척추 경막외 지방종의 MR Imaging에 따른 임상적 분석

왕희선,이승명 조선대학교 의학연구소 2013 The Medical Journal of Chosun University Vol.38 No.1

Spinal epidural lipomatosis (SEL) is a rare condition of adipose tissue accumulation in the epidural space. A total of 2,309 subjects from March 2011 to April 2012 were studied. We found different morphologic “variants” of dural sac compression in grade III. The trifid type, resembling the letter “Y", was the most common form. The round type and the localized mass in lateral recess were seen in other cases. Surgical decompression was performed regardless of morphologic variants in SEL grade III with neurologic symptoms. All patients recovered from neurologic symptoms. In subjects who received adequate conservative treatment, decompressive surgery could be helpful in treatment of SEL grade III with neurologic symptoms.

Bone Cement Augmented Screw Fixation for Severe Osteoporotic Spine: Large Series of Clinical Application

왕희선,김희열,주창일,김석원,이승명,신호 대한척추신경외과학회 2011 Neurospine Vol.8 No.2

Objective: The purpose of this study was to evaluate the clinical efficacy of bone cement augmented screw fixation for the patients accompanying severe osteoporosis. Methods: Between February 2004 and August 2007, 157 patients with various spinal diseases including fractures accompanying severe osteoporosis underwent a bone cement augmented screw fixation (947 levels). About 4.8cc of polymethylmethacrylate was injected into the each vertebral body through transpedicular route. We divided the patients into two groups (Group I: Posterior fusion for compression/burst fractures or idiopathic scoliosis, Group Ⅱ: Interbody fusion for various spinal diseases). Imaging and clinical features were analyzed, including bone cement augmented levels, fusion rate, clinical outcome and complications. The visual analog scale (VAS), Oswestry disability questionnaire and modified MacNab’s criteria were used for the assessment of pain and functional capacity. Results: In both groups, a significant improvement in VAS and Oswestry disability questionnaire was achieved. 146 out of 157 patients (93%) were graded as excellent or good result according to the modified MacNab’s criteria. None of the patients experienced operative death, screw pullout or cut-up. However, there were two cases of neurologic deterioration as a result of bone cement extravasation. Conclusion: Bone cement augmented transpedicular screwing can reduce the possibility of screw loosening and pullout in patients with severe osteoporosis. Objective: The purpose of this study was to evaluate the clinical efficacy of bone cement augmented screw fixation for the patients accompanying severe osteoporosis. Methods: Between February 2004 and August 2007, 157 patients with various spinal diseases including fractures accompanying severe osteoporosis underwent a bone cement augmented screw fixation (947 levels). About 4.8cc of polymethylmethacrylate was injected into the each vertebral body through transpedicular route. We divided the patients into two groups (Group I: Posterior fusion for compression/burst fractures or idiopathic scoliosis, Group Ⅱ: Interbody fusion for various spinal diseases). Imaging and clinical features were analyzed, including bone cement augmented levels, fusion rate, clinical outcome and complications. The visual analog scale (VAS), Oswestry disability questionnaire and modified MacNab’s criteria were used for the assessment of pain and functional capacity. Results: In both groups, a significant improvement in VAS and Oswestry disability questionnaire was achieved. 146 out of 157 patients (93%) were graded as excellent or good result according to the modified MacNab’s criteria. None of the patients experienced operative death, screw pullout or cut-up. However, there were two cases of neurologic deterioration as a result of bone cement extravasation. Conclusion: Bone cement augmented transpedicular screwing can reduce the possibility of screw loosening and pullout in patients with severe osteoporosis.

Advantages of the Plating for Anterior Cervical Discectomy and fusion: Comparison with Wearing Cervical Collar Without Plate

