2011, Vol.18, No.3

The Differentiation of Phase of Spinal Cord Injury Based on the Changes in Gene Expression

양준영 , 이준호 , 이준규 and 2 other persons | 2011, 18(3) | pp.75~82 | number of Cited : 0

Epidemiology of the Spinal Cord and Cauda Equina Injury in Korea -Multicenter Study-

양준영 , 심대무 , 김태균 and 6 other persons | 2011, 18(3) | pp.83~90 | number of Cited : 3

Radiologic Characteristics of Vertebral Artery Injury in the Cervical Spine Fracture

안면환 , 공병식 , 김정래 and 1 other persons | 2011, 18(3) | pp.91~95 | number of Cited : 0

The Changes in Neural Foramen Shown on Computed Tomography Depending on the Changes in the Height of Intervertebral Disc after Anterior Cervical Discectomy and Fusion (ACDF)

Young-Sang Lee , Woo-Suk Song , Jun Cheol Choi and 7 other persons | 2011, 18(3) | pp.96~102 | number of Cited : 1

Study Design: A prospective radiological assessment. Objectives: Changes in the height, area, and width--captured using computed tomography (CT)--of the neural foramen with respect to changes in the intervertebral disc height, after undergoing an anterior cervical disc removal and fusion procedure. Summary of Literature Review: The multiple authors of this study, by obtaining central canal and area of neural foramen by increasing the disc spacing height and area of the neural foramen, attempted to assess the height increase of disc spacing. It is necessary to consider the synergistic effects of decompression through dissection of the posterior longitudinal ligament (PLL). Materials and Methods: The authors studied 17 patient cases that underwent one segment anterior cervical discectomy and fusion (ACDF) for degenerative cervical disease from June 2006 to March 2007. All patient cases underwent autogenous iliac bone graft or cage insertion with plate fixation procedure. We measured the areas of the neural foramen, heights of the vertebra body above and below the removed intervertebral disc with CT before and after ACDF. Radiographic measurements were averaged. Results: Among the 17 cases, the height of the cervical disc increased in 15 cases and decreased in 2 cases. The heights of the neural foramen increased in 19 cases and showed no changes in 13 cases. The areas of the neural foramen increased in 23 cases and decreased in 6 cases. The heights of vertebral body above and below the removed disc increased by 5.4% (p=0.734), and the heights of the neural foramen increased by 13.3% (p=0.002). The area of the neural foramen increased by 13.6% (p=0.192). The widths of the neural foramen increased by 2.3% (p=0.586). The intervertebral disc height, neural foramen height, and neural foramen area increased by 39.6%, 8.4%,and 17.9%, respectively, after a 2mm lengthening of bone transplant. The intervertebral disc height, neural foramen height, and neural foramen area increased by 59.8%, 22.9%, and 10.3%, respectively, after a 3mm lengthening of bone transplant. The height and area of neural foramen increased by 18.3% and 18.2%, respectively, after the PLL removal and dissection. Conclusions: The follow-up observations of the intervertebral disc height, neural foramen height, and neural foramen area showed increases after one segment ACDF in cervical disease cases, when compared to the preoperative radiographic findings. As the height of bone transplant increased, the intervertebral disc height, neural foramen height, and neural foramen area increased. The neural foramen height and neural foramen area significantly increased, when PLL was dissected. Key Words: Intervertebral disc, Neural foramen, Anterior interbody fusion, Cage

Efficiency of Implant Removal for Treatment of the Thoraco-lumbar Unstable Fractures - Multi Segments Fixation ∙ Single Segment Fusion -

박희전 , 심영준 , 김완기 and 2 other persons | 2011, 18(3) | pp.103~110 | number of Cited : 1

