• Journal of Korean Neurosurgical Society
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• v.46 no.4
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• pp.300-304
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• 2009

Objective : This is retrospective study of clinical and radiological outcomes of anterior cervical fusion using Bongros-$HA^{TM}$ (BioAlpha, Seongnam, Korea) which is a type of synthetic hydroxyapatite (HA) spacer to evaluate the efficacy in its clinical application and usefulness as a reliable alternative to autograft bone. Methods : Twenty-nine patients were enrolled in this study and 40 segments were involved. All patients were performed anterior cervical interbody fusion using HA spacer and plating system. Indications for surgery were radiculopathy caused by soft-disc herniation or spondylosis in 18 patients, spondylotic myelopathy in 1 patient, and spinal trauma in 10 patients. Cervical spine radiographs were obtained on postoperative 1day, 1week, and then at 1, 2, 6, and 12 months in all patients to evaluate intervertebral disc height, and the degrees of lordosis. Cervical computed tomography was done at postoperative 12 month in all patients to confirm the fusion status. The mean period of clinical follow-up was 17 months. Results : Complete interbody fusion was achieved in 100% of patients. Preoperative kyphotic deformities were corrected in all cases after surgery. Intervertebral disc height was well maintained during follow up period. There were no cases of graft extrusion, graft deterioration and graft fracture. Conclusion : HA spacer is very efficient in achieving cervical fusion, maintaining intervertebral disc height, and restoring lordosis. When combined with the placement of a cervical plate, immediate stability can be achieved and graft related complication can be prevented.

• Journal of Korean Neurosurgical Society
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• v.29 no.4
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• pp.507-513
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• 2000

Objective : Posterior lumbar interbody fusion(PLIF) with transpedicular screw fixation(TPSF) have many merits in the treatment of spondylolisthesis. The aim of this study was to compare cage PLIF group(PLIF using cage and TPSF) with chip PLIF group(PLIF using autologous bone chips and TPSF) as surgical treatment of spondyloisthesis. Methods : PLIF and TPSF were performed in 44 patients with spondylolisthesis from January 1994 to December 1998. The surgical methods were divided into two groups. One group was cage PLIF(20 patients), and the other group was chip PLIF(24 patients). We analyzed the change of anterior translation, change of intervertebral space height, fusion rate, clinical outcomes, and postoperative complications in two groups. Result : There was no significant difference in reduction and maintenance of anterior translation between two groups. Intervertebral space height was increased in the two groups at immediate postoperative state. At last followup, it was decreased compared to preoperative height in chip PLIF group. In cage PLIF group, last follow-up height was decreased compared to immedate postoperative height, but it was significantly increased compared to preoperative height. Fusion rates were 70.9% and 90% in chip PLIF group and cage PLIF group, respectively. Excellent and good clinical outcomes were 79.2% in chip PLIF group and 85% in cage PLIF group, but there was no statistical significance. Complications were screw fracture(1 case), CSF leakage(1 case) in chip PLIF group and screw loosening and retropulsion of cage(1 case), CSF leakage(2 cases) in cage PLIF group. Conclusion : PLIF using cage is better than PLIF using autologous bone chips in the maintenance of intervertebral space height and fusion rate. But there is no statistical difference of the clinical outcomes between the two groups. Further studies, especially on long term follow-up, should be considered.

• Journal of Korean Neurosurgical Society
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• v.65 no.1
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• pp.96-106
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• 2022

