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1.  Cervical Perineural Cyst Masquerading as a Cervical Spinal Tumor 
Asian Spine Journal  2014;8(2):202-205.
Tarlov (perineural) cysts of the nerve roots are common and usually incidental findings during magnetic resonance imaging of the lumbosacral spine. There are only a few case reports where cervical symptomatic perineural cysts have been described in the literature. We report such a case where a high cervical perineural cyst was masquerading as a cervical spinal tumor.
PMCID: PMC3996346  PMID: 24761204
Tarlov's cysts; Perineural cyst; Spinal cyst; spine; Cervical spine
2.  Tuberculosis of Sacrum 
Asian Spine Journal  2014;8(1):112.
PMCID: PMC3939363  PMID: 24596614
5.  Osteoblastoma of C2 Corpus: 4 Years Follow-up 
Asian Spine Journal  2012;6(2):136-139.
Osteoblastomas are rare neoplasms of the spine. The majority of the spinal lesions arise from the posterior elements and involvement of the corpus is usually by extension through the pedicles. An extremely rare case of isolated C2 corpus osteoblastoma is presented herein. A 9-year-old boy who presented with neck pain and spasmodic torticollis was shown to have a lesion within the corpus of C2. He underwent surgery via an anterior cervical approach and the completely-resected mass was reported to be an osteoblastoma. The pain resolved immediately after surgery and he had radiologic assessments on a yearly basis. He was symptom-free 4 years post-operatively with benign radiologic findings. Although rare, an osteoblastoma should be considered in the differential diagnosis of neck pain and torticollis, especially in patients during the first two decades of life. The standard treatment for osteoblastomas is radical surgical excision because the recurrence rate is high following incomplete resection.
PMCID: PMC3372549  PMID: 22708018
Osteoblastoma; Osteoid osteoma; C2 corpus; Anterior cervical approach
6.  Focal Ligamentum Flavum Hypertrophy with Ochronotic Deposits: An Unusual Cause for Neurogenic Claudication in Alkaptonuria 
Asian Spine Journal  2012;6(2):148-151.
Neurogenic claudication resulting from focal hypertrophy of the ligamentum flavum in the lumbar spine due to ochronotic deposits has not been reported till date. The authors discuss one such case highlighting the pathogenesis, histological and radiological features. Salient features of management are also emphasized upon.
PMCID: PMC3372552  PMID: 22708021
Spinal stenosis; Ligamentum flavum; Alkaptonuria
7.  Motion Induced Artifact Mimicking Cervical Dens Fracture on the CT Scan: A Case Report 
Asian Spine Journal  2012;6(3):216-218.
The diagnostic performance of helical computed tomography (CT) is excellent. However, some artifacts have been reported, such as motion, beam hardening and scatter artifacts. We herein report a case of motion-induced artifact mimicking cervical dens fracture. A 60-year-old man was involved in a motorcycle accident that resulted in cervical spinal cord injury and quadri plegia. Reconstructed CT images of the cervical spine showed a dens fracture. We assessed axial CT in detail, and motion artifact was detected.
PMCID: PMC3429615  PMID: 22977704
Reconstruction; Motion artifact; Mimicking; Cervical fracture
8.  Thirty Years after Paul Randall Harrington (September 27, 1911-November 29, 1980) 
Asian Spine Journal  2010;4(2):141-142.
PMCID: PMC2996628  PMID: 21165320
9.  Acute Intravenous Injection Toxicity Study of Escherichia coli-Derived Recombinant Human Bone Morphogenetic Protein-2 in Rat 
Asian Spine Journal  2014;8(2):113-118.
Study Design
Prospective in vivo toxicity study.
To evaluate the conducted acute toxicity study of Escherichia coli (E. coli)-derived recombinant human bone morphogenetic protein-2 (rhBMP-2) with 6-weeks old Sprague-Dawley rats.
Overview of Literature
rhBMP-2 has well-known osteoinductivity and it is used as a bone graft substitute. E. coli-derived rhBMP-2 can be mass-produced with relatively low costs. E. coli-derived rhBMP-2 facilitates osteoblastic differentiation and bone formation in vitro and in vivo. However, studies regarding side effects or toxicity of E. coli-derived rhBMP-2 have not been published. Thus, we conducted the acute toxicity study of E. coli-derived rhBMP-2 on 6-weeks old Sprague-Dawley rats.
