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pISSN : 2093-4378 / eISSN : 2093-4386

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2016, Vol.23, No.2

  • 1.

    Clinical Outcomes of a Zero Profile Implant for Single-Level Anterior Cervical Discectomy and Fusion

    Dae Ho Ha | Sung Kyun Oh | Dae Moo Shim | 2016, 23(2) | pp.71~76 | number of Cited : 0
    Abstract
    Study Design: A retrospective study. Objectives: To evaluate and compare the clinical results of a zero profile implant with a conventional stand-alone cage. Summary of Literature Review: A new zero-profile interbody fusion implant named Zero-P was developed in order to avoid platerelated complications. Materials and Methods: Twenty-three patients with cervical degenerative disc disease were enrolled. Twelve of these were implanted with a stand-alone cage, and 11 patients received a Zero-P. The mean follow-up time was 16.7 months, ranging from 12 to 34 months. Intraoperative parameters, clinical outcomes (Korean Neck Pain Disability Index [K-NDI], visual analog scale [VAS] score for neck/arm pain), dysphagia scores, and device-related complications were recorded. Results: At the 6-week, 3-month, 6-month, and 12-month follow up, the K-NDI and VAS scores significantly improved in both groups. Dysphagia scores in both groups have no significant differences (p>0.05). However, the cage subsidence rate was significantly higher in the stand-alone cage group (p<0.05). Conclusions: Clinical outcomes of ACDF with the Zero-P were satisfactory. The incidence of cage subsidence was lower than with the conventional stand-alone cage.
  • 2.

    Factors Associated with Early Postoperative Complications in Patients with Cervical Spondylotic Myelopathy

    Min Woo Kim | 서정호 | 이규열 | 2016, 23(2) | pp.77~83 | number of Cited : 0
    Abstract
    Study Design: Retrospective. Objectives: To investigate factors related to early postoperative complications of surgery for cervical spondylotic myelopathy (CSM). Summary of Literature Review: Factors associated with increased risk of complications from surgery for CSM are greater age, greater estimated blood loss, longer operative duration, and anterior-posterior combined procedures. Materials and Methods: The records of patients (male 32, female 19, mean age 61 years) who underwent surgery for CSM between November 2004 and December 2014 were investigated for early postoperative complications and potentially related factors. Factors considered were age, gender, duration of symptoms, diabetes, smoking, comorbidity, preoperative Japanese Orthopedic Association (JOA) score, numbers of cervical levels involved, ossification of the posterior longitudinal ligament (OPLL), operative approach, fusion, operative duration, estimated blood loss (EBL), maximal cord compression ratio on MRI, and cord signal intensity change on T2-weighted MRI. Results: Early postoperative complications were observed in 12 of 51 patients and included motor weakness in 3, pneumonia in 2, and delirium, dysphagia, hematoma, pulmonary thromboembolism, sore, seizure, wound dehiscence, and superficial infection, each in 1. Factors associated with early postoperative complications were operative duration (p=0.024), maximal cord compression ratio on MRI (p=0.009), and cord signal intensity change on T2-weighted MRI (p=0.009). The other factors were not found to correlate significantly. Conclusions: Factors associated with early postoperative complications for CSM are operative duration, compression ratio at the level of maximal cord compression on MRI, and cord signal intensity change on T2-weighted MRI.
  • 3.

    Comparison of the Efficacy and Safety Profiles of a Pelubi Sustained Release Tab Versus a Pelubi Tab in Patients with Chronic Back Pain: A Randomized, Double - Blind, Multi - Institution Phase III Study