Objective : The most common complication of anterior cervical discectomy and fusion (ACDF) is cage subsidence and maintenance of disc height affects postoperative clinical outcomes. We considered cage subsidence as an inappropriate indicator for evaluating preservation of disc height. Thus, this study aimed to consider patients with complications such as reduced total disc height compared to that before surgery and evaluate the relevance of several factors before ACDF. Methods : We retrospectively reviewed the medical records of 40 patients who underwent stand-alone single-level ACDF using a polyetheretherketone (PEEK) cage at our institution between January 2012 and December 2018. Our study population comprised 19 male and 21 female patients aged 24-70 years. The minimum follow-up period was 1 year. Twenty-seven patients had preoperative bone mineral density (BMD) data on dual-energy X-ray absorptiometry. Clinical parameters included sex, age, body mass index, smoking history, and prior medical history. Radiologic parameters included the C2-7 cobb angle, segmental angle, sagittal vertical axis, disc height, and total intervertebral height (TIH) at the preoperative and postoperative periods. Cage decrement was defined as the reduction in TIH at the 6-month follow-up compared to preoperative TIH. To evaluate the bone quality, Hounsfield unit (HU) value was calculated in the axial and sagittal images of conventional computed tomography. Results : Lumbar BMD values and cervical HU values were significantly correlated (r=0.733, p<0.001). We divided the patients into two groups based on cage decrement, and 47.5% of the total patients were regarded as cage decrement. There were statistically significant differences in the parameters of measuring the HU value of the vertebra and intraoperative distraction between the two groups. Using these identified factors, we performed a receiver operating characteristic (ROC) curve analysis. Based on the ROC curve, the cut-off point was 530 at the HU value of the upper cortical and cancellous vertebrae (p=0.014; area under the curve [AUC], 0.727; sensitivity, 94.7%; specificity, 42.9%) and 22.41 at intraoperative distraction (p=0.017; AUC, 0.722; sensitivity, 85.7%; specificity, 57.9%). Using this value, we converted these parameters into a bifurcated variable and assessed the multinomial regression analysis to evaluate the risk factors for cage decrement in ACDF. Intraoperative distraction and HU value of the upper vertebral body were independent factors of postoperative subsidence. Conclusion : Insufficient intraoperative distraction and low HU value showed a strong relationship with postoperative intervertebral height reduction following single stand-alone PEEK cage ACDF.

• Journal of Biomedical Engineering Research
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• v.25 no.5
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• pp.361-367
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• 2004

The axial compressive strength, relative 3-D stability and osteoconductive shape design of an intervertebral fusion cage are important biomechanical factors for successful intervertebral fusion. Changes in the stress distribution of the vertebral end plate and in cage stability due to changes in the spike shape of a newly contrived box-shaped fusion cage are investigated. In this investigation, the initial contact of the cage's spikes with the end plate and the penetration of the cage's spikes into the end plate are considered. The finite element analysis is conducted to study the effects of the cage's spike height, tip width and angle on the stress distribution of the vertebral end plate, and the micromigration of the cage in the A-P direction. The stress distribution in the end plate is examined when a normal load of 1700N is applied to the vertebra after inserting 2 cages. The micromigration of the cage is examined when a pull out load of l00N is applied in the A-P direction. The analysis results reveal that the spike tip width significantly influences the stress concentration in the end plate, but the spike height and angle do not significantly influence the stress distribution in the end plate touching the cage's spikes. In addition, the analysis results show that the micromigration of the cage can be reduced by adjusting the spike angle and spike arrangement in the A-P direction. This study proposes the optimal shape of an intervertebral fusion cage, which promotes bone fusion, reduces the stress concentration in a vertebral end plate, and increases mechanical stability.

• Journal of Korean Neurosurgical Society
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• v.61 no.1
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• pp.89-96
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• 2018

Objective : Morphometric data for the lumbar posterior longitudinal ligament (PLL) was investigated to identify whether there is a difference in the morphometry of the PLL of the lumbar spine at each level with respect to the pattern of intervertebral disc displacement. Methods : In 14 formalin-fixed adult cadavers (12 males and 2 females), from L1 to L5, the authors measured the width and height of the PLL and compared them with other landmarks such as the disc and the pedicle. Results : Horizontally, at the upper margin of the disc, the central portion of the superficial PLL covered 17.8-36.9% of the disc width and the fan-like portion of the PLL covered 63.9-76.7% of the disc width. At the level of the median portion of the disc, the PLL covered 69.1-74.5% of the disc width. Vertically, at the level of the medial margin of the pedicle, the fan-like portion of the PLL covered 23.5-29.9% of the disc height. In general, a significant difference in length was not found in the right-left and male-female comparisons. Conclusion : This study presents the morphometric data on the pattern of intervertebral disc displacement and helps to improve the knowledge of the surgical anatomy of the lumbar PLL.

