PURPOSE: The purpose of this study is to analyze the risk factors for early adjacent segment disease (EASD) in patients undergoing revision surgery within 5 years from the first operation as compared with those after more than 10 years. MATERIALS AND METHODS: A total of 755 patients with degenerative lumbar disease underwent lumbar spinal fusion of 3 or less segments between August, 1988 and May, 2009. Of these, 44 patients underwent revision surgery due to adjacent segment disease (ASD) until May, 2014. These patients presented with ASD, 19 and 13 of whom underwent revision surgery within 5 years and after more than 10 years of the first one, and were thus assigned to group A (n=19) and group B (n=13), respectively. Thirty-two of these patients were enrolled in this study and baseline and clinical characteristics, including sex, age, fusion method, preoperative diagnosis, the number of fused segments, fusion level, and radiological measurements were compared between the two groups. Radiological measurements included pre- and postoperative lumbar lordotic angle (LLA), pre- and postoperative fusion segment lordotic angle (FSLA), pre- and postoperative FSLA per level and the correction of LLA, FSLA, and FSLA per level. For statistical analysis, univariate analysis with the chi-square test was performed using SPSS 14.0. RESULTS: In group A, the number of patients undergoing posterior lumbar interbody fusion (PLIF) rather than posterolateral fusion, those with postoperative FSLA per level of <20° and the adjacent segment levels to L4-5 and L5-S1 was significantly larger compared with group B (p=0.018, 0.046, and 0.009, respectively. CONCLUSION: In conclusion, our results indicate that the degree of risk of EASD was relatively higher in association with PLIF, postoperative FSLA per level of <20° and the adjacent segment levels to L4-5 and L5-S1.
Diagnosis ; Humans ; Methods ; Risk Factors ; Spinal Fusion*

Adolescent ; Humans ; Scoliosis ; surgery ; Spinal Fusion ; methods

Adolescent ; Bone Transplantation ; methods ; Humans ; Scoliosis ; surgery ; Spinal Fusion ; methods

Adolescent ; Humans ; Scoliosis ; classification ; surgery ; Spinal Fusion ; methods

OBJECTIVETo put some improvements to the traditional transforaminal lumbar interbody fusion (TLIF) and discuss its clinical significance.

METHODSCompleted the traditional posterior lumbar interbody fusion (PLIF) and TLIF procedure in 12 fresh cadavers, dissect further to expose the surrounding anatomical structures, and put the modified TLIF surgery according to the anatomical findings. And simulated the operation in 12 fresh cadavers, analyzed its feasibility and potential advantages.

RESULTSThe early anatomical study found that the related nerve root was in a state of high tension and certain risk of injury when completed the traditional PLIF and TLIF surgery, and found certain operational area between the superior articular process and the midline structures of the spinous processes and interspinous ligaments. Put the modified TLIF surgical approach according to the anatomical findings, which the operating area is located in PLIF outside and TLIF inside. As the following words: Take a posterior-middle incision, preserve the supraspinous and interspinous ligaments, and the spinous processes, dissect the bilateral paravertebral muscle, expose lamina and facet joints, not including transverse process, and remove unilateral inferior two third lamina, inferior articular process and expose the articular surface of the superior articular process, then dispose the intervertebral space for interbody fusion obliquely in the unilateral approach. Successfully completed the modified TLIF procedure in 12 fresh cadavers, the results showed that the technique has the following advantages. (1) Only remove unilateral inferior two third lamina and inferior articular process, preserve the supraspinous and interspinous ligaments, and the spinous processes, not expose the transverse process. (2) Both central canal, and lateral recess and nerve root canal of the operative side can be decompressed effectively simultaneously. (3) Avoid excessive traction to the thecal sac and traversing nerve roots and decrease the injury rate due to the reservation of the midline structures and the oblique manipulation, and less injury rate of the exiting nerve root, because of not necessary to expose it routinely.

CONCLUSIONSThe modified TLIF is safe and feasible, could effectively reduce the nerve roots injuries. Maybe it's a better choice for most of the Chinese patients at present.

OBJECTIVETo study the relevant position of C(2) pedicle to C(2) inferior articular process, set up a technique of C(2) pedicle screw placement with the inferior articular process of axis as an anatomic landmark.

METHODSFifty C(2) bone specimens were used to measure the distance from the sagittal midline to the medial border, the midpoint and the lateral border of C(2) inferior articular process or C(2) pedicle; the width and the height of the C(2) pedicle were also evaluated. The anatomic relation between the measurements data of C(2) pedicle and that of C(2) inferior articular process were analyzed, and the technique of C(2) pedicle screw fixation was established.

RESULTSThe medial border of C(2) inferior articular process was averaged (3.67 +/- 0.41) mm lateral to that of C(2) pedicle, and the midpoint C(2) inferior articular process was averaged (1.15 +/- 0.44) mm lateral to the lateral border of C(2) pedicle, respectively. Using the C(2) inferior articular process as landmark, two techniques was established for C(2) pedicle screw placement. The entry point of method A was located in 2 mm medial and superior to the central point of C(2) inferior articular process; the entry point of method B was at the crossing point of the medial border C(2) inferior articular process with the superior quarter of C(2) inferior articular process.