Study Design: A retrospective study. Objectives: To evaluate the safety and usefulness of implant removal based on fusion by radiological change analyses and non-fused segment motion angle after open reduction, multi-segment fixation, and single segment fusion. Summary of Literature Review: There have been reports that discuss possible fracture of fixator, loss of reduction, or failure of fixation in certain cases of single segment fixation consistent with thoracolumbar fracture. Materials and Methods: We analyzed 83 patients who had undergone treatment by fixation of the top 2 segments and the bottom segment. The posterolateral fusions were performed for the top segment for thoracolumbar fractures. The mean follow-up was 21.3months. Wedge and local kyphotic angles, anterior, and posterior heights of the vertebral body were measured on plain radiograph. The range of motion of each segment was recorded by flexion-extension lateral radiographs at 6 month after the removal of implants. Results: Radiologic assessments performed on 83 patients demonstrated preoperative mean wedge angle, kyphotic angle, mean anterior body height of 20.1°, 18.5° and 62.0%, respectively, and, postoperatively, these were corrected by 9.0°, 9.3° and 24.6%, respectively. In the 44 cases that had the implants removed, the correction losses were 0.4°(P=0.258) and 3.7°(P=0.000), 0.5 %( P=0.756), and at the last follow-up, compared to measurements prior to the removal. There was no statistical significance in wedge angle or anterior body height. The range of motion measured on the non-fused segment was 3.9°on average at 6-months after the hardware removal. Conclusions: The multi-segments fixation and single-segment fusion for the thoracolumbar fracture can preserve correction and the motion of non-fusion segment. Although the implant removal after union can sustain motion, further studies regarding degenerative change of the non-fused segment are necessary. Key Words: Thoracolumbar spine, Fracture, Pedicular screw, Implant Removal

Measurement of Canal Encroachment Using Axial and Sagittal-Reconstructed Computed Tomographic Images in Thoracolumbar Burst Fractures

Kim Jim Ho , 전창훈 , 정남수 and 2 other persons | 2011, 18(3) | pp.111~116 | number of Cited : 0

Study Design: A retrospective study. Objectives: The aim of this study was to examine the usefulness of axial and sagittal-reconstructed CT images in the evaluation of spinal canal encroachment by thoracolumbar burst fractures. Summary of Literature Review: The dimensions of spinal canal encroachment by burst fractures have been described using axial CT images in the thoracolumbar region and sagittal-reconstructed images in the lower cervical region. However, the validity and reliability,depending on the measuring method, have not been fully evaluated. Materials and Methods: A hundred and ninety-nine patients, who had diagnosed as a thoracolumbar burst fracture, were included in this study. Three orthopedic surgeons independently measured the canal encroachment of the burst fragment in the axial CT images and the sagittal-reconstructed images using the ratio of spinal length (method 1) and the ratio of area (method 2). The validity for the evaluation of the deformity and fracture stability was evaluated. In addition, the reliability of each method was assessed. Results: Sixty-seven stable burst fractures and 132 unstable burst fractures were assessed. The mean kyphotic angle of stable and unstable burst fracture were 11.89 ± 8.49°and 15.90 ± 9.63°(P=0.005). The mean canal encroachment ratios of stable fracture were 17.21 ± 15.82 % (axial-method 1), 16.71 ±16.49 % (axial-method 2), 19.54 ± 17.03 % (sagittal reconstructed-method 1), and 11.75 ± 12.33% (sagittal reconstructed-method 2). The mean canal encroachment ratios of unstable fracture were 31.54 ± 17.10 % (axial-method 1), 29.67 ± 18.47 % (axial-method 2), 28.53 ± 18.60 % (sagittal reconstructed-method 1), and 21.20 ± 15.11 % (sagittal reconstructedmethod 2). There was no relationship between the fracture deformity and the canal encroachment ratio in all 4 methods. All ratios in the 4 method showed significant differences in the evaluation of fracture stability. All methods except method 1 in the sagittal-reconstructed images showed significant differences in the assessment of neurologic compromise. Conclusions: The measurement of a canal encroachment area using axial and sagittal-reconstructed images was valid in the description of fracture stability. Key Words: Thoracolumbar, Burst fracture, Canal encroachment, Computed tomography

Clinical Value of Nerve Root Sedimentation Sign in Lumbar Spinal Stenosis

Hyeon Jun Kim , 이규열 , 김우철 and 1 other persons | 2011, 18(3) | pp.117~122 | number of Cited : 0

