• Journal of Korean Neurosurgical Society
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• v.62 no.5
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• pp.603-609
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• 2019

Objective : The purpose of this retrospective study was to determine which of the proximal adjacent segment disease (ASD) and distal ASD was more prevalent and what parameters is more related to ASD in proximal levels and distal levels after more than 2 levels fusions. Methods : The medical records were reviewed retrospectively for 856 cases. A total of 66 cases of ASD were enrolled. On preop magnetic resonance imaging, disc degeneration was measured at the upper and lower parts of surgically treated levels and confirmed by the commonly used Pfirrmann grade. Segmental flexibility in sagittal plane was embodied in segment range of motion (ROM) obtained through flexion and extension X-ray before surgery. Coronal angle was recorded as methods Cobb's angle including fusion levels preoperatively. For the comparison of categorical variables between two independent groups, the chi-square test and Fisher exact test were performed. Results : Proximal ASD and distal ASD were 37/856 (4.32%) and 29/856 (3.39%), respectively. The incidence of proximal ASD was relatively high but insignificant differences. In comparison between ASD group and non ASD group, proximal Pfirmman was higher in proximal ASD and distal Pfirmman was higher in distal ASD group (p=0.005, p<0.008, respectively). However, in the ROM, proximal ROM was higher in proximal ASD, but distal ROM was not different between the two groups (p<0.0001, p=0.995, respectively). Coronal angle was not quite different in both groups (p=0.846). Conclusion : In spite of higher frequency in ASD in proximal level in spinal fusion, it is not clear that incidence of ASD in proximal level is not higher than that of distal ASD group in more than 2 level thoracolumbar fusions. Not only Pfirrmann grade but also proximal segmental ROM is risk factor for predicting the occurrence of ASD in patients more than 2 level of thoracolumbar spine fusion operation excluding L5S1.

• Journal of Veterinary Clinics
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• v.25 no.6
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• pp.529-532
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• 2008

The object of this study was to evaluate the durations from onset of neurological sign until surgery and regaining of the deep pain perception (DPP) after decompression as prognostic indicators for the outcome of decompression surgery in dogs with thoracolumbar intervertebral disc disease (IVDD). The compression lesions in the thoracolumbar vertebrae were localized by plain radiograph, computed tomography and neurological examination in 28 dogs with hindlimb paralysis. The follow up was carried out for 6 months after laminectomy. During the follow up, regaining DPP and walking ability were evaluated. Improvement to normal or paretic gait after surgery was judged as success of the surgical treatment.The success rate of surgical treatment was 70 % (7 out of 10 dogs) when surgical intervention was carried out within 24 hours but 38.9 % (7 out of 18) over 24 hours (P<0.05). The success rate of surgical treatment was 87.5 % (14 out of 16 dogs) when DDP was regained within 5 weeks after surgery but there was 0 % (0 out of 12 dogs) when DDP was not regained within 5 weeks after surgery (P<0.05). Other parameters such as compression rate in CT scan and laminectomy methods did not related with the success of the surgery. These results suggested that the time of surgery after onset and duration of regaining of DPP after decompression were useful parameter to predict the success of surgical treatment for thoracolumbar disc herniation in dogs.

• Journal of Veterinary Clinics
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• v.27 no.6
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• pp.713-717
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• 2010

Outcomes of non-surgical and surgical treatments for thoracolumbar intervertebral disc disease (IVDD) are well-reported. However, little is known regarding the outcome for treatments of cervical IVDD. This study systematically reviewed the outcomes in dogs with cervical IVDD that were managed non-surgically and surgically. Clinical success rates for surgical treatment were significantly higher (100%) than for non-surgical treatment (51.4%). In the non-surgical treatment group, clinical success rates were negatively correlated with spinal cord compression rates. Based on the results of this study, surgical treatment is deemed more effective than non-surgical treatment for dogs with cervical IVDD. Also, the degree of spinal cord compression on computed tomography or magnetic resonance imaging is a useful prognostic indicator before non-surgical treatment.

• Journal of Veterinary Clinics
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• v.34 no.5
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• pp.377-380
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• 2017

An 8-year-old, shih-tzu female dog was referred due to neurological signs including paraparesis and back pain. On the complete blood count, hematologic analysis showed elevated leukocytosis. Serum biochemical analysis revealed elevated serum alkaline phosphatase concentration and C-reactive protein concentration. On the neurologic exam, the dog was suspected to have thoracolumbar myelopathy. On magnetic resonance imaging, there were masses within the spinal canal at L1-3 intervertebral disc space that were located dorsal to spinal cord. It was hyperintense on T1-, T2-weighted magnetic resonance images, Fluid-attenuated inversion recovery, and fat suppression images. The contrast-enhanced T1-weighted images showed no enhancement. The lesions were well circumscribed. The spinal cord was compressed and displaced ventrally by the mass. After removal of the masses via L1-L3 dorsal laminectomy, pyogranulomatous inflammation was confirmed by histopathological examination. Six months after surgery, the dog recovered uneventfully and remained fully ambulatory with no neurological deficits. This case demonstrates the utility of magnetic resonance imaging for the diagnosis of spinal canal pyogranulomatous inflammation.

