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2015, Vol.22, No.4

  • 1.

    The Relationship of Minor Trauma with the Surgical Outcome in Patients with Cervical Myelopathy

    김민우 | 이규열 | 김동률 and 2other persons | 2015, 22(4) | pp.133~139 | number of Cited : 0
    Abstract
    Study Design: Retrospective study. Objectives: To determine the influence of trauma on the neurologic course in patients who have undergone surgery for cervical myelopathy. Summary of Literature Review: The postsurgical outcomes were worse from trauma in patients who had a cervical ossification of the posterior longitudinal ligament (OPLL) or cervical canal stenosis, in comparison with patients who did not. Materials and Methods: The study was conducted on 70 patients who had undergone surgery due to cervical myelopathy from January 2004 to December 2013 and had at least 1 year of follow-up. Depending on trauma history, the patients were divided into two groups, and their radiological (simple radiographic, computed tomographic, and magnetic resonance imaging) and clinical (Japanese Orthopaedic Association [JOA] score, motor power of upper extremities) results were compared retrospectively. Results: Among 70 patients in total, 18 patients were in the trauma group and 52 were in the non-trauma group, and all cases in the trauma group had a history of minor trauma (11 cases of drivers traffic accidents, 4 cases of slipping and falling, 2 cases of minor pedestrian accidents, and 1 case of falling). Radiologically narrower diameter of the spinal canal showed statistically significant difference between two groups (p=0.042). The JOA scores before and after surgery and the recovery rate did not have a clinically meaningful difference with trauma. However, the degree of motor improvement was significantly higher for the trauma group within 1 week after surgery (p=0.040). Conclusions: Minor trauma itself may adversely affect the patients’ clinical courses.
  • 2.

    Clinical Outcome of Simple Discectomy for Recurrent Lumbar Disc Herniation

    김동준 | YOUNG-DO KOH | 김종오 and 1other persons | 2015, 22(4) | pp.140~145 | number of Cited : 0
    Abstract
    Study Design: This is a retrospective study. Objectives: To analyze the clinical outcomes of simple discectomy in patients with recurrent lumbar disc herniation. Summary of Literature Review: There are two methods of studying the treatment of recurrent lumbar disc herniation. The first type of study considers fusion for the prevention of complications such as postoperative lumbar segmental instability and persistent back pain. The second type of study assumes that simple discectomy without fusion is sufficient in the surgical management of recurrent lumbar disc herniation. Materials and Methods: Sixteen patients who underwent simple discectomy due to recurrent lumbar disc herniation were followed up over 3 years. The mean age was 52.8 years (38-68 years). The mean follow-up period was 75.4 months (36-144 months). VAS scores for back pain and radiating lower leg pain were each compared pre- and post-operatively. The Oswestry Disability Index (ODI) was used to analyze the clinical outcome. A modified MacNab’s outcome was used to evaluate patient satisfaction. Subjective survey data in a Delphi checklist was reviewed to verify clinical lumbar instability. Results: The mean back pain VAS score showed 87.5% improvement (p<0.001). The mean lower leg VAS score showed 89% improvement (p<0.001). The mean preoperative ODI score was 29.9, and the mean score checked at the last follow up was 3.5. It thus showed 88.3% improvement (p<0.001). Excellent or good satisfaction was reported by fourteen patients (87.5%), and clinical lumbar instability was identified in one patient (6.3%). Conclusions: Simple discectomy without fusion is one of treatment option for recurrent disc herniation without instability.
  • 3.

    Potential Risk Factors for Subsequent Fractures according to Treatment of Primary Osteoporotic Vertebral Fractures

