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Biochemical Factors of Intervertebral Disc Degeneration: Implications for Disc Regeneration.

Journal of Korean Society of Spine Surgery.2007;14(2):120-128. doi:10.4184/jkss.2007.14.2.120

Intervertebral disc degeneration is main cause of various spinal degenerative conditions, and results in a significant socio-economic burden and morbidity to those affected. Intervertebral disc degeneration is a multifactorial process that has no known curative method. Hence, various factors that cause intervertebral disc degeneration, especially biochemical ones, were discussed in this study.
Intervertebral Disc Degeneration* ; Intervertebral Disc* ; Regeneration*

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Congenital Absence of a Pedicle of L4 in the Spinal Stenosis: A Case Report.

Yon Il KIM ; Jae Chul LEE ; Woo Seok CHOI ; Byung Joon SHIN

Journal of Korean Society of Spine Surgery.2007;14(2):115-119. doi:10.4184/jkss.2007.14.2.115

Congenital absence of a lumbar pedicle is an uncommon anomaly, and most cases are asymptomatic and discovered incidentally. A 72-year-old man presented with lower back pain that radiated to his bilateral lower extremities. Physical examination revealed no neurological deficits. Plain radiographs of the lumbar spine revealed absence of the left L4 pedicle, along with hypertrophy and sclerosis of the contralateral pedicle. Magnetic resonance imaging showed stenosis of the L3-4 neural canal. Computed tomography revealed absence of the left L4 pedicle associated with hypertrophy and sclerosis of the right L4 pedicle and facet joint. The symptoms of the patient were resolved after posterior decompression without fusion. Here, we report one case of congenital absence of an L4 pedicle detected in a spinal stenosis patient who need to undergo a decompressive surgery for the spinal stenosis caused by contralateral facet hypertrophy.
Aged ; Constriction, Pathologic ; Decompression ; Humans ; Hypertrophy ; Low Back Pain ; Lower Extremity ; Magnetic Resonance Imaging ; Neural Tube ; Physical Examination ; Sclerosis ; Spinal Stenosis* ; Spine ; Zygapophyseal Joint

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Deep Vein Thrombosis in May-Thurner Syndrome Patient after Operative Treatment of Acute Cauda Equina Syndrome: A Case Report.

Jeong Hyun YOO ; Hyung Soo KIM ; Soo Tai CHUNG ; Jai Hyung PARK ; Joo Hak KIM ; Seung Do CHA ; Kwang Gyu JUNG ; Sang Joon PARK

Journal of Korean Society of Spine Surgery.2007;14(2):110-114. doi:10.4184/jkss.2007.14.2.110

May-Thurner syndrome, compression of the left common iliac vein by the right common iliac artery, or intimal hypertrophy of the vein resulting from chronic pulsatile force of the right common iliac artery, may results in deep vein thrombosis on the left lower extremity. A patient presented to our facility with deep vein thrombosis caused by May-Thurner syndrome, and showed post-operative fever, pain, and tenderness over the left leg, showing severe lumbar disc herniation with acute cauda equina syndrome. This syndrome should be considered as one of the causes of deep vein thrombosis in the left lower extremity.
Cauda Equina* ; Fever ; Humans ; Hypertrophy ; Iliac Artery ; Iliac Vein ; Leg ; Lower Extremity ; May-Thurner Syndrome* ; Polyradiculopathy* ; Veins ; Venous Thrombosis*

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Cervical and Thoracolumbar Epidural Abscess: A Case Report.

Choong Hyeok CHOI ; Hyoung Jin KIM ; Hyun Joo PAI ; Ye Soo PARK

Journal of Korean Society of Spine Surgery.2007;14(2):105-109. doi:10.4184/jkss.2007.14.2.105

Epidural abscess is a rare disease that can cause severe neurological complications or death if it is not recognized and treated early. Authors report a case of panspinal epidural abscess, which is diagnosed by MRI and treated with surgical drainage and antibiotics.
Anti-Bacterial Agents ; Drainage ; Epidural Abscess* ; Magnetic Resonance Imaging ; Rare Diseases

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Neurologic Complication after Percutaneous Vertebroplasty with Polymethylmethacrylate: A Case Report.

Sang Bum JANG ; Myoung Ho KIM ; Sang Hyuk MIN ; Ho Dong PAIK

Journal of Korean Society of Spine Surgery.2007;14(2):101-104. doi:10.4184/jkss.2007.14.2.101

In recent years, percutaneous vertebroplasty has frequently been used to treat osteoporotic compression fractures. This procedure is generally known to be safe because of the rare occurrence of complications. However, it is accompanied by the risk of cement leakage, and the cement can be easily removed using a surgical technique. Most neurological complications occurred due to extravasation of cement into the spinal canal. Comparatively, there were no reports of neurological complications due to the extravasation of cement into the paravertebral area. Here, we report a case of right-exiting L1 spinal root compression after percutaneous vertebroplasty with polymethylmethacrylate (PMMA). We proceeded to cement removal and nerve root decompression by a paraspinal open microsurgical technique in the event of neurological complication.
Decompression ; Fractures, Compression ; Polymethyl Methacrylate* ; Spinal Canal ; Spinal Nerve Roots ; Vertebroplasty*

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The Availability of Autogenous Bicortical Iliac Bone Graft in Anterior Cervical Interbody Fusion.

