STUDY DESIGN: A retrospective study. OBJECTIVES: To report the results and techniques of posterior vertebral column resections for fixed lumbosacral deformity. SUMMARY OF LITERATURE REVIEW: Fixed lumbosacral deformity results in gross imbalance and progressive compensatory thora-columbar deformity due to the absence of a mobile spine caudally. MATERIAL AND METHODS: Twenty-five consecutive fixed lumbosacral deformity patients subjected to PVCR were reviewed after a minimum follow-up of 2 years. The offending vertebra was below the L4 in all cases. The etiological diagnoses were congenital scoliosis, congenital kyphoscoliosis, post-traumatic kyphosis and post-infectious kyphosis in 6, 3, 2 and 14 patients, respectively. The average age at the time of operation was 38 years, with a male:female ratio of 7:18. The indication for PVCR was fixed lumbosacral deformities that could not be brought to a reasonable balance on traction or forced side bending. RESULTS: On average 2.1, ranging from 1 to 5, vertebrae were removed, with 52 removed in all. The average fusion extent was 4.5 vertebrae, ranging from 2 to 8. An anterior column reconstruction was carried out with an autogenous bone graft in all patients, with the additional insertion of titanium mesh in 12. The distal anchor went down to the L5, S1 and S2 in 4, 12 and 9 patients, respectively. A preoperative scoliosis of 3812 was corrected to 158 (60% correction), and a preoperative kyphosis of 3525 was corrected to -511 (40% correction). A preoperative coronal imbalance of 2.0cm was improved to 0.9cm, and a preoperative sagittal imbalance of 9.3 cm was improved to 4.6 cm. The mean operation time and blood loss were 280 minutes and 2810ml, respectively. Following complications were encountered in 5 patients: 2 transient neurologies, 2 compression fractures at proximal adjacent vertebra and 1 pseudoarthrosis. CONCLUSIONS: A posterior vertebral column resection is an effective procedure for the management of a fixed lumbosacral deformity. It provides satisfactory correction and improved functional outcomes. However, it is a technically demanding and exhausting procedure, with possible risks for complications
Congenital Abnormalities* ; Diagnosis ; Follow-Up Studies ; Fractures, Compression ; Humans ; Kyphosis ; Pseudarthrosis ; Retrospective Studies ; Scoliosis ; Spine* ; Titanium ; Traction ; Transplants

STUDY DESIGN: A retrospective cross-sectional study OBJECTIVES: To analyze the prevalence and characteristics of lumbar scoliosis using plain abdominal X-rays, according to age. LITERATURE REVIEW SUMMARY: The single lumbar curves of adolescents have shown 10 ~20% idiopathic scoliosis, but the reported prevalence of adult lumbar scoliosis ranges from 2.5 to 7.5%. In Korea, there is no useful basic data concerning lumbar scoliosis. MATERIALS AND METHODS: A total of 2877 plain abdominal radiographies (supine and erect), taken at our hospital, between August 2001 and June 2002, were retrospectively investigated. The ages of the patients ranged from 11 to 80 years, and the patients were grouped according to age. The prevalence, Cobb angle, ratio of males and females, ratio of right and left curves, location of end and apex vertebra, the number of involved vertebra in primary curve, amount of rotation and osteophytes were all examined. RESULTS: The overall prevalence of lumbar scoliosis was 4.3% (N=124), but rapidly increased after the sixth decade. The average Cobb angle was 16.2 degree. A positive correlation was found between the Cobb angle and age (r=0.275, P<0.05). The ratios of males to females and of the right to left curves were both about 1:2. The most common sites of upper end vertebra were T12 and L1, that of the lower end vertebra L4 and those of the apex L2 (N=48) and L3 (N=40). Most (N=111) had grade 1 rotation. With regard to the magnitude of the curves, no other factors were statistically significant. CONCLUSIONS: De novo scoliosis can be considered to develop rapidly after the sixth decade. The Cobb angle had a positive correlation with age (r=0.275, p<0.05). These data are thought could be useful and valuable for future study of lumbar scoliosis.
Adolescent ; Adult ; Cross-Sectional Studies ; Epidemiologic Studies* ; Female ; Humans ; Korea ; Male ; Osteophyte ; Prevalence ; Radiography, Abdominal ; Retrospective Studies ; Scoliosis* ; Spine

