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Analysis of MRI Findings of Adolescent Lumbar Disc Herniation (Comparision with Adult Lumbar Disc Herniation Findings).

Journal of Korean Society of Spine Surgery.2000;7(1):44-52.

STUDY DESIGN: We compared the MRI and X-ray findings of adolescent lumbar disc herniation with that of adult. OBJECTIVES: Purpose of study was to assess the different pathologic findings of adolescent lumbar disc herniation from adult in MRI and to predict the causes indirectly. SUMMARY OF LITERATURE REVEIWS: There are many debates about the causes of adolescent lumbar disc herniation, because disc herniation occurs before the degenerative changes of aging process of intervertebral disc. Trauma, structural anomalies and degenerative changes have been suggested as a cause MATERIALS AND METHODS: We reviewed 29 adolescents and 36 adults with surgically proven lumbar disc herniation. Type of herniation, direction of herniation, severity of herniation, disc height, decrease of signal intensity, annular tear, facet asymmetry in MRI and associated spinal structural anomalies in plain X-ray were assessed. All of involved segments and operated segments were seperately analysed. Results were compared between two groups. RESULTS: In adolescent group, definite degenerative changes such as decrease of signal intensity and annular tear of operated segments were found. Multiple levels were involved in adolescent as same with adult group.. All the findings showed no significant differences between two groups, but signal intensity of nucleus pulposus was severely decreased in adult group. In adolescent group, incidence of male and incidence of Schmorl's node were high which suggested that herniated disc has deep relationship with trauma. Facet asymmetry was more frequent in adolescent. CONCLUSION: Pathologic premature degeneration presented already in adolescent disc herniation, and multiple level involvement suggested that underlying diathesis contributes to development of disc herniation, but degeneration of nucleus pulposus was severe in adult group. Trauma and facet asymmetry seem to be other factors in development of disc herniation.
Adolescent* ; Adult* ; Aging ; Disease Susceptibility ; Humans ; Incidence ; Intervertebral Disc ; Intervertebral Disc Displacement ; Magnetic Resonance Imaging* ; Male

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Treatment of Lumbar Spinal Stenosis with Diabetes Mellitus.

Sang Wook BAE ; Ho Yoon KWAK ; Baik Yong SONG ; Nam Hong CHOI ; Ho Jun KIM

Journal of Korean Society of Spine Surgery.2000;7(1):37-43.

STUDY DESIGN: This retrograde study was designed to compare the clinical features and postoperative clinical results between diabetic and non-diabetic patients who had been performed decompression and arthrodesis with instrumentation. SUMMARY OF LITERATURE REVIEW: There are controversies in the treatment results of diabetic patients. OBJECTIVE: To identify poor results in the patients of lumbar spinal stenosis accompanied diabetes mellitus and to find out variables influencing postoperative results among diabetics. MATERIALS AND METHODS: We analyzed 27 diabetic patients and sex, age-matched 27 non-diabetic patients who were diagnosed as lumbar spinal stenosis and operated from April, 1995 to December, 1998. In all patients, duration of symtoms, sensory and motor deficits, comorbidity, level of operations were investigated and in diabetics, duration of diabetes, amount of insulin administered before operation and presence of diabetic neuropathy were included. Clinical results, postoperative complications were compared between diabetics and non-diabetics. RESULTS: Considerable improvement was reported by 19(71%) in diabetic group and 21(78%) in non-diabetic group. Complication rate such as of infection and delayed wound healing was not higher in diabetic group than non-diabetic group. Duration of diabetes and amount of insulin before operation did not affected the result of operations. CONCLUSION: The outcome of surgery was similary successful in the two groups.
Arthrodesis ; Comorbidity ; Decompression ; Diabetes Mellitus* ; Diabetic Neuropathies ; Humans ; Insulin ; Postoperative Complications ; Spinal Stenosis* ; Wound Healing

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Late Infection of Spinal Instrumentation.

