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1.  Radiographic Assessment of Effect of Congenital Monosegment Synostosis of Lower Cervical Spine between C2-C6 on Adjacent Mobile Segments 
Asian Spine Journal  2014;8(5):615-623.
Study Design
A prospective radiographic study of cervical spine with congenital monosegment fusion.
Purpose
To evaluate the effect of cervical synostosis on adjacent segments and the vertebral morphology.
Overview of Literature
There are numerous clinical studies of adjacent segment disease (ASD) after monosegment surgical fusion. However, there was no report on ASD in the cervical spine with congenital monosegment synostosis.
Methods
Radiograms of 52 patients, aged 5 to 90 years, with congenital monosegment synostosis (CMS) between C2 and C6, who complained of neck/shoulder discomfort or pain were studied. 51 were normally aligned and one was kyphotically aligned.
Results
Spondylosis was not found in the patients below 35 years of age. Only 12 out of 24 patients with normally aligned C2-3 synostosis had spondylosis in 19 more caudal segments, and only one at C3-4. A patient with kyphotic C2-3 had spondylolysis at C3-4. In 8 patients with C3-4 synostosis, spondylosis was found in only 9 caudal segments (4 at C4-5, 4 at C5-6, and 1 at C6-7). The caudate C4-5 disc was the most liable to degenerate in comparison with other caudate segments. Caudal corporal flaring and inwaisting of the synostotic vertebra were the features that were the most evident. In 2 of 9 C4-5 and 7 out of 10 C5-6 synostosis patients, spondylosis was found at the two adjacent cephalad and caudate segments, respectively. Only corporal inwaisting without flaring was found. In all cases, spondylosis was confined to the adjacent segments. More advanced spondylosis was found in the immediate caudal segment than the cephalad one.
Conclusions
It is concluded that spondylosis at the mobile segments in a synostotic spine is thought to be a fusion-related pathology rather than solely age-related disc degeneration. Those data suggested that CMS definitely precipitated the disc degeneration in the adjacent segments.
doi:10.4184/asj.2014.8.5.615
PMCID: PMC4206811  PMID: 25346814
Synostosis; Cervical; Congenital; Alignment; Adjacent segment disease
2.  Effect of Correction of the Contractured Flexed Osteoarthritic Knee on the Sagittal Alignment by Total Replacement 
Asian Spine Journal  2013;7(3):204-211.
Study Design
A prospective analysis of an adaptive change of the spinopelvic alignment after total knee arthroplasty.
Purpose
To evaluate the effect of correction of the contractured knee in flexion on the spinopelvic alignment by total knee arthroplasty.
Overview of Literature
Flexion contracture of the knee joint may affect the body posture and precipitate the symptoms in the lumbar spine, which is known as the 'knee-spine syndrome'.
Methods
Fifteen patients who could be followed at least over 12 months were used in this study. Neutral whole spine lateral standing radiograms taken at certain intervals were analyzed. The subjects were divided into two groups (group A, the patients who obtained over 10° correction; group B, the others). The sacral slope, the pelvic tilt and the pelvic incidence were measured preoperatively and at 12 months and thereafter postoperatively in all the patients. Also, the thoracic kyphosis, lumbar lordosis, and lumbosacral angle were measured, including the spinal sagittal balance, S1 overhang and spino-sacral angle.
Results
The average correction of the contractured knee in flexion were 13.8° in group A and 2.7° in group B. The median of changes of the sacral slope were 4.2° in group A and -0.4° in group B. These results revealed that there was a significant increase of the sacral slope for group A (p=0.001). However, there were no significant differences between the other parameters.
Conclusions
The sacral slope appears to be affected by the change of the flexion contracture after total knee arthroplasty.
doi:10.4184/asj.2013.7.3.204
PMCID: PMC3779772  PMID: 24066216
Sagittal; Alignment; Spine; Pelvis; Total knee arthroplasty
3.  Multiple Pyogenic Spondylodiscitis with Bilateral Psoas Abscesses Accompanying Osteomyelitis of Lateral Malleolus - A Case Report - 
Asian Spine Journal  2008;2(2):102-105.
A psoas abscess is a potentially life-threatening infection. Multiple pyogenic spondylodiscitis with bilateral psoas abscesses accompanying an osteomyelitis of the lateral malleolus is an extremely rare event. We present our experience with needle aspiration for the treatment of osteomyelitis of the lateral malleolus and CT-guided percutaneous catheter drainage for a psoas abscess in an elderly patient. Both infections were completely resolved without recurrence. A psoas abscess should be included in the differential diagnosis of a patient with low back pain during musculoskeletal infection. Percutaneous needle aspiration or CT-guided percutaneous catheter drainage is an effective method for treating certain musculoskeletal infections.
doi:10.4184/asj.2008.2.2.102
PMCID: PMC2852090  PMID: 20404964
Spondylodiscitis with psoas abscess; Osteomyelitis of lateral malleolus; CT-guided percutaneous drainage
4.  Lumbar Pyogenic Spondylodiscitis and Bilateral Psoas Abscesses Extending to the Gluteal Muscles and Intrapelvic Area Treated with CT-guided Percutaneous Drainage - A Case Report - 
Asian Spine Journal  2008;2(1):51-54.
Bilateral psoas abscesses extending to the gluteal muscle and intrapelvic area are uncommon. We present our experience with computed tomography (CT)-guided percutaneous catheter drainage for the treatment of multiple aggressive abscesses in a diabetic patient. The abscesses completely resolved after the procedures. Psoas abscess should be considered in the differential diagnosis of older diabetic patients with fever, flank or back pain, and flexion contracture of the hip joint. CT scanning is a useful method in diagnosing abscesses, and CT-guided percutaneous catheter drainage is an effective treatment method in selected patients.
doi:10.4184/asj.2008.2.1.51
PMCID: PMC2857484  PMID: 20411143
Psoas abscess extending into the gluteal muscle and intrapelvic area; Diabetic patient; CT-guided percutaneous drainage
5.  Spinal Epidural Abscess with Pyogenic Arthritis of Facet Joint Treated with Antibiotic-Bone Cement Beads - A Case Report - 
Asian Spine Journal  2007;1(1):61-64.
Most epidural abscesses are a secondary lesion of pyogenic spondylodiscitis. An epidural abscess associated with pyogenic arthritis of the facet joint is quite rare. To the best of our knowledge, there is no report of the use of antibiotic-cement beads in the surgical treatment of an epidural abscess. This paper reports a 63-year-old male who sustained a 1-week history of radiating pain to both lower extremities combined with lower back pain. MRI revealed space-occupying lesions, which were located in both sides of the anterior epidural space of L4, and CT scans showed irregular widening and bony erosion of the facet joints of L4-5. A staphylococcal infection was identified after a posterior decompression and an open drainage. Antibiotic- bone cement beads were used as a local controller of the infection and as a spacer or an indicator for the second operation. An intravenous injection of anti-staphylococcal antibiotics resolved the back pain and radicular pain and normalized the laboratory findings. We point out not only the association of an epidural abscess with facet joint infection, but also the possible indication of antibiotic-bone cement beads in the treatment of epidural abscesses.
doi:10.4184/asj.2007.1.1.61
PMCID: PMC2857502  PMID: 20411156
Epidural abscess; Facet joint infection; Lumbar spine; Antibiotic-bone cement bead

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