2018, Vol.25, No.1

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: 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.

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.

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.