One mg of BMP-2 was diluted in 0.285 mL of glycine buffer to prepare high BMP-2 concentrations (3.5 mg/mL). Intermediate (0.9 mg/mL) or low (0.35 mg/mL) concentrations of BMP-2 solution was prepared by serial dilutions. The compound was administrated at a dose of 0, 0.7, 1.8, 7 mg/kg by single intravenous injection to five of male and female rats. After the injection, the gross general observations including changes of body weight and histopathological analysis was performed for 14 days.
No animal was found dead during the experiment and the body weight changes were both statistically insignificant in the control and experimental groups. No abnormal sign was shown in general observations and autopsy examinations.
Thus, the lethal dose of E. coli-derived rhBMP-2 should be higher than 7 mg/kg with a single intravenous injection.
PMCID: PMC3996333  PMID: 24761191
Recombinant human-bone morphogenetic protein-2; Acute toxicity test; Mortality; Intravenous injection
10.  Outcomes of Fluoroscopically Guided Lumbar Transforaminal Epidural Steroid Injections in Degenerative Lumbar Spondylolisthesis Patients 
Asian Spine Journal  2014;8(2):119-128.
Study Design
A prospective cohort.
To report the short and long term outcomes of fluoroscopically guided lumbar transforaminal epidural steroid injection (TFESI) in degenerative lumbar spondylolisthesis (DLS) patients.
Overview of Literature
TFESI has been widely used for the treatment of lumbosacral radicular pains. However, to our knowledge, there has been no study which has evaluated the outcomes of TFESI in patients with DLS.
The DLS patients received fluoroscopically guided lumbar TFESI with 80 mg of methylprednisolone and 2 mL of 1% lidocaine hydrochloride. Patients were evaluated by an independent observer before the initial injection, at 2 weeks, at 6 weeks, at 3 months, and at 12 months after the injections. Visual analog scale (VAS), Roland 5-point pain scale, standing tolerance, walking tolerance, and patient satisfaction scale were evaluated for outcomes.
Thirty three DLS patients treated with TFESI, who were completely followed up, were included in this study. The average number of injections per patient was 1.9 (range from 1 to 3 injections per patient). Significant improvements in VAS and Roland 5-point pain scale were observed over the follow up period from 2 weeks to 12 months. However, the standing and walking tolerance were not significantly improved after 2 weeks. At 2 weeks, the patient satisfaction scale was highest, although, these outcomes declined with time. The DLS patients with one level of spinal stenosis showed significantly better outcome than the DLS patients with two levels of spinal stenosis. Five patients (13%) underwent surgical treatment during the 3 to 12 months follow up.
TFESI provides short term improvements in VAS and Roland 5-point pain scale, standing tolerance, walking tolerance and patient satisfaction scale in DLS patients. In the long term, it improves VAS but limits the improvements in Roland 5-point pain scale, standing tolerance, walking tolerance and patient satisfaction scale.
PMCID: PMC3996334  PMID: 24761192
Degenerative lumbar; Spondylolisthesis; Epidural injection; Steroid; Outcome
11.  Demineralized Bone Matrix, as a Graft Enhancer of Auto-Local Bone in Posterior Lumbar Interbody Fusion 
Asian Spine Journal  2014;8(2):129-137.
Study Design
A case controlled study with prospective data collection.
To evaluate the early influence and the final consequence of demineralized bone matrix (DBM) on auto-local bone as a graft enhancer in posterior lumbar interbody fusion (PLIF).
Overview of Literature
DBM is known as an osteoinductive material; however, it has not been clearly recognized to enhance auto-local bone with a small amount.
Patients who had a PLIF were allocated into two groups. Group I (70 cases) used auto-local bone chips and group II (44 cases) used DBM as an additive to auto-local bone, 1 mL per a segment. Group selection was alternated. Early assessment was performed by computed tomography at 6 months and final assessment was done by simple radiography after 24 months at least. The degree of bone formation was assessed by 4 grade scale.
