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2017, Vol.24, No.2

  • 1.

    Changes in Perceptions of Narcotic Analgesic Treatment and Quality of Life in Chronic Back Pain Patients

    김민욱 | Choong-young Kim | 이지원 and 3other persons | 2017, 24(2) | pp.65~71 | number of Cited : 0
    Abstract
    Study design: Prospective study. Objectives: This study was conducted to investigate changes in perceptions of treatment using narcotic analgesics and quality of life in chronic back pain patients. Summary of Literature Review: Negative perceptions of narcotic analgesics as pain killers have been established as factors affecting compliance and adherence. Materials and Methods: A total of 140 patients who had chronic back pain for over 3 months were examined using clinical scales such as the Korean version of the Oswestry Disability Index (KODI), the Short Form-12 (SF-12), and a visual analog scale (VAS). The survey regarding narcotic analgesics classified patients as having positive perceptions if they reported absolutely not wanting to use them or being unlikely to use them at the primary interview and after 4 weeks of treatment. Results: Ninety-four patients (68%) reported negative perceptions of narcotic analgesics at the primary interview. Sixty-one of those patients (64%) changed their perceptions, reporting positive perceptions after 4 weeks of treatment, as indicated by the ODI (p=0.01), SF-12 (p=0.01), and VAS (p=0.01) scores. A change from positive to negative perceptions after 4 weeks of treatment was observed in 13 patients (28%) who experienced adverse effects of narcotics treatment (p=0.01). Among the 33 patients (23%) whose negative perceptions did not change, dissatisfaction with previous treatment was found to be a contributing factor in 22 (66%). Conclusions: Clinical improvements after treatment using narcotic analgesics in chronic back pain patients resulted in a significant positive impact on perceptions about narcotic analgesics. Narcotic analgesics could be an alternative treatment choice in chronic back pain patients because of improvements in their quality of life.
  • 2.

    Short-Term Effects of Selective Nerve Root Block in Spinal Stenosis Patients According to Spinal Canal Dimensions

    안영준 | 임세혁 | 박상현 | 2017, 24(2) | pp.72~79 | number of Cited : 3
    Abstract
    Study Design: Prospective study. Objectives: To assess the correlation between symptom improvement and spinal canal dimensions in patients who underwent selective nerve root block for lumbar spinal stenosis. Summary of Literature Review: When the canal size is relatively small, the pressure on the nerve root increases. Decompressive surgery relieves more pain in such patients. Materials and Methods: From July 2009 to March 2011, 141 patients received selective nerve root block for 1-level central lumbar spinal stenosis in our hospital. We evaluated the patients using a visual analog scale (VAS) before the procedure and 1 hour, 1 month, and 3 months following the procedure. We measured the spinal canal using magnetic resonance imaging. Results: There was no significant correlation between spinal canal dimensions and the pre-procedure VAS. We divided the patients into 3 groups using the average and the standard deviation of the patients’ spinal canal dimensions (<73.1 mm2, 73.1-172.5 mm2, >172.5 mm2) (p<0.01). One hour after the procedure, the VAS scores changed by 1.43±1.8, 1.62±1.7, and 1.53±1.5, respectively, with no significant differences among the 3 groups. However there were significant differences in the VAS changes 1 month and 3 months following the procedure, with results of 2.39±1.7 and 1.39±1.5, 4.65±2.1 and 4.28±2.3, and 4.97±2.2 and 6.83±1.9 (p<0.01), respectively. Conclusions: The smaller the area of the spinal canal, the less likely symptoms were to improve after selective nerve root block. The results of this study will help predict the effects of selective nerve root block in spinal stenosis patients.
  • 3.