    Ki-Tack KIM | Tae Kyun Kim | 최지웅 and 4other persons | 2016, 23(2) | pp.84~92 | number of Cited : 0
    Abstract
    Study Design: A randomized, double-blind, multi-institution, phase III study. Objectives: To evaluate the efficacy and safety of the Pelubi Sustained Release (SR) Tab in patients with chronic back pain, in comparison with the Pelubi Tab, whose efficacy has already been approved, a phase 3 clinical trial was conducted. Summary of Literature Review: The Pelubi Tab Has shown clinical efficacy in patients with back pain. Materials and Methods: From April 11, 2014 to July 24, 2014, 166 chronic back pain patients were recruited as subjects through a multi-institution, double-blind, random sample. We compared the experimental and control groups’ clinical efficacy, which was estimated by the 100-mm Pain Visual Analog Scale (VAS) after 28 days of medication. We also compared the treatment efficacy of both drugs by using a variation of the Oswestry Disability Index (ODI) and Physician Global Assessment (PGA), with the total usage of relief medicine. The side effects and clinical pathology were also noted. Results: Neither group showed a significant difference in 100-mm Pain VAS or ODI variation (p=0.1702, p=0.9041). There was no statistically significant difference between the experimental group and the control group in PGA or total usage of relief medicine. The ODI and PGA variation were not worse in the experimental group than the control group. The two groups showed no significant differences in side effects (p=0.9708). Conclusions: This study found that the Pelubi SR Tab applied to back pain patients was not inferior to the Pelubi Tab and did not show any significant difference in terms of safety. The Pelubi SR Tab can be used with the same expectation of safety as the Pelubi Tab. Materials and Methods: From April 11, 2014 to July 24, 2014, 166 chronic back pain patients were recruited as subjects through a multi-institution, double-blind, random sample. We compared the experimental and control groups’ clinical efficacy, which was estimated by the 100-mm Pain Visual Analog Scale (VAS) after 28 days of medication. We also compared the treatment efficacy of both drugs by using a variation of the Oswestry Disability Index (ODI) and Physician Global Assessment (PGA), with the total usage of relief medicine. The side effects and clinical pathology were also noted. Results: Neither group showed a significant difference in 100-mm Pain VAS or ODI variation (p=0.1702, p=0.9041). There was no statistically significant difference between the experimental group and the control group in PGA or total usage of relief medicine. The ODI and PGA variation were not worse in the experimental group than the control group. The two groups showed no significant differences in side effects (p=0.9708). Conclusions: This study found that the Pelubi SR Tab applied to back pain patients was not inferior to the Pelubi Tab and did not show any significant difference in terms of safety. The Pelubi SR Tab can be used with the same expectation of safety as the Pelubi Tab.
  • 4.

    Radiographic and Clinical Outcomes of Posterior Interbody Fusion for High-Grade Spondylolisthesis

    정재윤 | Hyoung-Yeon Seo | Kim Sung Kyu | 2016, 23(2) | pp.93~99 | number of Cited : 0
    Abstract
    Study Design: Retrospective study. Objectives: To evaluate the clinical and radiological outcomes of posterior interbody fusion using pedicle screw fixation after posterior decompression for high-grade spondylolisthesis. Summary of Literature Review: The surgical treatment of high-grade spondylolisthesis has been controversial. However, few reports on the results of reduction and posterior interbody fusion after posterior decompression have been published. Materials and Methods: Thirteen patients with L5-S1 high-grade spondylolisthesis (Meyerding grade III, IV) who underwent reduction and posterior interbody fusion were analyzed with at least 2 years of follow-up. The mean age of the patients (male 2, female 11) was 51 years. Classified by the type of spondylolisthesis, 10 cases were isthmic, 2 cases dysplastic, and 1 case degenerative. A visual analogue scale (VAS), the Oswestry Disability Index (ODI) score, bone union, anterior slippage, and slip angle were used in comparing clinical and radiographic outcomes. Results: All cases showed improvement of preoperative symptoms. The VAS and ODI score improved from a mean of 8.9 points and 36.2 points preoperatively to 2.1 points and 10.2 points, respectively, at last follow-up. The degree of anterior slippage measured by Taillard’s method was improved from a mean of 57.7% before surgery to mean of 14.6% at last follow-up. The slip angle also changed from a mean of 2.4° kyphosis before surgery to a mean of 7.6° lordosis at last follow-up. There were two complications: infection and new radiating pain. Conclusions: Reduction and posterior interbody fusion using pedicle screw fixation after posterior decompression was a useful surgical method for high-grade spondylolisthesis that corrected lumbosacral kyphosis, filled the structural space of the anterior column, and acheived fusion of interbody movement.
  • 5.

