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Fusion of Pedicular Cleft Using Pedicle Screw Fixation: A Case Report.

Jin Soo KIM ; Ki Tack KIM ; Kyung Soo SUK ; Jung Hee LEE ; Sang Hun LEE ; Jae Hyung EOH

Journal of Korean Society of Spine Surgery.2008;15(2):106-110. doi:10.4184/jkss.2008.15.2.106

There is a broad range of lumbar pedicular and neural arch anomalies, with spina bifida occulta and spondylolysis being especially common. It is very rare for a pedicular cleft to be associated with contralateral spondylolysis in the same vertebral segment. We observed L4 spondylolisthesis, clefting of the left L4 hypertrophied pedicle associated with contralateral spondylolysis, and spinal stenosis on a radiographic study of the lumbar spine. Operative treatment was performed, with posterior decompression, partial removal of the hypertrophied pedicle, posterior lumbar interbody fusion using a cage, and posterior instrumentation. The patient's neurologic symptoms resolved after operative treatment. Fusion of the left pedicle cleft was observed on 6-month follow-up CT. We report one case of pedicular cleft fusion using pedicle screw fixation and present a review of the relevant literature.
Decompression ; Follow-Up Studies ; Neurologic Manifestations ; Spina Bifida Occulta ; Spinal Stenosis ; Spine ; Spondylolisthesis ; Spondylolysis

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Multidrug-resistant Tuberculosis Spondylitis: A Case Report.

Sung Chan KI ; Ki Soo KIM ; Yoon Hong KIM ; Yong Soo CHOI

Journal of Korean Society of Spine Surgery.2008;15(2):102-105. doi:10.4184/jkss.2008.15.2.102

Multidrug-resistant tuberculosis, resistant to at least isoniazid and rifampicin, continues to present a serious challenge to human health. However, there are no reports addressing multidrug-resistant tuberculous spondylitis in Korea. We report a case of multidrug-resistant tuberculous spondylitis at L2-L3 in a 30-year-old woman.
Adult ; Drug Resistance, Multiple ; Humans ; Isoniazid ; Korea ; Rifampin ; Spondylitis ; Tuberculosis ; Tuberculosis, Multidrug-Resistant

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A Novel Concept for the Best Coronal Alignment of Pedicle Screws in Multilevel Lumbar Posterior Instrumentation - A Technical Note.

Suk Jung KANG ; Changju HWANG ; Sung Woo LEE ; Young Joon AHN ; Yung Tae KIM ; Dong Ho LEE ; Choon Sung LEE

Journal of Korean Society of Spine Surgery.2008;15(2):96-101. doi:10.4184/jkss.2008.15.2.96

Correct alignment of pedicle screws is imperative in multilevel instrumentation. However, there has been no report addressing the technical aspects of this subject. If the head diameter of a pedicle screw is D, the head height is H, and the convergence angle of the screw being inserted is alpha, then the distance between the extension line of the medial borders of the inserted screw heads and the insertion point of the adjacent screw (A) is described by the following formula: A = 1/2Dcos alpha- Hsin alpha If an L3 pedicle screw (D=13 mm, H=15 mm) is to be inserted with a convergence angle of 14 degrees after the insertion of L4 and L5 screws, its insertion point should be 3.6 mm medial to the extension line of the centers of the L4 and L5 screws and 2.7 mm lateral to the extension line of their medial borders for all screw heads, so it can be aligned in the coronal plane. In order to achieve the best alignment, a pedicle screw is inserted between the extended line of the centers and that of the medial borders of the inserted adjacent screw heads. For the routine range of convergence angles, it is essential to move the entry point medially toward the extended line connecting the medial borders of the inserted adjacent screw heads.
Head

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Unilateral Transforaminal Lumbar Interbody Fusion in Spondylolisthesis: Comparison with Conventional Posterior Lumbar Interbody Fusion Through Bilateral Approach.