왕희선,김희열,김석원,이승명,김현성,김성훈 대한척추신경외과학회 2011 Neurospine Vol.8 No.3

Objective: Most patients wear cervical braces regardless of any anterior cervical discectomy and fusion (ACDF) technique for cervical disc herniation, even in the plating. We compared clinical and radiological results in patients with cervical disc herniations. The purpose of this study was to evaluate the efficacy of plate insertion during ACDF and determine if this could eliminate the need for external cervical braces after ACDF. Methods: In this study, we evaluated 67 patients treated for single level cervical disc herniation with radiculopathy. The patients were divided into two groups: 30 patients treated with ACDF using a Solis® cage with plating who did not wear a cervical brace after the operation (Group I: Plated group), and 37 patients treated with ACDF using a Solis® cage without plating who wore a cervical brace for 3 months (Group II: Non-plated group). Clinical outcomes were assessed using the neck disability index (NDI), and visual analogue scale (VAS) for neck and arm pain at different times after the surgery. In addition, modified MacNab’s grading criteria were used to assess the subjective patients’ outcome at the last follow-up. Fusion was assessed at 6, 12, and 18 months after the surgery using upright AP, lateral, and flexion-extension views. Results: Excellent or good results were achieved in the most patients from both groups. Patients in both groups showed marked pain relief in terms of neck and arm pain scores over all time intervals. The NDI scores in both groups significantly improved when compared to preoperative scores; however, at 1 and 2 months after the surgery, patients in Group I (Plated group) had significantly better NDI scores compared to Group II (Non-plated group). Higher rates of fusion were reported in Group I over all time intervals although none of these were statistically significant. There were two patients who required second surgery for cage subsidence in Group II. Conclusion: Our study demonstrates that anterior cervical fusion with plating for cervical radiculopathy is a safe and effective treatment which can eliminate unnecessary need for an external cervical brace.

경추 신경근병증이 동반된 경추 척수증 환자에서 추궁성형술 및 추간공 확장술의 유용성

왕희선,김명훈,김석원,이승명,주창일 조선대학교 의학연구원 2014 The Medical Journal of Chosun University Vol.39 No.4

We studied clinical utility of open door laminoplasty with foraminotomy in CSM with multilevel radiculopathy. We divided into two groups; the first group underwent laminoplasty with formainotomy, and the second group underwent laminoplasty and multiple ant. approaches. In the first group, the JOA score increased from a preoperative 13.3 to postoperative 16.0 (range, 10 to 18), and in the second group from 12.8 to 15.5 (range, 10 to 18). However, the pre-operative VAS score was 6.1, 6.5 and, 2 weeks after surgery, had decreased to 2.4, 1.4, the last score was the same, 1.8, finally. The open door lami-noplasty with foraminotomy was easily performed and clinical profiles were similar to those for the laminoplasty and multi-ple anterior approach.

Cerebellar Infarction Following Epidural Abscess after Epidural Neuroplasty

이현영,왕희선,Seok Won Kim,주창일 대한척추신경외과학회 2015 Neurospine Vol.12 No.1

Epidural neuroplasty is found to be effective in removing fibrous tissue occurring in the epidural space for various reasons. We report a case of cerebellar infarction caused by epidural abscess after epidural neuroplasty. To the best of our knowledge, this is the first report of cerebellar infarction developed as a result of epidural abscess accompanying bacterial meningitis after epidural neuroplasty. We also discuss the etiology, pathogenesis, and prognosis of this rare pathologic entity.

Severe Retrolisthesis at the Adjacent Segment after Lumbar Fusion Combined with Dynamic Stabilization

김민찬,왕희선,주창일,김석원 대한신경손상학회 2017 Korean Journal of Neurotrauma Vol.13 No.1

Lumbar fusion using the pedicle screw system is a popular operative procedure, with favorable clinical results and high fusion rates. However, the risk of adjacent segment disease after lumbar fusion is problematic. We report a complicated case of severe retrolisthesis at L3-4 level following dynamic interspinous process stabilization at L2-3 level and a fusion at L4-5 level. The radiological and clinical fndings of this complication are discussed, and a review of the literature is presented. (Korean J Neurotrauma 2017;13(1):50-53

치아 돌기 골절의 치료 : 할로 베스트와 전방 나사못 고정술에 대한 임상적 고찰

김명훈,왕희선,하상우,김석원,이승명,김병욱 조선대학교 의학연구소 2013 The Medical Journal of Chosun University Vol.38 No.3

