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pISSN : 2093-4378 / eISSN : 2093-4386

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2013, Vol.20, No.1

  • 1.

    Correlation of Adjacent Segmental Disease with Tilt Angles of the Upper and Lower Instrumented Vertebra in the Degenerative Lumbar Scoliosis

    양준영 | 이준규 | Yong-bum Joo and 2other persons | 2013, 20(1) | pp.1~7 | number of Cited : 0
    Abstract
    Study Design: Retrospective study. Objectives: To evaluate the correlation of adjacent segmental disease with tilt angles of the upper and lower instrumented vertebra after instrumented posterolateral fusion for degenerative lumbar scoliosis. Summary of Literature Review: There has been no study of radiologic measurement and decision of fusion level using the angle of pedicle screws inserted for treatment of degenerative lumbar scoliosis. Materials and Methods: From 2004 to 2008, 74 patients that underwent decompression and posterolateral fusion for degenerative lumbar scoliosis were included in this study. In all cases, instrumentation and posterolateral fusion were both performed. The sex ratio was 31:43, the mean age was 68.7 years and the mean follow up duration was 37.4 months. The angle between each upper end plate of the upper vertebral body and lower end plate of the lower vertebral body of the fusion, and the line parallel to the axis of the sagittal line of vertebrae was each defined as UIV-a and LIV-b. The correlation of development of adjacent segment disease and UIV-a, and LIV-b angle was investigated. Results: Sum of the absolute value of UIV-a and LIV-b had a statistically significant positive correlation with that of adjacent segment disease. Also, UIV-a alone, had a statistically positive correlation with the development of proximal adjacent segment disease. Conclusions: Since it is proven that adjacent segment disease has positive correlation with the sum of the absolute value of UIV-a and LIV-b, the extent of fusion should be adjusted to make the line parallel to the line perpendicular to the sagittal surface.
  • 2.

    Results of Dual Growing Rods Treatment for Progressive Pediatric Spinal Deformity

    김형복 | 정현수 | 문은수 and 5other persons | 2013, 20(1) | pp.8~15 | number of Cited : 3
    Abstract
    Study Design: A prospective study. Objectives: To report the results of new designed dual growing rods system for progressive pediatric spinal deformity. Summary of Literature Review: The current expandable spinal implant system appears effective in controlling progressive pediatric spinal deformity, allowing for spinal growth. However, there was no report concerning the growing rod in Korea. Materials and Methods: Between 2010 and 2011, seven pediatric patients, who had a minimum of 1year follow-up, had undergone surgery for spinal deformity correction with a dual growing rods technique. We analyzed the demographic and radiologic data, including height, weight, age at surgery, diagnosis, number of lengthening, Cobb’s angle of the major curve, thoracic kyphosis angle, lumbar lordosis angle, T1-S1 length, instrumented segment length, and complications, from the preoperative period to the last follow up period. Results: Four male and three female patients with 5 neuromuscular scoliosis, 1 idiopathic juvenile osteoporosis and 1 spondyloepiphyseal dysplasia had underwent corrective surgery with dual growing rods. The mean age at the initial surgery was 11.6 years (7-13.8). The mean follow-up duration was 19.3 months (12-24), and the mean lengthening procedure time was 2.8 (2-4) for every patient. Cobb’s angle of scoliosis curve was corrected from preoperative 80.2°(55-136) to 37.6° (15-81) on the last follow-up. Thoracic kyphosis angle and lumbar lordosis angle were changed from preoperative 48.7°(12-101) and 38.3°(9-72) to 44.5°(12-75) and 18.8°(1-46) on the last follow-up, respectively. Growth length during the follow-up period was measured as instrumented segment is 46 mm (33-59) and T1-S1 segment is 82 mm (66-98). Complications, such as breakage of rod in 3 cases and soft tissue infection in 1 case, occurred during the follow-up period. Conclusions: New designed dual growing rods system for pediatric patients with progressive spinal deformity is an effective and relatively safe method because of adequate correction and acceptable rate of complications.
  • 3.

    Relation Between Adjacent Superior Segmental Disease and Facet Joint Violations After Posterolateral Lumbar Fusion

    이규열 | 고만석 | 김우철 and 2other persons | 2013, 20(1) | pp.16~21 | number of Cited : 0
    Abstract
    Study Design: To analyze the relationship between the adjacent superior segment disease and facet joint violations after lumbar fusion. Objectives: We retrospectively analyzed the relationship between the adjacent superior segment disease and facet joint violations after lumbar fusion. Summary of Literature Review: Among numerous literatures regarding adjacent superior segment disease, there is no analysis concerning the relationship between adjacent superior segment disease and facet joint violations after lumbar fusion. Materials and Methods: We reviewed 2056 patients who underwent lumbar fusion, between March 2004 and April 2009. Analysis was performed for 79 (3.8%) of the 2056 patients with adjacent superior segment disease and needed a second operation. A facet joint was considered as 3 types of violations with computed tomography scans if any of the following situations were encountered: pedicle screw clearly within the facet joint; pedicle screw head clearly within the facet joint; and pedicle screw and/or screw head within 1mm from or abutting the facet joint, without clear joint involvement. Results: The incidence of the violations was 45% (36/79) of all patients and 28% (44/158) of all screws. The incidence of L4-5 facet joint violations was 35% (28/79) of patients with adjacent superior segment disease, statistically. Conclusions: Facet joint violations were observed in patients with the adjacent superior segment disease after posterolateral lumbar fusion. Because L3-4 facet joint violations increased when L4-5 fusion was done, more care should be taken to avoid facet joint violations when the surgeon is considered for insertion of the pedicle screws at L4-5.
  • 4.

