Jing-Shan Huang

Pigmented Villonodular Synovitis of the Temporomandibular Joint Presenting as a Middle Cranial Fossa Tumor

p t d a T t Pigmented villonodular synovitis (PVNS) is an infrequently occurring proliferative lesion arising from the synovial membranes of particular body joints, bursae, and associated tendon sheaths. This condition was first described by Jaffe et al in 1941 and has an annual incidence of 1.8 cases per 1 million individuals in the United States. PVNS is related to a family of lesions ncluding pigmented villonodular tenosynovitis and igmented villonodular bursitis, with the diagnosis epending on the anatomic area involved. Both nodlar and diffuse forms of PVNS are currently recogized. The most common nodular patterns associted with PVNS include giant cell tumor, xanthoma, anthogranuloma, and myeloplaxoma, with each orm generally tending to affect a discrete part of the ynovium. Diffuse PVNS, which typically affects the entire synovium, has been referred to as giant cell fibrohemangioma, chronic hemorrhagic villous synovitis, and benign polymorphocellular tumor. Alhough PVNS can occur in virtually any joint of the uman body, approximately 80% of cases involve the nee, with the hip, ankle, foot, hand, elbow, and houlder accounting for almost all other cases. To our nowledge, PVNS involvement of the temporomanibular joint (TMJ) is very uncommon, with only 45 ases reported in the literature since 1973 (Table 1).

Surgical treatment of multilevel cervical radiculomyelopathy caused by the concomitant ossification of the ligamentum flavum and the posterior longitudinal ligament

Objectives:  A two‐stage operation is essential for patients with cervical spine myelopathy that is the result of concomitant ligamentum flavum and posterior longitudinal ligament ossification.

Traumatic Spinal Fracture Dislocation with Neurological Deficit in a 14-Year-Old Boy: Management by Spine Decompression, Posterior Fusion, and Continued-Short-Segment Instrumentation

Thoracolumbar fracture-dislocation by definition is a three-column injury, according to the Denis three-column concept, which may yield an unstable spinal column and neurological deficit. Treatment of fracture-dislocation of the thoracolumbar and lumbar spine remains controversial. Although conservative treatment has been beneficial, the inherent instability of this injury usually requires surgical intervention utilizing an anterior or posterior approach for long-term stabilization. We report a 14-year-old boy exhibiting a traumatic L1 fracture-dislocation sustained after jumping from a building’s third floor. Severe low back pain, lower extremity weakness, and urine retention were addressed by nerve decompression and continuedshort- segment fusion from the posterior approach. Excellent clinical outcome and no failure of hardware was reported at the six-month follow-up.

Glioblastoma Multiforme of the Cerebellum: Report of Two Cases

Glioblastoma multiforme (GBM) usually arises in the supratentorial region, and rarely occurs in the cerebellum. Cerebellar GBM was first described in 1928 by Carmichael, and only 105 cases have since been reported in the literature. Only one case has ever been reported in Asia. Herein, we report two additional cases of cerebellar GBM occurring in the Asian area. Both patients had a history of dizziness, unsteady gait, and obvious cerebellar signs. Tumor excision along with postoperative posterior fossa irradiation was performed in each case. We discuss the clinical symptoms, radiological features, surgical findings, and radiotherapeutic strategies, and then review the literature.

Pain Relief by Percutaneous Vertebroplasty for Osteoporotic Compression Fractures: An Evaluation of Polymethylmethacrylate Injection Volume

Percutaneous vertebroplasty may provide pain relief in the treatment of patients with severe osteoporotic compression fracture. A retrospective study was done to determine the relationship between injection volume and therapeutic benefits. Methods and Results: Polymethylmethacrylate (PMMA) was injected into 79 compression fractures in a total of 70 patients. The amounts of PMMA injected ranged from 2 to 9 milliliters. We divided our patients into two groups according to the volume of PMMA injected. Group A had the volume injected ranging from 2 to 5 milliliters whereas Group B, 6 to 9mL. The injection of bone cement was stopped immediately whenever a backflow opacification was observed in the posterior third of the vertebral body in order to prevent iatrogenic spinal cord compression. In Group A patients, the mean postoperative pain score was decreased to 1.28. The mean decreased pain score was 3.28. In Group B patients, the mean postoperative pain score decreased to 1.09. The mean decreased pain score was 3.39. There was no significant difference between these two groups in the decreased pain score (P=0.52) and postoperative pain status (P=0.14). Conclusions: The author found no correlation between the injection volume and its therapeutic benefit. Greater amount of PMMA injected will not give a better clinical outcome to patients with osteoporotic compression fracture. The injection of PMMA should be stopped immediately whenever a backflow opacification is observed in the posterior third of the vertebral body in order to prevent epidural leakage. The presence of PMMA epidural leakage may decrease the pain relief benefit after percutaneous vertebroplasty.

