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Kyu Yeol LEE ; Chul Hong KIM ; Chang Geun SONG

Journal of Korean Society of Spine Surgery.2002;9(2):157-163. doi:10.4184/jkss.2002.9.2.157

STUDY DESIGN: The metal failure of pedicle screw system followed by posterolateral or posterior fusion used in variable cases(spine fracture, degenerative disorder of spine, deformity of spine) was analyzed retrospectively. PURPOSE: The goal of this study was to analyze frequency and clinical consequence of pedicle screw fixation system failure in the treatment of different etiology(spine fracture, degenerative disorder, deformity of spine) and to evaluate affected factors in metal failure. MATERIALS AND METHODS: We performed survivorship analysis on 442 patients treated with pedicle screw system from September 1990 to December 1999. The average follow-up period was 54 months(from 18 months to 129 months). As affected factors, some variables such as etiology, kinds of system and extent of fusion were subjected to analyzed their influence on metal failure. We also performed analysis about relationship between metal failure and clinical results. We defined the metal failure as 1) breakage of screw or rod 2) screw bending above 5 degrees 3) dissociation of rod-screw coupling system and 4) screw pull out from vertebral body or pedicle. RESULTS: We found out 33 cases of metal failure: among 2786 screws, 41 screws had a problem. The metal failure rate was different between each etiology ; 12 cases in fracture(10%), 21 cases in degenerative disorder(6.9%). There was also difference between a kinds of implants; 13 cases in side assembling type(5.4%), 20 cases in back open type(10.5%). However, there were no difference according to extent of fusion; 6 cases in one segment(6.9%), 21 cases in two segments(8.1%), 6 cases in more than three segments(6.3%). Among the overall patients with metal failure (33 cases), only eight patients were complaint significant symptoms. And three of this eight patients were improved after reoperation The mean interval to metal failure was 14.4 months from operation. CONCLUSION: The metal failure was more common in spine fracture(p<0.05) and back open type pedicle system(p<0.05). However, there was no relationship with extent of fusion(p>0.05). And metal failure did not significantly affect the clinical results(p>0.05).
Congenital Abnormalities ; Follow-Up Studies ; Humans ; Reoperation ; Retrospective Studies ; Spine ; Survival Rate

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Surgical Treatment of Post-Traumatic Kyphosis with Neurologic Compromised Osteoporotic Fracture: Comparison between Anterior-Posterior Surgery versus Posterior Egg-Shell Procedure.

Se Il SUK ; Jin Hyok KIM ; Ewy Ryong CHUNG ; Sang Min LEE ; Jung Hee LEE ; Sung Soo KIM ; Sung Wook WON ; Soo Chul PARK ; Rack Yong CHUNG

Journal of Korean Society of Spine Surgery.2002;9(2):148-156. doi:10.4184/jkss.2002.9.2.148

