2019, Vol.26, No.4

Clinical Significance of Resection Type and Margin following Surgical Treatment for Primary Sarcoma of the Spine: A Multi-Center Retrospective Study

Hyoungmin Kim

, Sam Yeol Chang

, Se-Jun Park and 3 other persons | 2019, 26(4) | pp.117~125 | number of Cited : 0

Study Design: A retrospective multi-center study. Objectives: To analyze oncological outcomes according to the resection type and surgical margin following surgical treatment for primary spinal sarcoma. Summary of Literature Review: Previous studies using registry databases have shown that surgery and negative margins were associated with improved survival for primary spinal sarcoma. However, few studies have comprehensively analyzed the clinical significance of the resection type and surgical margin for the oncological outcomes of this rare malignancy. Materials and Methods: We retrospectively reviewed consecutive patients who underwent surgical resection for primary spinal sarcoma between 1997 and 2016 at two tertiary medical centers. Overall survival and the occurrence of local recurrence and distant metastasis were compared between the groups using Kaplan-Meier curve analysis and the log-rank test. Results: Thirty-three patients (21 males,12 females) with a mean age of 45.1 years and a median follow-up of 36 months were included. There were 13 (39.4%) chondrosarcomas, 12 (36.4%) osteosarcomas, and eight different histological diagnoses. The cohort was categorized into four groups: 1) total en bloc resection with a negative margin (n=12; 36.4%), 2) total en bloc resection with a positive margin: (n=5; 15.2%), 3) total piecemeal resection (n=12; 36.4%), and 4) subtotal resection (n=4; 12.1%). Total en bloc resection with a negative margin was associated with improved overall survival (p=0.030) and less distant metastasis (p=0.025) and local recurrence (p=0.004). Conclusions: Achieving a negative margin through total en bloc resection, although technically demanding, improves oncological outcomes in primary spinal sarcoma. Key words: Primary spinal sarcoma, En bloc resection, Survival, Recurrence, Metastasis

Comparative Measurements of Preoperative and Postoperative Radiological and Clinical Parameters of Direct Lumbar Interbody Fusion in Degenerative Spinal Disease Patients

Changhwa Hong

, Kim Woo Jong

, Yong Cheol Hong

and 3 other persons | 2019, 26(4) | pp.126~131 | number of Cited : 1

Which Criterion Is More Reliable for Selecting the Distal Fusion Level in Cases of Adolescent Idiopathic Scoliosis with Structural Thoracolumbar/Lumbar Curves: Static or Dynamic?

Jae Hwan Cho

, Chang Ju Hwang

, Jae Woo Park

and 2 other persons | 2019, 26(4) | pp.132~140 | number of Cited : 0

Study Design: Retrospective comparative study. Objectives: To compare the reliability of 2 criteria to predict the radiological outcomes of corrective surgery in cases of adolescent idiopathic scoliosis (AIS) with structural thoracolumbar/lumbar (TL/L) curves. Summary of Literature Review: Distal fusion level selection in AIS with structural TL/L curves is debatable. Materials and Methods: This study included 131 AIS patients with structural TL/L curves who underwent corrective surgery in which distal fusion was stopped at L3. Whole-spine standing radiographs and bending radiographs were obtained preoperatively. The patients were divided into 2 groups according to their findings on bending radiographs (dynamic criterion) and by the last touching vertebra and the lower end vertebra (static criterion). Radiological outcomes were assessed by reviewing postoperative radiographs. Reliability tests were conducted to compare the predictability of radiological outcomes using these 2 methods. In addition, radiological parameters were compared between both criteria. Results: Among 131 patients, 25 showed radiologically poor outcomes (19.1%). The sensitivity of the dynamic and static criteria was 0.69 and 0.50, respectively. The specificity of each criterion was 0.49 and 0.64, respectively. Overall, the dynamic criterion showed superior reliability (p=0.03). However, no significant difference in radiological parameters could be found in a comparison of both criteria. Conclusions: Although the dynamic criterion was more sensitive for predicting poor radiological outcomes when stopping fusion at L3 in patients with structural TL/L curves, its specificity was lower than that of the static criterion. Thus, both dynamic and static criteria should be considered when selecting the distal fusion level in cases of AIS with structural TL/L curves. Key words: Adolescent idiopathic scoliosis, Double major curve, Distal fusion level, Lower instrumented vertebra

Radiologic Comparison of the Sacroiliac Joint Degeneration Following Lumbar or Lumbosacral Fusion

Jemin, Yi

, Woo Dong Nam

| 2019, 26(4) | pp.141~150 | number of Cited : 1

Factors Associated with the Effect of Conservative Treatment in Surgically Indicated Single-Level Lumbar Spinal Stenosis Patient

Young-Joon Ahn

, 임세혁

, Seok-In Jang

| 2019, 26(4) | pp.151~159 | number of Cited : 1

Osteoid Osteoma of the Sacrum - A Case Report -

Ki-Won Kim

, Chang-Rack Lim

, Ji-Hyun Ryu

and 1 other persons | 2019, 26(4) | pp.160~165 | number of Cited : 0

Three-Column Fracture in the Thoracolumbar Junction Caused by Low-Energy Trauma in a Patient with Baastrup Disease - A Case Report -

