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Initial Clinical Outcomes of Minimally Invasive Lateral Lumbar Interbody Fusion in Degenerative Lumbar Disease: A Preliminary Report on the Experience of a Single Institution with 30 Cases.

Young Cheol NA ; Hyo Sang LEE ; Dong Ah SHIN ; Yoon HA ; Keung Nyun KIM ; Do Heum YOON

Korean Journal of Spine.2012;9(3):187-192. doi:10.14245/kjs.2012.9.3.187

OBJECTIVE: The object of this study was to evaluate the clinical and radiological outcomes of minimally invasive lateral lumbar interbody fusion. METHODS: This study included 30 patients who underwent minimally invasive lateral lumbar interbody fusion at our hospital between May 2011 and February 2012 for the following diagnoses: degenerative disc disease, adjacent-segment degeneration, degenerative spondylolisthesis and lumbar degenerative scoliosis. Pain assessment was reported from 0 to 10 using a subjective visual analog scale (VAS) upon admission and at every follow-up day. Lumbar X-rays were obtained in the standing position upon admission and the 1st and 5th postoperative day, and at every follow-up day after the operation. The heights of the intervertebral disc space and neural foramen were measured using an electronic caliper with the PACS software. The surgical outcome was assessed as excellent, good, fair or poor using the Odom scale at the last follow-up. RESULTS: The mean VAS for low back pain were 4.93+/-1.47 on admission and 2.01+/-1.35 at last follow-up, respectively, and for leg pain, the scores were 4.87+/-2.16 on admission and 1.58+/-1.52 at last follow-up. The mean height of intervertebral disc space increased by 34% (7.93+/-2.33 preoperatively, and 11.09+/-4.33 immediately after surgery, p<0.01). The mean height of neural foramen also increased by 6.4% without any statistical significance (19.17+/-2.84 preoperatively, and 20.49+/-4.50 immediately after the surgery). Minimally invasive lateral lumbar interbody fusion was successful in 27 patients (90%) at last follow-up. Surgical complications were reported as transient postoperative thigh sensory changes (5 patients, 16.7%), transient psoas muscle weakness (3 patients, 10%), cage migration (2 patients, 6.7%), lumbar plexus injury (1 patient, 3.3%), and pain aggravation (1 patient, 3.3%). CONCLUSION: The minimally invasive lateral lumbar interbody fusion is a safe and effective procedure for treating degenerative lumbar disease with good outcomes and moderate complications. Further follow-up is necessary to establish its safety and efficacy.
Electronics ; Electrons ; Follow-Up Studies ; Humans ; Intervertebral Disc ; Leg ; Low Back Pain ; Lumbosacral Plexus ; Pain Measurement ; Psoas Muscles ; Scoliosis ; Spinal Fusion ; Spondylolisthesis ; Thigh ; Treatment Outcome

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Comparative Study between a Curved and a Wedge PEEK Cage for Single-level Anterior Cervical Discectomy and Interbody Fusion.

Hwan Soo KIM ; Joon Suk SONG ; Weon HEO ; Jae Hoon CHA ; Dong Youl RHEE

Korean Journal of Spine.2012;9(3):181-186. doi:10.14245/kjs.2012.9.3.181

OBJECTIVE: This study evaluated the efficiency of a curved polyetheretherketone (PEEK) cage in comparison with a wedge PEEK cage according to radiologic and clinical outcomes in patients with cervical degenerative disease. METHODS: A total of 37 patients who suffering from cervical disc disease with radiculopathy or myelopathy were reviewed retrospectively. Seventeen patients were underwent anterior cervical discectomy and interbody fusion with a curved shape PEEK cage (curved cage group), and twenty patients with wedge shape PEEK cage (wedge cage group). Clinical assessment was graded using Odom's criteria, NDI score and VAS score. For radiologic analysis, disc height (DH), segmental angle (SA), subsidence were measured at the preoperative and last follow up. RESULTS: A comparison of the preoperative and postoperative results revealed improvements after the surgery in the DH and SA in both cage groups. The change of postoperative DH between the preoperative and the last follow-up in wedge cage group and curved cage group was 6.85% and 25.5%, respectively. The change of postoperative SA was 1.75degrees and 0.95degrees, respectively. There was no statistically significant difference in the DH and SA between the 2 groups. The subsidence rate in the wedge cage group and curved cage group was 20% and 6%, respectively. CONCLUSION: The 2 different cage groups showed significant improvements in the disc height, segmental angle and clinical outcomes. However, the shape of PEEK Cage influences the tendency for subsidence. Increasing contact surface area and fitting into two adjacent vertebral body prevent significant subsidence.
Diskectomy ; Follow-Up Studies ; Humans ; Ketones ; Polyethylene Glycols ; Radiculopathy ; Retrospective Studies ; Spinal Cord Diseases ; Stress, Psychological

