Radiological Assessment of Morphological Changes of Lumbar Spine: From First to 9th Decade of Life

Methods@#Radiograms of 1,496 patients (555 males and 941 females) from the first to 9th decade were examined for this study. Sagittal and coronal alignment, disc space narrowing, spur formation including diffuse idiopathic spinal hyperostosis (DISH), spondylolisthesis, and ballooned discs associated with biconcave bodies due to osteoporosis were among the parameters of lumbar spine morphologies examined on high-quality radiographs by both human observers and computers. @*Results@#The alignment of the lumbar spine altered after birth and set at growth maturity, and then the curve was maintained till the end of the 5th decade afterward and the curve gradually hypolordotic. There were three types of coronal alignment abnormalities can be seen: idiopathic, osteopathic, and discogenic (degenerative lumbar scoliosis [DLS]). DLS developed after 6th decade. There was no scoliosis associated with spondylolysis or the post-laminofacetectomy period. Disc space narrowing and corporal spur formation were not seen till the end of 3rd decade comparatively speaking, the corporal spurs generated in the non-scoliotic spine were smaller than those in the scoliotic spine. DISH began to appear in the 5th-decade patients and its incidences increased gradually afterward. Porosis-related vertebral body collapse started to happen after 6th decade. There are three different types of spondylolisthesis: anterior, posterior, and lateral. The lateral slip occurred only in the scoliotic spine. All types were related to degenerative discs. @*Conclusions@#It has been shown that the morphology of the lumbar spine changes throughout time.

A Primer to Diving Physiology / 대한정형외과학회잡지

Human beings are well adapted to the atmospheric environment. Understanding of the environmental difference between normal atmospheric and underwater condition is the key step to know the physiology of human diver. Diving means the simple physical action of getting into water or sea. It is impossible to stay longer in the deep underwater if the respiratory gas is not supplied by the certain equipment. Factors affecting the body in deep diving must be considered. These facts should be taught to the individuals who like to enjoy diving sports, deep sea construction workers, and submarine sailors. Also the government should have diving regulation. In this review simple physiological changes due to the diving depth, divers’ sickness, and its management are provided.

Availability of Vertebroplasty Needle as Alternative Bone Biopsy Needle for the Spinal Lesions / 대한정형외과학회잡지

Fifty-eight patients were subjects in this study. The clinical diagnosis was the presumed osteoporotic spine fractures in 48 patients, infections in seven patients, and tumors in three patients. Image-intensifier-guided closed transpedicular needle biopsy with a vertebroplasty needle (11 gauge, 120-mm length needle with a stylet Luer lock syringe) for the thoracolumbar lesions were performed under local anesthesia. The overall results showed a high histological diagnostic yield: in the 48 osteoporotic fractures, 36 (75%) were confirmed to be osteoporotic bones. In the seven infectious lesions, the lesions were confirmed to be tuberculosis in five and pyogenic in two. In the three tumors one was a malignant lymphoma, while tumor tissues were not found in two cases. No biopsy associated complications were found. The image-intensifier-guided closed vertebroplasty needle biopsy is a safe and reliable procedure with high diagnostic accuracy and should be an integral part of managing the spinal pathology.

Effect of Congenital C4–5 Synostosis on Adjacent Mobile Segments: Radiographic Assessment

Methods@#Radiograms of the 11 study subjects (six men and five women), aged 22–90 years who visited the outpatients’ clinic for various neck complaints without trauma history were examined. C4–5 synostosis was an incidental finding in all the subjects. @*Results@#All the fused bodies were inwaisted and had anterior caudal breaking but no interior corporal flaring. Adjacent segment disease was not found in eight patients aged <40 years. Disk degeneration was found at C3–4 and C5–6 in three patients each and at C6–7 in two patients. Disk degeneration was limited to the adjacent segments. @*Conclusions@#Degenerative disk changes are associated with the natural aging process, and the corporal morphology of the fused vertebral becomes inwaisted similar to that in the single vertebrae.

Effect of Congenital C4–5 Synostosis on Adjacent Mobile Segments: Radiographic Assessment

Methods@#Radiograms of the 11 study subjects (six men and five women), aged 22–90 years who visited the outpatients’ clinic for various neck complaints without trauma history were examined. C4–5 synostosis was an incidental finding in all the subjects. @*Results@#All the fused bodies were inwaisted and had anterior caudal breaking but no interior corporal flaring. Adjacent segment disease was not found in eight patients aged <40 years. Disk degeneration was found at C3–4 and C5–6 in three patients each and at C6–7 in two patients. Disk degeneration was limited to the adjacent segments. @*Conclusions@#Degenerative disk changes are associated with the natural aging process, and the corporal morphology of the fused vertebral becomes inwaisted similar to that in the single vertebrae.

