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Selective Laminoplasty For Cervical Myelopathy: 3 Cases Report.

Journal of Korean Society of Spine Surgery.2012;19(3):116-121. doi:10.4184/jkss.2012.19.3.116

STUDY DESIGN: 3 cases report. OBJECTIVES: We present 3 cases of cervical myelopathy treated successfully by selective laminoplasty on 2 levels or less, using Kurokawa technique with a review of the relevant articles. SUMMARY OF LITERATURE REVIEW: As there were no clear criteria for the numbers of the laminae that require decompression in a standard laminoplasty, a wide level laminoplasty from C3 to C7 has been generally done. As a result, complications such as axial pain, C5 root paresis, and loss of range of motion have been reported commonly. To reduce these complications, recent studies have attempted less invasive procedures, such as selective laminoplasty or preservation of posterior ligament and muscle components. MATERIALS AND METHODS: There were two cases of developmental stenosis and one posterior compressive stenosis that underwent selective laminoplasty. The posterior shift of the spinal cord and the dural expansion were measured by magnetic resonance imaging at 3 or 4 weeks after surgery. Clinical outcomes were evaluated by Japanese Orthopedic Association (JOA) score. Axial pain was classified as follows; never: Grade 0; mild: Grade 1; moderate: Grade 2; and severe: Grade 4. RESULTS: The spinal cord had a tendency to shift posterioly and the dura mater was expanded in all cases. Clinical outcomes and axial pain were also improved in all. CONCLUSIONS: Selective laminoplasty that enabled the surgeon to perform a less invasive surgery preserving operative time and the patient to have a lower risk of C5 root paresis is effective for the developmental stenosis or posterior compressive stenosis less than 3 levels.
Asian Continental Ancestry Group ; Constriction, Pathologic ; Decompression ; Dura Mater ; Humans ; Ligaments ; Magnetic Resonance Imaging ; Muscles ; Operative Time ; Orthopedics ; Paresis ; Range of Motion, Articular ; Spinal Cord ; Spinal Cord Diseases

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The Treatment of Transverse Fracture of The Upper Sacrum According to Roy-Camille Classification (Suicidal Jumper's Fracture): 4 Cases Report.

Young Joon AHN ; Bo Kyu YANG ; Seung Rim YI ; Seong Wan KIM ; Hong Jun JUNG ; Jung Ha LEE ; Seok Jin KIM ; In Seok CHOI

Journal of Korean Society of Spine Surgery.2012;19(3):110-115. doi:10.4184/jkss.2012.19.3.110

STUDY DESIGN: A Case report. OBJECTIVES: We report 4 cases of transverse fracture of upper sacrum with good clinical results. SUMMARY OF LITERATURE REVIEW: There is no clear guideline for the treatment of transverse fracture of upper sacrum. MATERIALS AND METHODS: Four patients, who visited our institute for transverse fracture of upper sacrum, were reviewed from January 2006 to July 2009. RESULTS: All patients had good clinical results after treatment. CONCLUSIONS: In all cases, patients were managed conservatively without reduction or internal fixation. Only for Roy-Camille type 2 and 3 transverse fracture of the upper sacrum with neurologic deficit, decompression was performed, yielding good clinical results.
Decompression ; Humans ; Neurologic Manifestations ; Sacrum

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Herniation of Upper Lumbar Disc: Clinical Finding & Surgical Result.

Dong Eun SHIN ; Chang Soo AHN ; Duck Yun CHO ; Hyung Ku YOON ; Tae Hyung KIM ; Jin Young BANG ; Yoon Sik CHA

Journal of Korean Society of Spine Surgery.2012;19(3):103-109. doi:10.4184/jkss.2012.19.3.103

