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Study Design: Retrospective study. Objectives: The purpose of this study was to investigate whether preoperative sagittal alignment and range of motion (ROM) affectadjacent segment degeneration (ASD) and disease after anterior arthrodesis in degenerative cervical spinal disorders. Summary of Literature Review:There is no study about the relationship between preoperative ROM and sagittal alignment and thedevelopment of ASD yet. Materials and Methods: We took a retrospective approach to study 136 patients who underwent an anterior arthodesis for less than 2segments with PEEK cage and plate construct method for degenerative cervical diseases and who have a minimum of 3 years of followup. We analyzed ASD and cervical ROM, such as less than 40°(group A) and more than 40°(group B) and sagittal alignment, such aslordosis or kyphosis with less than 10°(group a), 10°~30°(group b) and more than 30°(group c). Adjacent segment degeneration wasgraded according to Park’s classification and Hillibrand method. Results: There was no statistically significant difference between group A(1.35±0.48) and group B (1.44±0.50) in the correlation betweenthe cervical ROM and the variation of disc height(p=0.07). Concerning the relationship between the ROM and osteophyte formation onadjacent segment, no statistically significant difference has been found between group A(1.64±0.88) and group B(1.43±0.67) (p=0.06). The disc height change at the final follow up after cervical sagittal alignment showed no statistically significant difference among thegroups: Group A presented with 1.53±0.50, group B with 1.30±0.46 and group C with 1.40±0.50.(p=0.08) Regarding sagittal alignment andosteophyte change, there was no statistically significant difference among the groups as group A showed an average of 1.33±0.48, groupBan average of 1.56±0.88 and group Can average of 1.60±0.82(p=0.07). Conclusion: Although the preoperative sagittal alignment and ROM did not significantly affect adjacent segment degeneration anddiseases in a mid-term follow-up evaluation after anterior arthrodesis with PEEK cage and plate in degenerative cervical spinal disorders,we think a future study is required with a sufficient number of patients and a long term follow-up because there were borderlinestatistical significances shown in the present study.

Study Design: Prospective clinical study. Objectives:The aim of the study was to verify the effectiveness of L2 spinal nerve root block for patients who are suffering from lowback pain and referred pain with compound causes. Summary of Literature Review: Most of low back pain and referred pain arises from discs, facet joints and sacroiliac joints. Allstructures above have the pain perception pathway through sympathetic nerves with a connection to L2 spinal nerves. Materials and Methods: We selected patients with low back pain and referred pain for more than 2 weeks. Each 50 patients wererandomly allocated to an experimental and a control group.The experimental group underwent a L2 spinal nerve root block with 2cc of0.25% bupibacaine at the symptom dominant side. The control group underwent a skin infiltration with 2cc of 2% lidocaine only. Thepain was assessed with a visual analogue scale (VAS) consisting of 100 points at 5minutes, day 1, day 3, day 5, day 7 and day 30 postprocedure. Results: Both groups showed a significant improvement after the procedures(p=0.000). However, a greater improvement wasshown in the experimental group(p=0.000). In the individual analysis, the experimental group had improved as time elapsed and thesignificancewas maintained until 30 days. However, in control group, the significance was lost at day 30. Conclusion: L2 spinal nerve root block is recognized to reduce the low back and referred pains which arise from compound causes in adegenerative spinal disease.

