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pISSN : 2093-4378 / eISSN : 2093-4386

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2019, Vol.26, No.3

  • 1.

    Caudal Epidural Injection with a Catheter in Patients with Failure of Conventional Epidural Blocks

    신동은 | TAEKEUN AHN | James Sungwook Yang and 2other persons | 2019, 26(3) | pp.69~75 | number of Cited : 0
    Abstract
    Study Design: Retrospective study. Objectives: The purpose of this study was to analyze and report the results of caudal epidural injections using a catheter in patients in whom conventional epidural block had failed. Summary of Literature Review: Epidural nerve block is often used to treat chronic back pain and radicular pain in degenerative lumbar disease, and percutaneous epidural neuroplasty or surgery may be an alternative if it fails. Material and Methods: In total, 146 patients who were treated with caudal epidural block using a catheter were recruited for this study from January 1, 2015 to June 30, 2019. Forty-five patients who had not undergone any epidural block in the past were excluded from the study. Among patients who did not have a fracture and were followed up for at least 1 month, the medical records of 61 patients with degenerative disc herniation, spondylosis, and stenosis were reviewed retrospectively. Visual analogue scale (VAS) scores were evaluated before and after the procedure. Results: Of the 61 patients who had undergone epidural block through a transforaminal caudal approach with no pain control effect, there were 18 males and 43 females. Their mean age was 66.3 years and the average follow-up period was 2.64 months. There were 46 cases of spinal stenosis, 33 cases of spondylosis, 2 cases of spondylolisthesis, 9 cases of disc herniation and 1 case of ankylosing spondylitis. The mean number of epidural blocks was 5.85 (times) before the procedure. The mean initial VAS score was 5.34 and the final follow-up VAS score was 2.70. There was a significant difference between before and after the procedure (p<0.05). The mean duration of effect after the procedure was 1.84 months and the mean number of procedures was 2.30. After the procedure, there were 4 cases of surgical treatment, 2 cases of neuroplasty, and 3 cases of epidural block using other methods over more than 1 year of followup. Conclusions: The result of this clinical study suggests that caudal epidural injections using a catheter may be effective for patients with low back pain who have not responded to previous epidural blocks before surgical treatment. Key words: Back pain, Catheter, Epidural block, Caudal block
  • 2.

    The Effects of Sagittal Spino-Pelvic Alignment on the Clinical Symptoms of Thoracolumbar Kyphosis in Osteoporotic Patients

    송대건 | Whoan Jeang Kim | Jae Won Lee and 4other persons | 2019, 26(3) | pp.76~83 | number of Cited : 1
    Abstract
    Study Design: Retrospective study. Objectives: The purpose of this study was to gassess gln-llgnmnnlnl mm-the effect of saittaspiopevic aignmetothe ciicasyptosof thoracolumbar kyphosis (TLK; T10-L2 Cobb’s angle >20°) inosteoporotic patients. Summary of Literature Review: Few studies have investigated the clinicalsymptoms and radiologicalfeatures of TLK caused by de­generative changes. There is also controversy over whether clinicalsymptoms willdeteriorate inpatients with TLK or which treatment should be chosenaccordingto the degree of TLK. Materials and Methods: FromMay 2005 to May 2016, we reviewed 75 patients who were diagnosed with TLK (T10-L2 Cobb’s angle >20°) and osteoporosis. Patients were excluded fromthe study if they had neurologicalsymptoms, underlyingspinaldisorders, or unstable vertebralfractures. Fifty patients with TLK due to anosteoporotic vertebralcompressionfracture (group F) and 25 patients with senile TLK (group S) were assessed by clinicalsymptoms and radiologicalparameters. Thoracolumbar kyphosis angle and sagittalverticalaxis (SVA) were also analyzed. Clinicalsymptoms were assessed usinga visualanalogue scale (VAS) and the Oswestry Disability Index (ODI). Results: There were no significant differences inclinicalsymptoms (VAS, ODI) and radiologicalparameters betweengroups F and S, or accordingto the degree of -33-44lnl mmgnnlmn ngl ml-TLK (20°-30°, 0°-40°, >0°). Ciicasyptoswere significatyore severe ipatiets with saittaibaance (SVA >5 cm) thaninthose with sagittalbalance. Conclusions: Sagittalimbalance is a more important factor affectingclinicalsymptoms thanthe cause or the degree of TLK. Therefore, sagittalimbalance should be considered inthe management of TLK inosteoporotic patients. Key Words: Thoracolumbar kyphosis, Osteoporosis, Sagittalspino-pelvic alignment, Sagittalimbalance
  • 3.