Dong Jun KIM ; Jong Oh KIM ; Yeo Hon YUN ; Young Do KOH ; Nam Ki KIM

Journal of Korean Society of Spine Surgery.2012;19(4):158-163. doi:10.4184/jkss.2012.19.4.158

STUDY DESIGN: Retrospective study. OBJECTIVES: To demonstrate the fusion rate, degree of subsidence and donor site morbidity of anterior cervical interbody fusion with autogenous bicortical iliac bone graft and anterior cervical locking plate. SUMMARY OF THE LITERATURE REVIEW: In anterior cervical discectomy and fusion with autogenous tricortical iliac bone graft, a large percentage of patients report chronic donor site pain. MATERIALS AND METHODS: Retrospective research was done for 39 patients who underwent anterior cervical interbody fusion with autogenous bicortical iliac bone graft, from January 2006 to July 2011, with a follow up period of longer than 1 year. Fusion rates and subsidece of the graft is estimated with radiographs. Neck pain and donor site pain was estimated with visual analogue scale (VAS) and dysfunction was estimated with the neck disability index (NDI). RESULTS: A 95% of patients who underwent anterior cervical interbody fusion with autogenous bicortical iliac bone graft revealed definitive fusion with little amount of subsidence. The mean VAS score was 0.7 on the donor site and the mean NDI score was 3.8 at the final visit. There was excellent clinical outcome without complication at the donor site or the recipient site. CONCLUSIONS: Anterior cervical interbody fusion with autogenous bicortical iliac bone graft showed high fusion rates and minimal subsidence with excellent clinical outcomes. Therefore, bicortical iliac bone graft is an effective operational procedure in anterior cervical interbody fusion.
Diskectomy ; Follow-Up Studies ; Humans ; Neck ; Neck Pain ; Retrospective Studies ; Tissue Donors ; Transplants

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Effect of Axial loading on Lumbar spine MRI: Comparative Study of Effect between a Patient Group with Claudication and a Patient Group without Claudication.

Jin Young LEE ; Jeong Gil LEE ; Bum Suk OH ; Hyo Beom LEE ; Bon Jae KOO

Journal of Korean Society of Spine Surgery.2012;19(4):152-157. doi:10.4184/jkss.2012.19.4.152

STUDY DESIGN: This study intended to find out differences of effects by axial loading in MRI examination in a patient group with neurologic claudication and a group without neurologic claudication. OBJECTIVES: It was intended to understand in which group the effects of axial loading can be expected when taking MRI on the lumbar spine. SUMMARY OF THE LITERATURE REVIEW: The study of Willen and Danielson found spinal canal stenosis, which cannot be found by existing methods comparing an MRI taken in bended posture of lumbar without axial loading implementation by MRI taken with axial loading implementation. Hiwatashi et al. also reported that there was a change of treatment direction by laminectomy after axial loading in patients who were intended to take a conservational treatment before the axial loading. MATERIALS AND METHODS: A total of 39 patients and 54 intervertebral discs were compared. The distances from a sagittal plane before and after intervertebral discs were compared by measuring a sectional area of dura mater in a horizontal plane image and two groups were compared by existence of patients' neurologic claudication. RESULTS: The AP diameter before and after a intervertebral discs increased into 41.98 mm from 41.1 mm on the average and the sectional area of dura mater showed 137.47mm2 before loading and 119.86mm2 after loading on the average. There was not a significant difference in the distances before and after axial loading implementation, but a significant difference was found in the sectional area of dura mater. CONCLUSION: Axial loading would contribute to diagnose spinal disease, and especially, spinal canal stenosis in a patient group with claudication.
Constriction, Pathologic ; Dura Mater ; Humans ; Intervertebral Disc ; Laminectomy ; Posture ; Spinal Canal ; Spinal Diseases ; Spinal Stenosis ; Spine

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The Association of Lumbosacral Sagittal Alignments and the Patterns of Lumbar Disc Degeneration.

Chong Suh LEE ; Sung Soo CHUNG ; Se Jun PARK ; Kwang Hee CHO ; Seong Kee SHIN

Journal of Korean Society of Spine Surgery.2012;19(4):145-151. doi:10.4184/jkss.2012.19.4.145