Study Design: Retrospective study. Objectives: The aim of this study was to report the usefulness of lumbar posterior foraminotomy and central decompression usingtubular retractor with minimally invasive technique. Summary of Literature Review: Posterior decompression and arthrodesis for the treatment of lumbar spinal stenosis with foraminalstenosis is a classical surgical method. It is inappropriate for patients who have rejection to arthrodesis or medical problems, because itmay have several complications. Materials and Methods: Clinical results were obtained from 12 patients who underwent posterior foraminotomy and centraldecompression from January 2009 to April 2011 and were assessed using a Visual analogue scale, Oswestry disability index and theProlo outcome scale. Results: Six Of 12 patients showed immediate relief of radiculopathy. Postoperative posterior lumbar pain and spasm were negligible,and no surgically related complication was noted. During the follow-up period, the Oswestry disability index decreased from24.25±2.89(pre-op) to 19.33±3.02(Last F/U)(p=0.28, paired t-test) in 8 of 12 patients. Conclusions: A minimally invasive posterior foraminotomy and central decompression could be an alternative surgical option for thetreatment of lumbar spinal stenosis with foraminal stenosis, especially in subjects with old age, having medical problems and refusal ofarthrodesis.

Study Design: A retrospective study. Objectives: To assess the relationship between surgical outcomes and preoperative MRI findings, a retrospective review was conductedon the surgical outcomes depending on the preoperative MRI findings including type of herniation and Modic changes. Summary of Literature Review: In most reports, the patients that have large disc herniation were expected to have improved surgicaloutcomes. However, there have been controversies regarding the outcomes and Modic changes. Materials and Methods: The retrospective review was conducted in 82 patients who underwent a discectomy for single level lumbardisc herniation. The average follow-up period was 34.2 months. Among their preoperative baseline MRI measurements, the stage of discherniation, degree of nerve root compression, degree of dural sac compression, and Modic change of vertebral endplate were evaluatedfor the subsequent comparison between the preoperative and postoperative changes and ODI score. Results: Patients with extrusion or sequestration type showed significant improvements compared to the patients with protrusion typedisc herniation. By degree of nerve root compression, patients with root compression showed significant improvements compared to thepatients who had contact type. The degree of dural sac compression revealed no correlation with changes in the ODI score. 23 of the 82patients, the preoperative MRI showed a Modic change. Compared to the group who did not show such a Modic change, they turned outto be unrelated to the preoperative and postoperative changes in the ODI score. Conclusion: Patients who had extrusion or sequestration type disc herniation showed a better clinical improvement than protrusiontype. Patients with compression type root lesion showed better clinical improvement than contact type root lesion. No correlation wasnoted regarding the outcomes of the surgical treatment and degree of dural sac compression or Modic changes.

Study Design: Retrospective study. Objectives: We studied the clinical results and prognostic factors for the postoperative caudaequinasyndrome (CES). Summary of Literature Review: The CES is a rare complication, but its aftereffects are serious. And no satisfactory discussion about itsaccurate treatment guidelines and prognosis has been provided yet. Materials and Methods: 10 patients who were diagnosed with a postoperative CES were enrolled from June 2004 to February 2011. Patients were classified into group I with a favorable neurologic prognosis and groupII without neurologic improvement. The medicalhistory, diagnosis, involved segmentand duration till CES was obtained, the duration was performed till second decompression and theclinical symptoms and the outcome of surgical treatment were investigated. Results: Group I contained of 6cases and group 4 of cases.On average were 1.25(0.5-3) hours required for group I and 22(8-38) hours forgroup II until CES was diagnosed. The time span for the second operation was 7(3-12) hours for group I and 12.25(5-24) hours for groupII. Of 6 cases showing motor losswere 4 cases classified as group II at the last follow-up. Of 10 cases with voiding difficulties belonged 4cases to the group II. Voiding difficulty was continued as clinical symptom in 4 patients of group II after the secondary decompression. Conclusion: The less the motor loss and voiding difficulty before the secondary decompression and the faster diagnosis and surgicaldecompression, the better the prognosis. In particular, as voiding difficulty showed the lowest recovery rate, it is considered to affectprognosis and satisfaction most seriously.