• Journal of Korean Neurosurgical Society
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• v.44 no.5
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• pp.327-333
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• 2008

Objective: The purpose of this study is to verify the usefulness of the rabbit model for disc degeneration study. Materials: The L1-L2, L2-L3, L3-L4. or L4-L5 lumbar intervertebral disc (IVD) of 9 mature male New Zealand White rabbits were injured by inserting a 16-gauge needle to a depth of 5 mm in the left anterolateral annulus fibrosus while leaving L5-L6 IVD uninjured. Three other rabbits also received intradiscal injections of rabbit disc cells transfected with adenovirus and bone morphogenetic protein-2 (ad-BMP-2) at L4-L5 in addition to injury by 16-gauge needle at the L1-L2 level. Using digitized radiographs, measurements of IVD height were made and analyzed by using the disc height index (DHI). Magnetic resonance imaging (MRI) scans of the injured discs, injected discs, and uninjured L5-L6 discs were performed at 15 weeks post surgery and compared with preoperative MRI scans. Results: All twelve rabbits showed consistent results of disc degeneration within 15 weeks following annular puncture. DHIs of injured discs were significantly lower than that of the uninjured L5-L6 discs (p<0.05). The mean value of disc degeneration grade of injured discs was significantly higher than that of uninjured discs (p<0.05). The injection of disc cell transfected with ad-BMP-2 did not induce disc regeneration at 15 weeks after injection. Conclusion: This study showed that the injured disc had a significant change in DHI on simple lateral radiograph and disc degeneration grade on MRI scans within 15 weeks in all rabbits. Rabbit annular puncture model can be useful as a disc degeneration model in vivo.

• Journal of Korean Neurosurgical Society
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• v.47 no.5
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• pp.338-344
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• 2010

Objective : This study assessed the safety and efficacy of one level unilateral laminotomy bilateral decompression (ULBD) with the placement of a device for intervertebral assisted motion (DIAM) compared with one level ULBD only in elderly patients with degenerative lumbar spinal stenosis (DLSS). Methods : A non randomized prospective analysis was performed on 16 patients who underwent one level ULBD with DIAM (Group A) and 20 patients with one level ULBD only (Group B) between February 2007 and March 2008. Radiographic imaging, visual analog scale (VAS) and MacNab outcome scale were obtained before and after surgery at a mean interval of 21 months (range 17-27 months). Results : The disc height, interpedicular distance, slip distance and segmental lordotic angle were similar between two groups. In the group A, there was no significant difference between the pre- and post-operative imaging in terms of the sagittal balance and disc height. Both groups showed significant improvement in the clinical outcomes. In addition, there was significantly less low-back pain in the group A than in the group B at the last follow up, while the clinical improvement of the leg pain and MacNab outcome scale showed no significant difference in the two groups. There were no major complications or DIAM associated complications. Conclusion : ULBD with DIAM is a safe and efficacious treatment for selective elderly patients with DLSS, particularly for relieving low back pain comparing to ULBD. ULBD with DIAM did not alter the disc height or sagittal alignment at the mean 21 months follow-up interval.

• Journal of Korean Neurosurgical Society
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• v.59 no.4
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• pp.385-391
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• 2016

