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pISSN : 2093-4378 / eISSN : 2093-4386

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2017, Vol.24, No.4

  • 1.

    Risk Factors Predicting New Compression Fractures in Patients with Osteoporotic Vertebral Compression Fractures

    유성림 | 고영도 | 최신우 | 2017, 24(4) | pp.203~210 | number of Cited : 0
    Abstract
    Study Design: A retrospective study. Objectives: To investigate the risk factors associated with new compression fractures in patients with osteoporotic vertebral compression fractures. Summary of Literature Review: Previous studies have reported that a history of osteoporotic vertebral fractures and decreased bone mineral density were risk factors for new compression fractures. It is not certain whether vertebroplasty is a risk factor for new compression vertebral fractures. Materials and Methods: This retrospective study included a total of 52 patients who were diagnosed with an osteoporotic vertebral compression fracture and could be followed up for at least 1 year. Age, sex, bone mineral density, body mass index, osteoporosis treatment, fat infiltration of the back muscles, the sagittal index, vertebroplasty, and underlying diabetes mellitus or hypertension were compared between patients who developed new compression fractures during 1 year of follow-up and those who did not. For statistical analysis, the t-test and chi-squ are test were used to analyz ethe relationship of each factor with osteoporotic vertebral compression fracture incidence, and multiple logistic regression analysis was performed to analyze multifactorial explanatory factors. Results: No significant differences were found between the 2 groups regarding sex, underlying disease, the sagittal index, and fat infiltration of the back muscles. Patients who developed a new compression fracture were significantly older (p=0.011), had a lower body mass index (p=0.001), had lower bone mineral density (p=0.008), and were more likely to have taken osteoporosis medication for less than 6 months (including no medication, p=0.019). The logistic regression analysis showed that the risk of developing new compression fractures was significantly elevated in patients with a low body mass index (odds ratio [OR]=0.69, p=0.02), bone mineral density (OR=0.43, p=0.005), and less than 6 months of osteoporosis medication use (including no medication, OR=1.083, p=0.041). Conclusions: The risk of developing new compression fractures in patients with osteoporotic vertebral compression fractures was associated with body mass index, bone mineral density, and having taken osteoporosis medication for less than 6 months.
  • 2.

    Clinical and Radiographic Results of Artificial Disc Replacement Combined with Anterior Cervical Discectomy and Fusion Versus Two-Level Anterior Cervical Discectomy and Fusion in Two-Level Cervical Disc Disease

    현윤석 | 신재혁 | 박준식 and 3other persons | 2017, 24(4) | pp.211~220 | number of Cited : 0
    Abstract
    Study Design: Retrospective case-control study. Objectives: To compare the clinical and radiographic outcomes of a hybrid construct (HC) of cervical artificial disc replacement (CADR) combined with anterior cervical discectomy and fusion (ACDF) (group I) with 2-level ACDF (group II) in patients with 2-level cervical disc disease. Summary of Literature Review: ACDF is reported to potentially promote degenerative changes in the adjacent segment. CADR has been expected to reduce the risk of adjacent segment degeneration. However, its clinical course has yet to be sufficiently clarified. Materials and Methods: Twenty-six patients underwent 2-level cervical disc surgery. Single-level CADR combined with ACDF was performed in 14 patients. Twelve patients underwent 2-level ACDF. Clinical profiles were assessed using the neck disability index (NDI) and visual analogue scale scores of arm and neck pain. Dynamic lateral cervical radiographs were obtained preoperatively and at 1, 6, 12, and 18 months postoperatively. The range of motion (ROM) of the overall cervical spine (C2-7) and the adjacent segments was measured. Results: Group I showed a superior NDI at 18 months postoperatively (p<0.05). The mean C2-7 ROM of bothgroups recovered to thepreoperative ROM. At 18 months postoperatively, the C2-7 ROM of group I was higher than that of group II (p<0.05). The superior adjacent segment ROM was higher in group II (p<0.05), starting at 6 months. The inferior adjacent segment ROM showed no significant difference between the groups (p>0.05). Conclusions: The HC group showed comparable clinical and radiographic outcomes to those of the 2-level ACDF group. HC can be used selectively in the treatment of patients with 2-level cervical disc disease.
  • 3.

