 28.1 years old, and mean follow-up period was 18 months. The computer tomography was done in all cases and the fracture and dislocation types were classified by Cain's classification. For the evaluation of results, pain scale, grasping power, range of motion of wrist and metacarpophalangeal joint were analyzed preoperatively and at final follow up, and the arthritic change of the hamatometacarpal joint was also checked. RESULTS: According to Cain's classification, type Ia was one case, type Ib was two, type II was six, and type III was three. The pain scale was improved from 7.75 preoperatively to 0.92 at last follow up. The mean grasping power was improved up to 97.5% of normal. The preoperative range of motion of the wrist joint measured to be 60 degrees in extension and 70 degrees in flexion; the final range of motion indicated to be 75 degrees in extension and 80 degrees in flexion. The preoperative range of motion of the metacarpophalangeal joint measured to be 0 degrees in extension and 70 degrees in flexion; the final range of motion indicated to be 0 degrees in extension and 85 degrees in flexion. Carpometacarpal arthritis was developed in two cases. CONCLUSION: The open reduction and internal fixation is considered as one of good treatment option in the delayed diagnosed hamatometacarpal fracture and dislocation.

Helical Blade versus Lag Screw for Treatment of Intertrochanteric Fracture

PURPOSE: To evaluate the radiographic and functional outcomes between who had unstable intertrochanteric fracture, treated with the ITST (lag screw design) and the PFNA (helical blade design). MATERIALS AND METHODS: We selected each 17 and 13 patients of unstable intertrochanteric fracture which were treated with ITST or PFNA from April 2005 to December 2008. We evaluated the radiographic results by follow-up radiography and the clinical outcomes with the mobility score of Parker and Palmer, Social function scoring system. RESULTS: The mean sliding distance of cervical screw with ITST nails was not shown significant differences than with using PFNA nails. The other factors were not statistically different. Decrease of mobility score of Parker and Palmer, Social function score were similar. 2 cases of cutting out was noted with ITST nails and 1 case of cutting out was noted with PFNA nails. CONCLUSION: Unlike the existed biomechanical reposts, there are no differences that are clinical and radiological results in treatment of unstable intertrochanteric fracture using the ITST nails and PFNA nails.

Bipolar Hemiarthroplasty for the Femoral Neck Fractures in Elderly Patients

PURPOSE: To evaluate the clinical results of bipolar hemiarthroplasty in elderly patients more than 65 years of age with a femoral neck fracture. MATERIALS AND METHODS: Forty-six bipolar hemiarthroplasties in 43 patients more than 65 years of age which could be followed more than 3 years were included in this study. The clinical outcomes were evaluated using Harris hip score, pain score and support score. The radiological results were analyzed by femoral stem loosening and bipolar cup migration. RESULTS: The average Harris hip score was 88.7 (62~96) points. An excellent score was recorded in 34 cases, good in 7 cases, fair in 3 cases and poor in 2 cases. The average pain score was 39.3 points and there were no pain in 20 cases, slight pain in 17 cases, mild pain in 6 cases and moderate pain in 2 cases. The average support score was 9.6 points and 32 patients could walk without the use of any assistive devices. Two cases were converted to total hip arthroplasty due to femoral stem loosening with or without bipolar cup migration. CONCLUSION: For the early ambulation and functional recovery of elderly patients with femoral neck fracture, bipolar hemiarthroplasty was considered as one of recommendable methods.

Evaluation of the Radiographic Contributing Factors of Hallux Valgus Interphalangeus / 대한족부족관절학회지

PURPOSE: To statistically evaluate the contributing role of the 3 radiographic factors (Obliquity, Asymmetry, Joint deviation) of the hallux valgus interphalangeus with comparison to the normal control group. MATERIALS AND METHODS: The study is based on the standing foot AP radiographs of the 77 feet (56 patients) of the hallux valgus interphalangeus out of 119 feet of randomly sampled patients of the age range 20 to 60. Fractures or other foot disorders have been excluded. Obliquity, asymmetry and joint deviation factors formed by proximal and distal phalanges of hallux are measured by one observer and evaluated the statistical significance of the contribution of the 3 factors to the hallux interphalangeal angle (HIA). RESULTS: The average age of the patients were 36.0 years old and average HIA was 14.5 degrees +/- 2.8 degrees. Obliquity was measured 4.8 degrees +/- 2.90 degrees, asymmetry 8.2 degrees +/- 3.28 degrees and joint deviation 2.0 degrees +/- 1.85 degrees. All 3 factors showed the statistical significance as the contributing factors to the HIA and among them, the asymmetry played the biggest role (p<0.05). CONCLUSION: Hallux interphalangeal angle is formed by 3 radiographic factors (Obliquity, Asymmetry, Joint deviation), and among them the asymmetry factor plays the biggest role.

