Park Ym

Single-stage transpedicular decompression and posterior instrumentation in treatment of thoracic and thoracolumbar spinal tuberculosis: a retrospective case series.

Objective We compare the surgical results of single-stage posterior surgical procedure performed at a single institute with those of anterior procedure, and propose single-stage posterior surgical approach, laminectomy and posterior decompression with transpedicular instrumentation as an alternative operative method for thoracic and thoracolumbar spinal tuberculosis. Methods From January 2001 to December 2004, 10 patients (group 1) who had less bone destruction or poor medical condition were treated with posterior decompression and transpedicular instrumentation that was supplemented with posterolateral bone fusion and chemotherapy. Seven patients (group 2) who had greater bone destruction were treated with anterior decompression, bone fusion, and anterior instrumentation. Except one case who expired, all patients were followed up for average 18 months (6 mo to 3.5 y). Results Spinal tuberculosis was completely cured and the grafted bones were fused in all 16 patients. The visual analog scale and Frankel grade improved in all cases. There was no persistence or recurrence of infection possibly related to the instrumentation. There were no differences in the radiological results in both groups. The kyphosis was significantly corrected after surgical management. However, the loss of correction also occurred considerably in both groups. Conclusions The posterior decompression with transpedicular instrumentation can be an alternative treatment method of less-involved spinal tuberculosis especially for patients in early phase of bone destruction or ones with mild kyphosis.

Clinical and radiological Comparison of treatment of atlantoaxial instability by posterior C1–C2 transarticular screw fixation or C1 lateral mass-C2 pedicle screw fixation

We compared the clinical and radiological results of posterior atlantoaxial fixation surgery using transarticular screws to those using a polyaxial screw-rod system in 55 patients with symptomatic atlantoaxial instability. Patients underwent posterior C1-C2 fixation: 28 patients (group 1) underwent C1-C2 transarticular screw fixation and 27 patients (group 2) underwent C1 lateral mass-C2 pedicle screw fixation. Patients were followed-up for at least 24 months. The clinical and radiological results were evaluated in the early postoperative period and at 3, 6, 12 and 24 months after surgery. Long-term postoperative stability and bone fusion were examined. After surgery, 93% of patients in group 1 and 96% of patients in group 2 were free of neck pain. The solid fusion rates were 82% for group 1 patients and 96% for group 2 patients at 12 months (p<0.092). In group 1, three patients showed fibrous union. Four patients had hardware failure due to a screw malposition (one in group 1) and pseudoarthrodesis (two in group 1 and one in group 2). One patient in group 1 had cerebrospinal fluid leakage. One patient in group 2 had occipital neuralgia. One vertebral artery injury occurred during the screw placement in group 1 and another in group 2 during the muscle dissection. C1-C2 transarticular screw fixation and C1 lateral mass-C2 pedicle screw fixation both produced excellent results for stabilization of the atlantoaxial complex, but the radiological outcome tended to be superior in C1 lateral mass-C2 pedicle screw fixation.

Remote Cerebellar Hemorrhage Complicated after Supratentorial Surgery: Retrospective Study with Review of Articles

OBJECTIVE Remote cerebellar hemorrhage (RCH) is one of the rare complications occurring after supratentorial surgery, and its pathomechanism is poorly understood. We report 10 cases of RCH from our institution and review 154 cases from a database in order to delineate incidence, common presentation, risk factors, and outcomes of this complication. In addition, the means of prevention are discussed. METHODS We reviewed the medical records of 10 patients who experienced RCH after undergoing supratentorial surgery at our institution between 2001 and 2008. A database search in Medline revealed 154 cases of RCH in the English literature. Characteristic features were analyzed and compared. RESULTS There were 10 cases of RCH among 3307 supratentorial surgery cases, indicating a 0.3% incidence. All patients had characteristic imaging features of RCH, namely a streaky bleeding pattern in the superior folia of the cerebellum. Seven patients had a history of preoperative hypertension. Four cases were related to cerebral aneurysms, and other four developed after the removal of brain tumors. Cerebrospinal fluid (CSF) drainage apparatuses were installed postoperatively in all cases. Outcomes according to modified Rankin scale (mRS) were good in 7 patients, with 1 fatal case. CONCLUSION RCH is a rare complication after supratentorial surgery, and the exact etiology still remains uncertain. Hypertension and perioperative loss of CSF seem positively correlated with RCH, but no single risk factor is totally responsible. Patients with RCH should be closely observed to improve their prognosis.

Multiple Vertebral Involvement of Rheumatoid Arthritis in Thoracolumbar Spine: A Case Report

Although little attention has been paid to the less common rheumatoid involvement of the thoracic and lumbar regions, some studies have shown that rheumatoid synovitis with erosive changes can develop in these diarthrodial joints. We report a patient with seropositive rheumatoid arthritis (RA) involving the thoracic and lumbar vertebra with a collapse of the T12 vertebra, who was treated with percutaneous vertebroplasty. In this case of a painful pathological fracture due to RA, percutaneous vertebroplasty was found to be helpful in eliminating the pain. The paper presents the histological evidence, the pathogenesis and treatment of the thoracolumbar lesions affected by RA with a review of the relevant literature.