No abstract available.

Nowadays, the minimally invasive technique is the current trends in all medical fields. The spine is not the exception. By the development of modern optical devices and computer technology, thoracoscopy arose as new powerful tool in thoracic area. Many spinal disorders which were previously treated by transthoracic surgery are entering into the area of thoracoscopic surgery. The indication for thracoscopic surgery is getting wider and wider as technologies progress. So it seems to be difficult to define its indication strictly, as long as the patient can tolerate one-lung ventilation and endoscopy is accessible. In thoracic discectomy, thoracoscopy not only shortened operation time, hospital stay and chest tube insertion duration, but also lowered medical expense, postoperative pain and complication rate. But the patient selection is not yet established. Corpectomy can be performed in metastatic tumor removal or debridement of osteomyelitis by thoracoscopy. Thereafter, reconstruction or instrumentation is possible to prevent postoperative spinal deformity. In correction of spinal deformity, thoracoscopic surgery showed similar outcomes compared to thoracotomy in deformity correction, bone fusion, and functional outcome. There was also no statistical difference in complication rates between them. Pulmonary complications seen in thoracoscopic surgery such as atelectasis, pneumothorax and hemothorax were common. They seem to be related with the one-lung ventilation and the thoracoscopic approach itself, distinct from thoracotomy. But most complications were not life-threatening with some exceptions. Considering the development during the past two decades, the speed of development of thoracoscopic surgery will accelerate and the role of thoracoscopic surgery will become more important. In the development of thoracoscopy, the technical progression of optics and computer engineering will play important roles.
Chest Tubes ; Congenital Abnormalities ; Debridement ; Diskectomy ; Endoscopy ; Hemothorax ; Humans ; Length of Stay ; One-Lung Ventilation ; Optical Devices ; Osteomyelitis ; Pain, Postoperative ; Patient Selection ; Pneumothorax ; Pulmonary Atelectasis ; Spine ; Thoracoscopy ; Thoracotomy

OBJECTIVE: With improvement in endoscopic visualization and surgical tools, several minimally invasive procedures such as transpedicular fixation, interbody fusion, or decompression have advocated their respective advantages. But all these procedures are developed separately and are not related to other techniques. The authors utilize these procedures as organized procedure like comprehensive conventional procedure. This study is designed to study early results of minimally invasive decompression, interbody fusion, and endoscopic pedicle screw fixation. METHODS: We utilized minimally invasive decompression, interbody fusion, and endoscopic pedicle screw fixation on 12 consecutive patients(9 female, 3 male, mean age 54.8 years). For decompression, unilateral laminectomy and controlateral laminar undercutting was performed through tubular retractor, and interbody fusion(PLIF or TLIF) was done with one cage and bone packing. Pedicle screw fixation was done using expandable tubular retractor under endoscopic visualization and fluoroscopic guidance. Contralateral screw fixation was done with the same manner. RESULTS: There were five spinal stenosis and seven degenerative spondylolisthesis. All patients received one level (L4-5) decompression, interbody fusion, and fixation. Mean operating time was 245.8 minutes. There was dural tear in one patient. All patients were excellent or good with average follow up of 7.2 months. Bone fusion was not evident due to short-term follow-up, but there were no instability or screw loosening. CONCLUSION: Although it is small series and has short-term follow-up, this study demonstrates that minimally invasive decompression, interbody fusion, and pedicle screw fixation are feasible and effective.
Decompression* ; Female ; Follow-Up Studies ; Humans ; Laminectomy ; Male ; Spinal Fusion ; Spinal Stenosis ; Spondylolisthesis

