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2010, Vol.17, No.1

  • 1.

    Prevalence And Risk Factor of Degenerative Disease of Adjacent Segment after Anterior Cervical Arthrodesis

    김영태 | 백동훈 | Choon Sung Lee and 3other persons | 2010, 17(1) | pp.1~6 | number of Cited : 2
    Abstract
    Study Design: A retrospective radiologic and clinical analysis of 48 patients following anterior cervical fusion. Objectives: To examine the prevalence of symptomatic adjacent segment disease after anterior cervical fusion and determine the risk factors affecting its progression. Summary of Literature Review: Symptomatic adjacent segment disease appears to occur at a rate of 2% to 3% per year. Materials and Methods: Forty-eight patients, who were followed up for more than 3 years after anterior cervical arthrodesis, were enrolled in this study. A modification of the Robinson criteria was used for the clinical evaluation and the radiographic grading of Hilibrand was used for the radiology evaluation. Kaplan-Meier survival analysis was used to examine the survival rate. Age, gender, number of fusion segments, preoperative ROM, angle of lordosis, spinal canal diameter and radiologic degeneration of adjacent segments were selected as potential risk factors. The subjects were divided into two groups according to their clinical symptoms. Results: Symptomatic adjacent segment disease developed in 11 of the 48 patients(22.9%). The disease free survival rates were 88.7%, 82.4% and 58.7% at 5, 10 and 15 years, respectively. A study of the risk factors showed that preoperative degenerative changes and narrow spinal canal in the adjacent segments were significant. However, there were no significant associations with age, gender, number of fusion segments, preoperative ROM and angle of lordosis. Conclusion: The prevalence of symptomatic adjacent segment disease after anterior cervical fusion was considerable and higher when the patients had preoperative degenerative changes and a narrow spinal canal in the adjacent segments.
  • 2.

    Treatment Outcome of Lower Lumbar Fracture with Neurological Deficit

    김현준 | 이규열 | 강민수 and 3other persons | 2010, 17(1) | pp.7~12 | number of Cited : 0
    Abstract
    Study design: A retrospective study. Objectives: To evaluate the clinical results of surgical treatment for a lower lumbar fracture with a neurological deficit. Summary of Literature Review: There are several methods for treating lower lumbar fractures with neurological deficits but no definitive guidelines have been established. Materials and Methods: From 2000 to 2008, this study reviewed 26 patients who had undergone surgery to treat a lower lumbar fracture with a neurological deficit and could be followed up for more than 12 months. The changes in the kyphotic angle, changes in the vertebral body height, compromise ratio of the spinal canal, recovery of neurological deficit, and clinical results were evaluated. Results: There were 15, 7 and 4 cases with a third, fourth and fifth lumbar fracture, respectively. There are 19, 2 and 5 cases of an unstable bursting fracture, chance fracture and translational injury, respectively. The compromise ratio of the spinal canal improved from 67.2±9.4% to 16.4±4.6%, and the changes in the kyphotic angle improved from 14.5±3.2°to 7.6±2.4°postoperatively and 9.7±4.3 at the last follow-up. The changes in the vertebral body height improved from 41.3±8.4% to 23.4±6.3% and the bone union rate was 92.3%. The neurological deficit recovered with 1.27°according to the Frankel classification and good functional results were obtained in 84.6% of cases. Conclusions: Recovery of the neurological deficit and good clinical results were obtained with the recovery of the kyphotic angle and bone union with posterior decompression and instrumented posterolateral fusion in lower lumbar fractures with a neurological deficit.
  • 3.

    Factor Analysis Affecting the Leakage of Bone Cement After Vertebroplasty

    김재훈 | 송경진 | 김태승 and 2other persons | 2010, 17(1) | pp.13~17 | number of Cited : 3
    Abstract
    Study Design: Retrospective study Objective: This study examined the causative factors of cement leakage in an osteoporotic compression fracture that had received percutaneous vertebroplasty. Summary of Literature Review: Percutaneous vertebroplasty is simple and safe for the treatment of osteoporotic compression fractures. However, serious complications, such as pulmonary emboli and paraplegia, can occur if the bone cement leaks into the pulmonary artery or spinal canal. Materials and Methods: Between Oct. 2002 and Apr. 2008, 95 patients (148 vertebral bodies) underwent percutaneous vertebroplasty for the treatment of an osteoporotic compression fracture. The presence of cement leakage was evaluated by plain radiography and computed tomography. The correlations between cement leakage and gender, age, level of fractured vertebra, fracture type, bone density, procedure, injecting amount, preoperative vertebral body compression rate, timing of surgery, and the existence of an intravertebral cleft on magnetic resonance imaging (MRI) were analyzed. Results: Leakage was found in 37 bodies on plain radiography and 56 on the CT-scan. A comparison of the leakage and non-leakage groups revealed the bone density (p=0.046) and amount injected (p=0.000) to be related to cement leakage. Multivariate logistic regression showed that injecting more than 4.0ml was related to cement leakage with an odds ratio of 2.23(95% CI, 1.476~3.377). Conclusions: Cement leakage after percutaneous vertebroplasty is associated with the amount injected. Therefore, the cement volume should be restricted to the amount required for pain relief.
  • 4.

