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1.  Fatal Rhabdomyolysis following Spine Surgery in a Morbidly Obese Patient: A Case Report 
Korean Journal of Spine  2014;11(4):238-240.
We generally believe that obese patients are faced on higher risk of developing perioperative complications. Rhabdomyolysis is a rare but potentially life-threatening condition caused by the release of injured skeletal muscle components into the circulation. It usually results from mechanical damage to the muscle, intoxication, or a postictal state after a seizure. In the present study, we have reported a rare case of rhabdomyolysis developing in a morbidly obese patient after upper thoracic spinal fusion surgery. We have found acute renal failure that evolved during the course of treatment resulted in a fatal outcome even though the patient received intensive supportive care. Our experience suggests that this rare complication should be considered in morbidly obese patients and those efforts should be made to avoid rhabdomyolysis.
doi:10.14245/kjs.2014.11.4.238
PMCID: PMC4303285  PMID: 25620985
Spine; Rhabdomyolysis; Obesity
2.  Effectiveness of Repeated Radiofrequency Neurotomy for Facet joint Syndrome after Microscopic Discectomy 
Korean Journal of Spine  2014;11(4):232-234.
Objective
Postoperative facet joint syndrome requiring radiofrequency neurotomy (RFN) is a relatively common problem following microscopic discectomy. However, the efficacy of repeated RFN after microscopic discectomy has not been clearly documented. The purpose of this study was to determine the success rate and symptom-free duration of repeated RFN for facet joint syndrome after microscopic discectomy.
Methods
Medical records from 56 patients, who had undergone successful initial RFN following microscopic discectomy, experienced recurrence of pain, and subsequently had repeated RFN, were reviewed and evaluated. Responses of repeated RFN were compared with initial radiofrequency neurotomy for success rates and duration of relief. The criterion for RFN to be successful was defined as greater than 50% relief from pain and sufficient satisfaction of patients with prior RFN to have repeated RFN.
Results
Fifty-six patients (41 women and 15 men; mean age=48 years) had repeated RFNs, which were successful in all except three patients. RFN denervated three bilateral segments (L3-L4, L4-L5, and L5-S1) in all patients. Mean duration of relief after initial RFN was 9.2 months (range 3-14). The mean duration of relief after secondary RFN in 53 patients was 9.0 months (range 4-14). The success rates and duration of relief remained consistent after subsequent RFNs.
Conclusion
Repeated RFN for lumbar facet joint pain after microscopic discectomy is an effective palliative treatment. It provided a mean duration of relief of 9.0 months and >94% success rate.
doi:10.14245/kjs.2014.11.4.232
PMCID: PMC4303287  PMID: 25620983
Facet syndrome; Radiofrequency; Neurotomy; Discectomy
3.  Acute Hydrocephalus as a Complication of Cervical Spine Fracture and Dislocation: A Case Report 
Korean Journal of Spine  2014;11(2):74-76.
Hydrocephalus is a well-known complication of head injury, but an uncommon complication of a spinal lesion. Here, we present a rare case of acute obstructive hydrocephalus secondary to a cervical fracture and dislocation. A 60-year-old female patient was transferred to the emergency department with quadriplegia and respiratory difficulty. Imaging studies showed a cervical fracture and dislocation at the C3-4 level. She required intubation and mechanical ventilation. Twenty-four hours after admission, her mental status had deteriorated and both pupils were dilated. Computed tomography of the brain showed acute hydrocephalus; therefore, extraventricular drainage (EVD) was performed. After the EVD, her mental status recovered and she became alert, but she remained quadriplegic and dependent on the ventilator. Two months after injury, she died because of respiratory failure caused by pneumonia.
doi:10.14245/kjs.2014.11.2.74
PMCID: PMC4124928  PMID: 25110487
Hydrocephalus; Cervical; Fracture
4.  Posterior Lumbar Interbody Fusion Using an Unilateral Cage: A Prospective Study of Clinical Outcome and Stability 
Korean Journal of Spine  2014;11(2):52-56.
Objective
The purpose of this study was to evaluate the clinical and radiological results of instrumented posterior lumbar interbody fusion (PLIF) using an unilateral cage.
