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2014, Vol.21, No.4

  • 1.

    The Analysis of the Outcome of Short- and Long-Segment Posterior Instrumentation for Thoracolumbar Bursting Fractures

    김우철 | 이규열 | Wang Lih and 3other persons | 2014, 21(4) | pp.139~145 | number of Cited : 1
    Study Design: A retrospective study. Summary of the Literature Review: The reports comparing short- and long- segment instrumentation are insufficient. Objectives: To determine the postoperative results and to analyze relative factors affecting results between short- and long-segmentinstrumentation in thoracolumbar fractures. Materials and Methods: From March 2006 to March 2012, 97 patients with thoracolumbar fracture were treated with posterior instrumentation. They were divided into 2 groups, the short- (Group I) and long-segment groups (Group II). To analyze factors affecting results,several factors including age, anterior column height (ACH), and the kyphotic angle were reviewed. For radiologic evaluation, postoperativeand follow-up radiographs were evaluated by measuring the kyphotic angle and ACH. Additionally, the presence of complicationswas reviewed. Results: Groups I and II consisted of 45, 52 cases and had mean ages of 50.3, 55.8 years, respectively. In Group I, the ACH increasedfrom 44.2% to 75.3% postoperatively, and remained 72.8% at follow-up. The kyphotic angle decreased from 19.4° to 10.6° postoperatively,and remained at 12.8° at follow-up. In Group II, the ACH recovered from 41.6% to 76.4% postoperatively, and was 74.8% atfollow-up. The kyphotic angle decreased from 21.6° to 12.6° postoperatively, and was 13.9° at follow-up. The canal compromise, age,and comminution were not directly related with results. However, the mean age of the 7 cases showing complications was 72 years, andthe 7 cases had severe comminuted fractures. Conclusions: The short- and long-segment instrumentations of thoracolumbar fractures are not significantly different with respect tothe results attained. However, in order to decrease complications, we should pay attention to age and fracture comminution. Key Words: Thoraolumbar, Burst fracture, Pedicle screw, Long segment, Short segment
  • 2.

    Cement Leakage after Vertebroplasty; Correlation with Patterns of Compression Fractures and Bone Mineral Density (BMD)

    김성완 | 안영준 | 양보규 and 6other persons | 2014, 21(4) | pp.145~150 | number of Cited : 0
    Study Design: Retrospective studyObjectives: To analyze the influence of fracture patterns and the result of bone mineral density on cement leakage after percutaneousvertebroplasty for osteoporotic vertebral compression fractures. Summary of Literature Review: Leakage of bone cement after vertebroplasty has known to be related with the direction of corticaldisruption of fractured vertebral body and low bone mineral density (BMD). Materials and Methods: One hundred eighty-two patients with osteoporotic vertebral compressions were studied from January 2009to August 2013. The patients’ fracture levels and patterns were compared. Among them, the cement leakage patterns were analyzedin 105 patients who had undergone vertebroplasty. The findings were compared with fracture patterns including cortical disruption andBMD. Results: Seventy-five cases of cement leakage were observed. Among them, intradiscal leakage was the most common type of leakage. In the patient group with low BMD, there was a high incidence of lower and posterior cortical disruption in the fractures. Patientswith posterior cortical disruption demonstrated a higher incidence of leakage into the spinal canal and anterior cortex. No significantcorrelation was observed between fracture patterns and leakage. Conclusions: A surgeon should use caution in performing vertebroplasty in patients with low BMD and posterior disruption of thevertebral cortex.
  • 3.

