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Slip Reduction Rate between Minimal Invasive and Conventional Unilateral Transforaminal Interbody Fusion in Patients with Low-Grade Isthmic Spondylolisthesis.

Chang Hyun OH ; Gyu Yeul JI ; Jae Kyun JEON ; Junho LEE ; Seung Hwan YOON ; Dong Keun HYUN

Korean Journal of Spine.2013;10(4):232-236. doi:10.14245/kjs.2013.10.4.232

OBJECTIVE: To compare the slip reduction rate and clinical outcomes between unilateral conventional transforaminal lumbar interbody fusion (conventional TLIF) and unilateral minimal invasive TLIF (minimal TLIF) with pedicle screw fixation for treatment of one level low-grade symptomatic isthmic spondylolisthesis. METHODS: Between February 2008 and April 2012, 25 patients with low-grade isthmic spondylolisthesis underwent conventional TLIF (12 patients) and minimal TLIF (13 patients) in single university hospital by a single surgeon. Lateral radiographs of lumbar spine were taken 12 months after surgery to analyze the degree of slip reduction and the clinical outcome. All measurements were performed by a single observer. RESULTS: The demographic data between conventional TLIF and minimal TLIF were not different. Slip percentage was reduced from 15.00% to 8.33% in conventional TLIF, and from 14.15% to 9.62% in minimal TLIF. In both groups, slip percentage was significantly improved postoperatively (p=0.002), but no significant intergroup differences of slip percentage in preoperative and postoperative were found. The reduction rate also not different between conventional TLIF (45.41+/-28.80%) and minimal TLIF (32.91+/-32.12%, p=0.318). CONCLUSION: Conventional TLIF and minimal TLIF with pedicle screw fixation showed good slip reduction in patients with one level low-grade symptomatic isthmic spondylolisthesis. The slip percentage and reduction rate were similar in the conventional TLIF and minimal TLIF.
Humans ; Spine ; Spondylolisthesis*

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Recurrence Rate after Herniotomy only versus Discectomy in Lumbar Disc Herniation.

Jong Soo PARK ; Sang Eun CHOI ; Tae Koo CHO ; Sang Hyuk KIM ; Wootack RHEE ; Woo Jae KIM ; Seong Il HA ; Jae Hyeon LIM ; Il Tae JANG

Korean Journal of Spine.2013;10(4):227-231. doi:10.14245/kjs.2013.10.4.227

OBJECTIVE: Lumbar disc herniation (LDH) recurrence necessitating reoperation can pose problems following spinal surgery, with an overall reported incidence of approximately (3-13%). The purpose of this study is to identify the rate of recurrent disc herniation, to discuss the radiologic indications for herniotomy and to analyze clinical outcomes compared with conventional discectomy. METHODS: This study is a retrospective case control study. The authors retrospectively reviewed 114 patients who underwent herniotomy & conventional discectomy by a single surgeon for single-level LDH between June 2009 and May 2012. Herniotomy group was 57 patients and conventional discectomy group was 57 patients that were selected from 631 patients using stratified randomization. Evaluation for LDH recurrence included detailed medical chart and radiologic review and telephone interview. Postoperative VAS and the Korean version of ODI were examined one week after surgery. Clinical outcome was investigated according to Odom's criteria from three months to three years. RESULTS: Of the 114 patients for whom the authors were able to definitively assess symptomatic recurrence status, four patients (7%) experienced LDH recurrence following single-level herniotomy and three patients (5.2%) conventional discectomy. There were no differences in the VAS and Korean version of ODI between herniotomy group and conventional discectomy group. The herniotomy group had better results than the conventional discectomy group in clinical outcome from three months to three years, but the difference was not significant. CONCLUSION: There were no significant differences in clinical outcome between herniotomy and conventional discectomy. Recurrence rates following herniotomy for LDH compare favorably with those in patients who have undergone conventional discectomy, lending further support for its effectiveness in treating herniotomy.
Case-Control Studies ; Diskectomy* ; Humans ; Incidence ; Intervertebral Disc Displacement ; Interviews as Topic ; Lumbar Vertebrae ; Random Allocation ; Recurrence* ; Reoperation ; Retrospective Studies

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The Clinical Characteristics of Lower Lumbar Osteoporotic Compression Fractures Treated by Percutaneous Vertebroplasty : A Comparative Analysis of 120 Cases.

