OBJECTIVE: To evaluate the diagnostic value of computed tomography-myelography (CTM) compared to that of magnetic resonance imaging (MRI) in patients with lumbar radiculopathy. METHODS: The study included 91 patients presenting with radicular leg pain caused by herniated nucleus pulposus or lateral recess stenosis in the lumbar spine. The degree of nerve root compression on MRI and CTM was classified into four grades. The results of each imaging modality as assessed by two different observers were compared. Visual analog scale score for pain and electromyography result were the clinical parameters used to evaluate the relationships between clinical features and nerve root compression grades on both MRI and CTM. These relationships were quantified by calculating the receiver-operating characteristic curves, and the degree of relationship was compared between MRI and CTM. RESULTS: McNemar's test revealed that the two diagnostic modalities did not show diagnostic concurrence (p<0.0001). Electromyography results did not correlate with grades on either MRI or CTM. The visual analog pain scale score results were correlated better with changes of the grades on CTM than those on MRI (p=0.0007). CONCLUSION: The present study demonstrates that CTM could better define the pathology of degenerative lumbar spine diseases with radiculopathy than MRI. CTM can be considered as a useful confirmative diagnostic tool when the exact cause of radicular pain in a patient with lumbar radiculopathy cannot be identified by using MRI. However, the invasiveness and potential complications of CTM are still considered to be pending questions to settle.
Constriction, Pathologic ; Electromyography ; Humans ; Leg ; Magnetic Resonance Imaging* ; Myelography ; Pain Measurement ; Pathology ; Radiculopathy* ; Spine ; Visual Analog Scale

Since the launch of cervical total disc replacement (CTDR) in the early 2000s, many clinical studies have reported better outcomes of CTDR compared to those of anterior cervical discectomy and fusion. However, CTDR is still a new and innovative procedure with limited indications for clinical application in spinal surgery, particularly, for young patients presenting with soft disc herniation with radiculopathy and/or myelopathy. In addition, some controversial issues related to the assessment of clinical outcomes of CTDR remain unresolved. These issues, including surgical outcomes, adjacent segment degeneration (ASD), heterotopic ossification (HO), wear debris and tissue reaction, and multilevel total disc replacement (TDR) and hybrid surgeries are a common concern of spine surgeons and need to be resolved. Among them, the effect of CTDR on patient outcomes and ASD is theoretically and clinically important; however, this issue remains disputable. Additionally, HO, wear debris, multilevel TDR, and hybrid surgery tend to favor CTDR in terms of their effects on outcomes, but the potential of these factors for jeopardizing patients' safety postoperatively and/or to exert harmful effects on surgical outcomes in longer-term follow-up cannot be ignored. Consequently, it is too early to determine the therapeutic efficacy and cost-effectiveness of CTDR and will require considerable time and studies to provide appropriate answers regarding the same. For these reasons, CTDR requires longer-term follow-up data.
Cervical Vertebrae ; Diskectomy ; Female ; Follow-Up Studies ; Humans ; Intervertebral Disc Degeneration ; Ossification, Heterotopic ; Prognosis ; Radiculopathy ; Spinal Cord Diseases ; Spine ; Surgeons ; Total Disc Replacement

OBJECTIVE: The authors introduce a technique of direct repair of pars defects in symptomatic lumbar spondylolysis using pedicle screws and universal hooks. METHODS: From March 2001 to September 2001, six patients with symptomatic lumbar spondylolysis and positive pars injection test underwent this procedure. Patients with lumbar instability and discogenic pain were excluded. After posterior midline incision, clearing of fibrous, cartilaginous and sclerotic tissues in and around the defects of pars was done until healthy bone was exposed. Strips of cancellous bone were taken from adjacent laminae and packed into the defects of pars. After insertion of the pedicle screws, universal hooks were placed in the lower margin of the lamina of the involved vertebra. With gentle compression between the head of screw and universal hook, the nut was fixed. Same procedures were done on the contralateral side. RESULTS: Postoperatively, all six patients experienced clinical improvement and there was no complication related with operation. CONCLUSION: This new technique is considered useful for direct repair of the defects in symptomatic lumbar spondylolysis without significant injury in the normal structures.
Head ; Humans ; Nuts ; Spine ; Spondylolysis*

