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pISSN : 2093-4378 / eISSN : 2093-4386

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2017, Vol.24, No.1

  • 1.

    Risk Factors for Osteoporotic Vertebral Fracture in Cushing Syndrome

    Seung-Hwan Lee | Byeong-Mun Park | Kyung-Sub Song and 5other persons | 2017, 24(1) | pp.1~6 | number of Cited : 0
    Study design: Retrospective study. Objectives: The goal of this study was to evaluate the risk factors of osteoporotic vertebral fractures (OVFs) in patients with Cushing syndrome. Summary of Literature review: In most reports, vertebral fractures in Cushing syndrome have been found to be related to osteoporosis. However, few studies have analyzed the clinical risk factors for OVFs. Materials and Methods: Thirty-two patients with Cushing syndrome who visited the orthopaedic department complaining of back pain were included in this study. Standing lateral X-rays were performed to evaluate the presence of vertebral fractures, and bone mineral density (BMD) was measured. Results: Of the 32 patients with Cushing syndrome with back pain, 8 (25%) were diagnosed with OVFs using morphometric criteria. The average weight and body mass index of the vertebral fracture group (VF group) were significantly higher than the values observed in the non-vertebral fracture group (non-VF group) (p=0.004, p=0.018). Lumbar BMD was significantly lower in the VF group (p=0.006). A risk factor for OVFs in Cushing syndrome was osteoporosis (odds ratio=18.56, 95% confidence interval=1.72-200.21, p=0.016) regardless of gender, obesity, menopause, or urine free cortisol levels. Conclusions: OVFs in Cushing syndrome have been associated with overweight, and overweight is an indicator of compliance in the treatment of Cushing syndrome. Therefore, weight reduction and the prevention of osteoporosis should be emphasized in patients with Cushing syndrome to prevent OVFs.
  • 2.

    Conservative Treatment of Pyogenic Spondylitis in the Elderly

    Dong-Geun Kang | Soon-Taek Jeong | Dong-Hee Kim and 2other persons | 2017, 24(1) | pp.7~15 | number of Cited : 1
    Study Design: Retrospective study. Objectives: To analyze the outcomes of conservative management in elderly patients over 65 years of age who were diagnosed with pyogenic spondylitis. Summary of Literature Review: The surgical treatment of pyogenic spondylitis can lead to complications in elderly patients in a poor general condition or with underlying diseases. Materials and Methods: We performed a retrospective review of 32 patients who were diagnosed with pyogenic spondylitis and had a minimum of 12 months of follow-up. Age, sex, comorbidities, clinical symptoms, and the involved segments were analyzed retrospectively. The diagnosis was assessed using clinical, laboratory, and radiologic findings. Antibiotic therapy was either specific (if positive culture results were found) or broad-spectrum cephalosporin (when the pathogenic agent was not isolated). Outcomes were assessed using residual pain and neurologic deficits. Results: The mean onset time was 23.5 days (range, 3-90 days). The mean period of intravenous antibiotic therapy was 36.3 days (range, 10-90 days). All cases underwent conservative management, and 4 patients with progressive neurologic deficits due to epidural abscess underwent posterior laminectomy and abscess drainage. In all cases, the infection was successfully treated, although 12 cases reported residual lower back pain and 2 continued to exhibit minor neurologic deficits. Conclusions: In elderly patients with pyogenic spondylitis, satisfactory results were obtained with conservative management using antibiotics and orthosis after an early diagnosis, unless progressive neurologic symptom instability or spine deformities were noted.
  • 3.