STUDY DESIGN: Retrospective study. OBJECTIVES: To compare the surgical results between anterior-posterior surgery and posterior eggshell procedures in post-traumatic kyphosis with neurologic compromised osteoporotic fracture. SUMMARY OF LITERATURE REVIEW: Combined anterior-posterior surgery is usually recommended in cases of kyphotic deformities with neurologic deficit secondary to osteoporosis. However, it is associated with significant morbidity in elderly patients. MATERIALS AND METHODS: Twenty-six post-traumatic kyphosis with neurologic compromised osteoporotic fracture patients subjected to either anterior-posterior surgery (n=11) or posterior egg-shell procedure (n=15) were analyzed. The average age at the operation was 62.6 years (range: 50-82), male : female ratio was 12 : 14, and the average follow up was 2.9 years (range:2.0-4.9). Preoperative interval from injury to operation was 15.4 months (range: 1-36). Thoracolumbar (T12-L1) fracture was in 20 and lumbar fracture was in 6. RESULTS: There was no significant difference in age, sex, preoperative and postoperative Frankel grade, and preoperative vertebral collapse between two groups(p<0.05). In anterior-posterior group, the mean operation time was 351 minutes with a mean blood loss of 2892 ml, and preoperative kyphosis of 22 degrees was corrected to 11 degrees at latest follow-up with 7 cases of neurologic improvement. In the eggshell group, the mean operative time was 215 minutes with blood loss of 1930 ml, and preoperative kyphosis of 34 degrees was corrected to 8 degrees at latest follow-up with 11 cases of neurologic improvement. Egg-shell group showed significantly less operation time and blood loss with beter kyphosis correction. In anterior-posterior group, postoperative pneumonia was developed in 2 and superficial infection in 1. Distal screw loosening was detected in 4, 2 in anterior-posterior group and 2 in posterior eggshell group. One of them was treated by revision and others were treated by brace more than 6 months. CONCLUSIONS: Posterior eggshell procedure showed a better kyphosis correction with significantly less operation time and blood loss. It is a preferable alternative to anterior-posterior surgery in post-traumatic kyphosis with neurologic compromised osteoporotic fracture.
Aged ; Braces ; Congenital Abnormalities ; Female ; Follow-Up Studies ; Humans ; Kyphosis* ; Male ; Neurologic Manifestations ; Operative Time ; Osteoporosis ; Osteoporotic Fractures* ; Pneumonia ; Retrospective Studies

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Intraoperative Spinal Nerve Root Injuries during Surgery for Degenerative Low Back Disease.

Byung Joon SHIN ; Jae Chul LEE ; Ki Hoon RYU ; Ho Won JUNG ; Kyung Je KIM ; Yon Il KIM

Journal of Korean Society of Spine Surgery.2002;9(2):142-147. doi:10.4184/jkss.2002.9.2.142

STUDY DESIGN: A retrospective study OBJECTIVE: To analyze incidence, causes and prognosis of the spinal nerve root injury during the degenerative low back surgery. SUMMARY OF LITERATURE REVIEW: There were very few studies about intraoperative spinal nerve root injuries during low back surgery. MATERIALS AND METHODS: Six hundred and twenty seven patients underwent degenerative low back surgery from Jan 1990 to Jan 2001 were included in this study. All patients were operated on by the first author and operation records made by the author himself were reviewed. Eight cases of intraoperative spinal nerve root injury were identified and causes and level of injuries, preoperative diagnosis, types of surgery and follow-up clinical results were analyzed. RESULTS: Eight cases of nerve root injury were developed during 5 posterior laminotomies for discectomy and 3 instrumentation and fusion. Spinal nerve root injuries were caused by Kerrison punch in 4 cases, pituitary forcep in 2, rongeur in 1, and not certain but probably by Kerrison punch in 1 case. The levels of injuries were 5th lumbar nerve root in 4 cases, and 1st sacral nerve root and 2nd lumbar nerve root in 1 case respectively. Two cases had sacral nerve rootlet injury with paramedian dural tear but the level of root injury was uncertain. Six of 8 patients had symptoms. There were sensory loss in 4 patients, pain in 2, and one patient had both sensory loss and loss of big toe extension power. Neurological symptoms were not improved throughout the follow-up period, but 2 patients who had pain were resolved their symptoms by 3 months. CONCLUSIONS: Incidental spinal nerve root injury occurred in 1.3 percentage of the patients who underwent low back surgery. Half of them had neurologic symptoms and they showed poor prognosis. However motor deficit was relatively uncommon and it might be related to the anatomical characteristics of spinal nerve root.
Diagnosis ; Diskectomy ; Follow-Up Studies ; Humans ; Incidence ; Laminectomy ; Neurologic Manifestations ; Prognosis ; Retrospective Studies ; Spinal Nerve Roots* ; Spinal Nerves* ; Surgical Instruments ; Toes

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The Relationship between Sagittal Spinal Alignment and Surgical Results in Degenerative Lumbar Scoliosis with Spinal Stenosis.