The subjects of both groups were homogenous and had similar Oswestry Disability Index at final assessment. The ratio of auto-local bone chips and DBM was 6:1. The degree of bone formation at 6 months after surgery was superior in group II. However, there was no significant difference between the two groups at the final assessment.
DBM was not recognized to enhance auto-local bone with small amount.
PMCID: PMC3996335  PMID: 24761193
Demineralized bone matrix; Graft enhancer; Posterior lumbar interbody fusion
12.  Spinous Process Osteotomy to Facilitate the Access to the Spinal Canal When Decompressing the Spinal Canal in Patients with Lumbar Spinal Stenosis 
Asian Spine Journal  2014;8(2):138-144.
Study Design
Retrospective study.
The main purpose of this study was to investigate the union-rate of the spinous process after performing a spinous process osteotomy and whether union affects the clinical results after surgery.
Overview of Literature
In the present study, spinous process osteotomy was used to facilitate access to the spinal canal when performing a decompressive procedure for lumbar spinal stenosis. The aim of this study was to evaluate the union rate of the spinous process and its effect on the clinical results of the procedure.
All patients were included in the study that underwent a decompressive procedure through spinous process osteotomy be between January 1, 2007 and December 31, 2007. Operation protocols were reviewed. A computed tomography (CT) scan was performed to evaluate the union of the osteotomies of the spinous process. According to the CT-scans, patients were divided into three groups: "complete-union," "partial-union," and "non-union." Patients reported their clinical results through a self-administered questionnaire.
The mean period of follow up was 21.6 months (range, 16-28 months). A total of 44% of the performed osteotomies were considered as united. Ten patients (18%) were classified as "complete-union," 30 patients (55%) as "partial-union," and 15 patients (27%) as "non-union." The "complete-union" group showed better clinical results and scored significantly better in the Oswestry Disability Index and EQ-5D. However, no statistical difference was found in the pain-scores. There were no differences between the "partial-union" group and the "no-union" group.
We found a radiologic union for 60 out of 135 (44%) spinous process osteotomies.
PMCID: PMC3996336  PMID: 24761194
Spinal stenosis; Osteotomy
13.  A New Electrophysiological Method for the Diagnosis of Extraforaminal Stenosis at L5-S1 
Asian Spine Journal  2014;8(2):145-149.
Study Design
A retrospective study.
To examine the effectiveness of using an electrodiagnostic technique as a new approach in the clinical diagnosis of extraforaminal stenosis at L5-S1.
Overview of Literature
We introduced a new effective approach to the diagnosis of extraforaminal stenosis at the lumbosacral junction using the existing electrophysiological evaluation technique.
A consecutive series of 124 patients with fifth lumbar radiculopathy were enrolled, comprising a group of 74 patients with spinal canal stenosis and a second group of 50 patients with extraforaminal stenosis at L5-S1. The technique involved inserting a pair of needle electrodes into the foraminal exit zone of the fifth lumbar spinal nerves, which were used to provide electrical stimulation. The compound muscle action potentials from each of the tibialis anterior muscles were recorded.
The distal motor latency (DML) of the potentials ranged from 11.2 to 24.6 milliseconds in patients with extraforaminal stenosis. In contrast, the DML in patients with spinal canal stenosis ranged from 10.0 to 17.2 milliseconds. After comparing the DML of each of the 2 groups and at the same time comparing the differences in DML between the affected and unaffected side of each patient, we concluded there were statistically significant differences (p<0.01) between the 2 groups. Using receiver operating characteristic curve analysis, the cutoff values were calculated to be 15.2 milliseconds and 1.1 milliseconds, respectively.
This approach using a means of DML measurement enables us to identify and localize lesions, which offers an advantage in diagnosing extraforaminal stenosis at L5-S1.
PMCID: PMC3996337  PMID: 24761195
Diagnosis; Evoked potencials; Spinal stenosis; Diagnostic techniques and procedures; Far-out syndrome
14.  Clinical Findings and Results of Surgical Resection of Thoracolumbar Osteoid Osteoma 
Asian Spine Journal  2014;8(2):150-155.
