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2014, Vol.21, No.2

  • 1.

    A Survey on the Exercise Program after Surgery for the Herniated Lumbar Disc in the Hospital Websites

    Dae Moo Shim | KIM TAE KYUN | 임철민 and 2other persons | 2014, 21(2) | pp.57~62 | number of Cited : 1
    Study Design: Exercise therapy after lumbar disc herniation surgery which is presented through hospital website was studied. Objectives: To assess the efficacy of exercise therapy after lumbar disc herniation surgery; the methods of evaluation are identifiedthrough the participating hospital’s web site and exercise therapy that is presented on reference is compared. Summary of Literature Review: Exercise therapy after lumbar disc herniation surgery is effective; however, patient training is neededto ensure compliance. Materials and Methods: After searching on five different portals using the term ‘spine surgery,’ 230 websites were retrieved. Theperformance of lumbar disc herniation surgery and presentation of postoperative exercise therapy was discovered and the presentation ofexercise therapy for surgery type and departments difference were investigated. Exercise therapy were classified according to purposesand method for reference and the number of each exercise therapy was investigated. Exercises which were divided by postoperativeperiod were also investigated. Results: In 230 websites were retrieved; there were a total of 103 hospitals performing lumbar disc herniation surgery: 23 websites (22%)proposed exercise therapy after surgery is 23(22%), and 2(9%) of websites proposed exercise therapy for the type of surgery. The numberof exercise therapy proposed by the website was 15; of the exercises mentioned, deep abdominal muscle contractions was the mostcommonly mentioned, using the treadmill was least. There were 5 websites that proposed exercise therapy divided by postoperativeperiod. Conclusions: Only 22% of hospitals with websites that performed lumbar disc herniation surgery proposed postoperative exercisetherapy. Although th common trends seem biased, postoperative exercise therapy needs more attention and the construction of websitesfor patient access is necessary to provide better rehabilitation for patients. Key Words: Lumbar Disc Herniation, Postoperative exercise, Web site
  • 2.

    Changes of Spinopelvic Parameter using Iliac Screw In Surgical Correction of Sagittal Imbalance Patients

    Whoan Jeang Kim | 지용주 | 송대건 and 6other persons | 2014, 21(2) | pp.63~69 | number of Cited : 1
    Study Design: A retrospective-based study. Objectives: To evaluate the usefulness of iliac screws in the surgical correction of sagittal imbalance by changes of spinopelvicparameters. Summary of Literature Review: Although reports exist regarding the fusion rates on lumbosacral fusion by iliac screws, no previousstudies address the issue of changes of spinopelvic parameters on surgical correction of sagittal imbalance by iliac screws. Materials and Methods: We analyzed a total of 23 patients who were operated on by pedicle subtraction osteotomy and posteriorfusion on sagittal imbalance. Patients were divided into two groups: 1) non-iliac screw fixation and; 2) iliac screw fixation. The twogroups were compared during the preoperative and postoperative stages, and the last follow-up spinopelvic parameters of two groups. Results: Spinopelvic parameters, except for pelvic incidence, were corrected after surgery; some corrected values of spinopelvicparameters were lost during follow-up. There was a statistically significant difference in the last follow-up period between lumbarlordosis and pelvic tilt. Values of postoperative lumbar lordosis and pelvic tilt was similar to each other; however, during the follow-upperiod corrected values of spinopelvic parameters of non-iliac screw fixation group were more lost. There were no statistically significantchanges in postoperative and last follow-up sacral slope and pelvic incidence. Conclusions: Sagittal imbalance could be corrected by pedicle subtraction osteotomy, and corrected values of lumbar lordosis andpelvic tilt of iliac screw fixation group could be maintained well compared to non-iliac screw fixation. Iliac screw fixation could be usefulfor maintenance of corrected values of spinopelvic parameters in surgical correction of sagittal imbalance. Key Words: Sagittal imbalance, spinopelvic parameter, Surgical correction, Iliac screw
  • 3.