Study Design: Retrospective study. Objectives: The aim of the study was to investigate the usefulness of a handheld digital pulse oximetry in the detection of lowerextremity arterial disease. Summary of Literature Review: Pulse oximetry is a well-established method for noninvasive evaluation of arterial oxygenation. Materials and Methods: A Retrospective study was performed in 45 patients with lower extremity arterial disease. We compared theaccuracy of a handheld digital pulse oximetry and the ankle brachial index (ABI). Digital pulse oximetry was conducted for 42 patientswith 84 limbs to measure the SaO2 of their index fingers and big toes in supine position. The ABI was defined as abnormal if it was lessthan 0.9. Pulse oximetry of big toes was defined as abnormal if the SPO2 was less than 96% or it was more than 2% lower than that ofthe index finger. Results: Digital pulse oximetry had a sensitivity of 47%(95% CI, 34-60%) and specificity of 86%(95% CI, 64-96%). ABI had a sensitivityof 49%(95% CI, 34-64%) and specificity of 95%(95% CI, 72-99%). Positive predictive values were 91%(95% CI, 74-98%) for digitalpulse oximetry and 96%(95% CI, 77-99%) for ABI. Negative predictive values were 37%(95% CI, 24-51%) for digitial pulse oximetry and43%(95% CI, 25-72%) for ABI. In 22 cases with acute ischemicwere the sensitivity 73%, the specifity 100%, the positive predictive value100% and the negative predictive value 79%. Conclusions: Handheld digital pulse oximetry of the big toes seems as accurate as ABI to detect lower extremity arterial diseases. Thecombination of both will help to distinguish low extremity arterial disease and spinal radiculopathy.

Study Design: A review of related literatures of diagnosis and treatment of spinal tuberculosis. Objectives: The aim of the study was to discuss treatment strategies by understanding of emerging problems related to spinaltuberculosis. Summary of Literature Review: Owing to modern diagnostic modalities, development of prevention and chemotherapy, the incidencesof tuberculosis infection including spinal tuberculosishave been decreasing. Moreover, these medical these improvements of medicaland surgical treatments the improvement of surgical techniques for spinal tuberculosis reduced the incidence of kyphosis or neurologiccomplications such as Pott’s paralysis. Materials and Methods: Review of related literatures. Results: Recently,the occurrence of multi-drug resistant strain, an increasing number of opportunistic infections and an atypicalpresentation in spinal tuberculosis are emerging as new challenges. Conclusions: An appropriate diagnosis and surgical interventions are our obligation as clinicians dealing with this unique infectiousdisease to minimize the complications for the treatment of spinal tuberculosis.

Study Design: This is a retrospective clinical study. Objectives: To compare the efficacy of lidocaine and bupivacaine for the ultrasound-guided lumbar medial branch block in chronic lowback pain. Summary of Literature Review: There is no study for comparison of the efficacy between lidocaine and bupivacaine for the medialbranch block. Materials and Methods: From August 2011 to May 2013, 186 patients were assigned 0.5% lidocaine(n=136) or 0.25%bupivacaine(n=45) for the ultrasound-guided lumbar medial branch block. All procedures have been performed by the same operator, and23G, 10 cm needle was placed and drug was injected under ultrasound guide. To target medial branches from lumbar spinal nerve, thegroove at the root of transverse process and the base of superior articular process has been identified on transverse scan. Patients wereevaluated by pre- and post-interventional(1 hour) Visual Analog Scale and analyzed statistically. Results: Reduction of VAS score in bupivacaine group is significantly greater than that in lidocaine group and post-interventional VASscore in bupivacaine group is significantly lower than that in lidocaine group through analysis of covariance test with adjusted preinterventionalVAS score. In multivariate analysis, while age, sex and treatment level were not significant factors, pre-interventionalVAS score and the kind of drug were significant factors. Severe pain before treatment and bupivacaine was indicator of better result. Bupivacaine group reduced pain score in the VAS 2.285 more than lidocaine group with adjustment with other factors. Conclusions: Bupivacaine is more effective than lidocaine in the reduction of pain after ultrasound-guided lumbar medial branch blocksin posterior facet joint syndrome.