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2014, Vol.21, No.3

  • 1.

    Biphasic Calcium Phosphate and Local Autobone Mixed Graft in Lumbar Posterolateral Fusion

    Jung-Wook Huh | Young-Chul Ko | Chul-Young Jung and 5other persons | 2014, 21(3) | pp.103~108 | number of Cited : 1
    Study Design: Retroprospective study. Objectives: To evaluate the efficacy of biphasic calcium phosphate and local autobone mixed graft in cases of spinal stenosis andspondylolisthesis in posterolateral fusion by examining radiologic union rates and clinical outcomes. Summary of Literature Review: It can be a practical alternative to the use of tricalcium phosphate in hydroxyapatite as a graft aidsince using hydroxyapatite mixture in lumbar spine fusion has been reported to lead to a high rate of bone union. Materials and Methods: From July 2011 to February 2013, we followed up 107 patients who had lumbar posterolateral fusion usingbiphasic calcium phosphate composed of HA/TCP (60:40) and local autobone mixed graft. Of these patients, 64 had spinal stenosis and43 had spondylolisthesis. The bone fusion rate was determined using Lenke’s criteria and clinical outcomes were evaluated using Kim’smethod. Results: In spinal stenosis, bone union was presented in 53 patients (of 64; 82.8%) and in spondylolisthesis, 35 patients (of 43;81.4%). In spinal stenosis, the clinical outcomes resulted in 20 excellent, 34 good, 9 fair and 1 poor. (84.4%, excellent or good) Inspondylolisthesis, the clinical outcomes resulted in 10 excellent, 25 good, 7 fair and 1 poor. (81.4%, excellent or good)Conclusion: Posterolateral fusion using biphasic calcium phosphate and local autobone mixed graft showed high rates of bone unionand acceptable clinical outcomes, and is considered a satisfactory bone graft aid. Key Words: Spinal stenosis, Spondylolisthesis, Biphasic calcium phosphate, Posterolateral fusion
  • 2.

    Effectiveness of Selective Nerve Root Block for the Patient with a Single Level Lumbar Spinal Stenosis who is on the Operation Schedule

    Dae Ho Ha | Kim Yu Mi | Dae Moo Shim and 3other persons | 2014, 21(3) | pp.109~115 | number of Cited : 0
    Study Design: Retrospective study. Objectives: We reported the therapeutic usefulness of a selective nerve root block (SNRB) for patients with a single level spinalstenosis. Summary of Literature Review: Selective nerve root block for the radiculopathy due to lumbar disc herniation, spinal stenosis, andspondylolisthesis have been reported frequently. Materials and methods: We retrospectively examined 44 patients with single-level spinal stenosis, for whom surgical treatment wasconsidered due to the failure of other conservative treatments from January 2005 to January 2010. All 44 patients were admitted forsurgical decompression. Selective nerve root block was done just before a final decision of surgical procedure; patients with his or her 50% or more pain reduction could avoid surgery. Results: In fourty-four cases, twenty-seven pateints underwent a surgical operation. Seventeen patients avoided surgical proceduresby successful SNRB. As a result of a 3 year follow-up, the VAS score was significantly and continuously low on the operation group(p=0.02~0.03). K-ODI and Roland-Morris Disability scores were low in both groups until 1 year after the operation and SNRB procedure(p=0.026~0.042, p=0.03), but there was no statistically significant difference beteween the two groups after 2 years upon followup(p=0.072~0.14, p=0.06). Generally, the operation group had good results until 1 year after operation and had better tendency forimprovement. The data displayed a high probability of surgical treatment among the patients with foraminal stenosis (p=0.039)highlight – this sentence says there is no difference after 1 year and there is still no difference after 2 years. If this is true, the sentenceneeds to be rewritten so that it says both times show no difference. If there is a difference between 1 year and 2 year then the sentenceneeds to be rewritten to make this more clear. The next sentence seems to say they are different. Conclusions: Selective nerve root block avoided the surgical intervention in 39% of the patients with the spinal stenosis refractory tothe conservative treatment. Thus it is one of options for the refractory spinal stenosis.
  • 3.

    Clinical Results And Prognostic Factors for Thoracic Myelopathy Caused by Ossification of Yellow Ligament after Surgical Treatment