    Risk Factors of Cage Subsidence after Posterior Lumbar Interbody Fusion

    Dong-Yeong Lee | Soon-Taek Jeong | Changhwa Hong and 3other persons | 2016, 23(2) | pp.100~107 | number of Cited : 1
    Abstract
    Study Design: Retrospective study. Objectives: The purpose of this study was to evaluate risk factors for subsidence after posterior lumbar interbody fusion (PLIF). Summary of Literature Review: Body mass index (BMI), bone mineral density (BMD), cage characteristics (titanium or poly-ether-etherketone (PEEK)) and degree of disc distraction are risk factors for cage subsidence after PLIF. Materials and Methods: From January 2010 to January 2015, a total of 69 patients (93 segments) who were diagnosed with degenerative lumbar spine disease at the current authors’ institution and underwent follow-up for at least 1 year were included in this retrospective study. Data on all factors related to cage subsidence were taken into consideration. The degree of association for each of the factors was determined through the calculation of odds ratios (ORs) with a 95% confidence interval. Logistic regression analyses were performed. The P-value that represented statistical significance was set below 0.05. Results: There were no significant associations between fused segment level and cage subsidence (p=0.588), nor were there any significant associations between the kind of cage (titanium or PEEK) and cage subsidence (p=0.371). Using logistic regression, the factors with a P-value below the 0.20 level in univariate analyses were included in the multivariate analyses. In multivariate analyses, diabetes mellitus (DM) (p=0.029, OR, 4.524), osteoporosis (p=0.026, OR, 6.046), and degree of disc distraction (p=0.010, OR, 1.446) had significant associations with cage subsidence. In addition, there were significant associations between cage subsidence and instrument failure (p=0.008, OR, 8.235). Conclusions: DM and osteoporosis, which may affect bony structures, have significant associations with cage subsidence after PLIF. Cage insertion with excessive disc distraction during surgery may also affect cage subsidence after PLIF.
  • 6.

    Late Pyogenic Spondylitis after Vertebroplasty with PMMA - filled Adjacent Segments - A Case Report -

    Eui-Sung Choi | 김용민 | 정수리 | 2016, 23(2) | pp.108~113 | number of Cited : 0
    Abstract
    Objectives: To report a rare case of late pyogenic spondylitis around the cement mass in T12 that developed 4 years after vertebroplasty with L1-3 bodies already filled with cement due to previous vertebroplasty. Summary of Literature Review: Pyogenic spondylitis after vertebroplasty is a rare complication, but very difficult to manage. Materials and Methods: A 56-year old female visited us with pyogenic spondylitis around the T12 body. The bodies of L1-L3 had been filled with cement eight years previously, followed by another vertebroplasty for T12 four years previously in a local clinic. At first, conservative management with intravenous antibiotics was attempted for 8 weeks, without clinical improvement. Therefore, anterior surgery for T12 corpectomy, removal of the cement, and fusion was performed. Result: The infection was cured and anterior fusion was achieved, and the patient was able to return to her previous activities. Conclusions: Though previous vertebroplasty of the adjacent vertebral body seemed to be a major obstacle to achieving fusion, anterior surgical treatment was the ultimate solution to this complex problem.
  • 7.