STUDY DESIGN: A retrospective study. OBJECTIVES: We attempted to establish an efficient diagnosis and treatment modality by analyzing clinical manifestations and operative results of upper lumbar disc herniations. SUMMARY OF LITERATURE REVIEW: Upper lumbar disc herniations represented a lower incidence but have become easier to diagnose by predictable clinical aspects and an MRI scan. The operative results have been satisfactory. MATERIALS AND METHODS: We evaluated 41 cases, which were operated with posterior laminectomy and discectomy from September, 1996 to November, 2009. We analyzed pre-operative history, clinical and MRI findings, and then assessed operative results by Kim's criteria and functional change in the follow up. RESULTS: The prevalence of upper lumbar disc herniations in all disc herniations was 8.8%. Pre-operative manifestations were lower back pain (85.4%), radiating pain (80.5%), sensory deficit (53.7%), motor deficit (53.7%), and depressed knee jerk (65.9%). The positive rate of the femoral stretching test (78.0%) was higher than the straight leg raising test (39.0%). The VAS score changed from preoperative 9.0+/-0.8 into postoperative 1.4+/-1.3 points. The operative results were excellent or good in 82.9%. The rate of resuming previous work, including slight modification was 90.2%. CONCLUSIONS: Predictable clinical aspects of the upper lumbar disc herniations are anterior thigh pain with lower back pain, variable motor deficit, sensory deficit, depressed knee jerk and the positive femoral nerve stretching test. Through careful examination and radiological evaluations such as MRI, operative treatment can obtain a symptomatic improvement and satisfactory results.
Diskectomy ; Femoral Nerve ; Incidence ; Knee ; Laminectomy ; Leg ; Low Back Pain ; Magnetic Resonance Imaging ; Prevalence ; Retrospective Studies ; Thigh

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The Prognostic Factor of Posterolateral Fusion in Degenerative Spondylolisthesis.

Tae Woo SUNG ; Ki Chan AN ; Gyu Min KONG ; Dae Hyun PARK ; Tai Yeon YOON

Journal of Korean Society of Spine Surgery.2012;19(3):97-102. doi:10.4184/jkss.2012.19.3.97

STUDY DESIGN: A retrospective analysis of the posterolateral fusion in degenerative spondylolisthesis. OBJECTIVES: Posterolateral fusion has been performed for patients about Meyerding grade1, 2 with degenerative spondylolisthesis in L4-5. We evaluated the prognostic factors of posterolateral fusion, alone for degenerative spondylolisthesis. SUMMARY OF LITERATURE REVIEW: It is reported that posterolateral fusion has almost equal postoperative clinical and radiographic results with the interbody or circumferential fusion for spondylolisthesis. However, there have been some unsatisfactory results after posterolateral fusion alone and the causes are yet unknown. MATERIAL AND METHODS: From January 2002 to July 2008, we analyzed postoperative clinical outcomes of 42 patients who were diagnosed with Meyerding 1 or 2 grade degenerative spondylolisthesis at L4-5. All the patients were classified into group I and group II, based on the clinical outcome evaluation method by Kirkaldy-Willis. Ten patients (Group I) were found to have poor or fair clinical outcomes, while 32 patients (Group II) were found to have excellent or good clinical outcomes. The mean duration of the follow up was 16.3 (12-23) months. We looked into postoperative body mass index and bone mass density, and found degenrative lumbar disc through preoperative MRI, retrospectively. We measured angular motion by dynamic radiographs and preoperative slip angle through a Taillard method. RESULTS: In group I, the average preoperative BMI was 25.7 (21.2~31.4) and the average T score of bone density was -3.0 (-1.9~-4.2). There was 1 case of Grade 3, 3 cases of Grade 4 and 6 cases of Grade 5 by preoperative Pfirmann classification. The average angular motion was 11.8 (9.1~14.2) and the average preoperative slip angle was 8.4 (6.9-9.6). In group II, the average preoperative BMI was 24.3 (20.72~28.1) and the average T score of bone density was -2.1 (-0.9~-3.1). There were 26 cases of Grade 3, 5 cases of Grade 4 and 1 case of Grade 5 by preoperative Pfirmann classification. The average angular motion was 8.8 (6.2~12.1) and the average preoperative slip angle was 6.2 (3.6-7.9). There were statistically significant differences between the two groups in BMI, stage of disc degeneration, preoperative angular motion, and slip angle. (p=0.04, 0.04, 0.05, 0.03, respectively) CONCLUSION: We concluded that posterolateral fusion has exhibited worse clinical results in cases of BMI less than -2.8, disc degeneration greater than grade 4, angular motion greater than 9.4 degrees, and slip angle greater than 7.1 degrees; as such, we need to consider other surgical methods.
Body Mass Index ; Bone Density ; Follow-Up Studies ; Humans ; Intervertebral Disc Degeneration ; Retrospective Studies ; Spondylolisthesis

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Optimal Standing Radiographic Positioning in Patients with Sagittal Imbalance.

