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2008, Vol.15, No.2

  • 1.

    Clinical Importance of Mri in Thoracolumbar spinal fracture

    노정호 | 정남수 | 박정욱 and 2other persons | 2008, 15(2) | pp.67~72 | number of Cited : 1
    Study Design:Retrospective radiologic assessmentObjectives:To assess the clinical importance of MRI for the diagnosis of posterior spinal ligament complex injuries in thora-columbar fractures.Summary ofLiterature Review:Evaluation of spinal instability is important in thoracolumbar fractures. When simple radiogra-phy and CT alone are performed, spinal instability may be missed, especially that involving the posterior spinal ligament com-plex.Materials and Methods:Eighty-seven patients who were evaluated using simple radiography, computed tomography (CT), andmagnetic resonance imaging (MRI) between March 1994 and March 2003 were included in the study. The local kyphotic anglewas measured on lateral radiography, and it was then compared to the fracture pattern on MRI. Statistical analysis was per-formed using ANOVA.Results:There was no correlation between the local kyphotic angle on radiography and fracture involvement on MRI (p=0.106).In 41 patients who were found to have involvement of the anterior column on CT, 25 had anterior column involvement, 4 hadmiddle column involvement, and 12 had posterior column involvement on MRI. In 36 patients who were found to haveinvolvement of the middle column on CT, 17 had involvement of the middle column and 19 had involvement of the posteriorcolumn on MRI. The fractures of the ten patients who were found to have posterior column involvement on CT were all seenon MRI. The coincidence of fracture patterns between CT and MRI, which was evaluated using Cohen's Kappa analysis, was0.434. The sensitivity of CT compared with MRI was 0.741 in the middle column and 0.243 in the posterior column.Conclusions:Many thoracolumbar fractures are missed on both simple radiography and CT. MRI is essential for accurate diag-nosis of posterior spinal ligament complex injuries, especially when there is involvement above the middle column, or whencanal encroachment is seen on CT.
  • 2.

    Posterior lumbar interbody fusion with cage and local bone graft in spondylolisthesis -Unilateral caged versus bilateral caged-

    안동기 | 이송 | 최대정 and 2other persons | 2008, 15(2) | pp.73~80 | number of Cited : 0
    Study Design:Retrospective, controlled studyObjective:To compare one and two-caged posterior lumbar interbody fusion (PLIF) with local bone grafting for spondylolisthe-sis.Summary of Literature Review:Even though there are many reports on PLIF using cages and local bone grafting, Studiescomparing one and two-caged PLIFs are rare.Materials and Methods:Sixty-three patients who underwent pedicle screw fixated PLIF using cages and local bone grafts werefollowed for more than 1 year. Twenty-five patients had one cage (group I), and 38 patients had two cages (group II). Samplingerror, disc height, sagittal Cobb angle, coronal Cobb angle, fusion rate, Oswestry disability index (ODI), operation time, blood loss,and neurologic complications were assessed.Results:There was no sampling error between the two groups, except with regard to diagnosis: degenerative spondylolisthesis,15 cases in group I and 9 cases in group II; spondylolytic spondylolisthesis, 10 cases in group I and 29 cases in group II(p=0.004). Fusion rates were 87.5% and 88.2% for groups I and II, respectively (p=1.000). More disc height loss occurred in groupI (0.6 mm) than in group II (0.0 mm) (p=0.041). Over-3mm-disc height-losses were noted more frequently in group I (20%) thanin group II (2.6%) (p=0.022). ODI improved from 28.1 to 12.3 (72.1% improvement) in group I and from 29.2 to 12.7 (79.3%improvement) in group II. There were no significant differences in operation time, amount of blood loss, or neurologic complica-tions between the two groups.Conclusion:Unilateral one-caged PLIF with local bone grafting and posterior instrumentation was no different from bilateraltwo-caged PLIF with regard to fusion rates or radiologic or clinical results. The statistically significant differences in discheight seemed to be clinically insignificant. Disc height loss of greater than 3 mm was much more common in group I, with one-caged PLIF.
  • 3.

