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2008, Vol.15, No.1

  • 1.

    Posterior Hemivertebra Excision in Congenital Scoliosis

    안종국 | Jinhyok Kim | Sung-Soo Kim and 3other persons | 2008, 15(1) | pp.1~8 | number of Cited : 0
    Abstract
    Study Design: Retrospective study Objectives: To evaluate the surgical outcome of congenital scoliosis with a hemivertebra treated by posterior hemivertebra excision and pedicle screw instrumentation. Summary of Literature Review: Posterior hemivertebra excision can be accomplished through a single posterior approach, and excellent correction and outcome may be achieved. Materials and Methods: Forty patients with one fully segmented hemivertebra treated by posterior hemivertebra excision with pedicle screw instrumentation were retrospectively analyzed after a minimum follow-up of 2 years (range 2~7.7 years). The mean age at surgery was 15.9 years (range 2.6~37.9 years). Preoperative and postoperative standing radiographs were used to assess radiographic parameters. Results: The average number of vertebrae in the major curve was 4.2 (range 3~8), and the average flexibility was 29% (range 8~59%). The average length of fusion was 3.5 segments (range 1~6). The number of fused vertebrae had a positive correlation with age at the index surgery (r=0.345, p􀍻0.05). Mean preoperative scoliosis of 48±12。was corrected to a mean of 17±10。 (65% correction), and mean preoperative kyphosis of 46±18。was corrected to a mean of 12±12。at the most recent follow-up. The compensatory curve had a mean of 25±10。preoperatively and spontaneously corrected to a mean of 8±8。(70% correction) at the most recent follow-up. The mean operating time was 233±81 min, with an average blood loss of 2904 ml. There was neither crankshaft phenomenon nor iatrogenic spinal stenosis in 6 patients under the age of 5 years after an average follow- up of 6 years. Conclusions: Posterior hemivertebra excision using pedicle screw instrumentation in congenital scoliosis due to a hemivertebra is a safe and effective procedure. Posterior hemivertebra excision at an early age may reduce the fusion length while avoiding the induction of iatrogenic spinal stenosis during follow-up.
  • 2.

    Polyaxial Screws with Thick Rod versus Monoaxial Screws with Thin Rod in Video-Assisted Thoracoscopic Scoliosis Surgery(AVTS)

    Hak Sun Kim | 김주영 | 박진오 and 7other persons | 2008, 15(1) | pp.9~17 | number of Cited : 0
    Abstract
    Study Design:Prospective controlled cohort studyObjective:To analyze the clinical outcome of video-assisted thoracoscopic surgery (VATS) between two different types ofimplants.Summary of Literature Review:The problem of correction loss has been reported with VATS, and different screws and rodshave been developed to overcome this problem. Different implants will have varying effects in correctional outcome afterVATS. Materials and Methods:A total of 39 cases of idiopathic adolescent scoliosis treated with VATS between June 2001 and Janu-ary 2005 were included in the study (mono-axial screws and a 4.5 mm rod: thin rod group=19 cases; poly-axial reductionscrews and a 5.5 mm diameter rod: thick rod group=20 cases). All patients were followed for over 2 years postoperatively. Forthe comparison of surgical outcomes between the two groups, radiographic measurements were performed in the coronal andsagittal planes. Results:Preoperative scoliosis angle (thin rod group 49.8。, thick rod group 47.1。), age, BMI, Risser stage, union time, operativetime, and blood loss showed no statistical difference between the two groups. Postoperative average correction rate of scoliosisangle was 69% (15.8。) in the thin rod group and 70% (14.1。) in the thick rod group. However, correction rate after 2 years was51% (24.5。) in the thin rod group and 60% (18.7。) in the thick rod group, showing statistically significant difference. There wasa tendency toward correction loss in the thin rod group (8.7。vs. 4.6。p=0.0057). Conclusion:Postoperative correction rate was satisfactory in both groups. However, the thin rod group showed substantial cor-rection loss. Therefore, poly-axial screws and thick rods are more suitable in VATS correction of scoliosis.
  • 3.

    The Usefulness of Bone Scan in the Osteoporotic Vertebral Compression Fracture Patients Treated With Kyphoplasty

