OBJECTIVE: We investigated the clinical outcome of kyphoplasty using calcium phosphate (CaP) for vertebral augmentation compared with polymethylmethacrylate (PMMA). We conducted a retrospective study to determine whether patients with osteoporotic vertebral fracture who underwent CaP kyphoplasty had improved outcome in the correction of vertebral body and relief of pain compared with those who underwent PMMA treatment. METHODS: From January 2005 to December 2006, 117 consecutive patients with osteoporotic compression fracture were treated at our institute. Among them, 23 patients have treated to kyphoplasty using PMMA or CaP. We reviewed the clinical data and imaging studies retrospectively as sources for analysis. RESULTS: The 23 patients included in the study. A mean ages of CaP and PMMA group were 70+/-9.5 and 67+/-9.5 years respectively. Preoperative compression ratios (CR) were 0.71+/-0.12 and 0.74+/-0.15 on both groups. Postoperative CR, however, showed the difference between two groups. The differences of preoperative and postoperative Cobb`s angle were 10.04 and 2.18 on CaP and PMMA group respectively and the mean injected volume of cement were 3.85+/-1.73 and 4.4+/-1.23 ml. CONCLUSION: The amount of injected volume of bone cement in kyphoplasty has no difference on both groups. But, follow-up compression ratio and Cobb`s angle are larger in CaP group than PMMA group. However, pain and functional recovery is not different on both group. As a result, CaP can not sufficiently support the strength of vertebral body, but be used to control the acute pain.
Calcium ; Calcium Phosphates ; Follow-Up Studies ; Fractures, Compression ; Humans ; Kyphoplasty ; Polymethyl Methacrylate ; Retrospective Studies

OBJECTIVE: The aim of this study is to evaluate the transition of lumbar spinal treatments for geriatric patients over 70 years old over two decades. METHODS: We retrospectively assessed 730 patients who were 70 years and older and underwent lumbar surgery. We analyzed the number of diseases, operation methods and complications with 5-year intervals from 1987 to 2006. RESULT: The number of patients older than 70 years who underwent lumbar surgery increased according to our analysis of the period spanning from 1987 to 2006. Thirty-two (1%), 77 (1.7%), 232 (4.4%), and 389 (8.2%) patients over 70 years underwent lumbar spine surgeries. Among them, the 8, 29 and 45 patients had one level degenerative spondylolisthesis for the periods 1992-1996, 1997-2001 and 2002-2006. Twenty-four, 29 and 58 patients had lumbar stenosis during all these time periods. Over time, we performed a larger variety of operations as well as more aggressive operations. From January 2002 to December 2006, a total of 308 patients were over 70 years old and had lumbar spine surgeries performed on them. Among them, the ASA class I was 58 (19%), the ASA class II was 213 (69%) and the ASA class III was 37 (12%). During that period, PLIFs and PS fixations were performed on 69 patients. Among them, 8 patients were ASA III. Large numbers of lumbar arthorodesis have been performed in geriatric patients over the age of 70 years in our series. CONCLUSION: The surgical treatment of degenerative spine disease in the elderly patients was increased due to improved surgical technique and advances in medical treatment including anesthesia. The authors suggest that fusion surgery can be done safely in elderly patients even though they have high-grade ASA classification.
Aged ; Anesthesia ; Constriction, Pathologic ; Humans ; Retrospective Studies ; Spine ; Spondylolisthesis

OBJECTIVE: The purpose of this study is to evaluate the accuracy and safety of pedicle screws in the treatment of thoracic spine disease. METHODS: Thirty-eight patients who had undergone thoracic pedicle screw fixation between January 2003 and December 2007 were retrospectively studied. Postoperative computed tomography scans were obtained using 3-mm axial cuts to evaluate the pedicle screw placement. The screws were further evaluated by the location and degree of the perforation. RESULTS: Of the 214 thoracic pedicle screws placed, 174 (81.3%) were fully contained within the pedicle or anterior cortices of the vertebral body. Of the remaining 40 (18.7%) screws, 25 (62.5%) were lateral perforations, 12 (30.0%) were medial perforations, and 3 (7.5%) were anterior perforations of the vertebral body. The screws inserted at T1-T4 (28.5%) and T5-T8 (34.8%) revealed a higher perforation rate than the screws inserted at T9-12 (11.4%). No neurologic or vascular complications were encountered, but one screw 6 mm above a medial perforation required reinsertion. CONCLUSION: Although clinical outcomes were not affected by mild displacement of thoracic pedicle screws, accurate measurements and considerable experience were required in the placement of screws, especially screws placed in the upper and midthoracic spine.
Displacement (Psychology) ; Humans ; Retrospective Studies ; Spine