    A comparison of Decompression and Fusion Surgery in Lumbar Degenerative Spondylolisthesis

    안중현 | Sung-Woo Choi | 신병준 and 2other persons | 2014, 21(4) | pp.151~158 | number of Cited : 0
    Study Design: A retrospective, controlled studyObjectives: To assess clinical and radiologic results of decompression without fusion surgery in the treatment of stable lumbardegenerative spondylolisthesis (LDS) and to compare clinical outcomes of fusion surgery. Summary of Literature Review: Although it is reported that decompression surgery is effective in treating LDS, few reports havecompared the outcomes of treatment using decompression and instrumented fusion. Materials and Methods: A retrospective study was performed and fifty eight degenerative spondylolisthesis patients who receiveddecompression treatment with or without fusion surgery with follow up for at least 2 years were included. The number of patients inthe decompression and fusion groups were 23 each and they were selected with age and slip degree taken into account. Clinical factorswere evaluated using the Oswestry Disability Index (ODI), Visual Analogue Scale (VAS) of the back/leg and high risk of operation. Radiological factors were evaluated such as slippage, angulation, and disc height at the affected level in preoperative and final followup. Results: There was no statistical difference between the decompression and fusion groups in the VAS of the back/leg, slippage, andhigh risk of operation preoperatively (p>0.05). The mean operative time was 73.9 minutes in the decompression group and 123.7 minutesin the fusion group. The mean blood loss was 134.5mL in the decompression group and 323.5mL in the fusion group. VAS of the back/legand ODI improved in both groups and there were no significant differences between the two groups statistically. Conclusions: Decompression with/without fusion had a favorable clinical outcome in stable degenerative spondylolisthesis patients. However, fusion involves more operative time and blood loss compared to simple decompression. Simple decompression is a goodtreatment option, especially in operative high risk patients.
  • 4.

    Change of Lumbar Isometric Extensor Strengths after Posterior Lumbar Interbody Fusion in Patients with Lumbar Degenerative Disease

    Seo Yong Gon | LEE, CHONG SUH | Kyung Chung Kang and 1other persons | 2014, 21(4) | pp.159~165 | number of Cited : 1
    Study Design: Prospective cohort study. Objectives: This study was undertaken to examine changes in lumbar isometric extensor strength after posterior lumbar interbodyfusion (PLIF) surgery. Summary of Literature Review: In most reports, the patients that have undergone PLIF surgery have been shown to have muscleweakness and atrophy. However, the research conducted regarding the changes in muscle strength throughout a follow up period isinsufficient. Materials and Methods: Forty-nine patients (mean age, 65 years (range, 45 to 77)), scheduled for posterior lumbar interbody fusion dueto symptomatic degenerative diseases, were enrolled. Preoperatively and 3, 6, and 12 month after surgery, lumbar isometric extensorstrength was assessed using a MedX instrument in 7 angular positions (0-72°). The mean isometric strength and rate of increase werecalculated. Isometric strengths were compared according to patients’ age (<60, 60-70, and ≥70 years) and fusion level (short: <3; andlong: ≥3) and the respective relationships were analyzed. Results: The mean isometric strength changed from 89.0 preoperatively to 85.3, 110.4, and 120.8 ft-lb at each follow-up, respectively. The rate of increase of strength was significantly greater at 0°(36.1 %) than at 72°(24.2 %) (p=0.019). Preoperative isometric strengthswere similar in each age and fusion level group, but isometric strengths at the final follow-up were significantly lower in older patientsand in the long level fusion group (p=0.002 and 0.043, respectively). Mean isometric strength at the last follow-up showed significantassociations with age and fusion level (r=-0.431 and -0.317, p=0.002 and 0.030, respectively). Conclusion: After lumbar fusion surgery, back muscle strength slightly decreased until 3 months and then significantly increased. However, postoperative strength increases were lower in older patients and those in the long level (>3) fusion group. These results couldbe basic data for a rehabilitation program after lumbar fusion.
  • 5.