    전득수 | 신원주 | 김광희 | 2008, 15(1) | pp.18~22 | number of Cited : 2
    Abstract
    Study Design: Retrospective study. Objectives: To compare the clinical results of kyphoplasty between osteoporotic patients with compression fractures and rib hot uptake on bone scan and patients without rib hot uptake. Summary of Literature Review: The incidence of osteoporotic rib fractures is 0.3% in postmenopausal women. Materials and Methods: Between July 2005 and July 2006, 72 kyphoplasties for osteoporotic vertebral compression fractures were performed, and all patients had a bone scan study. On bone scan study, 41 patients (57.7%) had hot uptake in their ribs. Results were assessed by visual analog scale (VAS). Results: The incidence of hot uptake was 67.8% in thoracic fractures, 40.0% in lumbar fractures, and 72.7% in thoracolumbar fractures. Hot uptake was significantly more common with thoracic and thoracolumbar fractures than with lumbar fractures (p<0.05). The incidence of hot uptake was 49.1% in one- and two-level fractures and 84.6% in over three-level fractures. This finding demonstrated significant difference between the two groups (p<0.05). The mean VAS scores for all cases were 8.2/3.4/3.2 at preoperative/immediate postoperative/after 3 months, respectively. In thoracic fractures, they were 8.2/3.9/3.1; lumbar fractures 8.0/3.2/3.1; and thoracolumbar fractures 8.3/3.7/3.0, respectively. The immediate postoperative VAS score in lumbar fractures was better than in thoracic fractures (p<0.05). The VAS scores in thoracic fractures with hot uptake were 8.3/4.1/3, and those without hot uptake were 7.8/2.8/3.0. The immediate VAS score in thoracic fractures without hot uptake was better than in those with hot uptake (p<0.05). Conclusions: Thoracic and multiple osteoporotic compression fractures are often accompanied by rib fractures. Bone scan is a useful tool to detect rib fractures and predict the prognosis of kyphoplasty.
  • 4.

    The Comparison of the Results Between AO Internal Fixator(Long lever-arm)and Screw-Rod system(Short lever-arm) Through Posterior Approach in Unstable Thoracolumbar Fractures

    김영태 | kim moon chan | 강석중 and 5other persons | 2008, 15(1) | pp.23~30 | number of Cited : 0
    Abstract
    Study design: Prospective study. Objectives: To analyze the outcome of posterior reduction and fixation with the AO internal fixator and with the screw-rod system in unstable thoracolumbar fractures and to investigate differences in effectiveness between the two methods. Summary of literature review: In unstable thoracolumbar fractures, fixation with the AO internal fixator is an effective method for posterior reduction. However, the results of correction are quite variable. Materials and methods: We analyzed 51 patients with unstable thoracolumbar fractures who underwent correction through posterior approach between 1997 and 2003. We divided the patients into two groups: Patients in Group A (25 cases) were treated with the AO internal fixator, and patients in Group B (26 cases) were treated with the screw-rod system. We added transpedicular bone grafts for 17 patients in Group A. We evaluated correction of deformity (anterior and posterior height of vertebral body, sagittal index, disc height), loss of correction, spinal canal clearance, and neurological recovery. Results: Comparing correction of deformity, we saw better results in Group A than in Group B in regards to sagittal index and anterior height of vertebral body. However, we saw a higher degree of correction loss in the anterior height of the vertebral body in Group A. We grafted autogenous bone into the fracture site by transpedicular approach for 17 patients in Group A. We saw less correction loss in the anterior vertebral body height and sagittal index. In regard to spinal canal clearance, we saw better results in Group A (18%) than in Group B (10%). As for neurological recovery, we could not find any statistically significant difference between the two groups. Conclusions: Through an operative procedure, we could achieve better results in restoration of anterior vertebral height and canal clearance with the AO internal fixator system. Further study is necessary to keep the reduced state of vertebral height.
  • 5.

    Radiographic Changes of Adjacent Upper Segment Performed Short Segmental Lumbosacral Fusion-Does Total Laminectomy Influence Adjacent Upper

    황대우 | 신재흥 | 김병민 and 3other persons | 2008, 15(1) | pp.31~37 | number of Cited : 0
    Abstract
    Study Design:Retrospective study. Objectives:The purpose of this study was to compare factors that influence degenerative changes in patients undergoing totallaminectomy and patients undergoing partial laminectomy. Summary of Literature Review:Lumbar or lumbosacral fusion with total or partial laminectomy may result in adjacent seg-ment problems of the upper segment. However, the differences between the two procedures that may influence adjacent seg-ment instability are still controversial. Materials and Methods:We evaluated 95 patients, followed up for at least 2 years, who had been treated with short level (atmost 2 levels) posterior lumbar interbody fusion with pedicle fixation, secondary to spinal stenosis. Treatment proceduresincluded total laminectomy (42 cases) and partial laminectomy (53 cases). We analyzed the preoperative status of the interverte-bral discs (Thompson grade), difference of disc height, and difference between preoperative segmental sagittal angle and lastfollow-up sagittal angle. We excluded cases that required revision secondary to infection, nonunion, or hematoma formation.However, we included cases that required revision due to adjacent segmental problems during the follow-up period. Results:The mean age of the patients treated with total laminectomy was 59.0± 10.9 years, and of the patients treated withpartial laminectomy was 58.8± 10.2 years. The preoperative Thompson grade showed no statistical difference. The difference indisc height and segmental sagittal angle between the preoperative and last follow-up examinations showed no statistical dif-ference between the two groups. Conclusions:There was no significant difference in the radiographic or clinical outcomes based on removal or preservation ofposterior structures. Nevertheless, we need further follow-up to evaluate adjacent segment degeneration.
  • 6.