Sang Bum KIM ; Taek Soo JEON ; Seung Ryol RYU ; Seung Hwan KIM ; Cheol Mog HWANG

Journal of Korean Society of Spine Surgery.2008;15(2):87-95. doi:10.4184/jkss.2008.15.2.87

STUDY DESIGN: Retrospective controlled study. OBJECTIVES: The aim of this study was to determine if unilateral TLIF is comparable to conventional PLIF with regard to radiologic and clinical outcomes, and to examine the viability of local bone for bone grafting in lumbar interbody fusion. SUMMARY OF LITERATURE REVIEW: TLIF, a modified form of PLIF, is a new spinal fusion technique that avoids the typical complications of PLIF. MATERIALS AND METHODS: We analyzed 32 cases of single-level TLIF or PLIF in patients with degenerative or isthmic spondylolisthesis, who were followed for more than 1 year. The patients in group 1 underwent TLIF, and the patients in group 2 underwent PLIF. The fusion rate, changes in disc height, and degree of anterolisthesis in the fused segment were analyzed radiologically. The clinical results were evaluated using the Oswestry Disability Index and visual analog scale. We also analyzed operative time, blood loss, and complications in both groups. RESULTS: Radiologically and clinically, there were no significant differences between the two groups in terms of fusion rate, changes in disc height, or degree of anterolisthesis in the fused segment. The mean operative time was 200 minutes in group 1 and 240 minutes in group 2. The mean blood loss was 854 ml in group 1 and 1102 ml in group 2(p>0.05). CONCLUSIONS: TLIF is a potentially useful alternative to conventional PLIF in patients with degenerative or isthmic spondylolisthesis. Additionally, local bone may be a viable source of bone grafts for single-level TLIF and PLIF.
Bone Transplantation ; Humans ; Operative Time ; Retrospective Studies ; Spinal Fusion ; Spondylolisthesis ; Transplants

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MRI Assessments of Adjacent Disc Degeneration Following Lumbar Fusion.

Nam Su CHUNG ; Chang Hoon JEON ; Gu Young CHUNG ; Jeoung Wook PARK

Journal of Korean Society of Spine Surgery.2008;15(2):81-86. doi:10.4184/jkss.2008.15.2.81

STUDY DESIGN: Retrospective case-control study OBJECTIVE: To use MRI to assess intervertebral disc degeneration at adjacent levels after spinal fusion and after discectomy. SUMMARY OF LITERATURE REVIEW: Degeneration of adjacent intervertebral discs following lumbar spinal fusion is one of the principal reasons for considering motion preservation techniques, such as placement of an artificial disc. Much attention has recently been directed toward disc morphometric studies using MRI. MATERIALS AND METHODS: Fifty-six patients who underwent spinal surgery for lumbar degenerative disease and who underwent a minimum of 2 years of follow-up MRIs were included in this study. Thirty-four patients were included in the lumbar fusion study group, and 22 patients were included in the discectomy control group. The MRI Thompson classification was used to grade both upper and lower adjacent disc degeneration preoperatively and at the time of last follow-up. RESULTS: There were significant changes in Thompson degenerative grade in the upper adjacent levels for both the fusion group patients and in the discectomy group patients. However, there was no statistically significant difference between the two groups with regard to either the upper or lower adjacent levels (p=0.146 and 0.350, respectively). CONCLUSIONS: In this short-term study comparing MRI outcomes in spinal fusion and discectomy patients, no significant difference in adjacent disc degeneration was observed between the two group.
Case-Control Studies ; Diskectomy ; Follow-Up Studies ; Humans ; Intervertebral Disc ; Intervertebral Disc Degeneration ; Retrospective Studies ; Spinal Fusion

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Posterior Lumbar Interbody Fusion with Cage and Local Bone Graft in Spondylolisthesis: Unilateral-caged versus Bilateral-caged.

Dong Ki AHN ; Song LEE ; Dea Jung CHOI ; Kwan Soo KIM ; Tae Woo KIM

Journal of Korean Society of Spine Surgery.2008;15(2):73-80. doi:10.4184/jkss.2008.15.2.73

STUDY DESIGN: Retrospective, controlled study OBJECTIVE: To compare one and two-caged posterior lumbar interbody fusion (PLIF) with local bone grafting for spondylolisthesis. SUMMARY OF LITERATURE REVIEW: Even though there are many reports on PLIF using cages and local bone grafting, Studies comparing one and two-caged PLIFs are rare. MATERIALS AND METHODS: Sixty-three patients who underwent pedicle screw fixated PLIF using cages and local bone grafts were followed for more than 1 year. Twenty-five patients had one cage (group I), and 38 patients had two cages (group II). Sampling error, disc height, sagittal Cobb angle, coronal Cobb angle, fusion rate, Oswestry disability index (ODI), operation time, blood loss, and neurologic complications were assessed. RESULTS: There was no sampling error between the two groups, except with regard to diagnosis: degenerative spondylolisthesis, 15 cases in group I and 9 cases in group II; spondylolytic spondylolisthesis, 10 cases in group I and 29 cases in group II (p=0.004). Fusion rates were 87.5% and 88.2% for groups I and II, respectively (p=1.000). More disc height loss occurred in group I (0.6 mm) than in group II (0.0 mm) (p=0.041). Over-3mm-disc height-losses were noted more frequently in group I (20%) than in group II (2.6%) (p=0.022). ODI improved from 28.1 to 12.3 (72.1% improvement) in group I and from 29.2 to 12.7 (79.3% improvement) in group II. There were no significant differences in operation time, amount of blood loss, or neurologic complications between the two groups. CONCLUSION: Unilateral one-caged PLIF with local bone grafting and posterior instrumentation was no different from bilateral two-caged PLIF with regard to fusion rates or radiologic or clinical results. The statistically significant differences in disc height seemed to be clinically insignificant. Disc height loss of greater than 3 mm was much more common in group I, with one-caged PLIF.
Bone Transplantation ; Humans ; Retrospective Studies ; Selection Bias ; Spondylolisthesis ; Transplants