Pavlov’s Ratio of the Cervical Spine in a Korean Population: A Comparative Study by Age in Patients with Minor Trauma without Neurologic Symptoms

Background@#There are many studies on the vertebral body-to-canal ratio, the so-called Pavlov’s ratio of the cervical spine. However, there are no studies on its relation with age to clarify each bony component’s contribution to the spinal canal formation and its size. The aim of this study was to investigate differences and changes in the vertebral body-to-canal ratio according to age in an asymptomatic population. @*Methods@#This is a cross-sectional study of 280 asymptomatic individuals. A total of 140 men and 140 women representing each decade of life from the first to the seventh were included in this study. The anteroposterior length of the vertebral body and canal from C3 to C6 was measured on sagittal radiographs to calculate the vertebral body-to-canal ratio. @*Results@#The average Pavlov’s ratio was significantly larger (p < 0.001) in the first decade of life. The average Pavlov’s ratio of the individuals in the first decade of life was 1.09 between C3 and C6 (1.08 at C3, 1.07 at C4, 1.11 at C5, and 1.13 at C6; range, 0.78–1.51). There was no significant difference among the other decades of life. @*Conclusions@#We assessed the Pavlov’s ratio of the cervical spine in an asymptomatic population. It is our belief that the spinal canal size is the largest in the first decade of life, and the Pavlov’s ratio becomes almost fixed throughout life after maturity.

Magnetic Resonance Imaging Observations of the Conus Medullaris in a Korean Population

STUDY DESIGN: Retrospective study (level of evidence: level 3). PURPOSE: To study the anatomy of the conus medullaris in Koreans. OVERVIEW OF LITERATURE: The anatomical position of the conus medullaris is well-documented in anatomy textbooks; however, the shape of the conus in the canal rarely described. Furthermore, to our knowledge, no study in Korea has not yet assessed the shape of the conus as well as its position in the canal via cadavaric dissection and/or magnetic resonance imaging (MRI). METHODS: MRI findings of 189 Korean patients aged 2–94 years (93 men and 94 women) were assessed. No subjects from other ethnicities were included. The method proposed by Arai and colleagues was used to assess the termination point and shape of the conus in the canal. The position of the intervertebral disc trisection of the vertebral body closest to the tip of the conus was recorded at the canal level. RESULTS: The tip of the conus medullaris was positioned from the upper T12 body to the L2–L3 disc, mostly in L1 bodies (52.4%), followed by the L2 bodies (22.5%), the L1–L2 disc, and the L2–L3 disc (1.1%). The shape of the conus was classified as type A in 74 (39.6%), type B in 58 (31%), and type C in 55 patients (29.4%). The conus did not terminate at the L3 body in any patient. In the first decade ones (five children) conus positioned rather lowly from L1 bodies to L2–L3 disc, and no type A conus shape, and mostly type B (80%). CONCLUSIONS: The conus medullaris was positioned mostly in the lower one-third of L1 and it in the first decades terminated lowly. No type A in the first decade one, and type B was mostly frequently formed which was followed by type C.

Essential Basic Bacteriology in Managing Musculoarticuloskeletal Infection: Bacterial Anatomy, Their Behavior, Host Phagocytic Activity, Immune System, Nutrition, And Antibiotics

Surgery-related infections have not been irradicated until now. To solve this problem, it is important to know the relationship between bacterial anatomy and bacterial behavior in the tug-of-war between host and pathogen. In this article, bacterial anatomy and functional behavior, host phagocytic activity, immune system, nutrition and antibiotics are reviewed to win the war against the tiny invaders and leave the host unharmed. My suggestion is that scientists should direct their studies not only to developing potent new antibiotics that will never give rise to drug-resistant mutants, but also to developing a very competitive immune system that can suppress or control infection without the aid of antibiotics.