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Correction of Coronal Imbalance in Degenerative Lumbar Spine Disease Following Direct Lateral Interbody Fusion (DLIF).

Ju Seong KIM ; Hyo Sang LEE ; Dong Ah SHIN ; Keung Nyun KIM ; Do Heum YOON

Korean Journal of Spine.2012;9(3):176-180. doi:10.14245/kjs.2012.9.3.176

OBJECTIVE: The authors have recently been using a surgical technique of minimally invasive direct lateral interbody fusion (DLIF) for correcting of coronal imbalance. The purpose of this study was to evaluate the surgical outcome and complication of DLIF. METHODS: We undertook retrospective analysis of a consecutive series of 8 DLIF procedures in Degenerative lumbar spine disease since May 2011. Four patients underwent DLIF only, and the others underwent combined DLIF and posterior fixation. Data on intra- and postoperative complications were collected. The pre- and postoperative X-rays were reviewed. We investigated coronal deformity, Cobb's angle, and apical vertebral translation (AVT). The mean follow-up period was months with a range of 2 to 8 months. RESULTS: A mean preoperative coronal Cobb's angle was 21.8degrees (range 11.5-32.4degrees). Following after DLIF, the mean Cobb's angle was decreased to 13.0degrees (range 2.9-21.5degrees). Following additional posterior screw fixation, mean Cobb's angle was further decreased to 7.4degrees (range 2.9-13.2degrees). A mean preoperative AVT was 2.0 cm(range 0.6-3.5 cm), and improved to 1.4 cm(range 0.3-2.4 cm) and 0.8 cm(range 0.2-1.8 cm) postoperatively (DLIF and, posterior fixation respectively). One patient (12.5%) showed cage migration during follow-up period. Two patients (25%) developed motor weakness, and 4 patients (50%) experienced postoperative thigh paresthesias or dysesthesias. During follow up period, motor weakness had resolved in 1 patient. Sensory symptoms were improved in all patients at the last follow-up. CONCLUSION: Degenerative lumbar disease can be effectively corrected by DLIF with acceptable complications.
Congenital Abnormalities ; Follow-Up Studies ; Humans ; Lumbosacral Plexus ; Paresthesia ; Postoperative Complications ; Retrospective Studies ; Spine ; Thigh

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Surgical Results and Risk Factors for Recurrence of Lumbar Disc Herniation.

Jung Tae OH ; Ki Seok PARK ; Sung Sam JUNG ; Seung Young CHUNG ; Seong Min KIM ; Moon Sun PARK ; Han Kyu KIM

Korean Journal of Spine.2012;9(3):170-175. doi:10.14245/kjs.2012.9.3.170

OBJECTIVE: Recurrent lumbar disc herniation has been defined as disc herniation at the same level, regardless of ipsilateral or contralateral herniation, with a pain-free interval greater than 6 months. The aim of this study is to analyze outcomes and identify the potential risk factors for recurrent lumbar disc herniation. METHODS: The authors retrospectively reviewed the cases of 178 patients who underwent open discectomy for single-level lumbar disc herniation. Visual analogue scales and modified Macnab criteria were used to compare the clinical outcomes between the recurrent group and the non-recurrent group. Sex, age, discectomy level, degree of disc degeneration, type of disc herniation, pain-free interval after first-operation, smoking status, and trauma were investigated as potential recurrence risk factors. RESULTS: Of the 178 patients for whom the authors were able to definitely assess symptomatic recurrence status, 18 patients (10.1%) underwent revision surgery for recurrent disc herniation. The most common level involved was L4-L5 (61%) and the mean period of time to recurrence was 18.7 months (6-61 months). There were 17 cases of ipsilateral herniation and 1 case of contralateral herniation. The types of herniation for which revision surgery was done were protrusion (3 cases), and transligamentous extrusion (14 cases). There were five excellent, eight good, and two fair results. CONCLUSION: Repeated discectomy for recurrent disc herniation produced unsatisfactory outcomes. Factors such as sex, type of disc herniation and traumatic events were found to be significant risk factors.
Diskectomy ; Humans ; Intervertebral Disc Degeneration ; Lumbar Vertebrae ; Oxalates ; Recurrence ; Retrospective Studies ; Risk Factors ; Smoke ; Smoking ; Weights and Measures

