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2010, Vol.17, No.3

  • 1.

    Efficiency of Anterior Interbody Fusion using Cage Packed with DBM in the Distractive Flexion Injury of Cervical Spine - Demineralized Bone Matrix vs Autoiliac Cancellous Bone -

    박희전 | 김완기 | 심영준 and 1other persons | 2010, 17(3) | pp.111~119 | number of Cited : 2
    Abstract
    Study Design: This is a retrospective study. Objectives: We wanted to evaluate the effectiveness and safety of a PEEK cage filled with DBM in patients with a distractive flexion injury of the cervical spine. Summary of the Literature Review: AIF of the cervical spine using an autoiliac bone graft and plate fixation is known to be an effective treatment for traumatic injuries. However, the complications arising from the donor site are troublesome, and so fusion with cage is an alternative treatment. Materials and Methods: We analyzed 32 cases (22 males and 10 females) with distractive flexion injury of the cervical spine. They underwent anterior decompression and interbody fusion with a PEEK cage and anterior plate fixation. In 18 patients, the cage was filled with autogenous iliac bone (Group I), and for the other 10 the cages were filled with DBM (Group II). Results: All the cases in Group I and Group II achieved fusion except for one case of nonunion in group II. The anterior and posterior vertebral heights of the fused segments of group II were decreased more than those of group I, resulting a statistical difference (p=0.003). The changes of segmental lordosis (p=0.69) and the neurologic status (p=0.22) showed no statistical difference between the two groups. Conclusions: AIF using a PEEK cage filled with DBM and plate fixation showed no significant clinical differences compared to the case of iliac bone autografting. However, from a radiologic perspective, the time to achieve union was extensive and a case of nonunion was also observed. Therefore, many considerations are necessary when using DBM as a replacement for iliac bone autografting and further research should be done on this subject.
  • 2.

    Measurement of Vertebral Compression and Kyphosis in the Thoracolumbar and Lumbar Fractures

    손광현 | 정남수 | 전창훈 | 2010, 17(3) | pp.120~126 | number of Cited : 4
    Abstract
    Study Design: A retrospective radiologic study. Objectives: We wanted to compare the compression ratio and kyphosis of thoracolumbar and lumbar fractures according to the radiologic measuring methods and we wanted to analyze their relationship with the stability of fracture. Summary of the Literature Review: There are several methods for measuring the compression ratio and kyphotic angle in thoracolumbar fractures, but no definitive measurements and no different values according to the stability have been established. Materials and Methods: From July 2002 to August 2008, the plain films, CT, MRI and medical records of thoracolumbar and lumbar fracture were reviewed. The compression ratio and kyphotic angle were calculated by several different formulas with using the lateral view of the plain X-ray film, the sagittal reconstruction image of CT and the sagittal image of MRI and the results were compared. Each subject was classified according to both McAfee’s classification and the TLISS classification. Results: Two hundred forty eight vertebral bodies of 205 thoracolumbar fracture patients were analyzed. The compression ratio according to formula 1, which was calculated as 1-anterior vertebral height/posterior vertebral height, was significantly correlated with Cobb’s angle and the local kyphotic angle. There was no significant difference between the Cobb’s angle calculated using the lateral X-ray and that using the sagittal view of CT; however, it was significantly less using the sagittal MRI view. The unstable fractures according to McAfee’s classification showed a significantly higher compression ratio and kyphotic angle compared to those of the stable fractures. Conclusions: The compression ratio formula 1 was most significantly correlated with the kyphotic deformity. The unstable fractures showed a mean compression ratio higher than 30%, a mean Cobb’s angle of 15° and local kyphotic angle of 18°. The sagittally reconstructed CT was a useful measuring method for the evaluation of kyphotic deformity, and it was more accurate than that of the plain film.
  • 3.

    Lower-Pressure Percutaneous Vertebroplasty Using Larger-Diameter Bone-Cement Fillers

    안동기 | 이송 | 최대정 and 3other persons | 2010, 17(3) | pp.127~138 | number of Cited : 0
    Abstract
    Study Design: This is a retrospective, case-controlled study Objective: We wanted to evaluate the efficacy of lower-pressure percutaneous vertebroplasty (LP-PVP) using larger-diameter cement fillers for treating osteoporotic vertebral compression fracture (VCF). Summary of the Literature Review: Despite the popularity of conventional PVP(C-PVP), critical complications associated with cement leakage have been widely reported due to the inadequate viscosity of flabby cement. Materials and Methods: With excluding Kummell’s disease, 23 VCF’s were treated with LP-PVP using 2.8mm-diameter cement fillers,51 VCF’s were treated with kyphoplasty(KP) using the same size of cement fillers and 19 VCF’s were treated with C-PVP using 1.4mmdiameter biopsy needles. The clinical and radiographic results along with the complications were investigated for more than one year. Results: The visual analogue scale (VAS) was improved in all the groups. The infused cement volume was 5.9±1.6ml for the LP-PVP,5.9±1.9ml for the KP and 3.5±1.0ml for the C-PVP (p=0.000). The collapsed vertebral height was restored by 10.8±10.3%, 13.0±12.7%and 4.7±7.6%, respectively, in each group (p=0.000) with a reduction loss of 2.1±1.8%, 1.1±1.4% and 5.9±4.2%. respectively, in each group (p=0.000) at follow-up. These was a reduction of the vertebral kyphotic angle by 3.0±4.0°, 3.7±4.4° and 4.2±4.4°, respectively,in each group (p=0.528) with reduction loss of 1.0±0.9°, 0.1±1.7° and 3.5± 2.8°, respectively, in each group (p=0.000). There was a reduction of the regional Cobb’s angle by 4.3±2.6°, 3.1±4.7° and 2.9±3.8°, respectively, in each group (p=0.184) with a reduction loss of 3.6±4.5°, 0.1±1.5° and 1.0±4.1°, respectively, in each group (p=0.000). Extravasation of cement was noticed in 6 cases (26.1%) of LP-PVP,in 14 cases (27.5%) of KP and 4 cases (26.1%) of C-PVP (p=0.689). No cases of additional VCF happened for the LP-PVP, eight cases of additional VCF happened (15.7%) for the KP and one case of additional VCF happened (5.3%) for the C-PVP (p=0.030). Conclusion: The LP-PVP showed clinically and radiologically results that were similar to those of KP with a higher amount of infused cement volume compared to that of C-PVP. LP-PVP is thought to be effective for the clinical and radiolographic aspects and to have fewer complications for the treatment of osteoporotic VCF.
  • 4.