Methods
Seventeen patients with unilateral radiculopathy who underwent bilateral percutaneous screw fixation with a single fusion cage inserted on the symptomatic side for treatment of focal degenerative lumbar spine disease were prospectively enrolled in this study. Their clinical results, radiological parameters, and related complications were assessed 10 days, 3 months, and 12 months postoperatively.
Results
There was no pseudarthrosis, instrumented fusion failure, significant cage subsidence, or retropulsion in any patient. The surgery restored the disc space height and maintained it as of 12 months postoperatively and did not exacerbate the lumbar lordotic and scoliotic angles. All patients had excellent or good outcomes according to the modified MacNab's criteria. The mean pain score according to the visual analogue scale was 7.5 preoperatively but had improved to 2.5 when reassessed 3 months postoperatively. The improvement was maintained as of 12 months postoperatively.
Conclusion
In cases of uncomplicated unilateral radiculopathy, PLIF using a single cage can be an effective and safe procedure with the advantage of preserving the posterior elements of the contralateral side. A shorter operative time and greater cost-effectiveness than for PLIF using bilateral cages can be expected.
doi:10.14245/kjs.2014.11.2.52
PMCID: PMC4124929  PMID: 25110483
Spine; Fusion; Cage; Unilateral
5.  Totally Ossified Metaplastic Spinal Meningioma 
A 61-year-old woman with a very rare case of totally ossified large thoracic spinal metaplastic meningioma, showing progressing myelopathy is presented. Computed tomographic images showed a large totally ossfied intradural round mass occupying the spinal canal on T9-10 level. Magnetic resonance imaging revealed a large T9-10 intradural extramedullary mass that was hypointense to spinal cord on T1- and T2-weighted sequences, partial enhancement was apparent after Gadolinium administration. The spinal cord was severely compressed and displaced toward the right at the level of T9-10. Surgical removal of the tumor was successfully accomplished via the posterior midline approach and the histological diagnosis verified an ossified metaplastic meningioma. The clinical neurological symptoms of patient were improved postoperatively. In this article we discuss the surgical and pathological aspects of rare case of spinal totally ossified metaplastic meningioma.
doi:10.3340/jkns.2013.54.3.257
PMCID: PMC3836938  PMID: 24278660
Ossified spinal tumor; Metaplastic meningioma; Grossly total resection
6.  Brown-Séquard Syndrome Caused by a Cervical Synovial Cyst 
Synovial cysts are recognized as an uncommon cause of radicular and myelopathic symptoms. They are most frequently found in the lumbar region. The cervical spine or cervicothoracic junction is a rare location for a degenerative intraspinal synovial cyst as compared with the lumbar spine. At given cervical spinal levels, synovial cysts probably share clinical features with disc herniation and stenosis. However, the pathogenesis of synovial cysts remains still controversial. Here, we report a rare case of a synovial cyst in the lower cervical spine presented as Brown-Séquard syndrome and include a brief review of the literature. To the best of our knowledge, no previous report has been issued in the English literature on a synovial cyst presenting with Brown-Séquard syndrome. Neurologic function recovered completely after complete removal of the cyst and expansive laminoplasty.
doi:10.3340/jkns.2014.55.4.215
PMCID: PMC4094748  PMID: 25024827
Brown-Séquard syndrome; Synovial cyst; Cervical
7.  Implant Removal after Percutaneous Short Segment Fixation for Thoracolumbar Burst Fracture : Does It Preserve Motion? 
Objective
The purpose of this study was to evaluate the efficacy of implant removal of percutaneous short segment fixation after vertebral fracture consolidation in terms of motion preservation.
Methods
Between May 2007 and January 2011, 44 patients underwent percutaneous short segment screw fixation due to a thoracolumbar burst fracture. Sixteen of these patients, who underwent implant removal 12 months after screw fixation, were enrolled in this study. Motor power was intact in all patients, despite significant vertebral height loss and canal compromise. The patients were divided into two groups by degree of osteoporosis : Group A (n=8), the non-osteoporotic group, and Group B (n=8), the osteoporotic group. Imaging and clinical findings including vertebral height loss, kyphotic angle, range of motion (ROM), and complications were analyzed.