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A PET/CT-based Morphometric Study of Spinal Canal in Korean Young Adults: Anteroposterior Diameter from Cervical Vertebra to Sacrum.

Moo Sung KANG ; Jeong Yoon PARK ; Dong Kyu CHIN ; Kyung Hyun KIM ; Sung Uk KUH ; Keun Su KIM ; Yong Eun CHO

Korean Journal of Spine.2012;9(3):165-169. doi:10.14245/kjs.2012.9.3.165

OBJECTIVE: To establish normative data for spinal canal AP diameter from cervical vertebra to sacrum in the Korean young and to assess the exposed spinal canal after laminectomy which was related with restenosis by post-laminectomy membrane formation. METHODS: From PET/CT, axial bone-window CT of 83 young adults (20-29 years) were obtained, and we measured AP diameters of C3, C5, C7, T1, T4, T8, T12, L1, L3, L5 and S1. We also measured exposed AP diameter of C3, C5, C7, T1 and T2 above imaginary line for laminectomy. RESULTS: The shortest mean AP diameter was at C5 (14.5+/-1.5 mm), and the longest was at S1 (17.4+/-2.3 mm). AP diameter increased from C3 (14.6+/-1.1 mm) to T1 (16.1+/-1.2 mm) at cervical spine. In the thoracic spine, the diameter gradually decreased from T1 (16.1+/-1.2 mm) to T8 (14.6+/-1.3 mm) and increased to T12 (16.7+/-1.2 mm). The diameter decreased from L1 (16.7+/-1.3 mm) to L3 (15.7+/-1.9 mm), and it increased to S1 (17.4+/-2.3 mm) at lumbar spine. Exposed AP diameter above imaginary line for laminectomy was the longest at C3 (4.8+/-1.2 mm) and gradually decreased to T1 (3.3+/-0.9 mm) and T2 (0 mm). CONCLUSIONS: Spinal AP diameter was the shortest in the mid-cervical area (C5) and increased to the upper thoracic area. From the upper thoracic vertebra, the diameter gradually decreased to the mid-thoracic vertebra (T8) and then increased to the lower thoracic vertebra. Lumbar vertebra also was similar with thoracic vertebra. Below T2, there was no exposed dural sac after laminectomy. This means that restenosis by post-laminectomy membrane formation can occur above T1.
Cervical Vertebrae ; Female ; Humans ; Laminectomy ; Lumbar Vertebrae ; Membranes ; Sacrum ; Spinal Canal ; Spine ; Thoracic Vertebrae ; Young Adult

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Percutaneous Disc Coagulation Therapy (PDCT) comparing with Automated Percutaneous Lumbar Discectomy (APLD) in Patients of Herniated Lumbar Disc Disease: Preliminary Report.

Cheon Wook PARK ; Joo Yong LEE ; Woo Jin CHOI ; Sang Keun CHANG

Korean Journal of Spine.2012;9(3):159-164. doi:10.14245/kjs.2012.9.3.159

OBJECTIVE: Percutaneous techniques are rapidly replacing traditional open surgery. This is a randomized controlled trial study of clinical outcomes of Percutaneous Plasma Disc Coagulation Therapy (PDCT) in patients with HLD(herniated lumbar disc) as a new percutaneous access in comparison with Automated Percutaneous Lumbar Discectomy (APLD) in its clinical application and usefulness as a reliable alternative method. METHODS: The authors analyzed 25 patients who underwent PDCT randomized 1:1 to 25 who underwent APLD between June, 2010 and October, 2011. All patients had herniated lumbar disc diseases. The clinical outcomes were evaluated using Visual Analog Scales (VAS) score and MacNab's criteria. RESULTS: The age of the patients who underwent PDCT ranged from 29 to 88 years with a mean age of 51.8 years. The age of the APLD undergone patients' population ranged from 30 to 66 with a mean age of 46.0 years. The average preoperative VAS score in PDCT was 7.60 and 1.94 at 7months post-operatively, and in APLD was 7.32, and 3.53 at 7 months post-operatively (p<0.001). In Macnab's criteria, 20 patients (80%) had achieved favorable improvement (excellent and good) in PDCT group. In Macnab's criteria, 16 patients (64%) had achieved favorable improvement in APLD group (p<0.001). CONCLUSION: PDCT can be considered a viable option as a new percutaneous access to herniated lumbar disc. PDCT showed to be more effective than APLD in this study, allowing stable decompression and safe minimally invasive operation to an area desired by the operator in lumbar disc herniation patients, although further long term clinical evaluations are still necessary.
Decompression ; Diskectomy ; Humans ; Plasma ; Weights and Measures