    Clinical Outcomes of Percutaneous Endoscopic Lumbar Discectomy for Adjacent Lumbar Disc Herniation after Lumbar Posterolateral Fusion by Radiologic Evaluations

    Young-Chul Ko | Dong-Jun Ha | Jung-Wook Huh and 4other persons | 2017, 24(4) | pp.221~230 | number of Cited : 0
    Abstract
    Study Design: A retrospective study. Objective: To analyze the effectiveness of percutaneous endoscopic lumbar discectomy (PELD) for adjacent lumbar disc herniation through radiologic evaluations. Summary of Literature Review: PELD minimizes posterior structural damage, allowing rapid rehabilitation. Subjects and Methods: This study was conducted on 45 patients who were followed up for 1 year after PELD for adjacent lumbar disc herniation from March 2014 to February 2016. The modified Macnab criteria, the modified Suezawa and Schreiber score (MSS score), and visual analogue scales for the back (VAS-B) and legs (VAS-L) were evaluated. The disc height ratio and segmental angulation change were compared before posterolateral fusion and before PELD. Moreover, spinal stenosis was confirmed on magnetic resonance imaging (MRI) before PELD. Results: Based on the modified Macnab criteria, 53.3% patients received an evaluation of at least “good,” and the mean MSS score improved from 4.77 to 6.99 at 1 year after the operation. The mean VAS-B score decreased from 7.02 to 4.67, and the mean VAS-L score decreased from 8.15 to 4.24 at 1 year after the operation. The mean disc height ratio was 87.1%, and the mean segmental angulation change was 6.5°, with a greater change in the “fair” or “poor” group, and the rate of spinal stenosis on MRI was also higher in the “fair” or “poor” group. Conclusion: The clinical outcomes of PELD, which is accompanied by degenerative changes on simple radiographic images such as disc space narrowing and increased segmental angulation or spinal stenosis on MRI, may not be satisfactory. Therefore, decisions regarding surgery should be made carefully in such cases.
  • 4.

    Efficacy of Cervical Expansive Laminoplasty for Quadriplegic Patients Without Cervical Bony Injury

    김현태 | Hyoung-Yeon Seo | Kim Sung Kyu | 2017, 24(4) | pp.231~235 | number of Cited : 0
    Abstract
    Study design: Retrospective study. Objectives: To evaluate the efficacy of cervical expansive laminoplasty for patients with quadriplegia due to traumatic cervical spinal cord injury (SCI) without skeletal injury Summary of Literature Review: There are a few studies on the surgical results for acute cervical SCI without bony injury. Materials and Methods: From 2003 to 2010, among the patients who visited emergency room with post-traumatic quadriplegia, 12 patients who had underwent cervical expansive laminoplasty for acute cervical SCI without body injury and cord compression on MR images were included in this study. We evaluate the pre-operative swelling on MRI, the change of neurologic symptoms at pre-, post operative state, respiration state, complication and survival period. Results: The average of motor index scores at the time of admission to the emergency room was 23 (4-30), and the average was changed to 29(4-43) during the follow-up period. No significant neurological improvement was observed in 11 cases except 1 case. The average time for operation after the injury was 26 hours(9-72). 4 patients showed paradoxical respiration when they first visited emergency room and the symptom continued after the operation and during follow-up periods. Another 4 patients showed paradoxical respiration after the operation. In all 8 cases who showed paradoxical respiration, tracheostomy and occasional ventilation were needed. In the follow-up period, 6 patients died due to respiratory failure within 1 year after the surgery. All these patients presented severe spinal cord edema on preoperative MRI with paradoxical respiration. Conclusions: Efficacy of expansive laminoplasty for quadriplegic patients due to acute cervical SCI without bony injury may be limited. In many patients, no significant neurological recovery was observed but it was clearly identified that prognosis was related to the grades of spinal cord edema and paradoxical respiration
  • 5.

    Abscess of the Cervical Spine Caused by Klebsiella Peumoniae with Acute Compressive Flexion Injury - A Case Report -