Objective : The purpose of this study was to evaluate long-term follow-up radiologic/clinical outcomes of patients who underwent anterior cervical discectomy and inter-body fusion (ACDF) with stand-alone cages (SAC) in a single academic institution. Methods : Total 99 patients who underwent ACDF with SAC between February 2004 and December 2012 were evaluated retrospectively. A total of 131 segments were enrolled in this study. Basic demographic information, radiographic [segmental subsidence rate, fusion rate, C2-7 global angle, and segmental angle changes)/clinical outcomes (by Odom's criteria and visual analog score (VAS)] and complications were evaluated to determine the long-term outcomes. Results : The majority were males (55 vs. 44) with average age of 53.2. Mean follow-up period was 62.9 months. The segmental subsidence rate was 53.4% and fusion rate was 73.3%. In the subsidence group, anterior intervertebral height (AIH) had more tendency of subsiding than middle or posterior intervertebral height (p=0.01). The segmental angle led kyphotic change related to the subsidence of the AIH. Adjacent segmental disease was occurred in 18 (18.2%) patients. Total 6 (6%) reoperations were performed at the index level. There was no statistical significance between clinical and radiological outcomes. But, overall long-term clinical outcome by Odom's criteria was unsatisfactory (64.64%). The neck and arm VAS score were increased by over time. Conclusion : Long-term outcomes of ACDF with SAC group were acceptable but not satisfactory. For optimal decision making, more additional comparative long-term outcome data is needed between ACDF with SAC and ACDF with plating.

• The Journal of Korea CHUNA Manual Medicine
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• v.3 no.1
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• pp.43-53
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• 2002

Objectives : The object is to study a clinical effect regarding the conservative treatment of the patient who was diagnosed as the herniated Intervertebral lumbar disc(HIVD) and hospitalized in the oriental medical hospital and clinical study about the type of the HIVD. Methods. The clinical studies were done on 65 cases (hospitalized in Dept. of Oriental Rehabilitation Medicine, jaseng on oriental medical hospital from June 2001 to May 2002) who complained of low back pain or sciatica and diagnosed as HIVD on CT(computerized tomography) or MRI(magnetic resonance imaging). They were given both oriental conservative treatment and exercise during the hospitalization period. We investigated and observed 20 items about sex, age, weight, height, occupation, smoking. obesity, duration of disease, clinical symptom and treatment duration in basis of medical recording which was drawn up at patient hospitalization. We classified HIVD with 4 types(Bulging. Protruded. Extruded, Sequestered) and decided the case which simultaneously had 2 overs with Mixed type. The treatment evaluation standard was classified with 4 branches; Excellent. Good, Fair and Poor. Results & Conclusions : The treatment result of over 'fair' is bulging type 85%, protruded type 92.7%, extruded type 100% and the mixed type was 85.1 %. The effect was good in order of bulging, mixed, protruded and extruded type. It appeared most plentifully with 30 people in L4-5 and L5-S 1 disc herniation type.

• Journal of Biomedical Engineering Research
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• v.39 no.1
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• pp.22-29
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• 2018

Intervertebral disc(IVD) mainly consists of Annulus fibrosus(AF) and Nucleus pulposus(NP), playing a role of distributing a mechanical load on vertebral body. IVD tissue engineering has been developed the methods to achieve anatomic morphology and restoration of biological function. The goal of present study is to identify the possibilities for creating a substitute of IVD the morphology and biological functions are the same as undamaged complete IVD. To fabricate the AF and NP combine biphasic IVD tissue, AF tissue scaffolds have been printed by 3D bio-printing system with natural biomaterials and NP tissues have been prepared by scaffold-free culture system. We evaluated whether the combined structure of 3D printed AF scaffold and scaffold-free NP tissue construct could support the architecture and cell functions as IVD tissue. 3D printed AF scaffolds were printed with 60 degree angle stripe patterned lamella structure(the inner-diameter is 5mm, outer-diameter is 10 mm and height is 3 mm). In the cytotoxicity test, the 3D printed AF scaffold showed good cell compatibility. The results of histological and immunohistochemical staining also showed the newly synthesized collagens and glycosaminoglycans, which are specific makers of AF tissue. And scaffold-free NP tissue actively synthesized glycosaminoglycans and type 2 collagen, which are the major components of NP tissue. When we combined two engineered tissues to realize the IVD, combined biphasic tissues showed a good integration between the two tissues. In conclusion, this study describes the fabrication of Engineered biphasic IVD tissue by using enable techniques of tissue engineering. This fabricated biphasic tissue would be used as a model system for the study of the native IVD tissue. In the future, it may have the potential to replace the damaged IVD in the future.