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2015, Vol.22, No.3

  • 1.

    The Impact of Lumbar Lordosis on the Adjacent Segment Disease after Posterior Lumbar Interbody Fusion

    김기택 | 석경수 | LEE SANG HUN and 5other persons | 2015, 22(3) | pp.69~74 | number of Cited : 0
    Study Design: A retrospective study. Objectives: We analyzed the risk factors and relevance of lumbar lordosis on the incidence of adjacent segment disease after posterior lumbar interbody fusion. Summary of Literature Review: Maintaining lumbar sagittal balance is important for decreasing the incidence of adjacent segment disease after posterior lumbar interbody fusion. Materials and Methods: Among the patients who had undergone posterior lumbar interbody fusion of 1 or 2 levels between August 2001 and October 2008, we analyzed 153 patients who were available for at least three years of follow-up; among the subjects, 115 were males and 38 were females. Mean age among the patients at the time of initial surgery was 60.3 (range, 41-82) and mean followup period was 5.6 years (range, 3-11). The causative diseases were spinal stenosis in 78 cases, degenerative spondylolisthesis in 51 cases, isthmic spondylolisthesis in 23 cases, and degenerative disc disease in 1 case. At last follow-up, there were 52 cases (33.9%) of adjacent segment disease. Among them were found 21 cases (40.4%) of disc degeneration, 17 cases (32.7%) of instability, and 14 cases (26.9%) of simultaneous disc degeneration and instability. A total of 10 patients (6.5%) underwent a revision operation, and the mean period from initial to revision operation was 5.5 years (range, 3.1-10.3). We analyzed the correlation between risk factors of adjacent segment disease and the incidence of the disease depending on the gap between lumbar lordosis and pelvic incidence, and compared the clinical results of the 2 groups using modified Whitecloud classification. Results: The incidence of adjacent segment disease was not statistically significant for patient age, sex, BMD, degree of obesity, causative disease, and the level of previous surgery. However, the incidence of adjacent segment disease was statistically higher in patients who had more than 9 degrees gap between lumbar lordosis and pelvic incidence (p=0.013). In our analysis of clinical results, 63.5% of the group of patients who developed adjacent segment disease and 80.2% of the group without adjacent segment disease had good or satisfactory results (p=0.031). Conclusion: Maintaining lumbar sagittal balance is important for decreasing the incidence of adjacent segment disease after posterior lumbar interbody fusion, and close observation is needed in patients with 9 or more degrees gap between lumbar lordosis and pelvic incidence.
  • 2.

    Analysis of Treatment Methods for Subsequent Vertebral Fractures Following Osteoporotic Compression Fractures

    김정훈 | 김성수 | 이동현 and 5other persons | 2015, 22(3) | pp.75~81 | number of Cited : 1
    Study Design: A multicenter retrospective study. Objectives: To compare the incidence and pattern of subsequent vertebral fractures following conservative treatment versus vertebroplasty or kyphoplasty for acute osteoporotic vertebral compression fractures. Summary of Literature Review: Previous studies suggest that new vertebral fractures may increase following vertebroplasty or kyphoplasty because bony cement inserted into the vertebral body of a fractured bone can elevate its strength and stiffness, which in turn, may increase the probability of the compression fractures. Materials and Methods: From three hospitals, we recruited 135 patients who had been treated for acute osteoporotic compression fractures and had available spine images taken at their 1-year follow-up. The patients were divided into two groups according to treatment methods. Group C had been managed conservatively, and Group VK had undergone vertebroplasty or kyphoplasty. The two groups were compared for subsequent vertebral fractures. Results: Group C consisted of 76 patients, and Group VK had 59. There were no significant differences between the two groups in terms of age, sex, medical comorbidity, body mass index (BMI), bone mineral density, presence of prior vertebral fracture or acute fracture level (p>0.05). New vertebral fractures were detected in 25 patients (19% of total subjects): 6 (8%) from Group C, and 19 (32%) from Group VK, demonstrating a significantly higher incidence in the VK group (p=0.0007). In the subgroup analysis, there was no significant difference between vertebroplasty and kyphoplasty (p>0.05). While four of the six patients (67%) in Group C had subsequent fractures in nonadjacent vertebrae, 14 of the 19 patients (74%) in Group VK had subsequent fractures in adjacent vertebrae. Conclusions: Subsequent vertebral fractures were found in 19% of subjects at one year after treatment for acute osteoporotic compression fractures. Compared with conservative treatment, vertbroplasty or kyphoplasty significantly increased the occurrence of subsequent vertebral fractures, which appeared more often in adjacent vertebrae.
  • 3.