OBJECTIVE: Laminoplasty is one of the potential surgical options for compressive spinal pathologies. The use of laminoplasty in spinal cord tumor surgery is not popularized by this time. To demonstrate the usefulness of laminoplasty in spinal cord tumor surgery, the authors analyze the results of patients who underwent laminoplasty for removal of cervical spinal cord tumor. METHODS: Between 1992 and 2000, 47 patients had received operation for the removal of the cervical spinal cord tumor. Of them, 29 patients were enrolled for this study. 17 patients received laminoplasty and 12 patients received laminectomy. The medical records and radiologic studies were analyzed retrospectively. The mean follow-up duration was 61.6 months. RESULTS: Modified Kurokawa method for laminoplasty was utilized in all cases. Neurilemmoma was the most common pathology. Average operated segments ware 2.8 segments in laminectomy group and ware 3.8 segments in laminoplasty group. Taking time for the operation with laminoplasty(avg. 291min) was longer than that for laminectomy(avg. 275min). Kyphotic deformity was developed in 1 patient in laminoplasty group and in 2 patients in laminectomy group. All laminoplasty patients revealed stability in radiologic follow-up. One patient who underwent laminoplasty presented recurrent neurilemmoma, which could be removed easily by virtue of less adhesion and undistorted anatomy. CONCLUSION: This study demonstrates that patients who underwent laminoplasty have less kyphotic deformity and keep space with protection from adhesion. We conclude that the laminoplasty is one of the useful procedures, especially in younger patients with large multiple intradural tumors and mass over several segments.
Congenital Abnormalities ; Follow-Up Studies ; Humans ; Laminectomy ; Medical Records ; Neurilemmoma ; Pathology ; Retrospective Studies ; Spinal Cord Neoplasms* ; Spinal Cord* ; Virtues

Operative management using instruments is being used widely for stabilization for the patients with lower cervical spine injuries. Although these instrumentation can fix unstable spine segments firmly, selection and application are not defined clearly in association with injured column. Authors investigated the results of these operation in terms of relationship between injured column and operated column. Eighty five patients were enrolled(male 67, female 18) in this study for the past three years. We applied two-column concept with fiducial line of posterior longitudinal ligament delete Patients were classified into three injured groups based on dynamic X-ray and MRI findings and three operated groups according to operated columns(anterior, posterior, and both). We studied the results with relationships between the respective groups. Anterior approach was performed in all anterior, 2 posterior, and 25 both-column injured patients and 14 patients received both-column operation. Incomplete reduction or malalignment was found in 6 patients. Five of them were both-column injured cases with anterior approach, and 2 of six both-column injured cases on C7-T1 were failed with anterior procedure. There were 7 surgical complications(all in both-column injured cases with one side procedure). Even though both-column injured cases could be managed with anterior procedure only, but it did not afford secure fixation in some cases and might have been associated with complications. Anterior cervical approach has to be performed with consideration of spinal column and level, and circumferential fusion and fixation must be considered in selected both-column injured cases.
Female ; Humans ; Longitudinal Ligaments ; Magnetic Resonance Imaging ; Spine*

In retrospective study of 35 cases(male=17, female=18) of lumbar spondylolisthesis(isthmic 24, degenerative 6 iatrogenic 5) treated with different surgical management, we elucidate the result of follow-up radiologic changes and surgical outcome. Percent-slip was reduced and percent-disc height was increased in all three groups at 1 month after the operation. But 6 months follow-up after the operation revealed that percent-slip was increased to around the value of preoperation in PPLF group(Pedicle screw fixation with posterolateral fusion, 13cases) and PLIF group(Posterior lumbar interbody fusion only, 11cases) and that percent-disc height was decreased compared to postoperative 1 month in PPLF group. Although PPIF group(Pedicle screw fixation with posterior lumbar interbody fusion, 11cases) showed better correction and maintenance. But there was no significant differences in overall outcome among the three surgical groups(PPLF :76.9%, PLIF : 81.8%, % of satisfaction) and the outcome of surgery was not related with bone union rate(PPLF=76.9%, PLIF=72.7%, PPIF=81.8%) or accompanied NIC and HNP. There were 6 patients with complications(17.1%), such as two wound infection, two screw fractures and two others. Futher longterm follow-up and evaluation is needed for clarifying the efficiency and superiority in surgical options associated with type, degree of slip, complications, bone fusion and patient satisfaction.
Adult* ; Follow-Up Studies ; Humans ; Patient Satisfaction ; Retrospective Studies ; Spondylolisthesis* ; Wound Infection

