No abstract available.
Ankle* ; Arthrodesis*

OBJECTS: There was a trend to perform fusion and instrumentation in spinal stenosis surgery, because of extensive decompression and instability. However, the introduction of microscope in spine operation can minimize the range of excision of anatomical structure and reduced the decompressin level in the multiple lesions and the incidence of spinal fusion. The purpose of this study were to assess the outcome of this procedure in 3 years follow up and to identify the clinical features of the patients and technical aspects of the operation that were associated with a poor outcome. MATERIALS AND METHODS: Twenty-one patients were identified as having had a microscopic decompression without arthrodesis, for degenerative lumbar spinal stenosis over 60 years or their who had osteoporosis with Saville's index 2 or higher. The follow up period was more than 3 years. The clinical results was evaluated by Kim's criteria. RESULTS: Eleven cases were above good results in two levels involved 14 cases, 2 cases above good results in three levels involved 5 cases and 1 case above good results in four levels involved 2 cases. In the cases of affected duration, 7 cases are less than 1 year or more than 5 years each 6 cases and 2 cases were above good results by the criteria. We concluded that the long-term outcome of decompressive surgery in the elderly is good; it does not differ from that reported for younger patients . CONCLUSIONS: Selective microscopic decompression is one of the effective method for the elderly patients or patients with osteoporosis in addition to multiple stenotic lesions.
Aged ; Arthrodesis ; Decompression* ; Follow-Up Studies* ; Humans ; Incidence ; Osteoporosis* ; Spinal Fusion ; Spinal Stenosis* ; Spine

OBJECTIVE: The authors investigated the efficacy of the calcium sulfate(OsteoSet(r) pellets) as an autograft extender when used to perform posterolateral lumbar fusions. PATIENTS AND METHODS: Twenty patients who underwent lumbar posterolateral arthrodesis for various spinal diseases between October 1999 and March 2000 were evaluated. Arthrodesis was performed by transpedicular screw fixation and bone grafting with a mixture of autograft + calcium sulfate in a 1:1 ratio. At time intervals of 1, 2, 3, and 6 months, postoperative radiographs were obtained to review the resorption of calcium sulfate and the evidence of fusion. A modified Lenke scale was used to assess the status of the fusion. RESULTS: At 2 months after operation, the average modified Lenke scale score for the OsteoSet(r) pellets group was 3.8. However at 6 months after operation, the average modified Lenke scale score for the OsteoSet(r) pellets group was 1.8. Resorption of calcium sulfate pellets was revealed in all cases at 6 months after surgery. CONCLUSION: It is presumed that a combination of calcium sulfate and autograft can play a role as an effective autograft extender in the posterolateral spinal fusion.
Arthrodesis ; Autografts ; Bone Transplantation ; Calcium Sulfate* ; Calcium* ; Humans ; Spinal Diseases ; Spinal Fusion ; Transplants*

To evaluate the relationship between surgical procedures and clinical outcomes in degenerative lumbar spinal stenosis, we retrospectively analyzed the results of the patients who had been performed decompressive lumbar spinal surgery. Eighty-five patients with degenerative lumbar spinal stenosis underwent decompressive lumbar spinal surgery between Jan. 1994 and Dec. 1996. The patients were randomly assigned to one of two groups; decompression alone(47 patients) and decompression with arthrodesis(38 patients). Among the patients with arthrodesis, the instruments were placed in 34 patients. The follow-up duration was 16-51 months(mean; 32.8 months). Functional outcome was excellent or good in 96% of the patients with decompression alone and in 97% of those with decompression with arthrodesis(p=0.667), and the overall patient's satisfaction was 87.5% and 89.5%, respectively. Although the various factors, which could be possible influent to the clinical outcome, were considered, there were no statistically significant differences in results between the two groups. The findings of this study demonstrate that the spinal fusion procedure has no benefit in clinical outcomes of the patients with degenerative lumbar spinal stenosis. Thus the fusion procedures with instrumentation should be used only in carefully selected patients because of its potential risks of serious complications, such as nerve root injury, massive bleeding, and infection.
Arthrodesis* ; Decompression ; Follow-Up Studies ; Hemorrhage ; Humans ; Laminectomy* ; Retrospective Studies ; Spinal Fusion ; Spinal Stenosis*

