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pISSN : 2093-4378 / eISSN : 2093-4386

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2018, Vol.25, No.1

  • 1.

    Neurological Complications of Posterior Spinal Surgery: Incidence and Clinical Features

    신원식 | 안동기 | 이정수 and 2other persons | 2018, 25(1) | pp.1~8 | number of Cited : 0
    Study design: Retrospective study. Objectives: To identify clinical features and risk factors helpful for the prevention and early diagnosis of neurological complications. Overview of Literature: Previous studies have investigated postoperative complications only for specific disease entities and did not present distinctive clinical features. Materials and Methods: This was an observational study of patients who underwent posterior thoracolumbar spinal surgery in the orthopedic department of a single hospital over the course of 19 years (1995-2013). The incidence, cause, onset time, and risk factors of complications were investigated. Neurological deterioration was graded on a 5-point numeric scale: G1, increased leg pain or sensory loss, G2, unilateral motor weakness; G3, bilateral motor weakness; G4, cauda equina syndrome; and G5, complete paraplegia. Results: Sixty-five cases out of 6574 (0.989%) developed neurological complications due to the following causes: epidural hematoma, 0.380%; instrumentation with inadequate decompression, 0.213%; mechanical injury, 0.167%; inadequate discectomy, 0.061%; and unknown cause, 0.167% (p=0.000). The grade of neurological deterioration was G1 in 0.167% of patients, G2 in 0.517%, G3 in 0.228%, G4 in 0.046%, and G5 in 0.030%. Neurological deterioration was most severe in patients who experienced epidural hematoma, followed by those in whom complications occurred due to instrumentation with inadequate decompression, unknown causes, mechanical injury, and inadequate discectomy, in order (p=0.009). Revision surgery was a significant risk factor (p=0.000; odds ratio, 2.741). The time that elapsed until symptom development was as follows, in order: unknown cause, 0.6 hours; epidural hematoma, 5.4 hours; mechanical injury, 6.6 hours; inadequate discectomy, 18.0 hours; and instrumentation with insufficient decompression, 36.0 hours (p=0.001). Conclusions: The incidence of neurological complications in our cohort was 1%. Revision surgery increased the risk by 3 times. Severe cases (cauda equina syndrome or complete paraplegia) rarely developed, occurring in 0.08% of patients. The major causes of neurological decline were epidural hematoma and instrumentation with inadequate decompression. Close observation in the early period was important for the diagnosis because most patients developed symptoms within 12 hours. Delayed diagnosis was most common in complications caused by instrumentation with inadequate decompression.
  • 2.

    Treatment of Multiple Thoracolumbar and Lumbar Spine Fractures: Comparison of Contiguous and NonContiguous Fractures in Non-Osteoporotic Patients

    손홍문 | Yi Kyu Park | Sin Wook Kang | 2018, 25(1) | pp.9~27 | number of Cited : 0
    Study Design: Retrospective study. Objectives: To evaluate the outcomes of multiple thoracolumbar and lumbar fractures depending on whether the fractures were contiguous. Summary of the Literature Review: The treatment of multiple spine fractures in patients without osteoporosis has rarely been reported. Materials and Methods: From February 2004 to January 2016, 81 patients without osteoporosis who had acute thoracolumbar and lumbar fractures and underwent posterior fusion surgery were evaluated. Patients were divided into 2 groups (group A: contiguous, group B: non-contiguous). We investigated the causes of the injuries, the locations of the injuries within the spine, the range of fusion levels, and functional outcomes based on the patients’ general characteristics. Results: Group A comprised 37 patients and group B comprised 44 patients. In most patients, the fusion included 3 segments (group A: 12, group B: 14) or 4 segments (group A: 9, group B: 10). Group A scored 21.2 and group B scored 19.0 on the Korean Oswestry Disability Index. In both groups, longer fusion was associated with poorer clinical results. In the clinical evaluation of the fusion rate, there was no statistically significant difference between the 2 groups (p=0.446). Conclusions: In this study, patients with multiple vertebral fractures showed more fusion segments and poor clinical outcomes in contiguous fractures. In the patients with non-contiguous fractures, the clinical results were better when a minimal number of segments was fused. Therefore, the authors recommend conservative treatment to minimize the number of segments that are fused in noncontiguous multiple thoracolumbar and lumbar fractures when decompression is not necessary.
  • 3.