Results
Significant pain relief was achieved in both groups at final follow-up versus preoperative values. In terms of vertebral height loss, both groups showed significant improvement at 12 months after screw fixation and restored vertebral height was maintained to final follow-up in spite of some correction loss. ROM (measured using Cobb's method) in flexion and extension in Group A was 10.5° (19.5/9.0°) at last follow-up, and in Group B was 10.2° (18.8/8.6°) at last follow-up. Both groups showed marked improvement in ROM as compared with the screw fixation state, which was considered motionless.
Conclusion
Removal of percutaneous implants after vertebral fracture consolidation can be an effective treatment to preserve motion regardless of osteoporosis for thoracolumbar burst fractures.
doi:10.3340/jkns.2014.55.2.73
PMCID: PMC3958576  PMID: 24653799
Fusion; Percutaneous; Removal
8.  Acute hydrocephalus caused by intraspinal neurocysticercosis: case report 
BMC Research Notes  2014;7:2.
Background
Intraspinal neurocysticercosis is an uncommon manifestation that may present as an isolated lesion. Furthermore, acute hydrocephalus caused by isolated intraspinal neurocysticercosis without concomitant cerebral involvement is extremely rare.
Case presentation
A 64-year-old man presented with a history of severe headache, an unsteady gait, and occasional urinary incontinence. Magnetic resonance imaging of the thoraco-lumbar spine revealed multiple, cystic, contrast-enhancing intraspinal lesions. A computed tomographic scan of the brain showed marked ventricular dilatation but no intraparenchymal lesions or intraventricular cysticercal lesions. This case of acute hydrocephalus was found to be caused by isolated intraspinal neurocysticercosis and was treated by ventriculoperitoneal shunt placement and surgical removal of the intraspinal lesions (which were histologically confirmed as neurocysticercosis), followed by administration of dexamethasone and albendazole.
Conclusion
Isolated spinal neurocysticercosis should be considered in the differential diagnosis of acute hydrocephalus when no explanation is found in the brain, particularly in geographical regions endemic for cysticercosis.
doi:10.1186/1756-0500-7-2
PMCID: PMC3892021  PMID: 24383427
Spinal; Neurocysticercosis; Hydrocephalus
9.  Clinical Outcomes of Percutaneous Endoscopic Surgery for Lumbar Discal Cyst 
Objective
Discal cyst is rare and causes indistinguishable symptoms from lumbar disc herniation. The clinical manifestations and pathological features of discal cyst have not yet been completely known. Discal cyst has been treated with surgery or with direct intervention such as computed tomography (CT) guided aspiration and steroid injection. The purpose of this study is to evaluate the safety and efficacy of the percutaneous endoscopic surgery for lumbar discal cyst over at least 6 months follow-up.
Methods
All 8 cases of discal cyst with radiculopathy were treated by percutaneous endoscopic surgery by transforaminal approach. The involved levels include L5-S1 in 1 patient, L3-4 in 2, and L4-5 in 5. The preoperative magnetic resonance imaging and 3-dimensional CT with discogram images in all cases showed a connection between the cyst and the involved intervertebral disc. Over a 6-months period, self-reported measures were assessed using an outcome questionaire that incorporated total back-related medical resource utilization and improvement of leg pain [visual analogue scale (VAS) and Macnab's criteria].
Results
All 8 patients underwent endoscopic excision of the cyst with additional partial discectomy. Seven patients obtained immediate relief of symptoms after removal of the cyst by endoscopic approach. There were no recurrent lesions during follow-up period. The mean preoperative VAS for leg pain was 8.25±0.5. At the last examination followed longer than 6 month, the mean VAS for leg pain was 2.25±2.21. According to MacNab' criteria, 4 patients (50%) had excellent results, 3 patients (37.5%) had good results; thus, satisfactory results were achieved in 7 patients (87.5%). However, one case had unsatisfactory result with persistent leg pain and another paresthesia.
Conclusion
The radicular symptoms were remarkably improved in most patients immediately after percutaneous endoscopic cystectomy by transforaminal approach.
doi:10.3340/jkns.2012.51.4.208
PMCID: PMC3377877  PMID: 22737300
Lumbar discal cyst; Percutaneous endoscopic transforaminal cystectomy
10.  Delayed Esophageal Perforation after Cervical Spine Plating 
Korean Journal of Spine  2013;10(3):174-176.
