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Study Design: A retrospective clinical and radiological analysis Objectives: To determine the relationship between the classifications of unstable burst fractures on the thoracolumbar region, radiologic studies, signal change area on MRA and analysis of the prognostic factors. Summary of Literature Review: MRI is the first imaging modality that visualizes the extent of spinal cord derangement directly and it has the potential to provide an accurate diagnosis and prognosis. Materials and Methods: From March 1998 to September 2006, 39 patients who were eligible for a follow up of more than 1 year with an unstable burst fracture on the thoracolumbar region were studied. With these cases, The size of the bone fragment at the initial injury, signal change area on MRI, time to surgery, reduction rate of the bone fragments, recovery of the posterior curvature of the vertebrae and height of the vertebral body were analyzed. Results: The mean fracture size rate, average time to surgery, reduction rate of bone fragment and the recovery rate of the height of the vertebral body was 46.1±12.8%, 17±4.5 hours, 35.2±10.1%, and 57.9±17.4%, respectively. The data shows that the time elapsed until surgery had no relationship with the prognosis (P=0.317). Injuries with broad signal changes on MRI were not associated with the reduction rate of bone fragments, recovery of posterior curvature of the vertebrae and the height of the vertebral body. Conclusions: In unstable burst fractures of the thoracolumbar region, although a comparison of the prognostic factors on simple X-ray film had no significance, it still has significant meaning when correlated with the signals on MRI.

Study Design: A retrospective study Objectives: To compare the radiological and clinical outcomes of three surgical methods Summary of literature Review: There were many proposed surgical treatments for lumbar degenerative kyphosis but the best treatment is still controversial. Materials and Methods: Thirty three patients (all female) had undergone surgery. The mean age at surgery was 61.2. The average follow-up period was 34.7 months. The patients were divided into three groups. Group A included 7 cases with a correction by a posterior osteotomy, Group B included 15 with a posterior correction without an osteotomy, and Group C included 11 with combined anterior-posterior surgery. The radiographic measurements of lumbar lordosis, upper lumbar lordosis, lower lumbar lordosis, and pelvic tilt were performed before surgery, after surgery, and at the final follow-up visit. The loss of correction, complication rates and the clinical results were also compared. Results: Postoperative correction of the lumbar and lower lumbar lordosis were significantly higher in group A and C than group B. The correction of upper lumbar lordosis was significantly higher in group A than group C. On the final follow-up, there was no significant difference in the loss of correction and clinical results between the three groups. The number of cases with complications in groups A, B and C was 4 (57%), 2 (13.3%) and 2 (18.2%), respectively. Two patients in group A required additional surgery. Conclusions: Groups A and C were more effective than posterior-only correction. There was no significant difference in the clinical results between the three groups but complication rate was higher in Group A than the other groups. Combined anterior and posterior surgery can be a safe and effective method for correction.

Study Design: A retrospective study Objective: To analyze the complications, clinical outcome and any correlative risk factors of degenerative spinal deformity surgery in elderly patients. Summary of Literature Review: There is some controversy regarding the postoperative complications and the factors influencing them in the elderly patients who had undergone degenerative spinal deformity surgery. Materials and Methods: Seventy eight patients, who underwent posterior decompression and posterolateral fusion requiring a minimum 3 level fusion for a degenerative spinal deformity associated with spinal stenosis between May, 2001 and May, 2006, were reviewed after a follow-up period of at least 1 year. This study compared the postoperative complications and clinical outcomes of patients over 65 years (group A) with patients between 50~64 years (group B). The risk factors that could influence the complications and clinical outcomes were evaluated and analyzed statistically. Results: The postoperative complication rate was 53% in group A and 40% in group B without statistical significance. However, group A had a significantly higher frequency of minor complications than group B, particularly in urinary retention and postoperative delirium. There was an association between diabetes and deep wound infection as a major complication in groups A and B. Being male was a risk factor for urinary retention and longer surgery time, and abundant blood loss was significant risk factors for postoperative delirium in group A. Conclusion: There were no significant differences in the treatment result for degenerative spinal deformity between patients older than 65 and younger than 65. It is considered that the blood sugar should be controlled strictly before and after surgery, and appropriate management is needed for postoperative delirium and urinary retention in elderly patients.

Study design: A retrospective study Objectives: To introduce the technique of minimally invasive transforaminal lumbar interbody fusion and examine its clinical and radiologic results. Summary of Literature Review: Transforaminal lumbar interbody fusion with a mini-incision using a tubular retractor was recently developed. The aim of this procedure is to reduce the approach-related morbidity and achieve better results in an effective and safe manner. Materials and Methods: Thirty eight patients were followed up for more than 1 year. Their mean age was 57 years and the mean follow-up was 19 months. The diagnosis was spinal stenosis, spondylolisthesis and recurred herniated nucleus pulposus in 22, 14 and 2 patients, respectively. The Oswestry disability index, intervertebral disc space height, fusion rate and complications were evaluated. Results: The Oswestry disability index improved from 30 points (range, 50~16 points) to 10 points (range, 2-24 points) at the last follow-up. Thirty-four patients (90%) showed excellent or good results. The intervertebral disc space height increased from 8.7 mm to 10.8 mm. Two cases showed nonunion but the clinical results were good. Complications included one case of infectious spondylitis requiring antibiotics, one case of cage dislodgement requiring additional surgery and one case of a pedicle screw malposition showing no clinical symptoms. Conclusions: Minimally invasive transforaminal lumbar interbody fusion reduced the soft tissue injury and blood loss and shortened the recovery period compared to the traditional open techniques.