OBJECTIVE: Destructions of vertebral body due to various etiologies including acute fracture, tumor, post-traumatic deformity and infection lead to progressive destruction of vertebral body, kyphotic deformities and further neurological deficits. Titanium mesh cages (TMCs) with cancellous autograft bone after corpectomy of the thoracolumbar spine provide immediate structural support to the anterior column. The aim of this study is to evaluate the radiological, neurological and clinical outcomes of patients with the TMCs-bone graft composite after thoracolumbar corpectomy. METHODS: Sixteen patients underwent reconstruction using titanium mesh cages in thoracolumbar corpectomy between July 2000 and February 2005. The radiological and clinical course was documented over a mean follow up duration of 28.2 months. The degree of kyphosis, construct height and the subsidence of the cage in relation to the vertebral endplates were measured preoperatively, early postoperatively, and at the latest follow up. RESULT: The mean kyphotic angle of 3.9degrees before surgery was reduced to -2.6degrees immediately after surgery, and at the last follow up to be 3.4degrees. There was a significant difference between the preoperative versus postoperative kyphotic angle (p=0.003). The mean construct height of involved vertebra before surgery was 41.6 mm and the mean construct height immediate after surgery and at follow up were 47.9 mm and 41.5 mm, respectively. There was a significant difference between the preoperative versus postoperative construct height (p<0.0001). But there was no significant difference between the preoperative versus follow up in kyphotic angle and construct height. The mean subsidence was 5.7 mm. However, there was no case of severe collapse or significant recurrence of deformity. All patients had not attained significant neurological deterioration after surgery without major complications. CONCLUSION: In this study, TMCs after thoracolumbar corpectomy is a successful adjunct for anterior vertebral column reconstruction. In our cases, TMCs with anterior instrumentation alone allows a good structural support and maintain spinal alignment.
Congenital Abnormalities ; Follow-Up Studies ; Humans ; Kyphosis ; Recurrence ; Spine ; Titanium ; Transplants

OBJECTIVE: The clinical and radiographic success of a two-level discectomy and autologous iliac bone fusion with anterior cervical plate fixation (ACDFP) was compared with that of a one-level corpectomy and fusion using a titanium mesh cage (corpectomy) for the treatment of degenerative cervical disc disease. METHODS: From January 2004 to December 2007, there were 45 consecutive cases of two disc level degenerative cervical disc disease treated with either ACDFP or corpectomy. The medical records and radiological studies were reviewed, retrospectively. The clinical outcomes were measured using Odom's criteria. The radiologic assessment was performed using images showing the lordosis and bony fusion. RESULTS: Twenty-seven patients were treated with ACDFP. Eighteen patients were treated with corpectomy. The clinical outcome was excellent or good in 25 cases (93%) and 17 cases (94%) treated with ACDFP and corpectomy, respectively. The fusion rate was 96% and 94% for ACDFP and corpectomy, respectively. There was a slight increase in the cervical lordosis in both groups, but there was no significant difference between the 2 groups. There were no irriversible complications in both groups. Reversible complications were encountered in 1 case of corpectomy, and 7 cases of ACDFP, which were mainly associated with donor site. CONCLUSION: Either a ACDFP or a corpectomy provides good clinical outcome and similar bone fusion rates for degenerative disc diseases. However, absence of donor site complications makes a corpectomy better than ACDFP.
Animals ; Diskectomy ; Humans ; Lordosis ; Medical Records ; Retrospective Studies ; Tissue Donors ; Titanium

OBJECTIVES: Although successful fusion rates have approached almost 100%, fusion may increase the biomechanical stresses imposed on the adjacent segments leading to transitional disease. These issues have leg some investigators to explore novel approaches, that is 'posterior dynamic stabilization'. In this study, we compared clinical outcome of two different posterior dynamic stabilization instruments: 'Interspinous U' and 'DIAM' device, respectively. METHODS: A retrospective review was performed for all the patients with disc degenerative diseases treated with decompression procedure from 2004 to 2007. The plain lateral and flexion-extension views were taken immediately after surgery and at each follow-up. The disc height ratio(DH), total lumbar lordotic angle (TLA) and segmental lordotic angle (SLA) were used to observe the change of initial status. The clinical outcome was measured by Odom's criteria and compared. Also, in lateral view, decrease of bony density around instruments was regarded as bony erosion. RESULTS: Mean follow-up durations for 'Interspinous U' and 'DIAM' were 39 and 14 months, respectively. Instruments were used for 21 and 16 patients for 'Interspinous U and 'DIAM' groups, respectively. Satisfactory groups were 61% and 74% for 'Interspinous U and 'DIAM' groups. But, there was no statistical difference between two groups in the change of DH, TLA and SLA. In 'Interspinous U' group, two cases showed spinal instability with bony erosion, and five cases showed bony erosion around instruments. CONCLUSION: 'DIAM'group showed higher patient satisfaction and no bony erosion. To ascertain the difference, analysis with larger population and a long-term follow-up period will be needed.
Decompression ; Follow-Up Studies ; Humans ; Leg ; Patient Satisfaction ; Research Personnel ; Retrospective Studies