Study Design
Descriptive, cases series study.
To evaluate clinical findings and results of treatment of patients with spinal osteoid osteoma who underwent surgery.
Overview of Literature
Osteoid osteoma is a benign tumor with spinal involvement rate of about 10%. It is manifested during adolescence with symptoms such as painful scoliosis. To treat the problem, operation on the patients and excising the nidus are suggested.
This descriptive study was conducted on 11 patients with spinal osteoid osteoma at our orthopedic educational center. All patients were treated through open surgery and nidus curettage. All samples were pathologically confirmed. Imaging methods (spiral computed tomography-scan) was used in preoperative planning. Scoliosis and other clinical findings were studied.
The study was conducted on 11 patients comprising 6 females (54.5%) and 5 males (45.5%) with the mean age of 14.6 years. Mean deviation of scoliosis resulting from spinal osteoid osteoma was 22.8 degrees. There was more scoliosis in the involvement of the lumbar vertebra. In comparison with adults, scoliosis was more severe in youths. There was one case of vertebra body involvement with manifestation of painful scoliosis. Due to lack of careful preoperative examination, the surgery was repeated for this case. No sign of recurrence was observed in patients who underwent open surgery and all scoliosis in the follow-up had improved.
Based on our findings, surgical excision of spinal ostoeid osteoma was successful and complete recovery was achieved in spinal deformity in the course of follow-up. Scoliosis is often seen during adolescence and lumbar involvement is more severe.
PMCID: PMC3996338  PMID: 24761196
Osteoid osteoma; Review; Spinal deformity; Scoliosis
15.  C2 Pars/Pedicle Screws in Management of Craniocervical and Upper Cervical Instability 
Asian Spine Journal  2014;8(2):156-160.
Study Design
A retrospective study.
To evaluate the efficacy and the safety of craniocervical and upper cervical stabilization by using C2 pars/pedicle screw fixations.
Overview of Literature
The management of craniocervical and upper cervical instability has progressed over the past two decades due to good achievements in the instrumentation and the increased awareness on spinal anatomy and biomechanics. However, there is insufficient studies or solid conclusions on this topic, thus, we tried to investigate and present our findings.
Twenty-two patients were operated upon and were followed up from March 2008 to October 2010. One patient had craniocervical instability (post-surgical), 15 patients had atlantoaxial instability of different etiologies (trauma, tumors, inflammatory and degenerative) and 6 patients had hangman fractures. Patients' ages ranged from 18 to 52 years old. with 5 female patients and 17 male patients.
Radiological follow ups performed immediately post-operation showed good screw positioning and complete reductions in nearly all the cases. All patients were followed up for more than one year. Sound fusions were observed among all patients.
The use of pars/pedicle screws is a very effective, sound, safe and easy surgical modality for treating craniocervical, atlantoaxial and upper cervical instabilities. Increasing studies for the biomechanics of this important region and longer periods of follow-ups are necessary to document the usefulness of this modality when treating such patients.
PMCID: PMC3996339  PMID: 24761197
Craniocervical; Cervical spine; C2 pars screws; C2 pedicle
16.  Role of Coflex as an Adjunct to Decompression for Symptomatic Lumbar Spinal Stenosis 
Asian Spine Journal  2014;8(2):161-169.
Study Design
Prospective cohort study.
To assess whether additional implantation of Coflex following spinal decompression provided better clinical outcomes compared to decompression alone for symptomatic lumbar spinal stenosis (LSS) and to determine whether improvement in clinical outcomes correlated with changes in the radiological indices studied.
Overview of Literature
Literature on benefits of additional Coflex implantation compared to decompression alone for symptomatic LSS is limited.
Patients with symptomatic LSS who met the study criteria were offered spinal decompression with Coflex implantation. Those patients who accepted Coflex implantation were placed in the Coflex group (n=22); while those opting for decompression alone, were placed in the comparison group (n=24). Clinical outcomes were assessed preoperatively, six-months, one-year and two-years postoperatively, using the Oswestry disability index, 100 mm visual analogue scale (VAS)-back pain and VAS-leg pain, and short form-36 (SF-36). Radiological indices (disc height, foraminal height and sagittal angle) were assessed preoperatively, six months, one year, and two years postoperatively.