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Clinical Importance of MRI in Thoracolumbar Spinal Fracture.

Jeong Ho ROH ; Nam Su CHUNG ; Jeoung Wook PARK ; Dong Sun SHIN ; Chang Hoon JEON

Journal of Korean Society of Spine Surgery.2008;15(2):67-72. doi:10.4184/jkss.2008.15.2.67

STUDY DESIGN: Retrospective radiologic assessment OBJECTIVES: To assess the clinical importance of MRI for the diagnosis of posterior spinal ligament complex injuries in thoracolumbar fractures. SUMMARY OF LITERATURE REVIEW: Evaluation of spinal instability is important in thoracolumbar fractures. When simple radiography and CT alone are performed, spinal instability may be missed, especially that involving the posterior spinal ligament complex. MATERIALS AND METHODS: Eighty-seven patients who were evaluated using simple radiography, computed tomography (CT), and magnetic resonance imaging (MRI) between March 1994 and March 2003 were included in the study. The local kyphotic angle was measured on lateral radiography, and it was then compared to the fracture pattern on MRI. Statistical analysis was performed using ANOVA. RESULTS: There was no correlation between the local kyphotic angle on radiography and fracture involvement on MRI (p=0.106). In 41 patients who were found to have involvement of the anterior column on CT, 25 had anterior column involvement, 4 had middle column involvement, and 12 had posterior column involvement on MRI. In 36 patients who were found to have involvement of the middle column on CT, 17 had involvement of the middle column and 19 had involvement of the posterior column on MRI. The fractures of the ten patients who were found to have posterior column involvement on CT were all seen on MRI. The coincidence of fracture patterns between CT and MRI, which was evaluated using Cohen's Kappa analysis, was 0.434. The sensitivity of CT compared with MRI was 0.741 in the middle column and 0.243 in the posterior column. CONCLUSIONS: Many thoracolumbar fractures are missed on both simple radiography and CT. MRI is essential for accurate diagnosis of posterior spinal ligament complex injuries, especially when there is involvement above the middle column, or when canal encroachment is seen on CT.
Humans ; Ligaments ; Magnetic Resonance Imaging ; Retrospective Studies ; Spinal Fractures

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Disc Excision and Posterior Lumbar Interbody Fusion for Internal Disc Derangement.

Chul Hyung KANG ; Jae Hong CHUN

Journal of Korean Society of Spine Surgery.2001;8(1):62-67. doi:10.4184/jkss.2001.8.1.62

STUDY DESIGN: This study reviewed prospectively 15 patients with chronic persistent low back pain who were treated with disc excision and posterior lumbar interbody fusion(PLIF). Outcomes of treatment were evaluated by a follow-up interview and x-ray studies. OBJECTIVES: To evaluate the efficacy of surgical treatment of patients with chronic persistent low back pain resulting from internal disc derangement (IDD) that does not respond to conservative treatments. SUMMARY OF LITERATURE REVIEW: Chronic persistent low back pain resisting to all known modalities of conservative treatments represents a difficult problem. The efficacy of any specific treatment methods for this group of patients is controversial. MATERIALS AND METHODS: Between 1994 and 2000, 15 patients were treated with disc excision and PLIF at Keimyung University Hospital from 1994 to 2000. The clinical outcomes were evaluated by postoperative follow-up interviews, and the fusion results were evaluated by x-ray studies. RESULTS: All patients responded properly to the follow-up evaluation. 66.6% of the patients had satisfactory results(13.3% excellent, 53.3% good, 26.7% fair, 6.7% poor), and a successful fusion was obtained in all of the patients. CONCLUSION: These results suggest that disc excision and PLIF for IDD patients is effective modality in treatment of IDD.
Follow-Up Studies ; Humans ; Low Back Pain ; Prospective Studies

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Calcium Sulfate as a Graft Substitute for Spinal Fusion.

