2019, Vol.26, No.2

Analysis of Preoperative Factors Affecting Postoperative Spinal Canal Expansion after Posterior Decompression for the Treatment of Multilevel Cervical Myelopathy

Byung-Wan Choi

, Seung Chul Kim

| 2019, 26(2) | pp.33~39 | number of Cited : 0

Study Design: Retrospective analysis Objectives: To evaluate preoperative factors related with spinal canal expansion after posterior decompression for the treatment of multilevel cervical myelopathy. Summary of Literature Review: Data about preoperative factors related with spinal canal expansion after posterior cervical decompression surgery are inconsistent. Materials and Methods: We reviewed 67 patients with cervical myelopathy who underwent posterior laminectomy or laminoplasty. Radiologically, we evaluated the C2-7 Cobb angle and range of motion using X-rays from the preoperative assessment and final followup. Expansion of the spinal canal at 6 weeks postoperatively was evaluated using magnetic resonance imaging and compared with the preoperative values. The preoperative factors of age, sex, number of operated levels, operation method, and radiological parameters were investigated as factors potentially related to postoperative spinal canal expansion using multivariate regression and correlation analyses. The clinical outcome was analyzed by the Neck Disability Index (NDI) and Japanese Orthopaedic Association (JOA) scores. Results: The postoperative spinal canal expansion was 4.76 mm in sagittal images and 4.31 mm in axial images, with higher values observed in males and cases of severe preoperative cord compression. A lordotic preoperative Cobb angle was related to postoperative spinal canal expansion and JOA score improvement, but without statistical significance. The clinical outcomes of NDI (18.3→14.8) and JOA scores (10.81→14.6) showed improvement, but were not significantly related with any preoperative factors. Conclusions: The amount of preoperative spinal canal stenosis was associated with postoperative spinal canal expansion after posterior decompression in multilevel cervical myelopathy. The preoperative Cobb angle was not related to postoperative spinal canal expansion or clinical improvement. Key Words: Cervical myelopathy, Posterior decompression, Spinal canal expansion, MRI, Cobb angle

When is the Optimal Time Point for Predicting the 1-Year Follow-up Outcome of Selective Nerve Root Block for Cervical Radiculopathy?

손휘승

, Ahn， Myun Whan

, Lee Gun Woo

| 2019, 26(2) | pp.40~49 | number of Cited : 0

Use of an Epidural Steroid Sponge for Postoperative Pain Control in Lumbar Discectomy

KIM TAE KYUN

, Hyun Kyu Yu

, Sung Kyun Oh and 2 other persons | 2019, 26(2) | pp.50~55 | number of Cited : 0

Study Design: Retrospective study. Objectives: This study was conducted to evaluate the effects of using an epidural steroid sponge for postoperative pain control in lumbar discectomy. Summary of Literature Review: There are many methods to control postoperative pain after lumbar discectomy, including opioid analgesics, epidural catheters, and epidural steroid Gelfoam sponges. Materials and Methods: A total of 72 patients who underwent surgery between March 2011 and February 2014 were enrolled. Their average age was 54 years (range, 24-82 years). In group A (35 patients), Gelfoam was inserted after being soaked with a solution of 2% lidocaine (400 mg/20 mL; 1 vial) and dexamethasone (5 mg/mL; 1 ampoule). In group B (37 patients), it was inserted after soaking with normal saline. Postoperative pain was assessed by visual analogue scale (VAS) scores. Pain above 5 points was controlled by a narcotic analgesic agent, and the duration and number of postoperative interventions, the period of time before walking after the operation, and the period until the date of discharge after surgery were assessed and compared. The Mann-Whitney U test was used as a nonparametric method. P-values less than 0.05 were considered to indicate statistical significance. Results: In group A, 15 patients did not require analgesics on the day of surgery. In 20 patients, no analgesics were needed on postoperative day (POD) 1. In group B, 8 patients on the day of surgery and 13 patients on POD 1 did not require analgesics. In group A, 26 patients were able to walk on the day of surgery, and all patients were able to walk on POD 1. In group B, 19 patients was able to walk on the day of surgery and all patients were able to walk on POD 1. The mean number of hospital days before discharge was 6.3 in group A and 8.2 in group B. Conclusions: By continuously releasing low doses of steroids into the epidural space, this technique provided satisfactory results for postoperative pain control. Key Words: Lumbar disc herniation, Gelfoam sponge, Lumbar discectomy, Epidural analgesia