Whoan Jeang KIM ; Jin Sup YEOM ; Jong Won KANG ; Kyou Hyeun KIM ; Seung Hun LEE ; Keun Jong CHOY ; Won Sik CHOY

Journal of Korean Society of Spine Surgery.2002;9(2):133-142. doi:10.4184/jkss.2002.9.2.133

STUDY DESIGN: A retrospective study. OBJECTIVES: To analyze the correlation between clinical results and sagittal vertical axis, clinical results and total lumbar lordosis in degenerative lumbar scoliosis with spinal stenosis. SUMMARY OF LITERATURE REVIEW: There has been no report about the relation between sagittal spinal alignment and surgical outcome of degenerative lumbar scoliosis. MATERIALS AND METHODS: We reviewed 38 surgical cases of degenerative lumbar scoliosis from February 1997 to February 2001 with an average follow-up of 35 months. In whole spine standing AP and lateral radiographs, scoliotic angle(Cobb method), total lumbar lordosis(L1-S1) and the sagittal vertical axis(C7 plumb line) were measured. In lumbar flexion-extension and standing side bending views, the lateral translation was measured and instability was determined. Clinical results were evaluated based on the Kirkaldy-Willis criteria. RESULTS: The scoliotic angles at preoperative, postoperative and follow-up were 15.0+/-4.9, 5.3+/-3.1 and 7.1+/-3.7 degrees retro-spectively. Total lumbar lordosis were 28.7+/-6.1, 40.6+/-7.3 and 35.1+/-10.2 degrees retrospectively. Sagittal vertical axis at preoperative and the last follow-up were 3.3+/-3.2 and 0.1 +/-3.3 cm retrospectively. According to Kirkaldy-Willis criteria, 6 cases were excellent, 24 cases good, 7 cases fair and 1 case poor. There was no statistical correlation between total lumbar lordosis and the clinical results (r=-0.061, p=0.717). Sagittal vertical axis was significantly correlated with the clinical results (r=0.519, p=0.001). CONCLUSIONS: For improvement of surgical outcome of degenerative lumbar scoliosis, the sagittal vertical axis should be used as a parameter of sagittal alignment rather than the total lumbar lordosis.
Animals ; Axis, Cervical Vertebra ; Follow-Up Studies ; Lordosis ; Retrospective Studies ; Scoliosis* ; Spinal Stenosis* ; Spine

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Radiologic Result of Displacement according to Position and Measurement Methods in Spondylolisthesis.

Dae Moo SHIM ; Tae Kyun KIM ; Dae Ho HA ; Young Jin KIM ; Ha Heon SONG ; Soo Uk CHAE ; Yong Woo CHO ; Dae Sic AHN

Journal of Korean Society of Spine Surgery.2002;9(2):127-132. doi:10.4184/jkss.2002.9.2.127

STUDY DESIGN: Prospective analysis was based on radiographic appearance in 80 cases of spondylolisthesis taken in positional change. PURPOSE: The aim of the study was to investigate the flexion-extension lateral radiographs about the difference between decubitus and upright position and the measurement method of displacement in spondylolisthesis. SUMMARY OF LITERATURE REVIEW: Although the flexion-extension lateral radiographs of spine were known the most preferable diagnostic method for spine instability, there are some debates about the difference of displacement according to the patient position and measurement methods. MATERIALS AND METHODS: The radiographs of 80 patients with spondylolisthesis were taken in the decubitus and upright position. Extent of the displacement were measured by Taillard, DuPuis, modified Qunnell & Stockdale method and Ferguson angle, slip angle, lordosis angle and vertebral centroid measurement of lumbar lordosis(CLL) were measured, according to position. RESULTS: Significant difference between the positions was shown on the CLL and lordosis angle. Differences between positions analyzed from Taillard, DuPuis, modified Qunnell & Stockdale method, Ferguson angle and slip angle had no statistical significance. Differences between positions analyzed from the pathologic movement of translation(>4 mm) had a clinically significance in the upright position rather than the decubitus. CONCLUSION: The lateral flexion-extension radiographs on upright position rather than decubitus position are considered as the more useful diagnostic method.
Animals ; Humans ; Lordosis ; Prospective Studies ; Spine ; Spondylolisthesis*

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Measurements of Lateral Mass of Cervical Spine Using MRI for Lateral Mass Screw Fixation.