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Lumbar Disc Screening Using Back Pain Questionnaires: Oswestry Low Back Pain Score, Aberdeen Low Back Pain Scale, and Acute Low Back Pain Screening Questionnaire.

Do Yeon KIM ; Chang Hyun OH ; Seung Hwan YOON ; Hyung Chun PARK ; Chong Oon PARK

Korean Journal of Spine.2012;9(3):153-158. doi:10.14245/kjs.2012.9.3.153

OBJECTIVE: To evaluate the usefulness of back pain questionnaires for lumbar disc screening among Korean young males. METHODS: We carried out a survey for lumbar disc screening through back pain questionnaires among the volunteers with or without back pain. Three types of back pain questionnaire (Oswestry Low Back Pain Score, Aberdeen Low Back Pain Scale, and Acute Low Back Pain Screeing Questionnaire) were randomly assigned to the examinees. The authors reviewed lumbar imaging studies (simple lumbar radiographs, lumbar computed tomography, and magnetic resolutional images), and the severity of lumbar disc herniation was categorized according to the guidelines issued by the Korean military directorate. We calculated the relationship between the back pain questionnaire scores and the severity of lumbar disc herniation. RESULTS: The scores of back pain questionnaires increased according to the severity of lumbar disc herniation. But, the range of scores was very vague, so it is less predictable to detect lumbar disc herniation using only back pain questionnaires. The sensitivity between the back pain questionnaires and the presence of lumbar disc herniation was low (16-64%). CONCLUSION: Screening of lumbar disc herniation using only back pain questionnaires has limited value.
Back Pain ; Humans ; Intervertebral Disc Displacement ; Korea ; Low Back Pain ; Magnetics ; Magnets ; Mass Screening ; Military Personnel ; Surveys and Questionnaires

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The Correlation between Insertion Depth of Prodisc-C Artificial Disc and Postoperative Kyphotic Deformity: Clinical Importance of Insertion Depth of Artificial Disc.

Do Youl LEE ; Se Hoon KIM ; Jung Keun SUH ; Tai Hyoung CHO ; Yong Gu CHUNG

Korean Journal of Spine.2012;9(3):147-152. doi:10.14245/kjs.2012.9.3.147

OBJECTIVE: This study was designed to investigate the correlation between insertion depth of artificial disc and postoperative kyphotic deformity after Prodisc-C total disc replacement surgery, and the range of artificial disc insertion depth which is effective in preventing postoperative whole cervical or segmental kyphotic deformity. METHODS: A retrospective radiological analysis was performed in 50 patients who had undergone single level total disc replacement surgery. Records were reviewed to obtain demographic data. Preoperative and postoperative radiographs were assessed to determine C2-7 Cobb's angle and segmental angle and to investigate postoperative kyphotic deformity. A formula was introduced to calculate insertion depth of Prodisc-C artificial disc. Statistical analysis was performed to search the correlation between insertion depth of Prodisc-C artificial disc and postoperative kyphotic deformity, and to estimate insertion depth of Prodisc-C artificial disc to prevent postoperative kyphotic deformity. RESULTS: In this study no significant statistical correlation was observed between insertion depth of Prodisc-C artificial disc and postoperative kyphotic deformity regarding C2-7 Cobb's angle. Statistical correlation between insertion depth of Prodisc-C artificial disc and postoperative kyphotic deformity was observed regarding segmental angle (p<0.05). It failed to estimate proper insertion depth of Prodisc-C artificial disc effective in preventing postoperative kyphotic deformity. CONCLUSION: Postoperative segmental kyphotic deformity is associated with insertion depth of Prodisc-C artificial disc. Anterior located artificial disc leads to lordotic segmental angle and posterior located artificial disc leads to kyphotic segmental angle postoperatively. But C2-7 Cobb's angle is not affected by artificial disc location after the surgery.
Congenital Abnormalities ; Humans ; Retrospective Studies ; Total Disc Replacement

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An Early Comparative Analysis of the Use of Autograft Versus Allograft in Anterior Cervical Discectomy and Fusion.

