No abstract available.

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

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

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

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

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*

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*

Although methylprednisolone (MP) is the standard of care in acute spinal cord injury (SCI), its functional outcome varies in clinical situation. Recent report demonstrated that MP depresses the expression of growth-promoting neurotrophic factors after acute SCI. The present study was designed to investigate whether continuous infusion of brain-derived neurotrophic factor (BDNF) after MP treatment promotes functional recovery in severe SCI. Contusion injury was produced at the T10 vertebral level of the spinal cord in adult rats. The rats received MP intravenously immediately after the injury and BDNF was infused intrathecally using an osmotic mini-pump for six weeks. Immunohistochemical methods were used to detect ED-1, Growth associated protein-43 (GAP-43), neurofilament (NF), and choline acethyl transferase (ChAT) levels. BDNF did not alter the effect of MP on hematogenous inflammatory cellular infiltration. MP treatment with BDNF infusion resulted in greater axonal survival and regeneration compared to MP treatment alone, as indicated by increases in NF and GAP-43 gene expression. Adjunctive BDNF infusion resulted in better locomotor test scores using the Basso-Beattie-Bresnahan (BBB) test. This study demonstrated that continuous infusion of BDNF after initial MP treatment improved functional recovery after severe spinal cord injury without dampening the acute effect of MP.
Animals ; Anti-Inflammatory Agents/pharmacology ; Axons/pathology ; Brain-Derived Neurotrophic Factor/metabolism/*pharmacology ; Choline O-Acetyltransferase/metabolism ; Female ; GAP-43 Protein/metabolism ; Gene Expression Regulation ; Immunohistochemistry ; Methylprednisolone/metabolism/*pharmacology ; Osmosis ; Rats ; Rats, Sprague-Dawley ; Reverse Transcriptase Polymerase Chain Reaction ; Spinal Cord/pathology ; Spinal Cord Injuries/*pathology ; Time Factors

With current developments in surgical instrumentation, the surgical management of symptomatic isthmic lumbar spondylolisthesis is diversifying. Many authors agree, the basic elements for this condition, are decompression of compressed neural structure, bone fusion, and internal fixation with or without reduction. In eleven isthmic lumbar spondylolisthesis patients treated between Jannuary and December 1994, we applied band fixation instead of the usual metalic rigid fixation after decompression and posterior interbody fusion using carbon fusion cages. Serial lumbar X-rays were taken, and we studied the changes in displacement, disc height and bone fusion, as well as evaluating surgical outcome and complications. Preoperative percent-slip was 18.5+/-5.5, and this fell to 12.7+/-6.3 and 12.4+/-6.1 at postoperative 6 and 18 months respectively. Percent-disc height was higher than its preoperative value, and the increase was maintained(21.2+/-6.2 preoperatively; 30.0+/-6.0 and 29.7+/-5.1 at postoperative 6 and 18 months respectively). In all patients, fusion was good, and there were no surgical complications. Over 18 months, the outcome in nine patients was good or excellent, but in 2 patients, it was not good. The poor results may be because the tension band was too tight and possible neural damage or incomplete decompression. On the basis of these observations, we concluded that posterior lumbar interbody fusion with Graf band fixation is good for fusion and for the maintenance of displacement and disc height, and that if performed with care, this is a possible surgical option in cases of isthmic lumbar spondylolisthesis.
Carbon ; Decompression ; Humans ; Spondylolisthesis* ; Surgical Instruments

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