    Outcome Comparison between Percutaneous Vertebroplasty and Conservative Treatment in Acute Painful Osteoporotic Vertebral Compression Fracture

    나화엽 | Young-Sang Lee | 박태훈 and 2other persons | 2014, 21(2) | pp.70~75 | number of Cited : 0
    Study Design: A retrospective comparative study. Objectives: To compare the outcome of percutaneous vertebroplasty (VP) and conservative treatment for the treatment of acute painfulosteoporotic vertebral compression fractures (VCF). Summary of Literature Review: Vertebroplasty is a common procedure for the treatment of acute painful osteoporotic VCF. However,controversy still exists regarding clinical outcomes of the procedure compared with more conservative treatment. Material and Methods: A consecutive group of patients, undergoing VP and conservative treatment at our hospital, between July 2005and October 2008, were reviewed retrospectively. All patients were reviewed with at least 1 year of follow up. A total of 58 patientsunderwent 59 VP procedures under local anesthesia at post injury 2 weeks; a total of 31 underwent conservative treatment. These twogroups were compared by the kyphotic angle and loss of vertebral body height at immediate post-injury, post-injury 6weeks and 1y ear,radiologically. And they were compared by the visual analog scale(VAS) score and ambulatory status at the same time, clinically. Results: At the time of immediate post-injury, six weeks after post-injury, one year after injury, height loss was 29.73%, 19.81%, 22.59%in the VP group, respectively, and 31.20%, 36.80%, 40.60% in the conservative treatment group, respectively. The Kyphotic angles were13.44°, 9.10°, 11.31° in VP group, respectively, and 10.29°, 15.83°, 19.00° in the conservative treatment group, respectively. There was a statistically significant reduction of height loss and kyphotic angle in VP group at post-injury of 6 weeks and 1 year(p<0.05). At the same time, VAS scores were 9.41, 4.32, 2.47 in the VP group, respectively, and 9.50, 6.25, 2.71 in conservative treatment group,respectively. Ambulation status was 3.61, 1.46, 1.22 in the VP group, respectively, and 3.65, 2.45, 1.32 in the conservative treatmentgroup, respectively. There was a statistically significant reduction of VAS score and improved ambulation status in VP group at post-6weeks, but no difference between two groups at post 1 year. There was no significant difference in new fractures of adjacent vertebraebetween the two groups (p>0.05). Conclusions: VP prevents further collapse and kyphosis relieves pain quickly and allows early ambulation, but in post-injury 1 yearfollow up, there was no significant difference in clinical outcomes. Proper treatment should be done with respect to patient’s age, generalcondition, economic status and complication. Key Words: Vertebral compression fracture, Osteoporosis, Vertebroplasty, Conservative treatment
  • 4.

    Necessity of Whole Spine Standing Lateral Radiograph in Adults over 50 Years Old Who Have Degenerative Lumbar Disease - Comparison with Supine Lumbar Lateral Radiograph -