STUDY DESIGN: A rectrospective study of microscopic lumbar decompressions was performed elderly patients suffering from multiple level of lumbar stenosis. OBJECTIVES: The Purpose of this study were to assess the outcome of this procedure performed only microscopic decompression on multiple lesions in 5 years follow up and to identify the clinical features of the elderly patients with multiple stenosis. SUMMARY OF BACKGROUND DATA: There was a common to perform fusion and instrumentation in spinal stenosis surgery, because of extensive decompression and instability. However the introduction of microscope in spine operation can minimize lesions and the incidence of spinal fusion. MATERIALS AND METHODS: Twenty-one patients were identified as having had a microscopic decompression without arthrodesis, for degenerative lumbar spinal stenosis over 60 years. The follow up period was more than 5 years. The clinical results was evaluated by Low-Back Outcome scale. RESULTS: Ten cases were above good results in two levels involved 14 cases, 4 cases above good results in three levels involved 6 cases, one case above good results in four levels. In the cases of affected duration, 4 of 5 cases in less than 1 year, 8 of 12 cases in 1 to 5 years, 3 of 4 cases in more than 5 years were above good results by the criteria. We had calculated the average score (54.8) and concluded that the long-term outcome of decompressive surgery in the elderly is good. CONCLUSION: Selective microscopic decompression is one of the effective method for the elderly patients or patients with osteoporosis in addition to multiple stenotic lesions. And preoprative root block is also useful for selective microscopic decompression.
Aged ; Arthrodesis ; Constriction, Pathologic ; Decompression* ; Follow-Up Studies* ; Humans ; Incidence ; Osteoporosis ; Spinal Fusion ; Spinal Stenosis* ; Spine

PURPOSE: This report examined the surgical treatment results and suggests proper treatment guidelines for revision surgery in the lumbar spine. MATERIALS AND METHODS: This study examined 97 patients, who underwent revision surgery from 1996 to 2004 with a follow-up of at least 1 year. The causes of revision surgery, treatment modalities and results of treatment were analyzed. The clinical results were evaluated using the Kirkaldy-Willis criteria. RESULTS: In the ninety-seven patients, recurred disc herniation (37 cases, 35 cases: same level, 2 cases: different level) was the leading cause of revision surgery. The other causes were spinal stenosis (17 cases), epidural fibrosis (9 cases), pseudoarthrosis (9 cases), junctional stenosis (9 cases), infection (8 cases), segmental instability (4 cases), metal failure (2 cases) and cyst (2 cases). Spinal fusion was performed in 91 patients, and decompression only was performed in the remaining 6 patients. The clinical results according to reasons for failure were good in cases of recurrent disc herniation. The results of spinal fusion were more successful than that of decompression only (p= 0.002). The results of short segment fusion were more satisfactory than those of long segment fusion (p=0.043). In the final follow-up results, excellent and good results according to Kirkaldy-willis criteria were found in 62 cases. CONCLUSION: Spinal arthrodesis is an effective treatment modality for revision surgery in the lumbar spine. However, long segment arthrodesis should be considered carefully because of the high level of disappointing results. In addition, selective arthrodesis of the pathologic level is recommended in revision surgery of the lumbar spine.
Arthrodesis ; Constriction, Pathologic ; Decompression ; Fibrosis ; Follow-Up Studies ; Humans ; Pseudarthrosis ; Spinal Fusion ; Spinal Stenosis ; Spine*

Pott's paraplegia has been frequently serious complication of tuberculous spondylitis, although antituberculous drugs have improved the prognosis and healing of the disease. There are much controvercy on treatement of Pott's paraplegia, which comprises immobilization with or without anterolateral antituberculous drugs, immobilization and early posterior arthrodesis, anterolatear decompression and radical anterior decompression with anterior spinal fusion. The method of anterior decompression and anterior interbody fusion which was introduced by Hdgson since 1956 has good reults. The author analyzed 27 consecutive cases of Pott's parsplegia operated at orthopedic departement, In Je Paik Hospital from May 1980 to August 1988. The results were as follows, 1. Number of cases in child was nine(33%), both sexes were similar. 2. Regions of spine involved were most common at thoracic spine(62%). Number of affected vertebrae was averaged 3.3 vertebrae. 3. There were nineteen early(70%) and eight late(30%) paraplegia. 4. There were two complete and twenty five incomplete paraplegia. 5. In operative finding, inflammatory products and sequestrated material was extrinsic factor in early in paraplegia. 6. The recovery of the paraplegia occur in twenty cases(74%) 7. The recovery of paraplegia after treatment was far better in type of early onset, type of incomplete paraplegia less than one year duration. 8. The radical anterior decompression and anterior interbody fusion was considered as recommendable method for remove of all pathologic foci, recovery of paraplegia and healing the tuberculosis with stability.
Arthrodesis ; Child ; Decompression ; Humans ; Immobilization ; Methods ; Orthopedics ; Paraplegia ; Prognosis ; Spinal Fusion ; Spine ; Spondylitis ; Tuberculosis ; Tuberculosis, Spinal

