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Cervical Intervertebral Disc Calcification in Children: A Case Report.

Dong Eun SHIN ; Chang Soo AHN ; Yong Suk CHO

Journal of Korean Society of Spine Surgery.2011;18(4):254-258. doi:10.4184/jkss.2011.18.4.254

STUDY DESIGN: A case report. OBJECTIVES: This case report presents a child who was treated conservatively after having being diagnosed with cervical intervertebral disc calcification. SUMMARY OF LITERATURE REVIEW: Cervical intervertebral disc calcification is considered as a degenerative change of spine. It is common in adults and in most cases, no symptoms are observed. In children, by contrast, it is a rare condition and frequently accompanies symptoms such as severe neck pain and dysphagia. MATERIALS AND METHODS: A 7-year-old male patient who suffered from neck pain and torticollis without trauma had been diagnosed with cervical intervertebral disc calcification and was treated conservatively. He was discharged after symptom relief, and has been followed up and observed in our outpatient department. RESULTS: The improvements of symptom and radiographic findings were found in the month follow up. CONCLUSIONS: Cervical intervertebral disc calcification shows similar symptoms to laryngopharyngeal abscess, traumatic injury and infective spondylitis, but through careful physical examination and radiologic evaluation, differential diagnosis is possible. After diagnosis, conservative treatment alone is sufficient. Antibiotic usage and surgical treatment are avoidable.
Abscess ; Adult ; Child ; Diagnosis, Differential ; Humans ; Intervertebral Disc ; Male ; Neck Pain ; Outpatients ; Physical Examination ; Spine ; Spondylitis ; Torticollis

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A Treatment Guideline for Neuropathic Pain.

Kook Jin CHUNG ; Jae Hyup LEE ; Changju HWANG ; Myun Whan AHN

Journal of Korean Society of Spine Surgery.2011;18(4):246-253. doi:10.4184/jkss.2011.18.4.246

STUDY DESIGN: A review of literature including definition, diagnosis and treatment of neuropathic pain. OBJECTIVES: To review and discuss the treatment guideline for neuropathic pain. SUMMARY OF LITERATURE REVIEW: Neuropathic pains are characterized by partial or complete somatosensory change caused by various disorders affecting central and peripheral nervous system, and are especially problematic because of their severity, chronicity and resistance to simple analgesics. MATERIALS AND METHODS: Review of literature. RESULTS: Tricyclic antidepressants and the anticonvulsants gabapentin and pregablin were recommended as first-line treatments for neuropathic pain. Opioid analgesics and tramadol were recommended as second-line treatments that can be considered for first-line use in selected clinical circumstances. Other medications such as dual reuptake inhibitors of both serotonin and norepinephrine would be used in severe cases. More invasive interventions (e.g., spinal cord stimulation) may sometimes be helpful. CONCLUSIONS: Treatment must be individualized for each patient and aggressive, combinatory pharmacotherapy and multidisciplinary approach are recommended for the treatment of neuropathic pain.
Amines ; Analgesics, Opioid ; Anticonvulsants ; Antidepressive Agents, Tricyclic ; Cyclohexanecarboxylic Acids ; gamma-Aminobutyric Acid ; Humans ; Neuralgia ; Norepinephrine ; Peripheral Nervous System ; Serotonin ; Spinal Cord ; Tramadol

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Gastrointestinal Risk Assessment in the Patients Taking Nonsteroidal Anti-inflammarory Drugs for Lumbar Spinal Disease.

Byung ho LEE ; Byung Joon SHIN ; Dong Jun KIM ; Jae Chul LEE ; Kyung Soo SUK ; Ye Soo PARK ; Ki Won KIM ; Kyu Jung CHO ; Keun young SHIN ; Min suk KOH ; Seong Hwan MOON

Journal of Korean Society of Spine Surgery.2011;18(4):239-245. doi:10.4184/jkss.2011.18.4.239