Kee Yong HA ; Sung Jin PARK ; Woo Sung CHOI ; Sang Hyun RHO

Journal of Korean Society of Spine Surgery.2001;8(1):53-61. doi:10.4184/jkss.2001.8.1.53

STUDY DESIGN: This is a prospective study to determine whether calcium sulfate(CS) used as a bone graft expander could promote spinal fusion as effectively as autogenous bone graft. OBJECTIVES: To investigate the ability of CS to serve as bone graft substitute when combined in a 1:1 ratio with autogenous graft bone(AGB). SUMMARY OF LITERATURE REVIEW: Autogenous bone is considered the most successful bone graft material and is presently gold standard. Many complications, however, have been reported. Thus, numerous biodegradable osteoconductive ceramic bone graft substitute have received attention as alternative to autogenous bone to reduce the complications. The advantage of a biodegradable graft material is its compatibility with the new bone remodeling process required to attain optimum mechanical strength. MATERIALS AND METHODS: Fifteen patients who had undergone posterolateral spinal fusion with instrumentation using CS mixed with AGB were evaluated. The patients received the autogenous iliac crest graft on one side of the spine and an equivalent volume of autogenous iliac crest/ CS combination on the other side. Thus, the patients serve as their own control. The number of segments fused was 45 segments. The implanted sites were assessed for new bone formation and bony fusion by plain radiography and CT. RESULTS: Of 47 segments fused with CS and AGB, 42 segments (89.4%) were completely fused. In contrast, segments fused with AGB alone, 44 segments (93.6%) were fused. One patient showed nonunion at the both side. Two patients had nonunion at the fused segments with CS and ABG. However, the other side showed complete union. 5 patients who underwent removal of hardware had grossly and histologically complete union. There were no complications related to CS. CONCLUSION: Calcium sulfate appeared to have some potential as a bone graft expender rather than a graft substitute when combined 1:1 ratio with ABG, despite fusion rate by CS mixed with AGB ws lower than AGB alone.
Bone Regeneration ; Bone Remodeling ; Calcium Sulfate* ; Calcium* ; Ceramics ; Humans ; Osteogenesis ; Prospective Studies ; Radiography ; Spinal Fusion* ; Spine ; Transplants*

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The Sagittal Balance and Compensatory Mechanisms in Lumbar Spinal Stenosis.

Changseop LEE ; Jang Seok CHOI ; Young Chang KIM ; Seong Suk SEO ; Ki Chan AN ; Sang Dong SON

Journal of Korean Society of Spine Surgery.2001;8(1):46-52. doi:10.4184/jkss.2001.8.1.46

PURPOSE: To evaluate the sagittal alignment and the main factors contributing to sagittal compensatory mechanism in lumbar stenosis. MATERIALS AND METHODS: 63 patients of spinal stenosis surgically treated were evaluated using 14x36 inch standing lateral films. The global sagittal balance was measured with C7 plumb line and hip flexion angle. The thoracic kyphosis, lumbar lordo-sis and pelvic tilting angle were compared to each of normal korean values to find out main factors participating in compensatory mechanism. At last follow-up, at least 6 months after surgery, the changes of sagittal parameters and global balance were evaluated according to the correction amount of pathologic segments angle to understand the compensatory mechanism and its contributing factors. RESULTS: The C7 plumb line was +3.04 cm(/0.91 SD), thoracic kyphosis 30.0dgree(/12.1), lumbar lordosis 43.1dgree(/14.7) and pelvic tilting angle 21.7dgree(/8.2). All patients except 8 showed global compensation state. The differences compared to normal korean values were 10 dgree of pelvic tilting angle and 2dgreeof thoracic kyphosis. Pelvic tilting angle was more contributing factor of compensatory mechanism than thoracic kyphosis. At last follow up, 14 patients surgically corrected 5dgreeor more showed significant posterior shift of C7 plumb line and increased lumbar lordosis(p<0.05). 11 patients aggravated 5dgree or more showed significant increase of adjacent segment angle to participate in compensatory mechanism(p<0.05). CONCLUSION: Most lumbar spinal stenosis patients showed compensated sagittal balance state. Adjacent segments and pelvic tilting were thought as main contributing factors of compensation mechanism.
Animals ; Compensation and Redress ; Constriction, Pathologic ; Follow-Up Studies ; Hip ; Humans ; Kyphosis ; Lordosis ; Spinal Stenosis*

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