KJC Korea
Journal Central

Study Design: A retrospective chart review. Objectives: To evaluate and compare the clinical outcomes of cervical transforaminal epidural block (CTEB) using local anesthetics with or without a steroid for cervical spondylotic radiculopathy (CSR). Summary of Literature Review: The typical mixture for a CTEB is a combination of local anesthetics with a non-particulate steroid. However, there are potential complications related to steroid injections such as steroid-induced osteoporosis, hypothalamus-pituitaryadrenal gland axis suppression, and hyperglycemia. Materials and Methods: From January 2018 to October 2019, 35 patients who underwent CTEB for CSR were enrolled in this study. Cases with arm pain over 4 on a visual analog scale (VAS) were included. In the first 19 cases, a combination of 1 mL of 1% lidocaine and 1 mL of dexamethasone was used (group A), and in the next 16 cases, 1 mL of 1% lidocaine mixed with 1 mL of normal saline was used (group B). Arm pain VAS and the Neck Disability Index (NDI) were obtained perioperatively. Results: Baseline characteristics were not significantly different between the two groups. In both groups, the arm pain VAS significantly decreased at 30 minutes, 2 weeks, and 6 weeks post-injection compared to pre-injection values. However, the arm pain aggravated 12 weeks post-injection. The NDI of both groups significantly improved 6 weeks post-injection compared to pre-injection. The clinical outcomes of arm pain VAS and NDI at 30 minutes, 2 weeks, and 6 weeks post-injection, as well as the amounts of change, were not significantly different between both groups. Conclusions: CTEB for CSR without a steroid improved symptoms by 6 weeks. The degree of improvement was similar to when CTEB was performed with a steroid in terms of VAS and NDI.

Study Design: Retrospective study. Objectives: To analyze the usefulness of flexion-extension radiographs in the diagnosis of degenerative cervical disease. Summary of Literature Review: There is little information about the efficacy of flexion-extension radiographs in the diagnosis of degenerative cervical disease. Methods and Materials: We analyzed 1,062 patients with cervical degenerative disease who underwent flexion-extension radiographs and computed tomography (CT) or magnetic resonance imaging (MRI). The range of motion of the cervical joints was measured. Segmental instability was evaluated using the sagittal translation (≥3.5 mm) between C2 and T1, the sagittal angulation (≥3.5°), the vertebral slip angle (≥ 10°), and the dynamic spinal canal stenosis (≤12 mm). The relationship between canal compromise on CT or MRI and radiological instability was also evaluated. Results: Cervical range of motion was 36.45°±17.63° (range, 2.1°-106.6°). Segmental instability was observed in 484 patients (nine cases of sagittal translation, 79 cases of sagittal plane rotation, 415 cases of a vertical slip angle, and 21 cases of dynamic spinal stenosis). Segmental instability was related with pathology in 218 patients with available CT or MRI (42%, including five cases of sagittal translation, 32 cases of sagittal plane rotation, 171 cases of vertical slip angle, and 10 cases of dynamic spinal stenosis. Conclusions: Flexion-extension radiographs of the cervical spine were useful in diagnosing and evaluating subaxial segmental instability.

Study Design: Prospective study. Objectives: To evaluate the effectiveness and safety of posterior interbody fusion with a new type of pedicle screws after posterior decompression for degenerative spinal disease. Summary of Literature Review: There are no reports of surgical treatment results using the new type of pedicle screw (LumFix™) analyzed herein. We report the results of posterior interbody fusion with this new type of pedicle screw. Materials and Methods: Ten patients underwent surgical treatment for degenerative spinal disease and were followed up for at least 1 year. In all cases, fixation using pedicle screws and posterior interbody fusion were performed after posterior decompression. Visual analogue scale (VAS) and Oswestry Disability Index (ODI) scores were measured before surgery, at 3 months postoperatively, and at 12 months postoperatively. Bone union was investigated through simple radiographs and computed tomography (CT) at 12 months postoperatively. In addition, blood inflammation levels and basic vital signs were investigated preoperatively and at the last follow-up. Results: In all cases, preoperative symptoms improved, and the back pain VAS improved from 7.30±1.49 preoperatively to 2.70±1.64 at 3 months postoperatively and 1.80±1.40 at the final follow-up. Leg pain was 7.40±1.17 preoperatively and 2.60±2.17 at 3 months postoperatively. At the last follow-up, it improved to 2.40±1.96 (p<0.001). The ODI improved from 28.80±4.89 preoperatively to 15.60±5.04 at 3 months postoperatively and 16.90±6.61 (p=0.002) at the final follow-up. Bone union was achieved in all cases. Inflammation levels and vital signs were within the normal range both preoperatively and at 12 months postoperatively. Conclusions: The LumFix™ pedicle screws used in this study were fused in 100% of patients with degenerative spinal diseases. No complications were observed, and the VAS of back and leg pain and ODI of the lumbar spine significantly improved. There were no abnormal findings in blood tests or vital signs, demonstrating biocompatibility. Therefore, the type of new pedicle screw analyzed in this study can be used in fusion surgery for degenerative spinal diseases.

