• Journal of Korean Neurosurgical Society
• /
• v.42 no.3
• /
• pp.184-190
• /
• 2007

Objective : The authors retrospectively analyzed clinical and radiographic features of patients who developed symptomatic adjacent segment degeneration (ASD) that required re-operation. Methods : From 1995 to 2004, among 412 patients who underwent posterior lumbar fusion surgery, the authors experienced twenty-six patients who presented symptomatic ASD. Records of these patients were reviewed to collect clinical data at the first and second operations. Results : The patients were 9 males and 17 females whose mean age was $63.5{\pm}8.7$ years. Among 319 one segment and 102 multi-segment fusions, 16 and 10 patients presented ASD, respectively. Seventeen ASDs were noticed at the cephalad to fusion (65%), eight at the caudad (31%), and one at the cephalad and caudad, simultaneously (4%). All patients underwent decompression surgery. Nine patients underwent additional fusion surgeries to adjacent degenerated segments. In 17 patients who underwent only decompression surgery without fusion, the success rate was 82.4%. In fusion cases. the success rate was observed as 55.5%. There were no statistically significant factors to be related to development of ASD. However, in cases of multi-level fusion surgery, there was a tendency toward increasing ASD. Conclusion : Multi-segment fusion surgery could be associated with a development of ASD. In surgical treatment of symptomatic ASD, selective decompression without fusion may need to be considered as a primary procedure, which could reduce the potential risk of later occurrence of the other adjacent segment disease.

• Journal of Korean Neurosurgical Society
• /
• v.58 no.1
• /
• pp.65-71
• /
• 2015

Objective : Lumbar spinal stenosis is conventionally treated with surgical decompression. However, bilateral decompression and laminectomy is more invasive and may not be necessary for lumbar stenosis patients with unilateral radiculopathy. We aimed to report the outcomes of unilateral laminectomy and bilateral pedicle screw fixation with fusion for patients with lumbar spinal stenosis and unilateral radiculopathy. Methods : Patients with lumbar spinal stenosis with unilateral lower extremity radiculopathy who received limited unilateral decompression and bilateral pedicle screw fixation were included and evaluated using visual analog scale (VAS) pain and the Oswestry Disability Index (ODI) scores preoperatively and at follow-up visits. Ligamentum flavum thickness of the involved segments was measured on axial magnetic resonance images. Results : Twenty-five patients were included. The mean preoperative VAS score was $6.6{\pm}1.6$ and $4.6{\pm}3.1$ for leg and back pain, respectively. Ligamentum flavum thickness was comparable between the symptomatic and asymptomatic side (p=0.554). The mean follow-up duration was 29.2 months. The pain in the symptomatic side lower extremity (VAS score, $1.32{\pm}1.2$) and the back (VAS score, $1.75{\pm}1.73$) significantly improved (p=0.000 vs. baseline for both). The ODI improved significantly postoperatively ($6.60{\pm}6.5$; p=0.000 vs. baseline). Significant improvement in VAS pain and ODI scores were observed in patients receiving single or multi-segment decompression fusion with fixation (p<0.01). Conclusion : Limited laminectomy and unilateral spinal decompression followed by bilateral pedicle screw fixation with fusion achieves satisfactory outcomes in patients with spinal stenosis and unilateral radiculopathy. This procedure is less damaging to structures that are important for maintaining posterior stability of the spine.

• Journal of Korean Neurosurgical Society
• /
• v.46 no.5
• /
• pp.425-430
• /
• 2009

Objective : The present study analyzed the risk factors, prevalence and clinical results following revision surgery for adjacent segment degeneration (ASD) in patients who had undergone lumbar fusion. Methods : Over an 8-year period, we performed posterior lumbar fusion in 81 patients. Patients were followed a minimum of 2 years (mean 5.5 years). During that time, 9 patients required revision surgery due to ASD development. Four patients underwent autogenous posterolateral arthrodesis and extended transpedicle screw fixation, 4 patients underwent decompressive laminectomy and interspinous device implantation, and 1 patient underwent simple decompression. Results : Of the 9 of patients with clinical ASD, 33.3% (3 of 9) of patients did not have radiographic ASD on plain radiographs. Following revision surgery, the clinical results were excellent or good in 8 patients (88.9%). Age > 50 years at primary surgery was a significant risk factor for ASD development, while number of fusion levels, initial diagnosis and type of fusion were not. Conclusion : The incidence of ASD development after lumbar surgery was 11.1% (9 of 81) in this study. Age greater than 50 was the statistically significant risk factor for ASD development. Similar successful clinical outcomes were observed after extended fusion with wide decompression or after interspinous device implantation. Given the latter procedure is less invasive, the findings suggest it may be considered a treatment alternative in selected cases but it needs further study.