Seok HAN ; Heung Sik PARK ; Yong Hun PEE ; Seong Hoon OH ; Il Tae JANG

Korean Journal of Spine.2013;10(4):221-226. doi:10.14245/kjs.2013.10.4.221

OBJECTIVE: The purpose of this study is to provide accurate understanding of clinical presentations and surgical outcomes as well as to identify the unique characteristics of lower lumbar osteoporotic compression fracture (OCF). METHODS: Clinical data were collected from 120 patients who had L3, L4 or L5 percutaneous vertebroplasty (PVP) performed from 2008 to 2012 at the single institute. L4 or L5 PVP patients were classified into group 1 and group 2 was for L3 PVP patients. Medical records were retrospectively investigated at 1 month after PVP. Long term follow-up results were obtained at a median value of 22 months after PVP. RESULTS: 75% of the patients in group 1 were not associated with traumatic events, 71% presenting with leg radiating symptoms and 46% requiring an additional decompressive surgery, more often than those in group 2. These differences are statistically significant (p<0.05). The short term medical record review demonstrated that only 73% of patients in group 1 were ameliorated with regard to back motion pain, whereas those in group 2 reported 87.7% rates of amelioration in identical category (p<0.05). The long term follow up confirmed a significantly worse outcome in group 1, with only 55.7% of patients reporting amelioration in their pain or functional status, but 71.7% rate of amelioration in group 2. CONCLUSION: The OCFs at the L4 or L5 level have different clinical characteristics from those at upper levels of the lumbar spine.
Follow-Up Studies ; Fractures, Compression* ; Humans ; Leg ; Medical Records ; Retrospective Studies ; Spine ; Vertebroplasty*

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Thoracic Extrapedicular (Transverse Process) Screws Fixation : Technical Note.

Gyeong Mi CHOI ; Dae Cheol RIM ; Sung Ki AHN ; Hyun Chul CHOI

Korean Journal of Spine.2009;6(2):90-94.

Authors performed extrapedicular screws fixation in thoracic spines. Because patient had very narrow thoracic pedicles, classical transpedicular screws fixation could not be accomplished. In case of narrow thoracic pedicles, extrapedicular screws fixation would be a good alternative technique. We describe here a method for thoracic extrapedicular screws fixation.
Humans ; Spine

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Dysphagia Caused by Ossificaion of the Cervical Anterior Longitudial Ligament : Report of Two Cases.

Bong Kyu SONG ; Jong Pil EUN ; Seung Soo PARK ; Sang Hyuk KIM

Korean Journal of Spine.2009;6(2):86-89.

We report two cases with progressive dysphagia and foreign body sensation resulted from severe cervical ossification of the anterior longitudinal ligament (OALL). A 63-years-old male presented progressive dysphagia and foreign body sensation with neck pain. Cervical computed tomography (CT) and magnetic resonance images (MRI) revealed diffuseOALL from C2 to C7 with esophageal compression by most severe OALL of C5, C6, C7 and spondylotic stenosis of C5- 6, C6-7. OALL removal of C5, 6, 7 and discectomy with interbody fusion via anterior approach was performed. The other 56-years-old female presented progressive dysphagia with foreign body sensation. Cervical CT and MRI revealed severe OALL of C4, 5, 6, 7 with esophageal compression and surgical removal was performed. In both patients, dysphagia and foreign body sensation was immediately relieved after operation and the distance between trachea and each cervical body was increased than preoperative distance in cervical lateral view.
Constriction, Pathologic ; Deglutition Disorders ; Diskectomy ; Female ; Foreign Bodies ; Humans ; Ligaments ; Longitudinal Ligaments ; Magnetic Resonance Spectroscopy ; Male ; Neck Pain ; Sensation ; Trachea

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Spine Fractures in Patients with Ankylosing Spondylitis : Three Cases Report.

