Intraspinal Clear Cell Meningioma -A Case Report-

Meningioma is one of the most common tumors of the spinal canal. Spinal meningiomas are usually found in the thoracic spine and intradural extramedullary space. Intraspinal clear cell meningiomas are a rare histological variant. Fewer than 20 intraspinal cases have been reported in the literature and only two cases have been reported in the Korean literature, but there is no report available in the Korean orthopedic literature. We report here on a case of an intraspinal clear cell meningioma that was found in the thoracic region and it was completely resected. The nonspecific MR imaging characteristics make the diagnosis of this tumor difficult. Histological examination must be used to differentiate clear cell meningiomas from other tumors. Clear cell meningioma represents an aggressive variant of meningiomas, and surgical reatment and adjuvant radiotherapy are though to be essential. Further more, long term follow-up observation will be needed for detecting recurrence of clear cell meningioma.ope

Enchondroma of a Digit Treated by Curettage Only

Purpose: Retrospectively, to evaluate the result of treatment by curettage only, enchondroma of the digits. Materials and Methods: Fifty-nine cases in 30 patients (male 11, female 19), from July 1997 to Febuary 2002, were reviewed with a minimum follow up of 1 year. Thirty patients were treated for enchondroma of the digits (including Oilier's disease 9, and Maffucci syndrome 2) by curettage only, and the degree of healing was evaluated radiologically. The average duration of follow up was 28.6 months (12-65 months). Results: The radiologic results were evaluated according to the degree of new bone formation by the criteria suggested by Tordai. Group I achieved 79.7% overall and 89.5% for solitary enchondroma, meaning complete healing with normal cortical thickness and a bone defect of less than 3 mm. The average duration of consolidation was 12.4 months, and 8.1months for solitary enchondorma. No recurrence or other complication occured. Conclusion: Curettage alone is a good treatment option for enchondroma of the digits as comparing with autogenous bone graft, which has the disadvantages of pain, infection, and immobilization.ope

Subsequent Vertebral Compression Fracture after Balloon Kyphoplasty in Osteoporotic Patients

Background: Osteoporosis is very important social health problem and osteoporotic vertebral compression fracture (VCF) is life-threatening disease in the advanced age. Until now it has been treated conservatively. Now conservative treatment were replaced by percutaneous vertebral augmentation procedures, especially balloon kyphoplasty. But many physicians wonder the mechanical adverse effect of cement in vertebral body on the adjacent vertebra. The purpose of this study is to know the fracture pattern and the frequency of adjacent vertebra after balloon kyphoplasty. Methods: We performed the retrospective study about 120 vertebrae in 96 patients. Mean time interval between the onset of symptom and the date of procedure was 29.6 days (range, 1~365 days). Mean follow up period after balloon kyphoplasty was 12 months (range, 6~25 months). Radiographic examination was performed every 2 month after procedure for evaluation of additional vertebral fracture. Results: All of the patients experienced pain relief following the procedure (average improvement in VAS=7, p<0.01). Incidence of new vertebral compression fracture was 10% (10 new VCF in 96 patients). Among them there were only 5 adjacent fractures (5%). When we analyzed the cases, all adjacent fractures except one were located cephalad direction of previous fracture and fractured within 2 month after procedure. Adjacent fractures were occurred in the group which end plates were not completely reduced after kyphoplasty. Conclusion: The additional fracture incidence of adjacent body after kyphoplasty is not higher than the incidence of natural osteoporotic fracture.ope

Analysis of the Factors Influencing on the Postoperative Results of Radial Head Fractures Combined with Elbow Dislocation

Purpose: Radial head fractures are the most common elbow fractures in adults, and are often accompanied with elbow dislocation resulting in various complications. This study examined the outcome of surgical treatment of a radial head fracture and its prognostic factors. Materials and Methods: From January 1997 to February 2004, a retrospective analysis was performed on 25 radial head fracture patients with an elbow dislocation, also including elbow fracture, whose follow-up data could be obtained for more than 12 months. The surgical results were evaluated according to the prognostic factors and the Mayo Elbow Performance Index, which assessed the elbow joint function and pain. Results: According to the Mayo Elbow Performance Index, the results were excellent in 11 cases, good in 5 cases, fair in 5 cases, and poor in 4 cases. Cases with post-surgical elbow joint instability showed statistically meaningful poor outcomes. However, there were good in the groups without an accompanied fracture, with no open fracture, type Ⅱ and Ⅲ Mason classification, and fixation period 4 weeks or less. Correlation analysis revealed a younger age and shorter immobilization period to have better results, and the immobilization period showed the strongest correlations with the Mayo Elbow Performance index. Conclusion: In conclusion, younger age, less severe injury in the initial event and a shorter immobilization period are good prognostic factors in radial head fractures combined elbow dislocations.ope