Triceps-Sparing Posterior Approach for Intra-articular Fracture of Distal Humerus

PURPOSE: To evaluate the therapeutic results of intra-articular fracture of distal humerus treated through triceps sparing posterior approach. MATERIALS AND METHODS: From February 2001 to December 2003, we reviewed total 9 cases of intra-articular fracture of distal humerus, which were treated by surgical treatment and were followed more than for 12 months. According to the OTA classification, nine cases were classified as type A; two, as type C1; five, as type C2; two. Triceps sparing posterior approach was used in all nine patients. An extensile posterior incision was used over the olecranon without triceps muscle injury. Exposure of the fracture site was done by obtaining medial-lateral mobility through dissection of medial and lateral edge of triceps muscle. Therapeutic results were assessed by bone union, duration for fracture union, complication. and for functional estimation, Mayo elbow performance score was checked and analysed. RESULTS: The range of the elbow joint motion was flexion contracture 5.2 degree to further flexion 135.5 degree on average. Clinical results using Mayo elbow performance score were as follows; six excellent, three good. Compressive neuropathy of ulnar nerve which has been done anterior transposition was observed in one patient. CONCLUSION: Triceps sparing posterior approach is useful surgical technique that provides sufficient exposure of medial and lateral condyle without injury of triceps muscle in intra-articular fracture of distal humerus to the extent of OTA type C2.

Radiologic Result of Treatment of Intertrochanteric Fracture Using Compression Hip Screw: Involvement of Lateral Cortex

PURPOSE: To assess the meaning of the unstable intertrochanteric fracture of femur with involvement of lateral cortex by analysing the radiologic result of the surgical treatment using a compression hip screw. MATERIALS AND METHODS: Classifing patients (who has taken the surgical treatment for intertrochanteric fracture of femur using compression hip screw from January 1999 to June 2002) in our hospital with 24 patients who had not much difference statistically in the compression screw located within the femur, Tip-Apex distance (TAD) the Singh Numerical Value of osteoporosis. The results were divided into two groups, group A (without fracture extends through lateral cortex of femur: 16 cases) and B (fracture extends through lateral cortex of femur: 8 cases), when analyzing it. And then analyzed the final examination in the evaluation of electrical potential level by radiology, change of the inside and outside of neck-shaft angle, descent level of the screw and the change of the neck-shaft angle. RESULTS: In the latest follow up, the sliding amount of the screw in group B, the average was 14.9+/-9.3 mm, and 6.7+/-3.6 mm in group A. There was no difference statistically (p value>0.05). In the varus change in group B, the average was 8.00+/-8.12degrees and in group A it ws 2.75+/-2.63degrees There was statistical difference(p value<0.05). In displacement after operation, it was 7.60+/-2.61 mm in group B and 0.5+/-1.80 mm in group A. There was statistical difference (p value<0.05). CONCLUSION: The intertrochanteric fracture with involvement of lateral cortex of femur have to be considered as unstable fracture having tendency of displacement.

In Vivo Effect of Intra-Tendinous Thermal Shrinkage on the Rabbit Patellar Tendon / 대한정형외과학회잡지

PURPOSE: In this vivo animal study, the authors evaluated the effect of thermal shrinkage on the rabbit patellar tendon using modified approaches involving intra-tendinous thermal treatment and protective immobilization. METHODS AND MEASURES: Of 30 New Zealand white rabbit patellar tendons, Twenty-five rabbits underwent tendon immobilization by fixation of the patella to the femur after thermal shrinkage of the right-side patellar tendon. Ten rabbits of those were sacrificed at 4 weeks and the other fifteen rabbits at 8 weeks. The left-side patellar tendon of twenty-five rabbits were underwent sham-control except thermal treatment. The rate of shrinkage and maximal peak stress and linear stiffness by unit area were assessed in these twenty-five rabbits. Differences between groups were statistically analyzed. Light and transmission electron microscopy examination were evaluated in all of thirty rabbits. RESULTS: The shrinkage rate immediately after thermal treatment did not change significantly at 4 and 8 weeks. The mean maximal tensile stress and linear stiffness at 8 weeks (372.30+/-164.37 N/m2 and 214.60+/-142.52 N/mm) were significantly higher than those measured at 4 weeks (233.84+/-91.12 N/m2 and 196.70+/-72.10 N/mm, respectively) allthough those were diminished when it compared with those of sham control group. Numerous collagen fibers with medium diameters and myofibroblasts indicative of a healing process were observed on histologic examination at 8 weeks. CONCLUSION: Intra-tendinous thermal shrinkage combined with a period of protective immobilization may be one of positive concern for prevention of re-stretching phenomenon as time goes by.

