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Differences of Fracture Patterns by the Level of the Thoracolumbar and Lumbar Burst Fractures.

Byung Joon SHIN ; Byung Woo KIM ; Yon Il KIM ; Soo Kyoon RAH

Journal of Korean Society of Spine Surgery.1998;5(1):47-52.

STUDY DESIGN: Surgically treated thirty-five Denis type B thoracolumbar and lumbar burst fractures were assessed to compare the differences of fracture patterns by the level of fracture. OBJECTIVE: To know the major surgical indications according to the level of fracture. SUMMARY OF BACKGROUND DATA: General operative indications of thoracolumbar and lumbar burst fractures were collapse of anterior body height more than 40-50%, kyphotic deformity more than 30 degrees, canal encroachment more than 50% and neurologic deficit. But we could not apply the same surgical indications to the whole thoraco]embar and lumbar burst fractures because their fracture patterns are different. METHODS: We compared the collapse of anterior body height, collapse of posterior body height, Cobb angle, wedge angle, canal encroachment and incidence of posterior injury according to the level of fracture. RESULTS: The higher the level of fracture, the more the collapse of anterior body height, Cobb angle, wedge angle and incidence of posterior injury But the lower the level of fracture, the more the canal encroachment. CONCLUSIONS: These results mean that the primary surgical indications for thoracolumbar junction are collapse of anterior body height, possibility of posterior injury and increased kyphosis, while for the lower lumbar fractures, amount of canal encroachment is an important factor to make decision for surgery.
Body Height ; Congenital Abnormalities ; Incidence ; Kyphosis ; Neurologic Manifestations

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Change of Lumbar Lordosis According to the Different Operative Positions.

Seong Hwan MOON ; Yong Ho KANG ; Nam Hyun KIM ; Jun Shik KIM ; Youn Yeong CHOI ; Hwan Mo LEE

Journal of Korean Society of Spine Surgery.1998;5(1):40-46.

No abstract available.
Animals ; Lordosis*

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Quantitation of C-reactive Protein Levels and Erythrocyte Sedimentation Rate after Spinal Surgery.

Dae Moo SHIM ; Tae Kyun KIM ; Ha Hun SONG ; Yong Suk SHIM ; Seong Ho LEE ; Jin Ho SONG

Journal of Korean Society of Spine Surgery.1998;5(1):33-39.

OBJECTIVES: In order to standardize the CRP, ESR and WBC count after three types of spinal surgery and get clinical usefulness from these laboratory dadas after spinal surgery and clincal usefulness of laboratory datas. MATERIAL AND METHODS: Three groups of patients(microdisectomy, anterior and posterior fusion) were chosen for the study. CRP, ESR and WBC levels were prospectively determined before surgery and at days 1-5, 10, 14,21 and 42 after surgery. RESULTS: In all patients, preoperative normal CRP level(<10mg/L) increased, reaching peak levels on the second day after anterior fusion(84.6mg/L), and at the third day after microdiscectomy(54.5mg/L) and posterolateral intercorporal fusion(152.2mg/L), with normalization in 5-10 days. Preoperative normal ESR level increased to peak level on the forth day after microdiscectomy(33.0mm/hr), and increased double peak levels after anterior(postoperative days 2&5) and posterolateral intercorporal fusion(postoperative days 3&5). ESR followed by a slow and irregular decrease, and at 42 days after surgery often remained elevated. WBC increased to variable peak level within normal limit in all patients. CONCLUSIONS: The rapid decline in CRP will probably be interrupted by a second rise or persisting elevation if infection occurs. CRP is presumably a better test than ESR for early detection of postoperative infection.
Blood Sedimentation* ; C-Reactive Protein* ; Erythrocytes* ; Humans ; Prospective Studies

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The Effects of TGF-beta1 & TGF-beta2 on the Proliferation of the Lumbar Facet Joint Capsule in Tissue Culture.

