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pISSN : 2093-4378 / eISSN : 2093-4386

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2019, Vol.26, No.4

  • 1.

    Clinical Significance of Resection Type and Margin following Surgical Treatment for Primary Sarcoma of the Spine: A Multi-Center Retrospective Study

    Hyoungmin Kim | Sam Yeol Chang | Se-Jun Park and 3other persons | 2019, 26(4) | pp.117~125 | number of Cited : 0
    Study Design: A retrospective multi-center study. Objectives: To analyze oncological outcomes according to the resection type and surgical margin following surgical treatment for primary spinal sarcoma. Summary of Literature Review: Previous studies using registry databases have shown that surgery and negative margins were associated with improved survival for primary spinal sarcoma. However, few studies have comprehensively analyzed the clinical significance of the resection type and surgical margin for the oncological outcomes of this rare malignancy. Materials and Methods: We retrospectively reviewed consecutive patients who underwent surgical resection for primary spinal sarcoma between 1997 and 2016 at two tertiary medical centers. Overall survival and the occurrence of local recurrence and distant metastasis were compared between the groups using Kaplan-Meier curve analysis and the log-rank test. Results: Thirty-three patients (21 males,12 females) with a mean age of 45.1 years and a median follow-up of 36 months were included. There were 13 (39.4%) chondrosarcomas, 12 (36.4%) osteosarcomas, and eight different histological diagnoses. The cohort was categorized into four groups: 1) total en bloc resection with a negative margin (n=12; 36.4%), 2) total en bloc resection with a positive margin: (n=5; 15.2%), 3) total piecemeal resection (n=12; 36.4%), and 4) subtotal resection (n=4; 12.1%). Total en bloc resection with a negative margin was associated with improved overall survival (p=0.030) and less distant metastasis (p=0.025) and local recurrence (p=0.004). Conclusions: Achieving a negative margin through total en bloc resection, although technically demanding, improves oncological outcomes in primary spinal sarcoma. Key words: Primary spinal sarcoma, En bloc resection, Survival, Recurrence, Metastasis
  • 2.

    Comparative Measurements of Preoperative and Postoperative Radiological and Clinical Parameters of Direct Lumbar Interbody Fusion in Degenerative Spinal Disease Patients

    Changhwa Hong | Woo Jong Kim | Yong Cheol Hong and 3other persons | 2019, 26(4) | pp.126~131 | number of Cited : 0
    Study Design: Retrospective study of prospectively-collected data. Objectives: To evaluate the radiological outcomes of direct lateral lumbar interbody fusion (DLIF). Summary of Literature Review: DLIF, as a minimally invasive spinal surgical procedure, is useful for degenerative spinal diseases. However, few reports have evaluated the clinical and radiological outcomes of DLIF in Korea. Materials and Methods: We analyzed 44 patients who underwent DLIF at our hospital from September 2015 to September 2017. Of these patients, 89 segments were included in this study. We measured preoperative and postoperative radiological values including the disc height, central canal area, height of the foramen, and segmental sagittal angle on magnetic resonance imaging. We also measured patients’ visual analogue scale (VAS) and Oswestry Disability Index (ODI) scores as clinical parameters. Results: Statistically significant improvements were found in the height of the left and right foramina (20.8% and 25.6%, respectively), the height of the intervertebral discs (86.0% and 84.3%, respectively), the cross-sectional area of the central nervous system (33.1%), lumbar lordosis, and the lumbar segmental angle (2.7° and 8.7°, respectively) after surgery. The VAS and ODI scores also showed significant improvements (65.7% and 67.7%, respectively) when compared with the preoperative level. Conclusions: DLIF was found to be effective for the treatment of diseases such as foraminal stenosis, degenerative spondylolisthesis,and adjacent segment diseases through indirect neuro-decompression of the bilateral foramina and central vertebrae. Key words: Spinal stenosis, Spinal fusion, Direct lateral lumbar interbody fusion
  • 3.

    Which Criterion Is More Reliable for Selecting the Distal Fusion Level in Cases of Adolescent Idiopathic Scoliosis with Structural Thoracolumbar/Lumbar Curves: Static or Dynamic?