Conservative therapy remains the mainstay treatment of chronic low back pain (LBP). If this has failed, surgical options may be considered in carefully selected patients. Still surgical treatment for chronic LBP is a matter of intensive and controversial discussions. Nevertheless, surgical management for chronic (LBP) has been evolved and increased gradually. Spinal fusion has been the established surgical option in cases that did not respond to conservative therapy. Besides spinal fusion, newer technologies such as artificial disc replacement, dynamic stabilization, and spinal cord stimulation are being increasingly considered. Although successful results of these procedures have been published, evidence-based data on the efficacy and benefits of most of these techniques are still lacking. However, empirical data show good or at least satisfactory clinical results of these procedures when they were applied under restrictive indication criteria. Further prospective randomized controlled studies are mandatory to determine the role of these procedures, and basic research is necessary to understand the pathogenesis of LBP at the molecular and genetic levels
Humans ; Low Back Pain* ; Spinal Cord Stimulation ; Spinal Fusion ; Total Disc Replacement

We report a case of atlantoaxial subluxation with bilateral high-riding vertebral artery with narrow isthmus. Because of the potential risk of bilateral vertebral artery injury, we performed atlantoaxial fixation using rod and screw instead of transarticular screw fixation. Although postoperative computed tomography reconstruction demonstrated slight breach of bilateral vertebral artery groove, postoperative angiography showed no evidence of vertebral artery injury. Though technically demanding, atlantoaxial fixation using rod and screw can be a one of the treatment options for atlantoaxial instability with bilateral high riding vertebral artery.
Angiography ; Vertebral Artery*

While most patients with hangman's fracture could be effectively managed with non-operative treatment, surgical intervention should be considered in unstable hangman's fracture with severe C2-3 dislocation or angulation. Author modified the posterior lateral mass plating techinic for the unstable hangman's fracture. While the C3 screw fixation was done with usual manner, author applied the long lag screw instead of usual short- or medium-sized screw through the isthmus of C2 for direct reduction and fixation of fractured segment. It is similar to anterior screw fixation for odontoid type II fracture in terms of simutaeneous reduction and fixation. Besides these procedure interfacetal fusion and ligamentoplasty were added in C2-3 articulation. Surgical point of view was discussed with literature review.
Dislocations ; Humans

Fracture of the odontoid process is subdivided into type I, II and III. The treatment of type II is problematic, in that both conservative treatment and surgery are usually unsatisfactory; in the other type, conservative management alone gives good results. Recently, however, the operative procedure has changed, in accordance with advances in surgical equipment and technique. The anterior or posterior approach may be used, and the anterior screw fixation is increasingly the operaive procedure of choice; indications, operative technique, complications and long-term prognosis have not, however, been reported. The procedure was initially applied to patients who had suffered posterior displacement, and in whom nonunion was likely, but because of improved equipment and technique, was seem to be succesful and safe and so was used in the initial management of all odontoid type II fracture. A anterior screw fixation effectively attaches displaced bony fragment to the odontoid process and immobilizes one that is fractured. The BOP(Biocompatible Osteoconductive Polymer) pin is more physiologic than metal screw, and does not compromise the area to be fused, eventhough it has no lag effect. The major advantages of anterior fixation are immediate stability and restoration, and the preservation of normal biomechanics of the spine. It can be used as the procedure of choice in most patients with odontoid type II fracture, while anterior fixation with a BOP pin may be suitable for some selected patients.
Humans ; Odontoid Process ; Prognosis ; Spine ; Surgical Equipment ; Surgical Procedures, Operative