Percutaneous Para-Pedicular Vertebroplasty for an Uppermost Instrumented Vertebral Fracture - A Case Report -

Objectives@#This case report presents a surgical technique used to perform vertebral anterior column stabilization in an elderly male patient who had recently been diagnosed with an uppermost instrumented vertebral fracture (IVF) at the site of previous posterior lumbar instrumented fusion (PIF).Summary of Literature Review: Although conservative treatment is also used for IVF, the proximal junction of PIF is an area where the compression load is concentrated biomechanically, so the uppermost IVF often requires surgical treatment. This may require fixation of extended segments and more surgical morbidity. @*Materials and Methods@#A 73-year-old male patient who had undergone PIF from L2 to L5 more than 20 years previously was recently diagnosed with uppermost IVF without a traumatic event. He complained of persistent back pain even after 2 months of conservative treatment. He ultimately underwent percutaneous vertebroplasty through the parapedicular approach.Result: The patients showed a favorable outcome at a 1-year follow-up. @*Conclusions@#Percutaneous vertebroplasty through the parapedicular approach for uppermost IVF at the site of a previous PIF might be a feasible and less invasive alternative.

Percutaneous Para-Pedicular Vertebroplasty for an Uppermost Instrumented Vertebral Fracture - A Case Report -

Objectives@#This case report presents a surgical technique used to perform vertebral anterior column stabilization in an elderly male patient who had recently been diagnosed with an uppermost instrumented vertebral fracture (IVF) at the site of previous posterior lumbar instrumented fusion (PIF).Summary of Literature Review: Although conservative treatment is also used for IVF, the proximal junction of PIF is an area where the compression load is concentrated biomechanically, so the uppermost IVF often requires surgical treatment. This may require fixation of extended segments and more surgical morbidity. @*Materials and Methods@#A 73-year-old male patient who had undergone PIF from L2 to L5 more than 20 years previously was recently diagnosed with uppermost IVF without a traumatic event. He complained of persistent back pain even after 2 months of conservative treatment. He ultimately underwent percutaneous vertebroplasty through the parapedicular approach.Result: The patients showed a favorable outcome at a 1-year follow-up. @*Conclusions@#Percutaneous vertebroplasty through the parapedicular approach for uppermost IVF at the site of a previous PIF might be a feasible and less invasive alternative.

Preganglionic Epidural Steroid Injection through Translateral Recess Approach

The approach we suggest was developed for cases in which the fourth and fifth lumbar and first sacral spinal nerves were affected in lumbar degenerative disc disease. Retrodiscal transforaminal epidural injection is known to be very effective for lumbar radiculopathy because of excellent access to primary pathology; however, access below L5 is often restricted by the anatomic characteristics of the L5–S1. In the translateral recess approach (TLR), proper final needle placement (i.e., in the axillary portion between the exiting and traversing nerve roots) can be achieved by setting the direction of the needle laterally and superiorly from the distal tip of the infra-adjacent spinous process toward the medial wall of the pedicle and neural foramen of the given level without neural injury. This approach is possible because of the wide interlaminar space in the L5–S1. Preganglionic epidural injection through TLR is an effective and safe spinal intervention for lumbosacral radiculopathy.

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 / 대한척추외과학회지

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.

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.