Prevalence of Thoracic Scoliosis in Koreans Using Simple Chest Radiography

Dong-Gune Chang

, Gang-Un Kim

, 석세일 and 6 other persons | 2019, 26(2) | pp.56~62 | number of Cited : 1

Study Design: A cross-sectional study. Objectives: To provide reference data for the study and treatment of thoracic scoliosis. Summary of Literature Review: There have been no reports on the prevalence of thoracic scoliosis in Korea. Materials and Methods: From August 2011 to October 2012, radiographs of patients under 80 years of age who underwent routine chest radiographs were retrospectively reviewed. Based on their age when the chest radiographs were obtained, the patients were divided into 8 groups. The prevalence and angle of the curve of thoracic scoliosis were investigated in each age group, and the prevalence of thoracic scoliosis according to sex, the direction of the curve, number of vertebrae in the major curve, the location and rotation of the apical vertebrae, and osteophyte location were examined. Results: The prevalence of thoracic scoliosis was 2.4% (621 patients), and female patients (3.0%, 375 of 12471) showed a higher prevalence than male patients (1.8%, 246 of 13654) (p<0.001). Right curvature was present in 445 patients and left curvature in 176 patients. In each age group, the prevalence and degree of thoracic scoliosis were 1.1% (14.2°±3.2°), 2.3% (17.4°±7.7°), 2.5% (17.0°±8.9°), 1.9% (15.8°±5.9°), 1.3% (15.5°±6.6°), 2.1% (18.0°±13.6°), 2.9% (14.3°±3.6°), and 6.1% (16.2°±4.8°), respectively. The mean curvature in all scoliosis patients was 16.0°±7.0°. The angle of the curve was significantly different by sex (15.4°±7.1° for males, 16.8°±7.6° for females). The average curve angle of patients with thoracic scoliosis was 16.0°±7.0°, among whom it was 10°-20° in 533 patients, 20°- 30° in 64, 30°-40° in 11, and over 40° in 13. Conclusions: This study could be used as a reference point for the study and treatment of thoracic scoliosis. Key Words: Scoliosis, Thoracic vertebrae, Prevalence

Ogilvie’s Syndrome after Lumbar Spinal Surgery

Su-Keon Lee , Seung-Hwan Lee

, Byeong-Mun Park

and 3 other persons | 2019, 26(2) | pp.63~67 | number of Cited : 0

Study Design: Case report. Objectives: We report a case of Ogilvie’s syndrome following posterior decompression surgery in a spinal stenosis patient who presented with acute abdominal distension, nausea, and vomiting. Summary of Literature Review: Ogilvie’s syndrome is a rare and potentially fatal disease that can easily be mistaken for postoperative ileus, and is also known as acute colonic pseudo-obstruction. Early recognition and diagnosis enable treatment prior to bowel perforation and requisite abdominal surgery. Materials and Methods: An 82-year-old woman presented with 6 months of worsening back pain with walking intolerance due to weakness in both legs. She had hypertension, asthma, and Cushing syndrome without bowel or bladder symptoms. Further workup demonstrated the presence of central spinal stenosis on magnetic resonance imaging. The patient underwent an L2-3 laminectomy and posterior decompression. Surgery was uneventful. Results: The patient presented with acute abdominal distension, nausea, and vomiting on postoperative day 1. The patient was initially diagnosed with adynamic ileus and treated conservatively with bowel rest, reduction in narcotic dosage, and a regimen of stool softeners, laxatives, and enemas. Despite this treatment, her clinical course failed to improve, and she demonstrated significant colonic distension radiographically. Intravenous neostigmine was administered as a bolus with a rapid and dramatic response. Conclusion: Ogilvie’s syndrome should be included in the differential diagnosis of postoperative ileus in patients developing prolonged unexplained abdominal distension and pain after lumbar spinal surgery. Early diagnosis and initiation of conservative management can prevent major morbidity and mortality due to bowel ischemia and perforation. Key Words: Ogilvie’s syndrome, Ileus, Lumbar surgery

KJCKorea
Journal Central

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

2019, Vol.26, No.2