    Jae Hwan Cho | Chang Ju Hwang | Jae Woo Park and 2other persons | 2019, 26(4) | pp.132~140 | number of Cited : 0
    Study Design: Retrospective comparative study. Objectives: To compare the reliability of 2 criteria to predict the radiological outcomes of corrective surgery in cases of adolescent idiopathic scoliosis (AIS) with structural thoracolumbar/lumbar (TL/L) curves. Summary of Literature Review: Distal fusion level selection in AIS with structural TL/L curves is debatable. Materials and Methods: This study included 131 AIS patients with structural TL/L curves who underwent corrective surgery in which distal fusion was stopped at L3. Whole-spine standing radiographs and bending radiographs were obtained preoperatively. The patients were divided into 2 groups according to their findings on bending radiographs (dynamic criterion) and by the last touching vertebra and the lower end vertebra (static criterion). Radiological outcomes were assessed by reviewing postoperative radiographs. Reliability tests were conducted to compare the predictability of radiological outcomes using these 2 methods. In addition, radiological parameters were compared between both criteria. Results: Among 131 patients, 25 showed radiologically poor outcomes (19.1%). The sensitivity of the dynamic and static criteria was 0.69 and 0.50, respectively. The specificity of each criterion was 0.49 and 0.64, respectively. Overall, the dynamic criterion showed superior reliability (p=0.03). However, no significant difference in radiological parameters could be found in a comparison of both criteria. Conclusions: Although the dynamic criterion was more sensitive for predicting poor radiological outcomes when stopping fusion at L3 in patients with structural TL/L curves, its specificity was lower than that of the static criterion. Thus, both dynamic and static criteria should be considered when selecting the distal fusion level in cases of AIS with structural TL/L curves. Key words: Adolescent idiopathic scoliosis, Double major curve, Distal fusion level, Lower instrumented vertebra
  • 4.

    Radiologic Comparison of the Sacroiliac Joint Degeneration Following Lumbar or Lumbosacral Fusion

    Jemin, Yi | Woo Dong Nam | 2019, 26(4) | pp.141~150 | number of Cited : 0
    Study Design: Retrospective study Objectives: To compare the degeneration of sacroiliac joint (SIJ) following lumbar or lumbosacral fusion. Summary of Literature Review: The SIJ is adjacent to lumbosacral junction and its degeneration can be the potential cause of pain. However, the study addressing SIJ degeneration following lumbar or lumbosacral fusion is very limited. Materials and Methods: From June 2002 to June 2012, 98 patients who underwent posterior decompression and posterolateral fusion were included in this study. The study group was divided into 2 groups according to the range of fusion. Group A had fusion to L5 and included 34 patients. Group B had fusion to S1 and included 64 patients. We evaluated the five years postoperative radiologic and clinical outcomes retrospectively. Results: There was no statistically significant difference of bilateral preoperative subchondral sclerosis and osteophytes of the SIJ between group A and group B. However, group B revealed statistically significant subchondral sclerosis and osteophyte formation of the SIJ than group A on every radiographs after postoperative 1 year. In group B, the number of fusion segments and age were statistically positively correlated with the degeneration of the SIJ. Conclusions: Degeneration of the SIJ revealed more rapid and more severe progression in lumbosacral fusion group than in lumbar fusion group. The number of fusion segments and age were positively correlated with the degeneration of the SIJ in lumbosacral fusion group. Therefore, these facts should be taken into account when performing spinal fusion. Key words: Lumbar degenerative disease, Posterolateral fusion, Sacroiliac joint, Adjacent segment disease
  • 5.

    Factors Associated with the Effect of Conservative Treatment in Surgically Indicated Single-Level Lumbar Spinal Stenosis Patient