    Validity of the Thoracolumbar Injury Classification System for Thoracolumbar Spine Injuries

    Kim Sung Kyu | Tae-Min Lee | 서형연 and 1other persons | 2017, 24(1) | pp.16~23 | number of Cited : 0
    Study Design: Retrospective study. Objectives: To evaluate the validity of the thoracolumbar injury classification system (TLICS) when making treatment decisions in a group of thoracolumbar fracture patients. Summary of Literature Review: Few studies have evaluated the validity of the TLICS in consecutively treated patients, although many have evaluated the application of the TLICS to thoracolumbar injuries. Materials and Methods: A retrospective study was performed among the 230 patients who were treated from 2003 to 2015 in our hospital for thoracolumbar injuries. Evaluations were made of clinical outcomes and radiologic results, and each case was analysed and scored according to the American Spinal Injury Association scale, the Magerl/AO classification, and the TLICS classification by 2 spinal surgeons. Results: Of the 230 patients, 116 (50.4%) received conservative treatment and 114 (49.6%) received surgical treatment. Of the 116 patients who received conservative treatment, 112 (96.6%) were treated according to the TLICS guidelines. Conservative treatment failed for 2 of the 4 patients (1.7%) whose treatment did not correspond with TLICS, and they required surgical treatment. Of the 114 patients who underwent surgical treatment, in 87 (76.3%) the treatment corresponded to the TLICS guidelines. Conclusions: The TLICS classification showed high validity for the conservative treatment of thoracolumbar injuries.
  • 4.

    Acute Epidural Hematoma Following Cervical Spinal Fracture in a Patient with Ankylosing Spondylitis Natural History of Lumbar Degenerative Kyphosis with Conservative Treatment

    Whoan Jeang Kim | 장선호 | 이규상 and 4other persons | 2017, 24(1) | pp.24~31 | number of Cited : 0
    Study Design: Retrospective study. Objectives: To evaluate the natural history of conservatively treated lumbar degenerative kyphosis (LDK). Summary of Literature Review: The correlations between the clinical and radiologic parameters of general adult spinal deformity (ASD) are widely known. However, in LDK, dynamic sagittal imbalance is present during ambulation, meaning that its pathogenesis and natural history are different and not widely recognized compared to those of other forms of ASD, resulting in many controversies regarding treatment. To elucidate the natural history of LDK, we analyzed the clinical and radiologic outcomes of patients, comparing their first and final follow-up visits, and evaluated correlations among clinical and radiologic parameters. Materials and Methods: From June 2006 to January 2014, 31 patients diagnosed with LDK who underwent conservative treatment were studied. The mean age of the patients was 72.5 years, and the mean follow-up period was 59.2 months. Clinical and radiologic evaluations were conducted on the first and final follow-up visits. Clinical evaluations were done using a visual analog scale and the Oswestry disability index, and radiologic evaluations were performed using spinal and pelvic parameters over a follow-up period of at least 24 months. Results: Patients who were diagnosed with LDK and underwent conservative treatment showed no significant differences in their clinical outcomes between the first and final follow-up. Some radiologic parameters significantly progressed. There were no significant differences between clinical and radiologic parameters at the initial and final follow-up visits. Conclusions: During the follow-up period of patients diagnosed with LDK, some radiologic parameters progressed. However, the progress of LDK and the clinical symptoms reported by the patients did not significantly change. Decisions regarding the treatment of LDK should not be made according to radiologic parameters showing the degree of deformity, but by carefully determining the patients’ clinical symptoms and disability level.
  • 5.

    Effectiveness of Selective Nerve Root Block for the Treatment of Single-Segment Lumbar Spinal Stenosis and Disc Herniation

    Tae Kyun Kim | 김창수 | 최영채 and 1other persons | 2017, 24(1) | pp.32~38 | number of Cited : 1
    Study design: Retrospective clinical study. Objectives: To determine and compare the therapeutic effectiveness of selective nerve root block performed for single-segment spinal stenosis and disc herniation. Summary of Literature Review: The usefulness of selective nerve root block has been reported in several previous studies, but those results were aggregated across many diseases, making it difficult to estimate its effectiveness for each disease. Materials and Methods: From January 2008 to January 2013, among patients who had undergone selective nerve root block, those who were diagnosed with single-segment spinal stenosis or disc herniation were enrolled in this study. Among a total of 103 patients, 47 spinal stenosis patients were classified as group 1, and 56 disc herniation patients as group 2. Visual analog scale (VAS) scores and Kim’s criteria were used to compare the reductions in radiating pain in each group. Results: In group 1, the VAS scores improved from 7.6 before the procedure to 2.6 and 3.3 at 1-month and 6-month follow-up visits, respectively. Kim’s criteria also improved from a mean of 1.6 before the procedure to 2.9 at the 6-month follow-up. In group 2, the VAS scores improved from 7.8 before the procedure to 2.1 and 2.7 at 1-month and 6-month follow-up visits, respectively. Kim’s criteria also improved from a mean of 1.8 before the procedure to 3.2 at the 6-month follow-up. Conclusions: Radiating pain in the lower limb due to spinal stenosis or disc herniation limited to a single segment was effectively controlled by selective nerve root block.
  • 6.