STUDY DESIGN: A cross-section observational study. OBJECTIVES: To evaluate the current prescription patterns of non-steroidal anti-inflammatory drugs (NSAIDs) and gastrointestinal (GI) risk assessment in patients with lumbar spine disease. SUMMARY OF LITERATURE REVIEW: NSAIDs are commonly prescribed medications for lumbar spine disease patients. Since the rate of GI complication varies for each patient, identification of individual GI risks is a prerequisite to prevent such a complication. There are few reports about the GI risks in patients with lumbar spine disease who take NSAIDs. MATERIALS AND METHODS: 2264 patients with lumbar degenerative spondylopathy who were taking NSAIDs were enrolled from May 2010 to September 2010. The Standardized Calculator of Risk for Event (SCORE) was used to measure patients' GI risk factors. NSAID prescription patterns and GI protective agents were also investigated. RESULTS: Being aged over 65 (1098 patients; 48.5%) and the presence of GI side-effects from NSAIDs (896 patients; 39.6%) were the most common risk factors. 31.9% and 5.8% percent of patients belonged to each of the high risk and the very high risk groups in GI risk factor analysis. The total prescription rate of gastroprotectants was 91.7% for all patients. However, the prescription rate of selective COX-2 inhibitors in the high risk group was low, and in 54.8% of patients who took COX-2 inhibitors there was GI discomfort. CONCLUSIONS: The prescription pattern of GI protective agents was not correlated with GI symptoms. Therefore, physicians should consider NSAID prescription based on the GI risk factors of individual patients.
Aged ; Anti-Inflammatory Agents, Non-Steroidal ; Cyclooxygenase 2 Inhibitors ; Humans ; Prescriptions ; Protective Agents ; Risk Assessment ; Risk Factors ; Spinal Diseases ; Spine

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Efficacy of Posterior Lumbar Interbody Fusion using PEEK Cage and Pedicle Screw Stabilization in Degenerative Lumbar Spinal Disorders: Minimum 3 Years Follow up Results.

Kyung Jin SONG ; Kwang Bok LEE ; Dong Hun HAM

Journal of Korean Society of Spine Surgery.2011;18(4):230-238. doi:10.4184/jkss.2011.18.4.230

STUDY DESIGN: A retrospective study. OBJECTIVES: To evaluate the three-plus year follow-up results of patients who underwent posterior lumbar interbody fusion with PEEK cage and pedicle screw fixation for lumbar degenerative disease. SUMMARY OF LITERATURE REVIEW: There are few previous reports addressing posterior lumbar interbody fusion using PEEK cage with mid-term follow up periods. MATERIALS AND METHODS: 260 patients who underwent posterior lumbar interbody fusion with PEEK cage and pedicle screw fixation for lumbar degenerative disease were enrolled. We classified patients into three groups according to their fusion level: group A (n=151) had one-level fusion, and group B (n=91) had two-level fusion, and group C (n=18) had three-level fusion. Clinical outcomes were evaluated by pre- and post-operative Visual analogue scale (VAS) scores, the Oswestry Disability Index (ODI), and complication and reoperation rates. Radiologic outcomes were measured by the fusion rate, sagittal alignment, disc height and changes. RESULTS: VAS (pre-operative to final follow-up) changed from 7.62+/-2.03 (5-10) to 3.19+/-1.94 (1-8) in group A, from 6.83+/-2.28(4-9) to 4.51+/-2.18(2-9) in group B and from 7.17+/-2.46 (5-10) to 4.63+/-1.97(1-9) in group C. Final follow-up ODI also decreased in group A (17.6+/-8.56%), group B (15.4+/-5.46%) and group C (24.7+/-7.46%). This corresponds to scores of 94.7% in group A, 92.3% in group B and 94.4% in group C. There were significant differences between preoperative, post-operative and final follow-up lumbar lordosis [p=0.042(group A), 0.036(group B), 0.045(group C)], segmental lordosis [p=0.036(group A), 0.039(group B), 0.047(group C)]. Reoperation was performed in patients 8 group A, 4 group B, and 1 group C, and there is no significant diffrence between groups. Adjacent segmental change was found in all reoperation patients, but showed no correlation with clinical results. CONCLUSIONS: Posterior lumbar interbody fusion with PEEK cage and pedicle screw fixation in lumbar degenerative disease showed excellent clinical results and fusion rates, regardless of patient fusion levels.
Animals ; Follow-Up Studies ; Humans ; Ketones ; Lordosis ; Polyethylene Glycols ; Reoperation ; Retrospective Studies

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Changes in Sagittal Spinopelvic Parameters according to Pelvic Incidence in Asymptomatic Old Korean Men.