    Surgical Extent of Metastatic Spine Tumor Excision and Its Effects on Postoperative Ambulatory Function: Comparison of Extensive Wide versus Palliative Excision Surgery

    Kim Young Hoon | Kim Sang-Il | Kee-Yong Ha and 4other persons | 2019, 26(3) | pp.84~93 | number of Cited : 0
    Abstract
    Study Design: Retrospective study. Objectives: To compare surgical outcomes such as the ambulatory period and survival according to different surgical excision tactics for metastatic spine tumors (MSTs). Summary of Literature Review: Surgical outcomes, such as pain relief and survival, in patients with MSTs have been reported in several studies, but the effects of differences in surgical extent on the ambulatory period have rarely been reported. Materials and Methods: Ninety-six patients with MSTs who underwent palliative (n=60) or extensive wide excision (n=36) were included. Palliative excision was defined as partial removal of the tumor as an intralesional piecemeal procedure for decompression. Extensive wide excision was defined as a surgical attempt to remove the whole tumor at the index level as completely as possible. The primary outcome was the ambulatory period following surgery. Other demographic and radiographic parameters were analyzed to identify the risk factors for loss of ambulatory ability and survival. Perioperative complications were also assessed. Results: The mean postoperative ambulatory period was longer in the extensive wide excision group (average 14.8 months) than in the palliative excision group (average 11.7 months) (p=0.021). The survival rates were not significantly different between the two surgical excision groups (p=0.680). However, postoperative ambulatory status and major complications within 30 days postoperatively were significant prognostic factors for survival (p=0.003 and p=0.032, respectively). Conclusions: The extent of surgical excision affected the ambulatory period, and the complication rates were similar, regardless of surgical excision tactics. A proper surgical strategy to achieve postoperative ambulatory ability and to reduce perioperative complications would have a favorable effect on survival. Key Words: Metastatic spine tumor, Surgical extent, Palliative, Wide, Ambulation
  • 4.

    Acute and Delayed Epidural Hematoma After Total Spondylectomy for a Metastatic Spinal Tumor -A Case Report -

    Young Kyu Kim | 김정훈 | 2019, 26(3) | pp.94~99 | number of Cited : 0
    Abstract
    Study Design: Case report. Objectives: We report a case of recurrent spinal epidural hematoma after total spondylectomy for a metastatic spinal tumor. Summary of Literature Review: Postoperative epidural hematoma is rare, and no case of delayed epidural hematoma after hematoma removal has been reported. Materials and Methods: A 74-year-old woman experienced a ninth thoracic vertebral (T9) pathologic fracture caused by a metastatic spinal tumor and underwent total spondylectomy. Immediate postoperative epidural hematoma occurred and neurological symptoms appeared. After hematoma removal, the symptom improved. Ten days after surgery, the neurological symptoms worsened again. Spine magnetic resonance imaging showed delayed epidural hematoma. Hematoma removal was done again. Results: The patient’s neurological symptoms improved after delayed hematoma removal. Conclusions: Delayed hematoma that cause neurological symptoms may occur after primary hematoma removal. If neurological symptoms recur after hematoma removal, the surgeon should consider the possibility of hematoma recurrence. Before total spondylectomy surgery, preoperative embolization is recommended. Key Words: Delayed epidural hematoma, Metastatic spinal tumor, total spondylectomy
  • 5.

