KJC Korea
Journal Central

Study Design: A retroprospective study. Objectives: We used a local autobone and β-tricalcium phosphate mixed graft with posterolateral fusion in spinal stenosis and spondylolisthesis and evaluated union rates to verify the efficacy. Summary of Literature Review: Several reports have shown high union rates of posterolateral fusion using β-tricalcium phosphate. However, in Korea, only one study reported a low union rate. Materials and Methods: Forty-two patients who underwent lumbar posterolateral fusion with a local autobone and β-tricalcium phosphate mixed graft from September 2010 to July 2011 were followed up. There were 32 cases with spinal stenosis and 10 cases with spondylolisthesis. Bone fusion was determined along with the fusion rates based on Lenke’s criteria. Clinical outcomes were determined using Kim’s method. Results: In spinal stenosis, bone union was presented in 19 cases(59.4%) out of 32 cases and in spondylolisthesis, bone union was presented in 7 (70.0%) out of 10. In spinal stenosis, 12 cases showed excellent outcome, 16 good, 3 fair and 1 poor, 27 cases(87.5%)were superior to the good. In spondylolisthesis, 2 cases showed excellent outcome, 5 good, 3 fair and 0 poor, 8 cases(70.0%) were superior to the good. Conclusions: Posterolateral fusion using a local autobone and β-tricalcium phosphate mixed graft showed lower bone fusion rates. We need further studies to enhance the fusion rate when using local autobone and β-tricalcium phosphate mixed grafts.

Study Design: Retrospective comparative study. Objectives: The aim of this study was to compare the efficacy of prophylactic antibiotics in spinal surgery for the occurrence of postoperative surgical site infection (SSI) and host immune reactions depending on various administration regimens and protocols. Summary of Literature Review: The superiority of one regimen or protocol of prophylactic antibiotics over others for SSI in spinal surgery has not been clearly demonstrated. We designed a controlled clinical trial to compare the occurrence of SSI with the changes of hematologic results depending on prophylaxis regimens and protocols. Materials and Methods: Between January 2007 and February 2011, two hundred consecutive patients who had undergone thoracolumbar/lumbar surgery for degenerative or traumatic disease were included. Postoperative protocol was altered for each group of fifty consecutive patients; 1st generation cephalosporins for 5-days (group A), 2nd generation cephalosporins for 5-days (group B),1st generation cephalosporins for 3-days (group C), and 2nd generation cephalosporins for 3-days (group D). Preoperative antibiotic prophylaxis was administrated within 1 hour prior to surgical incision with the same trial antibiotics. Intraoperative bacterial culture was performed from the surgical site. The occurrences of SSI were evaluated as either incisional or organ/space SSI. Serial changes in hematologic inflammatory markers (WBC, ESR, CRP) and DIC markers (fibrinogen, FDP, D-dimer) were compared until postoperative 2weeks. Results: The study groups were homogeneous regarding age, sex, body mass index, estimated blood loss, diabetes mellitus, smoking,diagnosis, baseline laboratory values, and type of surgery including instrumentation. Overall, 13 cases of incisional SSI (6.5%) and 3cases (1.5%) of organ/space SSI occurred. There was no difference in the occurrence of incisional and organ/space SSI among the 4groups (P=0.690, 0.799). Laboratory results revealed that postoperative changes in hematologic inflammatory markers and DIC markers were not influenced by prophylaxis regimens and protocols (all P>0.05). Conclusions: The occurrences of SSI and host immune responses were not influenced by postoperative antibiotics regimens and protocols. Hematologic investigation revealed that host immune responses did not depend on the type of prophylactic antibiotics.

Study Design: A retrospective study. Objectives: The purpose of this study was to assess the clinical efficacy and long term results of patients undergoing percutaneous vertebroplasty, with bone cement, for osteoporotic compression fractures. Summary of Literature Review: Percutaneous vertebroplasty is an effective surgical method for the treatment of osteoporotic compression fracture. Materials and Methods: Among 82 patients who underwent percutaneous vertebroplasty, with bone cement, between February 2005and February 2008, 54 patients who were followed-up for more than 4 years were selected. We compared the postoperative clinical and radiological findings immediately and at 1, 2, and 4 year follow-up. Clinical findings were evaluated using the Visual analogue scale (VAS)score. Radiologically, height of the vertebral body and adjacent vertebral body fracture were also assessed. Results: Clinical outcome by mean VAS score revealed a change from 5.9 to 3.8 points preoperatively. The mean VAS scores were 3.4, 3.5 and 3.7 at 1, 2, 4 year follow-up, retrospectively. The compression rate of the vertebral body on plain radiographs was 30.8%preoperatively, 22.4% immediately after the operation, 23.2% at 1 year follow-up, 26.9% at 2 year follow-up, and 29.7% at 4 year follow-up. A new adjacent vertebral body fracture was noted in 7 patients at 1 year follow-up and 3 patients at 2 and 4 year follow-up,respectively. Conclusions: Percutaneous vertebroplasty is a valuable method for the treatment of osteoporotic compression fractures, providing immediate pain relief as well as long term pain relief. However, percutaneous vertebroplasty gave unsatisfactory report about height of the vertebral body and adjacent vertebral body fracture.