    Survival Analysis Based on the Incidence of a New Fracture in an Adjacent Vertebra After Vertebroplasty or Kyphoplasty

    김성수 | 김동혁 | Jung-Hoon Kim | 2017, 24(2) | pp.80~86 | number of Cited : 1
    Abstract
    Study Design: Retrospective study. Objectives: To evaluate the factors affecting the incidence of new vertebral fractures and the survival rate associated with the occurrence of a new fracture in an adjacent vertebra after vertebroplasty or kyphoplasty for single-vertebral body fracture due to osteoporosis. Summary of Literature Review: It is controversial whether adjacent-vertebra fractures after vertebroplasty or kyphoplasty are due to the natural course of osteoporosis or are a complication of vertebroplasty. Materials and Methods: From May 2002 to January 2010, among 490 cases of vertebroplasty and kyphoplasty for the fracture of a single vertebral body due to osteoporosis, 250 cases were analyzed retrospectively, and a survival rate analysis was performed based on the incidence of a new fracture in an adjacent vertebral body. The survival rate analysis was conducted based on age at the time of surgery, gender, surgical method, leakage of cement into the vertebral disc, compression rate before surgery, recovery of vertebral height after surgery, bone density before surgery, surgeon, the presence of diabetes, and smoking. The average follow-up period was 13.8 months (range, 1 month to 7 years and 11 months) and the mean age at the time of surgery was 72.1 years (range, 47-92 years). Results: Among the 250 cases, a new fracture in an adjacent vertebral body occurred in 30 cases (12%). The 1-year survival rate of patients undergoing vertebroplastry or kyphoplasty for a vertebral fracture was 88.4%, the 5-year rate was 66.8%, and the 7-year rate was 53.5%. When the cases were analyzed according to whether the patient’s age at the time of surgery was under or over 70 years, the survival rate was significantly higher in the under-70 group (p=0.026). Moreover, when analyzing the survival rate using a 3% vertebral height recovery rate after surgery as baseline, the group that showed 3% or less had a significantly higher survival rate (p=0.04); moreover, the survival rate was significantly higher in patients with a bone density higher than −3.6 (p=0.046). In multiple factor analysis, age at the time of surgery (p=0.022) and the vertebral height recovery rate after surgery (p=0.046) were found to be statistically significant factors. Conclusions: The survival rate associated with a new fracture in an adjacent vertebra after vertebroplasty or kyphoplasty for osteoporotic compression fractures was significantly decreased at 1, 5, and 7 years. Based on the survival rate analysis, the most crucial factors were age and the vertebral height recovery rate after surgery.
  • 4.

    Union Patterns of Local Autogenous Bone Grafts Using Metal Cages, Allogenic Bone, and Local Autogenous Bone Around the Cages During Posterior Lumbar Interbody Fusion: A Retrospective CT Analysis

    Chan Ho Park | 김응하 | 윤건희 | 2017, 24(2) | pp.87~94 | number of Cited : 0
    Abstract
    Study Design: Retrospective study. Objectives: To conduct an analysis of the union rate and union patterns of local autogenous bone grafts using metal cages, allogenic bone, and local autogenous bone around the cages in posterior lumbar interbody fusion (PLIF). Summary of Literature Review: Local autologous bone grafting using metal cages is regarded as an effective method for union during PLIF without iliac bone harvesting. There are few studies about the additional bone grafting except using metal cages. Materials and Methods: Thirty-nine patients (68 segments) with postoperative computed tomography (CT) results from 6 to 18 months after PLIF were included. We used 2 metal cages filled with local autogenous bone intraoperatively (region C). We also grafted allogenic bone between 2 cages (region A) and local autogenous bone at the side of the cages (region B). Retrospective analyses of the coronal CT sections were performed using the modified Bridwell criteria for assessing the presence of union. A quantitative evaluation was performed using a scoring system that assessed the proportion of radiopaque parts of the union mass. Results: Among the 68 segments, union was observed in 64 segments, resulting in a union rate of 95.6%. The union rates in regions A, B, and C were 86.8%, 89.7%, and 94.1%, respectively. Trabeculation and the quantitative evaluation of union bone showed a statistically significant trend for improvement from regions A to C (p<0.001). Conclusions: In this study, the complementary effect of additional bone grafting other than local bone grafting was not proven, but it was effective in increasing the fusion area at around 90%. Keeping the height of disc space with the cages, additional bone grafting using local autogenous and allogenous bone may be used as an effective method for stable union.
  • 5.