Study Design: A retrospective study. Objectives: To assess the diagnostic value of the sedimentation sign seen on MRI with lumbar spinal stenosis and to compare postoperative clinical results. Summary of Literature Review: Nerve root sedimentation sign is an additional tool to diagnose lumbar spinal stenosis. Materials and Methods: There were 302 patients enrolled that had been diagnosed with lumbar spinal stenosis by MRI, which were reviewed to identify a sedimentation sign and all underwent the operative treatment. There were 142 patients who could not have their spinal stenosis diagnosis confirmed by MRI, and thus were selected as the control group to estimate the diagnostic value of nerve root sedimentation sign. Correlation with the duration of preoperative symptoms and the number of involved segments were compared and analyzed between sedimentation sign positive (Group I) and negative (Group II). We estimated Million Visual Analogue Score (MVAS) and Korean Oswestry Disability Index (KODI) for the assessment of the pain and the functional disability. Results: A positive sedimentation sign was found in 265 patients (87.7%) and diagnostic value was statistically significant (P<0.001). The involvement of 2 or more segments was significantly correlated with the sedimentation sign in the positive group (P<0.001). MVAS presented the improvement of 64.5±4.6%, KODI, 62.9±3.9% after surgical treatment in Group I. In Group II, each score showed improvement of 34.6±2.3% (MVAS), 37.1±1.8% (KODI). The improvement of these scores in Group I was better than in Group II. Conclusions: The nerve root sedimentation sign is an additional tool to diagnose lumbar spinal stenosis and the considerable factor to decide the operation. Key Words: Lumbar spine, Spinal stenosis, Sedimentation sign, Value of sedimentation sign

Conservative Treatment of Lumbar Disc Herniation - A Prospective Study of Disc Herniation Encroaching More than One-third of Spinal Canal -

Byungjoon Shin , Jae Chul Lee , 이호형 and 1 other persons | 2011, 18(3) | pp.123~131 | number of Cited : 1

Study Design: Prospective study. Objectives: To investigate the clinical results of conservative treatment for mid-to-large lumbar disc herniation diagnosed via magnetic resonance imaging (MRI) and the factors influencing treatment. Summary of Literature Review: There is limited information regarding the clinical results of conservative treatment for lumbar disc herniation. The recent studies using MRI have suggested favorable treatment results. Materials and Methods: The study subjects were 39 cases of herniated disc patients with over a 1/3 spinal canal encroachment -- based on MRI -- that were followed up for at least 1 year. The average age was 42.6-years-old (range of 12-76 years-old), and the average follow-up period was 28 months. The neurological deficit and the visual analogue scale (VAS) of back pain and radiating pain at the time of initial diagnoses and final follow-ups were compared, and the clinical results were evaluated based Kim & Kim’s criteria. Results: Although 4 of the 39 patients needed to undergo surgery during the follow-up period, 33 of the remaining 35 patients showed satisfactory (excellent and good ratings) results: 27 excellent, 6 good, 2 fair, i.e., a 85% (33 out of 39) satisfactory results. Of the 14 cases that had neurological defect at the initial diagnosis, only 1 case needed surgery, thereby resulting in a 93% (13 out of 14) satisfactory result. There were no statistically significant correlations among the degree of spinal canal encroachment and other factors such as age, sex, herniation type, and neurological deficit at initial diagnosis, and the clinical results at the final follow-up, conversion to surgery during follow-up, and remaining pains. Conclusions: The clinical results of conservative treatment in lumbar disc herniation were satisfactory even in cases of high degree of spinal canal encroachment. Therefore, conservative treatment of lumbar disc herniation should be considered first before resorting to surgical treatment. Key Words: Lumbar Disc Herniation, Conservative Treatment, MRI, Spinal Canal Encroachment

Comparative Study of Posterior Lumbar Interbody Fusion with Posterolateral Fusion in Degenerative Lumbar Spinal Disorders

이진영 , 강정우 , 박현태 and 5 other persons | 2011, 18(3) | pp.132~139 | number of Cited : 0