    Young-Joon Ahn | 임세혁 | Seok-In Jang | 2019, 26(4) | pp.151~159 | number of Cited : 1
    Study Design: Retrospective study of date collected prospectively. Objectives: To report analytic results about association factors related to effect of conservative treatment in surgically indicated single level lumbar spinal stenosis patient. Summary of Literature Review: There have been various reports about clinical outcomes and relative factors after surgical treatment of spinal stenosis. However, there are few reports about factors related to effect of conservative treatment in surgically indicated lumbar spinal stenosis patient. Materials and Methods: We based on 40 patients who had visited our hospital from May 2010 to April 2016 who were traceable for at least three years. We analysed 20 patients who improved symptom and who didn’t improved symptom then investigated association factors related to effect of conservative treatment. Clinical assessment was conducted using questionnaire and spinal canal’s area and muscle amount were measured in the MRI. Results: Average of the spinal canal of not-improved group is 91.29(±34.26) mm2, improved group is 130.70 (±32.18) mm2 and impoved group is wider (p=0.001). Muscle mass of improved group is 91.47(±9.43) cm2, not-improved group is 79.26 (±14.35) cm2, and improved group is wider (p=0.003). Repetitive strain and traffic accident were related in not-improved group (p=0.028). However, practiced stretching continuously were related to symptom improvement (p=0.022). Conclusions: Association factors related to effect of conservative treatment are cases of wide spinal canal, wide muscle amount, repetitive sprain, traffic accident and stretching. A small muscle amount can be considered as a key factor related to surgical conversion. Key words: Lumbosacral region, Spinal stenosis, Paraspinal muscle
  • 6.

    Osteoid Osteoma of the Sacrum - A Case Report -

    Ki-Won Kim | Chang-Rack Lim | Ji-Hyun Ryu and 1other persons | 2019, 26(4) | pp.160~165 | number of Cited : 0
    Study Design: Case report. Objectives: To report a case of osteoid osteoma arising in the sacrum in a 29-year-old male patient. Summary of Literature Review: Osteoid osteoma is a benign osteoblastic tumor that usually arises in the long bones. Osteoid osteoma involving the sacrum is extremely rare. Materials and Methods: A 29-year-old male patient presented with pain localized in his sacral area for 10 months. His pain was worse at night, relieved by non-steroidal anti-inflammatory drugs, and independent of physical activity. Bone scintigraphy showed increased uptake in the second sacral vertebra (S2). Computed tomography revealed a nidus located in the S2 spinous process. Magnetic resonance imaging showed bone and soft tissue edema around the nidus. Results: En bloc excision including the nidus revealed a diagnosis of osteoid osteoma and provided immediate relief of the patient’s long-lasting sacral pain. Conclusions: When a young patient presents with localized sacral pain that is worse at night, relieved by non-steroidal antiinflammatory drugs, independent of physical activity, and lasts longer than expected, proper imaging studies should be performed to rule out osteoid osteoma. Although less invasive treatment modalities have been introduced, classical en bloc excision is currently the gold standard for managing osteoid osteoma. Key words: Osteoid Osteoma, Sacrum, Benign bone tumor
  • 7.

    Three-Column Fracture in the Thoracolumbar Junction Caused by Low-Energy Trauma in a Patient with Baastrup Disease - A Case Report -

    Suh,Jung-Kuk | 박인근 | Jun-Ku Lee | 2019, 26(4) | pp.166~171 | number of Cited : 0
    Study Design: Case report. Objectives: We report a case of 3-column fracture caused by low-energy trauma in a patient with Baastrup disease who complained of acute radiating pain and motor weakness in the lower limbs after 3 weeks of conservative treatment. Subsequently, posterior fusion surgery was performed. Summary of Literature Review: Baastrup disease is characterized by enlargement and close approximation of adjacent spinous processes, and it mostly affects the L4-5 level of the spine. In patients with Baastrup disease affecting multiple levels of the lumbar spine, low-energy trauma can cause an unstable 3-column fracture with neurological compromise. Early recognition and surgical treatment prior to the emergence of a neurological deficit are required. Materials and Methods: An 84-year-old woman presented with back pain after falling down backward and colliding with the edge of a shelf at ground level. Considering the patient’s general condition and age, she was initially treated with close observation and placement of a spinal brace with serial radiographic follow-up. Results: Computed tomography found 3-column fracture at the T11 level, which is quite rare in cases of minor trauma. At a 3-week follow-up, she complained of gradual lower extremity weakness, and her general lower extremity motor function decreased to grade 1–2. The patient underwent posterior fusion 2 levels above and below the affected vertebral body (T9-10-12-L1). Surgery was uneventful and the patient’s motor function recovered. Conclusions: In patients with Baastrup disease affecting multiple levels of the lumbar spine, based on our experience, low-energy trauma can cause an unstable 3-column fracture with neurological compromise. We highly recommend scrutiny of the interspinous space in elderly patients, especially those with a spinal fracture caused by low-energy trauma. Key words: Baastrup’s disease, Kissing spine, Three-column fracture, Posterior fusion
  • 8.