    A Rare Extradural Spinal Meningioma with Nocturnal Chest Pain - A Case Report -

    Yougun Won | Sang Bum Kim | Min Gu Jang and 4other persons | 2019, 26(3) | pp.100~104 | number of Cited : 0
    Abstract
    Study Design: Case report. Objectives: To report a rare case of a spinal extradural meningioma in a patient with longstanding nonspecific thoracic nocturnal pain Summary of Literature Review: Meningioma is a frequent intradural extramedullary tumor that is associated with pain, sensory/motor deficits, and sphincter weakness. Spinal meningiomas most commonly occur in the thoracic spine, although they can also be found at other locations. Materials and Methods: A 65-year-old woman first visited the cardiac and gastrointestinal departments of our institution due to chest pain 2 years previously. No explanation for the complaint could be found in the heart or other organs. On a computed tomography scan of the thorax, a spinal mass was found a few months before the diagnosis. On magnetic resonance imaging, an extramedullary and extradural mass was observed at T7/8. Results: We performed surgery and found an extradural spinal meningioma upon the histological diagnosis. Postoperatively, the patient could adequately move both legs and feet and the nocturnal chest pain disappeared after surgery without any complications. Conclusions: Awareness of the rarity and nonspecific symptoms of extradural spinal meningiomas will be beneficial for their accurate diagnosis and proper treatment. Key Words: Extradural space, Thoracic pain, Iatrogenic dural injury, Spinal meningioma, Spine tumors
  • 6.

    Delayed-Onset Leg Weakness Caused by Posterior Migration of a Herniated Disc to the Thecal Sac Mimicking Epidural Hematoma in a Flexion-Distraction Injury of the Lumbar Spine - A Case Report -

    Han-Dong Lee | 전창훈 | Chung, Nam-Su and 1other persons | 2019, 26(3) | pp.105~110 | number of Cited : 0
    Abstract
    Study Design: Case report. Objectives: To document the first known case of posterior migration of a herniated disc in a lumbar flexion-distraction injury. Summary of Literature Review: Lumbar disc herniation is sometimes confused with epidural hematoma, especially when the disc migrates posterior to the thecal sac. There has been no report of posterior migration of a herniated disc after a lumbar flexion-distraction injury. Materials and Methods: A 47-year-old woman with no pertinent medical history was diagnosed with a flexion-distraction injury of the L2–L3 vertebrae after a motor vehicle accident. The patient had no neurological deficit initially. Magnetic resonance imaging (MRI) showed a space-occupying lesion with T2 hyperintensity and T1 isointensity on the dorsal side of the thecal sac at L2–L3. After posterior lumbar fixation and fusion, progressive leg weakness occurred 1 week postoperatively. Results: A second operation revealed no evidence of epidural hematoma, but a sequestrated disc. Decompression and sequestrectomy were performed, and the patient’s neurological status had recovered fully at 4 months postoperatively. Conclusions: This case highlights the potential for posterior migration of a herniated disc with flexion-distraction injuries of the thoracolumbar spine. Discontinuity of the posterior annulus fibrosus on MRI may aid the distinction of posterior migration of a herniated disc from epidural hematoma. Because posterior migration of a herniated disc is associated with progressive neurological deficits, surgeons must consider decompression surgery when such herniation is suspected, even in the absence of neurological symptoms. Key Words: Posterior migration, Herniated nucleus pulposus, Flexion-distraction injury, Motor weakness, Epidural hematoma
  • 7.

    Paraspinal Ancient Schwannoma of the Dorsal Ramus Nerve - A Case Report -

    Dae Geun Kim | Young Min Jo | 2019, 26(3) | pp.111~115 | number of Cited : 0
    Abstract
    Study Design: Case report. Objectives: We report a case of paraspinal ancient schwannoma located at the upper thoracic level that mimicked an atypical lipoma or complicated epidermoid cyst. Summary of Literature Review: Few case reports of paraspinal schwannoma have been reported and the incidence of ancient schwannoma in the paraspinal muscle layer is very rare. Materials and Methods: A 39-year-old man complained of a growing palpable back mass for 5 years. He experienced aggravated chronic discomfort around the mass while lying down. Both T1- and T2- weighted magnetic resonance imaging (MRI) showed a wellcapsuled and heterogeneous high-signal mass in the muscle layer at the level from the T1 to T4 vertebral bodies on the right side of the midline. The tumor was completely removed by en bloc resection. Results: The pathologic examination revealed S-100 protein expression with degenerative changes. The lesion was diagnosed as an ancient schwannoma. Conclusions: Schwannoma is one among the multiple possible causes of benign back masses. If a mass reveals a well-encapsulated heterogeneous mass on contrast MRI, a schwannoma should be suspected. Key Words: Schwannoma, Back muscles