Spinopelvic Orientation on Radiographs in Various Body Postures: Upright Standing, Chair Sitting, Japanese Style Kneel Sitting, and Korean Style Cross-Legged Sitting

BACKGROUND: Several previous studies reported on the impact of upright standing and chair sitting on the sagittal spinopelvic alignment. However, there are no studies on the impact of the two Asian (Korean and Japanese) style floor-sitting positions on the sagittal spinopelvic alignment. The purpose of this study was to evaluate the impact of four different body postures (standing, chair sitting, kneel sitting, and cross-legged sitting) on the sagittal spinopelvic alignment. METHODS: Sixteen selected healthy volunteers (10 males and six females) were subjects of this pilot study. In all subjects, radiographs were taken in comfortable standing and sitting positions. All spinal curvatures including lumbar lordotic angle (LLA), sacral slope (SS), pelvic tilt (PT), and pelvic incidence (PI) were measured on the radiographs. RESULTS: In standing position, the average LLA, SS, PT, and PI were 37.1°, 35.3°, 15.7°, and 51.0°, respectively. In chair sitting, the average LLA, SS, PT, and PI were 17.9°, 20.3°, 28.2°, and 49.5°, respectively. In kneel sitting (Japanese style), the average LLA, SS, PT, and PI were 31.8°, 38.3°, 14.2°, and 52.5°, respectively. In cross-legged sitting (Korean style), the average LLA, SS, PT, and PI were 9.8°, 13.4°, 38.3°, and 51.7°, respectively. LLA in standing (37.1°) and kneel sitting (31.8°) were very similar. Remarkable reduction in LLA was observed in Korean-style cross-legged sitting (9.8°), and LLA in chair sitting (17.9°) was about half of that in standing. SS was similar in standing (35.3°) and kneel sitting (38.3°), and it was reduced remarkably in cross-legged sitting (13.4°). PT was largest in cross-legged sitting (38.3°), and it was similar between standing (15.7°) and kneel sitting (14.2°). PIs were similar in all positions. CONCLUSIONS: The kneel sitting position did not show significant differences with the standing position when assessed using four parameters related to the sagittal spinopelvic alignment, whereas chair sitting and cross-legged sitting positions significantly altered the spinopelvic alignment compared to the standing position.

Prevalence of Diffuse Idiopathic Skeletal Hyperostosis Diagnosed by Whole Spine Computed Tomography: A Preliminary Study

BACKGROUND: Diffuse idiopathic skeletal hyperostosis (DISH) is characterized by ossification of the enthesis. The diagnosis has been mainly based on the chest or whole spine lateral plain film. Recently, chest or thoracolumbar computed tomography (CT) has been reported to be more reliable for the diagnosis of DISH. The purposes of this study were to investigate the prevalence and location of DISH and evaluate the prevalence of comorbidities, such as ossification of the posterior longitudinal ligament (OPLL) and ossification of the ligamentum flavum (OLF), using whole spine CT. METHODS: Whole spine CT scans of patients over 16 years of age who were examined at Cheju Halla General Hospital between February 2011 and December 2016 were reviewed for this study. The diagnosis of DISH was made according to the modified Resnick criteria. The prevalence of DISH in each age decade and its location were evaluated. Also, the prevalence of OPLL and OLF in DISH patients was investigated. RESULTS: The overall incidence of DISH was 24.4% (40 of 164 cases). There was no case of DISH in patients in their 40s and younger. The percentile incidences of DISH in patients in their fifth, sixth, seventh, eighth, and ninth decades were 20.0% (4 of 20 cases), 32.3% (10 of 31 cases), 40.0% (10 of 25 cases), 34.5% (10 of 29 cases), and 27.3% (6 of 22 cases), respectively. A strong positive correlation between the age decade and the incidence of DISH was noted (r = 0.853, p = 0.007). DISH patients had higher incidences of OLF (22.5%) and OPLL (37.5%). The most common location of DISH was the middle thoracic spine (90.0%) followed by the lower thoracic spine (87.5%). There was one case of DISH involving only the cervical spine. CONCLUSIONS: The incidence of DISH diagnosed by CT was higher than we expected. Whole spine CT can be a valuable modality to evaluate the location of DISH in the cervical and lumbar spine and the comorbidity rates of OLF and OPLL.

Traumatic Absence of the Shaft of the Radius in a Child: A 15-Year Follow-up after Reconstruction by a Modified Define's One Bone Forearm Procedure

Traumatic absence of the entire radial shaft in children has not been reported though there are a few reports of adult cases. We report a 5-year-old boy with traumatic absence of the entire right radial shaft. The Define's reconstruction procedure was chosen to localize the surgery only to the distal forearm and avoid further additional damage to the forearm muscles. The child's forearm was successfully reconstructed by the authors' modified Define's procedure, which was followed until his maturity. Hand function was well maintained.

