KJC Korea
Journal Central

Study Design: Case-control comparison study. Objectives: The aim of this study was to investigate whether single nucleotide polymorphisms (SNPs) of COL2A1 affect the development of ankylosing spondylitis (AS). Summary of Literature Review: Many factors have been reported to be involved in the etiology of AS. Human leukocyte antigen (HLA)-B27 has been established as a genetic factor involved in the development of AS; however, it has been reported in recent studies that various genetic polymorphisms may be related to the development of AS. The collagen, type II, alpha 1 gene (COL2A1 ) plays a role in cartilage formation and maintaining the vitreous humor in the eye. Several previous studies have investigated the associations of COL2A1 with spinal degenerative diseases, but no case-control comparative study has yet investigated the effect of COL2A1 variants on the development of AS. Materials and Methods: The study was planned with 96 AS patients in the study group and 330 healthy individuals in the control group. We searched the gene region of the COL2A1 gene in the NCBI SNP database (http://www.ncbi.nlm.nih.gov/snp), and 3 SNPs (rs3803183, rs2070739 and rs1793949) were found using sequencing to be significantly different between the AS and control groups. Multiple logistic regression models for genetic analysis were applied Results: Three SNPs (rs3803183, rs2070739 and rs1793949) of COL2A1 showed significant associations with AS patients compared to control subjects (p<0.05). Conclusions: SNPs of COL2A1 may be associated with the development of AS in the Korean population.

Study Design: A case-control study. Objectives: This study was conducted to demonstrate the reliability of mini-open anterior lumbar interbody fusion (ALIF) combined with lateral lumbar interbody fusion (LLIF) followed by 2-stage posterior fixation in patients with adult spinal deformity (ASD). Summary of Literature Review: Although the correction of ASD using LLIF has become more widespread, the amount of sagittal plane correction has been reported to be suboptimal. Materials and Method: Thirty ASD patients who underwent ALIF with LLIF followed by 2-stage posterior fixation (AP group) were compared to 60 patients who underwent posterior-only surgery (PO group) and were matched according to age, sex, diagnosis, fusion level, pelvic incidence, and follow-up duration. Spinopelvic parameters, hospitalization data, clinical outcomes, and complications were compared between the 2 groups. Results: Postoperative lumbar lordosis was greater in the AP group than in the PO group (p<0.001). The reduction in the sagittal vertical axis was also greater in the AP group than in the PO group (p=0.005). Postoperatively, 90.0% of the AP group had a pelvic incidence–lumbar lordosis value within 9°, whereas only 50.0% of the PO group met that criterion (p<0.001). The operation time of the AP group was longer than that of the PO group, while estimated blood loss and red cell transfusion were lower in the AP group. Postoperative medical complications and delayed surgical complications developed more frequently in the PO group. Conclusions: Mini-open ALIF with LLIF followed by 2-stage posterior fixation can restore sagittal balance more appropriately, with a lower rate of complications, than posterior-only surgery for the correction of ASD.

Study Design: Prospective survey analysis. Objectives: The purpose of our study was to investigate medical care utilization behavior and the conceptions of disease treatment among spine disease patients. Summary of Literature Review: Analyzing the medical care utilization behavior and conceptions of disease treatment among spine disease patients is important. Materials and Methods: A survey was administered to 500 first-time patients who visited the spine center of a tertiary educational hospital from May 2017 to August 2019. Results: A total of 479 valid responses were analyzed. A minority of patients (16.1%) visited the tertiary educational hospital without having previously visited a private hospital. Spinal procedures and surgery were considered negatively by 52.6% of respondents, and 14.8% of patients reported negative perceptions of orthopedic drugs. Conclusions: Extensive efforts will be required to improve unreasonable medical utilization behavior by changing patients’ incorrect knowledge and beliefs about hospitals, diseases, and treatments.

Study Design: Case report. Objectives: Despite precise iliosacral (IS) screw placement, we encountered a case of a neurological deficit due to a bony fragment that remained around the nerve root after reduction of the fracture gap in a patient with a pelvic ring injury. Summary of Literature Review: Percutaneous IS screw fixation is a commonly used procedure because it enables an adequate fixation force to be secured through a minimally invasive method in patients with pelvic ring fractures. Percutaneous IS screw fixation using C-arm fluoroscopy has been well described. In addition, several studies have investigated methods to prevent neurological damage. Materials and Methods: A 48-year-old man was diagnosed with a lateral compression type 1 pelvic ring fracture. Bilateral IS screw fixation was performed in the patient, who had no preoperative neurological abnormalities. He complained of pain around the sacroiliac joint that radiated to the lower leg after percutaneous IS screw fixation, and he was diagnosed with S1 radiculopathy on electromyography. Results: While reviewing the patient’s preoperative computed tomography images, a bony fragment in the fracture gap on the left S1 root was noted. After confirming S1 root entrapment, decompressive laminectomy was performed. Conclusions: Surgeons should be aware that postoperative neurological symptoms may be caused by a bony fragment resulting from the fracture, regardless of screw malposition in percutaneous IS screw fixation. Preoperative planning with meticulous image review and intraoperative neurological monitoring, as well as using full-threaded screws, may help to prevent this problem.

Study Design: Review article. Objectives: This review aims to present relevant considerations for the surgical treatment of spinal deformities accompanied by osteoporosis, how surgeons are trying to overcome the challenges posed by osteoporosis in patients with spinal deformities, and directions of further development. Summary of literature Review: Various trials have been done to overcome the short- and long-term complications associated with osteoporosis in order to achieve successful clinical results in the surgical treatment of spinal deformities. Materials and Methods: Review of the relevant articles. Results: The surgical goal of treating spinal deformities is to reverse neurological compromise and to restore balanced spine alignment. To achieve these goals, several surgical considerations should be kept in mind. Osteoporosis is an important issue related to early and long-term complications following surgery. As ways of overcoming the challenges posed by osteoporosis, rigid fixation techniques, proper selection of the fusion level, perioperative medical treatment, and effective bone grafting materials are described herein; however, further development in these domains is also necessary. Conclusions: Osteoporosis may be a major obstacle in spinal deformity surgery. Although several effective attempts have been made to overcome these limitations, further research and trials are needed to obtain better results.