Kook Jin Chung

Comparative study of balloon kyphoplasty with unilateral versus bilateral approach in osteoporotic vertebral compression fractures

This study analyses the radiological and clinical results according to the two techniques of unilateral and bilateral balloon kyphoplasty in osteoporotic vertebral compression fractures. Fifty-two patients with osteoporotic vertebral compression fractures occurring at the thoracolumbar junction were enrolled in this study. All patients were classified into two groups; group I was treated with a unilateral approach and group II with a bilateral approach. The Cobb angle was measured each time to evaluate the kyphotic angle during the pre- and post-operative periods and at last follow-up, and a 10-point visual analog scale for pain was recorded at the same time. We found that the bilateral approach had a greater advantage in the reduction of kyphosis and the loss of reduction was less than the unilateral approach for the treatment of osteoporotic vertebral compression fractures.RésuméCette étude analyse les résultats cliniques et radiologiques de deux techniques de kyphoplastie après fracture vertébrale ostéoporotique avec tassement. 52 patients ont été inclus dans l’étude. Tous les patients ont été classés en deux groupes. Le groupe 1 traité par abord unilatéral et le groupe 2 par un abord bilatéral. L’angle de Cobb a permis d’évaluer l’angle de cyphose pré et post-opératoire et au dernier recul. De même, une analyse de la douleur en 10 points a été utilisée sur la même période. En conclusion, nous pouvons indiquer que la kyphoplastie bilatérale permet une meilleure réduction vertébrale et diminue le tassement secondaire que l’on observe dans les abords unilatéraux.

Two levels above and one level below pedicle screw fixation for the treatment of unstable thoracolumbar fracture with partial or intact neurology

BackgroundTreatment of unstable thoracolumbar fractures is controversial regarding short or long segment pedicle screw fixation. Although long level fixation is better, it can decrease one motion segment distally, thus increasing load to lower discs.MethodsWe retrospectively analyzed 31 unstable thoracolumbar fractures with partial or intact neurology. All patients were operated with posterior approach using pedicle screws fixed two levels above and one level below the fracture vertebra. No laminectomy, discectomy or decompression procedure was done. Posterior fusion was achieved in all. Post operative and at final follow-up radiological evaluation was done by measuring the correction and maintenance of kyphotic angle at thoracolumbar junction. Complications were also reported including implant failure.ResultsAverage follow-up was 34 months. All patients had full recovery at final follow-up. Average kyphosis was improved from 26.7° to 4.1° postoperatively and to 6.3° at final follow-up. And mean pain scale was improved from 7.5 to 3.9 postoperatively and to 1.6 at final follow-up, All patients resumed their activity within six months. Only 4 (12%) complications were noted including only one hardware failure.ConclusionTwo levels above and one level below pedicle screw fixation in unstable thoracolumbar burst fracture is useful to prevent progressive kyphosis and preserves one motion segment distally.

Facet joint violation during pedicle screw insertion: a cadaveric study of the adult lumbosacral spine comparing the two pedicle screw insertion techniques

This article analyses the incidence of facet joint violation by pedicle screws inserted via the two most commonly used techniques, intersection and mammillary. Pedicle screws were inserted on each side of fresh-frozen human cadevaric specimen lumbosacral spines using the two techniques. All facet joints which were violated were found to be on the right side, where the mamillary process technique was employed. The incidence of facet joint violation was higher in the mammillary technique, which was statistically significant. The intersection technique appears to be safer than the mamillary with respect to violation of the adjacent superior facet joint.RésuméCet article analyse l’altération de la facette articulaire par la vis pédiculaire qui est habituellement introduite selon deux techniques, celle de l’intersection ou celle de la pénétration mammillaire. Les vis étaient insérées sur les deux côtés d’un specimen lombo-sacré cadavérique. Toutes les facettes articulaires atteintes étaient du côté de l’introduction mammillaire. La technique de l’intersection apparaît la plus sûre.

Arthroscopic Treatment of Septic Arthritis of Acromioclavicular Joint

Septic arthritis requires an early diagnosis and proper treatment to prevent the destruction of articular cartilage and joint contracture. This paper presents a rare case of septic arthritis of the acromioclavicular joint that was treated with arthroscopic debridement and resection of the distal clavicle.

Bilateral Traumatic Anterior Dislocation of the Hip with an Unstable Lumbar Burst Fracture

Traumatic anterior dislocation of the hip is rare. Bilateral traumatic anterior dislocation is an even rarer injury; indeed, only 5 cases have been reported in the English literature. We describe a case of a bilateral traumatic anterior dislocation of the hip and a concomitant unstable lumbar burst fracture following a mechanism of injury distinctly different from other reports.

Use of Huckstep nail in the periimplant femoral shaft fracture

87-year-old female underwent open reduction of distal femoral fracture and internal fixation with locking compression plate and bone graft. She was operated for ipsilateral proximal femoral fractures and stabilized by intramedullary interlocked nail 5 years ago. She developed stress fracture proximal to locked plate. We inserted Huckstep nail after removal of the previous operated proximal femoral nail without removing the remaining plate and screws. At 15 month followup the fractures have united. The Huckstep nail has multiple holes available for screw fixation at any level in such difficult situations.

Solitary epidural lipoma with ipsilateral facet arthritis causing lumbar radiculopathy.

A 55-year-old obese man (body mass index, 31.6 kg/m2) presented radiating pain and motor weakness in the left leg. Magnetic resonance imaging showed an epidural mass posterior to the L5 vertebral body, which was isosignal to subcutaneous fat and it asymmetrically compressed the left side of the cauda equina and the exiting left L5 nerve root on the axial T1 weighted images. Severe arthritis of the left facet joint and edema of the bone marrow regarding the left pedicle were also found. As far as we know, there have been no reports concerning a solitary epidural lipoma combined with ipsilateral facet arthorsis causing lumbar radiculopathy. Solitary epidural lipoma with ipsilateral facet arthritis causing lumbar radiculopathy was removed after the failure of conservative treatment. After decompression, the neurologic deficit was relieved. At a 2 year follow-up, motor weakness had completely recovered and the patient was satisfied with the result. We recommend that a solitary epidural lipoma causing neurologic deficit should be excised at the time of diagnosis.

Diagnosis of Herniated Tibialis Anterior Muscle by Dynamic Ultrasonography - A Case Report -

증례 보고 현역 군인인 21세 남성이 3일 전 약 10 km 구보를 한 뒤 발생한, 우측이 더 심한 양상을 보이는 양측 하퇴 전방 의 동통을 주소로 내원하였다. 과거력상 환자는 외상의 경력은 없었으며 10년 전부터 오랜 시간 서 있거나 장거 리 보행 및 구보후에 하퇴 전측방으로 동통이 발생한다고 하였으며 가족력은 없었다. 내원 시 시행한 이학적 검사 상 족관절의 배부굴곡 시 양측 하퇴의 중앙, 경골 전연의 외측으로 접하여 작은 연부 종괴가 촉지되었으며 이 종괴 는 족관절의 족저굴곡 시 소실되는 양상을 보였다. 양측 하지의 단순 방사선 촬영 결과 경.비골의 이상 소견은 관찰되지 않았다. 양측 하퇴 전방부에서 근육의 운동 시 크기가 증가하는 양측 하지의 종괴에 대해 우선 양성 연 부 조직 종양과의 감별 진단을 위해 초음파 검사를 시행 하였다. 초음파 소견상 증세가 더 심한 우측 하퇴 중앙의 경골에 접한 외측부에서 족관절의 족저 굴곡 시, 즉 이환 역동적 초음파를 통한 양측성 전경골근 탈출의 진단 증례 보고-