Kyung Soo SUK ; Ki Tack KIM ; Sang Hoon LEE ; Kyung Nam RYU

Journal of Korean Society of Spine Surgery.2002;9(2):121-126. doi:10.4184/jkss.2002.9.2.121

STUDY DESIGN: Lateral mass was measured using MRI for lateral mass screw fixation. OBJECTIVES: To measure the lateral mass of cervical spine using MRI for lateral mass screw fixation and find out the ideal entry point and insertion angle and length of lateral mass screws. SUMMARY OF LITERATURE REVIEW: Two methods of screw placement are in common use. The original technique, described by Ray-mond Roy-Camille, places the screw in a more or less straight sagittal direction and angling the screw laterally 10 to 20 degrees. Margerl technique involves placing the screw parallel to the facet joint and angling the screw laterally 25 to 30 degrees. MATERIALS AND METHODS: Axial MR images of the cervical spine parallel to the facet joints were obtained from C3 to C6 of 10 patients. The mean age of the patients were 48.0 years. The patients consisted of 6 male and 4 female patients. Ideal entry points, insertion angle and length of the lateral mass for lateral mass screw fixation were measured on the axial MR images using PACS digital measuring instument . RESULTS: Ideal entry point of a lateral mass screw was center of lateral mass in sagittal plane, 16mm lateral to the midline of the cervical spine, ideal direction of the lateral mass screw was parallel to the facet joint and angling the screw laterally 25.3 degrees, and ideal length of lateral mass screw was 17.9mm. CONCLUSIONS: Based on the results of the study, there were some differences of measurements depending on the patients and the level of the cervical spine. Therefore, a preoperative measurement of lateral mass was recommended in each patient and each level of the cervical spine.
Female ; Humans ; Magnetic Resonance Imaging* ; Male ; Spine* ; Zygapophyseal Joint

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Significance of Chin-brow Vertical Angle in Correction of Kyphotic Deformity of Ankylosing Spondylitis Patients.

Kyung Soo SUK ; Ki Tack KIM ; Jin Moon KIM ; Kwang Hoon CHUNG

Journal of Korean Society of Spine Surgery.2002;9(2):115-120. doi:10.4184/jkss.2002.9.2.115

STUDY DESIGN: Retrospective study of 34 ankylosing spondylitis patients with kyphotic deformity who performed correction osteotomy. OBJECTIVES: To assess significance of chin-brow vertical angle for planning and evaluating correction of kyphotic deformity with ankylosis of cervical spine in ankylosing spondylitis patients. SUMMARY OF LITERATURE REVIEW: Accurate assessment and measurement of spinal kyphotic deformity is required when planning treatment and assessing its results. The most reliable measure of trunk deformity is the chin-brow vertical angle. MATERIALS AND METHODS: Thirty-four ankylosing spondylitis patients with cervical ankylosis who had underwent pedicle subtraction extension osteotomy for correction of kyphotic deformity were studied. The patients consisted of 32 male and 2 female patients. Mean age was 35.7 years. Most common apex of kyphosis was T12 in 11 cases. The levels of osteotomy were L1 in 3 case, L2 in 4 cases, L3 in 17 cases, and L4 in 10 cases. Radiographic assessment for sagittal balance was performed by measuring thoracic kyphosis, lumbar lordosis, and distance between the vertical line on anterosuperior point of T1 and that of S1. Chin brow-vertical angle was measured on the preoperative and postoperative clinical photo of the patients. Clinical outcomes were assessed by questionnaire measuring changes in physical function, indoor activity, outdoor activity, psychosocial activity, pain, and patient 's satisfaction with the surgery. RESULTS: Chin brow-vertical angle was 35.5 degrees preoperatively and 1.8 degrees postoperatively. Final follow-up radiograph showed an increase in lumbar lordosis from 5.5 to 43.2 degrees(an increase of 37.7 degrees) while thoracic kyphosis remain stable from 50.4 to 50.2 degrees. Sagittal imbalance significantly improved from 101.5 to12.7 mm. Decreased chin-brow vertical angle correlated negatively with correction angle while chin-brow vertical angle did not correlate with overall clinical outcome. However, the patients with chin brow vertical angle greater than 10 degrees or less than -10 degree had significantly low score concerning the item of horizontal gaze. CONCLUSIONS: The ankylosing spondylitis patient with cervical ankylosis, who had chin-brow vertical angle ranging from -10 to 10 degrees, had better horizontal gaze. Based on the results of this study, measurement of chin-brow vertical angle was recom-mended for planning correction of kyphosis and accurate evaluation of treatment outcome.
Animals ; Ankylosis ; Chin ; Congenital Abnormalities* ; Female ; Follow-Up Studies ; Humans ; Kyphosis ; Lordosis ; Male ; Osteotomy ; Surveys and Questionnaires ; Retrospective Studies ; Spine ; Spondylitis, Ankylosing* ; Treatment Outcome