    The Effect of Teriparatide in Women with Osteoporosis after Lumbar Posterolateral Fusion or Posterior Lumbar Interbody Fusion

    서정호 | 이규열 | 김민우 | 2015, 22(3) | pp.82~91 | number of Cited : 0
    Study Design: Retrospective study. Objectives: To investigate radiologic and clinical outcomes of teriparatide in women with osteoporosis after instrumented lumbar posterolateral fusion (PLF) or posterior lumbar interbody fusion (PLIF). Summary of Literature Review: Teriparatide accelerated lumbar posterolateral fusion in women with postmenopausal osteoporosis. Materials and Methods: Eighty-six women older than 65 years old with osteoporosis underwent PLF or PLIF with bone graft between Februar, 2011 ato May, 2012 pPatients were divided into four group: teriparatide group with local bone (A-1: 13 patients;, teriparatide group with composite bone (A-2: 27 patients; non-teriparatide group with local bone (B-1: 14 patients; and non-teriparatide group with composite bone (B-2: 32 patients). At 3, 6, and 12 months postoperatively, the Oswestry Disability Index (ODI), visual analog scale (VAS), fusion rate, and period of bone union were evaluated. Results: VAS and ODI improved after surgery in all groups, but no significant differences were notell among the groupses Further, there was no significant difference among the groups for agef fusion level, and fusiops(p>0.05). Fusion rate was 94.44% in the A-1 group, 92.59% in the A-2 group, 79.17% in the B-1 group, and 76.92% in the B-2 group. Average period of bone union was 3.25 months, 3.65 months, 5.67 months, and 5.65 months respectively. Fusion rate and average bone union time made no significant differeneen among the groups divided by graft materials (p>0.05). However, those in the teriparatide group were significantly superior to those in the nonteriparatide group (p<0.05). Conclusions: In women with osteoporosis after PLF or PLIF with bonegraft, teriparatide showed superiority in the rate of fusion and the period of bone union.
  • 4.

    The Outcomes of Short and Long Segment Posterior Instrumentation of Thoracolumbar Burst Fractures with a Load Sharing Score of 7 or More

    서정호 | 이규열 | 2015, 22(3) | pp.92~98 | number of Cited : 0
    Study Design: Retrospective. Objectives: To investigate outcomes between short and long segment posterior instrumentation of thoracolumbar burst fractures with a load sharing score of 7 or more. Summary of Literature Review: Short segment instrumentation has been recommended in thoracolumbar burst fractures with a load sharing score of 6 or less, and long segment instrumentation has been recommended for those with a score of 7 or more. However, this standard is controversial. Materials and Methods: From March 2006 to January 2014, 45 patients with thoracolumbar fractures with a load sharing score of 7 or more were treated with posterior instrumentation. They were divided into two groups: short (group S) and long segment (group L) groups. Radiologic results were evaluated on the basis of the kyphotic angle and anterior column height. Complications were also reviewed. Results: Groups S and L consisted of 13 and 32 patients and had mean ages of 48.3 and 47.3 years, respectively. In group S, the anterior column height increased from 56.62% to 76.23% postoperatively, and remained at 71.15% at follow-up. The kyphotic angle decreased from 16.27° to 7.55° postoperatively, and was 13.17° at follow-up. In group L, the anterior column height recovered from 49.67% to 70.52% postoperatively, and was 63.73% at follow-up. The kyphotic angle decreased from 20.08° to 6.80° postoperatively, and was 14.18° at follow-up. The changes in the anterior column height and kyphotic angle were not significantly different between groups S and L. Seven cases had complications and the number of cases with complications was not significantly different between groups S and L. Conclusions: Short and long segment instrumentation of thoracolumbar fractures with a load sharing score of 7 or more did not achieve significantly different results.
  • 5.