    Whoan Jeang Kim | 박건영 | 성환일 and 4other persons | 2014, 21(2) | pp.76~83 | number of Cited : 0
    Study Design: Cross-sectional study. Objectives: Sagittal imbalance cannot be predicted depending on the degree of lumbar lordosis. Thus, we tried to evaluate thenecessity of whole spine standing lateral radiograph through comparison of the spinal and pelvic parameter between supine lumbarlateral radiograph and whole spine standing lateral radiograph. Summary of the Literature Review: No studies in the literature compare supine lumbar lateral radiograph and whole spine standinglateral radiograph. Materials and Methods: We randomly selected 50 males and 50 females among the patients over the age of 50 who visited ourhospital for outpatient due to degenerative lumbar disease. Lumbar lordosis (sLL/wLL), sacral slope (sSS/wSS), and pelvic tilt (sPT/wPT) were measured and compared respectively by supine lumbar lateral radiograph and whole spine standing lateral radiograph. Wecategorized as group AI (sLL<30˚) and group AII (sLL≥30˚) by supine lumbar lateral radiograph and analyzed them. We also categorized asgroup BI (SVA≤5 cm) and group BII (SVA>5 cm) by whole spine standing lateral radiograph and analyzed them. Results: There were no statistical difference in lumbar lordosis (sLL/wLL: 35.1˚/37.7˚) and pelvic parameter (sSS/wSS: 32˚/31.7˚, sPT/wPT: 24.3˚/24.2˚. sPI/wPI: 56.3˚/58.2˚) between supine lumbar lateral radiograph and whole spine standing lateral radiograph, and therewere also no statistical difference between two groups (group AI & AII) in SVA, lumbar lordosis and pelvic parameter. Pelvic parametercompared by supine lumbar lateral radiograph and whole spine standing lateral radiograph based on sagittal balance was no significantdifference, but lumbar lordosis appeared statistical difference. Conclusion: Sagittal imbalance appears quite a lot in patients with degenerative lumbar disease and supine lateral radiograph can’treflect the whole sagittal imbalance. So, whole spine standing lateral radiograph should be performed routinely to analyze the sagittalalignment. Key Words: Degenerative lumbar disease, Supine lumbar lateral radiograph, Whole spine standing lateral radiograph, Sagittal balance
  • 5.

    Generation of Proinflammatory Mediator of Intervertebral Disc Cells by Nicotine Stimulation

    서형연 | 김도연 | 윤주현 | 2014, 21(2) | pp.84~89 | number of Cited : 0
    Study Design: Experimental investigation in vitro. Objectives: To evaluate the relationship between the degeneration of intervertebral disc cells, and low back pain induced bydegeneration of intervertebral disc cells and increases in use of proinflammatory mediators via nicotine stimulation. Summary of Literature Review: Smoking is a leading cause of degeneration of intervertebral disc cells and low back pain. Accordingto the existing literature, nicotine, one of the main ingredients in cigarettes, causes the degeneration of intervertebral disk cells includingdecrease of glycoprotein through generation of carboxy-hemoglobin, vasoconstriction, and disability of fibrinolysis and changes ofmetabolism of nucleus pulposus cells. Materials and Methods: Annulus fibrosus of intervertebral disc and knee joint cartilage were collected from pigs; these cells wereacquired by gradual enzyme decomposition. Using Trypan blue, concentration and survival rate of cells were examined; cells wereinserted on alginate beads for tertiary cultivation. Nicotine was then applied at 0, 50, 100, 200 and 300 nM, respectively, and the sampleswere cultivated for three, six and nine days, respectively. After collecting culture fluid, it was measured for interleukin(IL)-1β, IL-6 andIL-8 with the ELISA Test. DNA of cells used for cultivation was quantitated and the amount of the resulting proinflammatory mediatorwas normalized. The results were then compared with the result of same study on cartilage of porcine knee joints. Results: For changes of the inflammatory mediator based on the concentration of nicotine, in nicotine stimulation with low concentrationof 50 nM and the control group, there was no significant change, while transient increases of inflammatory mediator showed in nicotinestimulation with concentrations of 100, 200 nM, respectively. There was not a significant increase of IL-1β observed in all nicotinestimulation groups; these were the same results in porcine cartilage study. The level of IL-6 in 200, 300 nM nicotine concentrationshowed significant increases, respectively. The level of IL-8 in high dose nicotine stimulation groups also showed significant increasesof DNA on the sixth day. And in porcine cartilage study group, significant changes were observed in 200, 300 nM, but the absolute valuewas lower than that of annulus fibrous cells group. Conclusion: Inflammatory mediators such as IL-6 and IL-8 increased as the result of tertiary cultivation of annulus fibrosus cells ofporcine intervertebral disk and nicotine stimulation. It is believed that the cells of the disc annulus are more sensitive than articularchondrocytes to nicotine stimulation. This may be the focus of future long-term studies effects of nicotine other inflammatory cytokinesKey Words: Intervertebral disc, Annulus fibrosus, Proinflammatory mediator, Nicotine
  • 6.

