• Journal of Korean Neurosurgical Society
• /
• 제55권1호
• /
• pp.12-17
• /
• 2014

Objective : Anterior cervical discectomy and fusion (ACDF) is often complicated by subsidence, pseudoarthrosis, kyphosis, and graft donor site morbidities. To decrease the occurrence of these complications, various types of cages have been developed. We designed this retrospective study to analyze and compare the efficacy and outcomes of ACDF using double cylindrical cages (DCC) (BK Medical, Seoul, Korea) versus an anterior cervical plating system with autogenous iliac crest grafts. Methods : Forty-eight patients were treated with autograft and plating (plate group), and 48 with DCC group from October 2007 to October 2011. We analyzed construct length, cervical lordotic curvarture, the thickness of the prevertebral soft tissue, segmental instability, and clinical outcomes. Results : There were no significant differences between the two groups with regard to the decrease in construct length or cervical lodortic curvature at the 3-, 6-, and 12-month follow-ups. The prevertebral soft tissue was thinner in the DCC group than the plate group immediately after surgery and at the 3-, 6-, and 12-month follow-ups. The difference in interspinous distance on flexion-extension was shorter in the plate group than the DCC group at the 3- and 6-month follow-ups. However, there was no significant difference in this distance between the two groups at the 12-month follow-up. Conclusion : A double cylindrical cage is a good alternative for fusion in patients with cervical degenerative diseases; the surgical method is relatively simple, allows good synostosis, has less associated prevertebral soft tissue swelling, and complications associated with autografting can be avoided.

• Journal of Korean Neurosurgical Society
• /
• 제38권4호
• /
• pp.265-268
• /
• 2005

Objective : With the increasing popularity of pedicle screw fixation devices for several indications, the safety and reliability of screw insertion in the small pedicle has become a major issue. Many studies have investigated the accuracy of screw placement after pedicle screw fixation using various method. The reported displacement rates have been very different. The purpose of the study is to investigate the proper placement of pedicle screw insertion in the lumbar spine on 26 consecutive patients. Methods : Between September and December 2003, 26 consecutive patients [16women and 10men] were analyzed after transpedicular screw fixation of the lumbar and lumbosacral spine. After pedicle screw fixation in this study, 2-mm slices of CT scan were performed in all patients to detect caudal and cranial deviation of screw and medial and lateral deviation. Pedcile screw placement related complication was evaluated clinically. Results : A total of 144 inserted pedicle were analyzed in 26patients, and 58pedicle screws [40.3%] were detected to be improper placement. There were 14level [9.0%] of caudal or cranial deviation and 44level [30.6%] of medial or lateral deviation to the pedicle. Extra-pedicle placement was found on 4levels [2.7%] with only lease of neurologic injury. Conclusion : Proper screw placement, though complication rate is low, is important not only for clinical symptom but also for biomechanics. Further study for screw placement related biomechanical changes is needed.

• Journal of Korean Neurosurgical Society
• /
• 제30권12호
• /
• pp.1369-1374
• /
• 2001

Objectives : The rates of pseudarthrosis for two- and three level fusion have been reported to be 17-63 and 50% without anterior cervical plating. The purpose of this study is to assess the effects of anterior cervical plating in the treatment of multilevel degenerative cervical disease such mostly the additional risks associated with hardware implants and its benefits, fusion rate and radiographic results, and clinical outcomes. Methods : Forty-seven patients who underwent operations between 1993 and 1997 were retrospectively reviewed. The technique for operation was same for both groups(Smith Robinson with autologous iliac bone graft). Group I consisted of 35 consecutive patients treated with anterior cervical decompression and fusion with anterior cervical plate fixation. Group II consisted of 12 consecutive patients treated without plate fixation. We compared clinical outcomes by Prolo score, radiographic results in the rate of fusion, cervical lordosis by Gore angle, disc height by Farfan method, and surgical complications between two groups. Results : The favorable clinical outcomes(excellent and good) by Prolo score were observed with the use of anterior cervical plate fixation(89% vs 75%). The successful fusion rate of multilevel cervical fusion was as seen with anterior cervical plate fixation(97% vs 75%). The overall graft complication rate in multilevel fusions was decreased, with anterior cervical plate fixation, and the hardware related complications were relatively minimal without serious consequences. Conclusion : Anterior cervical plate fixation in the treatment of multilevel cervical disorders is an effective stabilizing method which provides increased bony fusion rate, decreased graft complications, maintained cervical lordosis, early mobilization of the these patients without serious hardware related complications.