    Traumatic Lumbar Plexopathy by Seat Belt Injury

    Yung Park | Joong-Won Ha | 고민석 and 5other persons | 2017, 24(1) | pp.39~43 | number of Cited : 0
    Study Design: A case report. Objectives: To report and discuss an extremely uncommon cause of lumbar plexopathy seat belt injury. Summary of Literature Review: For patients who undergo traffic accidents, most cases of seat belt injury cause trauma to the lower torso. Seat belt injury is associated with variable clinical problems such as vascular injury, intestinal injury (perforation), vertebral injury (flexion-distraction injury), chest wall injury, diaphragmatic rupture/hernia, bladder rupture, lumbosacral plexopathy, and other related conditions. Materials and Methods: A 38-year-old male truck driver (traffic accident victim) who suffered monoplegia of his right leg due to lumbar plexus injury without spinal column involvement. Injury to a lumbar plexus and the internal vasculatures originated from direct compression to internal abdominal organs (the iliopsoas muscle and internal vasculatures anterior to the lumbar vertebrae) caused by the seat belt. We have illustrated an extremely uncommon cause of a neurologic deficit from a traffic accident through this case. Results: Under the impression of traumatic lumbar plexopathy, we managed it conservatively, and the patient showed signs of recovery from neurologic deficit. Conclusions: We need to review the lumbar plexus pathway, in patients with atypical motor weakness and sensory loss of the lower extremities which are not unaccompanied by demonstrable spinal lesions. Therefore, close history taking, physical examination and comprehension of injury mechanism are important in the diagnosis. Key words: Traumatic, Lumbar plexopathy, Seat belt injury
  • 7.

    Acute Epidural Hematoma Following Cervical Spinal Fracture in a Patient with Ankylosing Spondylitis

    Sangbum Kim | 오병학 | Youn Moo, Heo and 2other persons | 2017, 24(1) | pp.44~48 | number of Cited : 0
    Study Design: Case report. Objectives: To report a case of epidural hematoma following cervical spinal fracture in a patient with ankylosing spondylitis. Summary of Literature Review: An early surgical intervention for acute epidural hematoma following cervical spinal fracture led to improvements in the patient’s neurological deficits. Materials and Methods: A 76-year-old male with ankylosing spondylitis presented with neck pain and motor weakness of both upper and lower extremities after falling. He sustained fractures of the C7 body and the spinous processes of C5 and C6. Magnetic resonance imaging showed an extensive epidural hematoma from C7 to T5. The authors performed decompression from C6 to T2, and posterior instrumentation and fusion from C4 to T3. Results: An urgent surgical intervention was performed, and a good result was obtained. Conclusions: The authors describe an early surgical intervention in a case of acute epidural hematoma following cervical spinal fracture in a patient with ankylosing spondylitis.
  • 8.

