2010, Vol.17, No.2

Tissue Engineering of the Intervertebral Disc with Cultured Nucleus Pulposus Cells Using Atelocollagen Scaffold and Gene Therapy

김학선 , 이광일 , 김향 and 7 other persons | 2010, 17(2) | pp.49~56 | number of Cited : 0

Study Design: This is an in-vitro experiment using rabbit intervertebral disc (IVD) cells and growth factors. Objectives: We wanted to determine the effect of types I,and II atelocollagen and growth factor gene therapy for matrix regeneration of rabbit IVD cells. Summary of the Literature Review: Adenovirus-medicated growth factor gene therapy is efficient for matrix regeneration of the IVD. Atellocollagen has provided a favorable environment for matrix synthesis. However, a combined approach using gene and cell therapy in an atelocollagen scaffold has not yet been attempted. Materials and Methods: Rabbit IVD cells were transduced with Ad/TGF-β1 and Ad/BMP-2. The cells were then implanted to the atelocollagen scaffold. The [methyl-3H]thymidine incorporation for DNA synthesis and the [35S]sulfur incorporation for proteoglycan synthesis were measured. RT-PCR was performed for assessing the aggrecan, collagen type I, collagen type II and osteocalcin mRNA expressions. Results: The rabbit IVD cells with Ad/TGF-β1 and that were cultured in type I atelocollagen showed a 130% increase in new proteoglycan synthesis, while the rabbit IVD cells with Ad/TGF-β1 and that were cultured in type II atelocollagen showed a 180% increase in new proteoglycan synthesis (p<0.05). The rabbit IVD cells with Ad/BMP-2 and that were cultured in type I atelocollagen showed a 70% increase in new proteoglycan synthesis, while the rabbit IVD cells with Ad/BMP-2 and that were cultured in type II atelocollagen showed a 95% increase (p<0.05). Rabbit IVD cells with Ad/TGF-β1 and Ad/BMP-2 and that were cultured in type I and II atelocollagen demonstrated increased collagen type I and II mRNA expressions without an osteocalcin mRNA expression (p<0.05). Conclusion: Cell and gene therapy in an atelocollagen scaffold provided a efficient mechanism for chondrogenic matrix regeneration of rabbit IVD cells.

Adequate Serial Monolayer Passage Number of Human Intervertebral Disc Cells for Cell Therapy -Growth and Phenotype of Cells-

김용찬 , Ki Bok Kim , Moon Soo Park and 1 other persons | 2010, 17(2) | pp.57~65 | number of Cited : 0

Variations in Sagittal Spinopelvic Parameters According to the Lumbar Spinal Morphology in Healthy Korean Young Men

Young Joon Ahn , Youngbae B. Kim , Kyu-Bok Kang and 2 other persons | 2010, 17(2) | pp.66~73 | number of Cited : 3

Analysis of Risk Factors and Surgical Results of Lumbar Adjacent Segment Disease

김환정 , 강종원 , 김병섭 and 6 other persons | 2010, 17(2) | pp.74~81 | number of Cited : 4

Study Design: This is a retrospective study. Objectives: We analyzed the risk factors and the surgical results for adjacent segment disease after lumbar fusion. Summary of Literature Review: Many studies have been performed about the risk factors for adjacent segment disease, but the findings are still controversial. Materials and Methods: This study was carried out on 35 (13 men, 22 women) of 50 patients who underwent lumbar fusion due to adjacent segment disease with a minimum of 2 year follow-up period from July 1999 to July 2006. The differences of the interval to revision (IR) were statistically analyzed by the examining preexisting degenerative change in the adjacent segments on MRI, the number of fused segments, the lumbar lordosis and the sagittal balance. The surgical outcomes of reoperation were assessed by Brodsky’s criteria. Results: Junctional stenosis as adjacent segment disease was seen in 21 cases (60%) and instability was seen in 14 cases (40%),including 2 iatrogenic flat backs and 2 cases of lumbar degenerative kyphosis. The average IR was 93 months for the cases that had less than 2 segment fusion (20 cases) and 62 months in those with more than 3 segment fusion (15 cases). As for lumbar lordosis, 25 cases (71%) had a normal range of angle as well as 101 months until the IR and 10 cases (29%) had an abnormal range of angle as well as 64months until IR. Six cases were beyond the normal range of sagittal balance (17%) and their average IR value was 59 months. Otherwise,the cases with a normal range of sagittal balance had 109 months for the IR. The clinical outcome was excellent in 6 cases (17%) and good in 15 cases (43%). Conclusion: To decrease the adjacent segment disease, we should seriously consider the extent of lumbar fusion and we should restore the angle in lumbar lordosis to the physiological range and the sagittal balance during the initial operation.