Study design: A retrospective study Objectives: Contralateral undercutting laminoplasty via a unilateral laminotomy has been performed instead of bilateral partial laminectomy in lumbar spinal stenosis. This study compared the radiographic and clinical results of undercutting laminoplasty with bilateral partial laminectomy. Summary of literature review: Less invasive surgery has become attractive for minimizing soft tissue injury and reducing the recovery time. Materials and Methods: Twenty five patients, who underwent decompressive surgery for lumbar spinal stenosis and were followed- up more than one year, were enrolled in this study. Unilateral undercutting laminoplasty and bilateral partial laminectomy was performed in 13 and 12 cases, respectively. The blood loss was compared and the presence of instability was observed. The increase in dural cross sectional area was measured in the preoperative and postoperative CT scans. In the clinical assessment, the Oswestry disability index (ODI) and visual analogue scale (VAS) to pain was used. Results: The average blood loss per segment was 273 ml and 436 ml in the laminoplasty and laminectomy group. There was no case of instability after surgery but there was a significant difference in the increase in dural cross sectional area between the two groups: 109.7 ㎟ and 78.6 ㎟ in the laminoplasty and laminectomy group, respectively. The preoperative and final change in the ODI and VAS scores was similar between the two groups. Conclusions: Unilateral undercutting laminoplasty is a minimally invasive procedure with less blood loss than the conventional technique and is equally effective.

Study Design: A restrosepctive study Objectives: We present the diverse imaging features of a spinal nerve sheath tumor for the preoperative diagnosis and treatment. Summary of Literature review: The typical imaging findings of spinal nerve sheath tumors are reported in the literature. However, they can show diverse and unusual imaging features. Materials and methods: The study group consisted of 30 patients who had undergone MR imaging for a preoperative evaluation of a spinal nerve sheath tumor from September 1989 to February 2008. All patients had undergone surgery for a spinal tumor that was confirmed by biopsy. The mean follow-up period was 13.1 months. The T1-, T2-weighted spine echo images and contrast material images were obtained in the sagittal plane. Axial images were obtained in any area of the spine where the sagittal images demonstrated abnormal findings. The signal intensity of the lesion, homogenicity, heterogenicity were evaluated in the T1-, T2-, and enhanced images Results: Twenty-four cases were neurilemmoma and 6 cases were neurofibromas. Different types of neurilemmomas included neurilemmomas with cystic changes (n=6), focal hemorrhage (n=5), extensive vertebral destruction (n=1), and giant neurilemmoma( n=1). The T1-weighted image showed low and intermediate signal intensity. The T2-weighted image showed high-signal intensity except for one neurilemmoma. The Gd-DTPA enhanced image showed homogenous, heterogeneous, and rim enhancement except for one case of a neurilemmoma with cystic changes. Conclusions: Spinal nerve sheath tumors can show diverse and unusual imaging findings. An awareness of the uncommon presentations of these tumors is important for making a preoperative diagnosis and treatment. MRI is valuable in characterizing the soft tissue and bony anatomy in spinal neurilemmoma and neurofibroma.

Percutaneous vertebroplasty for osteoporotic compression fractures or malignant osteolytic spinal tumors provides pain relief. A pulmonary embolism caused by polymethylmethacrylate migration after this procedure is rare and its major complication, pulmonary infarction, involves necrosis of the lung parenchyme, resulting from interference with the blood supply. We report a case of a large pulmonary embolus (diameter 2 cm) after cement vertebroplasty for an osteoporotic vertebral compression fracture and successful management with anticoagulation only.

A 63 year-old female was brought to our hospital with severe lower back pain. She received antihypertensive drugs for 2 years but her blood pressure was normal upon arrival. She could not stand up or even walk. The MRI showed a subdural hematoma at the thoracolumbar region, which was extremely rare. The treatment applied was decompression through a spinal tap without surgery. After this, her pain subsided considerably. Two weeks later, MRI confirmed that there was no hematoma in the same region. She was discharged and has enjoyed her daily activities free of pain. A spontaneous subdural hematoma is an extremely rare disease. The condition was treated successfully in a conservative manner.

Gossypiboma is a mass within body consisting of a cotton matrix surrounded by a foreign-body reaction. Some patients may remain asymptomatic, while others develop early persistent infected conditions. Gossypiboma should be included in a differential diagnosis of a paravertebral mass in postoperative patients, and a thorough and a careful inspection of the surgical field before closure must be performed by surgeons to avoid the complications of gossypiboma even when there are correct counts. We present a patient in whom a gossypiboma at the 4th lumbar spine was encountered 40 years after a partial laminectomy with no subjective symptoms.

Brucellosis is a well known systemic, zoonotic disease that can affect many organs. We report a rare case of spondylodiscitis with an epidural abscess caused by brucellosis. The patient was treated surgically for severe pain and concomitant devastating neurological deficit. A diagnosis of spondylodiscitis or an epidural abscess due to brucellosis must be considered when acute back pain, radiating pain and febrile episodes occur, particularly in people in a high risk group.

A spinal cord injury is an ailment that can not be treated, but through skillfully planned laboratory research we have been able to accumulate knowledge and expertise that have dramatically improved our understanding of the pathophysiology of SCI. Recent active studies on apoptosis are in now progress, and apoptosis plays a significant role in the long term loss of cells due to damage of these cells. The field is now rapidly advancing due to the development of methodologies such as immunology, molecular biology and genetics. The recent advances in the field of neural regeneration have shed a positive outlook on what once appeared to be an impossible task, that is, to regenerate neurons in the CNS.