Study Design: Retrospective study. Objectives: To observe the short term effect of selective nerve root block (sNRB) depending on the contrast pattern and spinal canal size. Summary of Literature Review: A number of studies have demonstrated that sNRB is quite effective not only for patients with herniated intervertebral discs but also for those with spinal stenosis. Materials and Methods: The Visual Analog Scale(VAS) score was collected before and after the procedure from 217 subjects with lumbar spinal stenosis and underwent sNRB. Two types were classified after observing the contrast’s spreading pattern, Type I contrast reaching the spinal canal and Type II not reaching the spinal canal. Efficacy of the treatment for each type was also compared. In addition,the spinal canal size was classified into three categories. Treatment efficacy depending on the contrast pattern was also compared in each category. Results: When divided into two types based on the contrast pattern, type I showed a more significant reduction in VAS score according to T-test although both types showed a decrease in VAS score after the procedure. In regards to spinal canal dimension, both types showed decreased VAS scores after the procedure in patients with spinal canal size larger than 172.2mm2; however, there were no changes in VAS score before and after the procedure for those with spinal canal size smaller than 73mm2.Conclusions: There was a short term effect of selective nerve root block (sNRB) in patients with spinal stenosis regardless of their contrast pattern, type I group showing a stronger correlation. In regards to spinal canal dimension, patients with larger spinal canal sizes not only showed a significant decrease in VAS score after selective nerve root block (sNRB) but also showed differences depending on the contrast pattern. On the contrary, there was no significant difference in VAS score before and after selective nerve root block (sNRB)in patients with small spinal canal sizes, and there was also no difference in the outcome depending on the contrast pattern in patients with small spinal canal sizes. Therefore, when performing selective root nerve block (sNRB), the operator should remember to manipulate the angle and position of the spinal needle when injecting the appropriate drug after confirming that the contrast material reached the spinal canal. The operator should also consider surgical management when performing selective nerve root block (sNRB) in patients with severe central spinal stenosis.

Study Design: A retrospective study. Objectives: To examine the radiologic and clinical results of patients classified as excessive translation and excessive angulation,treated by posterolateral fusion only, or posterolateral fusion with posterior lumbar interbody fusion in isthmic spondylolisthesis. Summary of Literature Review: Isthmic spondylolisthesis is usually treated by PLF only or PLF with PLIF. But it is not reported the clinical and radiologic results classified by translation type. Materials and Methods: Patients who had received surgery for spondylolisthesis between January 2005 to January 2010, there were 56 for whom follow-up observations were possible for 2 years. According to the fusion methods and preoperative flexion-extension simple radiograph, we classified as excessive translation and excessive angulation by segmental instability and as PLF and PLIF by surgical methods. We examine the clinical results(Visual Analogue Scale, Oswestry Distability Index, operation time, blood loss,complication rate) and the radiologic results(reduction rate of slippage, change of segmental angle, reduction ratio of disc height , bone union). Results: In radiologic results, excessive angulation(group II) did not show significant difference from excessive translation(group I)in terms of reduction rate of slippage, change of segmental angle, reduction ratio of disc height, bone union. But we found excessive translation-PLIF(group I-B) was better than excessive translation-PLF(group I-A) and excessive angulation-PLIF(group II-B) was better than excessive angulation-PLF(II-A) in terms of reduction ratio of disc height(P<0.05). In clinical results, both sides group did not show significant difference in operation time, blood loss, complication rate. Conclusions: In spondylolisthesis patients, excessive translation group(I) and excessive angulation group(II) did not show significant difference in radiologic results and clinical results. But both sides group showed the PLF with PLIF was better than the PLF only in terms of reduction ratio of disc height.

