2008, Vol.15, No.1

Posterior Hemivertebra Excision in Congenital Scoliosis

안종국 , Jinhyok Kim , Sung-Soo Kim and 3 other persons | 2008, 15(1) | pp.1~8 | number of Cited : 0

Study Design: Retrospective study Objectives: To evaluate the surgical outcome of congenital scoliosis with a hemivertebra treated by posterior hemivertebra excision and pedicle screw instrumentation. Summary of Literature Review: Posterior hemivertebra excision can be accomplished through a single posterior approach, and excellent correction and outcome may be achieved. Materials and Methods: Forty patients with one fully segmented hemivertebra treated by posterior hemivertebra excision with pedicle screw instrumentation were retrospectively analyzed after a minimum follow-up of 2 years (range 2~7.7 years). The mean age at surgery was 15.9 years (range 2.6~37.9 years). Preoperative and postoperative standing radiographs were used to assess radiographic parameters. Results: The average number of vertebrae in the major curve was 4.2 (range 3~8), and the average flexibility was 29% (range 8~59%). The average length of fusion was 3.5 segments (range 1~6). The number of fused vertebrae had a positive correlation with age at the index surgery (r=0.345, p􀍻0.05). Mean preoperative scoliosis of 48±12。was corrected to a mean of 17±10。 (65% correction), and mean preoperative kyphosis of 46±18。was corrected to a mean of 12±12。at the most recent follow-up. The compensatory curve had a mean of 25±10。preoperatively and spontaneously corrected to a mean of 8±8。(70% correction) at the most recent follow-up. The mean operating time was 233±81 min, with an average blood loss of 2904 ml. There was neither crankshaft phenomenon nor iatrogenic spinal stenosis in 6 patients under the age of 5 years after an average follow- up of 6 years. Conclusions: Posterior hemivertebra excision using pedicle screw instrumentation in congenital scoliosis due to a hemivertebra is a safe and effective procedure. Posterior hemivertebra excision at an early age may reduce the fusion length while avoiding the induction of iatrogenic spinal stenosis during follow-up.

Polyaxial Screws with Thick Rod versus Monoaxial Screws with Thin Rod in Video-Assisted Thoracoscopic Scoliosis Surgery(AVTS)

HAK SUN KIM , 김주영 , 박진오 and 7 other persons | 2008, 15(1) | pp.9~17 | number of Cited : 0

The Usefulness of Bone Scan in the Osteoporotic Vertebral Compression Fracture Patients Treated With Kyphoplasty

Jun Deuk Soo , 신원주 , 김광희 | 2008, 15(1) | pp.18~22 | number of Cited : 2

Study Design: Retrospective study. Objectives: To compare the clinical results of kyphoplasty between osteoporotic patients with compression fractures and rib hot uptake on bone scan and patients without rib hot uptake. Summary of Literature Review: The incidence of osteoporotic rib fractures is 0.3% in postmenopausal women. Materials and Methods: Between July 2005 and July 2006, 72 kyphoplasties for osteoporotic vertebral compression fractures were performed, and all patients had a bone scan study. On bone scan study, 41 patients (57.7%) had hot uptake in their ribs. Results were assessed by visual analog scale (VAS). Results: The incidence of hot uptake was 67.8% in thoracic fractures, 40.0% in lumbar fractures, and 72.7% in thoracolumbar fractures. Hot uptake was significantly more common with thoracic and thoracolumbar fractures than with lumbar fractures (p<0.05). The incidence of hot uptake was 49.1% in one- and two-level fractures and 84.6% in over three-level fractures. This finding demonstrated significant difference between the two groups (p<0.05). The mean VAS scores for all cases were 8.2/3.4/3.2 at preoperative/immediate postoperative/after 3 months, respectively. In thoracic fractures, they were 8.2/3.9/3.1; lumbar fractures 8.0/3.2/3.1; and thoracolumbar fractures 8.3/3.7/3.0, respectively. The immediate postoperative VAS score in lumbar fractures was better than in thoracic fractures (p<0.05). The VAS scores in thoracic fractures with hot uptake were 8.3/4.1/3, and those without hot uptake were 7.8/2.8/3.0. The immediate VAS score in thoracic fractures without hot uptake was better than in those with hot uptake (p<0.05). Conclusions: Thoracic and multiple osteoporotic compression fractures are often accompanied by rib fractures. Bone scan is a useful tool to detect rib fractures and predict the prognosis of kyphoplasty.

