No abstract available.

No abstract available.

No abstract available.

No abstract available.

PURPOSE: This is a retrospective study evaluating the efficacy of posterior thoraco-lumbar interbody fusion for the treatment of thoraco-lumbar kyphotic deformity. MATERIALS AND METHODS: A posterior thoraco-lumbar interbody fusion was performed in 10 patients with thoracolumbar kyphotic deformity from April 1996 to April 1999. The mean age was 39.5 years (range 16 ~59 years), and five were male and five were female. The cause of deformity was tuberculous spondylitis in 7 cases, post-traumatic kyphosis in 2 cases, and ankylosing spondylitis in 1 case. Three cases involved thoracic spine alone, 3 cases involved thoracolumbar junction, and 4 cases involved lumbar spine alone. The chief complaint was lower back pain in 6 cases, progression of deformity in 2 cases, and both type in 2 cases. There was no patients with neurologic symptoms or signs. The average postoperative follow-up period was 19.5 months (range 12~33 months) RESULTS: By standard Cobb measurement, the mean preoperative kyphosis of 43.7 degrees was reduced to 19.3 degrees in the immediate postoperation and to 22.5 degrees in the last follow-up. Mean correction rate was 51.4% and average loss of correction was 3.2 degrees. Interbody fusion was achieved in 9 cases out of 10 by criteria of Lee et al. Clinical results such as back pain, fatigue pain, and tingling sensation were improved in 8 cases out of 10 by criteria of Lin et al. Nine patients were satisfied with the correction of the deformity. Mean operation time was 255 minutes and average amount of transfusion was 1400 ml(3.5 pints) of packed red cell. There was no serious complications like paraplegia or death. CONCLUSION: A posterior thoraco-lumbar interbody fusion is a relatively easy, safe and good-outcome technique for treatment of moderate thoraco-lumbar kyphotic deformity
Back Pain ; Congenital Abnormalities* ; Fatigue ; Female ; Follow-Up Studies ; Humans ; Kyphosis ; Low Back Pain ; Male ; Neurologic Manifestations ; Paraplegia ; Retrospective Studies ; Sensation ; Spine ; Spondylitis ; Spondylitis, Ankylosing

STUDY DESIGN: A retrospective study. OBJECTIVES: To evaluate the significance of the intraoperative postural reduction for kyphotic deformity in unstable burst fracture and confirm the relations of postural reduction and the final correction after loss of correction by posterior instrumentation. SUMMARY OF LITERATURE REVIEW: The loss of kyphotic correction after instrumentation in unstable burst fracture is found. Some methods have been developed to reduce the loss of correction. MATERIALS AND METHODS: 24 short-segment pedicle screw instrumentations in the patients with a unstable burst fracture were performed. We measured sagittal index, wedge angle of vertebral body and anterior vertebral height preoperatively, intraoperatively, postoperatively and at final follow-up. RESULTS: Sagittal index was 20.2 degrees preoperatively, 7.5 degrees intraoperatively, 0.9 degrees postoperatively and 7.2 degrees at final follow-up, so the loss of correction was 32.6%. Wedge angle of vertebral body was 20.3 degrees preoperatively, 10.1 degrees intraoperatively, 6.8 degrees postopera-tively and 9.4 degrees at final follow-up, so the loss of correction was 19.3%. Anterior vertebral height was 57.0%, 79.3%, 85.0%, and 78.8% respectively, so the loss of correction was 22.1%. The loss of correction occurred more in the disc space and less in the vertebral body itself. Postural reduction corrected 63% of sagittal index, 50% of wedge angle of vertebral body and 52% of anterior vertebral height. CONCLUSIONS: Postural reduction corrected kyphotic deformity appropriately. The correction by posterior instrumentation in unstable burst fracture was lost in some amount. The final correction was similar to the one by postural reduction. It is important to obtain the maximum postural reduction intraoperatively to prevent kyphotic deformity caused by loss of correction after surgery.
Congenital Abnormalities* ; Follow-Up Studies ; Humans ; Retrospective Studies

PURPOSE: To assess the effectiveness of transpedicular bone graft after short segmental fixation in the treatment of thora-columbar burst fracture. MATERIALS AND METHODS: Patients who were admitted to our hospital from January 1994 to December 1998 for thoracolumbar burst fracture and treated with open reduction and internal fixation were reviewed. Seventy-five cases who were followed up for more than 1 year were selected. Among of these, 45 cases were treated with internal fixation and posterior fusion only, and in 30 cases transpedicular bone graft was done additionally. Denis classification was used and preop., postop., final follow up wedge angle, Cobb's angle, the height of disc space, and anterior body height were compared and analized respectively. RESULTS: The preop, postop and final follow-up of wedge angle, cobb's angle, disc height and anterior body height were mea-sured. The preop, postop. and final follow up wedge angle of patients who underwent transpedicular bone graft and patients who were treated with posterior fusion only were 20.4 +/-8.4 degrees, 9.8+/-4.6 degrees, 11.5+/-5.3 degrees and 21.4+/-5.9 degrees, 6.7+/-3.1 degrees , 6.8+/-3.1 degrees respec-tively. The Cobb's angle were 19.2+/-7.3 degrees, 8.9 +/-4.4 degrees, 9.2+/-4.6 degrees and 20.2+/-9.9 degrees, 11+/-5.9 degrees, 15+/-6.9 degrees respectively. Anterior body height were 51+/-15.3%, 93 +/-8.8%, 91+/-8.9% and 53+/-11.3%, 88+/-12.8% and 84+/-15.3%. These values were statistically signifi-cant(p<0.05). CONCLUSION: Transpedicular bone graft reduced the loss of the Cobb's angle, wedge angle and anterior body height at postop. and last follow-up. The transpedicular bone graft was a valuable method to prevent reduction loss in the treatment of thoracolumbar burst fracture
Body Height ; Classification ; Follow-Up Studies ; Humans ; Transplants*