• Journal of Korean Neurosurgical Society
• /
• v.54 no.3
• /
• pp.201-206
• /
• 2013

Objective : To investigate the sagittal sacropelvic morphology and balance of the patients with SIJ pain following lumbar fusion. Methods : Among 452 patients who underwent posterior lumbar interbody fusion between June 2009 and January 2013, patients with postoperative SIJ pain, being responded to SIJ block were enrolled. For a control group, patients matched for sex, age group, the number of fused level and fusion to sacrum were randomly selected. Patients were assessed radiologic parameters including lumbar lordosis, pelvic incidence (PI), pelvic tilt (PT) and sacral slope (SS). To evaluate the sagittal sacropelvic morphology and balance, the ratio of PT/PI, SS/PI and PT/SS were analyzed. Results : A total of 28 patients with SIJ pain and 56 patients without SIJ pain were assessed. Postoperatively, SIJ pain group showed significantly greater PT (p=0.02) than non-SIJ pain group. Postoperatively, PT/PI and SS/PI in SIJ pain group was significantly greater and smaller than those in non-SIJ pain group respectively (p=0.03, 0.02, respectively) except for PT/SS (p=0.05). SIJ pain group did not show significant postoperative changes of PT/PI and SS/PI (p=0.09 and 0.08, respectively) while non-SIJ pain group showed significantly decrease of PT/PI (p=0.00) and increase of SS/PI (p=0.00). Conclusion : This study presents different sagittal sacropelvic morphology and balance between the patients with/without SIJ pain following lumbar fusion surgery. The patients with SIJ pain showed retroversed pelvis and vertical sacrum while the patients without SIJ pain have similar morphologic features with asymptomatic populations in the literature.

• Journal of Korean Neurosurgical Society
• /
• v.54 no.5
• /
• pp.379-383
• /
• 2013

Objective : There are differences in the clinical characteristics and surgical results between upper (L1-2 and L2-3) and lower (L3-4, L4-5, and L5-S1) lumbar disc herniations. We conducted this study to compare the clinical features and surgical outcomes between the two types of lumbar disc herniations. Methods : We retrospectively reviewed the clinical features of patients who underwent microdiscectomies from 2008 to 2012. We evaluated the clinical characteristics such as age, preoperative autonomic dysfunction, the presence or absence of previous lumbar surgery and fusion required during surgery. Visual Analogue Scale (VAS) scores about back pain and leg pain were evaluated preoperatively and at the final follow-up. Results : Upper lumbar group (n=15) was significantly older than lower lumbar group (n=148). The incidence of autonomic dysfunction was significantly higher in upper lumbar group. The number of patients with a previous lumbar surgery was significantly greater in upper lumbar group. There was no statistical significance for fusion required during surgery between two groups. Both groups showed a significant decrease in the VAS scores of leg pain. VAS scores of back pain were significantly decreased in lower lumbar group. But this was not seen in upper lumbar group. Both groups showed significant improvement of Oswestry Disability Index score. Conclusion : Upper lumbar group had different clinical characteristics from those of lower lumbar group and these include older age, a higher incidence of autonomic dysfunctions and a higher incidence of patients with previous lumbar surgery. There were no significant differences in surgical outcomes, except for back pain, between two groups.

