• Journal of Korean Neurosurgical Society
• /
• 제43권5호
• /
• pp.221-226
• /
• 2008

Objective : The aim of the present study was to assess the safety and efficacy of the dynamic stabilization system in the treatment of degenerative spinal diseases. Methods : The study population included 20 consecutive patients (13 females, 7 males) with a mean age of $61{\pm}6.98$ years (range 46-70) who underwent decompression and dynamic stabilization with the Dynesys system between January 2005 and August 2006. The diagnoses included spinal stenosis with degenerative spondylolisthesis (9/20, 45%), degenerative spinal stenosis (5/20, 25%), adjacent segmental disease after fusion (3/20, 15%), spinal stenosis with degenerative scoliosis (2/20, 10%) and recurrent intervertebral lumbar disc herniation (1/20, 5%). All of the patients completed the visual analogue scale (VAS) and the Korean version of the Oswestry Disability Index (ODI). The following radiologic parameters were measured in all patients : global lordotic angles and segmental lordotic angles (stabilized segments, above and below adjacent segments). The range of motion (ROM) was then calculated. Results : The mean follow-up period was $27.25{\pm}5.16$ months (range 16-35 months), and 19 patients (95%) were available for follow-up. One patient had to have the implant removed. There were 30 stabilized segments in 19 patients. Monosegmental stabilization was performed in 9 patients (47.3%), 9 patients (47.3%) underwent two segmental stabilizations and one patient (5.3%) underwent three segmental stabilizations. The most frequently treated segment was L4-5 (15/30, 50%), followed by L3-4 (12/30, 40%) and L5-S1 (3/30, 10%). The VAS decreased from $8.55{\pm}1.21$ to $2.20{\pm}1.70$ (p<0.001), and the patients' mean score on the Korean version of the ODI improved from $79.58%{\pm}15.93%$ to $22.17%{\pm}17.24%$ (p<0.001). No statistically significant changes were seen on the ROM at the stabilized segments (p=0.502) and adjacent segments (above segments, p=0.453, below segments, p=0.062). There were no patients with implant failure. Conclusion : The results of this study show that the Dynesys system could preserve the motion of stabilized segments and provide clinical improvement in patients with degenerative spinal stenosis with instability. Thus, dynamic stabilization systems with adequate decompression may be an alternative surgical option to conventional fusion in selected patients.

• Journal of Korean Neurosurgical Society
• /
• 제30권10호
• /
• pp.1193-1199
• /
• 2001

Objectives : The goal of operation for degenerative lumbar diseases is to relieve radiculopathy and low back pain and to prevent further degeneration. The authors analyzed the surgical results of posterior lumbar interbody fusion(PLIF) and $0^{\circ}$ fixation to evaluate the proper treatment policy in spinal stenosis, degenerative spondylolisthesis and low grade isthmic spondylolisthesis. Material and Methods : The authors performed PLIF on 92 patients and $0^{\circ}$ fixation on 138 patients with spinal stenosis, degenerative spondylolisthesis and low grade isthmic spondylolisthesis. We retrospectively studied clinical outcomes and subjective satisfaction of these patients by several criteria such as visual analog scale(VAS), Prolo's economic and functional outcome scale, medication usage after operation and questionaire for overall outcome. Result : Pre- and postoperative VAS on back pain and leg pain showed decrease of pain from 6.5, 6.7 to 2.2, 2.4 in PLIF group and from 7.0, 7.2 to 2.5, 2.7 in $0^{\circ}$ fixation group. Excellent and good outcomes on Prolo's scale were 81.5% in PLIF group and 82.6% in $0^{\circ}$ fixation group. Medication usage after operation was reduced in 79.3% of PLIF group and in 78.3% of $0^{\circ}$ fixation group. Patients' self-reported overall success of their procedure showed 82% in PLIF group and 84% in $0^{\circ}$ fixation group. Conclusion : Both PLIF and $0^{\circ}$ fixation showed good outcomes and provided biomechanically stable fusion in spinal stenosis, degenerative spondylolisthesis and low grade isthmic spondylolisthesis. Therefore, only PLIF seems necessary and considered a proper surgical treatment for these disorders.

