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2011, Vol.18, No.2

  • 1.

    Clinical Characteristics and Surgical Results of Spinal Intradural Tumor

    김환정 | 구제윤 | 배경완 and 4other persons | 2011, 18(2) | pp.43~50 | number of Cited : 0
    Study Design: A retrospective study about spinal intradural tumor. Objectives: We analyzed clinical symptom, findings of MRI, and surgical outcome of spinal intradural tumor. Summary of Literature Review: Intradural tumors are not commonly reported and they show non-specific clinical features. Materials and Methods: In this study, 18 patients who underwent surgical treatment and radiologically and pathologically diagnosed as spinal intradural tumor from 1997 to 2009 were reviewed. We evaluated pain, neurological symptoms, location of tumor as well as degrees of signal intensity and its enhancement of MRI(T1 and T2). And clinical outcomes were analyzed according to Klekamp-Samii scoring system and Visual Analogue Scale(VAS). Results: All patients were clinically suffered from back pain and radiating pain of lower extremity including 3 patients with neurological symptoms. We radiologically found single tumor in 16 cases and masses more than two lesion in 2 cases. 1 case was located on cord level(T7), 14 cases cauda equine level, and 3 cases sacral level. We performed laminectomy in 18 cases and posterior instrumentation was applied to 8 cases. In clinical features, mean Klekamp-Samii score was improved from 21.6 to 23.5(p<0.05) and VAS was recovered from 5.2 to 3.0 (p<0.05). Conclusions: Spinal intradural tumor has non-specific clinical symptoms. Therefore we should perform MRI to find intradural tumor and active management including surgical treatment should be performed due to clinically good results. Key Words: Spinal intradural tumor, MRI, Clinical symptom
  • 2.

    Clinical Effect of The Lumbar Facet Joint Arthrography and Injection for Facet Joint Syndrome

    Dae Ho Ha | Tae Kyun Kim | 심대무 and 1other persons | 2011, 18(2) | pp.51~56 | number of Cited : 0
    Study Design: Intra-articular injections of long acting steriod and local anesthetics after lumbar facet joint(LFJ) arthrography are routinely used for therapeutic purposes in selected patients for relief of chronic low back pain. However, because of the difficulty in finding an accurate position of the symptomatic joint, the possibility of complication and the placebo effect, there are doubts about the clinical application of this treatment. Objectives: This study was designed to assess the diagnostic value and clinical benefits of lumbar facet joint arthrogram & injection of long acting steriod and local anesthetics in patients with facet joint syndrome. Summary of Literature Review: The radiological relationship and the diagnostic elements of facet joint syndrome need to be analyzed and evaluated for increasing the effectiveness of lumbar injection. Materials and Methods: Fifty two patients with low back pain were enrolled in the trial and they met the following criteria: pain for more than 3 months, no root signs and no history of back surgery. The response to facet joint injection was analyzed according to the chief complaints, a provocative test, the Visual Analogue Scale(VAS), the Helbig & Lee(HL) score, the facet block procedure and the arthrogram findings. A questionnaire with a pain scale was administered immediately or the day after injection, and then after 1, 3, 6 and 12 weeks. The arthrograms were reviewed by a radiologist & orthopedic specialist. Results: One hundred sixty nine joint injections were performed in 52 patients (L 3-4, n=33; L4-5, n=64; L5-S1, n=72). Thirty one patients had a chief complain of back pain that was aggravated by extension/rotation of the trunk and the provocative test was positive in 73.1%. The rates of a good response in the study group were 69.2% after one day, 44.2% after 3 weeks and 36.5% after 12 months. Arthrograms revealed synovial cysts in 1 of these patients and 5 patients had abnormal communication with spondylolysis. Two patients had contrast extravasated into the epidural space during injection. Conclusions: Lumbar arthrography showed a low diagnostic value. Lumbar injections, as a useful procedure to diagnosis facet joint syndrome, could be a useful palliative treatment modality for treating chronic lower back pain. But strict diagnostic criteria through a scoring system is needed to achieve a higher degree of predictability and effectiveness of facet joint injection Key Words: Facet Joint Syndrome, Facet Joint Block
  • 3.