• Journal of Korean Neurosurgical Society
• /
• 제41권5호
• /
• pp.301-305
• /
• 2007

Objective : The postoperative subsidence of anterior cervical interbody fusion for cervical degenerative diseases gives rise to segmental kyphotic collapse, screw loosening, and chronic neck pain. So, intraoperative custom-made polymethylmethacrylate [PMMA] C-cage has been developed to prevent subsidence following anterior cervical fusion. Methods : A total of patients who underwent anterior cervical interbody fusion with a intraoperative custom - made cervical cage filled with local bone and demineralized bone matrix [group A] were analyzed prospectively from June 2004 to June 2005. These were compared with 40 patients who were treated with iliac bone graft [group B]. We evaluated subsidence ratio, change of segmental angle, distraction length and segmental angle. Statistical analysis was performed using independent sample t-test and Pearson correlation coefficient. Results : Group A had a statistically significant decrease in subsidence ratio [$0.64{\pm}0.43%$, p=0.00]. distraction length [$2.42{\pm}1.25\;mm$, p=0.02], and follow angle change [$1.78{\pm}1.69^{\circ}$, p=0.01] as compared with Group B. However, there was no statistically significant difference in postoperative segmental angle change [p=0.66]. On the analysis of the correlation coefficient, the parameters showed no interrelationships in the group A. On the other hand, subsidence ratio was affected by distraction length in the group B [Pearson correlation=0.448]. Conclusion : This operative technique would be contributed for the reduction of a postoperative subsidence after the anterior cervical interbody fusion procedure for cervical disc disease with moderate to severe osteoporotic condition and segmental loss of lordosis.

• Journal of Korean Neurosurgical Society
• /
• 제50권4호
• /
• pp.392-395
• /
• 2011

Idiopathic hypertrophic spinal pachymeningitis (IHSP) is a rare inflammatory disease characterized by hypertrophic inflammation of the dura mater and various clinical courses that are from myelopathy. Although many associated diseases have been suggested, the etiology of IHSP is not well understood. The ideal treatment is controversial. In the first case, a 55-year-old woman presented back pain, progressive paraparesis, both leg numbness, and voiding difficulty. Initial magnetic resonance imaging (MRI) demonstrated an anterior epidural mass lesion involving from C6 to mid-thoracic spine area with low signal intensity on T1 and T2 weighted images. We performed decompressive laminectomy and lesional biopsy. After operation, she was subsequently treated with steroid and could walk unaided. In the second case, a 45-year-old woman presented with fever and quadriplegia after a spine fusion operation due to lumbar spinal stenosis and degenerative herniated lumbar disc. Initial MRI showed anterior and posterior epidural mass lesion from foramen magnum to C4 level. She underwent decompressive laminectomy and durotomy followed by steroid therapy. However, her conditions deteriorated gradually and medical complications occurred. In our cases, etiology was not found despite through investigations. Initial MRI showed dural thickening with mixed signal intensity on T1- and T2-weighted images. Pathologic examination revealed chronic nonspecific inflammation in both patients. Although one patient developed several complications, the other showed slow improvement of neurological symptoms with decompressive surgery and steroid therapy. In case of chronic compressive myelopathy due to the dural hypertrophic change, decompressive surgery such as laminectomy or laminoplasty may be helpful as well as postoperative steroid therapy.

• Journal of Acupuncture Research
• /
• 제19권6호
• /
• pp.264-279
• /
• 2002

Objective : Ossification of the posterior longitudinal ligament(OPLL) is considered kind of degenerative disease usually found in the cervical vertebrae. Most of cases of OPLL have radiculopathy, myelopathy or both of them such as neck pain, numbness, myatonia. These symptoms seems to be similar with those of HIVD(Herniated intervertebral disc), sprain, spondylosis of C-spine. Lost of patients who have those symptoms are visiting oriental medicine hospital, clinic so we thought that making differential diagnosis, treating and prognosing might be needed with acupuncture, Herb medication. Methods : We examined the 3 patients of OPLL who visited Dong-in-dang Oriental Medicine Hospital from 1st November 1999 to 1st February 2002. We treated patients of OPLL with Oriental Medicine care (Acupuncture, Herb medication, Negative treatment) based on oriental diagnosis of neck pain(項强痛), numbness(痺證), myatonia. Results : clinical grade of 3 cases was all Gr III. After treated with oriental medical care, 2 cases were evaluated poor, I cases were evaluated fair and resulted in Clinical grade II. Conclusions : Treating OPLL with oriental medical carte was very difficult to palliate symptoms, to stop progress of OPLL. We might need to reconsider oriental medical care as conservative treatment for OPLL.

• 대한정형도수물리치료학회지
• /
• 제12권2호
• /
• pp.33-41
• /
• 2006

This study planed to analyze durability of effect and result that the Medx and Sling exercise gets to the strength of lumbar extensors. 15 patients who had enforce the minimal invasive lumbar surgery were executed 3 times per week for 8 weeks. The purpose of this study was to identify the influence of the mixed exercises of the Medx and Sling program on lumbar trunk muscles and to present basic data for the proper exercise prescription for lumbar patients. The results were as follows: 1) Left: Patients by lumbar hernia operation of trunk muscle strength by Sling-exercise: 0, 45, 90, 135, 180 (degree) treatment periods (P<0.05). 2) Right: Patients by lumbar hernia operation of trunk muscle strength by Sling-Exercise: 0, 45, 90, 135, 180 (degree) treatment periods (P<0.05). Medx treatment, a muscle strengthening lumbar extension exercise program, was now being used at local hospitals. In addition, Sling exercise, which is designed to develop lumbar muscle by way of reducing gravity in a new way so that it can accelerate the growth of muscles and ligaments in-depth in the patients, also has begun to be introduced gradually. In this study, therefore, the new mixed program (Sling and Medx training)can used as an exercise program that can reduce pain and increase lumbar muscles, not only for disk disease patients but also for all those who have undergone surgery or who haven't undergone surgery, who have chronic pain, and it also can be utilized as basic data for the new method of exercise.