    김민욱 | 윤대현 | 안상호 and 3other persons | 2015, 22(4) | pp.146~152 | number of Cited : 1
    Abstract
    Study Design: A retrospective study. Objectives: To investigate the potential risk factors for subsequent vertebral fractures according to the treatment of primary vertebral fractures. Summary of Literature Review: Many previous studies have been reported on bone mineral density, bone loss, and mechanical properties as risk factors for osteoporotic vertebral fractures. However, few studies have investigated subsequent osteoporotic vertebral fractures. Materials and Methods: 57 patients who had undergone follow-up magnetic resonance imaging (MRI) of the spine were divided into two groups depending on the development of subsequent vertebral fractures: the fracture group with 40 cases and the non-fracture group with 17 cases. The patients’ clinical and radiographic data including bone mineral density, medication for osteoporosis, body mass index, vertebroplasty of primary vertebral fractures, thoracic kyphotic angle and lumbar lordotic angle, fat infiltration of the back extensor muscle, and primary multiple fractures were examined. Results: The subsequent new vertebral fractures occurred at a mean of 24 ± 19 months after primary osteoporotic vertebral fractures. Vertebroplasty for primary fractures was associated with a higher incidence of subsequent new vertebral fractures (p=0.001). There was a significant increase in fat infiltration of the back extensor muscle after the primary vertebral fractures in the fracture group (p=0.001). A multiple logistic regression analysis showed the significance of vertebroplasty (odds’ ratio: 4.623, 95% confidence interval: 1.145–18.699, p=0.031). Conclusions: These results suggest that vertebroplasty for primary vertebral fractures and increased fat infiltration of the back extensor muscle could be risk factors related to the development of subsequent osteoporotic vertebral fractures.
  • 4.

    Relationship of the Pre-operative Condition of Paravertebral Muscle with Post-operative Functional Disability in Patients with Degenerative Lumbar Spinal Disease

    신동은 | 이윤석 | Ho-Jae Lee and 3other persons | 2015, 22(4) | pp.153~159 | number of Cited : 0
    Abstract
    Study Design: A retrospective study on the outcomes of surgical treatment for degenerative lumbar spinal disease. Objectives: To evaluate the pre-operative paravertebral muscle condition as a predictive factor in patients with degenerative lumbar spinal disease who undergo surgery. Summary of Literature Review: Previous studies have reported that the atrophy of the paravertebral muscle is associated with chronic low back pain. However, few studies have reported on the relationship of the pre-operative paravertebral muscle status with the postoperative functional disability scale. Materials and Methods: In this study, we reviewed the history of 20 patients with degenerative lumbar spinal disease treated by decompression and posterior lumbar interbody fusion with posterior instrumentation between 2010 and 2011. The evaluation included the paravertebral muscle volume, fat infiltration on magnetic resonance imaging (MRI), preoperative lumbar lordosis, levels operated on, and the Oswestry Disability Index (ODI). Further, the inter-relationship of the pre-operative paravertebral muscle status, lumbar lordosis, and levels operated on with the post-operative ODI was analyzed. Results: The mean cross-sectional area (CSA) of the paravertebral muscle at the L3–4 and L4–5 levels was 21.9±3.4 cm2 and 21.4± 3.3 cm2, respectively. The mean pre- and post-operative lumbar lordotic angle was 41.0±17.5°, and 42.3±11.1°, respectively. The lumbar lordotic angle and the levels operated on were not correlated with the post-operative ODI. However, the CSA of the paravertebral muscle at the L3–4 (r=–0.582, p<0.01) and L4–5 (r=–0.568, p<0.01) levels showed a negative correlation with the post-operative ODI. The levels operated on showed a positive correlation with the post-operative ODI (r=0.420, p<0.01). Conclusions: The mean CSA of the paravertebral muscle and the levels operated on in patients with degenerative lumbar spinal disease have a significant correlation with the post-operative clinical outcome.
  • 5.

    Variations in Matrix Metalloproteinase Expression by Disc Location in Patients with Sequestrated Lumbar Disc Herniation

    Kim Young Yul | 박도준 | Kee-Won Rhyu | 2015, 22(4) | pp.160~164 | number of Cited : 0
    Abstract
    Study Design: In vivo study Objectives: To evaluate variations in matrix metalloproteinase (MMP) expression levels according to the disc location in patients with sequestrated lumbar disc herniation. Summary of Literature Review: MMPs are considered to be the major catabolic enzymes in the intervertebral disc. MMPs have been known to be the primary mediators of extracellular matrix (ECM) degradation, to play major roles in disc degeneration by changing the collagens and the extracellular matrix, and to be involved in the processes of apoptosis and autoresorption of herniated disc materials by inducing inflammatory cytokines. Materials and Methods: The sequestered and contained disc materials were removed from seven patients with sequestered lumbar disc herniations. The materials from the contained discs were classified into group 1 and those of the sequestered discs into group 2. Immunochemistry tests were conducted for the tissues of both groups. The expression levels of MMP-1, 3, and 13 were checked using a fluorescence microscope. The amount of expression of each MMP was calculated using the percentage of expressed cells and analyzed statistically. Results: In the histological study, increased expression of MMP-1, 3, and 13 was found in group 2. In the statistical analysis after the quantification of MMP expression, the expression of all MMPs was found to have increased significantly in group 2 (p<0.05). Conclusions: The increased expression of MMP-1, 3, and 13 indicated that the inflammation and degeneration processes, and the spontaneous resorption by the surrounding tissues were more active in the sequestered disc group than in the contained disc group.
  • 6.