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Tactics for Surgical Treatment of the Double Thoracic Scoliosis: Significance of T1 tilt, first rib elevation and correction ratio.

Dong Ho LEE ; Jae Chul LEE ; Sae Hoon KIM ; Soo Taek LIM ; Bong Soon CHANG ; Choon Ki LEE ; Se Il SUK

Journal of Korean Society of Spine Surgery.2002;9(2):106-114. doi:10.4184/jkss.2002.9.2.106

STUDY DESIGN: A retrospective clinical and radiographic review. OBJECTIVES: The purpose of this study is to suggest the indications and more ideal objective amount of corrections of for upper and lower curves. SUMMARY OF LITERATURE REVIEW: There are many controversies exist about the diagnosis and treatment of double thoracic scoliosis yet. MATERIALS AND METHODS: Thirty-nine double thoracic scoliosis patients with left shoulder elevation and/or positive T1 tilt and an upper curve of 25 degrees or more were divided into two groups. Group I (24 patients) underwent fusion on both curves, and Group II (15 patients), on the lower curve alone. Cobb angles, T1 tilt, left first rib elevation (represents trapezial prominence), and shoulder level difference were measured from standing on pre- and post-operative standing films. The correction ratio [Upper curve correction(%)/Lower curve correction(%)] was used to represent describe how much the upper curve was had been corrected compared to versus the lower curve. RESULTS: T1 tilt did not correlate well with left shoulder elevation, but correlated with left first rib elevation. In Group I, T1 tilt and left first rib elevation improved significantly after fusion of the upper curve, whereas these were aggravated in Group II. In Group I, most of the patients with the a correction ratio of more than 0.8, showed balanced shoulder levels finally. CONCLUSIONS: In double thoracic scoliosis patients, T1 tilt and left first rib elevation should be considered in addition to not only left shoulder elevation and the rigidity of upper curve, but also the T1 tilt and left first rib elevation should be considered as the indication of the extension of fusion to upper curve. The amount of upper curve correction should be more than at least 80% of that of the lower curve for a balanced correction in the treatment of double thoracic scoliosis.
Diagnosis ; Humans ; Retrospective Studies ; Ribs* ; Scoliosis* ; Shoulder

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Determination of Distal Fusion Level with Segmental Pedicle Screw Fixation in Single Thoracic Idiopathic Scoliosis.

Se Il SUK ; Jin Hyok KIM ; Sang Min LEE ; Ewy Ryong CHUNG ; Ki Ho NAH ; Jung Hee LEE ; Sung Soo KIM ; Soo Chul PARK ; Rack Yong CHUNG ; Sung Wook WON

Journal of Korean Society of Spine Surgery.2002;9(2):98-105. doi:10.4184/jkss.2002.9.2.98