• Journal of Korean Neurosurgical Society
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• v.50 no.4
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• pp.332-340
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• 2011

Objective : Pyogenic spondylitis often results in acute neurological deterioration requiring adequate surgical intervention and appropriate antibiotic treatment. The purpose of this study was to conduct an analysis of the clinical effect of continuous irrigation via laminotomy in a series of patients with pyogenic spondylitis in thoracic and lumbar spine. Methods : The authors conducted a retrospective investigation of 31 consecutive patients with pyogenic thoracic and lumbar spondylitis who underwent continuous irrigation through laminotomy from 2004 to 2008. The study included 22 men and 9 women, ranging in age from 38 to 78 years (mean 58.1 years). The average follow-up duration was 13.4 months (range, 8-34 months). We performed debridement and abscess removal after simple laminotomy, and then washed out epidural and disc space using a continuous irrigation system. Broad spectrum antibiotics were administered empirically and changed according to the subsequent culture result. Clinical outcomes were based on the low back outcome scale (LBOS), visual analogue scale (VAS) score, and Frankel grade at the last follow-up. Radiological assessment involved plain radiographs, including functional views. Results : Common predisposing factors included local injection for pain therapy, diabetes mellitus, chronic renal failure, and liver cirrhosis. Causative microorganisms were identified in 22 cases (70.9%) : Staphylococcus aureus and Streptococcus spp. were the main organisms. After surgery, LBOS, VAS score, and Frankel grade showed significant improvement in most patients. Spinal stability was maintained during the follow-up period, making secondary reconstructive surgery unnecessary for all patients, except one. Conclusion : Simple laminotomy with continuous irrigation by insertion of a catheter into intervertebral disc space or epidural space was minimally invasive and effective in the treatment of pyogenic spondylitis. This procedure could be a beneficial treatment option in patients with thoracolumbar spondylitis combined with minimal or moderate destructive change of vertebrae.

• Journal of Yeungnam Medical Science
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• v.3 no.1
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• pp.95-102
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• 1986

Among the skeletal tuberculosis, tuberculous spondylitis is high incidence and curable disease, if early diagnosis and treatment are possible. We reviewed clinical manifestations and radiologic analysis of 30 cases tuberculous spondylitis from May 1983 to Sept. 1986, at Yeungnam medical center, Yeungnam University. The results were follows : 1. The frequent involve sites were thoracolumbar vertebra. 2. The continuous lesion is 86.7% of the all cases. 3. The most common type was intervertebral type, and lytic and sclerotic lesion were same incidence. 4. Paravertebral abscess, kyphosis and disc space narrowing were demonstrated more than 80.0% of the cases. 5. Computed tomography was more accurate diagnostic method rather than conventional plain study to evaluation of extent of lesion, involvement of spinal canal and cord, and size and location of paravertebral abscess. And CT guided abscess drainage procedure was helpful to diagnosis and treatment. 6. Ultrasonography was helpful to differential diagnosis between paravertebral abscess and other solid mass, and useful to follow up study of paravertebral abscess after treatment.

• Journal of Korean Neurosurgical Society
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• v.30 no.4
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• pp.451-455
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• 2001

Objectives : There have been several studies documenting the changing level of the conus throughout infancy and childhood, but there is only a little detailed study that documents the range of conus positions in a living adult population, especially in Korean, without spinal deformity. Methods : we made a sequential study of magnetic resonance images of the lumbar spine to determine the variation in position of the conus medullaris in 650 living korean adults population without spinal deformity who checked MRI to identify the cause of low back pain. The study population consisted of patients over the age of 16 years. A T1-weighted, midline, sagittal image was reviewed for identifying the postion of conus. This location was recorded in relation to the upper, middle, or lower third of the adjacent vertebral body or the adjacent intervertebral disc. Results : The study group consisted of 305 men(47%) and 345 women(53%) with a mean age 45.9 years(range, 16-79 years). The conus existed commonly at the middle third of L1(131cases, 20.2%), at the L1-2 intervertebral space(129cases, 19.8%), and the lower third of L1(123cases, 18.9%). The mean position of conus was the lower third of L1(range, middle third of T12 to middle third of L3). Conclusions : The mean position of conus was at the lower third of L1(range, middle third of T12 to middle third of L3). This results was same as that of foreign study. Our results of living korean adult population could allow for safe clinical procedures such as lumbar puncture, spinal anesthesia, and help to explain the differences among observed neurologic injuries from fracture-dislocation at the thoracolumbar junction.