Intra Pedicular Screw Fixation for Thoracolumbar Burst Fracture: Six-Year Experience

Pedicle screw fixation from posterior approach is one of the treatment options for thoracolumbar burst fracture. Traditionally, the pedicle screws are fixed above and below the fracture level, sparing the fracture level. The authors introduce a new technique of pedicle screw fixation involving the fracture level. This report presents our preliminary experience of pedicle screw fixation involving the fracture level in the treatment of thoracolumbar fracture and discusses the advantages. Materials and Methods: We reviewed records of patients treated from 1995 to 2003 and found a total of 16 patients with a diagnosis of thoracolumbar burst fracture. We measured the preoperative and postoperative Cobb angle and its difference. Fracture sites ranged from T12 to L5. In the patient with spinal instability, surgery was undertaken in order to achieve stabilization and laminectomy was performed for decompression of nerve root. Instrumentation included the transpedicle screw to secure the rod and crosslink bar to prevent rotation injury. Transpedicle screw fixation was used for stabilization. All our patients received laminectomy for decompression at the fracture level. Results: The mean age in patients with fixation involving the fracture level was 54.4 16.2. The mean follow-up period was 26.19 10.96 months (ranged from 13 to 50 months). Progression of kyphosis was considered if the difference between preoperative and postoperative kyphotic angle became positive. In patients fusion with the fracture level, the preoperative kyphotic angle was 21.25 9.92 degrees (ranged from 9 to 43 degrees); and the postoperative kyphotic angle was 11.81 10.51 degrees (ranged from 0 to 33 degrees). The corrected kyphotic angle was 9.44 4.44 degrees (ranged from 4 to 18 degrees). No kyphosis progression was noted in these 16 patients. There was no instrument failure found in our patients. Conclusions: Our clinical experience reveals that pedicle screw instrumentation is a very effective procedure in the treatment of fractures of the thoracic and lumbar spine, with a high percentage of fusions and a low percentage of hardware failures. We also find that pedicle screw fixation involving the fracture level can result in nearly complete reduction of the kyphotic deformity and less progression of kyphosis.

Transpedicular Hook Screw Fixation in the Treatment of Lumbar Spondylolysis in Young Patients

Objectives: In spondylolysis, there is a defect in the pars interarticularis. Most patients with spondylolysis, and even some with spondylolisthesis are asymptomatic, and they grow up not even aware of their condition. However, back pain is the most common symptom. Most patients with lumbar spondylolysis and low-grade spondylolisthesis can be treated conservatively. Surgical treatment is indicated when any type of spondylolisthesis is accompanied by a neurological deficit. Materials and Methods: We reviewed records obtained in patients treated surgically between 2000 and 2004 at Cathay Medical Center. We found a total of eight patients with a diagnosis of lumbar spondylolysis (pars fracture). In these patients-six men and two women, with ages ranging from 17 to 37 years. The diagnosis was made according to plain radiography, CT scan and MRI imaging. For patients with spinal instability, instrumentation included the trans-pedicular screws to secure the hook. Sufficient amounts of onlay autogenous cancellous bone graft across the spondylolytic defect were performed in all our patients. The final outcome was assessed by the following criteria:(1) whether instruments remained intact;(2)whether the postoperative fracture reduction was maintained;(3)whether the functional outcome was satisfactory; and(4)preoperative and postoperative plain radiographs. Results: We found a total of eight patients with a diagnosis of lumbar spondylolysis (pars fracture). Instrumentation included the trans-pedicular screws to secure the hook. Sufficient amounts of onlay autogenous cancellous bone graft across the spondylolytic defect were performed in all our patients. Follow-up plain radiography was done every 3 months after the operation. All our patients experienced significant pain relief from low back pain and radiculopathy. No screw pullout or loosening of the instrument was observed. No pseudoarthrosis was noted and all our patients had a bilateral union. In this article, we examine the effectiveness and advantages of transpedicular hook screws in the treatment of lumbar spondylolysis. Conclusions: Direct repair of spondylolysis with transpedicular hook screws can be recommended for patients with young age, a slight slip, an instability, or failure of conservative treatment.