Vertebral stabilization using transpedicular screw fixation device is widely used in the surgical treatment of degenerative lumber diseases such as spinal stenosis, pseudospondylolisthesis, and spinal instability. The use of transpedicular screw fixation devices provides substantial advantages with regard to an increase of the rate of solid arthrodesis, early rehabilitation, short segment spinal fusion, and restoration of sagittal lumbar lordosis. The authors analyzed 11 patients showing definite postoperative loss of the lumbar sagittal lordosis in a total of 110 surgical cases of degenerative lumbar diseases who underwent segmental spinal fusion using transpedicular screws from January 1981 to December 1993. The purpose of this study was to analyze the causes of loss of lumbar sagittal lordosis in the instrumented segments and to present some precautions in transpedicular screw fixation for surgical patients with degenerative lumbar spines to maintain corrected lumbar sagittal lordosis. The results from this study were as follows: 1. By standard Cobb lateral measurements, eleven cases in a total of 110 patients showed definite loss of lumbar sagittal lordosis more than 4 degrees. 2. The period reflecting loss of lordosis was roughly within postoperative four months which were critical fusion time of the grafted bone mass, which lasted an average of 4.8 months in this study. 3. The implants led to loss of lordosis consisted of 6 cases in 53 Diapasons, 4 cases in 32 Wiltses, and a case in 15 Steffee plate systems. Diapason & Steffee plate systems were classified as a rigid type and Wiltse system as a flexible one. 4. The causes of postoperative loss of lordosis were recognized as 2 cases of screw toggling, 5 cases of screw-rod locking failure and 4 cases of rod bending. 5. The group resulted in more loss of lordosis in degrees was related to significant change between preoperative and postoperative lordosis, distraction of disc space during operation, extensive discectomy, and reduction of degenerative spondylolisthesis which were the cases of the anterior column deficiency.
Animals ; Arthrodesis ; Diskectomy ; Humans ; Lordosis ; Rehabilitation ; Spinal Fusion ; Spinal Stenosis ; Spine ; Spondylolisthesis ; Transplants

OBJECTIVE: Transpedicular screw fixation systems are coming into wide use as an effective adjunct to lumbar spinal fusion procedures. However, there are some problems concerning hardware failure. In this report, we present an analysis of instrument-related complications following lumbar transpedicular screw fixation. METHODS: Lumbar spinal fusion using a transpedicular screw has been performed between 1995 and 2000 in 298 patients. We retrospectively investigated the complications related to screws and/or rods, which have been used in lumbar spinal fusions. RESULTS: The 262 patients(87.9%) who had undergone the surgery were satisfied with the results of their operations. The wound infection rate was 4.0%(n=12). Neural injuries occurred in 4 patients(1.3%); one patient was related to decompressive procedure and the others were related to instrumentation. The unsatisfactory screw placement occurred in 3.8%(60 of 1,582 screws placed). Forty-nine screws(81.7%) were misplaced in lateral direction in a total of 60 unsatisfactorily placed screws. Screw fractures occurred in 5(1.7%) patients, and the overall fracture rate was 0.3%(5 of 1,582 screws placed). Rod fractures occurred in 3(1.0%) patients and the overall fracture rate was 0.5%(3 of 596 rods placed). The breakage was usually apparent in the late stage of the clinical course, as seen on follow-up radiographs. CONCLUSION: We believe that failure of arthrodesis and multilevel fusion are the predisposing factors of instrument failure. The authors conclude that to minimize the complications following transpedicular screw fixation, it would be necessary to make a precise insertion of the transpedicular screw with adequate bone fusion.
Arthrodesis ; Causality ; Follow-Up Studies ; Humans ; Retrospective Studies ; Spinal Fusion ; Wound Infection

OBJECTIVE: The purpose of this study is to analyze clinical outcome of lumbar spinal fusion with autobone graft and with allobone graft as an additional autograft extender. METHODS: Fifty two patients who underwent lumbar posterolateral arthrodesis for degenerative lumbar diseases between February, 1998 and October, 2000 were evaluated. Arthrodesis was performed by transpedicular screw fixation. We used autogenous bone graft in 32 cases (Group A) and allobone graft in 20 cases (group B). Post operative radiographs were obtained to review the resorption of graft bone and the evidence of fusion. A modified Lenke scale was used to assess the status of the fusion. RESULTS: There were 17 men and 35 women. Mean follow up period was 12 months. According to the modified Lenke scale, spinal bone fusion rate was 93.75% in the group A and 85% in the groub B. CONCLUSION: Lumbar spinal fusion using allobone graft is favorably good compare to autobone graft.
Arthrodesis ; Autografts ; Female ; Follow-Up Studies ; Humans ; Male ; Spinal Fusion ; Transplants*