Both groups showed statistically significant (p<0.001) improvement in all the clinical outcome indicators at all points in time as compared to the preoperative status. However, improvement in the Coflex group was significantly greater (p<0.001) than the comparison group. Changes in the radiological indices did not correlate significantly with the improvement in clinical outcome indicators.
Additional Coflex implantation after spinal decompression in symptomatic LSS offers better clinical outcomes than decompression alone in the short-term. Changes in radiological indices do not correlate with the improvements in clinical outcomes after surgery for symptomatic LSS.
PMCID: PMC3996340  PMID: 24761198
Spinal stenosis; Decompression; Interspinous process device; Coflex
17.  Clinical and Radiological Outcomes of Segmental Spinal Fusion in Transforaminal Lumbar Interbody Fusion with Spinous Process Tricortical Autograft 
Asian Spine Journal  2014;8(2):170-176.
Study Design
A retrospective study.
To investigate clinical and radiological outcomes when using spinous process as a tricortical autograft for segmental spinal fusion in transforaminal lumbar interbody fusion (TLIF).
Overview of Literature
Interbody spinal fusion is one of the important procedures in spinal surgery. Many types of autografts are harvested at the expense of complications. Clinical and radiographic results of patients who underwent TLIF with intraoperative harvested spinous process autograft in Prasat Neurological Institue, Bangkok, Thailand, were assessed as new technical innovation.
Between October 2005 to July 2009, 30 cases of patients who underwent TLIF with spinous process tricortical autograft were included. Clinical evaluations were assessed by visual analog scales (VAS) and Prolo functional and economic scores at the preoperation and postoperation and at 2 years postoperation. Static and dynamic plain radiograph of lumbar spine were reviewed for achievement of fusion.
Initial successful fusion time in lumbar interbody fusion with spinous process tricortical autograft was 4.72 months (range, 3.8-6.1 months) postoperation and 100% fusion rate was reported at 2 years. Our initial successful fusion time in lumbar interbody fusion was compared to the other types of grafts in previous literatures.
The use of intraoperative harvested spinous process tricortical autograft has overcome many disadvantages of harvesting autograft with better initial successful fusion time (4.72 months). VAS and Prolo scores showed some improvement in the outcomes between the preoperative and postoperative periods.
PMCID: PMC3996341  PMID: 24761199
Transpedicular screw fixation; Transforaminal lumbar interbody fusion; Spinous process autograft; Tricortical autograft
18.  Surgical Management of Pyogenic Discitis of Lumbar Region 
Asian Spine Journal  2014;8(2):177-182.
Study Design
Retrospective review of patients who had pyogenic discitis and were managed surgically.
To analyze the bacteriology, pathology, management and outcome of pyogenic discitis of the lumbar region treated surgically.
Overview of Literature
Surgical management of pyogenic discitis is still an infrequently used modality of treatment.
A total of 42 patients comprised of 33 males and 9 females who had pyogenic discitis with a mean age of 51.61 years (range, 16-75 years) were included in this study. All the cases were confirmed as having pyogenic discitis by pus culture report and histopathological examination. The mean follow-up period was 41.9 months.
Debridement and posterior lumbar interbody fusion with autologous iliac bone graft was done in all cases. Thirteen (30.95%) patients had other medical co-morbidities. Five cases had a previous operation of the spine, and three cases had a history of vertebral fracture. Three patients were operated for gynaecological problems, and four cases had a history of urological surgery. L4-5 level was the most frequent site of pyogenic discitis. The most common bacterium isolated was Staphylococcus aureus (S. aureus). Radiologically good fusion was seen in the majority of patients.
Pyogenic discitis should be suspected in people having pain and local tenderness in the spinal region with a rise in inflammatory parameters in blood. The most common bacterium was S. aureus, but there were still a greater number of patients infected with other types of bacteria. Therefore, antibiotics therapy should be started only after isolating the bacteria and making the culture sensitivity report.
