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2012, Vol.19, No.2

  • 1.

    Is It Necessary to Add Anterior Decompression after Posterior Decompression for Thoracolumbar and Lumbar Fractures with Neurologic Deficit?

    유재원 | 손홍문 | 박상수 | 2012, 19(2) | pp.31~37 | number of Cited : 0
    Abstract
    Study Design: A retrospective study. Objectives: To understand the necessity of additional anterior decompression when treating with posterior decompression for thoracolumbar and lumbar fractures, with neurologic deficit. Summary of Literature Review: Additional anterior decompression is still a controversy after a posterior decompression Materials and Methods: We evaluated 38 patients who were treated with a decompression surgery for thoracolumbar and lumbar spine fractures with neurologic deficit. In the posterior decompression group, there were 26 patients, and there were 12 patients in the posterior and anterior decompression group. According to the Frankel grade, neurologic deficit was grade A 3, B 1, C 3, D 31, respectively. Unstable burst fractures were 22, flexion-distraction injuries 12, Chance fractures 2 and translational injuries 2 by the McAfee classification. Radiographic evaluation was carried out with comparison of the spinal canal encroachment and kyphotic angle. We evaluated the improvement of neurology, and compared with that of the preoperative canal encroachment. Results: During the posterior decompression, 5 neural injuries were found in the post. decompression group, and 4 in the post. and ant. decompression group. There was no significant difference of neurologic improvement between the two groups (improvement in 18(69%)and 8(67%), respectively) (p>0.05). Preoperative canal encroachment was 62% and 76%, respectively. But, preoperative canal encroachment and final neurologic improvement showed no significant correlations between the two groups (p>0.05). Conclusions: We could not find the difference of neurologic improvement between the post. decompression group and post. and ant. decompression group. We suggest that an additional ant. decompression for the thoracolumbar and lumbar spine fractures treated with post. decompression is not necessary.
  • 2.

    Comparison The Safety and The Efficacy between the Group of using Pelubiprofen Tab. and the Group of using Aceclofenac Tab. on Back Pain Patients - Multi Institution, Double Blind, Random Sample -

    신병준 | Tae Kyun Kim | 백종석 and 1other persons | 2012, 19(2) | pp.38~46 | number of Cited : 2
    Abstract
    Study Design: Multi institution, double blind, random sample. Objectives: We conducted a comparative study with Aceclofenac Tab, which is widely used in the clinical field in order to observe the Pelubiprofen Tab’s clinical efficiency in patients with back pain. Summary of Literature Review: Among the numerous literatures regarding the chronic back pain, there is are few studies with Pelubiprofen Tab`s clinical efficiency. Materials and Methods: We computed an experimental model through a case control study, practiced from January, 2010 to January, 2011, and thereby, 298 back pain patients were selected. This study was conducted through a multi institution, double blind, and random sample. We compared the experimental and control groups’ clinical efficiency that was estimated by VAS after 28 days of medication. Also, we compared the treatment efficiency of both drugs by using a variation of Oswestry Disability Index (ODI) and Physician’s Global assessment, with a total usage of relief medicine. Also, the side effect and clinical pathologic result were tested. Statistical analysis was done with three different methods, Safety method, ITT (Intent-To-Treat), and PP (Per Protocol). Logistic regression model was used, and this result was compared by a Chi-square or Fisher’s Exact test. Results: Comparing the VAS of both groups, VAS decreased with statistical significance. Both groups didn’t show a significant difference in VAS (p=0.6764). As the decrement of the total dosage of relief medicine, the decrease in the control group was rather higher, but the difference didn’t show any statistical significance (p=0.9955). The experimental group was not inferior than that of the control group in ODI and PGA variation. Analyzing the side effect, both groups didn’t show any significant difference (p=0.9843). Conclusions: As a result of the clinical trial, Pelubiprofen Tab. applied to back pain patients was not inferior to that of aceclofenac Tab., in terms of efficiency, and didn’t show any significant difference in safety.
  • 3.