    Epidural Lymphoma Mimicking Hematoma - A Case Report -

    Dong-Yeong Lee | Dong-Hee Kim | Soon-Taek Jeong and 2other persons | 2017, 24(1) | pp.49~54 | number of Cited : 0
    Study Design: Case report. Objectives: To present a rare case of a spinal epidural lymphoma mimicking a hematoma. Summary of Literature Review: The incidence of extranodal invasion of lymphoma is very low, and spinal compression as a clinical symptom rarely occurs in extranodal lymphoma. Materials and Methods: A 37-year-old woman who complained of neck pain that had lasted for the past 3 months with no underlying disease visited the hospital and was treated conservatively with medication and physical therapy. Even though the patient was given an epidural injection 1 month prior to visiting our hospital, the pain lingered and the cervical myelopathy became aggravated, so the patient was initially diagnosed with epidural hematoma. This predisposed the patient to treatment strategies such as laminectomy and fusion, but the patient was ultimately diagnosed with non-Hodgkin lymphoma. Results: The patient underwent a laminectomy with excision of the lesion and fusion. The patient was diagnosed with non-Hodgkin lymphoma as a result of this, and the patient’s radicular pain and numbness improved immediately following surgery, except for mild weakness in both hands. Conclusions: Although spinal epidural lymphoma is similar to hematoma, and is a very rare disease, surgeons should take it into consideration in the differential diagnosis of patients with a spinal epidural lesion. Key words: Myelopathy, Epidural, Lymphoma, Non-Hodgkin lymphoma, Hematoma
  • 9.

    First Coccygeal Vertebra Dislocation Treated by Open Reduction and Internal Fixation

    장세앙 | 유현승 | Ka-Ram Kim | 2017, 24(1) | pp.55~58 | number of Cited : 0
    Study Design: Case report. Objectives: To report the effectiveness of open reduction and internal (screw) fixation treatment performed to treat dislocation of the first coccygeal vertebra. Summary of Literature Review: Most treatment methods for coccygeal dislocation were conservative treatment for acute coccygodynia and coccygectomy for chronic coccygodynia. Materials and Methods: A 18-year-old female presented with severe coccygodynia due to a fall down the stairs. Computed tomography showed dislocation of the first coccygeal vertebra. We performed open reduction and internal fixation with a 4.0-mm shortthread cancellous screw with a washer, with no additional procedure for bone union. Results: Union was achieved 10 weeks postoperatively. Conclusions: Open reduction and internal (screw) fixation can be a useful method for coccygeal vertebra dislocation. Key words: Coccygeal vertebrae dislocation, Coccygodynia, Open reduction and internal fixation
  • 10.

    Analgesic Effects of Antiosteoporotic Drugs

    안동기 | 신원식 | Go We Kim | 2017, 24(1) | pp.59~64 | number of Cited : 0
    Study design: Literature review. Objectives: To propose possible mechanisms of osteoporotic back pain and its management with antiosteoporotic drugs. Summary of Literature Review: No general conclusion has yet been reached regarding whether osteoporosis without fractures can cause pain. Instead, only treatments for back pain without osteoporotic spine fractures have been reviewed in the previous literature. Although key studies of antiosteoporotic drugs have not investigated their analgesic efficacy, plausible mechanisms have been suggested. Materials and Methods: The analgesic effects of antiosteoporotic agents available in Korea were reviewed. Results: Rather than the long-term use of conventional analgesics or narcotics, antiosteoporotic drugs would be more beneficial because they can enhance bone strength and have fewer side effects. Both anabolic and antiresorptive agents available in Korea have been proven to have an analgesic effect against osteoporotic back pain, with or without fractures. Anabolic agents depend on skeletal effects. Among antiresorptive agents, bisphosphonates have both skeletal and extraskeletal mechanisms for analgesia. Calcitonin and selective estrogen receptor modulators mostly depend on extraskeletal effects. The order of analgesic strength for osteoporotic back pain is teriparatide > bisphosphonate > calcitonin. This implies that the analgesic effect of antiosteoporotic drugs primarily depends on their skeletal effects rather than on their extraskeletal effects. Moreover, because non-fracture osteoporotic pain has been recognized only in the spine, where fractures can occur without a sensible injury, pain may arise from undiscovered spine fractures. Conclusions: Antiosteoporotic drugs ameliorate osteoporotic back pain. Their analgesic strength is proportional to their fracture prevention efficacy.