• Journal of Korean Neurosurgical Society
• /
• 제46권4호
• /
• pp.285-291
• /
• 2009

Objective : This study examined the change of range of motion (ROM) at the segments within the dynamic posterior stabilization, segments above and below the system, the clinical course and analyzed the factors influencing them. Methods : This study included a consecutive 27 patients who underwent one-level to three-level dynamic stabilization with Bioflex system at our institute. All of these patients with degenerative disc disease underwent decompressive laminectomy with/without discectomy and dynamic stabilization with Bioflex system at the laminectomy level without fusion. Visual analogue scale (VAS) scores for back and leg pain, whole lumbar lordosis (from L1 to S1), ROMs from preoperative, immediate postoperative, 1.5, 3, 6, 12 months at whole lumbar (from L1 to S1), each instrumented levels, and one segment above and below this instrumentation were evaluated. Results : VAS scores for leg and back pain decreased significantly throughout the whole study period. Whole lumbar lordosis remained within preoperative range, ROM of whole lumbar and instrumented levels showed a significant decrease. ROM of one level upper and lower to the instrumentation increased, but statistically invalid. There were also 5 cases of complications related with the fixation system. Conclusion : Bioflex posterior dynamic stabilization system supports operation-induced unstable, destroyed segments and assists in physiological motion and stabilization at the instrumented level, decrease back and leg pain, maintain preoperative lumbar lordotic angle and reduce ROM of whole lumbar and instrumented segments. Prevention of adjacent segment degeneration and complication rates are something to be reconsidered through longer follow up period.

• The Korean Journal of Pain
• /
• 제9권1호
• /
• pp.140-144
• /
• 1996

Electrical stimulation is a common method for successful pain management for both acute and a some cases of chronic pain. The incidence of cervical sprain is very high with automobile accidents. Treatment of cervical sprain is consists of analgesic drugs and physical therapy. Lower back pain is a common problem in pain clinics. back pain management are complex, so we have difficulty to choose best treatment modality. The prevalence of herniated lumbar disc(HLD) is 1~3% of lower back pain. The cases of laminectomy varies between 10~20% and postoperative pain is prolonged for several day. We applied Acupuncture like TENS (ALTENS) on the digit for cervical sprain patients and post laminectomy pain patient for three days. The result was very satisfactory. And we found that total hospital days in ALTEND groups are shorter than control group in both disease entities. In conclusion, acupuncture like TENS on finger control gate is an effective method of the pain management.

• Journal of Chest Surgery
• /
• 제25권12호
• /
• pp.1404-1415
• /
• 1992

To understand the factors influencing Atrial fibrillation and embolism in mitral valve surgery and prevent their risk, we have reviewed our 324 patients who underwent mitral valve surgery from Fev. 1982 to May 1992. Age, disease duration, lesion type, left ventricular function and left atrial dimension were chosen as preoperative factors influencing the incidence of atrial fibrillation and embolism and their postoperative course, The number and type of replaced valve, site of atriotmy, LA obliteration, ACT and use of Defibrillator were chaser. as operative factors influencing postoperative rhythm change and postop emb-olization. The results of analyses were as follows 1. The incidence of preoperative atrial fibrillation, systemic embolism and LA throbmus was 63. 6%, 10.56% and 19.8% relatively. 2. The preoperative factors of atrial fibrillation onset was old age, prolonged symptom duration, stenotic lesion, lager LAD and lower ejection fraction. In the preoperative systemic embolism preoperative factors were old age, female, stenotic lesion. The left atrial thrombus found more commonly in patients with atrial fibrillation, old age, prolonged symptom duration, stenotic lesion and low ejection fraction. 3. The preoperative atrial fibriation persisted postoperatively in 165[50.9%] and converted to normal sinus rhythm in 50[15.4%]. The preoperative normal sinus rhythm per-eisted in 100[31%] and atrial fibrillation was occured postoperatively in 9[2.7%]. The prolonged symptom duration was the preoperative factor of persist atrial fibrillation. 4. Among 95 long term follow-up patients, atiral fibrillation was continued in 59[60%]. Conversion to normal sinus rhythm was more common significantly in left atriotomy and bileaflet valve replacement. 5. There were 12 patients who had postoperative embolism. Female, persist atrial fibrillation, no LA olbiteration and tilting disc monocusp valve were considered as possible factors influencing postoperative embolism but was impossible to analyse their statistical significance due to small sample size. So we have concluded that the patients with above risk factors need anticoagulant and early surgical intervention. Left atriotomy with minimal atrial injury, left auricular obliteration and bileaflet valve replacement may be needed to reduce postoperative atrial fibrillation persist and embolism.