    One-Stage Posterior Debridement, Interbody Fusion and Instrumentation in the Treatment of Pyogenic Lumbar Spondylodiscitis

    나화엽 | 이영상 | Jun Cheol Choi and 5other persons | 2010, 17(1) | pp.18~25 | number of Cited : 0
    Abstract
    Study Design: A retrospective study on the outcomes of surgical treatment for pyogenic lumbar spondylodiscitis. Objectives: To report the clinical outcomes of the surgical treatment of pyogenic lumbar spondylodiscitis using a one stage posterior approach. Summary of Literature Review: There are few reports on the treatment of pyogenic lumbar spondylodiscitis through a one stage posterior approach. Materials and Methods: Between June 1999 and June 2005, this study examined the history of 12 patients with pyogenic lumbar spondylodiscitis treated by simultaneous posterior debridement, autogenous iliac bone graft and pedicle screw fixation. The clinical outcomes were evaluated in terms of the pain level, neurological status, hematological parameters and radiology findings. Results: The clinical symptoms improved in all cases after surgery. There was no case of the infection recurring. The mean time for postoperative antibiotics and hospitalization was 6 weeks and 41.6 days, respectively. Radiological bony fusion was observed at 5.5 months on average. The mean preoperative, immediate postoperative and final follow-up sagittal angles were 4.6, 8.6 and 6.9º . Conclusion: One stage posterior interbody fusion and instrumentation for the treatment of pyogenic lumbar spondylodiscitis can provide radical debridement, bone graft and immediate stability without prohibiting the control of infection. Therefore, it can be used in selected cases.
  • 5.

    Multiple Noncontiguous Fractures in Cervical Spine - Cases Report -

    김명수 | 이창범 | 하정한 and 3other persons | 2010, 17(1) | pp.26~32 | number of Cited : 0
    Abstract
    Study Design: Cases report Objectives: We report 2 cases of relatively rare cervical fracture. Summary of Literature Review: Although numerous studies in the literature have investigated cervical spine injuries, patients with multiple-level cervical fractures have not been commonly described. Multiple non-contiguous cervical fractures are distinctively unusual. Materials and Methods: First case was a girl aged 8 years and 4 months who had multifocal compression fracture of C3, 5, 6 & T7, 8 without spinal cord injury. Second case was a thirty nine-year-old female who had Type I Hangman’s fracture and compression fractures of C3, 7. Results: We had satisfactory results of them treated nonsurgically. Conclusions: We should remind that cervical spinal column can incur multiple injuries in variant patterns.
  • 6.

    Epidural Granulocytic Sarcoma presenting as Thoracic Spinal Cord Compression - Case Report -

    신동은 | 안창수 | 정소영 and 1other persons | 2010, 17(1) | pp.33~37 | number of Cited : 0
    Abstract
    Study Design: A case report Objectives: This case report presents a patient with thoracic spinal cord compression, who had been on regular follow-up after being diagnosed with myelodysplastic syndrome. Summary of Literature Review: A granulocytic sarcoma is a rare tumor that occurs in the extramedullary sites, forming a localized lesion with a predilection in the orbit, sinus and periosteum. It rarely involves the central nervous system, particularly spinal cord. Material and Methods: For myelodysplastic syndrome, the patient underwent a bone marrow transplant for the condition. He was placed on conservative treatment until he developed sudden abdominal pain. He was admitted to our hospital through the emergency department. On the 2nd hospital day he complained of increasing weakness in his lower extremities. He underwent an emergency decompression of the spinal cord and his motor weakness completely disappeared. Results: No signs of recurrence were found on the follow up performed at 2 years and 6 months. Conclusion: Epidural granulocytic sarcoma is rare but can be treated successfully.
  • 7.

    Current Concept on the Classification and Treatment of Spondylolisthesis

    이재철 | 신병준 | 2010, 17(1) | pp.38~48 | number of Cited : 2
    Abstract
    Study Design: A review of literature including classification and treatment of spondylolisthesis Objectives: To review and discuss the classification and management of spondylolisthesis Summary of Literature Review: Spondylolisthesis is one of the common spinal disorders that can create significant problems for the patients and spine surgeons, but there have been confusion of natural history and treatment strategies. It can be attributed to the absence of etiology-based classification system for individual patient prognosis and treatment decision. Materials and Methods: Review of literature Results: Marchetti and Bartolozzi have developed an etiology-based classification which has two main categories; developmental and acquired. These two types of spondylolisthesis seem to have significantly different natural histories and each of them needs different strategies for treatment. Conclusions: Authors recommend using Marchetti and Bartolozzi classification system for spondylolisthesis patients.