    MRI Assessments of Adjacent Disc degeneration following lumbar fusion

    정남수 | 전창훈 | 정구영 and 1other persons | 2008, 15(2) | pp.81~86 | number of Cited : 0
    Study Design:Retrospective case-control studyObjective:To use MRI to assess intervertebral disc degeneration at adjacent levels after spinal fusion and after discectomy.Summary ofLiterature Review:Degeneration of adjacent intervertebral discs following lumbar spinal fusion is one of the prin-cipal reasons for considering motion preservation techniques, such as placement of an artificial disc. Much attention has recentlybeen directed toward disc morphometric studies using MRI.Materials and Methods:Fifty-six patients who underwent spinal surgery for lumbar degenerative disease and who underwenta minimum of 2 years of follow-up MRIs were included in this study. Thirty-four patients were included in the lumbar fusionstudy group, and 22 patients were included in the discectomy control group. The MRI Thompson classification was used tograde both upper and lower adjacent disc degeneration preoperatively and at the time of last follow-up. Results:There were significant changes in Thompson degenerative grade in the upper adjacent levels for both the fusion grouppatients and in the discectomy group patients. However, there was no statistically significant difference between the two groupswith regard to either the upper or lower adjacent levels (p=0.146 and 0.350, respectively). Conclusions:In this short-term study comparing MRI outcomes in spinal fusion and discectomy patients, no significant differ-ence in adjacent disc degeneration was observed between the two group.
  • 4.

    Unilateral Transforaminal Lumbar Interbody Fusion in Spondylolisthesis -Comparison with conventional posterior lumbar interbody fusion through bilateral approach-

    김상범 | 전택수 | 류승렬 and 2other persons | 2008, 15(2) | pp.87~95 | number of Cited : 0
    Study Design:Retrospective controlled study.Objectives:The aim of this study was to determine if unilateral TLIF is comparable to conventional PLIF with regard to radio-logic and clinical outcomes, and to examine the viability of local bone for bone grafting in lumbar interbody fusion. Summary ofLiterature Review:TLIF, a modified form of PLIF, is a new spinal fusion technique that avoids the typical compli-cations of PLIF.Materials and Methods:We analyzed 32 cases of single-level TLIF or PLIF in patients with degenerative or isthmic spondy-lolisthesis, who were followed for more than 1 year. The patients in group 1 underwent TLIF, and the patients in group 2underwent PLIF. The fusion rate, changes in disc height, and degree of anterolisthesis in the fused segment were analyzedradiologically. The clinical results were evaluated using the Oswestry Disability Index and visual analog scale. We also ana-lyzed operative time, blood loss, and complications in both groups. Results:Radiologically and clinically, there were no significant differences between the two groups in terms of fusion rate,changes in disc height, or degree of anterolisthesis in the fused segment. The mean operative time was 200 minutes in group 1and 240 minutes in group 2. The mean blood loss was 854 ml in group 1 and 1102 ml in group 2(p0.05). Conclusions:TLIF is a potentially useful alternative to conventional PLIF in patients with degenerative or isthmic spondylolis-thesis. Additionally, local bone may be a viable source of bone grafts for single-level TLIF and PLIF.
  • 5.

    A Novel Concept for the Best Coronal Alignment of Pedicle Screws in Multilevel Lumbar Posterior Instrumentation- A Technical Note -

    강석중 | 황창주 | 이성우 and 4other persons | 2008, 15(2) | pp.96~101 | number of Cited : 0
    Correct alignment of pedicle screws is imperative in multilevel instrumentation. However, there has been no report addressingthe technical aspects of this subject. If the head diameter of a pedicle screw is D, the head height is H, and the convergenceangle of the screw being inserted is α, then the distance between the extension line of the medial borders of the inserted screwheads and the insertion point of the adjacent screw (A) is described by the following formula:A = ½ Dcos α- Hsin αIf an L3 pedicle screw (D=13 mm, H=15 mm) is to be inserted with a convergence angle of 14 degrees after the insertion of L4and L5 screws, its insertion point should be 3.6 mm medial to the extension line of the centers of the L4 and L5 screws and 2.7mm lateral to the extension line of their medial borders for all screw heads, so it can be aligned in the coronal plane. In order toachieve the best alignment, a pedicle screw is inserted between the extended line of the centers and that of the medial bordersof the inserted adjacent screw heads. For the routine range of convergence angles, it is essential to move the entry point medial-ly toward the extended line connecting the medial borders of the inserted adjacent screw heads.
  • 6.