Spinal Tuberculosis in Children: Predictable Kyphotic Deformity after Cure of the Tuberculosis / 대한정형외과학회잡지

PURPOSE: To assess the chronological changes of disease-related kyphosis after chemotherapy alone. MATERIALS AND METHODS: A total of 101 children aged 2 to 15 years with spinal tuberculosis, accompanied by various stages of disease processes were enrolled for analysis. By utilizing the images in them, the growth plate condition and chronological changes of kyphosis after chemotherapy were analyzed at two points in time; the first assessment was at post-chemotherapy one-year and second at the final discharge. RESULTS: Complete disc destruction in the cervical, dorsal and lumbosacral spines was observed in 2 out of 40 children (5.0%), 8 out of 30 children (26.7%), and 6 out of 31 children (19.4%), respectively. In those cases, the residual kyphosis inevitably developed. In the remaining children, the discs were intact or partially damaged. Among the 101 children kyphotic deformity was maintained without change in 20 children (19.8%). Kyphosis decreased in 14 children (13.9%), while it increased in 67 children (66.3%) with non-recoverably damaged growth plate. CONCLUSION: Although it is tentatively possible to predict the deformity progress or non-progress and spontaneous correction at the time of the initial treatment, its predictive accuracy is low. Therefore, assessment of the chronological changes should be performed at the end of chemotherapy. In children with progressive curve change, assessment of deformity should be continued until maturity.

Mycobacterium Tuberculosis in Spinal Tuberculosis

Even in an era of remarkable medical advances, there is an issue of why tuberculosis remains in the list of disastrous diseases, afflicting humans and causing suffering. There has not been a plausible answer to this, and it has been suggested that clinicians and medical scientists could presently not win the war against the tubercle bacilli. With regards to this issue, based on the authors' own clinical and research experiences, in this review, the available literature was revisited in order to address the raised questions and to provide recent information on characteristics of tubercle bacilli and possible ways to more effectively treat tuberculosis.

Analysis of Sacrococcygeal Morphology in Koreans Using Computed Tomography

BACKGROUND: The sacrococcygeal morphology of Arabs and Europeans has been studied using computed tomography (CT) or magnetic resonance imaging to determine the cause of coccydynia. Studies have suggested differences in sacrococcygeal morphology among ethnic groups. However, there are no data on the sacrococcygeal anatomy of Koreans. METHODS: We conducted a retrospective analysis of 606 pelvic CT scans that were taken at Cheju Halla General Hospital between 2008 and 2014. Fractures of the sacrum or coccyx were excluded. Differences in the sacrococcygeal morphology among age groups stratified by decade of life and between genders were analyzed using sagittal plane pelvic CT scans. The morphological parameters studied were the sacral and coccygeal curved indexes, sacrococcygeal angle, intercoccygeal angle, coccygeal type, coccygeal segmental number, and sacrococcygeal fusion. RESULTS: The average sacral and coccygeal curved indexes were 6.15 and 7.41, respectively. The average sacrococcygeal and intercoccygeal angles were 110° and 49°, respectively. Type II coccyx was most common, and the rate of sacrococcygeal fusion was 34%. There was a moderate positive correlation between age and the sacral curved index (r = 0.493, p = 0.000) and a weak negative correlation between age and the coccyx curved index (r = −0.257, p = 0.000). There was a weak negative correlation between age and the intercoccygeal angle (r = −0.187, p = 0.000). The average intercoccygeal angle in males and females was 53.9° and 44.7°, respectively. CONCLUSIONS: The sacrum tended to be more curved and the coccyx straighter with age. The coccyx was straighter in females than males. Knowledge of the sacrococcygeal anatomy of Koreans will promote better understanding of anatomical differences among ethnicities and future studies on coccydynia.

Unilateral Talonavicular Coalition: A Case Report / 대한족부족관절학회지

Tarsal coalition is an abnormal union between two or more bones of the hind- and mid-feet, which can occur at various rates from cartilaginous to osseous union. Talonavicular coalition is reported less frequently than calcaneonavicular or talocalcaneal coalition and has been associated with various abnormalities, including symphalangism, clinodactyly, ray anomaly, clubfoot, other tarsal coalitions, and a ball-and-socket ankle joint. Patients with talonavicular coalitions are usually asymptomatic and rarely require surgical treatment. We review the literature and report on a case of 59-year-old male patient with talonavicular coalition.

Osteomyelitis Resulting from Chronic Septic Olecranon Bursitis: Report of Two Cases

We reported the two cases of olecranon osteomyelitis secondary to the iatrogenic chronic relapsing septic olecranon bursitis. Infection was well eradicated by excision of the infected bursa and curettage of the eroded olecranon under the coverage of antibiotic therapy.