Kyu Yeol LEE ; Young Hyun YOO ; Kwang Woo CHO

Journal of Korean Society of Spine Surgery.1998;5(1):25-32.

STUDY DESIGN: This study was undertaken to document the effect of TGF-beta 1 and TGF-beta2 on the proliferation of lumbar facet joint capsule. OBJECTIVES: To study the effect of TGF-beta1 and TGF-beta2 on the proliferation of lumbar facet joint capsule and their proliferation mechanism. SUMMARY OF LITERATURE REVIEW: TGF-beta1 and TGF-beta proliferated mesenchymal tissue . This proliferatine mechanism was involved of PLC-gamma- 1 and tyrosine kinase in signalling. MATERIAL AND METHODS: Three lumbar facet joint capsule was cultured in DMEM-20 media. Its proliferatine and inhibited effect was studied under the metabolic inhibitors and trasnsforming growth factors . RESULTS: TGF-beta1, and TGF-beta2, increased cell proliferation dependent on time and dosage. Both of TGF-beta1, and TGF-beta 2, specific antisense oligonucleotide blocked tile autoc.me effect of growth factor, PLC-gamma-1 specific antisense oligonucleotide inhibited the effect of TGF-beta 1, and TGF-beta2, Genistin inhibited the effect of TGF-beta 1, and TGF-beta2, in time and dosage dependent manner. CONCLUSION: The cell proliferation of lumbar facet joint capsule was involved in PLC- gamma-1 and tyrosine kinase in signalling.
Cell Proliferation ; Intercellular Signaling Peptides and Proteins ; Protein-Tyrosine Kinases ; Transforming Growth Factor beta ; Transforming Growth Factor beta1* ; Transforming Growth Factor beta2* ; Zygapophyseal Joint*

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The Facet Tropism of Lumbar in Young Adults.

June Kyu LEE ; Jae Sung AHN ; Jang Ik LEE

Journal of Korean Society of Spine Surgery.1998;5(1):18-24.

STUDY DESIGN: The purpose of this study was to determine whether facet joint orientation and/or tropism influences the prevalence of disc degeneration in MRI in young patients. OBJECTIVE: 41 patients with disc degeneration disease including HNP in MRI were assesed on facet joint angles and tropism between 18 and 30 years old. SUMMARY OF BACKGROUD DATA: The patients who had back pain had association between disc degeneration and facet tropism in adults. But some authors have suggested that facet tropism has no clinical relevance. Physiologic aging and premature disc degeneration induce a gradual loss of water and proteoglycan from nucleus pulposus. METHODS: We reviewed the 41 MRI of lumbar spine with disc degeneration and measured facet joint angles on the mid-disc cut, which was parallel to inferior vertebral end-plate of superior vertebra. In simple X-ray, we reviewed relation between the transitional vertebrae and disc degeneration. It was analyzed statistically the facet joint angles and facet tropism in each levels. RESULTS: The mean facet angles was more increased in upper vertebral facet joints but statistically nonspecific. The facet tropism was not significant in all lumbar levels and the effects of transitional vertebrae on disc degeneration were ignorable and unclear. CONCLUSIONS: No statistical relationship was found among the magnitude of the angle and facet tropism and the presence of disc degeneration at any levels in young patients.
Adult ; Aging ; Back Pain ; Equidae ; Humans ; Intervertebral Disc Degeneration ; Magnetic Resonance Imaging ; Prevalence ; Proteoglycans ; Spine ; Tropism* ; Young Adult* ; Zygapophyseal Joint

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Lumbar Spinal Stenosis and Diabetes Mellitus: Comparison of Surgical Outcome.

Seung Rim PARK ; Hyoung Soo KIM ; Joon Soon KANG ; Woo Hyeong LEE ; Joo Hyung LEE ; Seung Jun PARK

Journal of Korean Society of Spine Surgery.1998;5(1):9-17.