Necrotizing Fasciitis of the Low Extremity / 대한정형외과학회잡지

PURPOSE: To describe the clinical presentation and course of necrotizing fasciitis of low extremity and to analyze the factors affecting the clinical result of necrotizing fasciitis. MATERIALS AND METHODS: The medical records and MRI of 26 patient who had suffered from necrotizing fasciitis were reviewed retrospectively. RESULTS: There were 18 men and 8 women with a mean age of 43.8 years. Twenty two of 26 patients had a medical disease and the most common comorbidity was diabetes mellitus. Exquisite pain, erythema, warm skin were the most consistent clinical feature at the time of admission. Only six patients had a diagnosis of necrotizing fasciitis initially. The interval between onset of symptom and operative treatment was average 5.4 days in 20 patients who didn't have a diagnosis of necrotizing fasciitis initially, and among them, 2 patients died. There were limited range motion of knee joint in 3 cases, sacral osteomyelitis in 1 case, and sciatic nerve palsy in 1 case as a complication. CONCLUSION: We think that the diagnosis of necrotizing fasciitis should be considered with a high index of suspicion in patients who present with unexplained limb pain, and delay in operative treatment and wide involvement of the necrosis is associated with poor results of necrotizing fasciits.

Transforaminal Lumbar Interbody Fusion for the Treatment of Nonunion after Posterolateral Lumbar Fusion / 대한척추외과학회지

STUDY DESIGN: A retrospective study OBJECTIVES: To evaluate the clinical and radiological results of a transforaminal lumbar interbody fusion for the treatment of non-union after a posterolateral spinal fusion. LITERATURE REVIEW SUMMARY: In the case of nonunion after a posterolateral spinal fusion, the anterior column should be reconstructed. However, due to epidural scarring and fibrosis, the approach to the anterior column by conventional posterior lumbar interbody fusion (PLIF) is difficult. The authors have modified the original transforaminal lumbar interbody fusion (TLIF) developed by Dr. Harms, which offers potential advantages and provides a surgical alternative to the traditional methods. MATERIALS AND METHODS: Between January 2002 and August 2003, 10 cases of TLIF for the treatment of non-unions after a posterolateral spinal fusion were performed. There were 8 male and 2 female cases. The mean age of the patient was 63.3 years, ranging from 53 to 75 years. The levels of the TLIF were the L4-5 and L5-S1 in 9 and 1 cases, respectively. The mean interval between the revision and previous operations was 21.3 months, ranging 12 to 48 months. In the preoperative radiography, bony defect in posterolateral fusion mass, halos around screws and abnormal motions in the stress view were observed. Using the previous midline approach, exposure of the bilateral articular and transverse processes were performed. With a small osteotome, the superior articular process was removed along a line parallel to the superior margins of the pedicular screw head, to allow access to the neural foramen and lateral aspect of the disc space. The TLIF was performed through this space by inserting cages. The loosened screw was replaced by one that was thicker, coupled with a cancellous bone graft in the foramen. RESULTS: The average operation time and blood loss were 224 min. and 727 cc, respectively. Using Kirkaldy-Willis categories, the results were excellent in 1 case, good in 7, fair in 1 and poor in a further 1 case, with 1 case of nonunion was observed postoperatively. CONCLUSIONS: The transforaminal lumbar interbody fusion for the treatment of nonunion after a posterolateral spinal fusion is a reliable and safe technique, which seems to have the merit of less morbidity.