    Min Woo Kim | 이규열 | 2017, 24(4) | pp.236~240 | number of Cited : 0
    Abstract
    Study Design: Case report. Objectives: To report an unusual case of an abscess of the cervical spine caused by Klebsiella peumoniae accompanied by an acute compressive flexion injury. Summary of Literature Review: Spondylitis caused by Klebsiella peumoniae is very rare, and an unrecognized epidural abscess complicated with spinal cord compression can lead to severe neurologic deficits. Materials and Methods: A 66-year-old male patient diagnosed with a liver abscess caused by Klebsiella peumoniae was referred from the internal medicine department to our department due to abrupt posterior neck pain and limitation of motion after a fall from the bed. He showed persistent fever and progressive dysphagia. We diagnosed the condition as a massive cervical abscess caused by Klebsiella peumoniae accompanied by an acute compressive flexion injury. We performed drainage of the massive abscess, anterior fusion to treat the loss of the intervertebral discs at the C3/4 level, and corpectomy for a compression fracture of the C6 vertebral body using a cage and plate via an anterior approach. Subsequently, we performed posterior laminectomy with drainage at the C3-6 level and posterior instrumentation of C2-7 via a posterior approach. Results: Starting on the second postoperative day, the patient showed a decreased fever and gradual restoration of muscle strength and function in the upper extremities and hands. Conclusions: Klebsiella peumoniae may cause spinal infection as an opportunistic infection in patients with impaired immune function, and cervical infections in particular require aggressive early treatment because serious neurological symptoms may occur, even in cases of minor trauma.
  • 6.

    Surfer’s Myelopathy - A Case Report -

    곽동호 | Kim Young Hoon | Kee-Yong Ha and 3other persons | 2017, 24(4) | pp.241~245 | number of Cited : 0
    Abstract
    Study Design: A case report. Objectives: To report a rare cause of non-traumatic spinal cord injury (SCI) during surfing Summary of Literature Review: Surfer’s myelopathy is a non-traumatic SCI associated with the hyperextension posture during paddling in surfing. Although the definite pathomechanism has not been identified, cord ischemia followed by arterial infarction may be related to this injury. Materials and Methods: A young healthy male patient presented with a SCI that occurred during his first time surfing. Magnetic resonance imaging revealed a T2-hyperintense lesion in the spinal cord from D10 to the conus medullaris. Results: The patient completely recovered without any neurologic deficits after steroid therapy and other forms of supportive management. Conclusions: Since surfing is becoming more common in Korea, awareness of surfer’s myelopathy is important for early diagnosis and proper management.
  • 7.

    Paraplegia in an Ankylosing Spondylitis Patient with a Neglected Spine Fracture after Osteosynthesis for Fracture of the Femur - A Case Report -

    Sin-Wook Kang | 손홍문 | 유재원 | 2017, 24(4) | pp.246~251 | number of Cited : 0
    Abstract
    Study Design: Case report. Objectives: To report a case of paraplegia in a patient with thoracic kyphosis after osteosynthesis for a fracture of the femur. Summary of the Literature Review: There are few reports about cases of paraplegia after low extremity fracture surgery in patients with thoracic kyphosis with ankylosing spondylitis. Materials and Methods: An 86-year-old female patient presented with right hip pain. She had undergone surgery for an intertrochanteric fracture of the femur in the supine position under general anesthesia. Immediately after surgery, she showed paraplegia. Postoperative thoracolumbar spine images revealed a fracture through the disc at T12 and L1. However, she did not complain of back pain or any neurologic deficits before surgery. Results: Although the patient underwent emergent posterior decompression and fusion surgery, her neurologic compromise did not improve during 1 year of follow-up. Conclusions: It is necessary to check preoperative spine radiographs before surgery in elderly patients who have a kyphotic deformity and lower extremity fractures. Surgeons should consider changing the position of the patient and the type of anesthesia used during surgery when spine stability is in doubt.
  • 8.

    Brown-Séquard Syndrome and Cervical Vertebral Fractures after Blunt Cervical Trauma in a Traffic Accident - A Case Report -

    서승표 | Won Rak Choi | Chang-Nam Kang | 2017, 24(4) | pp.252~256 | number of Cited : 0
    Abstract
    Study Design: Case report Objectives: To report a case of Brown-Séquard syndrome after blunt cervical trauma. Summary of Literature Review: Brown-Séquard syndrome is a rare disease characterized by hemisection of the spinal cord, and it shows the best prognosis of the various types of incomplete spinal cord injuries. Materials and Methods: A patient with Brown-Séquard syndrome that occurred after a traffic accident was followed up for 2 years and 6 months. Results: We observed normal recovery of motor strength, but sensory impairment and deep tendon hyperreflexia remained. Conclusions: Brown-Séquard syndrome is known to have a good prognosis, but in this case, the neurological abnormality did not fully recover; therefore, we report this rare case and present a review of the literature.