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2010, Vol.17, No.4

  • 1.

    Radiographic Analysis of Atlantoaxial Fusion for Atlantoaxial Instability -Comparison of Posterior wiring, Transarticular screw, Posterior screw-rod fixation -

    정재윤 | Hyoung-Yeon Seo | 김기형 and 1other persons | 2010, 17(4) | pp.157~163 | number of Cited : 0
    Abstract
    Study Design: This is a retrospective study. Objectives: We wanted to clarify the association between the position of the atlantoaxial fusion angle and the change of the subaxial cervical spine alignment (SCA) and the reduction loss after atlantoaxial fusion (AAF) using the posterior wiring technique (PWT),transarticular screw fixation (TAF) and posterior screw-rod fixation (PSR) for treating atlantoaxial instability (AAI). Summary of the Literature Review: There are not many studies on the change of the SCA and the reduction loss after AAF. Material and Methods: Thirty five patients underwent AAF for AAI from 1986 to 2008. The mean follow-up period was 59.5 months. The surgical techniques were divided into three groups, that is, PWT: 17 patients, TAS: 10 and PSR: 8. The causes of instability were transverse ligament rupture in 12 patients, rheumatoid arthritis in 11, Os odontoideum in 6 and nonunion of an odontoid fracture in 6. Plain radiographs were used to assess the atlanto-dental interval, the posterior arch-lamina angle, the change of the SCA and the time of fusion. Results: Fusion was achieved in all the patients within 3.5 months (range: 3-5 months). The radiologic findings in the 5 PWT patients showed a reduction loss and 3 patients showed subaxial cervical kyphosis (SCK). The TAS group had no reduction loss or SCK. The PSR group had no reduction loss and one patient showed SCK. A statistically significant reduction loss and SCK occurred in the group in which there was a posterior arch-laminar angle greater than 10 degrees before and after surgery. Conclusions: For the treatment of AAI, the position of the AAF is associated with the change of the postoperative SCA. The preoperative lodortic position of C1-2 should be maintained to prevent the change of the SCA
  • 2.

    The Influence of Cervical Spondylosis to Acute Cervical Spinal Cord Injury

    Hyoung-Yeon Seo | 정재윤 | 김기형 | 2010, 17(4) | pp.164~168 | number of Cited : 0
    Abstract
    Study Design: A retrospective study Objectives: To examine the influence of cervical spondylosis on an acute cervical spinal cord injury. Summary of Literature Review: There are no reports on the relationship between cervical spondylosis and acute cervical spinal cord injuries. Materials and Methods: Twenty six patients who underwent operative treatment for acute cervical injuries with spinal cord injury were evaluated. The mean age and follow-up period was 58 years and 2.2 years, respectively. The evaluation was performed by examining the causes of the injuries, and the classification of fractures according to the presence of cervical spondylosis. This study compared the degrees of postoperative neurological recovery with motor index score in the groups with and without cervical spondylosis. Results: Cervical cord injuries were more prevalent in the group 60 years and older; 17 cases vs. 9 cases in the group under 60 years. Eleven (65%) and 6 (35%) cases in the group 60 years and older had sustained a high and low energy injury, respectively. In contrast,mostly high energy injuries (8 in 9 cases) were encountered in the group under 60 years of age. A low energy injury could cause a acute cervical cord injury in the group 60 years and older, who also had cervical spondylosis. In those cases, previous cervical spondylosis might be one of the etiologic factors. Conclusions: The cases with cervical spondylosis in the group 60 years and older tended to show incomplete cord injury and good postoperative neurological recovery when they had sustained cervical cord injuries.
  • 3.

