2011, Vol.18, No.2

Journal of Korean Society of Spine Surgery 2023 KCI Impact Factor : 0.03

pISSN : 2093-4378 / eISSN : 2093-4386
https://journal.kci.go.kr/krspine

Study Design: A retrospective study about spinal intradural tumor. Objectives: We analyzed clinical symptom, findings of MRI, and surgical outcome of spinal intradural tumor. Summary of Literature Review: Intradural tumors are not commonly reported and they show non-specific clinical features. Materials and Methods: In this study, 18 patients who underwent surgical treatment and radiologically and pathologically diagnosed as spinal intradural tumor from 1997 to 2009 were reviewed. We evaluated pain, neurological symptoms, location of tumor as well as degrees of signal intensity and its enhancement of MRI(T1 and T2). And clinical outcomes were analyzed according to Klekamp-Samii scoring system and Visual Analogue Scale(VAS). Results: All patients were clinically suffered from back pain and radiating pain of lower extremity including 3 patients with neurological symptoms. We radiologically found single tumor in 16 cases and masses more than two lesion in 2 cases. 1 case was located on cord level(T7), 14 cases cauda equine level, and 3 cases sacral level. We performed laminectomy in 18 cases and posterior instrumentation was applied to 8 cases. In clinical features, mean Klekamp-Samii score was improved from 21.6 to 23.5(p<0.05) and VAS was recovered from 5.2 to 3.0 (p<0.05). Conclusions: Spinal intradural tumor has non-specific clinical symptoms. Therefore we should perform MRI to find intradural tumor and active management including surgical treatment should be performed due to clinically good results. Key Words: Spinal intradural tumor, MRI, Clinical symptom

Study Design: Intra-articular injections of long acting steriod and local anesthetics after lumbar facet joint(LFJ) arthrography are routinely used for therapeutic purposes in selected patients for relief of chronic low back pain. However, because of the difficulty in finding an accurate position of the symptomatic joint, the possibility of complication and the placebo effect, there are doubts about the clinical application of this treatment. Objectives: This study was designed to assess the diagnostic value and clinical benefits of lumbar facet joint arthrogram & injection of long acting steriod and local anesthetics in patients with facet joint syndrome. Summary of Literature Review: The radiological relationship and the diagnostic elements of facet joint syndrome need to be analyzed and evaluated for increasing the effectiveness of lumbar injection. Materials and Methods: Fifty two patients with low back pain were enrolled in the trial and they met the following criteria: pain for more than 3 months, no root signs and no history of back surgery. The response to facet joint injection was analyzed according to the chief complaints, a provocative test, the Visual Analogue Scale(VAS), the Helbig & Lee(HL) score, the facet block procedure and the arthrogram findings. A questionnaire with a pain scale was administered immediately or the day after injection, and then after 1, 3, 6 and 12 weeks. The arthrograms were reviewed by a radiologist & orthopedic specialist. Results: One hundred sixty nine joint injections were performed in 52 patients (L 3-4, n=33; L4-5, n=64; L5-S1, n=72). Thirty one patients had a chief complain of back pain that was aggravated by extension/rotation of the trunk and the provocative test was positive in 73.1%. The rates of a good response in the study group were 69.2% after one day, 44.2% after 3 weeks and 36.5% after 12 months. Arthrograms revealed synovial cysts in 1 of these patients and 5 patients had abnormal communication with spondylolysis. Two patients had contrast extravasated into the epidural space during injection. Conclusions: Lumbar arthrography showed a low diagnostic value. Lumbar injections, as a useful procedure to diagnosis facet joint syndrome, could be a useful palliative treatment modality for treating chronic lower back pain. But strict diagnostic criteria through a scoring system is needed to achieve a higher degree of predictability and effectiveness of facet joint injection Key Words: Facet Joint Syndrome, Facet Joint Block

Study Design: This is a retrospective study Objectives: We made a scoring system using the symptoms of cauda equina syndrome(CES) and we studied the efficacy of the scoring system. Summary of the Literature Review: There has been no definite scoring system with clear factors that can predict the clinical results of cauda equine syndrome Materials and Methods: Between 1998 and 2006, 21 patients who were diagnosed with CES and who were followed for more than 2 years were enrolled in this study. There were 6 cases of HIVD, 6 cases of degenerative spondylosis, 7 cases of vertebral fracture and 2 cases of metastatic spinal tumor. We made a scoring system for CES (SSCES) using 8 symptoms among the general clinical manifestations that accompany CES, which are low back pain, sciatic neuropathy, sensory and motor disorder of the lower extremities,loss of a saddle sensation, voiding difficulty, disorder of the anal sphincter tone and deep tendon reflex disorder. Results: The last clinical outcomes were 3 excellent patients, 5 good patients, 5 fair patients and 8 poor patients. The mean preoperative SSCES was 11.7±2.8(7-16) and the mean final follow up score was 7.6±3.4(2-13). Eight cases that had a mean preoperative SSCES score of 6 or below showed good clinical results with a mean SSCES of 3.9±11(2-5) on the final follow up, and 13 cases with a mean preoperative SSCES score of 7 or above showed bad clinical results with a mean SSCES of 9.9±1.9(7-13) on the final follow up. Conclusions: The prognosis was better on the final follow up for the patients with a lowere preoperative SSCES. So, for the treatment of CES, preoperative evaluation using the SSCES is thought to be very useful for predicting the prognosis. Key Words: Cauda equina syndrome, Prognostic factor, Scoring system