2010, Vol.17, No.1

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

pISSN : 2093-4378 / eISSN : 2093-4386
https://journal.kci.go.kr/krspine

Study Design: A retrospective radiologic and clinical analysis of 48 patients following anterior cervical fusion. Objectives: To examine the prevalence of symptomatic adjacent segment disease after anterior cervical fusion and determine the risk factors affecting its progression. Summary of Literature Review: Symptomatic adjacent segment disease appears to occur at a rate of 2% to 3% per year. Materials and Methods: Forty-eight patients, who were followed up for more than 3 years after anterior cervical arthrodesis, were enrolled in this study. A modification of the Robinson criteria was used for the clinical evaluation and the radiographic grading of Hilibrand was used for the radiology evaluation. Kaplan-Meier survival analysis was used to examine the survival rate. Age, gender, number of fusion segments, preoperative ROM, angle of lordosis, spinal canal diameter and radiologic degeneration of adjacent segments were selected as potential risk factors. The subjects were divided into two groups according to their clinical symptoms. Results: Symptomatic adjacent segment disease developed in 11 of the 48 patients(22.9%). The disease free survival rates were 88.7%, 82.4% and 58.7% at 5, 10 and 15 years, respectively. A study of the risk factors showed that preoperative degenerative changes and narrow spinal canal in the adjacent segments were significant. However, there were no significant associations with age, gender, number of fusion segments, preoperative ROM and angle of lordosis. Conclusion: The prevalence of symptomatic adjacent segment disease after anterior cervical fusion was considerable and higher when the patients had preoperative degenerative changes and a narrow spinal canal in the adjacent segments.

Study design: A retrospective study. Objectives: To evaluate the clinical results of surgical treatment for a lower lumbar fracture with a neurological deficit. Summary of Literature Review: There are several methods for treating lower lumbar fractures with neurological deficits but no definitive guidelines have been established. Materials and Methods: From 2000 to 2008, this study reviewed 26 patients who had undergone surgery to treat a lower lumbar fracture with a neurological deficit and could be followed up for more than 12 months. The changes in the kyphotic angle, changes in the vertebral body height, compromise ratio of the spinal canal, recovery of neurological deficit, and clinical results were evaluated. Results: There were 15, 7 and 4 cases with a third, fourth and fifth lumbar fracture, respectively. There are 19, 2 and 5 cases of an unstable bursting fracture, chance fracture and translational injury, respectively. The compromise ratio of the spinal canal improved from 67.2±9.4% to 16.4±4.6%, and the changes in the kyphotic angle improved from 14.5±3.2°to 7.6±2.4°postoperatively and 9.7±4.3 at the last follow-up. The changes in the vertebral body height improved from 41.3±8.4% to 23.4±6.3% and the bone union rate was 92.3%. The neurological deficit recovered with 1.27°according to the Frankel classification and good functional results were obtained in 84.6% of cases. Conclusions: Recovery of the neurological deficit and good clinical results were obtained with the recovery of the kyphotic angle and bone union with posterior decompression and instrumented posterolateral fusion in lower lumbar fractures with a neurological deficit.

Study Design: Retrospective study Objective: This study examined the causative factors of cement leakage in an osteoporotic compression fracture that had received percutaneous vertebroplasty. Summary of Literature Review: Percutaneous vertebroplasty is simple and safe for the treatment of osteoporotic compression fractures. However, serious complications, such as pulmonary emboli and paraplegia, can occur if the bone cement leaks into the pulmonary artery or spinal canal. Materials and Methods: Between Oct. 2002 and Apr. 2008, 95 patients (148 vertebral bodies) underwent percutaneous vertebroplasty for the treatment of an osteoporotic compression fracture. The presence of cement leakage was evaluated by plain radiography and computed tomography. The correlations between cement leakage and gender, age, level of fractured vertebra, fracture type, bone density, procedure, injecting amount, preoperative vertebral body compression rate, timing of surgery, and the existence of an intravertebral cleft on magnetic resonance imaging (MRI) were analyzed. Results: Leakage was found in 37 bodies on plain radiography and 56 on the CT-scan. A comparison of the leakage and non-leakage groups revealed the bone density (p=0.046) and amount injected (p=0.000) to be related to cement leakage. Multivariate logistic regression showed that injecting more than 4.0ml was related to cement leakage with an odds ratio of 2.23(95% CI, 1.476~3.377). Conclusions: Cement leakage after percutaneous vertebroplasty is associated with the amount injected. Therefore, the cement volume should be restricted to the amount required for pain relief.