Study Design: Retrospective study. Objectives: The purpose of this study was to analyze several factors affecting the efficacy of epidural steroid injections as a nonoperative treatment modality in lumbar disc herniation patients. Summary of Literature Review: Despite several studies, the normal course of intervertebral disc herniation is not fully understood, and the optimal timing of surgery is unclear. Methods: From January 2017 to April 2019, among outpatients in our hospital, 64 patients diagnosed with 3-4 or 4-5 single-level lumbar disc herniation and followed up for at least 6 weeks were included. Epidural steroid injection was performed in all patients during their 1-week admission. Symptoms improved in 36 patients (group 1) and persisted or recurred in 28 patients (group 2), who were finally treated surgically. Demographic factors, magnetic resonance imaging findings, and clinical assessments were analyzed. Results: The only demographic factor with a significant difference between groups was symptom duration. In magnetic resonance imaging, significant differences were found in disc sequestration and the degree of the herniated disc. At 6 weeks after the injection, significant differences were found between the 2 groups in visual analog scale scores and the Korean version of the Oswestry Disability Index. Conclusions: Several factors must be considered when treating patients with lumbar disc herniation. Of note, longer symptom duration was found to be associated with a lower effectiveness of conservative treatment. The effects of treatment could also be influenced by the disc form and the degree of disc herniation.

Study Design: Case report. Objectives: We report a case of lumbar spine fracture sustained during a virtual reality (VR) game. Summary of Literature Review: As video games have evolved, so have video game-related injuries. Because VR gamers wear headsets that block their ability to see the surroundings, it is thought that VR gamers are more at risk than previous video gamers. However, no VR game–related injuries have yet been reported. Materials and Methods: A 53-year-old man sustained a lumbar spine fracture during a VR game. Because the game simulated his fall from a building, he lost his balance and fell down on the floor. A compression fracture of the third lumbar vertebra was demonstrated by imaging and conservative management using rigid orthosis was done. Results: At a 1-year follow up, computed tomography showed complete bone union of L3. Conclusions: Even though the activity was simulated, the resulting injury was all too real. Clinicians should never underestimate the risk of VR game injuries and should consider them in the differential diagnosis of musculoskeletal injuries.

Study Design: Case report. Objectives: To report our experience of a patient in her 20s with multiple contiguous osteoporotic compression fractures. Summary of Literature Review: It is uncommon to develop multiple contiguous osteoporotic compression fractures at a young age. Materials and Methods: A 26-year-old woman was admitted with lower back pain. On radiologic examinations, compression fractures of L1, L2 and L5 were observed. Bone mineral density testing indicated severe osteoporosis. Secondary osteoporosis was suspected, and further examinations were performed. The patient was diagnosed with adrenocorticotropic hormone–independent Cushing’s syndrome. On abdominal computed tomography, a tumor suspected to be an adenoma was observed on the left adrenal gland. Tumor resection surgery was then performed. Results: Pathologic findings confirmed that the tumor was an adenoma. The lumbar fractures had healed at 3 months after the fracture. Conclusions: If osteoporotic lumbar compression fracture occurs in a young patient, secondary osteoporosis should be suspected and the underlying cause must be found and treated.