Study Design: Retrospective study. Objectives: To assess the operative risks and complications of posterior decompression and fusion for degenerative spine disorders,we compared single level posterior decompression and posterolateral fusion of lumbar spine with total hip arthroplasty which have been evaluated in many reports and articles on complications and operative risks. Summary of Literature Review: There has been no study comparing the relative risks of spinal surgery with total hip arthroplasty. Materials and Methods: One hundred and thirty-six subjects (mean age 69.6 years) who received single level posterior decompression and posterolateral fusion for degenerative lumbar disorders from February 2000 to May 2010 were selected as group A, and 136 subjects (mean age 67.2 years) who received total hip arthroplasty during the same period were selected as group B. A comparative analysis was performed according to age, gender, pre-operative ASA status based on their underlying medical conditions, total operative time,blood loss, hospitalization period, incidence of major and minor complications and functional recovery at the time of final follow up using retrospective and statistical manners from medical records and radiologic evaluations. Results: The total operative time and blood loss were longer in group A with statistical significance (P<0.01). Major complications were frequent in group B with 16 cases and in group A with 6 cases (P<0.05). There were no significant differences in the total hospitalization period, incidence of minor complications and post-operative functional recovery. Conclusions: The present study revealed no increased operative risks for surgery for degenerative lumbar disorders compared with total hip arthroplasty in similar age groups.

Study Design: Retrospective study. Objectives: To evaluate clinical & radiologic significance about complications of spinopelvic fixation with iliac screw in patients with adult spinal deformity. Summary of Literature Review: Complications of iliac screw fixation in adult spinal deformity patients was obscure in spite of the good results of iliac screw fixation. Material and Methods: We analyzed 27 patients, followed over 1-year, with adult spinal deformity (lumbar degenerative kyphosis,degenerative lumbar scoliosis, flat back syndrome). The study was done for complications of iliac screw fixation by clinical and radiological evaluations. Results: Post-operative iliac screw prominence were 15 cases (55.5%) , iliac screw breakage was 1 case (3.7%), bursitis was 1 case (3.7%), sacroiliac joint pain were 5 cases (18.5%), halo sign around iliac screw were 23 cases (85.1%), and 3 cases (11.1%) were performed reoperation. There was no significance between halo sign and sacroiliac joint pain. Conclusions: Iliac screw fixation is a very useful operative method without severe complications on spinopelvic fixation. There are some complications of iliac screw fixation and iliac screw prominence is a most common problem, but few counterplan exits. So, further studies about reducing complication method, management protocols of iliac screw complication were needed.

Study Design: Case report. Objectives: To report a case of osteosarcoma involving the thoracic spine in an elderly patient. Summary of Literature Review: Spinal osteosarcoma has been reported as a relatively low incidence (3-5%) of musculoskeletal osteosarcoma. Dominant histologic type was osteoblastic. Radical excision or palliative excision followed by adjuvant chemotherapy and radiation therapy was tried. The overall prognosis was shown to be poorer than osteosarcomas in other skeletal areas. Materials and Methods: A review of clinical and radiologic data of osteosarcoma involving the 12th thoracic spine that were confirmed by histopathology. Results: Palliative surgery followed by adjuvant radiation therapy and chemotherapy was performed. Conclusions: We report here the clinical and radiological findings of a case of osteosarcoma that arose in the thoracic spine with a literature review.

Study Design: A case report. Objectives: To report a rare case of subacute delayed ascending myelopathy. Summary of Literature Review: After low spinal cord injury, the cord injury may proceed to a proximal level and lead to subacute delayed ascending myelopathy. The patient suffered from orthostatic hypotension, weakness and sensory loss in the upper extremities and dyspnea. MRI showed more proximal progression of the spinal cord injury. There is no prevention or treatment for this condition. Materials and Methods: A 62-year-old man fell from heights and had 11th thoracic spine flexion-distraction injury. Upon arrival at the hospital, he was found to suffer from lower extremity weakness and sensory loss, but showed no neurologic symptom in his upper extremities. Two days later, we performed posterior instrumentation with fusion, and no postoperative neurologic symptom change was detected. One week after the fall, he suffered from dyspnea, upper extremity weakness and sensory loss. MRI was taken and we discovered that his spinal cord injury had proceeded to the 2nd cervical spine level. Results: Three months later, he showed little improvement in his upper extremity motor power, but not to the extent of the previous low spinal injury. Conclusion: Physicians should pay attention to the upper extremity and respiratory function of the patient with low spinal cord injury,because the level of spinal cord injury may proceed to a proximal level.