Comparison of Mechanical Property of Conventional Rods versus Growing Rods for Pediatric Early Onset Scoliosis

STUDY DESIGN: This is a mechanical study. OBJECTIVES: We wanted to investigate the mechanical properties of newly developed dual growing rods for obtaining approval for their clinical application. SUMMARY OF LITERATURE REVIEW: The current expandable spinal implant system appears effective for controlling progressive early onset scoliosis, and it allows for spinal growth and improving lung development. MATERIALS AND METHODS: We investigate the yield load and ultimate load during compression, tension and torsion of the growing rods and the conventional rods assembly using UHMWPE blocks, and the diameter of the rods was 6.0 mm and they expanded 5cm long. We also performed a fatigue test with growing rods, and the diameter of which was 6.0 mm and it expanded 2.5cm long. The guideline for the American Society for Testing Materials was followed during the entire mechanical test. With the growing rods and conventional rods, we tested for each mechanical property7 times with the new rods and blocks. RESULTS: The yield load of the growing rods and conventional rods were 845.2+/-18.2 (N) and 812.9+/-29.9 (N), respectively, and the ultimate load of the growing rods and conventional rods were 961.9+/-31.1 (N) and 914.9+/-25.6 (N), respectively, when compression force was applied. The yield load and ultimate load of the growing rods were statistically higher than those of the conventional rods (p0.05). The yield loads of the growing rods and conventional rods were 11.56+/-0.59 (Nm) and 12.46+/-0.71 (Nm), respectively, the ultimate loads of the growing rods and conventional rods were 16.97+/-0.94 (Nm) and 17.42+/-2.66 (Nm) during the torsion, respectively. The yield load and ultimate load of the growing rods were statistically lower than that of the conventional rods (p<0.05). CONCLUSIONS: The newly developed growing rods have a higher yield load and ultimate load under compression, a similar ultimate load under tension and a lower yield load and ultimate load under torsion. The differences of the yield load and ultimate load under torsion were minimal, and so the growing rods and conventional rods have similar mechanical propertiesope

Antibiotic Microbial Prophylaxis for Spinal Surgery: Comparison between 48 and 72-Hour AMP Protocols

STUDY DESIGN: This is a prospective randomized cohort study. PURPOSE: We intended to evaluate the efficacy of a 48 hour antibiotic microbial prophylaxis (AMP) protocol as compared with a 72 hour AMP protocol. OVERVIEW OF LITERATURE: The current guideline for the prevention of surgical site infection (SSI) suggests the AMP should not exceed 24 hours after clean surgery like spinal surgery. But there exist some confusion in real clinical practice about the duration of postoperative antibiotic administration because the evidence of the guideline was not robust. METHODS: The subjects were 548 patients who underwent spinal surgery at our department from April 2007 to December 2008. The patients were classified into two groups according to the prophylaxis protocol: group A, for which AMP was employed for 72 hours postoperatively and group B, for which AMP was employed for 48 hours postoperatively. Five hundred two patients out of 548 patients were followed until 6 months postoperatively. The incidence of SSI in the two groups was analyzed. RESULTS: The overall infection rate was 0.8%. There was no significant difference in infection rate between the two groups. The overall infection rate for the patients who underwent instrumented fusion was 0.9%. There was no significant difference in the infection rate between the patients of the two groups who underwent instrumented fusion. CONCLUSIONS: AMP for 48 hours is as efficient as AMP for 72 hours.ope

Delayed Onset Neurological Deterioration due to a Spinal Epidural Hematoma after a Spine Fracture

There are no reports of a 7-day delay in the onset of neurological deterioration because of a spinal epidural hematoma (SEH) after a spinal fracture. A hematoma was detected from the T12 to L2 area in a 36-year-old male patient with a T12 burst fracture. On the same day, the patient underwent in situ posterior pedicle instrumentation on T10-L3 with no additional laminectomy. On the seventh postoperative day, the patient suddenly developed weakness and sensory changes in both extremities, together with a sharp pain. A MRI showed that the hematoma had definitely increased in size. A partial laminectomy was performed 12 hours after the onset of symptoms. Two days after surgery, recovery of neurological function was noted. This case shows that spinal surgeons need to be aware of the possible occurrence of a delayed aggravated SEH and neurological deterioration after a spinal fracture.ope