    Clinical Efficacy of Cages in Anterior Cervical Fusion for Degenerative Cervical Disease

    박문수 | Woo-Kie Min | 고상봉 and 3other persons | 2019, 26(4) | pp.172~177 | number of Cited : 0
    Study Design: Review of the literature. Objectives: To present up-to-date information on the use of cages in anterior cervical fusion for degenerative cervical disease. Summary of Literature Review: The use of cages in anterior cervical fusion for degenerative cervical disease remains controversial. Materials and Methods: Review of the relevant literature. Results: The use of cages in anterior cervical fusion of one and multiple disc levels was effective in terms of biomechanical stability and clinical outcomes without complications at the donor site compared with use of an autograft. However, the use of only a cage had many drawbacks, so the combined use of a cage and a cervical plate is recommended. Conclusions: The use of cages in anterior cervical fusion was effective in terms of clinical outcomes, and the combined use of a cage and a cervical plate is recommended. Key words: Degenerative cervical disease, Anterior cervical fusion, Clinical efficacy, Cage, Cervical plate
  • 9.

    The Evidence for Nonoperative Treatment of Lumbar Spinal Diseases

    안동기 | Hak-Sun Kim | 서형연 and 2other persons | 2019, 26(4) | pp.178~190 | number of Cited : 1
    Study Design: Review article. Objectives: To assess the evidence for nonoperative treatment of various degenerative spinal degenerative diseases. Summary of Literature Review: No study has yet evaluated the evidence for preoperative nonoperative treatment of lumbar spinal diseases. Methods: The evidence regarding nonoperative treatment for each disease was reviewed through NASS guidelines, and the treatment effect compared to surgical treatment was reviewed through the SPORT series. The efficacy of nonoperative treatment according to disease severity and certain special conditions was investigated through corresponding individual articles. Results: No kind of nonoperative treatment could change the fundamental progression of degenerative spinal disease. The natural course of lumbar disc herniation is favorable regardless of treatment. More than 70% of routine cases improve within 6 weeks. However, it does not take a full 6 weeks to decide whether to perform surgery or not. The evidence for transforaminal epidural steroid injections for short-term pain control is grade A. There is grade B evidence for nonoperative treatment with the goal of mid- to long-term pain control. However, we cannot say that those outcomes are better than the natural course of the disease itself. In cases of radicular weakness, the degree of weakness is correlated with the final outcomes, but it is not evident whether the duration of weakness is correlated with surgical outcomes. Early surgery is usually necessary due to intolerable pain, rather than stable motor weakness. The social cost of herniated discs arises from the loss of patients’ productivity, rather than from direct medical expenses. The natural course of spinal stenosis involves provoked pain and the need for palliative care. Unlike disc herniation, rapid deterioration and marked improvement do not occur. The symptoms of mild to moderate lumbar stenosis are unchanged in 70% of cases, improve in 15%, and worsen in 15%. No study has compared nonoperative treatment with the natural course of the disease. There is no evidence for nonoperative treatment of severe stenosis. Epidural spinal injections are effective for controlling short-term pain. Spontaneous recovery of radicular weakness does not occur, and urgent surgery is necessary in such cases. There is no evidence regarding the natural course and nonoperative treatment of degenerative spondylolisthesis. The working group consensus recommends that it should follow the pattern of nonoperative treatment of spinal stenosis when radicular stenosis symptoms are predominant. Overall, 40%-66% of cases of adult bilateral isthmic spondylolysis progress to symptomatic spondylolisthesis. No studies have investigated nonoperative treatment except physical exercise. Conclusions: Although short-term symptom amelioration can be achieved by nonoperative treatment, the fundamental progression of the disease is not affected. For conditions excluded from most studies, such as prior spine surgery, cauda equina syndrome, progressive neurological deficit, and uncontrollable severe pain associated with instability, deformity, or vertebral fractures, there were not enough studies to reach informed conclusions. Our review found no evidence regarding nonoperative treatment for such conditions. Furthermore, the treatment methods for each disease are not clearly distinguished from each other, and the techniques used for disc herniation have been applied to other diseases without any evidence. Key words: Lumbar spine, Degenerative spinal disease, Nonoperative treatment