Suh,Jung-Kuk

, Inkeun Park , Jun-Ku Lee

| 2019, 26(4) | pp.166~171 | number of Cited : 1

Study Design: Case report. Objectives: We report a case of 3-column fracture caused by low-energy trauma in a patient with Baastrup disease who complained of acute radiating pain and motor weakness in the lower limbs after 3 weeks of conservative treatment. Subsequently, posterior fusion surgery was performed. Summary of Literature Review: Baastrup disease is characterized by enlargement and close approximation of adjacent spinous processes, and it mostly affects the L4-5 level of the spine. In patients with Baastrup disease affecting multiple levels of the lumbar spine, low-energy trauma can cause an unstable 3-column fracture with neurological compromise. Early recognition and surgical treatment prior to the emergence of a neurological deficit are required. Materials and Methods: An 84-year-old woman presented with back pain after falling down backward and colliding with the edge of a shelf at ground level. Considering the patient’s general condition and age, she was initially treated with close observation and placement of a spinal brace with serial radiographic follow-up. Results: Computed tomography found 3-column fracture at the T11 level, which is quite rare in cases of minor trauma. At a 3-week follow-up, she complained of gradual lower extremity weakness, and her general lower extremity motor function decreased to grade 1–2. The patient underwent posterior fusion 2 levels above and below the affected vertebral body (T9-10-12-L1). Surgery was uneventful and the patient’s motor function recovered. Conclusions: In patients with Baastrup disease affecting multiple levels of the lumbar spine, based on our experience, low-energy trauma can cause an unstable 3-column fracture with neurological compromise. We highly recommend scrutiny of the interspinous space in elderly patients, especially those with a spinal fracture caused by low-energy trauma. Key words: Baastrup’s disease, Kissing spine, Three-column fracture, Posterior fusion

Clinical Efficacy of Cages in Anterior Cervical Fusion for Degenerative Cervical Disease

박문수

, Woo-Kie Min

, 고상봉

and 3 other persons | 2019, 26(4) | pp.172~177 | number of Cited : 0

The Evidence for Nonoperative Treatment of Lumbar Spinal Diseases

안동기

, Hak-Sun Kim

, 서형연

and 2 other persons | 2019, 26(4) | pp.178~190 | number of Cited : 2

Study Design: Review article. Objectives: To assess the evidence for nonoperative treatment of various degenerative spinal degenerative diseases. Summary of Literature Review: No study has yet evaluated the evidence for preoperative nonoperative treatment of lumbar spinal diseases. Methods: The evidence regarding nonoperative treatment for each disease was reviewed through NASS guidelines, and the treatment effect compared to surgical treatment was reviewed through the SPORT series. The efficacy of nonoperative treatment according to disease severity and certain special conditions was investigated through corresponding individual articles. Results: No kind of nonoperative treatment could change the fundamental progression of degenerative spinal disease. The natural course of lumbar disc herniation is favorable regardless of treatment. More than 70% of routine cases improve within 6 weeks. However, it does not take a full 6 weeks to decide whether to perform surgery or not. The evidence for transforaminal epidural steroid injections for short-term pain control is grade A. There is grade B evidence for nonoperative treatment with the goal of mid- to long-term pain control. However, we cannot say that those outcomes are better than the natural course of the disease itself. In cases of radicular weakness, the degree of weakness is correlated with the final outcomes, but it is not evident whether the duration of weakness is correlated with surgical outcomes. Early surgery is usually necessary due to intolerable pain, rather than stable motor weakness. The social cost of herniated discs arises from the loss of patients’ productivity, rather than from direct medical expenses. The natural course of spinal stenosis involves provoked pain and the need for palliative care. Unlike disc herniation, rapid deterioration and marked improvement do not occur. The symptoms of mild to moderate lumbar stenosis are unchanged in 70% of cases, improve in 15%, and worsen in 15%. No study has compared nonoperative treatment with the natural course of the disease. There is no evidence for nonoperative treatment of severe stenosis. Epidural spinal injections are effective for controlling short-term pain. Spontaneous recovery of radicular weakness does not occur, and urgent surgery is necessary in such cases. There is no evidence regarding the natural course and nonoperative treatment of degenerative spondylolisthesis. The working group consensus recommends that it should follow the pattern of nonoperative treatment of spinal stenosis when radicular stenosis symptoms are predominant. Overall, 40%-66% of cases of adult bilateral isthmic spondylolysis progress to symptomatic spondylolisthesis. No studies have investigated nonoperative treatment except physical exercise. Conclusions: Although short-term symptom amelioration can be achieved by nonoperative treatment, the fundamental progression of the disease is not affected. For conditions excluded from most studies, such as prior spine surgery, cauda equina syndrome, progressive neurological deficit, and uncontrollable severe pain associated with instability, deformity, or vertebral fractures, there were not enough studies to reach informed conclusions. Our review found no evidence regarding nonoperative treatment for such conditions. Furthermore, the treatment methods for each disease are not clearly distinguished from each other, and the techniques used for disc herniation have been applied to other diseases without any evidence. Key words: Lumbar spine, Degenerative spinal disease, Nonoperative treatment

KJCKorea
Journal Central

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

2019, Vol.26, No.4