STUDY DESIGN: This retrograde study was designed to compare the clinical features and postoperative clinical results of diabetic and non-diabetic patients who had undergone decompression and postero-lateral fusion with instrumentation. OBJECTIVE: To determine whether diabetes affected the outcome of surgery and to identify the clinical features associated with a poor outcome. SUMMARY OF BACKGROUND DATA: Symptoms of peripheral angiopathy and neuropathy as long-term complications of diabetes closely mimic those of lumbar stenosis and there may be a risk of inappropriate surgical intervention in patients with both diabetes and spinal stenosis. In the presence of diabetes, a poor surgical outcome might be expected. But only a few literatures have been documented. MATERIALS AND METHODS: We reviewed 21 diabetic(mean age 58.2 years) and 21 non-diabetic patients(mean age 61.3 years) who had undergone decompression and postero-lateral fusion with instrumentation for lumbar spinal stenosis at a mean of 32 months after operation by reviewing the medical records such as clinical symptoms and results of objective examination(including electrophysiologic study). RESULTS: The preoperative symptoms were similar in the two groups except that abrupt onset of symptoms, the presence of night pain and the absence of any posture-related pain relief were recorded only by diabetic patients. The level of decompression, co-morbidity rate, and intra-operative blood loss were similar in two groups, too. Nerve-conduction velocity was lowered in 66.7% of the diabetic and in 25% of the non-diabetic patients. Polyneuropathy, which are highly suspicious of diabetic neuropathy was detected 46.7% in only diabetic group. The long-term result was excellent or good for thirteen(61.9%) of the twenty-one diabetic patients and for nineteen(90.5%) of the twenty-one non-diabetic patients. CONCLUSIONS: Thus diabetic patients who haute spinal stenosis cannot be expected to have same clinical outcome as non-diabetic patients, which is consistent with the general belief of impression. Therefore, the selection of patient according to clinical and electrophysiologic findings would be the most important factor in determining the rate of success of surgical treatment.
Constriction, Pathologic ; Decompression ; Diabetes Mellitus* ; Diabetic Neuropathies ; Humans ; Medical Records ; Peripheral Vascular Diseases ; Polyneuropathies ; Spinal Stenosis*

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Biomechanical Evaluation of Supplemental Hook or Screw Fixation in Short Segment Spinal Instrumentation.

Jae Won YOU ; Tae Hong LIM

Journal of Korean Society of Spine Surgery.1998;5(1):1-8.

STUDY DESIGN: This biomechanical study was designed to perform flexibility tests in multiple loading directions to compare the stabilizing effects of supplemental hook or pedicle screw fixation on short segment pedicle instrumentation system. OBJECTIVE: To compare biomechanical flexibilities of short segment pedicle instrumentation constructs added by hook or pedicle screw fixation in an unstable calf spine model. SUMMARY OF BACKGROUND DATA: Short segment pedicle instrumentation is using recently for the surgical treatment of the unstable burst fractures of the thoracolumbar spine, but a high incidence of early screw tai lure in short segment pedicle instrumentation has reported. MATERIALS AND METHODS: Ten fresh frozen calf spines (T10-L3) were loaded with pure uncosstrained moments in flexion, extension, axial rotation, and lateral bending directions. A maximum moment of 6.4 Nm was achieved in 5 steps using dead weights. After removal of L1 vertebral body, testing was performed on intact specimens first and then each specimen after laminar hook or pedicle screw insertion on the short segment pedicle instrumentation of ISOLA implant. Any kinds of graft material or transfixation device were not used to make the worst possible case of instability of an injured spine. Three different fixation methods were instrumented. These included: (1) one level aboye and one level below with pedicle screw, (2) 2 levels above with pedicle screw and hook and one level below with pedicle screw, and (3) 2 levels abode and one level below with pedicle screws. RESULTS: At the level of corpectomy, all fixation methods significantly reduced motions in flexion, extension, and lateral bending as compared to the intact motion (P<0.001). The differences between all constructs were not statistically significant. The addition of a hook or screw on the short segment pedicle screw construct was not significantly reduced the flexibi lite as compared to the short segment pedicle screw construct. Axial rotational motions in groups I, II, and III were similar with each other and with intact motion as well and there were no significant statistical difference. The addition of the hook or screw on the short segment pedicle construct showed more stability as compared to the pedicle screw construct, but statistical difference was not. The addition of hook or screw on the short segment pedicle screw construct showed similar stability in all motions with each other. At the level above corpectomyl all tested fixation methods did not improve the axial rotational stability beyond the intact case, but reduced flexion, extension, and lateral bending motions significantly (p<0.001). The addition of hook or screw on the short segment pedicle screw construct showed significant stability in all motions (p<0.001) as compared to the short segment pedicle screw construct and their stabilities were similar with each other. CONCLUSIONS: All fixation methods showed more stabilities in all motions than normal specimen. The addition of pedicle screw on the short segment pedicle screw constructs are more stable than the addition of hook, but there was no statistical difference. Adding one level of fixation cranial to the fracture using pedicle screws or hooks may be necessary to decrease the rate of clinical failure and to enhance the stability of the construct with short segment pedicle instrumentation
Incidence ; Pliability ; Spine ; Transplants ; Weights and Measures