OBJECTIVE: Treatments of osteoporotic bursting vertebral body fracture(OBF) of thoracic and lumbar spines have been limited to conservative managements especially in the elderly patients. The authors correct kyphosis and stabilize the spine by the posterior approach with intraoperative polymethylmethacrylate(PMMA) vertebroplasty. METHODS: From March 1999 to June 2000, eight patients with OBF underwent posterior approach with intraoperative vertebroplasty. The patients included 7 women and 1 man aged 54-82 year. Average T-score on bone marrow density was -3.02. In the case of old fracture with sclerosis in the posterior wall, after laminectomy, the retropulsed posterior wall of the fractured spine was reduced with L-shaped micro-bone impactor through the lateral epidural spaces, in prone position. About 6cc of PMMA was injected into the fractured vertebral body via transpedicular route, and then, small amount of PMMA was also injected into each entry point of the screws. All patients underwent one above and one below short segment fixation followed by correction of kyphotic deformity. RESULTS: The preoperative clinical symptoms improved gradually in all patients. During postoperative follow-up for more than 7 months, there was no recurrence of the preoperative clinical symptoms, aggravation of kyphosis or instrumentation failure. CONCLUSIONS: It is suggested that posterior approach with short segment fixation and intraoperative PMMA vertebroplasty could be a new surgical modality for osteoporotic bursting fracture of the thoracic and lumbar spines especially in the aged.
Aged ; Bone Marrow ; Congenital Abnormalities ; Epidural Space ; Female ; Follow-Up Studies ; Humans ; Kyphosis ; Laminectomy ; Osteoporosis ; Polymethyl Methacrylate ; Prone Position ; Recurrence ; Sclerosis ; Spine* ; Vertebroplasty*

OBJECTIVE: This retrospective study was performed to evaluate the clinical and radiological results of anterior lumbar interbody fusion (ALIF) using two different stand-alone cages in the treatment of lumbar intervertebral foraminal stenosis (IFS). METHODS: A total of 28 patients who underwent ALIF at L5-S1 using stand-alone cage were studied [Stabilis(R) (Stryker, Kalamazoo, MI, USA); 13, SynFix-LR(R) (Synthes Bettlach, Switzerland); 15]. Mean follow-up period was 27.3 +/- 4.9 months. Visual analogue pain scale (VAS) and Oswestry disability index (ODI) were assessed. Radiologically, the change of disc height, intervertebral foraminal (IVF) height and width at the operated segment were measured, and fusion status was defined. RESULTS: Final mean VAS (back and leg) and ODI scores were significantly decreased from preoperative values (5.6 +/- 2.3 --> 2.3 +/- 2.2, 6.3 +/- 3.2 --> 1.6 +/- 1.6, and 53.7 +/- 18.6 --> 28.3 +/- 13.1, respectively), which were not different between the two devices groups. In Stabilis(R) group, postoperative immediately increased disc and IVF heights (10.09 +/- 4.15 mm --> 14.99 +/- 1.73 mm, 13.00 +/- 2.44 mm --> 16.28 +/- 2.23 mm, respectively) were gradually decreased, and finally returned to preoperative value (11.29 +/- 1.67 mm, 13.59 +/- 2.01 mm, respectively). In SynFix-LR(R) group, immediately increased disc and IVF heights (9.60 +/- 2.82 mm --> 15.61 +/- 0.62 mm, 14.01 +/- 2.53 mm --> 21.27 +/- 1.93 mm, respectively) were maintained until the last follow up (13.72 +/- 1.21 mm, 17.87 +/- 2.02 mm, respectively). The changes of IVF width of each group was minimal pre- and postoperatively. Solid arthrodesis was observed in 11 patients in Stabilis group (11/13, 84.6%) and 13 in SynFix-LR(R) group (13/15, 86.7%). CONCLUSION: ALIF using stand-alone cage could assure good clinical results in the treatment of symptomatic lumbar IFS in the mid-term follow up. A degree of subsidence at the operated segment was different depending on the device type, which was higher in Stabilis(R) group.
Arthrodesis ; Constriction, Pathologic ; Follow-Up Studies ; Humans ; Pain Measurement ; Retrospective Studies

In surgical treatments of degenerative lumbar disc disease, arthrodesis is well known to be a gold standard; however various disadvantages related to elimination of the segmental motion and the procedures of fusion surgery have become a matter of concern. To this end, total disc replacement (TDR) was recently highlighted as one of alternative surgical modalities and being used widely. However, although it has been almost 10 years since lumbar TDR was int- roduced and actively used in the clinic, its clinical usefulness is still in dispute. The authors review and put together the history, biomechanics, and currently available prostheses of lumbar TDR in the present study. Some of the recent preliminary, mid-term and long-term clinical results of lumbar TDR in degenerative lumbar spine diseases are also reviewed. Lastly, we look out over the future prospect of lumbar TDR.
Arthrodesis ; Biomechanics ; Dissent and Disputes ; Intervertebral Disc Degeneration ; Intervertebral Disc Displacement ; Prostheses and Implants ; Spine ; Total Disc Replacement