Study Design: A retrospective study. Objectives: The authors found that problems such as axial pain, donor site pain, loss of reduction, loosening or failure of fixation materials occurred relatively frequently after posterolateral fusion. For this, we had views on the ideas that the problems could be improved by an operation that fused vertebral bodies. Furthermore, we performed posterior lumbar interbody fusion and wanted to know the results. Summary of Literature Review: We performed posterior lumbar inter-body fusion as an alternative, due to complications of autoiliac bone graft that has complications, such as donor site pain. Materials and Methods: Sixty patients with single segment degenerative lumbar disease were treated with decompression,pedicle screws fixation, and spinal fusion. The patients were followed-up for more than 2 years. Thirty patients, who had undergone posterolateral fusion with autologous iliac bone graft, were classified as the “group 1”. The second 30 patients, who underwent posterior lumbar interbody fusion with cage and local bone graft, were classified as the “group 2”. The operation time, blood loss, fusion rate,lumbar lordotic angle, segmental angle were compared between the 2 groups. The clinical outcomes were evaluated by Kim’s functional evaluation scale. Results: The operation time was shorter in group 2 (142.74 minutes vs 171.64 minutes), there was a statistical difference between the 2groups. Intraoperative blood loss was more in group 2 (563.40 vs 551.78 mL), but total blood loss, including postoperative drained blood was less in group 2. The bony fusion rate was 90% in group 1, 97% in group 2. For the lumbar lordotic angle, the last outcome was less than the preoperative value. There was no statistical difference between the 2 groups. The segmental angle in group 1, the last outcome was less than the preoperative value. The segmental angle in group 2 was maintained the value through pre-operation to post-operation. Clinical outcomes were satisfactory in group 1 (96.67%) & in group 2 (100%). In group 1, 7 patients experienced pain at the iliac graft donor site. In group 2, there were 2 cases of retroposition of the cage. Conclusions: In the posterior lumbar interbody fusion group, operation time was shorter, total blood loss was less than in the posterolateral fusion group. Restoration and maintenance of the segmental angle in sagittal and coronal radiographs showed better outcomes, axial pain and iliac donor site pain were less. It is the authors’ position that posterior lumbar interbody fusion is an alternative operation to supplement the faults of posterolateral fusion. Key Words: Degenerative lumbar spinal disorders, Posterior lumbar interbody fusion, Posterolateral fusion

Clinical Results about More than 5 Years Follow-up after Open Discectomy

SOH JAE WAN , Byungjoon Shin , Jae Chul Lee and 2 other persons | 2011, 18(3) | pp.140~145 | number of Cited : 0

The Effect of Sacral Alar Screw on Long-level Fusion Including Lumbosacral Segment

정재윤 , 강경도 , Hyoung-Yeon Seo and 3 other persons | 2011, 18(3) | pp.146~152 | number of Cited : 1

Analysis of Intraoperative Neurological Complications in High-Risk Spinal Surgery with the Use of Motor Evoked Potential Monitoring

Jin-Hyeok Kim , 임동주 , Sung-Soo Kim and 2 other persons | 2011, 18(3) | pp.153~162 | number of Cited : 0

Study Design: This is retrospective study. Objectives: To evaluate the risk of operative techniques using Motor Evoked Potential (MEP) in high-risk spinal surgery. Summary of Literature Review: There are few studies regarding the evaluation of operative techniques by MEP. Materials and Methods: We studied 33 cases that had MEP during surgery from July 2007 to March 2009. Diagnoses included posttraumatic kyphosis (PTK) in eight cases, congenital deformity in eight cases, degenerative lumbar deformity in eight cases, ankylosing spondylitis (AS) in three cases, spinal tumor in three cases, adjacent segmental disease in two cases, and post-surgical kyphosis in one case. Posterior vertebral column resection (PVCR) and pedicle subtraction osteotomy (PSO) were performed in 27 cases (81.8%) and, in the others, posterior decompression with discectomy was performed. We analyzed the risk of operative techniques and evaluated the MEP. Results: MEP showed abnormal signal change in five cases (PVCR: one case, compression and distraction: four cases). The AS case did not demonstrate neurological change after surgery. Though the PTK on T12 operated by PVCR case did not show an abnormal MEP result,neurological change was observed postoperatively. The sensitivity, specificity, percent of false negatives, and percent of false positives of MEP were 80.0%, 96.4%, 20.0%, and 3.6%, respectively. Conclusions: MEP monitoring is a useful method to detect neurological injury during high-risk spinal surgery with satisfactory specificity. For low sensitivity and a high false negative rate, increased monitoring of cases and continuous follow-up is needed. In conclusion, compression and distraction and PVCR are high-risk techniques in kyphotic deformity correction. Key Words: High-risk Spinal surgery, Motor Evoked Potential (MEP), Operative technique, Neurological complication

Acute Spontaneous Cervical Spinal Epidural Hematoma with Spontaneous Resolution -A Case Report-

고영도 , 국성환 | 2011, 18(3) | pp.163~168 | number of Cited : 0

Delayed Paraplegia after Successful Percutaneous Vertebroplasty in a Patient with Osteoporotic Compression Fracture: A Case Report

김용찬 , 정남수 , 손원수 and 2 other persons | 2011, 18(3) | pp.169~173 | number of Cited : 0

Evidence Based Medicine in Spine Surgery

박병철 | 2011, 18(3) | pp.174~178 | number of Cited : 3

KJCKorea
Journal Central

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

2011, Vol.18, No.3