Kyu Bok KANG ; Young Jun AHN ; Yongjung J KIM ; Young Bae KIM ; Sung Chul PARK

Journal of Korean Society of Spine Surgery.2011;18(4):223-229. doi:10.4184/jkss.2011.18.4.223

STUDY DESIGN: A radiographic study of normal subjects. OBJECTIVES: To analyze sagittal spinal parameters according to the size of pelvic incidence (PI). SUMMARY OF LITERATURE REVIEW: There has been no previous study about the classification of spinopelvic parameters that has used a large cohort of asymptomatic older men with the same ethnic background as those in the current study. MATERIALS AND METHODS: We examined 160 males aged over 50 without disease, trauma, or history of operation on spine or lower extremities. Sagittal standing radiographs of the whole spine on 36-inch film were taken. Group 1 (n=30) had a PI of less than 40degrees. Group 2 (n=71) had PI between 40degrees and 50degrees, and group 3 (n=59) had a PI greater than 50degrees. Thoracic kyphosis, thoracolumbar kyphosis, lumbar lordosis, the vertebral slope of T12, sacral slope, and pelvic incidence were measured. The distances from the plumb line of C7, T12, and the lumbar apex to the posterosuperior corner of the sacrum were also measured. RESULTS: Subjects' average age was 64.1(53~83).Lumbar lordosis, sacral slope and pelvic tilt were all significantly increased in group 3. Thoracic kyphosis and the vertebral slope of T12 were not different between groups. The distances from the plumb line of C7, T12, and the lumbar apex to the posterosuperior corner of the sacrum were significantly translated anteriorly in group 3. CONCLUSIONS: Group 3, who had the largest PI, demonstrated the largest lumbar lordosis and the most forward transition of trunk. However there were no differences in thoracic kyphosis and the vertebral slope of T12 among the three groups.
Aged ; Animals ; Cohort Studies ; Humans ; Incidence ; Kyphosis ; Lordosis ; Lower Extremity ; Male ; Pelvis ; Sacrum ; Spine

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Posterior Lumbar Interbody Fusion Outcomes in Degenerative Lumbar Disease: Comparison of Results between Patients Over 70 and 50-65 Years of Age.

Eung Ha KIM ; Joon Hee YOON ; Yung Sung LEE ; Hae Dong JANG ; Hyung Tae KIM

Journal of Korean Society of Spine Surgery.2011;18(4):217-222. doi:10.4184/jkss.2011.18.4.217

STUDY DESIGN: A retrospective study. OBJECTIVES: This study analyzed the clinical and radiographic results of the posterior lumbar interbody fusion performed on patients 50-65 and >7-years-of-age suffering from degenerative lumbar disease. LITERATURE REVIEW SUMMARY: Several studies on posterior lumbar interbody fusion performed on patients aged about 65 years reported insignificant age-related differences in the spinal-fusion results. MATERIALS AND METHODS: The records of 121 patients with degenerative lumbar disease treated with posterior lumbar interbody fusion between 2004 and 2010 were assessed. The patients' clinical results, visual analogue scale (VAS) scores, Oswestry disability index (ODI) values, and complications before and after the surgery were compared. The radiographic results and changes in the fusion segmental angle before and after the surgery as well as in the height of the posterior intervertebral disc were also compared. RESULTS: In group A, comprising 44 patients >70-years-of-age, follow-up duration and number of comorbidities were 73.3 years and 17.8 months, respectively. In group B, comprising 77 patients 50-65-years-of-age, follow-up duration and number of comorbidities were 58.8 years and 31.8 months, respectively. In both groups, the average VAS scores and ODI values decreased. The incidence rate of vertebra-related postoperative complications was 13.6% in group A and 9.0% in group B. The incidence rate of general complications unrelated to the vertebra, was 18.1% in group A and 9.0% in group B. CONCLUSIONS: Posterior lumbar interbody fusion is considered effective even in patients over 70 years with a degenerative lumbar disease.
Aged ; Comorbidity ; Follow-Up Studies ; Humans ; Incidence ; Intervertebral Disc ; Postoperative Complications ; Retrospective Studies ; Spine ; Stress, Psychological

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Comparative Study of the Clinical Outcomes of Unilateral Transforaminal Lumbar Interbody Fusion(TLIF) with Bilateral TLIF using Wiltse Approach and Conventional Approach.