Risk Factors of Nonunion Demanding Surgical Treatment after Lumbar Posterolateral Fusion

하임식 , 이규열 , 손성근 and 2 other persons | 2010, 17(2) | pp.82~89 | number of Cited : 0

Study Design: This is a retrospective study for radiographically and clinically assessing nonunion after lumbar spine fusion. Objectives: We wanted to analyze the risk factors for nonunion that requires surgical treatment after lumbar spine fusion Summary of the Literature Review: A diagnosis of the nonunion after lumbar spine fusion was made by using only the only radiologic images. The incidence of nonunion has been underreported because there are many asymptomatic patients. Materials and Methods: The plain X-ray films were evaluated for 1317 patients who could be followed up more than 1 year after lumbar fusion. Nonunion was diagnosed at 1 year after fusion by instability seen on the flexion-extension radiograph and the clinical findings like as sustained pain and local tenderness at the surgical site. The risk factors we reviewed included age, the number of levels fused, associated diseases, smoking, alcohol drinking, the initial diagnosis, a previous history of spinal operation, infection, a clear zone and malposition of pedicle screws and metal failure. The relations between nonunion and the factors mentioned above were analyzed. Results: Thirty-nine patients were diagnosed as having nonunion underwent reoperation and all had surgically confirmed nonunion. Smoking, infection and a previous history of spine operation had a significant influence on nonunion (p < 0.05). Clear zones persisting more than 1 year and metal failure also had a significant influence on nonunion (p < 0.05). Age, the number of fused levels, the initial diagnosis and alcohol drinking were not shown to influence the rate of nonunion (p < 0.05). Conclusion: A through clinical and radiologic evaluation is essential to diagnose nonunion, and this should not be done according to the radiologic images only. Risk factors such as a previous history of spine operation, infection, smoking, the development of a clear zone and metal failure all showed a statistically significant influence on nonunion. Additionally, preoperative and postoperative evaluation of these parameters is needed to achieve bone union.

Pseudarthrosis at L5-S1 after Posterolateral Lumbar Fusion

조규정 , 박승림 , Jeong，Jae-Hoon and 1 other persons | 2010, 17(2) | pp.90~96 | number of Cited : 0

Study Design: This is a retrospective study. Objectives: We wanted to investigate the rate of pseudarthrosis at L5-S1 after posterolateral fusion only for degenerative lumbar spinal disease, and to determine the radiological findings that help diagnose pseudarthrosis. Summary of the Literature Review: The pseudarthrosis rate at L5-S1 is much higher than that at the other lumbar segments. However,there have been few studies for the rate and risk factors of pseudarthrosis at L5-S1. Materials and Methods: A total of 88 patients who underwent pedicle screw instrumentation and posterolateral lumbar fusion were evaluated with a minimum of 1-year follow up. Bony union was evaluated by the bony fusion mass, the angulation on the flexionextension radiographs and the radiolucent zone around the pedicle screws. The patients’ age, bony mineral density, the number of fused segments and lumbar lordosis were evaluated for their association with pseudarthrosis at L5-S1. Results: Pseudarthrosis developed in 22 patients at L5-S1 and in 8 patients at other levels. The change of angulation on the flexionextension radiographs at the last follow-up was 5.2° in the pseudarthrosis group and 1.7° in the fusion group (P=0.3). A radiolucent zone of the sacral screws was noted in 10 patients; in 7 of the 22 patients in the pseudarthrosis group and in 3 of the 66 patients in the fusion group. The average age, the mean number of levels fused and the bone mineral density were similar in both groups. Lumbar lordosis was not associated with the development of pseudarthrosis at L5-S1. Conclusion: The pseudarthrosis rate was significantly higher at L5-S1 than that at the other lumbar segments following instrumented posterolateral fusion. Pseudarthrosis was closely related to hypermobile angulation (≥5°) on the flexion-extension radiographs and a radiolucent zone around the sacral screws.

Clinical Outcome of the Operative Treatment for Lumbar Degenerative Spondylopathy in Patients Undergoing Dialysis

Byung Ho Lee , 문성환 , 이환모 | 2010, 17(2) | pp.97~103 | number of Cited : 1

Study Design: This is a retrospective review Objectives: We wanted to evaluate the clinical and radiological outcomes of operative treatment for lumbar degenerative diseases in patients who are undergoing dialysis. Summary of the Literature Review: Operative treatment for patients having spinal diseases with chronic renal failure (CRF) demands special consideration because of the medical and surgical complications and the poor clinical outcome. There are only few reports on operative treatment for lumbar degenerative diseases for patients who are undergoing dialysis. Materials and Methods: Eight patients with lumbar degenerative spondylopathy and CRF and who were undergoing dialysis were operated on from August 1998 to September 2007. The clinical and radiological outcomes were evaluated using the Japanese Orthopaedic Association (JOA) scale and the plain X-rays. The serum alkaline phosphatase levels were measured to evaluate the bone metabolism along with the postoperative improvement of clinical symptom. Results: We had 1 case of postoperative mortality with peritoneal dialysis due to sepsis that was caused by panperitonitis and another complication of discitis. Only 1 of 4 cases that underwent fusion procedure had radiological bony union. The mean JOA scores were 12.0(range: 10-14) preoperatively and 17.3 (range: 5-20) and 15.6 (range: 9-19) at postoperative 6 months and the final follow-up, respectively (p<0.05). The mean serum alkaline phosphatase levels were 80.9 (range: 43-142) preoperatively, 98 (range: 68-164) at postoperative 1month, 75 (range: 50-102) at postoperative 6 months and 108 (range: 60-209) at the final follow-up (p>0.05). Conclusions: The clinical outcomes of surgical treatments were improved for the degenerative spine disease patients who are undergoing dialysis. However after the fusion procedure, the bony fusion rate was low (25%). Since a high rate of perioperative medical complications can be expected, thorough medical evaluation during preoperation and postoperation is recommended.

Tardy Spinal Cord Compression without Bone Cement Leakage after Kyphoplasty - A Report of 3 Cases -

안동기 , 최대정 , 박훈석 and 1 other persons | 2010, 17(2) | pp.104~110 | number of Cited : 0

KJCKorea
Journal Central

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

2010, Vol.17, No.2