Tae Sik PARK ; Weon HEO ; Dong Youl RHEE ; Hwa Seung PARK ; Jun Sook SONG ; Se Heun JOUNG

Korean Journal of Spine.2009;6(2):81-85.

Ankylosing spondylitis (AS) is a chronic inflammatory rheumatic disease. Pathologic changes occurred in patients with AS result in a weakened vertebral column with increased susceptibility to fractures, even though a trivial injury. Fractures usually tends to involve the lower cervical spine, but rarely, they are also occurred in thoracolumbar spine. We present our experiences of three cases of spinal fracture in patients with AS, cervical, thoracic, and lumbar spine, with a review of literatures.
Humans ; Rheumatic Diseases ; Spinal Fractures ; Spine ; Spondylitis ; Spondylitis, Ankylosing

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Sacral Insufficiency Fracture with Osteoporotic Compression Fracture of the Thoracolumbar Spine : Incidence and High Risk Factors.

Ho Bum LEE ; Chan Woo PARK ; Ji Myoung HONG ; Chan Jong YOO ; Sang Gu LEE ; Woo Kyung KIM

Korean Journal of Spine.2009;6(2):75-80.

OBJECTIVE: The sacral insufficiency fractures (SIFs) are not uncommon and usually occur in osteoporotic bone with minimal or unremembered trauma. Especially, if they are accompanied by osteoporotic compression fracture of the thoracolumbar spine, SIFs can be usually overlooked due to subtle clinical symptoms and signs coupled with radiographic findings. The review aims to be raising awareness of the incidence & risk factors of the SIFs. METHODS: We retrospectively reviewed the 252 patients who were admitted at our hospital due to osteoporotic compression fracture of the thoracolumbar spine with minimal or unremembered trauma for 5 years. We assessed the incidence of the SIF being accompanied by osteoporotic compression fracture of the thoracolumbar spine and the effects according to sex, age, probable risk factors (diabetes mellitus & arterial hypertension), the location of fracture and the severity of osteoporosis. RESULTS: 252 patients, including 36 men (14.3%) and 216 women (85.7%) were involved in this study and the osteoporotic compression fractures were located at thoracic (36 cases), thoracolumbar junction (180 cases), lumbar spine (36 cases). There are 18 cases (the incidence: 7.1%), including 2 men (5.5%) and 16 women (7.4%) in which the SIF was accompanied by osteoporotic compression fracture of the thoracolumbar spine. The effects according to sex, age, probable risk factors, the location of fracture and the severity of osteoporosis were not statistically different in both groups (group with SIF and group without SIF). CONCLUSION:The clinicians need to consider the possibility of SIF in patients of osteoporotic compression fracture of the thoracolumbar spine.
Female ; Fractures, Compression ; Fractures, Stress ; Humans ; Incidence ; Male ; Osteoporosis ; Retrospective Studies ; Risk Factors ; Spine

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Endoscopic Versus Mini.open Carpal Tunnel Release in Patients with Bilateral Carpal Tunnel Syndrome.

Woo Young CHANG ; Young Min HAN ; Kyung Sool JANG ; Dong Kyu JANG ; Sang Kyu PARK ; Dong Sup CHUNG ; Young Sup PARK

Korean Journal of Spine.2009;6(2):68-74.

OBJECTIVE: The purpose of this study was to determine any differences in outcome and patient satisfaction between endoscopic release (ECTR) and open carpal tunnel release (OCTR) in patients with bilateral carpal tunnel syndrome who underwent both techniques. METHODS: Seven patients with confirmed bilateral idiopathic carpal tunnel syndrome were randomized to undergo endoscopic release using a single portal Agee technique to one hand and a minimal open release to the other. Subsequent assessments were made at 0, 3, and 12 months after operation using a modified Levin scale. We also analyzed subjective and objective outcomes retrospectively, including the time to return to full activity, patient preference, cosmetic satisfaction, scar tenderness, and pillar pain. The pain was assessed using a visual analogue scale from 1 to 10. RESULTS: Based on the Levin scale, there were no significant differences between hands at any follow-up interval. At the three-month follow up, mean scale scores were lower in the ECTR group; however, the differences did not reach statistical significance. Cosmetically, all patients were satisfied with their scar irrespective of the technique. There were no statistical differences in terms of scar tenderness and pillar pain. CONCLUSION:ECTR did not show any significant advantage over short-incision OCTR. Therefore, the operator's experience and skill in using a certain method is important, regardless of which technique is used.
Carpal Tunnel Syndrome ; Cicatrix ; Cosmetics ; Follow-Up Studies ; Hand ; Humans ; Imidazoles ; Nitro Compounds ; Patient Preference ; Patient Satisfaction ; Retrospective Studies