STUDY DESIGN: A retrospective study. OBJECTIVES: To compare the efficacy of demineralized bone matrix as a bone graft extender in lumbar posterolateral fusion with cases using an autogenous iliac bone graft. SUMMARY OF LITERATURE REVIEW: Since demineralized bone grafts were introduced for bone graft extension in 1995, many types of demineralized bone matrices have been used with improved fusion rates. MATERIALS AND METHODS: From October 2004 to December 2005, demineralized bone matrices were used as iliac bone graft extenders in 49 cases (Group I) of lumbar posterolateral fusion, compared with 50 cases receiving autogenous grafts (Group II) similar in age, bone marrow density, and number of fusion levels. Fusion status was graded by the Lenke classification and data was analyzed using a chi-square test through SPSS v.10.0. RESULTS: Group I had Lenke A in 7 cases (14.3%), B in 21 cases (42.9%), C in 15 cases (30.6%), and D in 6 cases (12.2%). Group II had Lenke A in 9 cases (18.0%), B in 26 cases (52.0%), C in 12 cases (24.0%), and D in 3 cases (6.0%). There was no statistical difference in fusion rate. CONCLUSION: Demineralized bone matrix could be used as a bone graft extender in lumbar posterolateral fusion.
Bone Marrow ; Bone Matrix* ; Classification ; Retrospective Studies ; Transplants

STUDY DESIGN: A retrospective study. OBJECTIVES: To explore the pattern of pain distribution in HNP and spinal stenosis with or without degenerative spondylolisthesis (DS), and to evaluate the diagnostic value of pain drawings in predicting the presence of a painful nerve root. SUMMARY OF LITERATURE REVIEW: The usefulness of pain drawing as a tool to predict the presence of painful nerve root compression is unclear. MATERIALS AND METHODS: Fifty-seven patients (27 HNP, 21 pure spinal stenosis, and 9 spinal stenosis with DS) with leg pain were recruited. The presence of painful nerve root compression was judged based on MRI and clinical findings. Each grid of the pain drawing is assigned an area code, and discriminant analysis was performed to explore indications of painful nerve root. Diagnostic values were evaluated by calculating sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV). RESULTS: Pain distribution was characterized by a dermatomal pattern in HNP and variable in the spinal stenosis group. Paresthesia on the sole was extracted as a discriminant factor indicating painful compression of the S1 nerve root. In HNP, the sensitivity, specificity, PPV, and NPV of this factor were 62%, 100%, 100%, and 74% respectively. In the spinal stenosis group, they were 80%, 56%, 27%, and 93%, respectively. CONCLUSIONS: The pain drawing can help assess painful nerve root compression as well as confirm the pattern of pain distribution.
Humans ; Leg ; Magnetic Resonance Imaging ; Paresthesia ; Radiculopathy* ; Retrospective Studies ; Sensitivity and Specificity ; Spinal Stenosis ; Spondylolisthesis ; Spondylosis*

STUDY DESIGN: A retrospective radiologic study of 23 cases OBJECTIVES: This study evaluated the etiology of correction loss after surgical treatment of osteoporotic vertebral fractures with neurologic deficits SUMMARY OF LITERATURE REVIEW: osteoporotic vertebral fractures with neurologic deficits were treated with anterior decompression with posterior instrumentation or an Egg shell operation. MATERIALS AND METHODS: We experienced 23 cases treated surgically for osteoporotic vertebral fracture with neurologic deficits. In group A (16 cases), anterior decompression with posterior instrumentation were performed, with group B (7 cases) receiving an Egg shell operation. The kyphotic angle using Cobb's method and endplate injury were evaluated preoperatively, postoperatively, and at last follow up. Group A was subdivided into A1 and A2 according to preoperative and postoperative kyphotic angle, as well as being divided by endplate injury into subgroup a and b. Overcorrection of preoperative kyphotic angles were performed in A1, and undercorrection in A2 group, with endplate injury in subgroup a. RESULTS: Postoperative correction was 13.4 degrees+/-3.4degrees and correction loss was 9.68degrees+/-8.05degrees in group A, and 21.5degrees+/-5.0degrees and 8.0degrees+/-1.73degrees in group B, respectively. Correction loss of group A1 (13.4degrees +/-8.8degrees ) was significantly larger than A2 (4.71degrees +/-3.14degrees ) (p=0.011). The correction loss of group A1a (18.0degrees +/-9.3degrees ) was significantly larger than group A2 (8.5degrees +/-3.1degrees ) (p=0.050) and A2a (p=0.036). The correction loss of group A1b was significantly larger than group A2b (p=0.029), and correction losses were not significantly different in A2a (6.0degrees +/-4.0degrees ) and A2b (3.25degrees +/-1.7degrees ) (p=0.289). CONCLUSIONS: Less Correction loss was found in the undercorrection and non-endplate injury group
Animals ; Decompression ; Egg Shell ; Follow-Up Studies ; Neurologic Manifestations* ; Osteoporosis ; Retrospective Studies