    Clinical Usefulness of Fentanyl Matrix Patch for the Patients with Chronic Low Back Pain

    정구영 | 전창훈 | Chung, Nam-Su and 1other persons | 2014, 21(4) | pp.166~172 | number of Cited : 0
    Study Design: Prospective observational study. Objectives: The aim of this study was to examine the usefulness of a fentanyl matrix patch in the management of chronic low back pain. Summary of Literature Review: Chronic low back pain is a significant disabling disease with high medical costs and socioeconomicaleffects. Oral medication is a fundamental tool for conservative treatment. The fentanyl matrix patch is currently regarded as analternative method for oral medication, however, the usefulness of the fentanyl matrix patch has not been fully evaluated. Materials and Methods: From September 2008 to May 2009, a multicenter, open, prospective observational study was conducted. The inclusion criteria included chronic pain patients that did not respond to conservative pain management. The clinical usefulness wasevaluated with pain intensity, and the KEQ-5D (Korean version of Euro QoL-5 dimension). Results: Overall, 538 patients were included in this study. The pain intensity decreased about 1.84 ± 1.91 at the second visit and furtherdecreased by about 2.52 ± 2.34 at the third visit (p<0.0001). The KEQ-5D score decreased about 0.12 ± 0.18 at the second visit, anddecreased further to 0.18 ± 0.24 at the third visit (p<0.0001). The number of patients with adverse effects was 121 (22.49%). Conclusions: The fentanyl matrix patch improves the pain and disability in patients with chronic low back pain. It is a useful alternativemethod for the management of chronic low back pain.
  • 6.

    Failure of Long Spinal Construct and Pseudarthrosis in a Patient with Parkinson Disease for the Treatment of Degenerative Lumbar Spinal Disorder - Case Report –

    김홍균 | 나현우 | 정국진 | 2014, 21(4) | pp.173~177 | number of Cited : 0
    Study Design: case report. Objective: We report a case of treated failure spinal construct and pseudarthrosis in a patient with Parkinson’s disease. Summary of Literature Review: There have been no reports about revision surgery due to failure and pseuarthrosis of degenerativelumbar spine disease in patients with Parkinson’s disease. Materials and Methods: A 55-year-old female who had been diagnosed with Parkinson’s disease 4 years ago presented with backpain and radiating pain on both legs. Radiographic assessment showed spinal stenosis from L2 to L5 combined with degenerativespondylolisthesis at L3-4. Posterior decompression, instrumentation, and posterolateral fusion were performed and her symptomsimproved. Results: Two years after the operation, she complained of severe back pain without injury. A simple X-ray showed the pull out ofbilateral L5 screws, and revision surgery was performed. Three years after the revision, she underwent re-reoperation due to metalfailure. The breakage of a unilateral pedicle screw at L5 was found, and her fusion level was extended to S1 with a posterior lumbarinterbody fusion with cages and alar screws. Finally, she has not shown any further failure but, a sagittal imbalance and aggravation ofpelvic incidence due to Parkinson’s disease have been detected. Conclusions: Spine surgeons always should consider metal failure, pseudarthrosis, and aggravated spinal imbalance caused by naturalhistory in patients with Parkinson’s disease.
  • 7.

    Old and New Fashion: Minimally Invasive Spine Surgery for Adjacent Segmental Spinal Stenosis after Luque Sublaminar Wiring and Posterolateral Fusion - Case Report -

    Seung-Pyo Suh | Chang-Nam Kang | 이재원 | 2014, 21(4) | pp.178~181 | number of Cited : 0
    Study Design: A case report. Objectives: To report a rare case of minimally invasive spine surgery after sublaminar wiring fixation with Luque rods. Summary of Literature Review: In the past, sublaminar wiring fixation with Luque rods was believed to be an effective fixationmethod; however, the development of transpedicular fixation resulted in the discontinuation of this method. Currently, instead of classicalsurgery using a broad incision, minimally invasive spine surgery is performed, which has a multitude of advantages. Material and Methods: Initially, the patient underwent Luque sublaminar wiring and posterolateral fusion. After 25 years, minimallyinvasive TLIF and percutaneous transpedicular fixation were performed for the adjacent segmental spinal stenosis. Results: A good bone union is developing with an excellent clinical outcome, 14 months after the surgery. Conclusions: We report a very rare case of a patient who underwent Luque sublaminar wiring and then, 25 years later, had spinesurgery with minimally invasive techniques.
  • 8.