• Journal of Korean Neurosurgical Society
• /
• v.65 no.6
• /
• pp.825-833
• /
• 2022

Objective : ABM/P-15 (anorganic bone matrix/15-amino acid peptide fragment) is a commercially available synthetically manufactured P-15 collagen peptide fragment, that is adsorbed on ABM. This study was done to investigate the efficacy of ABM/P-15 in achieving fusion in the lumbar spine and comparing it with that of recombinant bone morphogenic protein-2 (rhBMP-2) and demineralized bone matrix (DBM). Methods : A retrospective observational study of prospectively collected data of 140 patients who underwent lumbar spinal fusion surgeries in a single specialty spine hospital between 2016 and 2020, with a minimum 6-month follow-up was conducted. Based on the material used for the augmentation of the bone graft at the fusion site, the patients were divided into three categories namely ABM/P-15, rhBMP-2, and DBM group. Results : ABM/P-15, rhBMP-2, and DBM were used in 46, 44, and 50 patients, respectively. Patient characteristics like age, gender, bone mineral density, smoking history, and presence of diabetes mellitus were comparable amongst the three groups. Average follow-up was 16.0±5.2, 17.9±9.8, and 26.2±14.9 months, respectively in ABM/P-15, rhBMP-2, and DBM groups. The fusion was achieved in 97.9%, 93.2%, and 98% patients while the average time-to-union was 4.05±2.01, 10±4.28, and 9.44±3.49 months (p<0.001), respectively for ABM/P-15, rhBMP-2, and DBM groups. The average pre-operative Visual analogue scale score was 6.93±2.42, 7.14±1.97, 7.01±2.14 (p=0.900) for ABM/P-15, rhBMP-2 and DBM groups, respectively, which reduced to 1.02±0.80, 1.21±0.96, and 0.54±0.70 (p=0.112), respectively at the last follow up. Pre-operative Oswestry disability index scores were 52.7±18.02, 55.4±16.8, and 53.56±19.6 (p=0.751) in ABM/P-15, rhBMP-2, and DBM groups, which post-operatively reduced to 33.77±15.52, 39.42±16.47, and 38.3±15.89 (p=0.412) and further to 15.74±8.3, 17.41±10.45, and 16.76±9.81 (p=0.603), respectively at the last follow-up. Conclusion : ABM/P-15 appears to achieve union significantly earlier than rhBMP-2 and DBM in lumbar spinal fusion cases while maintaining a comparable clinical and complication profile.

• Journal of Korean Neurosurgical Society
• /
• v.66 no.1
• /
• pp.33-43
• /
• 2023

Objective : To compare the outcomes of anterior lumbar interbody fusion (ALIF), oblique lumbar interbody fusion (OLIF), and transforaminal lumbar interbody fusion (TLIF) in terms of global sagittal alignment. Methods : From January 2007 to December 2019, 141 adult patients who underwent multilevel interbody fusion for lumbar degenerative disorders were enrolled. Regarding the approach, patients were divided into the ALIF (n=23), OLIF (n=60), and TLIF (n=58) groups. Outcomes, including local radiographic parameters and global sagittal alignment, were then compared between the treatment groups. Results : Regarding local radiographic parameters, ALIF and OLIF were superior to TLIF in terms of the change in the anterior disc height (7.6±4.5 mm vs. 6.9±3.2 mm vs. 4.7±2.9 mm, p<0.001), disc angle (-10.0°±6.3° vs. -9.2°±5.2° vs. -5.1°±5.1°, p<0.001), and fused segment lordosis (-14.5°±11.3° vs. -13.8°±7.5° vs. -7.4°±9.1°, p<0.001). However, regarding global sagittal alignment, postoperative lumbar lordosis (-42.5°±9.6° vs. -44.4°±11.6° vs. -40.6°±12.3°, p=0.210), pelvic incidence-lumbar lordosis mismatch (7.9°±11.3° vs. 6.7°±11.6° vs. 11.5°±13.0°, p=0.089), and the sagittal vertical axis (24.3±28.5 mm vs. 24.5±34.0 mm vs. 25.2±36.6 mm, p=0.990) did not differ between the groups. Conclusion : Although the anterior approaches were superior in terms of local radiographic parameters, TLIF achieved adequate global sagittal alignment, comparable to the anterior approaches.