    Risk Factors and Postoperative Prognostic Factors of Spontaneous Spinal Epidural Hematoma

    Whoan Jeang Kim | 정상욱 | 이규상 and 5other persons | 2015, 22(4) | pp.165~169 | number of Cited : 0
    Abstract
    Study Design: Retrospective study. Objectives: To explore the risk factors and the factors associated with the neurological improvement after operation in the spontaneous spinal epidural hematoma. Summary of Literature Review: The cause of the spontaneous spinal epidural hematoma is unknown. The objective risk and prognostic factors are still controversial. Materials and Methods: From January 2006 to December 2014, a total of 12 patients with spontaneous epidural hematoma were evaluated. The risk and prognostic factors analyzed were sex, age, underlying diseases, medications, neurologic status, level and extent of hematoma, cord edema, and interval from onset to surgery. We analyzed the correlation between each factor and neurologic recovery. The neurologic status was analyzed using the American Spinal Injury Association impairment scale (AIS) at the first and the last neurologic examination. Results: The average age of the patients was 68.6 years. Seven patients were treated with anticoagulation therapy, and two were advised to switch to a healthier diet. The initial neurologic status of the patients was AIS A in 2 cases, B in 5 cases, C in 4 cases, D in 1 case, and in two patients, cord edema was revealed on magnetic resonance imaging (MRI). The interval of time from onset to surgery was less than 24 hours in 6 cases, 24–48 hours in 4 cases, and more than 48 hours in 2 cases. Conclusions: The prognostic factors associated with spontaneous spinal epidural hematoma were found to be initial neurologic status, cord edema on MRI, and interval from onset to surgery. We found no correlation between anticoagulation therapy or healthy diet and spontaneous spinal epidural hematoma, but anticoagulation therapy cannot be excluded as a risk factor.
  • 7.

    Restoration of Segmental Lordosis and Related Factors in Interbody Fusion for Degenerative Lumbar Disease

    김응하 | 서정무 | Joong Hyeon Ahn | 2015, 22(4) | pp.170~177 | number of Cited : 0
    Abstract
    Study Design: A retrospective study. Objectives: To analyze restoration of segmental lordosis and factors related to interbody fusion and the fusion rate with degenerative lumbar disease. Summary of Literature Review: Few studies have addressed the restoration of segmental lordosis and factors related to interbody fusion for degenerative lumbar disease. Materials and Methods: Records of 43 patients treated by anterior lumbar interbody fusion (ALIF) or posterior lumbar interbody fusion (PLIF) surgery from 2011 to 2013 were reviewed. ALIF used a metal cage with a 10° lordotic angle and PLIF used a metal cage with an 8° lordotic angle. Preoperative, postoperative, and at least 1 year outcomes were analyzed from radiographs. As a related factor, segmental flexibility, disc height, osteophytes, vaccuum disc, hypertrophic facet, spondylolisthesis, and endplate violation were analyzed. We also analyzed the bony union rate. Results: The segmental lordotic angle was 4.67° before surgery, improved to 10.43° after surgery, and was 9.32° at the final follow-up. Comparing between the ALIF and PLIF at the L3-4 level in a similar number of patients revealed 7.24° and 4.61° restoration after ALIF and PLIF surgery, postoperatively. The difference was statistically significant (p=0.011). Segmental flexibility had a statistically significant positive correlation (p=0.013). Lower disc height and osteophytes limited restoration of segmental lordosis, but vaccuum disc was restored well after interbody fusion. Bony union was achieved in 92.8% of the cases. Conclusions: Intebody fusion, especially ALIF surgery, results in acceptable restoration of segmental lordosis. Even with narrowed disc space or osteophytes, remained segmental flexibility is an important factor of segmental lordosis restoration.
  • 8.