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Cervical Myelopathy due to Ossification of Yellow Ligament in a Patient with Reiter's Syndrome.

Kyung Soo SUK ; Ki Tack KIM ; Sang Hun LEE

Journal of Korean Society of Spine Surgery.2002;9(4):374-379. doi:10.4184/jkss.2002.9.4.374

Reiter's syndrome is described as an inflammation of the joints and tendon attachments at the joints, and is often accompanied by an inflammation of the eye;s conjunctiva and the mucous membranes, such as those of the mouth, urinary tract, vagina, and penis, and by a distinctive rash. Ossification of the yellow ligament associated with Reiter's syndrome has never been reported A 41-year old male patient with Reiter's syndrome was admitted to our hospital due to cervical myelopathy caused by ossification of yellow ligament. He was treated with laminectomy and fusion, from C3 to C7, by using a lateral mass screw and plate fixation. Laminectomy and fusion seems to be an appropriate treatment option for cervical myelopathy due to ossification of yellow ligament.
Adult ; Conjunctiva ; Exanthema ; Humans ; Inflammation ; Joints ; Laminectomy ; Ligaments* ; Male ; Mouth ; Mucous Membrane ; Penis ; Spinal Cord Diseases* ; Tendons ; Urinary Tract ; Vagina

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Preliminary Report of Temporary Posterior Instrumentation in Stable Thoracolumbar Burst Fractures.

Ho Guen CHANG ; Young Woo KIM ; Jong Churel JUNG ; Hyeong Su KIM ; Kee Byoung LEE

Journal of Korean Society of Spine Surgery.2002;9(4):364-373. doi:10.4184/jkss.2002.9.4.364