• Journal of Korean Neurosurgical Society
• /
• v.40 no.5
• /
• pp.346-350
• /
• 2006

Objective : The ability to induce segmental lordosis has been reported to be marginal with transforaminal lumbar interbody fusion[TLIF]. Therefore, we analyzed the short-term radiological outcomes of TLIF using $8^{\circ}$ wedged cages for isthmic spondylolisthesis. Methods : Twenty-seven patients with isthmic spondylolisthesis who underwent single level TLIF with pedicle screw fixation[PSF] using $8^{\circ}$ wedged cages were retrospectively evaluated. Changes in disc height, degree of anterolisthesis, segmental lumbar lordosis, whole lumbar lordosis and L1 axis S1 distance were evaluated using standing lateral radiographs before surgery, at 6 weeks follow-up and at the final follow-up. Results : The mean age of the patients was 49.9 years [range, 38 to 64 years]. The affected levels were L4-5 in 17 cases and L5-S1 in 10. There were 18 cases of Grade I isthmic spondylolisthesis and 9 cases of Grade II. At a mean follow-up duration of 9.9 months [range, 6 to 18 months], the disc height [p< 0.001] was significantly increased, and the degree of anterolisthesis was significantly reduced [p< 0.001]. Regarding the sagittal balance, the segmental lumbar lordosis was significantly increased [p=0.01], but other parameters were not significantly changed after surgery. Conclusion : TLIF with PSF using $8^{\circ}$ wedged cages significantly increased the segmental lumbar lordosis.

• Journal of Korean Neurosurgical Society
• /
• v.41 no.2
• /
• pp.88-94
• /
• 2007

Objective : The aim of this study is to investigate predictable risk factors for radiologic degeneration of adjacent segment after lumbar fusion and preoperative radiologic features of patients who underwent additional surgery with adjacent segment degeneration. Methods : Between January 1995 and December 2002, 201 patients who underwent lumbar fusion for degenerative conditions of lumbar spine were evaluated. We studied radiologic features, the method of operation, the length of fusion, age, sex, osteoporosis, and body mass index. Special attention was focused on, preoperative radiologic features of patients who required additional surgery were studied to detect risk factors for clinical deterioration. Results : Follow-up period ranged from 3 to 11 years. In our study, 61 [30%] patients developed adjacent segment degeneration, and 15 [7%] patients required additional surgery for neurologic deterioration. Age, the postoperative delay, facet volume, motion range, laminar inclination, facet tropism, and preexisting disc degeneration of adjacent segment considered as possible risk factors. Among these, laminar inclination and preexisting disc degeneration of adjacent segment were significantly correlated with clinical deterioration. Conclusion : The radiologic degeneration of adjacent segment after lumbar fusion can be predicted in terms of each preoperative radiologic factor, age and the postoperative delay. Laminar inclination and preexisting disc degeneration of adjacent segment have shown as strong risk factors for neurologic deterioration. Thus, careful consideration is warranted when these risk factors are present.

• Journal of Korean Neurosurgical Society
• /
• v.50 no.5
• /
• pp.409-414
• /
• 2011

Objective : The aim of this study was to evaluate the impact of sodium hyaluronate-sodium carboxymethyl cellulose (HA-CMC), an anti-adhesive material for spinal surgery, on bone fusion by applying it to rat spinal models after lumbar posterolateral fusion. Methods : Lumbar posterolateral fusion was performed at L4-5 using bone graft substitutes in 30 rats. HA-CMC was injected in 15 rats at a dose of 0.2 cc (HA-CMC group) and a saline solution of 0.2 cc in the other 15 rats (control group). Simple radiographs were taken until postoperative 9 weeks with an interval of one week. At postoperative 4 and 9 weeks, three dimensional computed tomography (3D CT) scanning was performed to observe the process of bone fusion. At 9 weeks, bone fusion was confirmed by gross examination and manual palpation. Results : There were no statistically significant differences in bone fusion between the two groups. 3D CT scanning did not reveal significant differences between the groups. The gross examination and manual palpation after autopsy performed at 9 weeks confirmed bone union in 93.3% of both groups. Conclusion : The anti-adhesive material used for spinal surgery did not have adverse effects on spinal fusion in rats.