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1.  Computerized Tomographic Measurements of Morphometric Parameters of the C2 for the Feasibility of Laminar Screw Fixation in Korean Population 
Objective
C2 laminar screw fixation is considered as an excellent alternative to Magerl's transfacetal approach or Harms construct for the atlantoaxial stabilization. However, to our knowledge, there is no report on the feasibility of the new approach to Korean population. We investigated morphometric parameters of the dorsal arch of the C2 to provide the quantitative data for the feasibility of laminar screw fixation.
Methods
One-hundred-and-two patients' cervical computed tomography had been reconstructed and investigated on the anatomical parameters related with C2 laminar screw placement. Sixty patients were male and forty-two patients were female. Measurements included the laminar thickness and slope, spino-laminar angle, and maximal screw length.
Results
Ages ranged from 20 to 81 and the mean age was 48.4. Mean laminar thickness was 5.7 mm (±1.0) (5.8 mm in male and 5.4 mm in female). Fifty-one patients (50%) had a laminar thickness smaller than 5.5 mm at least unilaterally, therefore the patients were considered as inappropriate candidates for the laminar screw fixation in the smaller side of the laminae. Mean value of maximal length of screw was 33.3 mm (34.3 mm in male and 31.9 mm in female). Mean spino-laminar angle was 43.2° and mean slope angle was 32.9°.
Conclusion
Half of patients had inappropriate laminar profiles to accommodate a 3.5 mm screw in at least one side of the axis. The three-dimensional computed tomography reconstruction is mandatory for the preoperative assessment for the feasibility of the C2 lamina.
doi:10.3340/jkns.2008.44.1.15
PMCID: PMC2588282  PMID: 19096651
Axis; Laminar screw
2.  Troublesome Occipital Neuralgia Developed by C1-C2 Harms Construct 
Recently, Harms and Melcher modified Goel's approach, the C1 lateral mass and C2 pedicle screw fixation, and the new technique is currently in favor among neurosurgeons. Comparing to the advantages of Harms construct, the disadvantages were not extensively investigated. We experienced a patient with severe occipital pain developed after the C1 lateral mass screw placement for the traumatic atlantoaxial instability. We reviewed literatures about Harms construct with focus on the occipital neuralgia as a postoperative complication and suggest here technical tips to avoid the troublesome pain.
doi:10.3340/jkns.2008.43.2.111
PMCID: PMC2588236  PMID: 19096615
Occipital neuralgia; Lateral mass screw; Atlantoaxial instability
3.  Modified Trajectory of C2 Laminar Screw - Double Bicortical Purchase of the Inferiorly Crossing Screw 
The crossing laminar screw fixation might be the most recently developed approach among various fixation techniques for C2. The new construct has stability comparable to transarticular or transpedicular screw fixation without risk of vertebral artery injury. Quantitative anatomical studies about C2 vertebra suggest significant variation in the thickness of C2 lamina as well as cross sectional area of junction of lamina and spinous process. We present an elderly patient who underwent an occipito-cervical stabilization incorporating crossed C2 laminar screw fixation. We preoperatively recognized that she had low profiles of C2 lamina, and thus made a modification of trajectory for the inferiorly crossing screw. We introduce a simple modification of crossing C2 laminar screw technique to improve stability in patients with low laminar profiles.
doi:10.3340/jkns.2008.43.2.119
PMCID: PMC2588229  PMID: 19096618
Laminar screw; Occipitocervical fixation
4.  Lumbo-sacro-pelvic Fixation Using Iliac Screws for the Complex Lumbo-sacral Fractures 
Fractures of lumbo-sacral junction involving bilateral sacral wings are rare. Posterior lumbo-sacral fixation does not always provide with sufficient stability in such cases. Various augmentation techniques including divergent sacral ala screws, S2 pedicle screws and Galveston rods have been reported to improve lumbo-sacral stabilization. Galveston technique using iliac bones would be the best surgical approach especially in patients with bilateral comminuted sacral fractures. However, original Galveston surgery is technically demanding and bending rods into the appropriate alignment is time consuming. We present a patient with unstable lumbo-sacral junction fractures and comminuted U-shaped sacral fractures treated by lumbo-sacro-pelvic fixation using iliac screws and discuss about the advantages of the iliac screws over the rod system of Galveston technique.