    Can Unilateral Minimally Invasive Transforaminal Lumbar Interbody Fusion (MIS TLIF) Result in Sufficient Reduction in Spondylolisthesis?: A Comparison with Open TLIF and Bilateral MIS TLIF

    구기형 | 이장연 | 김재현 | 2017, 24(2) | pp.95~102 | number of Cited : 0
    Abstract
    Study Design: Retrospective study. Objectives: To compare the radiologic results of unilateral or bilateral minimal invasive transforaminal lumbar interbody fusion (MIS TLIF) and conventional open lumbar interbody fusion. Summary of Literature Review: Only a few studies have compared the slip reduction and fusion rate between unilateral or bilateral MIS TLIF and conventional open TLIF. Materials and Methods: Between March 2007 and May 2015, 80 patients with single-level low-grade spondylolisthesis underwent unilateral MIS TLIF (26 patients), bilateral MIS TLIF (10 patients), or open TLIF (44 patients) by a single surgeon. Radiologic studies were performed preoperatively, 2 weeks postoperatively, and 12 months postoperatively. Slip reduction, the lumbar lordortic angle, and the fusion rate were analyzed. Results: The 3 groups exhibited significantly improved slip after operation. Significant differences were found among the 3 groups (p=0.015) and between the MIS TLIF group (31.76%±14.42%) and the open TLIF group (41.66%±15.98%) (p=0.01) in the slip reduction rate at 2 weeks after the operation. However, no significant difference was found between unilateral MIS TLIF and bilateral MIS TLIF (37.61%±15.0% vs. 29.5%±13.82%, p=0.148). In the lumbar lordotic angle, no significant difference was found among the 3 groups. There were no significant differences among the 3 groups in slip reduction or the fusion rate at 12 months after the operation. Conclusions: Our study suggests that unilateral MIS TLIF showed a similar slip reduction and fusion rate to bilateral MIS TLIF, but that conventional open TLIF showed better slip reduction than MIS TLIF, although it had a similar fusion rate.
  • 6.

    Kyphotic Deformity after Spinal Fusion in a Patient with Diffuse Idiopathic Skeletal Hyperostosis - A Case Report -

    김재동 | Park Ye-Soo | 이재원 | 2017, 24(2) | pp.103~108 | number of Cited : 0
    Abstract
    Study Design: Case report. Objectives: To report a case of progressive kyphotic deformity after spinal fusion in a patient with diffuse idiopathic skeletal hyperostosis (DISH). Summary of Literature Review: DISH is characterized by spinal and peripheral enthesopathy, and is a completely different disease from ankylosing spondylitis (AS). Though DISH can be associated with thoracic kyphosis, no reports have described a progressive thoracolumbar kyphotic deformity after spinal fusion surgery in a DISH patient. Materials and Methods: A 47-year-old male presented with pain in the thoracolumbar region. After excluding the possibility of AS and confirming the diagnosis of DISH, we performed spinal fusion for the treatment of a T11-T12 flexion-distraction injury. The kyphotic deformity was found to be aggravated after the first operation, and we then performed corrective osteotomy and additional spinal fusion. Results: The kyphotic deformity of the patient was corrected after the second operation. Conclusions: In DISH patients in whom AS must be excluded in the differential diagnosis, a kyphotic deformity can become aggravated despite spinal fusion surgery, so regular and continuous follow-up is required.
  • 7.