STUDY DESIGN: A prospective study of posterior instrumentation without fusion for the stable thoracolumbar fracture. OBJECTIVES: To confirm vertebral body collapse by roentgenography and computerized tomography after removing posterior instrumentation at 6 months postoperatively in stable thoracolumbar burst fractures. SUMMARY OF LITERATURE REVIEW: Many authors have reported that vertebral body collapse occurs after instrumentation removal. MATERIALS AND METHOD: Sixty patients admitted between March 1999 and March 2001 with thoracolumbar junction fractures were included. Patients were divided into 3 groups: Group I - the Conservative management group (20 patients), Group II - Reduction and posterior fixation with fusion group (20 patients), Group III - Reduction and temporary posterior fixation group (20 patients). The patients were aged between 21 and 49 years (mean 38), and the follow-up period exceeded 1 year (mean 13.3 months). We studied vertebral height, kyphotic angle, disc height and facet hypertrophy by roentgenography, and the continu-ity of the anterior cortical connection, cavity formation, sclerotic bone formation and new bone formation by CT. RESULTS: The loss of vertebral height was 7.9% (from 21.5 to 29.4%) in Group I, 3.7% in Group II (preop 35%, postop 12.7%, postop 1Yr. 16.4%), and 3.5% in Group III (preop. 35.2%, postop 5.6%, postop 1Yr. 9.1%). Loss of angulation was 4.2degrees (from 9.6 degrees to 13.8 degrees) in Group I, 3.0 degrees in Group II (preop 15.3 degrees, postop 7.2 degrees , postop. 1Yr. 10.2 degrees), and 3.0 degrees in Group III (preop 14.6 degrees , postop. 5.9 degrees , postop 1Yr. 8.9 degrees). Loss of disc height was not statistically different for the 3 groups. Degenerative changes of the posterior facet were seen 3 patients of Group I, 11 patients of Group II, and in 5 patients of group III. On CT scan of Group III, all cases showed cavity formation and sclerosis ,and continuity of the anterior cortical connection and of new bone formation into the cavity were seen in 18 cases. CONCLUSIONS: Vertebral body collapse were not observed by roentgenography by computerized tomography after removing the posterior instrumentation at 6 months postoperatively in stable thoracolumbar burst fractures.
Follow-Up Studies ; Humans ; Hypertrophy ; Osteogenesis ; Prospective Studies ; Radiography ; Sclerosis ; Tomography, X-Ray Computed

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Functional Outcome of the Surgical Correction of Neuromuscular Scoliosis.

Kee Won RHYU ; Kee Yong HA ; Young Hoon KIM ; Tae Hyok HWANG

Journal of Korean Society of Spine Surgery.2002;9(4):356-363. doi:10.4184/jkss.2002.9.4.356

STUDY DESIGN: A retrospective study of functional outcome after surgical correction of neuromuscular scoliosis. OBJECTIVES: To assess functional outcomes and their significances after the surgical correction of neuromuscular scoliosis. SUMMARY OF LITERATURE REVIEW: The surgical correction of neuromuscular scoliosis has been used to stabilize the trunk for balanced sitting, to improve cardiopulmonary function, and the function of the upper extremities. Many authors have reported favorable surgical results, but few studies have been undertaken on functional assessment after surgery. MATERIALS AND METHODS: Eighteen adult patients with neuromuscular scoliosis underwent surgical correction. Functional assessments were performed in terms of impairments, disabilities, and handicaps. The impairments included sitting ability, coronal Cobb's angle, pain after surgery, and cosmesis after surgery. The disabilities included dressing, feeding, toilet/bathing, locomotion, and the use of both hands, and the handicaps included the effort and time to care for patients. Each parameter was checked preoperatively, 6 months after surgery, and at the last follow-up. RESULTS: In terms of impairments, sitting ability, coronal Cobb's angle, pain, and cosmesis were improved by surgery. In terms of disabilities, dressing, toilet/bathing, and locomotion were not improved after surgical correction. However, the feeding and use of both hands were significantly improved. And, in terms of handicaps, both the effort and the time required for care were reduced post-surgically. CONCLUSIONS: We conclude that impairments, handicaps, and the functions of the upper extremities were improved after surgical intervention to stabilize the trunk and spine in cases of neuromuscular scoliosis, but that overall disabilities were unaffected. This latter apparent shortcoming is attributed to the inability of surgery to treat previous systemic disease affecting physical disabilities of lower extremities. However, surgical correction of neuromuscular scoliosis was found to be clinically significant in terms of improving the functions of the trunk and of the upper extremities.
Adult ; Bandages ; Follow-Up Studies ; Hand ; Humans ; Locomotion ; Lower Extremity ; Retrospective Studies ; Scoliosis* ; Spine ; Upper Extremity

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