The Comparison of the Results Between AO Internal Fixator(Long lever-arm)and Screw-Rod system(Short lever-arm) Through Posterior Approach in Unstable Thoracolumbar Fractures

김영태 , kim moon chan , 강석중 and 5 other persons | 2008, 15(1) | pp.23~30 | number of Cited : 0

Study design: Prospective study. Objectives: To analyze the outcome of posterior reduction and fixation with the AO internal fixator and with the screw-rod system in unstable thoracolumbar fractures and to investigate differences in effectiveness between the two methods. Summary of literature review: In unstable thoracolumbar fractures, fixation with the AO internal fixator is an effective method for posterior reduction. However, the results of correction are quite variable. Materials and methods: We analyzed 51 patients with unstable thoracolumbar fractures who underwent correction through posterior approach between 1997 and 2003. We divided the patients into two groups: Patients in Group A (25 cases) were treated with the AO internal fixator, and patients in Group B (26 cases) were treated with the screw-rod system. We added transpedicular bone grafts for 17 patients in Group A. We evaluated correction of deformity (anterior and posterior height of vertebral body, sagittal index, disc height), loss of correction, spinal canal clearance, and neurological recovery. Results: Comparing correction of deformity, we saw better results in Group A than in Group B in regards to sagittal index and anterior height of vertebral body. However, we saw a higher degree of correction loss in the anterior height of the vertebral body in Group A. We grafted autogenous bone into the fracture site by transpedicular approach for 17 patients in Group A. We saw less correction loss in the anterior vertebral body height and sagittal index. In regard to spinal canal clearance, we saw better results in Group A (18%) than in Group B (10%). As for neurological recovery, we could not find any statistically significant difference between the two groups. Conclusions: Through an operative procedure, we could achieve better results in restoration of anterior vertebral height and canal clearance with the AO internal fixator system. Further study is necessary to keep the reduced state of vertebral height.

Radiographic Changes of Adjacent Upper Segment Performed Short Segmental Lumbosacral Fusion-Does Total Laminectomy Influence Adjacent Upper

황대우 , 신재흥 , 김병민 and 3 other persons | 2008, 15(1) | pp.31~37 | number of Cited : 0

Study Design:Retrospective study. Objectives:The purpose of this study was to compare factors that influence degenerative changes in patients undergoing totallaminectomy and patients undergoing partial laminectomy. Summary of Literature Review:Lumbar or lumbosacral fusion with total or partial laminectomy may result in adjacent seg-ment problems of the upper segment. However, the differences between the two procedures that may influence adjacent seg-ment instability are still controversial. Materials and Methods:We evaluated 95 patients, followed up for at least 2 years, who had been treated with short level (atmost 2 levels) posterior lumbar interbody fusion with pedicle fixation, secondary to spinal stenosis. Treatment proceduresincluded total laminectomy (42 cases) and partial laminectomy (53 cases). We analyzed the preoperative status of the interverte-bral discs (Thompson grade), difference of disc height, and difference between preoperative segmental sagittal angle and lastfollow-up sagittal angle. We excluded cases that required revision secondary to infection, nonunion, or hematoma formation.However, we included cases that required revision due to adjacent segmental problems during the follow-up period. Results:The mean age of the patients treated with total laminectomy was 59.0± 10.9 years, and of the patients treated withpartial laminectomy was 58.8± 10.2 years. The preoperative Thompson grade showed no statistical difference. The difference indisc height and segmental sagittal angle between the preoperative and last follow-up examinations showed no statistical dif-ference between the two groups. Conclusions:There was no significant difference in the radiographic or clinical outcomes based on removal or preservation ofposterior structures. Nevertheless, we need further follow-up to evaluate adjacent segment degeneration.

RISK Factors for Adjacent Segment Disease After Lumbar Fusion

양준영 , 이준규 , 송호섭 and 2 other persons | 2008, 15(1) | pp.38~43 | number of Cited : 2

Autogenous Bone Graft and Bone Substitutes

황창주 , 이성우 , 안영준 and 3 other persons | 2008, 15(1) | pp.44~53 | number of Cited : 2

Autogenous Bone Graft and Bone Substitutes

김동준 | 2008, 15(1) | pp.54~65 | number of Cited : 2

KJCKorea
Journal Central

Journal of Korean Society of Spine Surgery 2023 KCI Impact Factor : 0.03

2008, Vol.15, No.1