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.
Objectives : Anterior tunnelling technique consist of anterior cervical fractional interspace decompression without fusion. This method provides sufficient space for adequate neuroforaminal decompression but avoids the need for fusion or fixation. We report early clinical results of 32 cases that underwent anterior tunnelling operation for treatment of cervical radiculopathy. Methods : This method is identical to conventional approach until the exposure of anterior cervical body and bilateral retraction of longus colli is made. A vertical window is then made at the vertebral bodies and disc space lateral to the insertion site of the longus colli. The window is deepened with drilling that follows a tunnelling fashion down to the compressive lesion. We analyzed clinical results from 32 patients who treated between December 1998 and August 2000. Results : Satisfactory results were obtained in 87% of the patients. Two patients required revision surgery. None revealed surgical spinal instability on last follow-up. Conclusion : Anterior tunnelling operation is an acceptable surgical option for the treatment of cervical radiculopathy. Its advantages are short hospitalization, minimal postoperative discomfort, and technical feasibility.
Kim, Sung-Hyun;Lee, Jung-Kil;Jang, Jae-Won;Seo, Bo-Ra;Kim, Tae-Sun;Kim, Soo-Han
Journal of Korean Neurosurgical Society
/
v.50
no.4
/
pp.332-340
/
2011
Objective : Pyogenic spondylitis often results in acute neurological deterioration requiring adequate surgical intervention and appropriate antibiotic treatment. The purpose of this study was to conduct an analysis of the clinical effect of continuous irrigation via laminotomy in a series of patients with pyogenic spondylitis in thoracic and lumbar spine. Methods : The authors conducted a retrospective investigation of 31 consecutive patients with pyogenic thoracic and lumbar spondylitis who underwent continuous irrigation through laminotomy from 2004 to 2008. The study included 22 men and 9 women, ranging in age from 38 to 78 years (mean 58.1 years). The average follow-up duration was 13.4 months (range, 8-34 months). We performed debridement and abscess removal after simple laminotomy, and then washed out epidural and disc space using a continuous irrigation system. Broad spectrum antibiotics were administered empirically and changed according to the subsequent culture result. Clinical outcomes were based on the low back outcome scale (LBOS), visual analogue scale (VAS) score, and Frankel grade at the last follow-up. Radiological assessment involved plain radiographs, including functional views. Results : Common predisposing factors included local injection for pain therapy, diabetes mellitus, chronic renal failure, and liver cirrhosis. Causative microorganisms were identified in 22 cases (70.9%) : Staphylococcus aureus and Streptococcus spp. were the main organisms. After surgery, LBOS, VAS score, and Frankel grade showed significant improvement in most patients. Spinal stability was maintained during the follow-up period, making secondary reconstructive surgery unnecessary for all patients, except one. Conclusion : Simple laminotomy with continuous irrigation by insertion of a catheter into intervertebral disc space or epidural space was minimally invasive and effective in the treatment of pyogenic spondylitis. This procedure could be a beneficial treatment option in patients with thoracolumbar spondylitis combined with minimal or moderate destructive change of vertebrae.
Purpose: The purpose of this study is to develop a walking-type two-row sesame reaper, which can simultaneously perform the cutting and collecting of sesame plants and other crops like perilla and soybean. Methods: The factors involved in reaping sesame were determined experimentally in order to design a prototype of the sesame reaper. The prototype is made up of four parts for cutting, conveying, collecting, and running. The height of two disc-plate saw blades on the cutting part is adjusted by an adjusting wheel, and peripheral speed is adjusted in accordance with the running speed. The conveying belt of the conveying part can be tilted from $0^{\circ}$ to $90^{\circ}$. The collecting part extracts a predetermined amount of transferred sesame plants. The prototype was used to evaluate the performance at different working speeds, so that the work efficiency can be calculated. Results: The center of gravity of the sesame plants was 900 mm, measured from the end of the cut stem. The diameter of the disc-plate saw blade was determined to be 355 mm, peripheral speed was 20.4-32.7 m/s, and the picking height of the conveying belt for sesame was 130 mm. The performance of transfer and collection of the sesame, when the insertion angles were $60^{\circ}$ and $90^{\circ}$, proved to be excellent. However, when the angle was over $120^{\circ}$, the performance was only 75-80%. The performance was at 100% efficiency when the ratio between running speed and conveying belt speed of the prototype was 1:2, which seems to be the ideal ratio for the sesame reaper. Conclusions: A sesame reaper was developed, which can integrate the processes of cutting, conveying, and collecting, by investigating and considering various factors involved in the reaping process. The sesame reaper can reduce the costs for yielding and producing sesame due to its highly efficient performance.