    Differences in Thoracolumbar Burst Fractures by Falls from Height with Associated Foot and Ankle Fractures

    Chung-Shik Shin | Byeong-Yeol Choi | 정의섭 and 1other persons | 2012, 19(2) | pp.47~51 | number of Cited : 0
    Abstract
    Study Design: This is a retrospective clinical study. Objectives: To know how the associated foot or ankle fracture influences the fracture pattern in the thoracolumbar burst fractures caused by falls from height. Summary of Literature Review: There were few studies on how the foot or ankle fracture influences the thoracolumbar fracture caused by falls from height. Materials and Methods: We reviewed 46 subjects, who underwent surgery due to burst fracture of the thoracic or lumbar region,caused by fall accidents, from May 2004 to October 2008. Among them, we defined 19 cases that had associated foot or ankle fractures as group A, and the other 27 cases as group B. We analyzed the differences of radiological and clinical findings, and functional outcomes between the two groups. Results: The falling heights were higher in group A than in group B (P<0.01). Thoracolumbar junction (T11-L2) was the most common location involved in both groups, but group A had more fractures on the lower lumbar region (L3-5), relatively (p=0.03). Kyphotic deformity was more severe in group B (p=0.01) but there were no significant differences in the wedge angle, amount of canal compromise,compression rate of anterior column between both groups (p=0.08, 0.46, 0.76). More segments were fused in group B (P=0.04). Neurologic deficit was more common in group B (p=0.03), but there were many complications related with foot or ankle fractures in group A (38%).There was no significant difference in the final clinical outcome between both groups (Pain scale p= 0.48, Work scale p=1.00). Conclusions: In patients who had burst fractures in the thoracic or lumbar region associated with foot or ankle fractures, there was a tendency to increase the incidence of lower lumbar fracture, relatively. The neurologic deficits were less common in this group of patients, but there was no difference in the functional outcome.
  • 4.

    Effectiveness of Selective Nerve Root Block for the Treatment of Radiculopathy in Degenerative Lumbar Scoliosis

    Suk-Joong Lee | Dae Moo Shim | Tae Kyun Kim and 1other persons | 2012, 19(2) | pp.52~58 | number of Cited : 2
    Abstract
    Study Design: Level III, Retrospective studies. Objectives: This study was conducted to evaluate the effects and usefulness of the selective nerve root block in advance for the Degenerative Lumbar Scoliosis patients, with radiating pain, who were scheduled for an operation. Summary of Literature Review: Selective nerve root block was introduced in 1971, by Macnab and it was used to make improvements for radiating pain, as a treatment of multiple lesions or a tool to help making a surgical decision, and to predict the result. After an introduction by Cooper, selective root block on degenerative sclerosis, with lower leg radiating pain, showed fine results on a short term follow-up and moderate to good results on long term follow-up. Materials and Methods: Between January 2005 to December 2009, 47 cases were selected from the patients, who underwent selective nerve root block, before the operation. The mean follow–up period was 38.4 months and the mean age was 67.1 years. The patients were divided into the operation group and the only selective nerve root block group. The treatment results in the SNRB group and the operation group were analyzed using Kim’s criteria and the Visual Analog Scale score. The groups were radiologically evaluated for the neural compression rate. Results: Among the 47 cases that were scheduled for an operation, 30 cases did not proceed to the operation. The average VAS score for the selective root block group and the operation group were 7.56 and 8.12, at the preoperative state and the preinjection state, respectively. After the selective nerve root block and surgical treatment, the scores were 3.71 and 2.64 at 1year follow up, respectively. There was no correlation with statistical significance between the initial VAS score and the degree of stenosis noted in the MRI (P>0.05). There was no statistical significant correlation between the initial relief from selective nerve root injections and the degree of stenosis noted in the MRI (P>0.05). However, there was a correlation with statistical significance between the operation rate and the degree of stenosis noted in the MRI (P<0.05). Conclusion: Selective nerve root block is considered to be an effective treatment for the Degenerative Lumbar Scoliosis patients with radiating pain, who are scheduled for an operation.
  • 5.