    A Comparison of Clinical Stability of Distal Instrument Fused Down to S1 with and without Sub-S1 Alar Screw in the Long Fusion using Segmental Pedicle Screw for Lumbar Degenerative Deformity

    김진혁 | 김성수 | 임동주 and 4other persons | 2010, 17(3) | pp.139~146 | number of Cited : 0
    Abstract
    Study Design: This is a retrospective study. Objectives: We wanted to assess the stability of distal instrumentation using the bilateral S1 and sacral alar screws for the treatment of degenerative lumbar deformity. Summary of the Literature Review: Various instrumentation methods have been introduced for increasing the strength of lumbosacral fusion. However, there are not many clinical studies that have evaluated the effectiveness of a sub-S1 alar screw for treating degenerative lumbar deformity surgery. Materials and Methods: A total of 39 patients with degenerative lumbar deformity were treated by long fusion and we retrospectively analyzed these patients after a minimum follow-up of 1 year. All the patients underwent an operation with distal instrumentation using either bilateral S1 screws alone (the S1 group) or additional bilateral sub-S1 sacral alar screws (the SA group). There were 19 patients in the S1 group and 20 patients in the SA group. The stability of the distal instrumentation was assessed by breakage or backout of a rod and/or screws based on simple radiography. Results: Instability of the distal instrumentation was detected in 6 cases (32%) in the S1 group and in 1 case (5%) in the SA group. The SA group had a more stability of the distal instrumentation than that of the S1 group with a significant difference (P<0.05). Distal instrumentation was unstable in 6 (19%) of the 32 cases with an anterior metal cage through posterior interbody fusion at L5-S1 and in 1(14%) of 7 cases without it at L5-S1. There was no significant difference in the stability of distal instrumentation in each group according to whether or not their L5-S1 was treated with an interbody cage (P>0.05). Conclusions: Bilateral sacral alar screws coupled with bilateral S1 screws can provide good distal fixation for stability of the distal instrumentation when performing long fusion for treating degenerative lumbar deformity.
  • 5.

    Laminoplasty Versus Laminectomy and Fusion for Multilevel Cervical Spondylosis

    이철원 | 강진헌 | 이규열 and 1other persons | 2010, 17(3) | pp.147~153 | number of Cited : 1
    Abstract
    Study Design: This is a retrospective study. Objectives: We wanted to compare the clinical and radiographic outcomes of laminoplasty and laminectomy & fusion to treat multilevel cervical spondylosis. Summary of the Literature Review: Laminoplasty and laminectomy & fusion are being increasingly used to treat multilevel cervical spondylosis, but definitive guidelines have not yet been established. Materials and Methods: Fifty eight patients who were followed up for more than a year and who were treated for multilevel cervical spondylosis with either laminoplasty or laminectomy & fusion between March 2000 and March 2009 were reviewed. Twenty eight patients who underwent laminectomy & fusion were matched with 30 patients who underwent laminoplasty. Results: The laminoplasty group showed statistically significant improvements in the Japanese Orthopaedic Association (JOA) score and Visual analogue scale (VAS) score. The cervical lordosis for the preoperative and latest sagittal alignment in the laminoplasty group decreased from 14 degrees to 5 degrees and the cervical kyphosis in the laminectomy & fusion group increased from 10 degrees to 15degrees with no statistically significant difference. However, 3 cases with less than 5 degrees of cervical lordosis in the laminoplasty group showed progression of kyphosis at the last follow-up. Conclusion: The clinical outcomes of laminoplasty for multilevel cervical spondylosis were better than those of laminectomy & fusion. However, it is considered that additional study for laminectomy & fusion is needed to prevent the long-term progress of cervical kyphosis in cases with preoperatively decreased cervical lordosis of less than 5 degrees, though it is impossible to make such comparisons with the small number of cases in our study.
  • 6.

    Discal Cyst of Lumbar Spine - A Case Report -

    이채칠 | CHO, SUNG-DO | 고상훈 and 5other persons | 2010, 17(3) | pp.154~156 | number of Cited : 0
    Abstract
    Study Design: This is a case report. Objective: We present here a patient who had a discal cyst of the lumbar spine along with neurological symptoms. Summary of the Literature Review: Discal cysts are intraspinal cysts that communicate with an adjacent intervertebral disc, and these are rare lesions that can cause lumbar radiculopathy. Because they are very rare, their natural history and the details of the therapeutic guidelines for the treatment of these cysts are still unknown. Material and Methods: The patient complained of moderate lumbar pain and right lower extremity radiculopathy and he was administered conservative treatment for 5 months. But the radiculopathy became aggravated and he then underwent a hemilaminectomy,cyst decompression and discectomy. Results: The radiculopathy disappeared and any signs of recurrence were not found on the follow up performed at 1 year. Conclusion: Discal cyst is rare, but it can be treated successfully.