    A Long, Solitary, Rosary-Shaped Spinal Neurofibroma

    Sung-Woo Choi | 신병준 | Jae Chul Lee and 2other persons | 2017, 24(2) | pp.109~114 | number of Cited : 0
    Abstract
    Study Design: Case report. Objectives: We report the case of a long, solitary, rosary-shaped neurofibroma that was misdiagnosed as another disease due to the patient’s surgical history involving repetitive procedures and its abnormal appearance. Summary of Literature Review: Neurofibroma is an intradural-extramedullary spinal tumor. It is generally not difficult to diagnose due to its frequent occurrence and specific magnetic resonance imaging (MRI) findings. However, to date, neurofibromatosis stigmata and long, solitary, rosary-shaped neurofibromas have rarely been reported. Materials and Methods: A 60-year-old woman was admitted to our hospital due to persistent pain, despite previous surgery and repetitive procedures. On physical examination, vision loss, hearing loss, skin discoloration, or subcutaneous nodules were not observed. A neurologic examination revealed normal motor and sensory function and voiding sensation. No pathologic reflexes such as the Babinski sign were observed. Previous sequential MRIs revealed intradural lesions that progressed from the thoracic vertebra 11 to the lumbar vertebra 3. She had no signs of neurofibromatosis stigmata, and the neurologic examination was unremarkable. The initial diagnosis was based on serial MRIs, which revealed a parasite infestation, a spinal cord tumor (myxopapillary-type ependymoma with hemorrhage), arachnoiditis, and vascular malformations. Total mass excision was performed, and the final diagnosis was neurofibroma. Results: There were no signs of a tumor remnants or local recurrence in a 1-year follow-up MRI study. Conclusions: Although intradural spinal tumors are very rare, their clinical features are nonspecific and resemble other degenerative spinal diseases, including spinal stenosis and disc herniation. These diseases may easily be overlooked by physicians.
  • 8.

    Successful Treatment of Internal Iliac Vein Rupture During Revisional Anterior Lumbar Spinal Surgery Using a Tack - Case Report -

    Sangbong Ko | Tae Bum Oh | Ki Hyuk Park | 2017, 24(2) | pp.115~120 | number of Cited : 0
    Abstract
    Study Design: Case report. Objectives: To report a rare case in which a tack was used to control bleeding due to a torn iliac vein during revisional anterior spine surgery. Summary of Literature Review: During anterior lumbar surgery, bleeding following a vascular injury is possible to control and reparable in most cases. During revisional anterior lumbar surgery, however, there are irreparable cases of bleeding as well. In some cases, it can threaten the patient’s life. Material and Methods: A 56-year-old man suffered from potentially fatal bleeding following iliac vein rupture during revisional anterior lumbar surgery. Primary vascular closure was impossible due to severe adhesion. We attempted to stop the venous bleeding with a tack, as an alternative treatment. The potentially fatal bleeding was controlled and the patient’s vital signs stabilized after hemostasis by the tack. Results: Hemostasis using the tack saved the patient’s life without any rebleeding. Conclusions: During revisional anterior lumbar surgery, bleeding following an iliac vein rupture can be controlled by a tack in cases that are irreparable due to severe adhesion.
  • 9.

    Idiopathic Spinal Cord Herniation

    김성수 | 2017, 24(2) | pp.121~128 | number of Cited : 0
    Abstract
    Study Design: Literature review. Objectives: The aim of this study was to provide insight into idiopathic spinal cord herniation (ISCH) in terms of clinical presentation, pathophysiology, diagnosis, classification, and treatment. Summary of Literature Review: ISCH is a rare disorder characterized by anterior displacement of the spinal cord through a ventral dural defect. It has increasingly been recognized and described over the past 10 years. Materials and Methods: Review of the English-language literature on ISCH. Results: ISCH occurs in middle-aged adults with a female preponderance. The most common clinical presentation is Brown- Sequard syndrome, which can progress to spastic paraparesis. Its pathophysiology is unknown. However, some authors proposed that inflammation may play an important role in the emergence of a dural defect. Magnetic resonance imaging typically shows an anterior kink of the thoracic spinal cord with an obliteration of the ventral subarachnoid space and the widened dorsal subarachnoid space. Surgery is generally recommended for patients with motor deficits or progressive neurological symptoms. The posterior approach has been used because it allows wide exposure of the spinal cord. The surgical treatment of ISCH consists of spinal cord reduction from the ventral dural defect, which can be managed with enlargement, direct repair, or duraplasty (dural repair with a patch). In recent years, duraplasty has been used more frequently than enlargement of the dural defect. Conclusions: ISCH causing thoracic myelopathy could be safely treated with surgical management. The possibility of this disease should be kept in mind when treating patients with progressive myelopathy.
  • 10.