Jae Ik SHIM ; Taik Seon KIM ; Sung Jong LEE ; Suk Ha LEE ; Dong Ki LEE ; Yoen Sik YU ; Yun Yeup KIM

Journal of Korean Society of Spine Surgery.2000;7(1):29-36.

STUDY DESIGN: A retrospective analysis of five cases of late spinal infection after spinal instrumentation and fusion. OBJECTIVES: These cases are reviewed to verify risk factors for late spinal infection after elective instrumentation and to manifest the treatment of this complication. SUMMARY OF LITERATURE REVIEW: Late spinal infection after elective spinal instrumentation and fusion are uncommon. The diagnosis is usually hard and requires much clinical suspicion. MATERIALS AND METHODS: 5 cases were in total 374 patients of the author's cases. These cases are reviewed retrospectively. RESULTS: All patients reported aggravated back pain. 4 patients had elevated erythrocyte sedimentation rates, averaging 44.8 mm/hour and elevated C-reactive protein, averaging 26.2mg/L. No distance foci of infection was identified. All patients got the radiolucent zone around screw fixation site, averaging 4.6mmwidth. The organisms were S. epidermidis in 1 case and coagulase(-) staphylococcus in 1 case. All cases were treated by operative method with debridement, instrument removal with or without revision and postoperative intravenous antibiotics. The average follow-up period was 18.2 months, one patient recurred back pain at 7 months after operation. CONCLUSION: The diagnosis of late infection after elective spinal instrumentation and fusion requires high suspicion of clinical symptoms and signs. All except one were successfully treated by operative treatment.
Anti-Bacterial Agents ; Back Pain ; Blood Sedimentation ; C-Reactive Protein ; Debridement ; Diagnosis ; Follow-Up Studies ; Humans ; Retrospective Studies ; Risk Factors ; Spine ; Staphylococcus

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Results of microscopic discectomy in lumbar disc herniation: A 5-years follow up.

Dae Moo SHIM ; Sang Soo KIM ; Tae Gyun KIM ; Ha Heon SONG ; Si Ho CHOI

Journal of Korean Society of Spine Surgery.2000;7(1):22-28.

PURPOSE: This study was performed in an attempt to determine if there was any clnical benefit of microdiscectomy(MD) over standard discectomy(SD). They were all followed up by an impartial observer at 1 year and 5 years. MATERIALS AND METHODS: All patients were operated on by the same surgeon by either method. We evaluate retrospectively 30 cases of microdiscectomy and 30 cases of standard discectomy using data derived from a questionnaire and chart review from January 1. 1988 to December 31. 1993. The operative results were analysed with Kim's criteria and that clinical results were statistically used to Paired two-tailed T test. RESULTS: 1) Mean operating time was about 117minutes in the standard discectomy, while 98 minutes in the microdiscectomy. 2) Mean time to return to work was about 9.6 weeks in the standard discectomy, while 5.9 weeks in the microdiscectomy, 3) In initial and 1 year follow up, microdiscectomy was superior to the standard discectomy but in 5 years follow up, the two procedures have a similar outcome. CONCLUSION: The advantage of microdiscectomy was more safe than standard discectomy, because it was magnified vision and brilliant illumination, precise identification of structures in deep fields(including nerve root and its related structures), a marked advantage to dissect the adhere nerve root to its surroundings structures, its capacity to preserve the integrity of normal tissue, and meticulous hemostasis. From this analysis, we conclude that microdiscetomy represents a small but significant refinement of standard discectomy
Diskectomy* ; Follow-Up Studies* ; Hemostasis ; Humans ; Lighting ; Surveys and Questionnaires ; Retrospective Studies ; Return to Work

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Radiologic Results of Posterior Lumbosacral Fixation according to Sacral Fixation Methods: Single Screw vs Double Screws.

Byung Joon SHIN ; Kyung Je KIM ; Yang Bum CHO ; Yon Il KIM

Journal of Korean Society of Spine Surgery.2000;7(1):15-21.

