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Study Design: The results for 37 surgical interventions in 31 consecutive patients with non-small cell lung cancer (NSCLC) with symptomatic spinal cord compression were reviewed retrospectively., Objectives: To evaluate postoperative outcomes and survival rates of NSCLC patients surgically treated for symptomatic spinal metastasis., Summary of Background Data: For patients with spinal cord compression secondary to lung cancer, the prognosis is usually poor. However, with the development of new chemotherapeutic drugs and targeted therapeutic agents, the survival rate may be better., Methods: From November 2000 to March 2005, 31 patients with symptomatic metastatic spinal cord compression secondary to NSCLC underwent palliative surgery using a posterolateral transpedicular approach (PTA) or combined posterior and anterior procedures. The indication for surgery was neurologic progression due to spinal cord compression., Results: The patients ranged in age from 20 to 81 years (mean, 61.4 years). Twenty-eight patients (90%) underwent PTA, and 3 patients had combined posterior and anterior procedures. Neurologic improvement by at least one Frankel grade was noted in 25 of 31 cases (80%). Overall, 74% of patients (23 of 31) were able to walk after surgery. There was no case of intraoperative mortality, but two deaths occurred in the postoperative period. Median survival time was 8.8 months., Conclusions: Even though lung cancer is considered an aggressive tumor, it is justifiable to aggressively treat patients with symptomatic spinal cord compression. Surgery by PTA can lead to good results in these patients.

Study Design: The aim of this case report is to examine the devastating complication that may follow vertebroplasty., Objectives: To report 1 case of intradural cement leakage caused by percutaneous vertebroplasty with polymethyl methacrylate., Summary of Background Data: Cement leakage is not a rare complication of vertebroplasty. But intradural cement leakage is rare. We herein report a rare but devastating complication of vertebroplasty., Methods: A 90-year-old woman with a T12 and L1 osteoporotic compression fracture underwent percutaneous vertebroplasty using polymethyl methacrylate at local hospital. A literature search was performed to assess complications of vertebroplasty., Results: She was transferred to our hospital due to abdominal pain. Physical examination revealed distended abdomen with local tenderness and weakness of both legs (muscle power: Grade 2). Plain radiograph of abdomen showed ileus and intradural cement leakage. Conservative treatment with nasogastric decompression was done, and her abdominal pain subsided 1 week later., Conclusions: Percutaneous vertebroplasty with polymethyl methacrylate is relatively safe, but it still should be proceeded under careful safeguard. The needle tip should not cross the medial border of the pedicle on the anteroposterior view before it has crossed the posterior cortex of the vertebral body on the lateral view. Good quality of image monitoring and clear visualization of cement should be helpful to prevent complications.

Spinal epidural lipomatosis (SEL) frequently occurs as a result of long-term steroid administration for various disorders, and patients often present with osteoporosis. Acute paraplegia in patients with extensive thoracic SEL is rare. We report a case of acute paraplegia caused by osteoporotic compression fracture with extensive thoracic SEL in a 44-year-old man with rheumatoid arthritis who had received steroid therapy for 4 years. He presented initially with abdominal distension and weakness of lower limbs, and a sudden onset of paraplegia with complete motor and sensory loss below the T6 level ensued. Plain radiographs showed an osteoporotic compression fracture of the T6 vertebra. Magnetic resonance imaging showed osteoporotic compression fractures of the T5 and T6 vertebrae and SEL from T2 to T10 vertebrae. Decompressive laminectomy with epidural fat debulking was performed, and the pathology was confirmed as epidural lipomatosis. His neurological condition showed no improvement below the T6 level 3 months after surgery. Osteoporotic compression fracture is a risk factor for acute paraplegia in patients with thoracic SEL and decompressive surgery should be performed without delay.

In the absence of trauma, fracture of the acetabulum is a rare injury, and an isolated insufficiency fracture in the supra-acetabular region is extremely rare. We describe a 59-year-old postmenopausal woman with systemic lupus erythematosus (SLE) who developed a fracture in the roof of the acetabulum with underlying corticosteroid-induced bony insufficiency. Faint medullary sclerosis over the roof of the acetabulum was observed on plain roentgenograms. Diagnosis was made using magnetic resonance imaging. Irregular linear low signal intensity lines were observed on T1-weighted, T2-weighted, proton density, and contrast enhanced images, and these represented the fracture. The fracture healed with conservative management. Insufficiency fracture in this location should be suspected in an osteopenic woman with spontaneous hip pain.

Background and Purpose: Few reports exist concerning the peak serum concentration of creatine kinase (CK) and the severity of crush syndrome, and the efficacy of fasciotomy in crush syndrome patients remains controversial. This study aimed to analyze and assess the clinical features, treatment, and outcome of patients with crush syndrome sustained in the Chi-Chi earthquake in September 21, 1999., Methods: Pertinent data were collected from major hospitals in central Taiwan via questionnaire. Patients with a peak serum CK concentration of more than 1,000 U/L within 2 weeks following the earthquake were included in the study. Eight hospitals responded and a total of 95 patients were included for the analysis., Results: Forty-four patients (46.3%) with acute renal failure were found to have a serum creatinine level of more than 159 mumol/L (1.8 mg/dL) or daily urine output of less than 400 mL. Thirty patients (31.6%) required hemodialysis, which completely restored renal function. The incidence of acute oliguria, acute renal failure, and the need for hemodialysis were significantly increased if the peak CK concentration was more than 50,000 U/L (p < 0.01). Thirty-five patients underwent fasciotomy to treat compartment syndrome caused by crush syndrome. Among these, 31 patients (88.6%) had a peak CK concentration higher than 10,000 U/L. The incidence of acute renal failure (p < 0.01) and the need for hemodialysis (p < 0.01) were significantly higher in the fasciotomy group than in the non-fasciotomy group. Eight patients developed superficial infection and 16 developed deep infections after fasciotomy. Six patients underwent amputations and one patient died of sepsis due to uncontrolled infection of the fasciotomy wound., Conclusion: CK concentration is a good indicator of the occurrence of acute renal failure and the need for dialysis. The high infection rate and amputation rate after fasciotomy may be due to inadequate debridement. Fasciotomy in crush syndrome patients with high serum CK concentrations should be deliberated.