STUDY DESIGN: A retrospective cross-sectional study OBJECTIVES: To analyze the prevalence and characteristics of lumbar scoliosis using plain abdominal X-rays, according to age. LITERATURE REVIEW SUMMARY: The single lumbar curves of adolescents have shown 10 ~20% idiopathic scoliosis, but the reported prevalence of adult lumbar scoliosis ranges from 2.5 to 7.5%. In Korea, there is no useful basic data concerning lumbar scoliosis. MATERIALS AND METHODS: A total of 2877 plain abdominal radiographies (supine and erect), taken at our hospital, between August 2001 and June 2002, were retrospectively investigated. The ages of the patients ranged from 11 to 80 years, and the patients were grouped according to age. The prevalence, Cobb angle, ratio of males and females, ratio of right and left curves, location of end and apex vertebra, the number of involved vertebra in primary curve, amount of rotation and osteophytes were all examined. RESULTS: The overall prevalence of lumbar scoliosis was 4.3% (N=124), but rapidly increased after the sixth decade. The average Cobb angle was 16.2 degree. A positive correlation was found between the Cobb angle and age (r=0.275, P<0.05). The ratios of males to females and of the right to left curves were both about 1:2. The most common sites of upper end vertebra were T12 and L1, that of the lower end vertebra L4 and those of the apex L2 (N=48) and L3 (N=40). Most (N=111) had grade 1 rotation. With regard to the magnitude of the curves, no other factors were statistically significant. CONCLUSIONS: De novo scoliosis can be considered to develop rapidly after the sixth decade. The Cobb angle had a positive correlation with age (r=0.275, p<0.05). These data are thought could be useful and valuable for future study of lumbar scoliosis.
Adolescent ; Adult ; Cross-Sectional Studies ; Epidemiologic Studies* ; Female ; Humans ; Korea ; Male ; Osteophyte ; Prevalence ; Radiography, Abdominal ; Retrospective Studies ; Scoliosis* ; Spine

PURPOSE: To clarify whether the bone resorption in femur measured by the expression of OPG & RANK-L was increased in tail suspended rat. MATERIALS AND METHODS: Four-week-old female Sprague Dawley rats were divided into two groups. The experimental group (n=79) was housed and fed with 2 weeks of tail suspension, and reloaded for 8 weeks without tail suspension. The control group (n=46) was housed and fed for 10 weeks without tail suspension. Bone mineral densities, serum levels of ALP and TRAP were measured in both groups. The expressions of the mRNAs of OPG and RANK-L were analyzed by RT-PCR. RESULTS: The ALP and TRAP were increased in the experimental group during both tail suspension and reloading, which reflected the increased bone metabolism in the experimental group. In femur of the experimental group, the expression of the mRNA of RANK-L was increased during tail suspension, and the expression the mRNA of OPG was decreased. With reloading, the expression of the mRNA of RANK-L in femur was decreased, while the expression of the mRNA of OPG was increased.
Animals ; Bone Density ; Bone Resorption ; Female ; Femur ; Hindlimb Suspension ; Humans ; Metabolism ; Osteoclasts ; Osteoporosis* ; Osteoprotegerin ; Rats* ; Rats, Sprague-Dawley ; RNA, Messenger ; Tail*

STUDY DESIGN: A retrospective study. OBJECTIVES: To evaluate the results of posterior segmental pedicle screw fixation in skeletally immature patients with scoliosis. SUMMARY OF LITERATURE REVIEW: Scoliosis correction, in the immature spine, frequently necessitates additional anterior surgery to prevent the crankshaft phenomenon. With the advent of posterior segmental pedicle screw fixation, it is unclear whether an additional anterior procedure will be required. MATERIAL AND METHODS: Seventeen scoliosis patients (10 idiopathic, 4 congenital and 3 others; 3 males and 14 females) were treated with segmental pedicle screw fixation only. Their results were reviewed for a deformity progression of more than 10 degrees, a rib vertebra angle difference (RVAD) progression of more than 10 degrees, and evidence of adding-on. All the patients had a 0 Risser index at the time of the operation. The mean age and follow-up times were 10.4, ranging from 7.2 to 11.8 years old, and 4.0, ranging from 3.0 to 5.4 years, respectively. RESULTS: The mean preoperative thoracic curve of 55 degrees was corrected to 22 degrees (58% correction) at last follow-up and the nonstructural lumbar curve of 31 degrees was corrected to 10 degrees (67% correction) at last follow-up. Preoperative thoracic kyphosis of 28 degrees was improved to 34 degrees at last follow-up. The RVAD were 23 degrees and 13 degrees, preoperatively and postoperatively, respectively. No patient showed a progression of 10 degrees or more in the postoperative coronal curve or RVAD. One patient had a progression of the deformity caudal to the instrumented segments. There were no neurological or screw-related complications. CONCLUSIONS: Posterior segmental pedicle screw fixation in skeletally immature patients with scoliosis may be effective in preventing the crankshaft phenomenon.
Congenital Abnormalities ; Follow-Up Studies ; Humans ; Kyphosis ; Male ; Retrospective Studies ; Ribs ; Scoliosis* ; Spine*