doi:10.3340/jkns.2007.42.6.495
PMCID: PMC2588180  PMID: 19096599
Iliac screw; U-shped sacral fracture; Lumbo-sacro-pelvic fixation
5.  Ganglion Cyst of the Posterior Longitudinal Ligament Causing Lumbar Radiculopathy 
Degenerated conditions such as herniated disc or spinal stenosis are common etiologies of lumbar radiculopathy. Less common etiologies include spinal extradural cyst such as synovial cysts and ganglion cysts. Ganglion cyst of the posterior longitudinal ligament (PLL) of the spine is a rare entity that can result in classical sciatica. Posterior longitudinal ligament cyst has no continuity with the facet joint and has no epithelial lining. Two young male patients presented with unilateral sciatica and were found to have intraspinal cystic lesions causing lumbar radiculopathy. Magnetic resonance imaging demonstrated rounded, cystic lesions (i.e., hypointense on T1- but hyperintense on T2-weighted images) adjacent to minimally dehydrated, nonherniated disc spaces in both cases. These patients underwent posterior decompression and cysts were excised, and their sciatic symptoms were completely resolved. Histological examination showed typical features of ganglion cysts in these cases.
doi:10.3340/jkns.2010.47.4.298
PMCID: PMC2864825  PMID: 20461173
Ganglion cyst; Intervertebral disc; Posterior longitudinal ligament
6.  Lumbar Intraspinal Extradural Ganglion Cysts 
The lumbar intraspinal epidural ganglion cyst has been a rare cause of the low back pain or leg pain. Ganglion cysts and synovial cysts compose the juxtafacet cysts. Extensive studies have been performed about the synovial cysts, however, very little has been known about the ganglion cyst. Current report is about two ganglion cysts associated with implicative findings in young male patients. We discuss about the underlying pathology of the ganglion cyst based on intraoperative evidences, associated disc herniation at the same location or severe degeneration of the ligament flavum that the cyst originated from in young patients.
doi:10.3340/jkns.2009.46.1.56
PMCID: PMC2729826  PMID: 19707495
Ganglion cyst; Synovial cyst
7.  The Incidence of Aneurysmal Subarachnoid Hemorrhage in Youngdong District, Korea 
Objective
The purpose of this study is to investigate the incidence of aneurysmal subarachnoid hemorrhage (SAH) in Youngdong district for 10 years.
Methods
From Jan. 1997 to Dec. 2006, 732 patients (327 males, 405 females, mean age: 54.8±13.1 years) with spontaneous SAH were admitted to our hospital. We reviewed the medical records and radiological findings regarding to the ictus of SAH, location and size of the ruptured aneurysms, Hunt-Hess grade and Fisher grade on admission, personal details such as address, age, and sex, and previous history of medical diseases.
Results
In these 732 patients, 672 cases were confirmed as aneurysmal SAH. Among them, 611 patients (262 males, 349 females, mean age: 54.9±13.2 years) came from Youngdong district. The average crude annual incidence of aneurysmal SAH for men, women, and both sexes combined in Youngdong district was 7.8±1.7, 10.5±2.7, and 9.1±2.1 per 100,000 population, respectively. Because of the problems related to the observation period and geographical confinement, it was suspected that the representative incidence of aneurysmal SAH in Youngdong district should be made during the later eight years in six coastal regions. Therefore, the average age-adjusted annual incidence for men, women, and both sexes combined was 8.8±1.4, 11.2±1.3 and 10.0±1.0, respectively in the coastal regions of Youngdong district from 1999 to 2006.
Conclusion
In overall, our results on the incidence of aneurysmal SAH was not very different from previous observations from other studies.
doi:10.3340/jkns.2007.42.4.258
PMCID: PMC2588204  PMID: 19096553
Aneurysmal SAH; Epidemiology; Incidence

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