STUDY DESIGN: This is a retrospective study comparing the radiologic results of sacral fixation using anteromedially directedsingle screw and triangulated double sacral screws. OBJECTIVES: To know whether the single screw fixation is enough for short level lumbosacral fusion. SUMMARY OF LITERATURE REVIEW: Method of sacral fixation is one of a hot issue in spinal instrumentation because of high complication rate. So, many kinds of sacral fixation methods were developed for long level spinal instrumentation. But, it is unclear whether we should use the special sacral fixation techniques instead of simple single screw fixation for the short level lumbosacral fusion. MATERIALS AND METHODS: Inclusion criteria of this study were fixation down to sacrum or sacralized L5, less than three segments fixation and minimum radiologic follow-up for one year. Of those patients treated with lumbosacral fixation using pedicle screw instrumentation from March 1989 to June 1998, forty-four patients met these criteria. They were divided into two groups according to the method of sacral fixation, Group I for single screw fixation and Group II for double screw fixation. Number of patients were 37 in Group I and 7 in Group II. The mean follow-up was 36.5 and 66.6 months, respectively. The radiologic results were evaluated by metal failure, change of lumbar lordosis, change of lumbosacral angle and change of L5-S1 disc space height. RESULTS: metal failure were identified in five patients(13.5%), all in sacral screws of Group I. There were 4 screw breakages and 1 screwrod dissociation. The change of lumbar lordosis was averaged 2.3 degrees(-17~38) in Group I and -4.0 degrees(-25~17) in Group II(p=0.194). The change of lumbosacral angle was averaged 2.3 degrees(-7~12) and 3.7 degrees(-1~12), respectively(p=0.596). The change of disc height was 5.6%(-13~33) and 8.8%(-5~16), respectively(p=0.381). CONCLUSIONS: Group I has much higher rate of instrumentation failure than Group II and all the instrumentation failures were occured at sacral screws. Other radiologic measurements were not statistically significant between the two groups. Stable fixation of the sacrum is necessary to prevent instrumentation failure at the sacrum even though the fusion is less than three levels.
Animals ; Follow-Up Studies ; Humans ; Lordosis ; Retrospective Studies ; Sacrum

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Morphologic Study of the Facet Joint in Spondylolysis and Isthmic Spondylolisthesis.

Chang Hoon JEON ; Woo Sig KIM ; Jae Hyun CHO ; Byoung Suck KIM ; Soo Ik AWE ; Shin Young KANG

Journal of Korean Society of Spine Surgery.2000;7(1):9-14.

STUDY DESIGN: Radiological investigation to study the morphologic difference of posterior facet joint in spondylolysis and isthmic spondylolisthesis. OBJECTIVES: To study the correlation of the clinical differences between the one with spondylolysis and another with isthmic spondylolisthesis with morphological analysis of posterior facets of lumbar spine in low back pain, anterior displacement and segmental instability. SUMMARY OF LITERATURE REVEIW: There are many studies for the lumbar facet in back pain, disc degeneration, degenerative spondylolisthesis. However, little is known about the correlation of facet joint between the spondylolysis and isthmic spondylolisthesis. METHODS: This study is done with 27 specimens which contain posterior facet and lamina from 25 patients due to spondylolysis or isthmic spondylolisthesis. We took the computed tomograms in each specimen and obtained the areas and angles of posterior facets of lumbar spine. RESULTS: The group with spondylolysis has mean area(Rt/Lt) of 158.4/159.3mnfand angle(Rt/Lt) of 49.8u/54.0u. The group with isthmic spondylolisthesis has mean area(Rt/Lt) of 172.3/189.6mnfand angle(Rt/Lt) of 44.3u/44.8u. The group with segmental instability has mean(Rt/Lt) area of 155.9/161.8mnfand angle of 48.1u/50.4u. The group without instability has mean area(Rt/Lt) of 173.4/185.2mnfand angle(Rt/Lt) of 46.2u/48.5u. CONCLUSION: There are no significant differences between the morphologic difference of facets with back pain and without back pain. The group with isthmic spondylolisthesis has greater mean area and less mean angle of facet than the group with spondylolysis, but, there are no statistical significant differences(p>0.05). There are no significant morphologic differences of facet between the group with segmental instability and without segmental instability.
Back Pain ; Humans ; Intervertebral Disc Degeneration ; Low Back Pain ; Spine ; Spondylolisthesis* ; Spondylolysis* ; Zygapophyseal Joint*

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The Production of Phospholipase A2 in Different Types of Cultured Human Intervertebral Disc Cells.