    Radiological and Clinical Outcome after Simple Discectomy of Central Massive Lumbar Disc Herniation

    고영도 | 이승준 | 김동준 | 2010, 17(4) | pp.169~176 | number of Cited : 0
    Abstract
    Study Design: This is a retrospective case control study. Objectives: To analyze our results following simple discectomy of central massive disc herniation focusing on instability for the usefulness of intervertebral fusion. Summary of Literature Review: Lumbar instability is a complication of central massive disc herniation. However, there is limited evidence on the correlation between lumbar instability and loss of disc material. Materials and Methods: A total of 25 patients who had undergone discectomy for a single-level lumbar disc herniation were followed up for two years. The clinical group (group A) included 12 patients that had a compromised canal with greater than 50% of the herniated disc, while the central axis of the herniated disc was less than 20% deviated from the center axis of the spinal canal, as seen on MRI. The control group ( group B) had 13 patients that had a compromised canal with less than 50% of the herniated disc while their axis was more than 20% deviated from the center axis of the spinal canal. Clinical and radiologic instability, pain and functional disability were compared between the two groups. Results: No differences was found between the two groups in clinical instability, radiological instability, visual analogue scale (VAS),and the Oswestry disability index (ODI). Conclusions: Central massive disc herniation after discectomy did not show a significant difference in clinical or radiological instability from that of other herniation types.
  • 4.

    Comparison of Mechanical Property of Conventional Rods versus Growing Rods for Pediatric Early Onset Scoliosis

    김진영 | 문은수 | 정현수 and 2other persons | 2010, 17(4) | pp.177~183 | number of Cited : 1
    Abstract
    Study Design: This is a mechanical study. Objectives: We wanted to investigate the mechanical properties of newly developed dual growing rods for obtaining approval for their clinical application. Summary of the Literature Review: The current expandable spinal implant system appears effective for controlling progressive early onset scoliosis, and it allows for spinal growth and improving lung development. Materials and Methods: We investigate the yield load and ultimate load during compression, tension and torsion of the growing rods and the conventional rods assembly using UHMWPE blocks, and the diameter of the rods was 6.0 mm and they expanded 5cm long. We also performed a fatigue test with growing rods, and the diameter of which was 6.0 mm and it expanded 2.5cm long. The guideline for the American Society for Testing Materials was followed during the entire mechanical test. With the growing rods and conventional rods,we tested for each mechanical property7 times with the new rods and blocks. Results: The yield load of the growing rods and conventional rods were 845.2±18.2 (N) and 812.9±29.9 (N), respectively, and the ultimate load of the growing rods and conventional rods were 961.9±31.1 (N) and 914.9±25.6 (N), respectively, when compression force was applied. The yield load and ultimate load of the growing rods were statistically higher than those of the conventional rods (p<0.05). The ultimate load of the growing rods and conventional rods were 3281.7±41.5 (N) and 3678.5±447.9 (N), respectively when tension force was applied. The ultimate load was similar for both types of rods (p>0.05). The yield loads of the growing rods and conventional rods were 11.56±0.59 (Nm) and 12.46±0.71 (Nm), respectively, the ultimate loads of the growing rods and conventional rods were 16.97±0.94(Nm) and 17.42±2.66 (Nm) during the torsion, respectively. The yield load and ultimate load of the growing rods were statistically lower than that of the conventional rods (p<0.05). Conclusions: The newly developed growing rods have a higher yield load and ultimate load under compression, a similar ultimate load under tension and a lower yield load and ultimate load under torsion. The differences of the yield load and ultimate load under torsion were minimal, and so the growing rods and conventional rods have similar mechanical properties.
  • 5.