PURPOSE: To report a technique of vertebral column resection using a single posterior approach and its results in the treatment of severe spinal deformities. MATERIALS AND METHODS: Seventy spinal deformity patients treated by posterior vertebral column resection (PVCR) were retrospectively reviewed with minimum follow up of 2 years (2-3.3 years). There were 34 males and 36 females with a mean age of 27.4 years. Etiologic diagnoses were; adult scoliosis in 7, congenital kyphoscoliosis in 38, and post-infectious kyphosis in 25. The surgery consisted of temporary stabilization of the vertebral column with segmental pedicle screw fixation, resection of the vertebral column at the apex of the deformity via the posterior route followed by gradual deformity correction and fusion. Radiological and clinical data were reviewed for deformity correction and clinical results. RESULTS: The total number of resected vertebrae were 143: 76 thoracic and 67 lumbar. Mean operation time was 4 hours 31 minutes with an average blood loss of 2, 333 mL. The deformity correction was 62.9% in the coronal plane and 45.2 degrees in the sagittal plane. Complications were encountered in 24 patients: 2 complete cord injuries in severe adult scoliosis and a single thoracic kyphosis patient who had significant preoperative cord compromise, 6 hematomas, 4 root injuries (all incomplete), 5 fixation failures, 2 infections and 5 hemopneumothoraxes. CONCLUSION: PVCR is an effective alternative for severe fixed spinal deformities. However, extreme caution must be taken in patients with preoperative cord compromise who have a high risk of neurological complications.
Congenital Abnormalities* ; Spine*

PURPOSE: To analyze surgical outcomes of thoracolumbar and lumbar scoliosis treated with segmental pedicle screw fixation, and to determine the exact distal fusion level. MATERIALS AND METHODS: Seven idiopathic thoracolumbar and lumbar scoliosis patients (6 thoracolumar and 1 lumbar scoliosis, 7 females with mean age of 15.9 years) subjected to segmental pedicle screw fixation with a minimum follow-up of 2 years were retrospectively analyzed for deformity correction, stable vertebra, lower instrumeted vertebral tilt (LIVT) and coronal balance using pre and post-operative standing radiographs. The bending stable vertebra and the rotational correction of L3 were measured in preoperative bending radiographs. The L3 rotation in the bending radiographs was less than Nash-Moe grade II in all patients. The bending stable vertebra was L3 in 4 patients and L4 in 3. An unsatisfactory result was defined as an LIVT of more than 10degrees or a coronal imbalance of more than 10 mm. RESULTS: Distal fusion went down to L3 in 6 patients and L4 in one patient whose bending stable vertebra had been L4 preoperatively. The preoperative average major curve of 52degrees was corrected to 10degrees (81% correction). The preoperative average thoracic curve of 27degrees and the average lumbosacral curve of 26degrees were corrected to 14degrees and 5degrees, respectively. Two patients with distal fusion to L3 showed unsatisfactory results; LIVT was more than 10degrees in both patients and coronal imbalance more than 10 mm in one. Both the patients had bending stable vertebra of L4 preoperatively. CONCLUSION: In the correction of thoracolumbar and lumbar scoliosis with segmental pedicle screw fixation, the curve could be fused to L3 when the L3 rotation in the bending radiograph was less than Nash-Moe grade II and the bending stable vertebra was L3.
Congenital Abnormalities ; Female ; Follow-Up Studies ; Humans ; Retrospective Studies ; Scoliosis* ; Spine

STUDY DESIGN: Retrospective study. OBJECTIVES: To compare the surgical results between anterior-posterior surgery and posterior eggshell procedures in post-traumatic kyphosis with neurologic compromised osteoporotic fracture. SUMMARY OF LITERATURE REVIEW: Combined anterior-posterior surgery is usually recommended in cases of kyphotic deformities with neurologic deficit secondary to osteoporosis. However, it is associated with significant morbidity in elderly patients. MATERIALS AND METHODS: Twenty-six post-traumatic kyphosis with neurologic compromised osteoporotic fracture patients subjected to either anterior-posterior surgery (n=11) or posterior egg-shell procedure (n=15) were analyzed. The average age at the operation was 62.6 years (range: 50-82), male : female ratio was 12 : 14, and the average follow up was 2.9 years (range:2.0-4.9). Preoperative interval from injury to operation was 15.4 months (range: 1-36). Thoracolumbar (T12-L1) fracture was in 20 and lumbar fracture was in 6. RESULTS: There was no significant difference in age, sex, preoperative and postoperative Frankel grade, and preoperative vertebral collapse between two groups(p<0.05). In anterior-posterior group, the mean operation time was 351 minutes with a mean blood loss of 2892 ml, and preoperative kyphosis of 22 degrees was corrected to 11 degrees at latest follow-up with 7 cases of neurologic improvement. In the eggshell group, the mean operative time was 215 minutes with blood loss of 1930 ml, and preoperative kyphosis of 34 degrees was corrected to 8 degrees at latest follow-up with 11 cases of neurologic improvement. Egg-shell group showed significantly less operation time and blood loss with beter kyphosis correction. In anterior-posterior group, postoperative pneumonia was developed in 2 and superficial infection in 1. Distal screw loosening was detected in 4, 2 in anterior-posterior group and 2 in posterior eggshell group. One of them was treated by revision and others were treated by brace more than 6 months. CONCLUSIONS: Posterior eggshell procedure showed a better kyphosis correction with significantly less operation time and blood loss. It is a preferable alternative to anterior-posterior surgery in post-traumatic kyphosis with neurologic compromised osteoporotic fracture.
Aged ; Braces ; Congenital Abnormalities ; Female ; Follow-Up Studies ; Humans ; Kyphosis* ; Male ; Neurologic Manifestations ; Operative Time ; Osteoporosis ; Osteoporotic Fractures* ; Pneumonia ; Retrospective Studies

