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2009, Vol.16, No.2

  • 1.

    Efficiency of Anterior Interbody Fusion using Cage and Plate in the Distractive Flexion Injury of Cervical Spine - Cage vs Tricortical Autoiliac Bone -

    박희전 | 김완기 | 유호영 | 2009, 16(2) | pp.71~78 | number of Cited : 2
    Abstract
    Study Design: This is a retrospective study Objectives: We wanted to evaluate the effectiveness and safety of anterior interbody fusion (AIF) using cage and plate fixation for treating distractive flexion injury of the cervical spine according to the radiological and clinical outcomes. Summary of the Literature Review: AIF of the cervical spine using autoiliac bone and plate fixation is known as an effective method for treating not only degenerative disease, but also trauma as well. However, the problem lies in the complications that occur at the donor site. To avoid these complications, the fusion method using a cage is becoming more frequently used, but there are not many reports on using a cage and plate for treating trauma in the cervical spine. Materials and Methods: We retrospectively analyzed 47 patients with distractive flexion injury of the cervical spine and who underwent anterior decompression and interbody fusion with a autoiliac bone graft and plate fixation (Group I, 32 patients) or who underwent anterior decompression and interbody fusion with cage and plate fixation (Group II, 15 patients). We statistically analyzed the changes of the segmental lordosis, the fused segmental body height, the fusion rate on plain radiography and the neurologic recovery with using an ASIA scoring system. Results: All the cases were fused by 12.6±2.5weeks after operation. The changes of segmental lordosis shows no statistical difference between the two groups (p=0.69). The anterior and posterior vertebral heights of the fused segments of Group I were more decreased than those of Group Ⅱ, and there was a statistical difference between the two groups (p=0.03, 0.04). The initial and last follow up neurologic statuses were not statistically difference between the two groups (p=0.11) Conclusions: For the treatment of fracture-dislocation injury in the cervical spine, AIF using a PEEK cage filled with autoiliac bone and plate fixation is an effective method with the least possibility of complications at the donor site, and at the same time, this surgical method shows equally satisfactory results, both radiologically and clinically, as fusion with using a tricortical autoiliac bone graft.
  • 2.

    The Efficacy of Kyphoplasty on Osteoporotic Vertebral Compression Fracture - A 1-Year Follow-up Study -

    안동기 | 이송 | 박훈석 and 3other persons | 2009, 16(2) | pp.79~88 | number of Cited : 5
    Abstract
    Study Design: This is a retrospective study. Objective: We wanted to evaluate the efficacy of kyphoplasty for treating osteoporotic VCF and we wanted to determine the risk factors for additional VCF. Summary of the Literature Review: Successful pain relief with performing kyphoplasty for VCF has been well documented. However, unsatisfactory reduction and additional VCF are remained problems for kyphoplasty. Materials and Methods: Sixty-three patients who underwent kyphoplasty were followed up for more than 1 year. The degree of reduction of the collapsed vertebral height, the vertebral kyphotic angle, the regional Cobb’s angle and the overall sagittal alignment, the visual analogue scale (VAS), the fracture configuration, the bone mineral density (BMD), the presence of intradiscal cement leakage and additional VCF were investigated. The risk factors for additional VCF were analyzed. Results: In terms of deformity correction, the collapsed vertebral height were restored (67.3±15.6% to 82.5±11.8%), the vertebral kyphotic angle was improved (12.1±6.9˚to 8.1±5.3˚), the degree of the regional Cobb’s angle was reduced (3.1±4.5˚) and the overall sagittal balance was improved (1.7±5.3 cm to 0.5±3.9 cm) with clinical satisfaction (VAS: 6.9±1.3 points to 2.3±0.9 points). But less than 40% of the patients reached the expected reduction criteria (the vertebral height >90%, the vertebral kyphotic angle and regional Cobb’s angle reduction >5˚). Additional VCF occurred in 10 patients (15.9%). The average BMD in the additional VCF group was T-score of -3.8 and that for the no-additional VCF group was T-score of -3.0 (p=0.025). The degree of reduction under general anesthesia was twice more than that under local anesthesia. Eleven cases (17.5%) of intradiscal cement leakages were noticed, but this showed no relevance to the fracture configurations and additional VCF. The overall sagittal alignment and cement volume showed no relevance to additional VCF. Conclusion: Kyphoplasty was excellent for pain reduction, but it was unsatisfactory for correcting deformity. Vertebral height correction was more effectively performed under general anesthesia. Additional VCF was caused by severe osteoporosis.
  • 3.