    Cerebellar Hemorrhage after Posterior Lumbar Decompression and Interbody Fusion Complicated by Dural Tear - A Case Report -

    최병완 | 이상민 | 윤민근 and 1other persons | 2014, 21(4) | pp.182~187 | number of Cited : 0
    Study Design: A case report. Objectives: To report a rare case of remote cerebellar hemorrhage (RCH), which was a complication after posterior decompression andlumbar interbody fusion (PILF). Summary of Literature Review: Remote cerebellar hemorrhage (RCH) after spinal surgery is a rare complication, and its cause isknown to be due to a loss of cerebral spinal fluid (CSF) through the dural tear. Most of the literature has disclosed that early diagnosisand treatment of RCH is very important in the patient with suspicious symptoms. Materials and Methods: A 57-year-old woman had posterior lumbar decompression and interbody fusion for the severe spinal stenosisat L4-5. During surgery, an accidental dural tear with CSF leakage occurred. The torn dura was sutured. Postoperatively, she developednausea and a severe headache. Hypotension developed at postoperative 2 hours. A brain CT showed RCH. The patient was conservativelymanaged with clamping of the wound drainage. Results: The nausea and severe headache were controlled and normal blood pressure could be maintained without dopamine therapyat postoperative day 2. The patient was discharged without any neurological deficit, and her consciousness was clear at postoperative 2weeks. Conclusions: Persistent postoperative nausea, headache, and hypotension after repair of the torn dura may suggest that the treatingsurgeons pay careful attention due to the possibility of RCH, even though the amount of CSF leakage is small.
  • 9.

    Epidural Gas-containing Pseudocyst in Lumbar Spine - A Case Report -

    김우성 | 이영상 | 김태현 and 1other persons | 2014, 21(4) | pp.188~192 | number of Cited : 0
    Study Design: Case report. Objectives: We report two cases regarding epidural air pseudocyst at the lumbar spine. Summary of Literature Review: Epidural air pseudocyst at the lumbar spine that provokes radiating pain and neurologic symptomscan be misdiagnosed as an epidural tumor or HIVD. Consequently, proper diagnosis and treatment of the epidural air pseudocyst at thelumbar spine is necessary. Materials and Methods: We report on two patients with radiculopathy and neurologic symptoms resulting from epidural airpseudocysts. In one patient, the epidural air pseudocyst was found within the epidural ligament flavum area on an MRI, and fluoroscopicguidedFNA (fine needle aspiration) was performed. In the other, the epidural air pseudocyst was found behind the posterior longitudinalligament and was accompanied by spinal stenosis. In this patient, we conducted open cystectomy and posterior decompression surgery. Results: After treatment, all patients have showed symptom improvement and they are currently living without discomfort. Conclusions: Due to frequent misdiagnosis, the careful diagnosis of lumbar epidural air pseudocyst is necessary. Physicians shouldselect a proper treatment plan concerning the patient’s condition and the location of the lesion.
  • 10.

    Customized Treatment for the Prevention of Osteoporotic Fracture

    Park Ye-Soo | Jin-Sung Park | 2014, 21(4) | pp.193~198 | number of Cited : 0
    Study Design: A review of related literature regarding the prevention of osteoporotic fractures. Objective: To discuss the customized treatment and prevention of osteoporotic fractureSummary of Literature Review: Various customized treatments for osteoporosis have been discussed. Materials and Methods: Review of related literatures. Results: It would be best to individualize medications based on each patient’s sex, age, bone density in the spine and hip bones,presence or absence of drug over-use for underlying comorbidities, presence or absence of a gastrointestinal disease, duration ofbisphosphonate usage, and presence or absence of an adverse effect, and drug efficacy according to the analysis of follow-up bonedensity, and compliance. Conclusions: Pharmacotherapy should be combined with various prophylactic therapies to prevent osteoporotic fractures. Variousfactors should be considered as well before selecting an osteoporosis medication. Different types of medications may have differenteffects in their ability to reduce fracture risk in patient with different bone densities and other characteristics.