The principle of treatment of type 2, 3 odontoid process fracture is controversial. The debate is in regard to which is effective between conservative treatment and surgery. We enrolled 41 patients with type 2, 3 odontoid process fracture from January 2007 to December 2011 at Chosun University Hospital. Patients in Group I (GI) received a halo vest and those in Group II (GII) underwent surgery by ant. screw fixation. The bone fusion was classified according to stable bone union, fibrous union, and unstable non-union. Patients in GI received halo vest for a mean period of 4.9 months and those in GII received a neck collar for a mean period of 3.8 months. Tweleve patients in GI and 17 patients in GII had stable bone union. Three patients in GI and two patients in GII had fibrous union. Five patients in GI and two patients in GII had non-union. The halo vest was a good conservative treatment for type 2, 3 odontoid process fracture : however, low bone fusion rate is a problem in particularly old age. However, ant. screw fixation is a better treatment in regard to short surgical time, short fusion time, and high bone fusion rate.

Spontaneous Intracranial and Spinal Subdural Hematoma: A Case Report

김대균,조용수,왕희선,김석원 대한신경손상학회 2019 Korean Journal of Neurotrauma Vol.15 No.2

Spinal subdural hematoma (SDH) is rarely reported, and their simultaneous occurrence with intracranial SDH is even more rare. A 67-year-old male patient with a history of posterolateral fusion to treat an L2 burst fracture came to our outpatient clinic due to an inability to walk by himself over the previous 3 weeks. A neurological examination revealed that the patient was alert with occasional confusion and slight motor weakness in the lower extremities. Brain and lumbar spine magnetic resonance imaging (MRI) was then performed. A brain MRI revealed a large subacute SDH along the right cerebral convexity and falx cerebri with midline shifting, and a spine MRI revealed a right side-predominant subacute SDH extending from L4 to S1. For treatment, burr hole trephination of the intracranial SDH and fluoroscopy-guided lumbar puncture of the spinal SDH were performed and resulted in a favorable outcome. This is a report of a rare case of spontaneous intracranial and lumbar spine SDH. We include a review of the current literature and a discussion of the pathogenesis of this condition in this report

Spontaneous Resolution of Non-traumatic Cervical Spinal Subdural Hematoma Presenting Acute Hemiparesis: A Case Report

박용진,김석원,주창일,왕희선 대한척추신경외과학회 2012 Neurospine Vol.9 No.3

Spontaneous cervical SDH with no underlying pathology is a very unusual condition. To the best of the authors' knowledge, only two cases have been previously reported. A 48-year-old female patient was admitted to our emergency room due to severe neck pain following standing up position with rapid onset of hemiparesis. MRI revealed a dorsolateral subdural hematoma from C3-C5 with cord compression. An emergency laminectomy was planned, but motor weakness gradually improved during surgical preparation. The patient showed substantial clinical improvement and complete recovery was confirmed after 7 days of conservative management without surgical treatment. To determine a differential diagnosis distinct from other conditions such as cervical epidural hematoma, a lumbar spinal puncture was performed. Follow-up MRI performed 10 days after admission revealed complete resolution of the hematoma. We report an extremely rare case of spontaneous cervical spinal subdural hematoma (SDH), present a review of relevant literature, and discuss the etiology, pathogenesis, and prognosis of this case.

Malignant Metastasis Misdiagnosed as Osteoporotic Compression Fracture: A Case Report

Seul Gi Kim,주창일,왕희선,김석원 대한신경손상학회 2018 Korean Journal of Neurotrauma Vol.15 No.1

In cases of vertebral collapse after a trivial injury in elderly patients with severe osteoporosis, it can be a diagnostic challenge to determine whether the cause is a benign compression fracture or malignant metastasis. A 78-year-old male patient was referred to the emergency department for the evaluation of weakness of the left lower limb. He had undergonepercutaneous vertebroplasty four months earlier after being diagnosed with L3 osteoporotic compression fracture. He wastreated with foraminotomy at the L3-4 level after being diagnosed with foraminal stenosis two months earlier at a spineclinic. Magnetic resonance (MR) images showed signifcant signal change from the vertebral body to the posterior element, and widely spreading extraspinal extension of soft tissue at L3. Computed tomography scan revealed osteolyticchanges in regions including the ventral body and pedicle. Emergent decompressive laminectomy and bone biopsy wereperformed, and the histologic evaluation showed metastatic squamous cell carcinoma. A retrospective review of previousMR images showed obvious pedicle and facet involvement, and paraspinal extension of soft tissue, which are highly suggestive of malignant metastasis