Object The authors conducted a retrospective observational study using kinetic MR imaging to investigate the relationship between instability, abnormal sagittal segmental motion, and radiographic variables consisting of intervertebral disc degeneration, facet joint osteoarthritis (FJO), degeneration of the interspinous ligaments, ligamentum flavum hypertrophy (LFH), and the status of the paraspinal muscles. Methods Abnormal segmental motion, defined as > 10° angulation and > 3 mm of translation in the sagittal plane, was investigated in 1575 functional spine units (315 patients) in flexion, neutral, and extension postures using kinetic MR imaging. Each segment was assessed based on the extent of disc degeneration (Grades I–V), FJO (Grades 1–4), interspinous ligament degeneration (Grades 1–4), presence of LFH, and paraspinal muscle fatty infiltration observed on kinetic MR imaging. These factors are often noted in patients with degenerative disease, and there are grading systems to describe these changes. For the first time, the authors attempted to address the relationship between these radiographic observations and the effects on the motion and instability of the functional spine unit. Results The prevalence of abnormal translational motion was significantly higher in patients with Grade IV degenerative discs and Grade 3 arthritic facet joints (p < 0.05). In patients with advanced disc degeneration and FJO, there was a lesser amount of motion in both segmental translation and angulation when compared with lower grades of degeneration, and this difference was statistically significant for angular motion (p < 0.05). Patients with advanced degenerative Grade 4 facet joint arthritis had a significantly lower percentage of abnormal angular motion compared to patients with normal facet joints (p < 0.001). The presence of LFH was strongly associated with abnormal translational and angular motion. Grade 4 interspinous ligament degeneration and the presence of paraspinal muscle fatty infiltration were both significantly associated with excessive abnormal angular motion (p < 0.05). Conclusions This kinetic MR imaging analysis showed that the lumbar functional unit with more disc degeneration, FJO, and LFH had abnormal sagittal plane translation and angulation. These findings suggest that abnormal segmental motion noted on kinetic MR images is closely associated with disc degeneration, FJO, and the pathological characteristics of interspinous ligaments, ligamentum flavum, and paraspinal muscles. Kinetic MR imaging in patients with mechanical back pain may prove a valuable source of information about the stability of the functional spine unit by measuring abnormal segmental motion and grading of radiographic parameters simultaneously.

No abstract

ObjectiveThe aims of current study are to compare complications following cranioplasty (CP) using either sterilized autologous bone or polymethyl methacrylate (PMMA), and to identify the risk factors for two of the most common complications: bone flap resorption (BFR) and surgical site infection (SSI).MethodsBetween January 2004 and December 2013, 127 patients underwent CP and were followed at least 12 months. Variables, including sex, age, initial diagnosis, time interval between decompressive craniectomy (DC) and CP, operation time, size of bone flap, and presence of ventriculo-peritoneal shunt, were analyzed to identify the risk factors for BFR and SSI.ResultsA total of 97 (76.4%) patients underwent CP using PMMA (Group I) and 30 (23.6%) underwent CP using autologous bone (Group II). SSI occurred in 8 (8.2%) patients in Group I, and in 2 (6.7%) in Group II; there was no statistically significant difference between the groups (p=1.00). No statistically significant risk factors for SSI were found in either group. In Group I, there was no reported case of BFR. In Group II patients, BFR developed in 18 (60.0%) patients at the time of CP (Type 1 BFR), and at 12-month follow up (Type 2 BFR) in 4 (13.3%) patients. No statistically significant risk factors for BFR were found in Group II.ConclusionCP using sterilized autologous bone result in a significant rate of BFR. PMMA, however, is a safe alloplastic material for CP, as it has low complication rate.

ObjectiveThe epidural fluid collection (EFC) as a complication of cranioplasty is not well-described in the literature. This study aimed to identify the predictive factors for the development of EFC as a complication of cranioplasty, and its outcomes.MethodsFrom January 2004 to December 2012, 117 cranioplasty were performed in our institution. One-hundred-and-six of these patients were classified as either having EFC, or not having EFC. The two groups were compared to identify risk factors for EFC. Statistical significance was tested using the t-test and chi-square test, and a logistic regression analysis.ResultsOf the 117 patients undergoing cranioplasty, 59 (50.4%) suffered complications, and EFC occurred in 48 of the patients (41.0%). In the t-test and chi-test, risk factors for EFC were size of the skull defect (p=0.003) and postoperative air bubbles in the epidural space (p<0.001). In a logistic regression, the only statistically significant factor associated with development of EFC was the presence of postoperative air bubbles. The EFC disappeared or regressed over time in 30 of the 48 patients (62.5%), as shown by follow-up brain computed tomographic scan, but 17 patients (35.4%) required reoperation.ConclusionEFC after cranioplasty is predicted by postoperative air bubbles in the epidural space. Most EFC can be treated conservatively. However, reoperation is necessary to resolve about a third of the cases. During cranioplasty, special attention is required when the skull defect is large, since EFC is then more likely.

the mountain in Mongol where there were close contacts with animals, contaminated water, lack of sewage system and poor personal hygiene. He grew up and mostly lived in Mongol. He has migrated to Korea and it has been only 6months in Korea. His consciousness was alert and his appearance looked to be normal. There were no neurologic deficits seen on physical examinations.He was admitted to our hospital and investigated with routine hematology that showed normal complete blood count, erythrocyte sedimentation rate and C-reactive protein were normal range. Human immunodeficiency virus-antibody test using enzyme-linked immunosorbent assay (ELISA) was negative. Cerebrospinal fluid (CSF) routine exam of spinal tapping revealed pleocytosis, predominant polymorphonuclear leukocytes, and acid fast bacilli stain and culture were negative. However, in ELISA investigation, serum and CSF parasite antibody immunoglobulin G for cysticercosis were positive. The electrocardiogram was normal sinus rhythm and three dimension echocardiography showed normal wall motion.The x-ray for the skull did not reveal abnormal appearance. Brain CT revealed multiple cystic lesions, which appeared as starry-night appearance, in the brain parenchyma (Fig. 1). Brain MRI showed numerous cystic lesions in the brain parenchyma and the lesions were also founded in temporalis muscle, around optic nerve and tongue (Fig. 2). On the spine MRI and whole body MRI, there were numerous cysticerci in subcutaneous tissue, skeletal muscles and the other organs (Fig. 3, 4). Therefore, we thought that cysticerci were disseminated throughout the whole body.The open biopsies were taken from the brain. Incision was made on the skin and the temporalis muscle was exposed with a whitish yellow egg. After Fronto-temporal craniotomy, anoth- INTRODUCTIONNeurocysticercosis is the most common parasite disease of the central nervous system 3,5,6,9,11,12,15) . However, disseminated cysticercosis is a very rare manifestation of the neurocysticercosis and fewer than 50 cases of disseminated cysticercosis have been reported in the world 2,7). Government medical college in India mentioned that among 450 cases of cysticercosis, only one case of disseminated cysticercosis was seen in their study 2) . Also, we underwent several cases of the neurocyticercosis in our institution but this case of disseminated cysticercosis was the first time we had treated in Korea.Although, the regimen for the treatment of neurocysticercosis is reported, there is no therapeutic regimen for the disseminated cysticercosis established in Korea. CASE REPORTA 39-year-old young man from Mongol presented with generalized tonic-clonic seizures and headache. He had not taken antiepileptic drugs and any other medications before this seizure attack. He complained of a headache, not depend on time but any time throughout the day. He did not have any medical diseases or operation in the past. In his childhood, he enjoyed to eat uncooked pigs, yaks, cows and horses. Additionally, he grew up at J Korean Neurosurg Soc...