Transforaminal Lumbar Interbody Fusion for the Treatment of Nonunion after Posterolateral Lumbar Fusion / 대한척추외과학회지

STUDY DESIGN: A retrospective study OBJECTIVES: To evaluate the clinical and radiological results of a transforaminal lumbar interbody fusion for the treatment of non-union after a posterolateral spinal fusion. LITERATURE REVIEW SUMMARY: In the case of nonunion after a posterolateral spinal fusion, the anterior column should be reconstructed. However, due to epidural scarring and fibrosis, the approach to the anterior column by conventional posterior lumbar interbody fusion (PLIF) is difficult. The authors have modified the original transforaminal lumbar interbody fusion (TLIF) developed by Dr. Harms, which offers potential advantages and provides a surgical alternative to the traditional methods. MATERIALS AND METHODS: Between January 2002 and August 2003, 10 cases of TLIF for the treatment of non-unions after a posterolateral spinal fusion were performed. There were 8 male and 2 female cases. The mean age of the patient was 63.3 years, ranging from 53 to 75 years. The levels of the TLIF were the L4-5 and L5-S1 in 9 and 1 cases, respectively. The mean interval between the revision and previous operations was 21.3 months, ranging 12 to 48 months. In the preoperative radiography, bony defect in posterolateral fusion mass, halos around screws and abnormal motions in the stress view were observed. Using the previous midline approach, exposure of the bilateral articular and transverse processes were performed. With a small osteotome, the superior articular process was removed along a line parallel to the superior margins of the pedicular screw head, to allow access to the neural foramen and lateral aspect of the disc space. The TLIF was performed through this space by inserting cages. The loosened screw was replaced by one that was thicker, coupled with a cancellous bone graft in the foramen. RESULTS: The average operation time and blood loss were 224 min. and 727 cc, respectively. Using Kirkaldy-Willis categories, the results were excellent in 1 case, good in 7, fair in 1 and poor in a further 1 case, with 1 case of nonunion was observed postoperatively. CONCLUSIONS: The transforaminal lumbar interbody fusion for the treatment of nonunion after a posterolateral spinal fusion is a reliable and safe technique, which seems to have the merit of less morbidity.

Treatment of Osteoporotic Vertebral Collapses of the Thoracolumbar Spine with Neurologic Deficits using Anterior Approach / 대한척추외과학회지

STUDY DESIGN: Retrospective OBJECTIVES: To evaluate the clinical and radiological results of treatment for thoracolumbar spine fractures, with neurological deficits, using an anterior approach in a senile osteoporotic spine. SUMMARY OF BACKGROUND DATA: With osteoporotic vertebral collapses, an operative treatment may be indicated for lesions that are considered unstable, especially if there is spinal canal compromise with neurological deficits. As for the treatment of these cases, a posterior approach destabilizes, and increases, the kyphotic deformity, resulting in the need for a longer fusion period. A combined anterior-posterior approach increases the morbidity. A one stage anterior decompression and anterior reconstructive stabilization is often the most reasonable operative choice. MATERIALS AND METHODS: Between January 1999 and August 2001, 12 cases of thoracolumbar osteoporotic vertebral collapse, with neurological deficits, were performed. There were 10 female and 2 male cases. The mean age for the patient was 69.3 years, ranging from 60 to 79 years. The numbers of each level of fractured vertebrae were; 2, 5, 4 and 1, in eleventh thoracic, twelfth thoracic, first lumbar and second lumbar vertebrae, respectively. All patients reported minor injury or trauma, and the average interval between injury and operation was 8.3 months, ranging from 1 to 36 months. There were 4 and 8 cases of neurological deficits in the Frankel D2 and D3 groups, respectively. The average preoperative local kyphotic angle was 23.8 degrees, ranging from 5 to 35 degrees, with a 66% loss in height, ranging from 42 to 83%). The average T score from the Bone Densitometry was -3.7 S.D, ranging from -3.2 to -4.4. The operations were performed by an extrapleural-retroperitoneal approach. The anterior instrumentation was performed with the Kaneda system and a titanium mesh cage. All cases were followed for more than 12 months. RESULTS: All cases had a solid bony fusion. The immediate postoperative average local kyphotic angle was 10.3 degrees, ranging from -14 to 22 degrees, and the correction loss at the last follow-up was 2.6 degrees, ranging from 0 to 9 degrees. All 12 patients with incomplete preoperative neurological deficits improved, postoperatively, to Frankel group E. CONCLUSIONS: The one stage anterior spinal decompression and reconstruction, with a Kaneda instrument and a titanium mesh cage, afforded enough stability in patient with an osteoporotic vertebral collapse to enable early ambulation and to achieve realignment and solid fusion, and seems to have merit in the neurological recovery following an operation.