    RISK Factors for Adjacent Segment Disease After Lumbar Fusion

    양준영 | 이준규 | 송호섭 and 2other persons | 2008, 15(1) | pp.38~43 | number of Cited : 2
    Abstract
    Study Design: Retrospective study Objectives: To determine the relationship between clinical outcome and adjacent segment degeneration (ASD) after lumbar fusion. Summary of Literature Review: Few studies have analyzed the correlation between clinical outcomes and ASD. Materials and Methods: Between January 2000 and December 2004, 217 patients who underwent lumbar spinal fusion (􀍼2 years of follow-up) were evaluated. The patients were divided into 2 groups: one-segment (A) and two-segment (B). The UCLA grading scale was used to evaluate the prevalence of ASD on radiography. The association between clinical outcome and ASD was evaluated by Spearman’s correlation. Results: ASD occurred in 11.6% (13/112) of patients in group A and 15.2% (16/105) of patients in group B. The number of cases which progressed to more than 2 levels of the degenerative grade were 0 cases in group A and 13 cases (81.3%) in group B. In A, 5 out of 13 ASD cases downgraded one level in their clinical outcomes. In B, all 16 ASD cases downgraded more than one level in their clinical outcomes. Worsening in degenerative grade, was correlated with worse clinical outcome (Spearman’s rho = 0.829, P 􀍻0.05). Conclusions: The association of clinical outcomes with ASD after fusion showed a significant correlation, especially association with ASD after multiple segment fusion.
  • 7.

    Autogenous Bone Graft and Bone Substitutes

    황창주 | 이성우 | 안영준 and 3other persons | 2008, 15(1) | pp.44~53 | number of Cited : 2
    Abstract
    Study Design: Retrospective study of adjacent segment disease. Objectives: To describe the incidence and clinical features of adjacent segment disease (ASD) after lumbar fusion and to determine its risk factors. Summary of Literature Review: The reported incidence of adjacent segment problems is variable, and little has been discussed about surgically treated cases. Risk factors also have not been precisely identified, especially based on structural changes seen on magnetic resonance imaging (MRI). Materials and Methods: We analyzed the records of 1,124 patients who underwent lumbar or lumbosacral instrumented fusions between August 1995 and March 2006 and had at least one year follow-up. Of these patients, 28 patients who needed secondary operations because of ASD were included in this study. The disease group was compared with an age-, sex-, fusion level-, and follow-up period-matched control group composed of the same number of patients, toward the purpose of analyzing six variables as risk factors. Results: The incidence of ASD requiring surgical treatment was 2.48%. The mean patient age was 58.4 years, which showed no statistically significant difference from that of the population in which ASD did not develop (57.0 years, p=0.429). Only 1 distal ASD occurred among 21 floating fusions. Facet degeneration was a significant risk factor (p􀍻0.01) on logistic regression analysis. Conclusion: Our study patients with ASD complained of severe symptoms with frequent neurological abnormalities. The incidence of distal ASD was much lower than that of proximal ASD. Pre-existing facet degeneration may confer a high risk of adjacent segment problems after lumbar fusion procedures.
  • 8.

    Autogenous Bone Graft and Bone Substitutes

    김동준 | 2008, 15(1) | pp.54~65 | number of Cited : 2
    Abstract
    Study Design:Reviews were conducted. Objectives:This article is a review of the properties of the various bone grafting materials currently available and includes dis-cussion of their efficacy in clinical practice. Summary ofBackground Data:Bone grafting is frequently performed in spinal surgery to achieve fusion. Autograft is the goldstandard bone graft material. However, due to limitations of supply and morbidity associated with the harvest of autograft,alternatives are being considered. Methods:The available literature was reviewed. Results:Synthetic bone graft substitutes consist of hydroxyapatite, tricalcium phosphate, calcium sulfate, or a combination ofthese minerals. All synthetic porous substitutes share numerous advantages over autografts and allografts including theirunlimited supply, easy sterilization, and easy storage. However, they do confer some disadvantages such as brittle handlingproperties, variable rates of resorption, and poor performance in some clinical conditions. Recent attention has been focused onosteoinductive materials such as demineralized bone matrix, recombinant bone morphogenetic proteins, and blood product con-centrates. The primary categories of substitute include bone growth factors. Clinical trials are under way, and pre-clinical stud-ies have reported promising results for generating bone. Conclusions:Despite tremendous efforts toward developing autograft alternatives, a single ideal bone graft substitute has notbeen developed. The number of clinical studies and direct-comparison studies between these products is limited. The surgeonshould understand the properties of each bone graft substitute, to facilitate appropriate selection in each specific clinical situa-tion.