PMCID: PMC3996342  PMID: 24761200
Pyogenic; Infection; Discitis; Antibiotics
19.  Role of Decompression in Late Presentation of Cervical Spinal Cord Disorders 
Asian Spine Journal  2014;8(2):183-189.
Study Design
Prospective study conducted at Jawaharlal Nehru Medical College, Datta Meghe Institute of Medical Sciences, Wardha, India.
To show the efficacy of decompression in the late presentation of cervical spinal cord disorders.
Overview of Literature
Studies by various authors have shown that early spinal decompression results in better neurological outcomes.
From January 2003 to January 2005, 11 of the 41 patients with cervical spinal cord compression, meeting the inclusion criteria, underwent anterior decompression; interbody graft placement and stabilization by anterior cervical locking plate. The neurologic and functional outcomes were recorded.
Five patients had spinal cord injury and 6 patients had compressive cervical myelopathy. Complications included 1 death and 1 plate loosening. No patient lost their preoperative neurological status. One patient had no improvement, 2 patients showed full recovery. The mean follow-up is 28.3 month. At the of rehabilitation, 6 were able to walk without support), 2 could walk with support, and 1 needed a wheelchair. The average American Spinal Injury Association motor score on admission to the hospital, 32.8 (standard deviation [SD], 30.5); admission to rehabilitation, 38.6 (SD, 32.4); discharge from rehabilitation, 46.2 (SD, 33.7). The most recent follow-up was 64.0 (SD, 35.3).
The anterior approach for cervical decompression allows for adequate decompression. This decompression is the best chance offered in even late reported cases, including posttraumatic cases where there is no evidence of cord transactions. The use of anterior cervical plates reduces the chances of graft loosening, extruding, or collapsing.
PMCID: PMC3996343  PMID: 24761201
Cervical vertebrae; Neglected disease; Quadriparesis; Surgical decompression
20.  Effectiveness of Preemptive Analgesia Using a Frequency Rhythmic Electrical Modulation System in Patients Having Instrumented Fusion for Lumbar Stenosis 
Asian Spine Journal  2014;8(2):190-196.
Study Design
A randomized prospective study.
To assess postoperative analgesic requirements after Phyback therapy preemptively in patients undergoing lumbar stabilization.
Overview of Literature
Frequency Rhythmic Electrical Modulation System is the latest method of preemptive analgesia.
Forty patients were divided into two groups. Patients who were to receive tramadol were allocated to "group A" and those who were to receive Phyback therapy were allocated to "group B." In patients with a visual analog scale score of >4 or a verbal rating scale score of >2, 75 mg of diclofenac IM was administered. The amount of analgesic consumption, the bolus demand dosage, and the number of bolus doses administered were recorded. Patient satisfaction was evaluated using the visual analog patient satisfaction scale.
There were statistically significant differences in the visual analog scale and verbal rating scale scores in the fourth, sixth, 12th, and 24th hours. The number of bolus infusions was significantly lower in group B. The amount of analgesic consumption was higher in group A. There was a significant difference between the two groups in the number of bolus infusions and the total amount of analgesic consumption, and this comparison showed better results for group B.
Application of Phyback therapy reduced postoperative opioid consumption and analgesic demand, and it contributed to reducing patients' level of pain and increased patient satisfaction. Moreover, the application of preemptive Phyback therapy contributed to reducing preoperative pain which may have reduced patient anxiety.
PMCID: PMC3996344  PMID: 24761202
Spinal stenosis; Postoperative pain; Analgesics; Electric stimulation therapy; Preanesthetic medication
21.  Intraoperative Life Threatening Acute Lung Injury Due to Multiple Septic Pulmonary Emboli during Transpedicular Biopsy and Kyphoplasty 
Asian Spine Journal  2014;8(2):197-201.