    Management of Deep Wound Infection After Posterior Lumbar Interbody Fusion With Cages

    김응하 | Won Sung Hun | 이상헌 | 2010, 17(4) | pp.184~190 | number of Cited : 0
    Abstract
    Study Design: Retrospective study Objective: The purpose of this study was to analyze patients who developed deep wound infections after receiving PLIF for degenerative lumbar disease, and report the treatment outcomes. Summary of Literature Review: Few studies have examined deep wound infections after PLIF, and there is some controversy regarding whether screws or cages need to be removed to treat infections. Materials and Methods: Nine cases(spinal stenosis 6, spondylolisthesis 3) developed a deep wound infection after PLIF from 2001 to 2007. The mean follow up was 48 months (24-72). The clinical results were evaluated using MacNab’s criteria. Results: The diagnosis of infection was made based on the clinical symptoms and signs, and inflammatory markers, such as ESR and CRP. The time to diagnosis was less than one week (2), three weeks (2), six weeks (1) and three months or more (4). Bacterial identification was performed on seven cases. MRSA was detected in one of them, and no bacteria were identified in the other six. In two of them, the infection subsided with antibiotic therapy only. In 7 cases, removal of the cage and anterior iliac strut graft was needed for infection control. In four cases, loosened screws were removed during debridement. In 2 cases, additional surgery for pseudarthrosis was required after curing the infection . Conclusions: In deep infections after PLIF, early diagnosis and bacterial identification are important for reducing the need for a later radical operation. It is recommended that blood markers of infection be measured with a short follow-up period. In a case of persistent infection against prolonged antibiotics, removal of the cage or screw is needed to treat the infection earlier.
  • 6.

    Clinical Availability, Diagnosis and Treatment of the Primary Psoas Muscle Abscess

    안기찬 | 김창완 | Min Young Kyoung | 2010, 17(4) | pp.191~197 | number of Cited : 1
    Abstract
    Study Design: This is a retrospective study on the clinical availability, diagnosis and treatment of primary psoas muscle abscess Objectives: This study investigated the causes and clinical results of patients with primary psoas muscle abscess. Summary of Literature Review: Primary psoas muscle abscess is not a common disease clinically, but it is a very dangerous disease if the diagnosis and treatment are delayed. Materials and Methods: Between October 2003 and February 2010, we investigated the symptoms, pathogens, the associated diseases and treatments of 17 patients (11 males and 6 females; mean age: 49.5 years old). We divided patients into the 3 groups According to the treatment options (Group 1: antibiotics alone, Group 2: percutaneous catheter drainage, Group 3: open drainage) and the correlation of the abscess size of each group was analyzed by the Kruskall Wallis method. Results: The most common complaint was lower back pain (14 patients). Staphylococcus aureus was the most common infectious organism (12 patients). All the patients were treated with broad spectrum antibiotics. Group 1 was composed of 4 patients and the average size of the abscess was 2.3cm (range: 1.2~4.5cm). Group 2 was composed of 7 patients and the average size of the abscess was 7.4cm (range: 3.8~12.2cm). Group 3 was composed of 6 patients and the average size of the abscess was 8.1cm (range: 6.1~14.7cm). There was a significant correlation of the abscess size between each group. (p=0.0007)Conclusions: The patients diagnosed with primary psoas muscle abscess complained about lower back pain, a febrile sense and gastrointestinal symptoms. Most of the primary psoas muscle abscesses are pyogenic infections. We have to use broad-spectrum antibiotics for the initial treatment. When the occasion demands, additional treatment like percutaneous catheter drainage and open drainage should be considered.
  • 7.

    Optimal Standing Radiographic Positioning in Patients with Sagittal Imbalance

    김환정 | 2010, 17(4) | pp.198~204 | number of Cited : 4
    Abstract
    Study Design: This is a review of the literature about radiographic positioning for patients with sagittal imbalance. Objectives: We wanted to verify the optimal radiographic positioning for patients with sagittal imbalance Summary of Literature Review: The standing lateral whole spine radiograph for identifying the sagittal alignment has a different value for the SVA according to the radiographic positioning. Materials and Methods: This is a review of the literature Results: The fists-on-the clavicle position or the cross-arm position not only represents a functional standing position, but it also causes a less negative shift of the SVA in patients with sagittal imbalance. Both the extended hip and knee positions are necessary to exclude a compensation mechanism of the lower extremity. Conclusions: The optimal radiographic positioning is essential to examine the degrees of sagittal imbalance.