The muscles relating to movement of painful low back was analyzed kinematically, by method of applying elastic tapes and putting non-elastic tapes on muscles involving those movements which cause pain and limitation of range of motion (ROM) in low back and trunk. Taping therapy which is effective for improvement of painful low back and which is supposed to facilitate the total and continual movement based on the postural reflexes will be presented in this paper. Fifty cases who had painful low back were investigated. Patients with painful low back were at first asked pain point and direction of painful movement, and then tested the muscles which are cause of those pain and limited motion. Before attaching tape, all subjects were divided into two groups, flexor pattern and extensor pattern, according to direction of increasing pain. Elastic tapes were applied from origin to insertion of objective muscles and non-elastic tapes were put on effective points of the muscles which were associated with respect to pain and limited ROM. As a result of this study, all subjects with low back pain significantly improved in pain and ROM at the low back. The longest treatment duration group for the low back pain cases was herniated lumbar disc(10.4 days) group. Low back pain have been treated by so many ways. muscles factor should be emphasized to be distinguish1y important to reduce low back pain. The muscles relating to make directly painful motion in low back and trunk should be confirmed by means of taping and painful motion should be analyzed by point of view of postural reflexes.
Choi, Young Hoon;Kwon, Shin Won;Moon, Jung Hyeon;Kim, Chi Heon;Chung, Chun Kee;Park, Sung Bae;Heo, Won
Journal of Korean Neurosurgical Society
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v.60
no.6
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pp.755-762
/
2017
Objective : The purpose of this study is to describe the detailed surgical technique and short-term clinical and radiological outcomes of lateral lumbar interbody fusion (LLIF) and in situ lateral screw fixation using a conventional minimally invasive screw fixation system (MISF) for revision surgery to treat rostral lumbar adjacent segment disease. Methods : The medical and radiological records were retrospectively reviewed. The surgery was indicated in 10 consecutive patients with rostral adjacent segment stenosis and instability. After the insertion of the interbody cage, lateral screws were inserted into the cranial and caudal vertebra using the MISF through the same LLIF trajectory. The radiological and clinical outcomes were assessed preoperatively and at 1, 3, 6, and 12 months postoperatively. Results : The median follow-up period was 13 months (range, 3-48 months). Transient sensory changes in the left anterior thigh occurred in 3 patients, and 1 patient experienced subjective weakness; however, these symptoms normalized within 1 week. Back and leg pain were significantly improved (p<0.05). In the radiological analysis, both the segmental angle at the operated segment and anterior disc height were significantly increased. At 6 months postoperatively, solid bony fusion was confirmed in 7 patients. Subsidence and mechanical failure did not occur in any patients. Conclusion : This study demonstrates that LLIF and in situ lateral screw fixation may be an alternative surgical option for rostral lumbar adjacent segment disease.
Nowadays, there are many attempts to develop domestic medical-equipments. In this study, it is performed to developed a new vertebral fusion device. The basic models are a rectangular-frame type and a screw type which are generally used for the patients. The main purpose of the development of a new device is to reduce the amount of bone taken out for the insertion of a device to vertebral disc and this paper is focused on th concept of a new device shape. In the results, two types are devised. One is a folding type and the other is a separate-push-in type device both are in primitive stage. However, in a folding type there are mechanical pins and the analysis of pins and the lock system is still in study and needs some time. Therefore a separate-push-in type is introduced in this study mainly and a prototype and 3-D finite element model are made and experimented and stress analyzed. From the results it is considered that it is stable for the basic loading condition of vertebra, however, it is required to develop a supporting operational equipment for the convenience of the operation in practice.