STUDY DESIGN: Retrospective review and radiological analysis. OBJECTIVES: We investigated whether the lumbosacral sagittal curvature have any relation to the patterns of lumbar disc degeneration. SUMMARY OF THE LITERATURE REVIEW: Recently, there have been many studies on the correlations between the changes of lumbar disc degeneration and associated factors, such as age, gender, weight, occupation, cigarette smoking, and genetics; but, it is hard to find research into lumbosacral sagittal alignments. MATERIALS AND METHODS: This study enrolled 117 young adult patients limited by age (18-35 years), BMD (<30kg/m2), no smoking, occupation except heavy worker, no prior lumbar surgery and no combined spinal deformity. By measuring the pelvic incidence, sacral slope, lumbar tilt angle, lumbar lordosis and lumbar axis indicating the parameters of sagittal alignments, we investigated the correlation between the number and severity of lumbar disc degeneration and the number of herniated intervertebral discs. RESULTS: This study found a moderate correlation between pelvic incidence, sacral slope, lumbar lordosis, and the number of lumbardegenerative disc (r=-0.451, p<0.001; r=-0.433, p<0.001; r=-0.425, p<0.001). We calculated the most proper cut-off value of pelvic incidence associated with more than three segments of multiple lumbar disc degeneration, using a minimum p-value approach. CONCLUSIONS: As pelvic incidence, sacral slope, and lumbar lordosis indicating the parameters of lumbosacral sagittal alignments get smaller, the numbers of lumbar disc degenerations and herniated intervertebral discs increase. When pelvic incidence is below 45.6 degrees, it is more likely for degenerative changes of lumbar disc to affect more than three segments.
Animals ; Axis, Cervical Vertebra ; Congenital Abnormalities ; Humans ; Incidence ; Intervertebral Disc ; Intervertebral Disc Degeneration ; Lordosis ; Occupations ; Retrospective Studies ; Smoke ; Smoking ; Young Adult

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Survival Analysis of Conservative Treatement in Osteoporotic Vertebral Fracture.

Young Do KOH ; Jong Oh KIM ; Rag Gyu KIM ; Dae Youn KIM ; Nam Ki KIM ; Dong Jun KIM

Journal of Korean Society of Spine Surgery.2012;19(4):138-144. doi:10.4184/jkss.2012.19.4.138

STUDY DESIGN: Prospective study. OBJECTIVES: To define the prognostic factors by analyzing the survival rates of osteoporotic vertebral fracture treated by conservative management. SUMMARY OF THE LITERATURE REVIEW: Due to an increasing elder population, many recent studies of osteoporosis have been done; pointing out that osteoporotic vertebral fracture may produce serious complications. However, there is nothing obviously demonstrated in both the management and prognosis of the osteoporotic vertebral fracture. MATERIALS AND METHODS: Survival analysis was done for 130 patients who had undergone conservative management for a single level vertebral fracture. Univariant and multivariant survival analysis was done for age at trauma, sex, body mass index (BMI), bone mineral density (BMD), smoking, diabetic history, fracture level, fracture type, vertebral compression ratio and regional Cobb's angle. RESULTS: Survival rate for conservative management was 70.7%. Univariant analysis for survival rate revealed significantly inferior results for age over 78 (p=0.008), T score< -3.5 (p=0.047), and crush or biconcave type than wedge type (p=0.021). Only the age factor showed significance in multivariant analysis (p=0.025, Hazard ratio=2.08). CONCLUSION: Conservative management in a single level osteoporotic vertebral fracture, showed a survival rate of 70.7% and age was the most important factor in conservative management. We should notice that age of more than 78 years is at high risk for failure in conservative management of vertebral fracture.
Age Factors ; Body Mass Index ; Bone Density ; Humans ; Osteoporosis ; Prognosis ; Prospective Studies ; Smoke ; Smoking ; Survival Analysis ; Survival Rate

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A Clinical Result of Pedicle Screw Fixation in Osteoporotic Spine: Complications and Prevention.

Eung Ha KIM ; Hyun Seok SONG ; Chang Geun KIM

Journal of Korean Society of Spine Surgery.2012;19(4):131-137. doi:10.4184/jkss.2012.19.4.131

STUDY DESIGN: Retrospective study. OBJECTIVES: To analyze the clinical results of patients who were treated by pedicle screw fixation in osteoporotic spine and suggest the methods for preventing a loss of fixation strength. SUMMARY OF THE LITERATURE REVIEW: There are some methods to decrease failure rate and increase fixation strength in the osteoporotic spine: use bicortical screw, cement augmentation and supporting anterior column by interbody fusion using cages. MATERIALS AND METHODS: Forty-four patients treated by spinal instrumentation using pedicle screw from 2004 to 2011 were followed for at least 12 months. Five men and 39 women were diagnosed as osteoporotic spine (T score <-3.0). Two hundred forty eight pedicle screws were included and statistically analyzed the correlation between the use of bicortical screw, cement augmentation, anterior column support and fixation loss of the pedicle screw. Radiologic results were evaluated to find out the mechanical complications, like loosening of the screw, fixation failure, and nonunion. RESULTS: There were 9 complications associated with mechanical strength, loosening of pedicle screws in 7, sinking down of cage in 4, and nonunion in 4 cases. Using bicortical pedicle screw, cement augmentation and anterior column support were significantly correlated with the increasing fixation strength (P=0.001, P=0.047, P=0.014). In addition, these three factors contribute to stabilize the instrumentation (Linear by linear association, P=0.012). CONCLUSIONS: These 3 methods, using bicortical pedicle screw, cement augmentation and supporting anterior column, are effective to enhance the fixation strength and prevent loss of holding power in the osteoporotic spine.
Female ; Humans ; Male ; Osteoporosis ; Retrospective Studies ; Spine

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