    Whoan Jeang Kim | 송대건 | 박건영 and 4other persons | 2014, 21(3) | pp.116~122 | number of Cited : 0
    Study Design: Retrospective study. Objectives: We analyzed the clinical results of thoracic myelopathy caused by ossification of yellow ligament (OYL) and to exploreprognostic factors after surgical treatment. Summary of Literature Review: Thoracic myelopathy due to OYL is difficult to treat; surgery is considered as treatment of choice. However, studies of the clinical results and prognostic factors are few due to its rare presentation. Materials and Methods: Twenty six patients who had surgery for thoracic myelopathy caused by OYL were evaluated from February2002 to April 2012. We describe the analysis of the clinical results after surgery and prognostic factors. Results: Modified Japanese orthopedic association (JOA) score was recorded in all patients by 5.7±1.3 points (range, 2-9 points)preoperatively, 7.8±1.7 points (range, 4-10 points) postoperatively, and 8.4±2.1 points (range, 5-11 points) at final follow-up. Hirabayashirecovery rate was recorded by 60.2±20.2% (range, 45.5-72.0%) postoperatively, 64.5±17.3% (range, 50.2-75.1%) at final follow-up. The Visual Analogue Scale (VAS) score was also improved by 7.6±1.8 points (range, 7-10 points) preoperatively, 4.5±1.3 points (range,3-6 points) postoperatively, and 3.8±1.6 points (range, 2-5 points) at final follow-up. Both modified JOA score and VAS score improvedsignificantly (p<0.05). In prognostic factor analysis, OYL type on CT axial image, duration of symptom, and preoperative severity ofmyelopathy was significant (p<0.05). Conclusion: We showed the effectiveness of surgery on patients who suffer from thoracic myelopathy caused by OYL and that OYL typeidentified by CT axial image, duration of symptom, and preoperative severity of myelopathy were significant prognostic factors. Key Words: Ossification of yellow ligament, Thoracic myelopathy, Clinical result, Prognostic factor
  • 4.

    Infectious Spondylitis Mimicking Osteoporotic Vertebral Compression Fractures - Report of Two Cases -

    Chang-Bae Kong | Bong-Soon Chang | Choon-Ki Lee | 2014, 21(3) | pp.123~128 | number of Cited : 0
    Study Design: Case study of two cases. Objectives: The aim of our study is to describe the rare MR imaging patterns of infectious spondylitis. Summary of the Literature Review: It is generally accepted that the intravertebral cleft sign is not shown in cases of infection ormalignancy, and thus, its recognition can obviate unnecessary imaging or biopsy because of its benign significance. Materials and Methods: Two patients are presented who developed worsening back pain after a minor trauma. Preoperative MRimages of these patients showed intravertebral fluid and benign vertebral compression fractures. Anterior decompression and fusionwere done and the bacteria isolated from the intraoperative cultures were Listeria monocytogenes and Mycobacterium tuberculosis,respectively. Results: After 2 years of follow-up, the patients were free of pain, without signs of infection, and showed correct fusion. Conclusions: MR findings in infectious spondylitis may simulate the patterns of osteoporotic VCFs. Key Words: Infectious spondylitis, Vertebral compression fractures, MR findings, Intravertebral cleft sign, Hematological parameters
  • 5.

    Conus Medullaris Syndrome Caused by Delayed Recollapse after Surgery of Burst Fracture - A Case Report -

    Jaewan Soh | 신병준 | Jae Chul Lee and 1other persons | 2014, 21(3) | pp.129~133 | number of Cited : 0
    Study Design: A case report. Objectives: Lumbar burst fracture was treated with operation, which delayed recollapse of L1 and led to conus medullaris syndrome. Summery of Literature Review: After operation, conus medullaris syndrome causing by delayed recollapse is not frequently reported. Materials and Methods: A 56-year-old male was admitted with lower back pain caused by a fall. Radiologic findings showed L1 burstfracture with about 42% of height loss. There was no neurologic deficit. Posterior fusion was performed using instrumentation. Fiveweeks after the operation, the patient was admitted for urination and defecation difficulty. Radiologic findings showed that the L1 hadrecollapsed with about 38% of height loss. To resolve the problem, anterior surgery was performed. Results: Two years after surgery, bladder and anal sphincter dysfunction wasn’t recovered. Conclusions: Lumbar burst fracture should be follow up carefully until union of the fracture because burst fracture leads to delayedrecollapse. Key Words: Lumbar spine, Conus medullaris syndrome, Burst fracture, Recollapse
  • 6.

    Sequestrated Intradural Disc Herniation Around Couns Medullaris - A Case Report -

    이재원 | Park Ye-Soo | 서완식 and 1other persons | 2014, 21(3) | pp.134~138 | number of Cited : 0
    Study Design: A case report. Objectives: To report a rare case of intradural disc herniation (IDH) around conus medullaris. Summary of Literature Review: IDH is rare with an incidence of less than 1% of all lumbar disc herniations. It is important todifferentiate IDH from other condition with accurate diagnosis and subsequent surgical treatment. IDH has a higher risk of neurologicdeficit, like conus medullaris syndrome and cauda equina syndrome. Materials and Methods: A 62 year-old male was affected by lumbar back pain radiating to the anterolateral aspect of the right thighfor 5 days. MRI showed a mass that existed on the anterior portion of the conus medullaris. We performed partial laminectomy at the L1-L2level. The mass located anteriorly in the intradural space was eliminated after durotomy by a posterior approach. Results: We confirmed the IDH for histopathology. Conclusions: IDH usually needs accurate differential diagnosis. Preoperative MRI scans are necessary to differentiate IDH from otherintradural lesions. The confirmative diagnosis can be done only in the operative field. Key Words: Intradural disc herniation, Conus medullaris