OBJECTIVE: To elucidate etiological factors of heterotopic ossification (HO) by evaluating retrospectively if HO is a unique finding following cervical total disc replacement (CTDR) or a finding observable following an anterior cervical interbody fusion (ACIF). METHODS: The authors had selected 87 patients who underwent anterior cervical surgery (TDR or ACIF), and could be followed up more than 24 months. A cervical TDR was performed using a Bryan disc or a ProDisc-C and an ACIF using a stand-alone cage or fibular allograft with a plate and screws system. The presence of HO was determined by observing plain radiography at the last follow up. The relation between HO occurrence and specific preoperative radio-logical findings (osteophyte and calcification of posterior longitudinal ligament (PLL)) at the index level was investigated. RESULTS: Cervical TDR was performed in 40 patients (43 levels) and ACIF in 47 patients (54 levels). At the final radiographs, HO was demonstrated at 27 levels (TDR-Bryan; 8/18, TDR-Prodisc-C; 12/25, ACIF-cage alone; 7/29, and ACIF-plate screw; 0/25). Mean ROM at the last follow-up of each TDR subgroup were 7.8+/-4.7degrees in Bryan, 3.89+/-1.77degrees in Prodisc-C, and it did not correlated with the incidence of HO. Fusion status of ACIF groups was observed as 2 case of grade 1, 6 of grade 2, and 21 of grade 3 in cage alone subgroup, and no case of grade 1, 4 of grade 2, and 21 of grade 3 in plate screw subgroup. Fusion status in ACIF-cage alone subgroup was significantly related to the HO incidence. The preoperative osteophyte at the operated level observed in 27 levels, and HO was demonstrated in 12 levels (TDR-Bryan; 3/5, TDR-Prodisc-C; 2/3, ACIF-cage alone; 7/11, and ACIF-plate screw; 0/8). Preoperative PLL calcification at the operated level was observed 22 levels, and HO was defined at 14 levels (TDR-Bryan; 5/5, TDR-Prodisc-C; 4/5, ACIF-cage alone; 5/7, and ACIF-plate screw; 0/5). The evidence of preoperative osteophyte and PLL calcification showed statistically significant relations to the occurrence of HO. CONCLUSION: HO was observed in both TDR and ACIF groups. HO was more frequently occurred in TDR group regardless of prosthesis type. In ACIF group, only cage alone subgroup showed HO, with relation to fusion status. Preoperative calcification of longitudinal ligaments and osteophyte were strongly related to the occurrence of HO.
Cinnarizine ; Follow-Up Studies ; Humans ; Incidence ; Longitudinal Ligaments ; Ossification of Posterior Longitudinal Ligament ; Ossification, Heterotopic ; Osteophyte ; Prostheses and Implants ; Retrospective Studies ; Total Disc Replacement ; Transplantation, Homologous

OBJECTIVE: This retrospective study of 13 patients who underwent surgical treatment for symptomatic lumbar synovial cyst was performed to evaluate the clinical findings and pathogenesis of lumbar synovial cyst. METHODS: The clinical characteristics of the patients were investigated by reviewing the hospital records, preoperative radiological images, and operation records. By observing preoperative CT scans Facet degeneration grade at the lesion and opposite side of pathologic level and adjacent levels were assessed and compared. RESULTS: There were 5 males and 8 females (average 65.8 year-old). Six patients presented with low back pain and leg pain, and 7 patients presented only leg pain. Most common pathologic level was L4-5. All patients underwent the cyst resection with/without decompressive laminectomy or discectomy. The additional instrumentation was not performed in all patients. No complications or recurrence was observed during average 34.5 months follow-up. There was no significant difference of facet degeneration grade between the lesion side of pathologic level and opposite side of same level or lower adjacent level. CONCLUSION: In the present study, all patients showed clinical improvement by the simple surgery without any instrumentation. No significant correlation between the occurrence of synovial cyst and the degeneration grade of facet joint was revealed.
Diskectomy ; Female ; Follow-Up Studies ; Hospital Records ; Humans ; Laminectomy ; Leg ; Low Back Pain ; Male ; Recurrence ; Retrospective Studies ; Synovial Cyst ; Zygapophyseal Joint

Ponticulus posticus is an abnormal bony bridge of posterior arch of atlas. The resulting foramen contains the vertebral artery and has clinical significance in lateral mass screw insertion into the first cervical vertebra. The authors report an atlantoaxial subluxation case showing a ponticulus posticus, which was surgically treated with posterior atlantoaxial screw fixation under the guidance of O-arm(R) imaging system coupled with navigation.
Atlanto-Axial Joint ; Congenital Abnormalities ; Humans ; Spine ; Vertebral Artery

A 52-year-old woman presented with a thoracic chordoma at T1-3 level as abnormal sensations on the trunk and low extremities and both legs weakness. Almost total resection was possible through posterolateral costotransversectomy. The patient could ambulate at 3 days after the operation without any sequelae. Histologic study revealed a malignant chordoma with no sarcomatous differentiation.
Chordoma ; Extremities ; Female ; Humans ; Leg ; Middle Aged ; Sensation