Whoan Jeang KIM

Journal of Korean Society of Spine Surgery.2010;17(4):198-204. doi:10.4184/jkss.2010.17.4.198

STUDY DESIGN: This is a review of the literature about radiographic positioning for patients with sagittal imbalance. OBJECTIVES: We wanted to verify the optimal radiographic positioning for patients with sagittal imbalance. SUMMARY OF LITERATURE REVIEW: The standing lateral whole spine radiograph for identifying the sagittal alignment has a different value for the SVA according to the radiographic positioning. MATERIALS AND METHODS: This is a review of the literature. RESULTS: The fists-on-the clavicle position or the cross-arm position not only represents a functional standing position, but it also causes a less negative shift of the SVA in patients with sagittal imbalance. Both the extended hip and knee positions are necessary to exclude a compensation mechanism of the lower extremity. CONCLUSIONS: The optimal radiographic positioning is essential to examine the degrees of sagittal imbalance.
Clavicle ; Compensation and Redress ; Hip ; Humans ; Knee ; Spine

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Clinical Availability, Diagnosis and Treatment of the Primary Psoas Muscle Abscess.

Ki Chan AN ; Chang Wan KIM ; Young Kyoung MIN

Journal of Korean Society of Spine Surgery.2010;17(4):191-197. doi:10.4184/jkss.2010.17.4.191

STUDY DESIGN: This is a retrospective study on the clinical availability, diagnosis and treatment of primary psoas muscle abscess. OBJECTIVES: This study investigated the causes and clinical results of patients with primary psoas muscle abscess. SUMMARY OF LITERATURE REVIEW: Primary psoas muscle abscess is not a common disease clinically, but it is a very dangerous disease if the diagnosis and treatment are delayed. MATERIALS AND METHODS: Between October 2003 and February 2010, we investigated the symptoms, pathogens, the associated diseases and treatments of 17 patients (11 males and 6 females; mean age: 49.5 years old). We divided patients into the 3 groups According to the treatment options (Group 1: antibiotics alone, Group 2: percutaneous catheter drainage, Group 3: open drainage) and the correlation of the abscess size of each group was analyzed by the Kruskall Wallis method. RESULTS: The most common complaint was lower back pain (14 patients). Staphylococcus aureus was the most common infectious organism (12 patients). All the patients were treated with broad spectrum antibiotics. Group 1 was composed of 4 patients and the average size of the abscess was 2.3cm (range: 1.2~4.5cm). Group 2 was composed of 7 patients and the average size of the abscess was 7.4cm (range: 3.8~12.2cm). Group 3 was composed of 6 patients and the average size of the abscess was 8.1cm (range: 6.1~14.7cm). There was a significant correlation of the abscess size between each group. (p=0.0007) CONCLUSIONS: The patients diagnosed with primary psoas muscle abscess complained about lower back pain, a febrile sense and gastrointestinal symptoms. Most of the primary psoas muscle abscesses are pyogenic infections. We have to use broad-spectrum antibiotics for the initial treatment. When the occasion demands, additional treatment like percutaneous catheter drainage and open drainage should be considered.
Abscess ; Anti-Bacterial Agents ; Catheters ; Drainage ; Humans ; Low Back Pain ; Male ; Psoas Muscles ; Retrospective Studies ; Staphylococcus aureus

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Management of Deep Wound Infection After Posterior Lumbar Interbody Fusion With Cages.