CONCLUSIONSThere is a steady anatomic relation between C(2) pedicle and C(2) inferior articular process, the C(2) inferior articular process could be as a convenient key anatomic landmark to determine the location of C(2) pedicle and the position of C(2) pedicle screw entry point.

The beneficial effect of the longitudinal traction-either halo-femoral or halo-pelvic and the anterior spinal fusion in some spinal disorders is well documented. This paper is a report of a patient who is suffering from spine tuberculosis with severe kyphosis and incomplete paraplegia. He was treated satisfactorily by applying a Crutchfield tong-femoral traction for four weeks followed by anterior spinal fusion. It is authors concept that the early cases of the active spine tuber-culosis with advancing kyphosis can be effectively treated by using the above mentioned method without introducing more complicated combination of the spinal osteotomy, halo-pelvic distraction and spinal fusion.
Humans ; Kyphosis ; Methods ; Osteotomy ; Paraplegia ; Spinal Fusion ; Spine ; Traction ; Tuberculosis

With the continuous advances in modern medical technology and equipment,minimally invasive surgery (MIS) is widely applied in clinical practice.Ultrasound (US) as a real-time,portable,and radiation-free medical imaging method can be used for the intraoperative guidance in MIS to ensure safe and effective surgery.However,the physical characteristics of conventional US fail to display some tissue structures of the human body due to the existence of gas and bone.US-based navigation can make up for the deficiencies by advanced imaging technologies including spatial orientation,image reconstruction,and multi-modality image fusion,being real-time,accurate,and radiation-free.Therefore,US-guided robots can achieve safe,effective,and minimally invasive operation in MIS.This paper reviews the studies of US-guided robots in MIS and prospects the development of this field.
Humans ; Robotics/methods* ; Minimally Invasive Surgical Procedures/methods* ; Ultrasonography ; Spinal Fusion/methods* ; Ultrasonography, Interventional/methods*

Lumbar spinal stenosis is a common category of spinal disease in which a decrease in the volume of the spinal canal results in compression of the neural elements. Its pressure symptoms are characterized by vague back-pain and chronic sciatica. The goals of surgical treatment in lumbar spinal stenosis are the relief of pain and the preservation or restoration of neurologic function. Extensive laminectomy in lumbar spinal stenosis results in postoperative instability and postoperative vertebral subluxation with pain, restricted movement, and further neural compression occurs after decompressive laminectomy. Therefore internal fixation devices have been used in these circumstances to prevent postoperative instability while the fusion being consolidated. From February 1988 to October 1988, 36 patients of lumbar spinal stenosis had undergone operations with decompressive laminectomy and segmental spinal instrumentation with transpedicular screws at the department of Orthopaedic Surgery, Yonsei University College of Medicine. In 18 patients degenerative changes in lumbar spine were the principal aetiologic factor:7 patients had spondylolisthetic spinal stenosis:ll patients had combined spinal stenosis. All patients were followed up for periods varying between twelve and ninteen months. According to Kim's criteria, the postoperative results were as follows;excellent in 17 cases(47.2% ), good in 15 cases(41.7% ) and fair in 4 cases(11.1% ). The study revealed that segmental spinal instrumentation with transpedicular screws provided a rigid fixation, early ambulation, minimal fusion and reducing of recovery period were possible. In conclusion, segmental spinal instrumentation with transpedicular screws is a good and reliable method of stabilization after extensive decompressive laminectomy.
Early Ambulation ; Humans ; Internal Fixators ; Laminectomy ; Methods ; Sciatica ; Spinal Canal ; Spinal Diseases ; Spinal Fusion ; Spinal Stenosis ; Spine

BACKGROUND: A systematic literature review of interspinous dynamic stabilization, including DIAM, Wallis, Coflex, and X-STOP, was conducted to assess its safety and efficacy. METHODS: The search was done in Korean and English, by using eight domestic databases which included KoreaMed and international databases, such as Ovid Medline, Embase, and the Cochrane Library. A total of 306 articles were identified, but the animal studies, preclinical studies, and studies that reported the same results were excluded. As a result, a total of 286 articles were excluded and the remaining 20 were included in the final assessment. Two assessors independently extracted data from these articles using predetermined selection criteria. Qualities of the articles included were assessed using Scottish Intercollegiate Guidelines Network (SIGN). RESULTS: The complication rate of interspinous dynamic stabilization has been reported to be 0% to 32.3% in 3- to 41-month follow-up studies. The complication rate of combined interspinous dynamic stabilization and decompression treatment (32.3%) was greater than that of decompression alone (6.5%), but no complication that significantly affected treatment results was found. Interspinous dynamic stabilization produced slightly better clinical outcomes than conservative treatments for spinal stenosis. Good outcomes were also obtained in single-group studies. No significant difference in treatment outcomes was found, and the studies compared interspinous dynamic stabilization with decompression or fusion alone. CONCLUSIONS: No particular problem was found regarding the safety of the technique. Its clinical outcomes were similar to those of conventional techniques, and no additional clinical advantage could be attributed to interspinous dynamic stabilization. However, few studies have been conducted on the long-term efficacy of interspinous dynamic stabilization. Thus, the authors suggest further clinical studies be conducted to validate the theoretical advantages and clinical efficacy of this technique.
Decompression, Surgical ; Humans ; Postoperative Complications ; *Spinal Fusion/adverse effects/methods ; Spinal Stenosis/physiopathology/surgery