Although anterior approaches to the cervical spine are popular and safe, they cause some of complications. Esophageal perforation after anterior spinal fusion is a rare but potentially life-threatening complication. We present a rare case of delayed esophageal perforation caused by a cervical screw placed via the anterior approach. A 43-year-old man, who had undergone surgery for complete cord injury at another orthopedic department 8 years previously, was admitted to our institute due to painful neck swelling and dysphagia. Radiological studies revealed a protruding screw and esophageal perforation. The perforation was found during surgery and was successfully repaired. This case emphasizes the need for careful long-term follow-up to check for delayed esophageal perforation in patients that have undergone anterior cervical spine plating.
doi:10.14245/kjs.2013.10.3.174
PMCID: PMC3941754  PMID: 24757482
Anterior cervical surgery; Esophageal perforation
11.  Intracranial Calcification Caused by a Brain Abscess : A Rare Cause of Intracranial Calcification 
Intracranial calcifications are relatively common computed tomographic findings in the field of neurosurgery, and cysticercosis, tuberculosis, HIV, and cryptococcus are acquired intracranial infections typically associated with calcifications. However, intracranial calcification caused by a bacterial brain abscess is rare. Here, we present a rare case of intracranial calcification caused by a bacterial brain abscess, from which staphylococcus hominis was isolated. To the best of our knowledge, no previous report has been published on intracranial calcification caused by bacterial brain abscess after decompressive craniectomy for traumatic brain injury. In this article, the pathophysiological mechanism of this uncommon entity is discussed and relevant literature reviewed.
doi:10.3340/jkns.2013.54.2.148
PMCID: PMC3809445  PMID: 24175034
Brain abscess; Calcification
12.  Short Segment Fixation for Thoracolumbar Burst Fracture Accompanying Osteopenia : A Comparative Study 
Objective
The purpose of this study was to compare the results of three types of short segment screw fixation for thoracolumbar burst fracture accompanying osteopenia.
Methods
The records of 70 patients who underwent short segment screw fixation for a thoracolumbar burst fracture accompanying osteopenia (-2.5< mean T score by bone mineral densitometry <-1.0) from January 2005 to January 2008 were reviewed. Patients were divided into three groups based on whether or not bone fusion and bone cement augmentation procedure 1) Group I (n=26) : short segment fixation with posterolateral bone fusion; 2) Group II (n=23) : bone cement augmented short segment fixation with posterolateral bone fusion; 3) Group III (n=21) : bone cement augmented, short segment percutaneous screw fixation without bone fusion. Clinical outcomes were assessed using a visual analogue scale and modified MacNab's criteria. Radiological findings, including kyphotic angle and vertebral height, and procedure-related complications, such as screw loosening or pull-out, were analyzed.
Results
No significant difference in radiographic or clinical outcomes was noted between patients managed using the three different techniques at last follow up. However, Group I showed more correction loss of kyphotic deformities and vertebral height loss at final follow-up, and Group I had higher screw loosening and implant failure rates than Group II or III.
Conclusion
Bone cement augmented procedure can be an efficient and safe surgical techniques in terms of achieving better outcomes with minimal complications for thoracolumbar burst fracture accompanying osteopenia.
doi:10.3340/jkns.2013.53.1.26
PMCID: PMC3579078  PMID: 23440679
Burst fracture; Osteopenia; Fusion
13.  Strategies for Noncontained Lumbar Disc Herniation by an Endoscopic Approach : Transforaminal Suprapedicular Approach, Semi-Rigid Flexible Curved Probe, and 3-Dimensional Reconstruction CT with Discogram 
Objective
The purpose of this study was to evaluate the efficacy of a transforaminal suprapedicular approach, semi-rigid flexible curved probe, and 3-dimensional reconstruction computed tomography (3D-CT) with discogram in the endoscopic treatment of non-contained lumbar disc herniations.
Methods
The subjects were 153 patients with difficult, non-contained lumbar disc herniations undergoing endoscopic treatment. The types of herniation were as follows : extraforaminal, 17 patients; foraminal, 21 patients; high grade migration, 59 patients; and high canal compromise, 56 patients. To overcome the difficulties in endoscopic treatment, the anatomic structures were analyzed by 3D reconstruction CT and the high grade disc was extracted using a semi-rigid flexible curved probe and a transforaminal suprapedicular approach.