    The Epidemiology and Importance of Osteoporotic Spinal Compression Fracture in South Korea

    신헌규 | 박종현 | 2015, 22(3) | pp.99~103 | number of Cited : 0
    Study Design: Review of the literature on the epidemiology and importance of osteoporotic spinal fractures. Objectives: To determine the epidemiology and importance of osteoporotic spinal fractures. Summary of Literature Review: Osteoporotic spinal fractures have been increasing in recent years. Materials and Methods: Review of the literature. Results: Osteoporotic spinal fractures can lead to a reduced quality of life and reduced life expectancy with increasing morbidity. They can also be a major cause of additional spinal fractures or secondary fractures. Conclusions: In an aging society, osteoporotic spinal fractures are considered a social problem. Preventive care should be emphasized.
  • 6.

    Diagnosis of Osteoporotic Spinal Fractures

    Kim Young Hoon | Kim Sang-Il | 한상엽 | 2015, 22(3) | pp.104~108 | number of Cited : 0
    Study Design: Literature review. Objectives: To present updated information on the diagnosis of osteoporotic spinal fractures (OSFs). Summary of Literature Review: Conventional modalities including simple radiographs, bone mineral density (BMD) tests, and bone scans are sufficient for diagnosis of OSFs. However, other clinical and radiographic clues should be considered for prediction of the prognosis and differential diagnosis. Materials and Methods: Review of the relevant literature. Results: Clinical clues including morphometric changes in the vertebral body are sufficient for diagnosis of OSFs. BMD testing is helpful for diagnosis of osteoporosis. However, simple radiographs and BMD tests do not present sufficient information on the prognosis of OSFs. The location of the involved segments, morphological characteristics, and other co-morbidities should be taken into consideration in the initial management of OSFs. Moreover, pathologic conditions leading to spinal fractures should be taken into account in some clinical situations. Conclusions: With increasing reports of complicated OSFs or other pathologic fractures, other diagnostic modalities and clinical factors should be considered in predicting the prognosis of OSFs and differentiating OSFs from other pathologic conditions.
  • 7.

    The Use of Vessel Loop Shoelace Technique for Closure of Wound Dehiscence Caused by Dural Tears Associated with Distractive Flexion Injury of Cervical Spine

    손홍문 | 유재원 | 박상수 and 1other persons | 2015, 22(3) | pp.109~113 | number of Cited : 0
    Study Design: A case report. Objectives: To report the use of the shoelace technique for treatment of wound dehiscence caused by dural tears. Summary of Literature Review: It is difficult to treat wound dehiscence caused by dural tears, as it can lead to infection, loss of soft tissue, and need for a long hospital stay. Materials and Methods: An 18-year-old male who had been injured in a traffic accident was diagnosed with bilateral facet dislocation of C7-T1, with no neurologic deficit. Clear secretion appeared during the operation, but it disappeared after posterior fusion. The wound began to open about 3 weeks after the operation. We used the vessel loop shoelace technique to suture the wound, Results: The patient had the stitches taken out in the outpatient clinic three weeks after suture. His wounds are healing without complication. Conclusion: The vessel loop shoelace technique may be a useful treatment for wound dehiscence caused by dural tears.
  • 8.

    Nodular Fasciitis as a Pseudosarcomatous Lesion in the Ligamentum Nuchae - A Case Report -