STUDY DESIGN: Retrospective study. OBJECTIVES: To determine the exact distal fusion level in the treatment of single thoracic idiopathic scoliosis (King III and IV) with segmental pedicle screw fixation and rod rotation. SUMMARY OF LITERATURE REVIEW: Pedicle screw fixation effectively shortens the distal fusion extent by improved 3-D deformity correction. However, the selection of distal fusion extent remains controversial in single thoracic idiopathic scoliosis. MATERIAL AND METHODS: Forty-two single thoracic adolescent idiopathic scoliosis patients subject to segmental pedicle screw fixation and rod rotation with minimum follow-up of 2 years (2-6 years) were analyzed. The patients were grouped according to the distal fusion level with reference to the standing neutral vertebra (NV) for comparison of deformity correction, radiological and clinical spinal balance using standing radiographs. Distal fusion down to NV +1 was in 9 patients, NV in 5, NV-1 in 9, NV-2 in 12 and NV-3 in 7 patients respectively. RESULTS: Preoperative 50+/-11 degrees of thoracic deformity was corrected to 13+/-5 degrees showing 74% of curve correction. Preoperative 23+/-7 degrees of lumbar deformity was corrected to 2+/-8 degrees showing 93% of curve correction. Postoperative adding on deformity was obtained in 14 patients. Significant difference was found not by King classification but by distal fusion level: significantly higher chance of unsatisfactory results from not going to the NV-1 (p=0.001). CONCLUSIONS: In correction of single thoracic idiopathic scoliosis with segmental pedicle screw fixation, the curve should be fused to NV-1 saving one or more motion segments when compared to the fusion to the stable vertebra.
Adolescent ; Classification ; Congenital Abnormalities ; Follow-Up Studies ; Humans ; Retrospective Studies ; Scoliosis* ; Spine

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Scoliosis in Children after Surgery for Congenital Heart Disease.

Jae Chul LEE ; Dong Ho LEE ; Jun Hwan AHN ; Soo Taek LIM ; Bong Soon CHANG ; Choon Ki LEE ; Se Il SUK

Journal of Korean Society of Spine Surgery.2002;9(2):91-97. doi:10.4184/jkss.2002.9.2.91

STUDY DESIGN: A retrospective study. OBJECTIVES: To analyze natural history and clinical features of scoliosis developed after surgery for congenital heart disease and to investigate the influence of cardiac surgery on the onset and progression of scoliosis. MATERIALS AND METHODS: Three hundred and five patients who had been operated for congenital heart disease from Jan.1988 to Dec.1990 and followed up for more than 5 years were analyzed. The curve which was more than 10 degrees on radiography was defined as significant scoliosis and the patients with congenital spinal anomalies were excluded. We compared age at surgery, cardiac disease and effect of cyanosis between scoliosis and non-scoliosis group. Furthermore, in scoliosis group, prevalence, onset of significant scoliosis, and manifestation of curve according to side of thoracotomy were assessed. RESULTS: Fifty-six patients(18.4%) had scoliosis of more than 10 degrees. As for location, high thoracic in 19, thoracic in 23, double thoracic in 8, thoraco-lumbar in 5 and double major in 1. Of the 42 patients with thoracic or high thoracic curves, 17(40%) showed convexity to the left. The magnitudes of curves were less than 40 degrees except 1. There was no significant difference in prevalence(p=0.513) and Cobb angle(p=0.634) between cyanosis and acyanosis group. Scoliosis developed between 3 and 6 years after cardiac operation in 26 patients(46%). In high thoracic curve, 6 of 7 patients with left thoracotomy demonstrated convexity to the left and 5 of 6 patients with right thoracotomy demonstrated convexity to the right(p=0.026). CONCLUSIONS: The prevalence of scoliosis after surgery for congenital heart disease was 18.4%. High thoracic and left thoracic curves were more frequent compared to idiopathic curves and a half of them developed 3 to 6 years after cardiac surgery. Most patients did not have severe curve to need surgical intervention and there was no correlation between severity of scoliosis and age at cardiac operation and cyanosis. In high thoracic curve, the tendency for the curve to be convex to the side of cardiac approach was demonstrated.
Child* ; Cyanosis ; Heart Defects, Congenital* ; Humans ; Natural History ; Prevalence ; Radiography ; Retrospective Studies ; Scoliosis* ; Thoracic Surgery ; Thoracotomy

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