    Spinal Epidural Abscess and Psoas Abscess Combined with Pyogenic Spondylodiscitis Following Vertebroplasty - A Case Report -

    Park, Jin-sung | KIM DONG HEE | 강번중 and 1other persons | 2014, 21(2) | pp.90~96 | number of Cited : 1
    Study Design: Case report. Objective: To report a case of extensive spinal epidural abscess and bilateral psoas abscesses combined with pyogenic spondylodiscitisafter a L3 vertebroplasty. Summary of Literature Review: Infection after vertebroplasty or kyphoplasty is a rare medical complication. Few reports on spinalepidural abscess and bilateral psoas abscesses, coupled with pyogenic spondylodiscitis after vertebroplasty, are available in the Englishmedical literature. Materials and Methods: The authors performed a clinical and radiographic case review. Results: A 74-year-old woman, without any existing medical illness, presented with a history of three weeks of lower back pain, fever,and neurologic deficits of both legs after vertebroplasty performed in another hospital. Magnetic resonance imaging demonstratedan extensive spinal epidural abscess from T10 to S1 and huge bilateral psoas abscesses combined with spondylodiscitis at L3-4. Urgent limited laminectomies and abscess drainage were performed from L1 to S1. The day after the operation, ultrasound-guidedpercutaneous drainage was performed to manage bilateral psoas abscesses. Methicillin-resistant Staphylococcus aureus was identifiedby intraoperative culture. Antibiotic therapy during hospitalization was maintained for six weeks with vancomycin and rifampicin. Theinfection was successfully treated without any neurologic deficit and spinal deformity. Conclusions: Vertebroplasty is relative safe and simple procedure; however, the procedure also may cause severe spinal infection. Aseptic techniques under sterile environment was required during surgery. It is important that early diagnosis and prompt surgicaldecompression in spinal epidural abscess with neurologic deficit. Limited surgery and antibiotic therapy could be a good treatment optionin spinal epidural abscess combined with pyogenic spondylodiscitis. Key Words: spinal epidural abscess, psoas abscess, pyogenic spondylodiscitis, vertebroplasty, complication
  • 7.

    Suspicious Reperfusion Injury of Spinal Cord After Multilevel Cervical Posterior Decompression without Remarkable Surgical Insult - Two Case Reports -

    이규열 | 유성곤 | 김기웅 | 2014, 21(2) | pp.97~102 | number of Cited : 0
    Study Design: Two case reports. Objectives: We present two cases of quadriplegia after posterior decompression with fusion caused by a suspicious reperfusion injuryof spinal cord without remarkable surgical insult. Summary of Literature Review: Posterior decompression and posterolateral fusion have been reported as effective procedures inpatients with multilevel myelopathy. However, postoperative spinal cord injury without remarkable intraoperative technical damagehas been reported in a few articles. Reperfusion mechanism was suggested as one of the leading causes and reported in some animalmodels. Materials and Methods: There was one case of ossification of the posterior longitudinal ligament and one developmental multilevelstenosis that underwent laminectomy with lateral mass instrumentation. After surgery, the patients presented with quadriplegia; MRIdemonstrated swelling of the spinal cord and intramedullary lesion in two cases. Results: After surgery, the patients presented with quadriplegia; MRI demonstrated swelling of the spinal cord and intramedullary lesionin two cases. Conclusion: Although patients with such a medical condition are rare, it is difficult to predict postoperative swelling of the spinal cordbefore surgery. The surgeon should thus be aware of such rare disease conditions involving the spinal cord before the surgical procedure. Key Words: Cervical myelopathy, Posterior decompression, Reperfusion injury