    Recompression of Vertebral Bodies after Balloon Kyphoplasty for Vertebral Compression Fractures - Preliminary Report -

    김영율 | Kee-Won Rhyu | 박창구 | 2009, 16(2) | pp.89~94 | number of Cited : 2
    Abstract
    Study Design: This is a retrospective and preliminary study. Objectives: We wanted to evaluate the characteristics of recompression of vertebral bodies without trauma after balloon kyphoplasty (KP) for treating osteoporotic vertebral compression fractures (VCF). Summary of the Literature Review: KP has been used for fracture reduction, maintenance of vertebral height and relief of pain in VCF. Despite of numerous satisfactory results, several factors have been noted to affect the clinical results of KP. Materials and Methods: Six patients with recompression of vertebral bodies without trauma after KP were reviewed. All the patients were female and their mean age was 75.9±4.1 years old. The follow-up period was 17.2±8.5 months. The compression rates of the operated vertebral bodies (CR) and the kyphotic angles (KA) were checked by using plain roentgenograms at the initial, postoperative and last follow-up periods. The preoperative MRIs were also reviewed. The clinical results were checked using the VAS. Results: The CRs at the initial, postoperative and last follow-up periods were 33.7±14.8%, 13.4±7.6% and, 26.9± 9.9%, respectively. The KAs were 19.2±7.2˚, 14.8±6.2˚and 20.5±7.4˚for each period, respectively. Statistically, the CR and KA at the initial-postoperative period and at the postoperative-last follow-up period showed significant differences (p<0.05). Intervertebral clefts were found in all the cases on MRI. Normal bones superior or inferior to cement were also seen in all the cases after KP. The VAS scores were 8.5±0.5, 2.3±0.5 and 3.0±0.6, retrospectively, and there were significant differences between each periods (p<0.05). Conclusions: Recompression of a vertebral body without trauma after KP for treating VCF was observed in the cases with a intervertebral cleft seen on MRI and normal bones superior or inferior to the cement were observed after KP. The causes of recompression may be subsequent compression or resorption of the remaining vertebral body.
  • 4.

    Change of Pelvic Tilt before and after Gait in Patients with Lumbar Degenerative Kyphosis

    김환정 | Ha-Yong Kim | 성환일 and 6other persons | 2009, 16(2) | pp.95~103 | number of Cited : 4
    Abstract
    Study Design: This is a retrospective study. Objectives: We wanted to verify the value of radiography and gait analysis to analyze the changes of the pelvic tilt before and after gait in the patients with LDK. Summary of Literature Review: Patients with lumbar degenerative kyphosis show dynamic changes that are closely associated with the motion of pelvis. Materials and Methods: We analyzed 18 lumbar degenerative kyphosis patients who didn’t have multiple vertebral compressio fractures, a past history of spinal surgery or surgery for degenerative arthritis of the knee or hip, and obesity which causes marker errors on the gait analysis. Pelvic tilt was statistically evaluated by utilizing radiographs and dynamically utilizing the gait analysis. The linear parameters of the gait cycle and the kinematic data were obtained from the gait analysis. Results: The LDK patients’ mean walking velocity was 80.7 cm/s, and it was largely decreased to 65% of the normal value. The cause of the decreased walking velocity was a decrease of stride length, and not a decrease of cadence. The mean static pelvic tilt in the gait analysis was -1.3±8.0˚, and there were 8 cases of anterior tilt and 10 cases of posterior tilt. The mean pelvic tilt during gait was 12.5±8.2˚, and there were 17 cases of anterior tilt and 1 case of posterior tilt. It was statistically significant difference (p<0.05) between the mean static pelvic tilt in gait analysis and the mean pelvic tilt during gait and the Pearson’s correlation coefficient was -0.88. Conclusions: Though there was no statistical significance, we observed anterior pelvic rotation after gait on the radiographs. As fatigue of the pelvic extensor muscles increases during gait, anterior pelvis tilt increases with statistical significance on the gait analysis. Therefore, we feel gait analysis is useful for evaluating the dynamic change of the pelvic tilt in patients with LDK.
  • 5.