Ki Tack KIM ; Kyung Soo SUK ; Sang Hun LEE ; Jung Hee LEE ; Kyoung Jun PARK ; Eun Seok SON ; Yoon Ho KWACK ; Se Hyuk HONG

Journal of Korean Society of Spine Surgery.2011;18(4):208-216. doi:10.4184/jkss.2011.18.4.208

STUDY DESIGN: Comparative study. OBJECTIVES: To compare the outcomes of unilateral TLIF, bilateral TLIF using Wiltse approach and bilateral TLIF using conventional midline approach. SUMMARY OF LITERATURE REVIEW: There are many studies about outcomes of Unilateral TLIF, but few have compared the 3 different fusion procedures. MATERIALS AND METHODS: 60 patients were divided into 3 groups. Each group has enrolled 20 patients (Study group: unilateral TLIF, Control group 1: bilateral TLIF using Wiltse approach, Control group 2: bilateral TLIF using conventional midline approach). For clinical outcomes, we compared operative time, blood loss, time for ambulation and discharge, VAS for back pain and leg pain and ODI among three groups. For radiologic evaluation, disc height and segmental lordosis were examined. RESULTS: The mean operative time was 147 minutes in study group(SG), 172 minutes in control group 1(CG1), 167 minutes in control group 2(CG2). The mean total blood loss was 466ml in SG, 569ml in CG1, 1140ml in CG2 respectively. VAS for back pain at the third postoperative day significantly decreased in SG and CG1 compared with CG2. There was no significant difference in ODI, disc height and segmental lordosis among the groups. CONCLUSION: Using Wiltse approach, there were several advantages in decreasing blood loss, immediate postoperative back pain, hospital stay and early ambulation. Clinical and radiological results of unilateral TLIF were comparable with bilateral TLIF.
Animals ; Back Pain ; Early Ambulation ; Humans ; Leg ; Length of Stay ; Lordosis ; Operative Time ; Walking

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The Treatment of Traumatic Atlantoaxial Rotatory Subluxation (Fielding Type I) and the Correlation between the Clinical Progress and Radiological Reduction Parameter.

Seong Wan KIM ; Young Joon AHN ; Bo Kyu YANG ; Seung Rim YI ; Seok Jin KIM

Journal of Korean Society of Spine Surgery.2011;18(4):202-207. doi:10.4184/jkss.2011.18.4.202

STUDY DESIGN: This is a retrospective study. OBJECTIVES: We will discuss clinical outcomes of adult traumatic atlantoaxial rotatory subluxation (Fielding type I) and verify the correlation between the clinical outcomes and radiological reduction rate. SUMMARY OF LITERATURE REVIEW: Atlantoaxial rotatory subluxation which usually occur in children by non-traumatic sources or minor trauma has been discussed persistently. However, studies of atlantoaxial rotatory subluxation which occur in adults over 20 years old, especially by traumatic injury is rare. MATERIALS AND METHODS: From October 2004 to April 2011, thirty patients diagnosed of traumatic atlantoaxial rotatory subluxation with 6 months follow-up period were enrolled in the study. After diagnosis, we started treating Halter traction with 5 lbs. We discontinued traction when the patient recovered over 90% of ROM and applied Philadelphia collar to the patient. We measured visual analogue scale (VAS) for cervical pain and ROM. We measured atlanto-dens interval (ADI) and lateral mass-dens interval (LDI) difference using three-dimensional computed tomography (3D-CT) to validate radiological reduction rate. RESULTS: At the end of follow-up, none of the patients complained over pain and all recovered to full ROM. ADI was in normal range during the whole treatment period. LDI difference gradually decreased during treatment period, however, only 8 cases (26.7%) came back to normal range. CONCLUSIONS: In traumatic atlantoaxial rotatory subluxation (Fielding type I), satisfactory clinical outcomes such as pain relief or ROM improvement using traction and the radiological reduction rate was also improved but it failed to achieve a complete reduction of LDI difference in radiography.
Adult ; Child ; Follow-Up Studies ; Humans ; Neck Pain ; Philadelphia ; Porphyrins ; Reference Values ; Retrospective Studies ; Traction

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The Usefulness and Technique of Unilateral Extrapedicular Approach in Vertebroplasty.