    김승환 | 김정수 | kyung Han Nam | 2015, 22(3) | pp.114~117 | number of Cited : 0
    Study Design: A case report. Objectives: Nodular fasciitis is a non-neoplastic soft-tissue lesion located in the deep subcutaneous region; it may be misdiagnosed as a malignant tumor due to its rapid growth and microscopic characteristics. We introduce an unusual case of nodular fasciitis which presented as a posterior neck mass. Summary of Literature Review: Nodular fasciitis is an unusual benign lesion.Becaue it sometimes shows aggressive microscopic characteristics, (being hypercellular and polymorphic), the condition has the potential to be misdiagnosed as sarcoma. Materials and Methods: A 20-year-old woman presented with a 1-month history of a progressively enlarging mass on her posterior neck. Computed tomography (CT) scans of the neck showed a markedly enhanced, well-defined, ovoid soft tissue mass at the posterior of the spinous process of C2. The patient underwent marginal excision. There was a 2 cm, well–capsulated, pinkish-gray mass. Results: She recovered without any complications. Histopathologic examination showed a spindle cell proliferation, increased cellularity, and nuclear atypia with mitosis. The immunohistochemistry stain showed negative findings. The mass was diagnosed as nodular fasciitis. Conclusions: A diagnosis of nodular fasciitis, not just malignant tumor, should be considered for a rapidly growing posterior neck mass showing aggressive microscopic appearance, Nodular fasciitis is a self-limiting lesion readily treated by marginal excision. However, follow-ups should be increased to watch for recurrence.
  • 9.

    Posterior Ring Apophysis Fracture Associated with Lumbar Disc Herniation Treated by Immobile Bony Fragment Excision - A Case Report -

    Woo Dong Nam | Jae Hwan Cho | Jemin, Yi and 1other persons | 2015, 22(3) | pp.118~122 | number of Cited : 0
    Study Design: A case report. Objectives: We report a case of posterior ring apophysis fracture (PRAF) with lumbar disc herniation treated by immobile bony fragment excision. Summary of Literature Review: PRAF causes severe radiculopathy, so treating with surgery is common. Materials and Methods: A 30-year-old male diagnosed with PRAF with lumbar disc herniation was treated with discectomy, but his clinical symptoms were not relieved. Consequently, bony fragment excision, extended laminectomy and interbody fusion were also done. Results: Radicular pain was relieved and showed good clinical outcome. Conclusions: When treating PRAF, bony fragment excision and extended laminectomy should be considered even if an immobile bony fragment exists.
  • 10.

    Surgical Treatment of Spinal Extradural Arachnoid Cyst – A Case Report –

    Whoan Jeang Kim | 정상욱 | 박건영 and 3other persons | 2015, 22(3) | pp.123~126 | number of Cited : 0
    Study Design: A case report. Objectives: To report a case of spinal extradural arachnoid cyst. Summary of Literature Review: Extradural arachonid cysts of the spine are a rare cause of spinal cord and nerve root compression. There are few reports about it, and the etiology remains unclear. Materials and Methods: The authors performed a clinical and radiographic case review. Results: A 56-year-old male patient presented with both lower extremity radiating pain and tingling sensation in both feet for four years. His MRI revealed a large, well-demarcated extradural lesion, isointense to cerebrospinal fluid from L1 to L3. We performed dural repair and laminectomy for partial resection of the cyst. The outcome was good in the immediate postoperative period, and the patient made a full recovery without complications. Conclusions: Surgical treatment should be considered for large spinal extradural arachnoid cysts with neurologic symptoms when conservative treatment does not work.
  • 11.

    Atypical Tuberculous Spondylitis - A Report of Two Cases -

    Hak Jin Min | 유형곤 | Seong Kee Shin | 2015, 22(3) | pp.127~132 | number of Cited : 0
    Study Design: Case study of two cases. Objectives: The aim of our study is to describe atypical patterns of tuberculous spondylitis. Summary of Literature Review: Few reports of tuberculous spondylitis have discussed atypical cases, which resulted in a poor prognosis due to the delay in early diagnosis and proper treatment. Materials and Methods: A 74-year-old female underwent an incision and drainage, and posterior decompression and fusion (PDF) due to tuberculous epidural abscess after vertebroplasty of a compression fracture at T12. A 52-year-old female underwent interbody fusion and posterior lateral fusion (PLF) because of aggravation of an abscess and neurologic symptoms following non-invasive intervention to treat atypical tuberculous spondylitis. Results: Clinical symptoms and serological tests of the patients were improved at postoperative 6 months. Conclusions: When a patient presents with focal bony or soft tissue abnormality on an image study, the possibility of non-typical tuberculous spondylitis has to be considered when infective spondylitis or a tumor is detected. Moreover, an invasive diagnosis tool such as biopsy will be needed for proper management.