Three-level Anterior Cervical Discectomy and Fusion with Cervical Plate / 대한척추외과학회지

STUDY DESIGN: Retrospective study. OBJECTIVES: To evaluate the clinical and radiological outcomes by the method of three-level anterior cervical discectomy and fusion with cervical plate. SUMMARY OF LITERATURE REVIEW: The arthrodesis rate and outcome for patients having three-level anterior cervical discectomy and fusion procedures is disappointing. The success of arthrodesis depends on several factors including bone graft type, size, and additional anterior plate fixation. MATERIALS AND METHODS: Five patients (average age, 69 years; all males) were observed. All had a anterior discectomy, placement of autogenous tricortical iliac bone graft at three-levels and application of a Orion plate. Clinical and radiologic results of bony union, cervical lordosis and intervertebral disc height were assessed. RESULTS: All clinical symptoms of patients had been resolved after operation. The postoperative scores by the criteria of Odom are 2 in excellent and 3 in good. The bony unions were achieved in all cases in the average 12 weeks after surgery (minimum 8 weeks, maximum 20 weeks). The sum of three-level intervertebral disc height in average was increased from 14.8 mm preoperatively to 25.4 mm postoperatively. The average angle of cervical lordosis was corrected from 18o preoperatively to 27o postoperatively. CONCLUSIONS: The three-level anterior cervical discectomy and fusion with Orion plate and autogenous tricortical iliac bone graft results in effective surgical treatment, which produces good clinical outcome, early and solid bony union, restoration of the normal cervical lordosis and disc space height.

Reconstruction of Lumbar Kyphosis with circumferential Fusion by Posterior-Anterior-Posterior Approach / 대한척추외과학회지

STUDY DESIGN: Six patients with the lumbar kyphosis who underwent the circumferential fusion by posterior-anterior-posterior method were reviewed retrospectively from January 1998 to June 1999. OBJECTIVES: To determine whether patients with lumbar kyphosis can be successfully treated by circumferential fusion by posterior-anterior-posterior method. SUMMARY OF LITERATURE REVIEW: In the lumbar kyphosis, many procedures have been reported to correct the deformity, including multiple osteotomy, transpedicular vertebral resection, posterior interbody fusion, etc. Circumferential fusion by posterior-anterior-posterior method is suggested in this report as a valuable technique for excellent deformity correction and maintenance. MATERIAL AND METHODS: The surgery consists of posterior structural release with decompression followed by anterior structural release with interbody fusion by use of bone graft and posterior fixation. Clinical and radiologic results of the lumbar lordosis, sacral inclination and C7 plumb-line were assessed. RESULT: The mean segments of anterior and posterior fusion were 2.8 and 3.5 respectively. All clinical symptoms of patients had been improved in more than good. The average angle of lumbar lordosis was corrected from kyphosis 2.8degree preoperatively to lordosis 31.2degree postoperatively. At the last follow-up, the average loss of correction was 2.3degree . The average angle of sacral inclination was corrected from 6.7degree to 50.8degree . The distance from supero-posterior corner of S1 to C7 plumb line was reduced from 11.0 cm to 2.75 cm. CONCLUSION: The circumferential fusion by posterior-anterior-posterior method offer an effective surgical treatment, which produce excellent deformity correction, fusion rate, maintenance of the correction and good clinical outcome.

Late Infection of Spinal Instrumentation / 대한척추외과학회지

STUDY DESIGN: A retrospective analysis of five cases of late spinal infection after spinal instrumentation and fusion. OBJECTIVES: These cases are reviewed to verify risk factors for late spinal infection after elective instrumentation and to manifest the treatment of this complication. SUMMARY OF LITERATURE REVIEW: Late spinal infection after elective spinal instrumentation and fusion are uncommon. The diagnosis is usually hard and requires much clinical suspicion. MATERIALS AND METHODS: 5 cases were in total 374 patients of the author's cases. These cases are reviewed retrospectively. RESULTS: All patients reported aggravated back pain. 4 patients had elevated erythrocyte sedimentation rates, averaging 44.8 mm/hour and elevated C-reactive protein, averaging 26.2mg/L. No distance foci of infection was identified. All patients got the radiolucent zone around screw fixation site, averaging 4.6mmwidth. The organisms were S. epidermidis in 1 case and coagulase(-) staphylococcus in 1 case. All cases were treated by operative method with debridement, instrument removal with or without revision and postoperative intravenous antibiotics. The average follow-up period was 18.2 months, one patient recurred back pain at 7 months after operation. CONCLUSION: The diagnosis of late infection after elective spinal instrumentation and fusion requires high suspicion of clinical symptoms and signs. All except one were successfully treated by operative treatment.