    Multidrug-resistant tuberculosis spondylitis; a case report-

    기성찬 | 김기수 | 김윤홍 and 1other persons | 2008, 15(2) | pp.102~105 | number of Cited : 1
    Multidrug-resistant tuberculosis, resistant to at least isoniazid and rifampicin, continues to present a serious challenge tohuman health. However, there are no reports addressing multidrug-resistant tuberculous spondylitis in Korea. We report a caseof multidrug-resistant tuberculous spondylitis at L2-L3 in a 30-year-old woman.
  • 7.

    Fusion of Pedicular cleft using pedicle screw fixation -case report-

    김진수 | 김기택 | 석경수 and 3other persons | 2008, 15(2) | pp.106~110 | number of Cited : 0
    There is a broad range of lumbar pedicular and neural arch anomalies, with spina bifida occulta and spondylolysis being especial-ly common. It is very rare for a pedicular cleft to be associated with contralateral spondylolysis in the same vertebral segment. Weobserved L4 spondylolisthesis, clefting of the left L4 hypertrophied pedicle associated with contralateral spondylolysis, and spinalstenosis on a radiographic study of the lumbar spine. Operative treatment was performed, with posterior decompression, partialremoval of the hypertrophied pedicle, posterior lumbar interbody fusion using a cage, and posterior instrumentation. The patient’sneurologic symptoms resolved after operative treatment. Fusion of the left pedicle cleft was observed on 6-month follow-up CT.We report one case of pedicular cleft fusion using pedicle screw fixation and present a review of the relevant literature.
  • 8.

    spontaneous spinal epidural hematoma after use of anticoagulation therapy

    이영상 | 김우성 | 최준철 and 2other persons | 2008, 15(2) | pp.111~114 | number of Cited : 0
    Spontaneous epidural hematoma (SEH) is an uncommon cause of spinal cord compression. It tends to occur in patients at highrisk for hemorrhage. Various medications are associated with SEH, including antiplatelet agents, anticoagulants, and throm-bolytics. Because patients usually present with neurologic deficits, early diagnosis and proper management are required toachieve full recovery. The principal management is surgical evacuation of the SEH via laminectomy. We present a case of a 51-year-old woman on both oral aspirin and intravenous heparin who subsequently developed a SEH.
  • 9.

    current status of lumbar total disc replacement(TDR)

    이종서 | 2008, 15(2) | pp.115~131 | number of Cited : 0
    Fusion surgery remains the gold standard for surgical treatment of lumbar degenerative disc disease (DDD). However, fusionsurgery has many intrinsic problems related to altered biomechanics and balance. Total disc replacement (TDR) has receivedincreasing attention over the last several years because of its capacity for both functional and symptomatic improvement and itsavoidance of problems intrinsic to fusion surgery. Artificial disc replacement is not a new concept, the first attempts havingbeen undertaken in the early 1950s. However, during the past 15 years, considerable advances have been made, with clinicalsuccess noted in several prospective randomized studies and mid-long term retrospective studies. Proper patient selection andsurgical technique are key factors in achieving a successful outcome. TDR plays a limited role and has limited indications forreplacing fusion surgery in patients with lumbar DDD. The main goal of TDR is restoration of normal intervertebral disc func-tion. Varying degrees of motion can be restored through TDR; however, the pattern of motion and center of rotation are notphysiologic. In spite of some favorable reports, many TDR-related problems remain to be solved. Successful disc function ismeasured not only in terms of quantity of motion, but also in terms of quality of motion and shock energy absorption capacity.For successful repair to be declared, facet unloading should be achieved, and fatigue strength should be improved. New proce-dures should be characterized by a reduction in the technical problems of implantation and retrieval. We expect that the nextgeneration of TDR will overcome the limitations of first generation TDR. This therapeutic modality shows much promise forthe treatment of lumbar DDD.