Results
The mean follow-up was 18.3 months. The mean visual analogue scale (VAS) of the patients prior to surgery was 9.48, and the mean postoperative VAS was 1.63. According to Macnab's criteria, 145 patients had excellent and good results, and thus satisfactory results were obtained in 94.77% cases.
Conclusion
In a posterolateral endoscopic lumbar discectomy, the difficult, non-contained disc is considered to be the most important factor impeding the success of surgery. By applying a semi-rigid flexible curved probe and using a transforaminal suprapedicular approach, good surgical results can be obtained, even in high grade, non-contained disc herniations.
doi:10.3340/jkns.2009.46.4.312
PMCID: PMC2773386  PMID: 19893718
Intervertebral disc herniation; Percutaneous discectomy; Posterolateal approach
14.  Isolated Coccygeal Tuberculosis 
Isolated tuberculosis of the coccyx is extremely rare. A 35-year-old man presented with a 3-month history of coccygeal and gluteal pain. Computed tomography and magnetic resonance imaging revealed osseous destruction and a large enhancing mass involving the coccyx with anterior and posterior extension. Pathologic examination of the surgical specimen revealed necrosis, chronic granulomatous inflammation, and multinucleated giant cells consistent with tuberculosis. This case highlights the importance of considering tuberculosis as a diagnosis even though unusual sites are involved.
doi:10.3340/jkns.2012.52.5.495
PMCID: PMC3539088  PMID: 23323174
Coccyx; Tuberculosis
15.  Bone Cement-Augmented Short Segment Fixation with Percutaneous Screws for Thoracolumbar Burst Fractures Accompanied by Severe Osteoporosis 
Objective
The purpose of this study was to determine the efficacy of bone cement-augmented short segment fixation using percutaneous screws for thoracolumbar burst fractures in a background of severe osteoporosis.
Methods
Sixteen patients with a single-level thoracolumbar burst fracture (T11-L2) accompanying severe osteoporosis treated from January 2008 to November 2009 were prospectively analyzed. Surgical procedures included postural reduction for 3 days and bone cement augmented percutaneous screw fixation at the fracture level and at adjacent levels without bone fusion. Due to the possibility of implant failure, patients underwent implant removal 12 months after screw fixation. Imaging and clinical findings, including involved vertebral levels, local kyphosis, canal encroachment, and complications were analyzed.
Results
Prior to surgery, mean pain score (visual analogue scale) was 8.2 and this decreased to a mean of 2.2 at 12 months after screw fixation. None of the patients complained of pain worsening during the 6 months following implant removal. The percentage of canal compromise at the fractured level improved from a mean of 41.0% to 18.4% at 12 months after surgery. Mean kyphotic angle was improved significantly from 19.8° before surgery to 7.8 at 12 months after screw fixation. Canal compromise and kyphotic angle improvements were maintained at 6 months after implant removal. No significant neurological deterioration or complications occurred after screw removal in any patient.
Conclusion
Bone cement augmented short segment fixation using a percutaneous system can be an alternative to the traditional open technique for the management of selected thoracolumbar burst fractures accompanied by severe osteoporosis.
doi:10.3340/jkns.2012.52.4.353
PMCID: PMC3488644  PMID: 23133724
Burst fracture; Fusion; Percutaneous
16.  Huge Psoas Muscle Hematoma due to Lumbar Segmental Vessel Injury Following Percutaneous Endoscopic Lumbar Discectomy 
We present a case of an acute psoas muscle hematoma following percutaneous endoscopic lumbar discectomy. A 60-year-old female who presented with far lateral lumbar disc herniation underwent endoscopic discectomy on the right side at the L4-5 level. On the second postoperative day, the patient complained of severe right flank and leg pain and her blood pressure decreased. A computed tomography scan showed a large acute psoas muscle hematoma at right L4-5 level. The patient was transfused with packed red blood cells and placed at absolute bed rest. After observing the patient in intensive care, the severe flank and leg pain subsided, but the mild back pain persisted. Although percutaneous endoscopic lumbar discectomy is an effective minimally invasive surgical technique for the treatment of lumbar disc herniation, this case highlights the inherent risks of acute lumbar segmental vessel injury.
doi:10.3340/jkns.2009.45.3.192
PMCID: PMC2666125  PMID: 19352485
Percutaneous endoscopic lumbar discectomy; Psoas muscle hematoma; Lumbar segmental vessel injury
17.  Endoscopic Transforaminal Suprapedicular Approach in High Grade Inferior Migrated Lumbar Disc Herniation 
Objective
Although endoscopic procedures for lumbar disc diseases have improved greatly, the postoperative outcomes for high grade inferior migrated discs are not satisfactory. Because of anatomic limitations, a rigid endoscope cannot reach all lesions effectively. The purpose of this study was to determine the feasibility of endoscopic transforaminal suprapedicular approach to high grade inferior-migrated lumbar disc herniations.