Sang Yong KIM ; Ki Seok PARK ; Sung Sam JUNG ; Seong Young CHUNG ; Seong Mim KIM ; Moon Sun PARK ; Han Kyu KIM

Korean Journal of Spine.2012;9(3):142-146. doi:10.14245/kjs.2012.9.3.142

OBJECTIVE: The purpose of this study is to verify the usefulness of autograft versus allograft in the radiographic and clinical outcome in early period after the surgery. METHODS: We performed a retrospective review of 38 patients who had undergone one- or two-level anterior cervical discectomy and fusion (ACDF) with rigid anterior plate fixation from March 2006 to May 2009. Interbody graft materials were iliac autograft (n=17) or with allograft (n=21). Fusion rate and graft collapse rate were assessed by radiographic analysis and clinical outcome was based on Odom's criteria. RESULTS: In autograft group, 13 patients achieved successful bone fusion (65%), whereas 7 patients (31.8%) in allograft group. There was statistically significant between two groups (p<0.05). Comparing immediate postoperative radiograph with last follow-up, the mean graft collapse was noted 1.3mm(15.5% change) in autograft group, whereas 2.0mm(24.7% change) in allograft group. There was no statistically significant collapse rate in autograft group (p>0.05), but statistically significant in allograft group (p<0.05). Clinical outcome was excellent or good in 94.1% in autograft group, and 90.5% in allograft group. CONCLUSION: In study, anterior cervical interbody fusion with an allograft got a result of lower fusion rate and higher collapse rate compared with autograft in early period after surgery, and clinical outcome showed similar results in both groups.
Cervical Vertebrae ; Diskectomy ; Female ; Follow-Up Studies ; Humans ; Retrospective Studies ; Spinal Fusion ; Transplantation, Homologous ; Transplants

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Radiological Efficacy of Cervical Lateral Mass Screw Insertion and Rod Fixation by Modified Magerl's Method (Yoon's Method) with Minimum 2 Years of Follow-up.

Do Yeon KIM ; Ji Yong KIM ; Seung Hwan YOON ; Hyung Chun PARK ; Chong Oon PARK

Korean Journal of Spine.2012;9(3):137-141. doi:10.14245/kjs.2012.9.3.137

OBJECTIVE: Cervical lateral mass screw insertion and rod fixation is a useful method for stabilizing the cervical disease, so various modified techniques were present. Many surgeons had reported the biomechanical safety according to the screw positioning method in the cervical spine, but the modified Magerl's method (Yoon's method) was not well studied. So, this study assessed the radiological efficacy of the modified Magerl's method with long-term follow-up. METHODS: This study retrospectively reviewed 323 lateral mass screws of 50 patients who had followed-up at least 2 years. Radiologic data were analyzed as parameters of complications after operation, including kyphotic or lordotic change, bone fusion, pull-out or malposition of screw, foraminal stenosis, adjacent disc degeneration or aggravation, pseudoarthrosis, and vertebral artery injury. RESULTS: The mean follow-up period was 32 (24 to 52) months. There were kyphotic changes in 4.0%(2 of 50 cases). Unsuccessful bone fusion occurred in 4.0%(2 of 50 cases). Among the 323 screws, screw pull-out (4.0%. 2 of 50cases, 3 of 323 screws), foraminal invasion (1.2% of total screws), and facet injury (0.6% of total screws) occurred. CONCLUSION: The lateral mass screw insertion and rod fixation by the modified Magerl's method (Yoon's method) is a safe and reliable technique with low rate of complication related to instruments in minimum 2 years follow-up.
Constriction, Pathologic ; Follow-Up Studies ; Humans ; Intervertebral Disc Degeneration ; Pseudarthrosis ; Retrospective Studies ; Spinal Fusion ; Spine ; Vertebral Artery

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