Age-Related Incidence of Cervical Spondylosis in Residents of Jeju Island

STUDY DESIGN: Cervical spine radiograms of 460 Jeju islanders. PURPOSE: To investigate the age-matched incidences and severity of the cervical disc degeneration and associated pathologic findings. OVERVIEW OF LITERATURE: Several related studies on the incidences of disc and Luschka's and facet joint degeneration have provided some basic data for clinicians. METHODS: Cervical radiographs of 460 (220 males and 240 females) patients in their fourth to ninth decade were analyzed. Ninety patients in their third decade were excluded because of absence of spondylotic findings. RESULTS: Overall incidence of cervical spondylosis was 47.8% (220 of 460 patients). The percentile incidences of spondylosis in the fourth, fifth, sixth, seventh, eighth and ninth decade was 13.2% (10 of 76 patients), 34.6% (37 of 107 patients), 58.9% (66 of 112 patients), 58.8% (50 of 85 patients), 70.3% (45 of 64 patients) and 75.0% (12 of 16 patients), respectively. The percentile incidences of one, two, three, four and five level spondylosis among 220 spondylosis patients was 45.5% (n=100), 34.1% (n=75), 15.0% (n=33), 4.5% (n=10), and 0.9% (n=2). Severity of disc degeneration ranged from ± to ++++, and was ± in 6.0% (24 segments), + in 49.6% (198 segments), ++ in 35.3% (141 segments), +++ in 9.0% (36 segments) and ++++ in 0.25% (one segment). Spurs and anterior ligament ossicle formed at the spondylotic segments, mostly at C4~6. The rate of posterior corporal spurs formation was very low. Olisthesis and ossification of the posterior longitudinal ligament were rarely combined with spondylosis. Cervical lordotic curve decreased gradually according to the progress of severity of spondylosis. CONCLUSIONS: The incidence of cervical spondylosis and number of spondylotic segments increase, and degeneration gradually becomes more severe with age.

Osteomyelitis Resulting from Chronic Septic Olecranon Bursitis: Report of Two Cases

We reported the two cases of olecranon osteomyelitis secondary to the iatrogenic chronic relapsing septic olecranon bursitis. Infection was well eradicated by excision of the infected bursa and curettage of the eroded olecranon under the coverage of antibiotic therapy.

Radiological Assessment of the Effect of Congenital C3-4 Synostosis on Adjacent Segments

STUDY DESIGN: Retrospective case series. PURPOSE: To assess the effect of non-kyphotic aligned congenital C3-4 synostosis on the adjacent segment in 10 patients. OVERVIEW OF LITERATURE: In the cervical spine, fusion disease at the adjacent motion segments may be a risk factor for potential neurological compromise and death. METHODS: Radiograms of 10 patients 13 to 69 years of age presenting with neck/shoulder discomfort or pain with or without trauma history were examined. C3-4 synostosis was found incidentally in all patients on routine examination radiographs of cervical spine. RESULTS: Adjacent segment disease (ASD) was not found in the three patients younger than 39 years of age. Five of the 10 (50%) patients, including a 67-year-old man, did not develop spondylosis in any of the cervical mobile segments. Spondylosis was observed only in the caudal 1-2 mobile segments in the remaining five patients. The youngest was a 40-year-old male who had spondylosis in the two caudal mobile segments (C4-5 and C5-6). Spondylosis was limited to the two close caudal mobile segments and was not in the cranial segments. Flaring of the lower part of synostotic vertebra associated with advanced narrowed degenerate disc was evident in five patients. CONCLUSIONS: Mobile segment spondylosis in the individuals with congenital monosegment C3-4 synostosis over age of 40 years may be a natural manifestation of aging and is not solely an adjacent segment disease directly and fully related with congenital C3-4 synostosis.

Calcaneal Insufficiency Avulsion Fracture in a Well-Controlled Type 2 Diabetic Patient: A Case Report / 대한족부족관절학회지

The calcaneal insufficiency avulsion fracture usually occurs in an area of fused apophysis in adults without significant history of trauma or overuse activities. It is an uncommon injury which has been described in patients with complicated diabetes, Charcot neuroarthropathy, amyloidosis with neuropathy, severe osteoporosis, and other conditions. Discussion of the issue of fracture location is still not sufficient. We report on a case of a 50-year-old male who experienced a non-traumatic diabetic calcaneal insufficiency fracture. Intraoperatively, a biopsy specimen was obtained from the exposed fracture site for histological study. We assume that the calcaneal fused apophyseal line is the weak point of failure due to various incomplete mixtures of trabecular bone, woven bone, and cartilaginous tissues, and may fail when repeated tensile stress is imposed.