    Motor Weakness of Right Ankle Dorsiflexion Caused by Increasing Size of Sacroiliac Joint Cyst after Posterior Lumbar Interbody Fusion in a Patient with Spinal Stenosis - A Case Report -

    Ji Eun Kwon | Young Joon Ahn | Bo Kyu Yang and 4other persons | 2015, 22(4) | pp.178~182 | number of Cited : 0
    Abstract
    Study Design: Case report Objectives: To report a case of motor weakness caused by the increasing size of a sacroiliac joint cyst after spinal fusion. Summary of Literature Review: There have been no reports on the increased size of a sacroiliac joint cyst and motor weakness after spinal fusion. Materials and Methods: A 63-year-old female was admitted with low back pain and right sciatica. Magnetic resonance imaging (MRI) findings showed the spinal canal narrowing at L4–5 and a cystic lesion on the right sacroiliac joint. After surgery, the symptoms were relieved. Results: One month after the operation, motor function had worsened to grade 4. Follow-up MRI revealed an increase in the size of the cystic lesion. Selective nerve root blocks were performed. There was gradual improvement, and the motor grade reached grade 5 seven months after the operation. Conclusions: We recommend that surgeons evaluate the adjacent segmental lesion by MRI before performing spinal fusion.
  • 9.

    Brain Tumor Mimicking Cervical Spinal Disease - A Case Report -

    Tae Kyun Kim | Chearl Hyoung Kang | Suk-Joong Lee | 2015, 22(4) | pp.183~185 | number of Cited : 0
    Abstract
    Study Design: Case report. Objectives: To report a case of cerebellar tumor mimicking cervical spinal disease with neck pain for one year. Summary of Literature Review: Neck pain is one of the most common symptoms of cervical spinal disease. Neck pain in the cervical spine is usually accompanied by radiculopathic or myelopathic symptoms. Pain aggravated with neck motion is another point of differentiation. However, the differential diagnosis of neck pain is not always easy. Materials and Methods: A 47-year-old woman presented with neck pain, without other symptoms of radiculopathy or myelopathy. The neck pain was not position-dependent and had exacerbated 1 week previously. Cervical magnetic resonance imaging (MRI) revealed a brain tumor in the cerebellum. Results: The patient underwent surgical craniotomy and tumor resection. The neck pain improved after surgery. Conclusions: If neck pain cannot be explained by cervical pathological conditions, the possibility of other causes, including brain pathology, should be considered.
  • 10.

    Conservative Treatment of Osteoporotic Spinal Fractures

    Lee, Jae Hyup | 김원철 | Lee, Jiho | 2015, 22(4) | pp.186~191 | number of Cited : 0
    Abstract
    Study Design: Literature review. Objectives: To present updated information on the conservative treatment of osteoporotic spinal fractures (OSFs). Summary of Literature Review: The treatments of osteoporotic spinal fractures are bed rest, pain medication, bracing, exercise and rehabilitation, and osteoporosis medication. However, there is disagreement about the outcomes of these treatments. Materials and Methods: Review of the relevant literature. Results: In the case of osteoporotic spinal fractures, analgesic administration, bracing, physical therapy, and exercise should be conducted. In order to prevent secondary fractures, bisphosphonates, selective estrogen receptor modulators, strontium ranelate, or parathyroid hormone, which has proven efficacy with respect to the prevention of secondary fractures, should be prescribed. Conclusions: We should actively prevent the occurrence of secondary fractures with fracture healing by implementing a proven effective treatment for osteoporotic spinal fractures.
  • 11.

    Percutaneous Vertebral Augmentation for the Treatment of Osteoporotic Spinal Fractures

    Kim Young | 하종문 | 정구현 | 2015, 22(4) | pp.192~196 | number of Cited : 0
    Abstract
    Study Design: Review of the literature. Objectives: To present updated information on percutaneous vertebral augmentation (PVA) for osteoporotic spinal fractures (OSFs). Summary of Literature Review: Vertebroplasty and kyphoplasty have been used to treat osteoporotic spinal fractures for many years. A recent meta-analysis provides strong evidence in favor of cement augmentation in the treatment of symptomatic vertebral compression fractures. Materials and Methods: Review of the relevant literature. Results: A meta-analysis showed greater pain relief, functional recovery, and improvement in quality of life with cement augmentation compared with control subjects. Conclusions: Percutaneous vertebral augmentation of osteoporotic spinal fractures results in shorter hospital stays, reduced incidence of complications, and more rapid return of functional independence.