Dong Jun KIM ; Jin Man WANG

Journal of Korean Society of Spine Surgery.2000;7(1):1-8.

STUDY DESIGN: Evaluation of phospholipase A2 production according to cell type of human intervertebral disc. SUMMARY OF LITERATURE REVIEW: It was reported that the phospholipase A2 activity in human lumbar disc herniation was more active than that in other tissues. OBJECTIVES: The purpose of this study was to evaluate the differences between the cells of anulus fibrosus and nucleus pulposus when lactate was added to the culture medium. MATERIALS AND METHODS: Cells from the anulus fibrosus and nucleus pulposus of a human intervertebral disc were prepared enzymatically. After the monolayer was set up, the cells were divided to three groups and lactate doses of a 0mM, 2mM or 5mM were added respectively. At two week after lactate addition the production of phospholipase A2 was measured by Northern blotting. RESULTS: Cells of nucleus pulposus produced a small amount of phospholipase A2. Those of anulus fibrosus showed a high activity of phospholipase A2 production. The concentration of lactate did not influenced on the production of phospholipase A2. CONCLUSION: The anulus fibrosus has an important role in the production of phospholipase A2 and is thought to be related with generation of discogenic pain.
Blotting, Northern ; Cell Culture Techniques ; Humans* ; Intervertebral Disc* ; Lactic Acid ; Phospholipases A2* ; Phospholipases*

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Usefulness of the ProSet MRI for Diagnosis of the Extraforaminal Disc Herniation.

Myun Whan AHN ; Ui Sik KIM ; Gi Beom KIM

Journal of Korean Society of Spine Surgery.2013;20(1):28-33. doi:10.4184/jkss.2013.20.1.28

STUDY DESIGN: This is a retrospective study. OBJECTIVES: The purpose of this study is to confirm the clinical usefulness of utilizing ProSet imaging for checking the nerve root compression and swelling in extraforaminal disc herniation. SUMMARY OF LITERATURE REVIEW: Diagnosing extraforaminal disc herniations can be neglected with using a conventional MRI. MATERIALS AND METHODS: A retrospective analysis was performed on 25 patients, who underwent both conventional & Principles of the selective excitation technique (ProSet) MR imaging for the evaluation of extraforaminal disc herniation, from April 2008 to October 2010. Radiographic analysis was based on the notion that the degree of nerve root compression and swelling was decided by Pfirrmann's classification. RESULTS: Severe compression in the ProSet 3D rendering image was observed in 21 subjects, as compared with 8 subjects in the conventional axial image. Especially, nothing was ever detected in the conventional sagittal image. Severe compression in the ProSet 3D rendering image was observed in 4 subjects, while their nerve root compression was not clear in the conventional axial image. Severe compression and severe swelling in the ProSet 3D & coronal image was observed in 15 subjects, while their nerve root compression was none or not clear in the conventional sagittal image. The swelling degree of the ProSet coronal image turned out bigger than the swelling degree of conventional axial image, and the signal intensity change was also obvious. CONCLUSIONS: ProSet imaging is regarded useful to investigate the symptom triggering nerves, because ProSet image not only observes better nerve root compression, but also identifies the swelling degree more easily than that of the conventional magnetic resonance imaging (MRI).
Humans ; Magnetic Resonance Imaging ; Radiculopathy ; Retrospective Studies

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The Result of Minimally Invasive Transforaminal Lumbar Interbody Fusion in Low Grade Spondylolisthesis - Minimum 2 Years Follow Up -.