Eung Ha KIM ; Sung Hun WON ; Sang Hun LEE

Journal of Korean Society of Spine Surgery.2010;17(4):184-190. doi:10.4184/jkss.2010.17.4.184

STUDY DESIGN: Retrospective study OBJECTIVES: The purpose of this study was to analyze patients who developed deep wound infections after receiving PLIF for degenerative lumbar disease, and report the treatment outcomes. SUMMARY OF LITERATURE REVIEW: Few studies have examined deep wound infections after PLIF, and there is some controversy regarding whether screws or cages need to be removed to treat infections. MATERIALS AND METHODS: Nine cases(spinal stenosis 6, spondylolisthesis 3) developed a deep wound infection after PLIF from 2001 to 2007. The mean follow up was 48 months (24-72). The clinical results were evaluated using MacNab's criteria. RESULTS: The diagnosis of infection was made based on the clinical symptoms and signs, and inflammatory markers, such as ESR and CRP. The time to diagnosis was less than one week (2), three weeks (2), six weeks (1) and three months or more (4). Bacterial identification was performed on seven cases. MRSA was detected in one of them, and no bacteria were identified in the other six. In two of them, the infection subsided with antibiotic therapy only. In 7 cases, removal of the cage and anterior iliac strut graft was needed for infection control. In four cases, loosened screws were removed during debridement. In 2 cases, additional surgery for pseudarthrosis was required after curing the infection. CONCLUSIONS: In deep infections after PLIF, early diagnosis and bacterial identification are important for reducing the need for a later radical operation. It is recommended that blood markers of infection be measured with a short follow-up period. In a case of persistent infection against prolonged antibiotics, removal of the cage or screw is needed to treat the infection earlier.
Anti-Bacterial Agents ; Bacteria ; Constriction, Pathologic ; Debridement ; Early Diagnosis ; Follow-Up Studies ; Humans ; Infection Control ; Methicillin-Resistant Staphylococcus aureus ; Pseudarthrosis ; Retrospective Studies ; Spondylolisthesis ; Transplants ; Wound Infection

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Comparison of Mechanical Property of Conventional Rods versus Growing Rods for Pediatric Early Onset Scoliosis.

Jin Young KIM ; Eun Su MOON ; Hyon Su CHONG ; Seung Joo LEE ; Hak Sun KIM

Journal of Korean Society of Spine Surgery.2010;17(4):177-183. doi:10.4184/jkss.2010.17.4.177

STUDY DESIGN: This is a mechanical study. OBJECTIVES: We wanted to investigate the mechanical properties of newly developed dual growing rods for obtaining approval for their clinical application. SUMMARY OF LITERATURE REVIEW: The current expandable spinal implant system appears effective for controlling progressive early onset scoliosis, and it allows for spinal growth and improving lung development. MATERIALS AND METHODS: We investigate the yield load and ultimate load during compression, tension and torsion of the growing rods and the conventional rods assembly using UHMWPE blocks, and the diameter of the rods was 6.0 mm and they expanded 5cm long. We also performed a fatigue test with growing rods, and the diameter of which was 6.0 mm and it expanded 2.5cm long. The guideline for the American Society for Testing Materials was followed during the entire mechanical test. With the growing rods and conventional rods, we tested for each mechanical property7 times with the new rods and blocks. RESULTS: The yield load of the growing rods and conventional rods were 845.2+/-18.2 (N) and 812.9+/-29.9 (N), respectively, and the ultimate load of the growing rods and conventional rods were 961.9+/-31.1 (N) and 914.9+/-25.6 (N), respectively, when compression force was applied. The yield load and ultimate load of the growing rods were statistically higher than those of the conventional rods (p<0.05). The ultimate load of the growing rods and conventional rods were 3281.7+/-41.5 (N) and 3678.5+/-447.9 (N), respectively when tension force was applied. The ultimate load was similar for both types of rods (p>0.05). The yield loads of the growing rods and conventional rods were 11.56+/-0.59 (Nm) and 12.46+/-0.71 (Nm), respectively, the ultimate loads of the growing rods and conventional rods were 16.97+/-0.94 (Nm) and 17.42+/-2.66 (Nm) during the torsion, respectively. The yield load and ultimate load of the growing rods were statistically lower than that of the conventional rods (p<0.05). CONCLUSIONS: The newly developed growing rods have a higher yield load and ultimate load under compression, a similar ultimate load under tension and a lower yield load and ultimate load under torsion. The differences of the yield load and ultimate load under torsion were minimal, and so the growing rods and conventional rods have similar mechanical properties.
Fatigue ; Lung ; Polyethylenes ; Scoliosis