A 55-year-old gentleman was presented to our clinic two months after a trivial fall with persistent pain, gibbus at the thoraco-lumbar junction and intact neurology. Radiological and laboratory investigations suggested osteoporotic fracture or metastasis. Due to unremitting pain, a plan was made to do transpedicular biopsy and kyphoplasty. Biopsy needles were inserted into both pedicles and an attempt at aspiration was made. Since the aspirate was dry, 5 to 6 mL of saline was injected through one needle and an attempt at aspiration was made through the other. Three-millilitres of sero-sanguineous material mixed with pus came out and kyphoplasty was deferred. After extubation, the patient developed severe bronchospasm and was transferred to the intensive care unit. Investigations confirmed multiple septic pulmonary emboli and the patient recovered completely after treatment. This report highlights that confirmation of the diagnosis is essential before performing any procedure that increases the intravertebral pressure and the place should have appropriate facilities to manage complications.
PMCID: PMC3996345  PMID: 24761203
Transpedicular biopsy; Kyphoplasty; Septic pulmonary emboli; Acute lung injury; Infective spondylitis
22.  Literature Review and Clinical Presentation of Cervical Spondylitis Due to Salmonella Enteritidis in Immunocompetent 
Asian Spine Journal  2014;8(2):206-210.
A 48-year-old woman was presented to our clinic with some fever and neck pains for about one month. Based on the symptoms and results of image, an empirical diagnosis of tuberculous cervical spondylitis was made. The pain was not significantly decreased after anti-tuberculosis therapy. And, 3 weeks later, she was re-admitted to our hospital for the unbearable pain. An exploration of the C4/5 by the anterior medial approach was recommended to evaluate the germ and debridement. Bacteriological tests showed that the pathogen was Salmonella Enteritidis. The pain was relieved significantly after operation and sensitive antibiotic treatments. Infections with Salmonella Typhi or Salmonella Paratyphi have been well-documented, while there are few reports of cervical spondylitis caused by Salmonella Enteritidis. We reported a case of a healthy woman with whom pyogenic cervical spondylitis of Salmonella Enteritidis was corroborated and treated and reviewed according to previous reports about spondylitis caused by Salmonella Enteritidis in the literature.
PMCID: PMC3996347  PMID: 24761205
Salmonella Enteritidis; Cervical vertebrae; Spondylitis; Immunocompetent
23.  Risk Factors for Recurrent Lumbar Disc Herniations 
Asian Spine Journal  2014;8(2):211-215.
The most common complication after lumbar discectomy is reherniation. As the first step in reducing the rate of recurrence, many studies have been conducted to find out the factors that may increase the reherniation risk. Some reported factors are age, sex, the type of lumbar disc herniation, the amount of fragments removed, smoking, alcohol consumption and the length of restricted activities. In this review, the factors studied thus far are summarized, excepting factors which cannot be chosen or changed, such as age or sex. Apart from the factors shown here, many other risk factors such as diabetes, family history, history of external injury, duration of illness and body mass index are considered. Few are agreed upon by all. The reason for the diverse opinions may be that many clinical and biomechanical variables are involved in the prognosis following operation. For the investigation of risk factors in recurrent lumbar disc herniation, large-scale multicenter prospective studies will be required in the future.
PMCID: PMC3996348  PMID: 24761206
Herniated disc; Lumbar region; Recurrence; Risk factors
24.  Comparison of Pyogenic Spondylitis and Tuberculous Spondylitis 
Asian Spine Journal  2014;8(2):216-223.
Pyogenic spondylitis and tuberculous spondylitis are common causes of spinal infection. It is difficult to differentiate tuberculous spondylitis and pyogenic spondylitis clinically and radiologically. Recently magnetic resonance imaging has been reported to be beneficial for early diagnosis and differential diagnosis of the spondylitis, and is being used extensively for diagnosis. However, the diagnosis must be considered in combination with corresponding changes in clinical manifestations, radiological findings, blood and tissue cultures and histopathological findings. Conservative treatments, including antimicrobial medications, are started initially. Surgical treatments, which include anterior or posterior approach, single-stage or two-stage surgery, with or without instrumentation, may be performed as indicated.
PMCID: PMC3996349  PMID: 24761207
Pyogenic spondylitis; Tuberous spondylitis; Differential diagnosis
25.  Pedicle Screw Nut Loosening: Potentially Avoidable Causes of Spine Instrumentation Failure 
Asian Spine Journal  2014;8(2):224-226.
PMCID: PMC3996350  PMID: 24761208

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