    Clinical Outcome Based Cauda Equina Syndrome Scoring System for Prediction of Prognosis

    양준영 | 이준규 | 송호섭 and 2other persons | 2011, 18(2) | pp.57~63 | number of Cited : 2
    Study Design: This is a retrospective study Objectives: We made a scoring system using the symptoms of cauda equina syndrome(CES) and we studied the efficacy of the scoring system. Summary of the Literature Review: There has been no definite scoring system with clear factors that can predict the clinical results of cauda equine syndrome Materials and Methods: Between 1998 and 2006, 21 patients who were diagnosed with CES and who were followed for more than 2 years were enrolled in this study. There were 6 cases of HIVD, 6 cases of degenerative spondylosis, 7 cases of vertebral fracture and 2 cases of metastatic spinal tumor. We made a scoring system for CES (SSCES) using 8 symptoms among the general clinical manifestations that accompany CES, which are low back pain, sciatic neuropathy, sensory and motor disorder of the lower extremities,loss of a saddle sensation, voiding difficulty, disorder of the anal sphincter tone and deep tendon reflex disorder. Results: The last clinical outcomes were 3 excellent patients, 5 good patients, 5 fair patients and 8 poor patients. The mean preoperative SSCES was 11.7±2.8(7-16) and the mean final follow up score was 7.6±3.4(2-13). Eight cases that had a mean preoperative SSCES score of 6 or below showed good clinical results with a mean SSCES of 3.9±11(2-5) on the final follow up, and 13 cases with a mean preoperative SSCES score of 7 or above showed bad clinical results with a mean SSCES of 9.9±1.9(7-13) on the final follow up. Conclusions: The prognosis was better on the final follow up for the patients with a lowere preoperative SSCES. So, for the treatment of CES, preoperative evaluation using the SSCES is thought to be very useful for predicting the prognosis. Key Words: Cauda equina syndrome, Prognostic factor, Scoring system
  • 4.

    Clinical Results of Unilateral Partial Vertebroplasty(UPVP) in Osteoporotic Vertebral Fracture

    양준영 | 이준규 | 차수민 and 1other persons | 2011, 18(2) | pp.64~69 | number of Cited : 7
    Study Design: This is a prospective clinical study Objectives: We wanted to compare the clinical results of conventional vertebroplasty(VP) and the newly devised unilateral partial vertebroplasty(UPVP) . Summary of Literature Review: There has not been any study on how to reduce the amount of cement used while maintaining the height of the vertebral body and minimizing the adjacent compression fractures. Materials and Methods: From 2004 to 2008, Group 1 underwent VP and group 2 underwent UPVP. We compared the difference of the VAS score, the period of hospitalization, the infused amount of cement, the progression of the vertebral body collapse and fresh fracture of the adjacent vertebral body on the follow-up simple radiographs. Results: In group 1, the mean VAS score changed from 6.69 to 2.80, the mean period of hospitalization was 2.30 days and the mean amount of cement infused was 6.50cc. The degree of vertebral body collapse was 0.83, 0.76, 0.69 and 0.63 on follow-up, and 3 cases had fresh fracture. In group 2, the mean VAS score changed from 6.41 to 2.61, the mean period of hospitalization was 2.23 days and the mean amount of cement infused was 3.74cc. The degree of collapse was 0.71, 0.69, 0.68 and 0.63 on follow up and 1 case had fresh fracture. The two groups showed no statistical significance for the change of the VAS score and the period of hospitalization, and the amount of cement was significantly less in group 2. The degree of collapse was not significantly different on the 4 times of follow-up. The frequency of fresh fracture was significantly less in group 2. Conclusions: UPVP could achieve similar results for pain relief, the period of hospitalization and vertebral body collapse as compared to that of VP, but fresh fracture of the adjacent vertebral body was less. So, UPVP could be a better method than VP. Key Words: Unilateral pedicle, Osteoporotic Compression Fracture, Vertebroplasty, Unilateral Partial Vertebroplasty
  • 5.

    Osteochondroma of 12th Thoracic Vertebra - A Case Report-

    이진영 | 송경원 | Hyun-Jin Park and 1other persons | 2011, 18(2) | pp.70~74 | number of Cited : 0
    Study Design: Cases report Objectives: We report 1 case of relatively rare osteochondroma that was in thoracic spine Summary of Literature Review: Osteochondroma is one of the most common benign tumor in bone, consist of 40%, but, rare in spine area occupying only 2%. We report a case of osteochondroma that was in the 12th vertebra of thoracic spine, that had severe right flank pain. We performed en bloc excisional biopsy of the bony mass. Materials and Methods: A fourty seven-year-old male complained right flank pain. He had mass of 12th thoracic costovertebral junction and underwent open excision and biopsy Results: The preoperative pain disappeared and any signs of recurrence were not found on the follow up performed at 1 year. Conclusions: The painful osteochondroma of thoracic spine is treated successfully by surgical technique. Key Words: Thoracic spine, Osteochondroma