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Radiological and Clinical Outcome after Simple Discectomy of Central Massive Lumbar Disc Herniation.

Young Do KOH ; Seung Jun RHEE ; Dong Jun KIM

Journal of Korean Society of Spine Surgery.2010;17(4):169-176. doi:10.4184/jkss.2010.17.4.169

STUDY DESIGN: This is a retrospective case control study. OBJECTIVES: To analyze our results following simple discectomy of central massive disc herniation focusing on instability for the usefulness of intervertebral fusion. SUMMARY OF LITERATURE REVIEW: Lumbar instability is a complication of central massive disc herniation. However, there is limited evidence on the correlation between lumbar instability and loss of disc material. MATERIALS AND METHODS: A total of 25 patients who had undergone discectomy for a single-level lumbar disc herniation were followed up for two years. The clinical group (group A) included 12 patients that had a compromised canal with greater than 50% of the herniated disc, while the central axis of the herniated disc was less than 20% deviated from the center axis of the spinal canal, as seen on MRI. The control group (group B) had 13 patients that had a compromised canal with less than 50% of the herniated disc while their axis was more than 20% deviated from the center axis of the spinal canal. Clinical and radiologic instability, pain and functional disability were compared between the two groups. RESULTS: No differences was found between the two groups in clinical instability, radiological instability, visual analogue scale (VAS), and the Oswestry disability index (ODI). CONCLUSIONS: Central massive disc herniation after discectomy did not show a significant difference in clinical or radiological instability from that of other herniation types.
Axis, Cervical Vertebra ; Case-Control Studies ; Diskectomy ; Humans ; Intervertebral Disc Displacement ; Retrospective Studies ; Spinal Canal

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The Influence of Cervical Spondylosis to Acute Cervical Spinal Cord Injury.

Hyoung Yeon SEO ; Jae Yoon CHUNG ; Ki Hyeong KIM

Journal of Korean Society of Spine Surgery.2010;17(4):164-168. doi:10.4184/jkss.2010.17.4.164

STUDY DESIGN: A retrospective study OBJECTIVES: To examine the influence of cervical spondylosis on an acute cervical spinal cord injury. SUMMARY OF LITERATURE REVIEW: There are no reports on the relationship between cervical spondylosis and acute cervical spinal cord injuries. MATERIALS AND METHODS: Twenty six patients who underwent operative treatment for acute cervical injuries with spinal cord injury were evaluated. The mean age and follow-up period was 58 years and 2.2 years, respectively. The evaluation was performed by examining the causes of the injuries, and the classification of fractures according to the presence of cervical spondylosis. This study compared the degrees of postoperative neurological recovery with motor index score in the groups with and without cervical spondylosis. RESULTS: Cervical cord injuries were more prevalent in the group 60 years and older; 17 cases vs. 9 cases in the group under 60 years. Eleven (65%) and 6 (35%) cases in the group 60 years and older had sustained a high and low energy injury, respectively. In contrast, mostly high energy injuries (8 in 9 cases) were encountered in the group under 60 years of age. A low energy injury could cause a acute cervical cord injury in the group 60 years and older, who also had cervical spondylosis. In those cases, previous cervical spondylosis might be one of the etiologic factors. CONCLUSIONS: The cases with cervical spondylosis in the group 60 years and older tended to show incomplete cord injury and good postoperative neurological recovery when they had sustained cervical cord injuries.
Follow-Up Studies ; Humans ; Retrospective Studies ; Spinal Cord ; Spinal Cord Injuries ; Spondylosis

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