• Journal of Korean Neurosurgical Society
• /
• 제29권2호
• /
• pp.180-187
• /
• 2000

Objective : A number of evidence have suggested a pivotal role of matrix metalloproteinases(MMP) on the degeneration of intervertebral disc. Proteins of intervertebral disc mainly consist of collagen and proteoglycan. These proteins can be destructed by MMP, resulting in changes of main collagen type and degeneration of matrix proteins. The present study was to determine the different effects of MMP-1 and MMP-2 on the degenerative spinal diseases, resulting from aging process. Clinical Materials & Methods : Thirty-one patients were randomly selected among 350 patients whose discs were resected during operation from March 1997 to February 1999. Patients were divided into two groups: group I with spinal stenosis and group II with herniated intervertebral disc. Group II was subdivided into the ruptured(Group Iia) and unruptured(Group Iib). Increases in MMP-1 immunopositive cells were observed in both groups, as evidenced by immunocytochemical staining. However, in marked contrast, the number of MMP-2 immunopositive cells were only seen in group II. There was no significant difference between Group IIa and Group IIb. The MMP-2 immunopositive cells were increased in the anulus fibrosus of ruptured(Group Iia) more than unruptured(Group Iib), but statistically it was not significant. In addition, the immunopositivity of MMP-1 and MMP-2 was proportional to patients's age. Conclusion : These results strongly suggests the possible involvement of MMP-2, but not MMP-1 in progressive herniated intervertevral disc.

• Tuberculosis and Respiratory Diseases
• /
• 제69권5호
• /
• pp.389-391
• /
• 2010

Spinal epidural emphysema is rare and has been described secondary to following medical intervention, such as lumbar puncture and epidural analgesia, pneumothorax or pneumomediastinum, degenerative disk disease, epidural abscess, and trauma. Rarely, it occurs after chest tube placement. We report a case of spinal epidural emphysema incidentally noted on HRCT after chest tube placement.

• Journal of Korean Neurosurgical Society
• /
• 제29권5호
• /
• pp.599-603
• /
• 2000

Objectives : In lumbar spine surgery it is observed that the ligamentum flavum(LF) is bilayered, and the inner layers can be left in situ to prevent peridural adhesion in open lumbar disc surgeries. The purposes of this study are to investigate ultrastructural differences between the inner and outer layer of lumbar LF by electron microscopic examination, and to see whether these differences are, if present, more prominent in chronic degenerative lumbar spinal disorders as compared with acute lumbar disc diseases. Methods : Biopsy specimens of LF were obtained from nine patients undergoing lumbar spine surgery, five of them for degenerative spinal stenosis and four for acute disc herniation. During the surgery the outer layers of LF were carefully dissected from the inner layer, and four pieces($1{\times}1{\times}1-mm$) of biopsy samples were made from each layer. These were examined with electron microscope for the morphologies and the contents of the elastic and the collagen fibers. Results : The outer layer of LF showed elastic fiber degeneration as evidenced and decreased fiber content, while the inner layer was relatively preserved in both cases of degenerative spinal stenosis and acute disc herniation. The ultrastructural changes of the layers were more evident in the outer layer. Conclusion : With these observations the authors believe that the LF degeneration may occur mainly in the outer layer, and that this fact may aid in making the rationale for using the inner layer as physiologic barrier to prevent peridural adhesion in open lumbar disc surgeries.

• Journal of Korean Neurosurgical Society
• /
• 제63권6호
• /
• pp.730-737
• /
• 2020

Objective : Spinal degeneration is a progressive disease, worsening over time. Lumbar degenerative disease (LDD) is a major spinal disease in elderly patients. Surgical treatment is considered for medically intractable patients with LDD and reoperation after primary surgery is not uncommon. The surgical outcome is occasionally unpredictable because of comorbidities. In the present study, the relationship between comorbidities and the incidence of reoperation for LDD over time was determined. Methods : The claims data of the health insurance national database were used to identify a cohort of patients who underwent spinal surgery for LDD in 2009. The patients were followed up until 2016. Medical comorbidity was assessed according to the Charlson comorbidity index (CCI). Cox proportional hazard regression modeling was used to identify significant differences in sex, surgery, age, causative disease, and comorbidity. Results : The study cohort included 78241 patients; 10328 patients (13.2%) underwent reoperation during the observation period. The reoperation rate was statistically higher (p<0.01) in males, patients 55-74 years and 65-74 years of age, and patients with decompression or discectomy. Significant association was found between increasing reoperation rate and CCI score (p<0.01). Based on multivariate analysis of comorbidities, the significantly higher reoperation rates were observed in patients with peripheral vascular disease, pulmonary lung disease, peptic ulcer, diabetes, and diabetes complications (p<0.01). Conclusion : The study results indicate the reoperation rate for LDD is associated with patient comorbidities. The comorbidities identified in this study could be helpful in future LDD studies.