    The Result of Minimally Invasive Transforaminal Lumbar Interbody Fusion in Low Grade Spondylolisthesis - Minimum 2 Years Follow Up -

    정흥태 | 조재림 | 김우철 and 2other persons | 2013, 20(1) | pp.22~27 | number of Cited : 0
    Abstract
    Study Designs: A retrospective study. Objectives: To analyze the clinical and radiological outcomes of spontaneous reduction via minimally invasive transforaminal lumbar interbody fusion (Mini-TLIF) as the treatment for low-grade symptomatic spondylolisthesis. Summary of Literature Review: Although minimally invasive transforaminal lumbar interbody fusion is technically demanding, this procedure is an effective method for spontaneous reduction of low grade spondylolisthesis. Materials and Methods: We analyzed consecutive series of 41 patients with low grade spondylolisthesis who underwent minimally invasive transforaminal lumbar interbody fusion, between April 2008 and July 2009. The minimum follow-up period was 2 years. Clinical evaluation was performed by an analysis of Visual Analogue Scale and Oswestry Disability Index. For the radiological evaluation, disc space height, slip percentage, and slip angle were analyzed. At the final follow-up, the fusion rate was analyzed according to the Bridwell’s anterior fusion grade. Results: For the evaluation of clinical outcomes, the Visual Analogue Scale for back pain decreased from 6.8±1.2 to 2.0±1.1, and that for radiating pain decreased from 7.9±1.3 to 1.7±1.1. Oswetry Disability Index decreased from 38.5±8.4 to 13.4±6.1. For the radiological evaluation, disc space height increased from 8.4±2.14mm to 11.8±1.54mm(P<0.05), slip percentage was reduced from 18.4±5.1% to 13.3±3.1%(P<0.05) and slip angle decreased from 10.6±4.5° to 6.2±3.4° (P<0.05). At the final follow-up, radiological union was obtained in 38 cases (92.7%). Conclusions: We conclude that minimally invasive transforaminal lumbar interbody fusion appears to be an effective method for spontaneous reduction of low grade spondylolisthesis if the surgeon becomes familiar with this method.
  • 5.

    Usefulness of the ProSet MRI for Diagnosis of the Extraforaminal Disc Herniation

    Ahn, Myun Whan | 김의식 | Kim, Gi Beom | 2013, 20(1) | pp.28~33 | number of Cited : 3
    Abstract
    ©Copyright 2013 Korean Society of Spine Surgery www.krspine.org 28Usefulness of the ProSet MRI for Diagnosis of the Extraforaminal Disc Herniation Myun-Whan Ahn, M.D., Ui-Sik Kim, M.D., Gi-Beom Kim, M.D. Department of Orthopaedic Surgery, Yeungnam University Hospital, Daegu, South Korea Study Design: This is a retrospective study. Objectives: The purpose of this study is to confirm the clinical usefulness of utilizing ProSet imaging for checking the nerve root compression and swelling in extraforaminal disc herniation. Summury of Literature Review: Diagnosing extraforaminal disc herniations can be neglected with using a conventional MRI. Materials and Methods: A retrospective analysis was performed on 25 patients, who underwent both conventional & Principles of the selective excitation technique (ProSet) MR imaging for the evaluation of extraforaminal disc herniation, from April 2008 to October 2010. Radiographic analysis was based on the notion that the degree of nerve root compression and swelling was decided by Pfirrmann’s classification. Results: Severe compression in the ProSet 3D rendering image was observed in 21 subjects, as compared with 8 subjects in the conventional axial image. Especially, nothing was ever detected in the conventional sagittal image. Severe compression in the ProSet 3D rendering image was observed in 4 subjects, while their nerve root compression was not clear in the conventional axial image. Severe compression and severe swelling in the ProSet 3D & coronal image was observed in 15 subjects, while their nerve root compression was none or not clear in the conventional sagittal image. The swelling degree of the ProSet coronal image turned out bigger than the swelling degree of conventional axial image, and the signal intensity change was also obvious. Conclusions: ProSet imaging is regarded useful to investigate the symptom triggering nerves, because ProSet image not only observes better nerve root compression, but also identifies the swelling degree more easily than that of the conventional magnetic resonance imaging (MRI).