    Spinopelvic Reconstruction with Femoral Allograft and Vertical Rectus Abdominis Myocutaneous Flap after Total Sacrectomy in Recurrent Sacral Chordoma - A Case Report -

    박상민 | 정종훈 | Choon-Ki Lee and 2other persons | 2016, 23(2) | pp.114~120 | number of Cited : 0
    Abstract
    Study Design: Case report. Objectives: To report a case of recurrent sacral chordoma treated with total sacrectomy and spinopelvic reconstruction. Summary of Literature Review: Sacral chordoma is a musculoskeletal tumor reported to have a low incidence. Surgical treatment is considered difficult due to the complicated sacropelvic structure, so the prognosis for patients with sacral chordoma has been considered poor. Materials and Methods: We report a surgical technique and outcomes from spinopelvic reconstruction with femoral allograft and vertical rectus abdominis myocutaneous flap after total sacrectomy. Results: We report no tumor recurrence at 43 months postoperatively. Conclusions: Spinopelvic reconstruction with thorough surgical planning after total sacrectomy was found to be a safe and effective treatment method.
  • 8.

    Extensive Intradural Epidermoid Cysts with Cauda Equina Syndrome in the Lumbosacral Spine - Case Report -

    TAEKEUN AHN | 신동은 | 권영우 and 1other persons | 2016, 23(2) | pp.121~126 | number of Cited : 0
    Abstract
    Study Design: A case report. Objectives: To report a rare case of extensive epidermoid cysts in the lumbosacral spine. Summary of Literature Review: The intradural epidermoid cyst with extensive involvement is rare, and previous reports have reported only extensive intramedullary epidermoid cysts. Materials and Methods: A 75-year-old male presented with progressive motor weakness of both extremities beginning 3 days prior. MRI showed extensive intradural extramedullary epidermoid cysts in the lumbosacral region. We performed total laminectomy from the L1 to the L5 level, and the cystic mass was removed. Results: We confirmed the epidermoid cyst on histopathologic examination. Conclusions: Extensive extramedullary epidermoid cysts are difficult to remove completely. Attempting complete removal may result in neurological deficit. Therefore, when surgical intervention is planned, the poor postoperative prognosis should be taken into consideration.
  • 9.

    Huge Intradural Lumbar Disc Herniation Mimicking an Intradural Spinal Tumor - A Case Report -

    Chung-Shik Shin | Byeong-Yeol Choi | Kyung-Tae Kim | 2016, 23(2) | pp.127~130 | number of Cited : 0
    Abstract
    Study Design: A case report. Objectives: To report a case of cauda equine syndrome due to a lumbar intradural disc herniation. Summary of Literature Review: IDH is rare but there is a higher incidence of neurologic deficit in IDH. Therefore, it should be treated immediately. Materials and Methods: A 34-year-old male patient was presented with cauda equina syndrome due to a lumbar intradural mass and underwent surgical excision. Results: Operative findings and the histologic study revealed an intradural disc herniation. Conclusions: IDH is very rare lesion but should be considered in a differential diagnosis if preoperative MRI demonstrates an intradural lesion.
  • 10.

    The Role of the Pelvis in Sagittal Alignment of Lumbar Degenerative Disease Patients

    김용찬 | 유기한 | 장철영 and 6other persons | 2016, 23(2) | pp.131~138 | number of Cited : 0
    Abstract
    Study Design: Literature review. Objectives: To present updated information on the relationship of the pelvis and lumbar degenerative disease (LDD) patients and to emphasize the importance of the pelvis in sagittal alignment of LDD patients. Summary of Literature Review: Although the relationship of the pelvis and sagittal alignment of LDD patients is controversial, many authors have reported a significant impact of the pelvis on LDD sagittal alignment. Materials and Methods: The authors identified references through a literature search on the pelvis and LDD and continuous monitoring of the literature during the past 30 years. Results: The pelvis and lumbar levels were related to whole-body sagittal alignment. The pelvis is also closely related to sagittal alignment of LDD patients. Therefore, the entire area should be regarded as a lumbopelvic complex. Conclusions: We need to consider the concept of a lumbopelvic joint and lumbopelvic lordosis, not a lumbosacral joint and lumbar lordosis. We must also evaluate the lumbopelvic complex to assess whole-body sagittal alignment and dynamic balance.