OBJECTIVE: Interspinous devices for dynamic stabilization of lumbar spine are undergoing development and clinical trials. A few short-term outcomes of interspinous devices have been reported but little has been mentioned about longterm outcomes. We reviewed 19 cases of interspinous implantation (Coflex Paradigm spine, Germany) to evaluate clinical long-term outcome and radiologic features. METHODS: From January 2003 to March 2004, 19 patients (13 female and 6 male) who underwent interspinous implantation were included and follow-up data on clinical and radiologic outcomes were obtained at last clinic visit (mean follow-up: 38 months). Clinical outcomes were assessed by Visual analogue scale (VAS) score and Odom..s criteria. RESULTS: Preoperative VAS score for low back pain and leg pain was improved from 4.9+/-2.4 and 7.5+/-2.4 to 2.6+/-1.2 and 3.0+/-1.8 respectively at postoperative last clinic visit (p<0.01). Using Odom..s criteria, 7 and 9 patients showed excellent (36.8%) and good (47.3%) results for low back pain and 7 and 11 showed excellent (36.8%) and good (57.9%) results for leg pain. Anterior and posterior disc height were decreased significantly on postoperative follow-up radiologic data due to discectomy at the level of instrumentation (p<0.01). There were no complications such as infection or device failure. CONCLUSIONS: In this long-term follow-up study, clinical outcome was good but disc degeneration after discectomy at instumented level resulting in decrease of disc height was observed.
Ambulatory Care ; Diskectomy ; Female ; Follow-Up Studies ; Humans ; Intervertebral Disc Degeneration ; Leg ; Low Back Pain ; Spine

OBJECTIVE: Postoperative motion preservation and prevention of adjacent segment degeneration is well recognized after placing artificial cervical disc prosthesis in patients with degenerative cervical disc disease. The authors investigated postoperative changes in motion dynamics in two different types of artificial cervical disc prosthesis, Bryan and Prestige LP cervical disc prosthesis, and compared them. METHODS: Twenty five patients underwent anterior cervical discectomy and implantation of artificial cervical disc prosthesis: 10 with Bryan and 15 with Prestige LP. Radiological assessments, including overall sagittal alignment angle, range of motion (ROM) of overall sagittal, functional spine unit (FSU) angle, segmental ROM of FSU and ROM of adjacent segment (Upper and Lower level) using static and dynamic lateral radiographs, were performed preoperatively and postoperatively. The mean postoperative follow up period was 18.6 months (range 10.4~28.5) in Bryan and 9.2 months (range 6.5~12.6) in Prestige LP. RESULTS: The overall sagittal alignment angle was decreased 2.9degrees in Bryan group (p=0.033) and increased 5.7degrees in Prestige LP group (p=0.017). The FSU angle at treated level was decreased 0.4degrees in Bryan group (p=0.929) and increased 2.9degrees in Prestige LP group (p=0.008). The ROM of overall sagittal was decreased in both groups (Bryan: 8.6degrees p=0.075, Prestige LP: 2.9degrees p=0.182). The segmental ROM of FSU was increased 1.0degrees in Prestige LP group (p=0.191) but, decreased 0.6degrees in Bryan group (p=0.929). The ROM of adjacent segment was decreased in both groups (Bryan: upper p=0.023 lower p=0.050, Prestige LP: upper p=0.570 lower p=0.132). The postoperative radiological results of comparison between two different artificial disc showed that overall sagittal alignment angle and FSU angle were more increased in Prestige LP (p=0.005, p=0.026, respectively). CONCLUSION: The segmental ROM of FSU was preserved and ROM of adjacent segment was decreased in both groups. This means that postoperative adjacent segment disease may be prevented regardless of types of implants. On comparison study, postoperative cervical curvature was more lordotic in Prestige LP. Therefore, Prestige LP is more suitable to maintain postoperative cervical lordosis. The limitation of our study is small number of case and short and unequal follow up period between two types of implants. Further long term study will be needed.
Animals ; Arthroplasty ; Diskectomy ; Follow-Up Studies ; Humans ; Lordosis ; Prostheses and Implants ; Range of Motion, Articular ; Spine