    Tophaceous Gout of the Lumbar Spine Mimicking Infectious Spondylodiscitis and Epidural Abscess

    우영하 | Ju-Seon Jeon | 정흥태 and 1other persons | 2018, 25(1) | pp.18~23 | number of Cited : 0
    Study Design: Case report Objectives: We report a case of surgically proven tophaceous gout of the lumbar spine at the L5-S1 level in a 43-year-old man that mimicked infectious spondylodiscitis and epidural abscess on magnetic resonance (MR) images. Summary of Literature Review: Some patients have chronic back pain with an epidural mass. Among the many causes of epidural masses, tophaceous gout of the lumbar spine is very rare. Materials and Methods: A 43-year-old man presented with fever and chronic back pain with radiating pain. In an MR image of L4- 5, an abnormal subcutaneous mass was found in the posterior epidural space. The subcutaneous mass was isointense on T1-weighted images compared with the intervertebral disc, and focally and strongly hyperintense and heterogeneous on T2-weighted images. After the intravenous administration of gadolinium contrast, the mass was fairly homogenous, with a low signal intensity and without enhancement. With the diagnosis of infective spondylitis with epidural abscess, we performed a decompressive mass resection. Results: The pathologic examination revealed multinuclear giant cells and amorphous crystalline fibrous tissue. The lesion was diagnosed as tophaceous gout. Conclusions: This case underscores the importance of considering tophaceous gout in the differential diagnosis of an epidural mass in a patient with chronic back pain.
  • 4.

    Sacral Stress Fracture Developing after Lumbosacral Fusion in a Patient with Spondylolisthesis - A Case Report -

    윤상현 | 신용은 | Jae-Uk Jung | 2018, 25(1) | pp.24~29 | number of Cited : 0
    Study design: Case report Objectives: To report a case of sacral stress fracture that developed after lumbosacral fusion. Summary of Literature Review: Sacral stress fractures rarely develop after lumbosacral fusion, and osteoporosis, female sex, being over 60 years old, and long segment fusion are known risk factors. Materials and Methods: A 66-year-old woman with spondylolisthesis at L5 on S1 underwent posterior lumbar interbody fusion and posterior instrumentation. A sacral stress fracture was found 4 weeks after the first operation, and we performed posterior reduction and posterior instrumentation with S2 alar screws. Results: The patient was free from symptoms and no further displacement was found at 3 months after the last operation. Conclusions: Sacral stress fracture after lumbosacral fusion can be treated with posterior reduction and posterior instrumentation with S2 alar screws.
  • 5.

    Widespread Lumbosacral Subdural Abscess after Bee Venom Therapy - A Case Report -

    이영상 | Jun Cheol Choi | Dong-Chan Eun and 1other persons | 2018, 25(1) | pp.30~34 | number of Cited : 0
    Study Design: Case report. Objectives: We report a case of widespread lumbosacral subdural abscess in a patient who underwent bee venom therapy. Summary of Literature Review: Subdural abscess is rare, but has a poor prognosis. Therefore, prompt recognition and appropriate treatment are paramount. Materials and Methods: A 54-year-old woman was hospitalized due to severe back pain. Two days previously, she had undergone bee venom therapy. The patient then visited the emergency room because of severe back pain. However, a paraspinal infection was not detected on enhanced magnetic resonance imaging (MRI). Six days after admission, the patient showed signs of meningeal irritation and an emergency cerebrospinal fluid analysis showed typical findings of bacterial meningitis. Although adequate antibiotic treatment was administered, 20 days after admission, the patient’s symptoms became aggravated. Pachymeningeal enhancement, myelomeningitis, and subdural abscess compressing the cauda equina were found on enhanced MRI. Thus, laminectomy between L3-L4 and L5-S1 was performed, as well as subdural abscess drainage. Antibiotic agents were applied for 6 weeks after the operation, and resolution of the subdural abscess was identified on follow-up MRI. Results: In this patient, lumbosacral subdural abscess occurred due to bee venom therapy. It was cured by adequate surgical and antibiotic treatment. Conclusions: Bee venom therapy can cause subdural abscess of the spinal cord. Even if it is a rare case, this possibility is worth consideration in the Korean medical context.
  • 6.

    Vertebral Body Fracture after Oblique Lumbar Interbody Fusion in 2 Patients - A Case Report -

    Gi-Soo Lee | 김상범 | Yougun Won and 3other persons | 2018, 25(1) | pp.35~39 | number of Cited : 1
    Study Design: Although the frequency of the oblique lumbar interbody fusion (OLIF) procedure has increased in recent years, reports on its complications remain rare. We report 2 cases of vertebral fracture after OLIF. Objectives: We aimed to report 2 cases of coronal vertebral fracture after an OLIF procedure in non-osteoporotic patients without significant trauma, and to review the complications of OLIF. Summary of Literature Review: There is a growing but limited literature describing early postoperative complications after OLIF. Materials and Methods: Patient 1 was an obese woman who underwent 2-level OLIF with posterior instrumentation procedures and subsequently experienced 2-level coronal plane fractures. Patient 2 was an elderly man who underwent 3-level OLIF without posterior instrumentation and experienced 1 coronal vertebral fracture. We report vertebral body fracture as a complication of OLIF through these 2 cases. Results: Patient 1 was treated nonsurgically after the fractures. The fractures healed uneventfully. However, patient 2 underwent posterior instrumented fusion and had a solid bridging bone above and below the fracture. Factors potentially contributing to these fractures are discussed. Conclusions: OLIF is an effective procedure for several spinal diseases. However, fracture can occur after OLIF even in non-osteoporotic patients. Factors such as intraoperative end-plate breach, subsidence, cage rolling, and inadequate posterior instrumentation could contribute to the development of fractures after oblique interbody fusion.