Practice Patterns on Osteoporosis Screening and Treatment at Orthopaedic Surgery Outpatient Unit and the Issue on Different Osteoporosis Treatment Guidelines in Korea

Background: We planned to present the percentage of patients neglected and deprived of a chance to be treated for osteoporosis by comparing the treatment guidelines and also analyze how well the screening and treatment guidelines were kept by the clinicians in orthopedic surgery outpatient unit. Methods: A cross sectional study was done to patients who visited orthopaedic surgery outpatient clinic from January 1, 2007 to February 28. Data on patients’ age, sex, comorbidities, past medical history, presence and location of previous fractures, whether osteoporosis screening was done using DXA, T-score, osteoporosis medications were collected. Results: The study population consisted of 6301 patients (males 2513, females 3788). 16.2~23.6% of patients who were indicated for osteoporosis treatment could not benefit from the public health insurance, and when T-score for the treatment indication by Korean Health Insurance Review Agency was raised from -3.0 to -2.5, the percentage of patients in the intermediate group was decreased to less than 10%. Among patients who were indicated for osteoporosis screening, only 44.5% actually received DXA, and among patients indicated for osteoporosis treatment, only 67.0% were taking medications. In addition, in females than males, and when the attending doctor was subspecialized in osteoporosis, the osteoporosis screening and treatment rates were significantly higher. Conclusion: More attention and strenuous effort on osteoporosis should be endowed with by orthopaedic surgeons in order to modify the propensity to underdiagnose and undertreat osteoporosis.ope

Prevention of New Vertebral Fractures after Treatment with Risedronate, Alendronate or Calcium Carbonate in Patients with Osteoporotic Compression Fracture Treated with Cement Augmentation

Purpose: To evaluate the rate of new fractures of the spine after risedronate, alendronate or calcium carbonate in patients who had vertebroplasty or kyphoplasty due to compression fracture. Materials and Methods: We studied 292 patients with osteoporotic compression fractures who had received vertebroplasty or kyophoplasty between June 2003 and October 2007. Of these, 199 were evaluated for new fractures of the spine after treatment with risedronate, alendronate or calcium carbonate. Patients (n=199) were assigned to 1 of 4 groups: No treatment (n=71), risendronate (n=64), alendronate (n=42) or calcium carbonate group (n=22). Results: New fractures of the spine were morphogenically found in 19 patients (26.8%) in the no treatment group, in 11 (17.2%) in the risendronate group, in 8 (19.1 %) in the alendronate group, in 5 (22.8%) in the calcium carbonate group. Symptomatically, they were found in 6 patients (8.5%) in the no treatment group, in 4 (6.3%) in the risendronate group, in 3 patients (7.1 %) in the alendronate group, and in 2 patients (9.1 %) in the calcium carbonate group. Conclusion: At one year follow up none of the differences between groups in new fracture rates of the spine were statistically significant.ope

A Comparison of Bone Mineral Density between Adolescent Idiopathic Scoliosis and Neuromuscular Scoliosis

Study Design A Cross-sectional study Objective This study evaluated the degree of osteoporosis of adolescent idiopathic scoliosis (AIS) and neuromuscular scoliosis (NMS) and compared bone mineral density. Literature Review In osteoporosis, bone mineral density was not as dense even in the outer layer, and the cortex was thinner than normal. A larger screw doss not enhance the screw stability and can break the thin cortex in osteoporotic vertebrae. Materials and Methods This study reviewed the cases of consecutive patients with scoliosis, who underwent an osteoporosis examination before surgery between August 2004 and June 2006. The osteoporosis examination included DEXA in lumbar vertebrae and proximal femur. The mean osteoporotic degree of both femurs was recorded. The data was analyzed using the BMD(bone mineral density, g/cm2) and Z value of the BMD according to age, gender, and ethnicity. Results The mean degree of the coronal deformity was 48.4 in AIS and 62.9 in NMS. A comparison of both groups revealed a significantly lower BMD and Z value of Femur, and BMD of the vertebra in the NMS patients (p<0.05). A comparison between AIS and non-ambulant NMS showed that all parameters were significantly lower in the non-ambulant NMS (p<0.05). Neither the BMD and Z value of the AIS nor the NMS were associated with the severity of the spinal deformity. Conclusion A lower BMD was measured in patients with non ambulant NMS than AIS. The degree of the osteoporosis, particularly of the non ambulant NMS patients need to be considered before undergoing surgery.ope