Methods
Between May 2006 and March 2008, a suprapedicular approach was performed in 53 patients with high grade inferior-migrated lumbar disc herniations using a rigid endoscope and a semi-rigid flexible curved probe. One-to-four hours after surgery, the presence of remnant discs was checked with MRI. The outcomes were evaluated with the visual analogue scale (VAS) score and the Oswestry Disability Index (ODI) one week after surgery.
Results
The L2-3 level was involved in 2 patients and the L3-4 level was involved in 14 patients, while the L4-5 level was involved in 39 patients. There were single piece-type in 34 cases and a multiple piece-type in 19 cases. Satisfactory results were obtained in all cases. The mean preoperative VAS for leg pain was 9.32±0.43 points (range, 7-10 points), whereas the mean ODI was 79.82±4.53 points (range, 68-92 points). At the last follow-up examination, the mean postoperative VAS for leg pain was 1.78±0.71 points and the mean postoperative ODI improved to 15.27±3.82 points.
Conclusion
A high grade inferior migrated lumbar disc is difficult to remove sufficiently by posterolateral endoscopic lumbar dscectomy using a rigid endoscope. However, a satisfactory result can be obtained by applying a transforaminal suprapedicular approach with a flexible semi-rigid curved probe.
doi:10.3340/jkns.2009.45.2.67
PMCID: PMC2651558  PMID: 19274114
Migrated disc herniation; Percutaneous endoscopic lumbar discectomy; Rigid endoscope; Flexible curved probe
18.  Recurrent Bacterial Meningitis Accompanied by A Spinal Intramedullary Abscess 
Bacterial meningitis is rarely complicated by an intradural spinal abscess, and recurrent meningitis is an uncommon presentation of a spinal intramedullary abscess. Here, we report a 63-year-old patient with recurrent meningitis as the first manifestation of an underlying spinal intramedullary abscess. To the best of our knowledge, no previous report has been issued on recurrent meningitis accompanied by a spinal intramedullary abscess in an adult. In this article, the pathophysiological mechanism of this uncommon entity is discussed and the relevant literature reviewed.
doi:10.3340/jkns.2012.51.6.380
PMCID: PMC3424182  PMID: 22949971
Spinal; Intramedullary abscess; Meningitis
19.  Short Segment Screw Fixation without Fusion for Unstable Thoracolumbar and Lumbar Burst Fracture : A Prospective Study on Selective Consecutive Patients 
Objective
The purpose of this prospective study was to evaluate the efficacy and safety of screw fixation without bone fusion for unstable thoracolumbar and lumbar burst fracture.
Methods
Nine patients younger than 40 years underwent screw fixation without bone fusion, following postural reduction using a soft roll at the involved vertebra, in cases of burst fracture. Their motor power was intact in spite of severe canal compromise. The surgical procedure included postural reduction for 3 days and screw fixations at one level above, one level below and at the fractured level itself. The patients underwent removal of implants 12 months after the initial operation, due to possibility of implant failure. Imaging and clinical findings, including canal encroachment, vertebral height, clinical outcome, and complications were analyzed.
Results
Prior to surgery, the mean pain score (visual analogue scale) was 8.2, which decreased to 2.2 at 12 months after screw fixation. None of the patients complained of worsening of pain during 6 months after implant removal. All patients were graded as having excellent or good outcomes at 6 months after implant removal. The proportion of canal compromise at the fractured level improved from 55% to 35% at 12 months after surgery. The mean preoperative vertebral height loss was 45.3%, which improved to 20.6% at 6 months after implant removal. There were no neurological deficits related to neural injury. The improved vertebral height and canal compromise were maintained at 6 months after implant removal.
