Introduction
A spondylitis developed after a surgery has been usually treated with drainage and curettage through anterior approach and autoiliac strut bone graft. However, anterior support with titanium cage combined with posterior pedicle screw fixation has been attempted. Implanting a foreign material is usually prohibited at an active pyogenic infection site. We tried to prove the usefulness of chip bone graft with metal cages in surgical treatment of spondylitis developed in posterior lumbar intebody fusion cases.
Materials and Methods
This is a retrospective study. The patients who received posterior lumbar interbody fusion (PLIF) between Jan. 2007 and Dec 2017 and had a spondylitis around the cage were reviewed. There were 1,831 PLIFs during the study period. There were 32 cases of surgical site infection and 20 of them were spondylitis around the cage. Ten out of the 20 cases had a revision surgery. All implants removal, drainage and curettage were done and interbody bone graft and pedicle screw re-fixation was done simultaneously. Five cases used autoiliac strut bone (Group I) and the other 5 cases used titanium cage and autoiliac chip bone (Group II) as interbody graft materials. The demographic, diagnostic and microbiological characteristics were investigated and the results of treatment were compared between the two groups.
Results
The diagnosis of infection was made at 282.0±106.1 (180~410) days in group I and 209±118.4 (75~335) days in group II after the PLIF. All cases had neither general fever nor local manifestations like heating and redness etc. All patients had back pain, however, only 2 cases of group II had neurological symptoms. C-reactive protein (CRP) level was elevated at 2 weeks from the PLIF in all cases (p<0.001). All cases had implant loosening at the time of their diagnosis. There was no failure of infection control. All cases showed normalization of CRP and radiological interbody fusion. The final Oswestry disability index (ODI) showed no difference between the two groups. ODI improved from 54.6±11.5 to 42.2±6.8 in group I (p=0.095) and from 63.6±6.9 to 44.8±11.7 in group II (p=0.025).
Conclusion
For the surgical treatment of spondylitis that were developed in PLIF, a comprehensive one stage operation that comprised all implants removal, drainage and curettage followed by simultaneous intebody bone graft with metal cages and pedicle screw re-fixation was useful to control the infection.

Objectives
to report a surgical site infection from Aspergillus after a lumbar discectomy. Aspergillus is ubiquitous fungus. People with normal immunity are usually not infected by it, however, surgical site infection from it often developed even in normal population.
Materials and Methods
The diagnostic and therapeutic experience of 55-year-old male patient who underwent L45 discectomy who had surgical site infection from Aspergillus was reviewed.
Results
He had 4 times surgical treatment and empirical antibiotic therapy due to progressive extension of infection without microbiologic confirmation. Aspergillus flavus was identified at 5th operation and he was cured by adding an anti-fungal agent.
Conclusions
An Aspergillus infection after an operation can be developed even in normal immunity population. If a surgical site infection patient without fever and draining sinus does not improve by conventional treatment, Aspergillus infection should be considered.

Spinal cord injury is a devastating condition that leaves permeant disability. Surgical decompression and stabilization with various pharmacological treatments have been tried to prevent secondary injury, however, their results have been disappointing. Therefore, novel therapeutic options are required enthusiastically. Cell transplantation that has the potential of neuroregenerative and neuroprotective ability is regarded as a promising remedy. We would like to describe about the micro-anatomy and the mechanism of injury of spinal cord injury. We also delineate transplanted cells; embryonic stem cell, induced pluripotent stem cell, mesenchymal stem cell as stem cells and Schwan cell, olfactory ensheathing cell as supporting cells with brief reviews of their experimental results.

Objectives
To verify the hypothesis that nerve compression by postoperative spinal epidural hematoma (POSEH) can be reduced by instillation of heparin through suction drains.
Materials and Methods
The patients who underwent posterior decompression and instrumentation between Jan. 2016 and Jun 2016 were allocated to study (using heparin) group and control group according to the operation date alternately. There were 61 cases in study group and 60 cases in control group. Two lines of suction drain were used in all cases. Thousand unit of heparin and 5ml of normal saline were instilled through the drain lines into the epidural space just before the wound closure. To prove the homogeneity between the two groups, demographic, patient related, operation related and clotting related data were compared. At day 7 after the operation, their MRIs were examined. The area of thecal sac was measured at the T2 weighted axial image that showed the maximal compression of the thecal sac by epidural hematoma. Two orthopedic doctors who were blinded to this study measured independently and the average values of the two were counted as final measured values.
Results
The two groups were homogenous in age, sex, number of fusion segments, whether virgin or revision operation, total blood loss, operation time, blood loss/10 min, whether taking anti-platelet drugs or not, platelet count, PT, aPTT and platelet function analysis. The smallest area of thecal sac in axial MRI was 124.4±49.9 mm² in study group and 121.7±47.4 mm² in control group. There was no significant difference (p=0.761)
Conclusions
In a posterior spine surgery, thecal sac compression by POSEH was not reduced by instillation of heparin into the epidural space.

Purpose
Higher viscous cement can be injected through larger-diametered tubes with lower pressure. The lower the cement modulus is, the less the stress-transfer would be. The lower-pressure percutaneous vertebroplasty with blood-mixed cement(LP-PVP^blood ) was devised to overcome technical problems in conventional percutaneous vertebroplasty(C-PVP). We would like to prove the validity of technical modifications to increase viscosity of cement being injected and reduce final modulus of cement.
Methods
Nineteen C-PVPs, 51 kyphoplasty (KPs), 23 LP-PVPs and 70 LP-PVP^blood s were analyzed in radiologic point of view. The successful cases with sufficient cement volume(≥ 5ml) were also analyzed as a subgroup.
Results
Asymptomatic cement leakage(CL) showed a similar tendency in LP-PV^blood (17.1%) compared to other groups(21.1~27.5%, p=0.514), even though the injected cement volume in LP-PVP^blood (6.9ml) was much more than that of C-PVP(3.5ml, p=0.000). Vertebral height restoration(VHR) was significantly higher(11.7%) than C-PVP(4.7%, p=0.024). Vertebral body subsidence(VS) was less in KP(1.1%) than others(2.1~5.9%, p=0.000). But, adjacent vertebral compression fractures(VCFs) happened more frequently in KP(15.7%) than others (0~5.3%, p=0.001). In subgroup analysis, the rates of successful cases were significantly higher in LP-PVP^blood (85.7%) than in C-PVP(5.3%, p=0.000). CLs and VHRs showed no significant differences. VS was significantly less in KP(1.0%, p=0.000) but adjacent VCF developed more frequently in KP(21.1%) than LP-PVP^blood (0%, p=0.001).
Conclusions
The LP-PVP^blood which stands for larger diameter tubes for injecting sufficient volume of higher viscous cement and more interdigitation by omitting balloon and lower modulus blood-mixed cement was appraised to reduce risk of cement leakage than C-PVP and decrease stress transfer to adjacent vertebrae than KP.