Hung Tae CHUNG ; Jae Lim CHO ; Moon Chan KIM ; Woo Chul KIM ; Do Keun KIM

Journal of Korean Society of Spine Surgery.2013;20(1):22-27. doi:10.4184/jkss.2013.20.1.22

STUDY DESIGNS: A retrospective study. OBJECTIVES: To analyze the clinical and radiological outcomes of spontaneous reduction via minimally invasive transforaminal lumbar interbody fusion (Mini-TLIF) as the treatment for low-grade symptomatic spondylolisthesis. SUMMARY OF LITERATURE REVIEW: Although minimally invasive transforaminal lumbar interbody fusion is technically demanding, this procedure is an effective method for spontaneous reduction of low grade spondylolisthesis. MATERIALS AND METHODS: We analyzed consecutive series of 41 patients with low grade spondylolisthesis who underwent minimally invasive transforaminal lumbar interbody fusion, between April 2008 and July 2009. The minimum follow-up period was 2 years. Clinical evaluation was performed by an analysis of Visual Analogue Scale and Oswestry Disability Index. For the radiological evaluation, disc space height, slip percentage, and slip angle were analyzed. At the final follow-up, the fusion rate was analyzed according to the Bridwell's anterior fusion grade. RESULTS: For the evaluation of clinical outcomes, the Visual Analogue Scale for back pain decreased from 6.8+/-1.2 to 2.0+/-1.1, and that for radiating pain decreased from 7.9+/-1.3 to 1.7+/-1.1. Oswetry Disability Index decreased from 38.5+/-8.4 to 13.4+/-6.1. For the radiological evaluation, disc space height increased from 8.4+/-2.14mm to 11.8+/-1.54mm(P<0.05), slip percentage was reduced from 18.4+/-5.1% to 13.3+/-3.1%(P<0.05) and slip angle decreased from 10.6+/-4.5degrees to 6.2+/-3.4degrees (P<0.05). At the final follow-up, radiological union was obtained in 38 cases (92.7%). CONCLUSIONS: We conclude that minimally invasive transforaminal lumbar interbody fusion appears to be an effective method for spontaneous reduction of low grade spondylolisthesis if the surgeon becomes familiar with this method.
Back Pain ; Follow-Up Studies ; Humans ; Retrospective Studies ; Spondylolisthesis

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Relation Between Adjacent Superior Segmental Disease and Facet Joint Violations After Posterolateral Lumbar Fusion.

Kyu Yeol LEE ; Man Seok KO ; Woo Chul KIM ; Sung Gon YOU ; Hyung Min YOON

Journal of Korean Society of Spine Surgery.2013;20(1):16-21. doi:10.4184/jkss.2013.20.1.16

STUDY DESIGN: To analyze the relationship between the adjacent superior segment disease and facet joint violations after lumbar fusion. OBJECTIVES: We retrospectively analyzed the relationship between the adjacent superior segment disease and facet joint violations after lumbar fusion. SUMMARY OF LITERATURE REVIEW: Among numerous literatures regarding adjacent superior segment disease, there is no analysis concerning the relationship between adjacent superior segment disease and facet joint violations after lumbar fusion. MATERIALS AND METHODS: We reviewed 2056 patients who underwent lumbar fusion, between March 2004 and April 2009. Analysis was performed for 79 (3.8%) of the 2056 patients with adjacent superior segment disease and needed a second operation. A facet joint was considered as 3 types of violations with computed tomography scans if any of the following situations were encountered: pedicle screw clearly within the facet joint; pedicle screw head clearly within the facet joint; and pedicle screw and/or screw head within 1mm from or abutting the facet joint, without clear joint involvement. RESULTS: The incidence of the violations was 45% (36/79) of all patients and 28% (44/158) of all screws. The incidence of L4-5 facet joint violations was 35% (28/79) of patients with adjacent superior segment disease, statistically. CONCLUSIONS: Facet joint violations were observed in patients with the adjacent superior segment disease after posterolateral lumbar fusion. Because L3-4 facet joint violations increased when L4-5 fusion was done, more care should be taken to avoid facet joint violations when the surgeon is considered for insertion of the pedicle screws at L4-5.
Head ; Humans ; Incidence ; Joints ; Retrospective Studies ; Zygapophyseal Joint

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