Conclusion
Short segment pedicle screw fixation, including fractured level itself, without bone fusion following postural reduction can be an effective and safe operative technique in the management of selected young patients suffering from unstable burst fracture.
doi:10.3340/jkns.2012.51.4.203
PMCID: PMC3377876  PMID: 22737299
Screw fixation; Burst fracture; Bone fusion
20.  Spontaneous Concomitant Intracranial and Spinal Subdural Hematomas in Association with Anticoagulation Therapy 
Simultaneous intracranial and spinal subdural hematomas are extremely rare. In most cases, they are attributed to major or minor trauma and iatrogenic causes, such as those resulting from spinal puncture. To the best of the authors' knowledge, there has been only two reports of spontaneous concomitant intracranial and spinal subdural hematomas in a patient receiving anticoagulant therapy who had an absence of evident trauma history. We report on a case of spontaneous concomitant intracranial and spinal subdural hematomas that occurred in association with anticoagulant therapy and present a review of the relevant literature.
doi:10.3340/jkns.2012.51.4.237
PMCID: PMC3377884  PMID: 22737307
Cranial; Spinal; Subdural hematoma; Anticoagulant therapy
21.  Foraminal Synovial Cyst Associated with Ankylosing Spondylitis 
Ankylosing spondylitis (AS) is frequently associated with inflammatory lesions of the spine and continuous fatigue stress fractures; however, an association with an intraspinal synovial cyst has not been previously reported. A 55-year-old man with a five year history of AS who presented with back pain and a right radiculopathy was admitted to the hospital. Five years previously, he underwent a percutaneous vertebroplasty for an osteoporotic L1 compression fracture, and was diagnosed with AS at that time. Plain radiographs showed aggravated kyphosis and a stress fracture through the ossified posterior element, below the prior vertebroplasty. Magnetic resonance images revealed a right foraminal cystic lesion at the L2-L3 level with effacement of the nerve root. A 1.6 cm cystic lesion that appeared to arise from the L2-L3 facet joint without direct communication was excised from the L2-L3 foramen. Pathological examination confirmed synovial cyst. The patient's symptoms resolved immediately after surgery except for a mild dysesthesia of the right leg. We report herein a rare case of foraminal synovial cyst associated with AS accompanying posterior element fracture with a review of literature.
doi:10.3340/jkns.2011.50.1.54
PMCID: PMC3159883  PMID: 21892407
Synovial cyst; Ankylosing spondylitis
22.  Paraspinal Muscle Sparing versus Percutaneous Screw Fixation : A Prospective and Comparative Study for the Treatment of L5-S1 Spondylolisthesis 
Objective
Both the paraspinal muscle sparing approach and percutaneous screw fixation are less traumatic procedures in comparison with the conventional midline approach. These techniques have been used with the goal of reducing muscle injury. The purpose of this study was to evaluate and to compare the safety and efficacy of the paraspinal muscle sparing technique and percutaneous screw fixation for the treatment of L5-S1 spondylolisthesis.
Methods
Twenty patients who had undergone posterior lumbar interbody fusion (PLIF) at the L5-S1 segment for spondylolisthesis were prospectively studied. They were divided into two groups by screw fixation technique (Group I : paraspinal muscle sparing approach and Group II: percutaneous screw fixation). Clinical outcomes were assessed by Low Back Outcome Score (LBOS) and Visual Analogue Scale (VAS) for back and leg pain at different times after surgery. In addition, modified MacNab's grading criteria were used to assess subjective patients' outcomes 6 months after surgery. Postoperative midline surgical scarring, intraoperative blood loss, mean operation time, and procedure-related complications were analyzed.
Results
Excellent or good results were observed in all patients in both groups 6 months after surgery. Patients in both groups showed marked improvement in terms of LBOSs all over time intervals. Postoperative midline surgical scarring and intraoperative blood loss were lower in Group II compared to Group I although these differences were not statistically significant. Low back pain (LBP) and leg pain in both groups also showed significant improvement when compared to preoperative scores. However, at 7 days and 1 month after surgery, patients in Group II had significantly better LBP scores compared to Group I.