Initial solidification condition during directional solidification of superalloy CM247LC was controlled with various cooling methods such as insertion of alumina disc or Ni foil or inoculant, and direct pouring of melt onto chill plate. Rapid cooling with direct pouring of melt onto chill plate resulted in generation of many fine grains and precipitation of fine γ' particles, as well as small dendrite arm spacing. Tensile properties of directionally solidified superalloy CM247LC were closely related to microstructure which was governed by initial solidification conditions. Directionally solidified CM247LC with small dendrite arm spacing and fine precipitates showed good tensile properties.
Purpose To evaluate whether the image quality of chest radiographs obtained using a camera-type portable X-ray device is appropriate for clinical practice by comparing them with traditional mobile digital X-ray devices. Materials and Methods Eighty-six patients who visited our emergency department and underwent endotracheal intubation, central venous catheterization, or nasogastric tube insertion were included in the study. Two radiologists scored images captured with traditional mobile devices before insertion and those captured with camera-type devices after insertion. Identification of the inserted instruments was evaluated on a 5-point scale, and the overall image quality was evaluated on a total of 20 points scale. Results The identification score of the instruments was 4.67 ± 0.71. The overall image quality score was 19.70 ± 0.72 and 15.02 ± 3.31 (p < 0.001) for the mobile and camera-type devices, respectively. The scores of the camera-type device were significantly lower than those of the mobile device in terms of the detailed items of respiratory motion artifacts, trachea and bronchus, pulmonary vessels, posterior cardiac blood vessels, thoracic intervertebral disc space, subdiaphragmatic vessels, and diaphragm (p = 0.013 for the item of diaphragm, p < 0.001 for the other detailed items). Conclusion Although caution is required for general diagnostic purposes as image quality degrades, a camera-type device can be used to evaluate the inserted instruments in chest radiographs.
Lee Hui-Sung;Chen Wen Ming;Song Dong-Ryul;Kwon Soon-Young;Lee Kwon-Yong;Lee Sung-Jae
Journal of Biomedical Engineering Research
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v.27
no.5
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pp.210-217
/
2006
Many types of interspinous distraction devices (IDDs) have been recently developed as an alternative surgical treatment to laminectomy and fusion with pedicle screws for the treatment of the lumbar spinal stenosis (LSS). They are intended to keep the lumbar spine in a slightly flexed posture to relieve pain caused by narrowing of the spinal canal and vertebral foramen. However, their biomechanical efficacies are not well known. In this study, we evaluated the kinematic behaviors and changes in intradiscal pressure (IDP) of the porcine lumbar spine implanted with IDD. For kinematics analysis, five porcine lumbar spines (L2-L6) were used and the IDD was inserted at L4-L5. Three markers (${\phi}{\le}0.8mm$) were attached on each vertebra to define a rigid body motion for stereophotogrammetric assessment of the spinal motion in 3-D. A moment of 7.5Nm in flexion-extension, lateral bending, and axial rotation were imparted with a compressive force of 700N. Then, IDD was implanted at L3-L4. IDPs were measured using pressure transducer under compression (700N) and additional extension moment (700N+7.5Nm). In kinematic behaviors, insertion of IDD resulted in statistically significant decrease 42.8% at the implanted level in extension. There were considerable changes in ROM at the adjacent levels, but statistically insignificant. In other motions, there were no significant changes in ROM as well regardless of levels. IDPs at the surgical level (L3-L4) under compression and extension moment decreased by 12.9% and 18.8% respectively after surgery (p<0.05). At the superiorly adjacent levels, IDPs increased by 19.4% and 12.9% under compression and extension, respectively (p<0.05). Corresponding changes at the inferiorly adjacent levels were 29.4% and 6.9%, but they were statistically insignificant (p>0.05). The magnitude of pressure changes due to IDD, both at the operated and adjacent levels, were far less than the previously reported values with conventional fusion techniques. Our experimental results demonstrated the IDDs can be very effective in limiting the extension motion that may cause narrowing of the spinal canal and vertebral foramens while maintaining kinematic behaviors and disc pressures at the adjacent levels.
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