    Nucleoplasty: Percutaneous Plasma Disc Decompression for the Treatment of Lumbar Disc Herniation

    Dong-Yeong Lee | Soon-Taek Jeong | 오진영 and 1other persons | 2017, 24(2) | pp.129~136 | number of Cited : 1
    Abstract
    Study Design: A review of the literature regarding nucleoplasty. Objectives: This aim of this article is to provide current information on nucleoplasty as a therapeutic intervention for herniated disc or discogenic back pain in degenerative disc disease. Summary of Literature Review: Nucleoplasty as a therapeutic intervention for discogenic pain is performed with increasing frequency, and has been reported to involve few complications and to have satisfactory clinical results. Materials and Methods: Review of the literature. Results: In nucleoplasty, the intervertebral disc is approached percutaneously. In this paradigm, a bipolar high frequency device in combination with ablation and coagulation is used to create a channel in the intervertebral disc in order to reduce intervertebral disc volume and to decrease intervertebral pressure and inflammatory markers. Standard indications for nucleoplasty have not been established, but it has been reported that the procedure had excellent outcomes regardless of the presence of radiculopathy or the results of discography. Many studies have reported their outcomes using various categories, because the procedure is comparatively new. Concomitantly, long-term follow-up studies remain to be performed, and each study reported a different follow-up period. Conclusions: Nucleoplasty has been found to show an excellent prognosis for discogenic back pain and a low incidence of complications. Moreover, since it is a minimally invasive procedure, it offers improved possibilities for return to daily life and work. If degenerative changes have not progressed to a great extent or the intervertebral level remains intact, nucleoplasty may be considered prior to surgery. Due to the lack of reports on the subject, prospective analyses in the future are required.
  • 11.

    Delayed Vertebral Collapse in Osteoporotic Vertebral Compression Fractures: Risk Factors and Treatment Strategies

    이정희 | 신승준 | 신원주 | 2017, 24(2) | pp.137~145 | number of Cited : 0
    Abstract
    Study Design: Literature review. Objectives: To review the complications of osteoporotic vertebral compression fractures (OCFs) with regard to risk factors and treatment strategies. Summary of Literature Review: Understanding the complications and treatment methods of OCFs is important given their increasing prevalence. Materials and Methods: Review of the literature. Results: The complications of OCFs include kyphotic deformity due to a delayed collapse of the vertebral body and neurologic deficits. The pathophysiologic mechanism of these complications has not been established; however, the most accepted theory is posttraumatic avascular necrosis of the vertebral body. The risk factors for these complications include fracture at the thoracolumbar junction, systemic usage of steroids, severe osteoporosis, and radiological intravertebral vacuum cleft. Most of these complications require surgical treatment, the indications for which include progressing axial back pain, pseudarthrosis, kyphotic deformity, and neurologic deficits. Surgical approaches for treating the complications of OCFs include anterior, posterior, and combined anteriorposterior approaches. Osteotomies should be done when deformity correction is needed. The decision among these various surgical methods should be made considering patient factors and the surgeon’s ability to achieve the best outcomes with solid fusion. Conclusions: The complications of OCFs include kyphotic deformity due to delayed collapse of the vertebral body and neurologic deficits. Most of these complications require surgical treatment, in which achieving solid fusion at the fracture site is the ultimate goal. Patient-related factors and the surgeon’s ability should be considered prior to making decisions regarding surgery.