Seong Jun AHN ; Bu Hwan KIM ; Moo Ho SONG ; Seong Ho YOO ; Doo Jae LEE

Journal of Korean Society of Spine Surgery.2011;18(4):195-201. doi:10.4184/jkss.2011.18.4.195

STUDY DESIGN: A retrospective study. OBJECTIVES: To evaluate the effectiveness of unilateral extrapedicular approach in the treatment of osteoporotic compression fracture, as compared to transbipedicular approach. SUMMARY OF LITERATURE REVIEW: There has been no comparative study assessing this topic. MATERIALS AND METHODS: 115 patients presenting with percutaneous vertebroplasty between Mar. 2002 and Feb. 2009, were divided into three groups: Group A (43 vertebrae; 29 patients) who were treated with bipedicular approach, Group B (66 vertebrae; 47 patients) treated with early cases of unilateral extrapedicular approach, and Group C (43 vertebrae; 39 patients) treated with late cases of unilateral extrapedicular approach. We analyzed radiological test results including the volume of injected cement and the distribution of intravertebral body, cement leakage, height restoration and kyphosis correction. Statistical analysis was done using SPSS. Clinical results were analyzed using VAS scores. RESULTS: The mean follow-up period varied from one year at minimum to seven years and six months at maximum. The mean volume of injected cement was 3.39cc/5.39cc/3.79cc for groups A, B and C respectively. Cement leakage was at 13.4/34.8/12.8% in each group. Cement leakage was higher in group B, but most leakage took place in early cases that we tried to inject more and more cement in early inexperienced period. Bilaterally well distributed cement in the vertebral body was at 85.7/76.9% in groups B and C respectively. VAS scores improved from 8.4/8.3/8.5 preoperatively to 2.0/2.0/1.6 postoperatively. CONCLUSIONS: Percutaneous vertebroplasty treated with unilateral extrapedicular approach can lessen perioperative operating time. This treatment led to clinical and radiologic results that were comparable to those with a bilateral transpedicular approach.
Follow-Up Studies ; Fractures, Compression ; Humans ; Hypogonadism ; Kyphosis ; Mitochondrial Diseases ; Ophthalmoplegia ; Retrospective Studies ; Vertebroplasty

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A Comparative Study of the Anterior Cervical Fusion with Harms Cage versus Iliac Bone Block: Clinical and Radiological Outcomes.

Jae Yoon CHUNG ; Ji Hyeon YIM ; Hyoung Yeon SEO ; Sung Kyu KIM ; Seung Hun LEE

Journal of Korean Society of Spine Surgery.2011;18(4):186-194. doi:10.4184/jkss.2011.18.4.186

STUDY DESIGN: A retrospective study. OBJECTIVES: To evaluate the clinical and radiological outcomes of anterior cervical fusion within Harms cage versus an iliac bone block graft. SUMMARY OF LITERATURE REVIEW: There is no current consensus regarding the optimal material for anterior cervical fusion. MATERIALS AND METHODS: This was a single-center study of 107 patients who either underwent anterior cervical fusion with an iliac bone block graft (n=56; group A) or a cancellous bone graft within the cervical Harms titanium cage (n=51; group B). Anterior plating occurred in all cases. Clinical outcomes and complications were evaluated using Visual Analogue Scale (VAS) scores and Odom's Criteria. Radiological outcomes were evaluated by the height of vertebral bodies, sagittal lordosis, the rate of bony union, and the subsidence of cage. RESULTS: The VAS of donor site pain was significantly higher in group A than in group B at the final follow-up. Sagittal lordosis was increased in both groups, but was significantly higher in group B than group A. The rate of bony union was 95% and 91% for both groups 6 months after surgery and reached 100% for both groups at the final follow-up. In terms of cage subsidence, the highest point of subsidence was at the inferior and posterior aspect of the cage and the average amount of subsidence was approximately 1.3 mm at final follow-up. CONCLUSIONS: Anterior cervical fusion using a cancellous bone graft within Harms titanium cage is a good method for anterior cervical fusion with iliac bone block.
Animals ; Consensus ; Follow-Up Studies ; Humans ; Lordosis ; Retrospective Studies ; Tissue Donors ; Titanium ; Transplants

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