    Radiological and Clinical Comparison of 1 Cage versus 2 Cages for Posterior Lumbar Interbody Fusion with PEEK Cage and Local Bone Graft

    전득수 | 신원주 | 이경찬 | 2009, 16(2) | pp.104~111 | number of Cited : 0
    Abstract
    Study Design: This is a retrospective study. Objectives: We wanted to compare and evaluate the results of using one cage and two cages with local bone grafting for each segment when performing posterior lumbar interbody fusion (PLIF). Summary of Literature Review: Some authors have reported that unilateral one-caged PLIF with local bone grafting and posterior instrumentation was no difference from bilateral two-caged PLIF regard to the fusion rates and the radiologic or clinical results. Materials and Methods: From March 2005 to February 2006, PLIF was performed on 36 patients who had lumbar degenerative disease. They were categorized as the cases for which one cage was used for a segment and the cases for which 2 cages were used for a segment. The clinical and radiological results in each group were compared. Results: There was complete union in 11 segments with using one cage (55%), complete union in 12 segments using two cages (77%) and incomplete unions in 9 segments with using one cage (45%) and incomplete union in 4 segments with using 2 cages (25%), and there wasn't any case of nonunion (p>0.05). The postoperative changes of the intervertebral disc space were a 2.0 mm increase with using one cage and a 2.2 mm increase with using two cages, yet these values decreased by 0.4 mm and 0.3 mm, respectively, on the last follow-up. The mean operation time was 89 minutes for one segment with one cage and 105 minutes for one segment with two cages. The blood loss was a mean of 602 ml with one cage and 802 ml with two cages (p>0.05). There was no significant difference between the one cage group and the two cages group for the Kirkadly-Willis criteria. Conclusion: Posterior decompression and PLIF with one PEEK cage for treating degenerative lumbar disease was more effective for the operation time and the amount of blood loss than that with two cages, but the fusion rate, the alteration of the intervertebral disc space, the improvement of pain and the clinical results were no different. However, these results are from short term follow up, so continuous follow up will be necessary in the future for assessing the long term prognosis.
  • 6.

    Differential Diagnosis between Tuberculous Spondylitis and Pyogenic Spondylitis

    구기형 | 이혁진 | Yeom, Jin Sup and 3other persons | 2009, 16(2) | pp.112~121 | number of Cited : 5
    Abstract
    Study Design: This is a retrospective study Objectives: We wanted to make the early differential diagnosis between tuberculous spondylitis and pyogenic spondylitis according to the clinical and MRI findings. Summary of the Literature Review: Making an early differential diagnosis between tuberculous spondylitis and pyogenic spondylitis is essential to start prompt and proper treatment. However, the clinical symptoms and MRI findings of both these illnesses can vary considerably. Material and Method: Ninety-five patients (49 men and 46 women, mean age: 54.5) who were treated from January 2001 to February 2007 and whose diagnosis was confirmed by laboratory or pathological studies were retrospectively reviewed. 50 patients with tuberculous spondylitis and 45 patients with primary pyogenic spondylitis were included. The patients with combined infection or an uncertain diagnosis were excluded. We compared the medical records and MRI findings between the different groups of patients. Results: The patients with tuberculous spondylitis were younger (48.2 years vs. 61.5 years, respectively) and they had a longer symptom duration (4.3 months vs 1.8 months, respectively). The erythrocyte sedimentation rate (ESR) and the C-reactive protein (CRP) level were significantly higher in the patients with pyogenic spondylitis (71.3/49.6 mm/hr and5.74/2.98 mg/dl, respectively). A high fever above 38 degree was more frequent in the patients with pyogenic spondylitis. Intraosseous abscess, epidural abscess, a well-definded paraspinal abscess, focal enhancement and severe destruction of the vertebral body on MRI were more frequent in the patients with tuberculous spondylitis. Four parameters such as a symptom duration longer than 3 months, no fever higher than 38 degree, a well-defined paravertebral abscess and an intraosseous abscess were selected. 42 patients in the tuberculous group had 3 or more of these four parameters. The sensitivity and specificity of these combined 4 parameters were 84% and 97.8%, respectively, for making the differential diagnosis between these 2 maladies. Conclusion: These diagnostic criteria might be useful to discriminate between tuberculous spondylitis and pyogenic spondylitis even without definite laboratory or pathological results.
  • 7.

    Multiple Extradural Arachnoid Cyst - A Case Report -

    Hak Jin Min | 김진수 | 윤의성 and 3other persons | 2009, 16(2) | pp.122~126 | number of Cited : 0
    Abstract
    Multiple extradural arachnoid cysts of the spine are extremely uncommon in children with only a few cases reported. The authors report a case of multiple extradural spinal arachnoid cysts in children with a review of the relevant literature.
  • 8.