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Efficacy of Microdecompression with Microscope and Tubular Retractor in Lumbar Foraminal Stenosis: Surgical Technique and Clinical Outcomes.

Hyun Min CHOI ; Kwan Ho PARK ; Tae Wan KIM ; Moon Pyo CHI ; Jae O KIM ; Jung Chul KIM

Korean Journal of Spine.2009;6(2):61-67.

OBJECTIVE: The objective of this study is to evaluate the efficacy of microdecompression (MD) with microscope and tubular retractor in lumbar foraminal stenosis (FS) and to analyze the clinical outcomes. METHODS: From January 2006 to December 2007, 22 patients with symptomatic lumbar FS underwent conventional decompressive surgery (CDS) and MD was performed in other 20 patients. Clinical outcome was measured using a Visual Analogue Scale (VAS) and Macnab?fs criteria. Spinal instability was determined by radiologic assessment of flexion-extension radiographs. RESULTS: The CDS group included 14 men and 8 women. The MD group included 14 men and 6 women. The mean age was 66.2 years (range, 46-80 yrs) in the CDS group and 65.4 years (range, 59-74 yrs) in the MD group. Average follow-up periods were 18.6 months in the CDS group and 16.5 months in the MD group. Mean operating time was 126 minutes in the CDS group and 168 minutes in the MD group. The mean VAS of back pain decreased from 2.68 to 1.36 in the CDS group and from 2.85 to 1.25 in the MD group. The mean VAS score of leg pain decrea- sed from 6.68 to 1.48 in the CDS group and from 6.65 to 1.40 in the MD group. The success rate of CDS group was 86.3 % (19/22), compared with 85.0% (17/20) for MD group. Radiologically, there was no spinal instability. CONCLUSION:MD could achieve neural decompression and offer an effective treatment of lumbar FS. However it was a technically demanding procedure and effective in limited operative indications. We need to consider long-term follow-up.
Back Pain ; Constriction, Pathologic ; Decompression ; Female ; Follow-Up Studies ; Humans ; Leg ; Male

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Cervical Intervertebral Disc Arthroplasty: Update.

Ki Jeong KIM ; Sang Hoon YOON ; Yong Jun JIN ; Sang Ki CHUNG ; Hyun Jib KIM

Korean Journal of Spine.2009;6(2):51-60.

Since 1966 the first metal ball shape implant was inserted into the cervical and lumbar areas by Dr. Fernstrom, numerous attempts and prostheses have been tried to maintain physiologic range of motion and prevent adjacent segment degeneration (ASD) after surgery. However fusion itself is not a single causative factor of ASD and other biologic factors including natural progression of degenerative process and mechanical factors also contribute in the development of ASD. Several well designed prospective randomized control studies for Bryan disc and Prodisc C have been recently documented preservation of spinal motion, superior or, at least, equivalent clinical outcome in comparing with anterior cervical arthrodesis, and less adverse postoperative events both in frequency and severity. Still remained or undetermined problems in cervical arthroplasty are heterotopic ossifications, segmental kyphosis of implanted levels, MR imaging compatibility, vertebral body fracture by keeled prostheses and long term wear properties. In spite of these unsolved problems and incompleteness of prosthetic design, cervical arthroplasty is now considered as one of standard methods in surgical management of one or two level cervical disc diseases and its indication may be broader in near future.
Arthrodesis ; Arthroplasty ; Biological Factors ; Intervertebral Disc ; Kyphosis ; Prostheses and Implants ; Range of Motion, Articular

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