Conclusion
In terms of LBP during the early postoperative period, patients who underwent percutaneous screw fixation showed better results compared to ones who underwent screw fixation via the paraspinal muscle sparing approach. Our results indicate that the percutaneous screw fixation procedure is the preferable minimally invasive technique for reducing LBP associated with L5-S1 spondylolisthesis.
doi:10.3340/jkns.2011.49.3.163
PMCID: PMC3085812  PMID: 21556236
Spondylolisthesis; Paraspinal muscle sparing approach; Percutaneous screw fixation; Back pain
23.  Screw Fixation without Fusion for Low Lumbar Burst Fracture : A Severe Canal Compromise But Neurologically Intact Case 
The low lumbar spine is deeply located in flexible segments, and has a physiologic lordosis. Therefore, burst fractures of the low lumbar spine are uncommon injuries. The treatment for such injuries may either be conservative or surgical management according to canal compromise and the neurological status. However, there are no general guidelines or consensus for the treatment of low lumbar burst fractures especially in neurologically intact cases with severe canal compromise. We report a patient with a burst fracture of the fourth lumbar vertebra, who was treated surgically but without fusion because of the neurologically intact status in spite of severe canal compromise of more than 85%. It was possible to preserve motion segments by removal of screws at one year later. We also discuss why bone fusion was not necessary with review of the relevant literature.
doi:10.3340/jkns.2011.49.2.128
PMCID: PMC3079100  PMID: 21519504
Burst fracture; Low lumbar spine; Fusion
24.  The Role of Bone Cement Augmentation in the Treatment of Chronic Symptomatic Osteoporotic Compression Fracture 
Objective
Bone cement augmentation procedures such as percutaneous vertebroplasty and balloon kyphoplasty have been shown to be effective treatment for acute or subacute osteoporotic vertebral compression fractures. The purpose of this study was to determine the efficacy of bone cement augmentation procedures for long standing osteoporotic vertebral compression fracture with late vertebral collapse and persistent back pain.
Methods
Among 278 single level osteoporotic vertebral compression fractures that were treated by vertebral augmentation procedures at our institute, 18 consecutive patients were included in this study. Study inclusion was limited to initially, minimal compression fractures, but showing a poor prognosis due to late vertebral collapse, intravertebral vacuum clefts and continuous back pain despite conservative treatment for more than one year. The subjects included three men and 15 women. The mean age was 70.7 with a range from 64 to 85 years of age. After postural reduction for two days, bone cement augmentation procedures following intraoperative pressure reduction were performed. Imaging and clinical findings, including the level of the vertebra involved, vertebral height restoration, injected cement volume, local kyphosis, clinical outcome and complications were analyzed.
Results
The mean follow-up period after bone cement augmentation procedures was 14.3 months (range 12-27 months). The mean injected cement volume was 4.1 mL (range 2.4-5.9 mL). The unipedicular approach was possible in 15 patients. The mean pain score (visual analogue scale) prior to surgery was 7.1, which decreased to 3.1 at 7 days after the procedure. The pain relief was maintained at the final follow up. The kyphotic angle improved significantly from 21.2 ± 4.9° before surgery to 10.4 ± 3.8° after surgery. The fraction of vertebral height increased from 30% to 60% after bone cement augmentation, and the restored vertebral height was maintained at the final follow up. There were no serious complications related to cement leakage.
Conclusion
In the management of even long-standing osteoporotic vertebral compression fracture for over one year, bone cement augmentation procedures following postural reduction were considered safe and effective treatment in cases of non-healing evidence.
doi:10.3340/jkns.2010.48.6.490
PMCID: PMC3053542  PMID: 21430974
Long standing; Compression fracture; Osteoporosis; Bone cement
25.  Bilateral Pedicle Stress Fracture Accompanying Spondylolysis in a Patient with Ankylosing Spondylitis 
Bilateral pedicle stress fracture is a rare entity and few cases have been reported in the literature. Furthermore, the majority of these reports concern previous spine surgery or stress-related activities. Here, the authors report ankylosing spondylitis as a new cause of bilateral pedicle stress fractures accompanying spondylolysis. The reported case adds to the literature on bilateral pedicle stress fracture and spondylolysis by documenting that ankylosing spondylitis is another cause of this condition.
doi:10.3340/jkns.2010.48.1.70
PMCID: PMC2916152  PMID: 20717516
Spine fracture; Spondylolysis; Ankylosing spondylitis

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