    Spine Fracture in Tuberculous Kyphosis - A Case Report -

    김진환 | 김성수 | Jun Young Choi and 1other persons | 2009, 16(2) | pp.127~133 | number of Cited : 0
    Abstract
    The spinal kyphosis caused by bony ankylosis is ankylosing spondylitis and tuberculous spondylitis. There are some reports on spinal fractures through the fused vertebral body in ankylosing spondylitis, but there is no report of spinal fractures occurring in a fused vertebral body after tuberculous spondylitis. The authors report a case of spinal fracture at the apex of acute angular kyphosis after tuberculous spondylitis, which resulted in a spontaneous correction of kyphosis without neurological deficits. The fracture was stabilized by posterior interbody fusion using a mesh cage after a posterior vertebral column resection and posterolateral fusion.
  • 9.

    Cauda Equina Syndrome due to Epidural Hematoma After Lumbar Epidural Block - A Case Report-

    안병우 | 김종관 | 윤종호 and 3other persons | 2009, 16(2) | pp.134~137 | number of Cited : 2
    Abstract
    Cauda equina syndrome after epidural block is a rare complication, but it requires emergency surgery when it is diagnosed. A 65-year-old man who underwent epidural block at a local clinic was admitted with right lower leg weakness and decreased leg sensation, severe lower radiating pain, dysuria and decreasing sensation in the perianal region. Magnetic resonance image showed protruded disc material between L4-L5 and a hematoma that occupied most of the spinal canal and this was compressing the spinal cord. These findings were diagnostic for cauda equina syndrome after epidural block and so laminectomy, excision of the herniated disc and removal of the hematoma were done. At 6 months follow-up, the neurologic symptoms were resolved except for the dorsiflextion of the ankle and the big toe. We report here on a case of cauda equina syndrome as a rare complication after epidural anesthesia.
  • 10.

    Intradural Extramedullary Metastasis to Lumbar Spinal Nerve of Cholangiocarcinoma - A Case Report -

    하중원 | 박융 | 김성국 and 2other persons | 2009, 16(2) | pp.138~141 | number of Cited : 0
    Abstract
    An intradural extramedullary metastasis to the spinal nerve root across dura mater is extremely rare. The authors encountered a case 39-year-old man who suffered radiculopathy arising from a soft mass around nerve root mimicking a nerve sheath tumor compressing the 4th lumbar nerve root in the right intervertebral foramen between the 4th and 5th lumbar spine. After an excisional biopsy, the metastatic infiltration of adenocarcinoma was confirmed pathologically. The primary lesion was found to be an intrahepatic cholangiocarcinoma with multiple metastases. This report suggests that an intradural metastatic tumor can show similar clinical and radiographic findings to other disease,s such as a nerve sheath tumor. The results also suggest that proper diagnosis and further treatment are possible only by pathological confirmation after and excisional biopsy.
  • 11.

    Sagittal Imbalance

    김기택 | 이정희 | 2009, 16(2) | pp.142~151 | number of Cited : 5
    Abstract
    Sagittal spinal balance is an essential factor for not only the external appearance, but also for the spine’s function. Fixed sagittal imbalance is the result of different causes, and this generally requires surgical treatment. Sagittal imbalance is mainly caused by decreased lumbar lordosis and increased thoracic kyphosis, and it can also be influenced by the pelvic incidence and flexion contracture of the hip and knee joints. So, a careful understanding and clinically considering the many factors and compensatory mechanisms that are associated with sagittal imbalance are needed. Proper surgical treatments provide a satisfactory outcome for these patients and good radiographic results. Correction of sagittal imbalance generally requires spinal osteotomy and long segment fusion. For the surgical treatment, we should consider the perioperative and postoperative complications of osteotomy and long segment fusion and then make proper decisions for the range of fusion of the proximal and distal sides and the selection of the correct method of osteotomy, the ideal correction angle and the best method of internal fixation. Problems such as loss of correction may occur postoperatively due to kyphotic change and pseudarthrosis of the proximal and distal sides. Therefore, we need to conduct a thorough analysis and make a detailed plan for the surgical approach. We should also study and understand the radiological factors when treating sagittal spinal balance because not only the spine, but also the pelvis, hip and knee joints are involved in forming the sagittal balance.