• 대한한방부인과학회지
• /
• 제19권3호
• /
• pp.203-213
• /
• 2006

Purpose : This study was carried out to evaluate correlation between Bone Mineral Density(BMD) and degenerative lumbar disease in postmenopausal low back pain patients. Methods : 69 postmenopausal patients with low back pain were examined. Magnetic resonance imaging was performed to evaluate degenerative lumbar disease and bone mineral density of lumbar spine was measured by Dual energy X-ray absorptiometry. Data were analyzed by Pearson's Linear Correlation Coefficient. Results : In postmenopausal patients with low back pain, BMD(T-score, Z-score) had negative correlation with the grade of intervertebral disc herniation and positive correlation with weight. Other lumbar diseases including Spinal stenosis, Spondylolisthesis and Facet joint arthrosis didn't have significant correlation with BMD. Conclusion : In postmenopausal patients with low back pain, BMD(T-score, Z-score) had inverse relationship with the grade of intervertebral disc herniation.

• Journal of Korean Neurosurgical Society
• /
• 제61권1호
• /
• pp.114-119
• /
• 2018

Objective : The purpose of this study was to determine the feasibility of screw fixation in previously augmented vertebrae with bone cement. We also investigated the influence of cement distribution pattern on the surgical technique. Methods : Fourteen patients who required screw fixation at the level of the previous percutaneous vertebroplasty or balloon kyphoplasty were enrolled in this study. The indications for screw fixation in the previously augmented vertebrae with bone cement included delayed complications, such as cement dislodgement, cement leakage with neurologic deficits, and various degenerative spinal diseases, such as spondylolisthesis or foraminal stenosis. Clinical outcomes, including pain scale scores, cement distribution pattern, and procedure-related complications were assessed. Results : Three patients underwent posterior screw fixation in previously cemented vertebrae due to cement dislodgement or progressive kyphosis. Three patients required posterior screw fixation for cement leakage or displacement of fracture fragments with neurologic deficits. Eight patients underwent posterior screw fixation due to various degenerative spinal diseases. It was possible to insert screws in the previously augmented vertebrae regardless of the cement distribution pattern; however, screw insertion was more difficult and changed directions in the patients with cemented vertebrae exhibiting a solid pattern rather than a trabecular pattern. All patients showed significant improvements in pain compared with the preoperative levels, and no patient experienced neurologic deterioration as seen at the final follow-up. Conclusion : For patients with vertebrae previously augmented with bone cement, posterior screw fixation is not a contraindication, but is a feasible option.

• 척추신경추나의학회지
• /
• 제1권1호
• /
• pp.105-111
• /
• 2006

Objective : The aim of this study was to evaluate association between lumbar spinal stenosis, one of degenerative diseases, and bone mineral density. Methods : We monitored 9 lumbar spinal stenosis patients in women above 50 years, visiting outpatient clinic of the Jaseng Oriental Medicine Hospital between January 5 2006 and March 31, 2006. They were diagnosed by radiologist ist after taking Magnetic Resonance Imaging(MRI). The cases were Investigated the bone mineral density using Dual Energy X-ray Absorptiomerty(DEXA). and then Picture Archiving Communication System(PACS) were used to assess correlation between lumbar spinal stenosis and bone mineral density. Results : 1. In comparison of the spinal canal area and lumbar spine 2 level bone mineral density, the data showed a significant result 2. The data, between spinal canal area and lumbar spine 1-2 level bone mineral density, indicated a significant result. 3. Also, the result of comparison between spinal canal area and the lowest value of bone mineral density showed significance. Conclusions : It showed that there is a statistically significant correlation between lumbar spinal stenosis and bone mineral density.

• Journal of Korean Neurosurgical Society
• /
• 제54권4호
• /
• pp.323-328
• /
• 2013

Objective : The purpose of this study was to examine the efficacy and perioperative complications associated with lumbar spinal fusion surgery, focusing on geriatric patients in the Republic of Korea. Methods : We retrospectively investigated 485 patients with degenerative spinal diseases who had lumbar spinal fusion surgeries between March 2006 and December 2010 at our institution. Age, sex, comorbidity, American Society of Anesthesiologists (ASA) class, fusion segments, perioperative complications, and outcomes were analyzed in this study. Risk factors for complications and their association with age were analyzed. Results : In this study, 81 patients presented complications (16.7%). The rate of perioperative complications was significantly higher in patients 70 years or older than in other age groups (univariate analysis, p=0.015; multivariate analysis, p=0.024). The perioperative complications were not significantly associated with the other factors tested (sex, comorbidity, ASA class, and fusion segments). Post-operative outcomes of lumbar spinal fusion surgeries for the patients were determined on the basis of MacNab's criteria (average follow up period : 19.7 months), and 412 patients (85.0%) were classified as having "excellent" or "good" results. Conclusion : Increasing age was an important risk factor for perioperative complications in patients undergoing lumbar spinal fusion surgery, whereas other factors were not significant. However, patients' satisfaction or return to daily activities when compared with younger patients did not show much difference. We recommend good clinical judgment as well as careful selection of geriatric patients for lumbar spinal fusion surgery.