INTRODUCTION: Cervical anterior interbody fusion may be considered to be the gold standard for treatment of symptomatic cervical degenerative disc disease. However, this method leads to degenerative changes at the levels adjacent to the fused segments. On the other hand, multilevel cervical artificial disc replacement is another treatment for cervical degenerative disease, but the effectiveness and stability of artificial disc has not been proven yet. The purpose of this study is to compare the two-level hybrid surgery (Cervical disc prosthesis replacement at one level, and interbody fusion with cage at the other level) with the classical two-level interbody fusion in relation to the clinical outcomes and effects on the adjacent segment levels. METHOD: 27 patients with two-level cervical degenerative disease were enrolled and assigned to each study group. Radiologic analysis was used to measure the range of movement (ROM) of cervical spine, functional spinal unit (FSU) and adjacent segment levels at 2 months postoperatively and follow-up period (Mean follow-up period was 9.3(+/-4.1) month). Furthermore, clinical outcomes were analyzed by using visual analogue scale (VAS) and Odom..s criteria. RESULT: Out of 27 patients, 14 patients received hybrid surgery (group A) and 13 patients received two-level interbody fusion using a cage with bone graft (group B). Both groups showed significant improvement in symptoms and the VAS scores after operation (group A: from 8.2 to 2.4, group B: from 8.0 to 3.2). In group A, ROM of C2-7 decreased at 2 month postoperatively, but it was restored to nearly preoperative state during follow-up period. ROM of C2-7 in group B also showed similar changes, and there were no statistically significant difference between two groups (group A: pre-operation 44.3degrees, 2 months after operation 29.0degrees and last follow-up 41.6degrees, group B: pre-operation 46.8degrees, 2 months after operation 26.3degrees and last follow-up 37.4degrees). In both upper and lower segments, ROM of group B was significantly increased during follow-up period, compared with ROM of group A. This reflected that adjacent segments in group B received more stress due to bone fusion of functional spinal unit. CONCLUSION: The hybrid surgery was somewhat effective in two-level cervical degenerative disease. ROM analysis of adjacent segments in hybrid surgery group suggested that this group received less stress at adjacent segments, compared with two-level anterior cervical fusion group. Further follow-up study is required to assess long-term outcomes of the hybrid surgery and its influence on adjacent levels.
Chimera ; Follow-Up Studies ; Hand ; Humans ; Prostheses and Implants ; Spine ; Total Disc Replacement ; Transplants

OBJECTIVE: We investigated whether there are any different results in the overall sagittal alignment, neutral functional spine unit (FSU) angle and segmental FSU ROM (range of motion) angle from the patients undergone by cervical arthroplasty with two kinds of artificial cervical disc prostheses, Bryan and Mobi-C cervical disc. METHODS: Twenty eight patients underwent anterior cervical discectomy and implantation of artificial cervical disc prosthesis; Eighteen of them underwent operation with Bryan and the rest of them with Mobi-C cervical disc prosthesis. These patients consist of fourteen females and fourteen males with mean age 46.9 years old and 9.4 months mean follow-up period. There were 4 cases of C 4-5, 18 cases of C 5-6 and 6 cases of C 6-7 level. We measured overall sagittal alignment, neutral FSU angle and segmental FSU ROM angle using lateral radiographs preoperatively and postoperatively. The clinical outcome was evaluated by neck disability index(NDI). RESULT: The average angle of overall sagittal alignments was changed from -17.45degrees preoperatively to -14.21degrees postoperatively in Bryan cervical disc group. It decreased 3.24degrees in cervical lordosis. However, in Mobi-C cervical disc group, the average angle of overall sagittal alignments was changed from -10.33degrees preoperatively to -16.89degrees postoperatively. It increased 6.56degrees in cervical lordosis. The averages of neutral FSU angles were -1.14degrees preoperatively and -3.26degrees postoperatively in Bryan cervical disc group, and were -0.93degrees preoperatively and -9.7degrees postoperatively in Mobi-C cervical disc group. The averages of segmental FSU ROM angles were 11.18degrees preoperatively and 10.61degrees postoperatively in Bryan cervical disc group, and was 8.31degrees preoperatively and 13.6degrees postoperatively in Mobi-C cervical disc group. NDIs were 24.0 preoperatively and 5.9 postoperatively in Bryan cervical disc group, and 24.7 preoperatively and 8.7 postoperatively in Mobi-C cervical disc group. CONCLUSION: Postoperative cervical lordosis and segmental FSU ROM angle were increased in Mobi-C cervical disc group (p<0.05). To preserve segmental motion and avoid adjacent segment degeneration is to the focus in cervical arthroplasty. To preserve cervical lordosis after operation is physiologic than postoperative cervical kyphosis. It remains controversial whether cervical kyphosis influences clinical outcome after anterior cervical operation. The results of this study show that the technical and mechanical improvement of Bryan cervical disc prosthesis may be considered.
Animals ; Arthroplasty ; Diskectomy ; Female ; Follow-Up Studies ; Humans ; Kyphosis ; Lordosis ; Male ; Neck ; Prostheses and Implants ; Spine