STUDY DESIGN: Retrospective study. OBJECTIVES: To determine the exact distal fusion level in the treatment of single thoracic idiopathic scoliosis (King III and IV) with segmental pedicle screw fixation and rod rotation. SUMMARY OF LITERATURE REVIEW: Pedicle screw fixation effectively shortens the distal fusion extent by improved 3-D deformity correction. However, the selection of distal fusion extent remains controversial in single thoracic idiopathic scoliosis. MATERIAL AND METHODS: Forty-two single thoracic adolescent idiopathic scoliosis patients subject to segmental pedicle screw fixation and rod rotation with minimum follow-up of 2 years (2-6 years) were analyzed. The patients were grouped according to the distal fusion level with reference to the standing neutral vertebra (NV) for comparison of deformity correction, radiological and clinical spinal balance using standing radiographs. Distal fusion down to NV +1 was in 9 patients, NV in 5, NV-1 in 9, NV-2 in 12 and NV-3 in 7 patients respectively. RESULTS: Preoperative 50+/-11 degrees of thoracic deformity was corrected to 13+/-5 degrees showing 74% of curve correction. Preoperative 23+/-7 degrees of lumbar deformity was corrected to 2+/-8 degrees showing 93% of curve correction. Postoperative adding on deformity was obtained in 14 patients. Significant difference was found not by King classification but by distal fusion level: significantly higher chance of unsatisfactory results from not going to the NV-1 (p=0.001). CONCLUSIONS: In correction of single thoracic idiopathic scoliosis with segmental pedicle screw fixation, the curve should be fused to NV-1 saving one or more motion segments when compared to the fusion to the stable vertebra.
Adolescent ; Classification ; Congenital Abnormalities ; Follow-Up Studies ; Humans ; Retrospective Studies ; Scoliosis* ; Spine

OBJECTIVES: To report the surgical technique and effectiveness in treating rigid adult scoliosis with one stage vertebral column resection and pedicle screw fixation through a single posterior approach(PVCR). MATERIALS AND METHODS: Twenty-one patients with low flexibility(less than 20~30%) subjected to PVCR were evaluated after a mean follow-up of 18.5 months(12~29 months). There were 10 males and 11 females. The mean age at the time of the operation was 32.1 years(19~61 years). Etiological diagnoses were idiopathic in 7, congenital in 12, neuromuscular in 2. Preoperatively, all the patients showed moderate to severe derangement of pulmonary function with reduced vital capacity(30%~57%). RESULTS: An average of 1.3 vertebrae(1~3 vertebrae) were removed. The resection of body was in thoracic in 12 and lumbar in 15. Posterior fusion was carried out in 6.8(3~12) levels. Following the surgery, preoperative thoracic scoliosis of 86degree(55~130degree) and lumbar scoliosis of 64degree( 35~110degree) were corrected to 38degree(15~65degree) and 25degree(14~61degree), showing a correction of 56.2%(39~78%) and 61.1% (44~82%) respectively. Preoperative kyphosis of 59degree(16~104degree) was corrected to 24degree(2~58degree), showing a correction of 60.2%(41~74%). Preoperative coronal imbalance and shoulder height difference was corrected to 0.6 cm and 1.0 cm respectively. The average operation time and transfusion were 253 minutes and 2835 ml. The complications comprised two transient neurological deficits, one aggravated neurological deficits, one monoparesis, one infection, and one pneumothorax. CONCLUSIONS: One stage posterior vertebral column resection is a promising new technique for rigid scoliosis, significantly reducing the operative time and morbidity of combined anterior-posterior resection.
Adult* ; Diagnosis ; Female ; Follow-Up Studies ; Humans ; Kyphosis ; Male ; Operative Time ; Paresis ; Pneumothorax ; Scoliosis* ; Shoulder ; Spine*