    Non-traumatic Atlanto-axial Rotatory Subluxation - A Case Report -

    박희전 | 권기연 | 김완기 and 2other persons | 2012, 19(2) | pp.59~63 | number of Cited : 0
    Abstract
    Study Design: A case report. Objectives: To report a case of diagnostic, clinical and radiologic follow-up of a non-traumatic atlanto-axial rotatory subluxation. Summary of Literature Review: Atlanto-axial rotatory subluxation, caused by a non-traumatic inflammation or infectious diseases,has been branded as “Grisel’s syndrome”. However, the pathophysiology of the syndrome has not been clearly understood, and its diagnostic criteria and appropriate treatment plans are not established. Material and Methods: The patient suffering from antlanto-axial subluxation without any neurological symptoms was treated with halter traction and Miami J brace. Results: The patient maintained a normal reduction state, and a normal cervical movement was observed after undergoing 4 weeks of non-surgical treatment. Conclusion: Early detection and treatment are essential and critical in avoiding catastrophic outcomes. It requires a combination of clinical assessment and appropriate radiographic imaging.
  • 6.

    Congenital Hypoplasia of the Posterior Arch of the Atlas Associated with a Fracture of the Odontoid Process - A Case Report -

    Sung Kyun Oh | 이승빈 | 2012, 19(2) | pp.64~67 | number of Cited : 0
    Abstract
    Study Design: Case report. Objectives: To report a rare posterior arch hypoplasia of the atlas and review the clinical significance. Summary of Literature Review: Congenital hypoplasia of posterior arch of the atlas is uncommon. In particular, the combined fracture of the odontoid process has not been reported. Material and Methods: A 56-year-old man developed severe neck pain after a traffic accident. Cervical CT scan revealed a fracture of the odontoid process and hypoplasia of posterior arch of the atlas. Results: Bony union was achieved after halo vest immobilization for three months. Conclusions: Hypoplasia of posterior arch of the atlas is determined incidentally in asymptomatic patients. However, the patients should be evaluated in detail with a 3D CT and MRI to avoid a misinterpretation as fracture, instability or misdiagnosis.
  • 7.

    Diastematomyelia in Adult - A Case Report -

    이진영 | 조주성 | 2012, 19(2) | pp.68~71 | number of Cited : 0
    Abstract
    Study Design: Case report. Objectives: We report an adult patient with diastematomyelia. Summary of Literature Review: Diastematomyelia is an uncommon congenital malformation of the vertebral axis, characterized by a separation of the spinal cord with an interposed bony, cartilaginous or fibrous septum. Most of the patients present this condition in childhood. The cases in adulthood are extremely rare. Materials and Methods: The authors experienced a 46-year old female patient with diastematomyelia presenting a gradual onset of neurologic claudication. We treated with decompressive laminectomy, septum removal and posterior instrumentation. Results: We had satisfactory surgical results. Conclusions: We report an extremely rare case of diastematomyelia in adulthood.
  • 8.

    Ossified Meningioma - A Case Report -

    안동기 | 문상호 | Song Lee and 4other persons | 2012, 19(2) | pp.72~76 | number of Cited : 1
    Abstract
    Study Design: A case report Objectives: To report an extremely rare case of the spinal meningioma containing bone. Summary of Literature Review: Spinal meningiomas represent 16.6-46.7% of the primary spinal tumors and 1 to 5% of them are calcified. Ossification is an extremely uncommon event that complicates the resection surgery. Materials and Methods: We experienced a 59-year-old patient who complained of weakness in the lower limbs and gait disturbance. Spinal cord compressing mass was discovered on a MRI at T6 and there was a vertical plate at the posterior side of the mass. Surgical finding showed complete ossification in the dural attachment site of the mass. Though the tumor mass could be excised with the inner layer of the dura mater en masse, more forceful retraction of the spinal cord was unavoidable than the other soft mass resection. Results: The preoperative neurological impairment improved after the surgery and she was able to walk well. Conclusions: Ossification makes a resection difficult and vulnerable to develop neurological deterioration. But if we could suspect such an ossification through an image test, it would be helpful to make a surgical plan to avert a neurologic complication.