• Journal of Korean Neurosurgical Society
• /
• 제30권sup2호
• /
• pp.235-241
• /
• 2001

Objective : Controversy exists which surgical treatment better in lumbar grade I spondylolisthesis, decompressive laminectomy with or without lumbar instrumentation. Methods : Out of Sixty-four patients with lumbar spondylolisthesis underwent surgery, 18 patients operated with decompressive laminectomy alone and 44 patients with decompession and lumbar instrument, during recent 5-years between January, 1994 and December, 1998. The author studied a long term follow-up in the above two groups to analyzing the overall clinical outcomes in each group and to determining the incidence of pos-toperative radiologic instability. Results : 1) Overall postoperative symptoms improvement were not so different in both groups. 2) Postoperative progressive subluxation is more common after decompressive laminectomy without instrumentation than with instrumentation group. 3) Overall clinical outcomes were slightly better in decompressive laminectomy without instrumentation than with instrumentation group but there was no significant difference. 4) Postoperative radiologic changes did not seem to influence the patient-reported clinical outcomes. 5) Postoperative complications is more common in decompressive laminectomy with instrumentation group than without instrumentation group. Conclusion : In the surgical management of grade I spondylolisthesis, the efficiency and superiority of surgical treatments requires the cost effectiveness and risk/benefit analysis of decompressive laminectomy with or without instrumentation. Therefore, Further detailed studies of long term follow up in a large number of patients in each group are needed for choice of best treatment.

• 한국정밀공학회:학술대회논문집
• /
• 한국정밀공학회 2005년도 추계학술대회 논문집
• /
• pp.236-239
• /
• 2005

This study investigated the effect of ovariectomy (OVX) on the rat bone fur long term (22 weeks). In previous researches, there were many studies for morphology of OVX-induced osteoporotic bones based on micro-Computed Tomography (micro-CT). However, there were few studies fpr detecting and tracking changes of mechanical characteristics in the lumbar vertebrae of OVX rat fur long-term. For this study, one female Sprague-Dawley rat was used: an OVX rat. The 4th lumbar of the OVX rat was utilized as a specimen. Morphological characteristics could be investigated fur the lumbar vertebrae in an OVX rat by using in-vivo Micro-CT. An OVX rat was scanned at week 0 (just before surgery), at week 4, at week 8, at week 16 and at week 22 after surgery. Micro finite element $({\mu}FE)$ analysis was used to investigate mechanical characteristics in the lumbar vertebrae for an OVX rat.

• 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.

• Journal of Korean Neurosurgical Society
• /
• 제47권4호
• /
• pp.313-315
• /
• 2010

Osteochondromas are common, benign tumors in the long bones, but osteochondromas are rare in the vertebrae. Most vertebral osteochondromas arise from the cervical or upper thoracic spine. However, lumbar osteochondromas have rarely been reported. In this report, a rare case of a lumbar osteochondroma arising from the spondylolytic L3 lamina in a 57-year-old woman is presented. She also had a ruptured disc and lumbar canal stenosis at L4-5-S1. The osteochondroma was completely removed and a posterior lumbar interbody fusion and instrumentation were performed. Considering the rarity of osteochondromas in the lumbar vertebrae, especially the L3 vertebra, it is possible that the pre-existing lumbar spondylolysis or spondylolisthesis was one of the factors affecting the occurrence or progression of the osteochondroma.

• Journal of Korean Neurosurgical Society
• /
• 제38권2호
• /
• pp.111-115
• /
• 2005

Objective : Upper lumbar disc herniation is rare disease, compared with lower. The lamina of this high level lumbar vertebra is narrower than that of low level, and this have taken surgeon into important consideration for surgical methods because partial removal of lamina for discectomy weakens the base of the articular process and may result in fracture. The authors an accurate preoperative diagnosis that enables the surgeon to operative approach for preserving the facet joint. Methods : Thirteen patients with upper lumbar disc herniation have underone surgical procedure by midline approach for removal of ruptured disc fragment and paraspinal approach for removal of residual disc materials simultaneously without instrumentation. All patients who underwent surgery were analyzed and long-term follow-up was conducted. Results : At a mean follow-up of 24months, there were complete resolution of presenting radiating leg pain in 85% of the patients, 7.5% were left with minimal residual discomfort, and 7.5% derived little or no benefit from surgery. The follow-up radiologic findings of all patients shows that lamina and facet joint have preserved safely and no instability. Conclusion : Simultaneously, paraspinal with midline approach provides highly satisfactory operating methods by simplifying exposure and greatly limiting the risk of complications. This provides the basis for a planned surgical approach in which destruction of the facet joint can be avoided.

• Journal of Trauma and Injury
• /
• 제30권4호
• /
• pp.212-215
• /
• 2017

The choice of the most appropriate treatment for thoracolumbar or lumbar spine burst fracture remains controversial from conservative treatment to fusion through a posterior or anterior approach. There are many cases where ligamentotaxis is used to reduce the burst fracture. However, indirect reduction using ligamentotaxis is often limited in the magnitude of the reduction that it can achieve. In our patient with severe burst fracture, we were able to restore an almost normal level of vertebral height and secure spinal canal widening by using only ligamentotaxis by posterior instrumentation. Before the operation, the patient had more than 95% encroachment of the spinal canal. This was reduced to less than 10% after treatment.

• International Journal of CAD/CAM
• /
• 제9권1호
• /
• pp.121-128
• /
• 2010

The purpose of this study is to clarify the mechanical behavior of human lumbar vertebrae (L3/L4) with and without fusion bone under physiological axial compression. The author has developed the program code to build the patient specific three-dimensional geometric model from the computed tomography (CT) images. The developed three-dimensional model provides the necessary information to the physicians and surgeons to visually interact with the model and if needed, plan the way of surgery in advance. The processed data of the model is versatile and compatible with the commercial computer aided design (CAD), finite element analysis (FEA) software and rapid prototyping technology. The actual physical model is manufactured using rapid prototyping technique to confirm the executable competence of the processed data from the developed program code. The patient specific model of L3/L4 vertebrae is analyzed under compressive loading condition by the FEA approach. By varying the spacer position and fusion bone with and without pedicle instrumentation, simulations were carried out to find the increasing axial stiffness so as to ensure the success of fusion technique. The finding was helpful in positioning the fusion bone graft and to predict the mechanical stress and deformation of body organ indicating the critical section.

• Journal of Korean Neurosurgical Society
• /
• 제54권2호
• /
• pp.128-131
• /
• 2013

Transforaminal lumbar interbody fusion (TLIF) is commonly used procedure for spinal fusion. However, there are no reports describing anterior cage dislodgement after surgery. This report is a rare case of anterior dislodgement of fusion cage after TLIF for the treatment of isthmic spondylolisthesis with lumbosacral transitional vertebra (LSTV). A 51-year-old man underwent TLIF at L4-5 with posterior instrumentation for the treatment of grade 1 isthmic spondylolisthesis with LSTV. At 7 weeks postoperatively, imaging studies demonstrated that banana-shaped cage migrated anteriorly and anterolisthesis recurred at the index level with pseudoarthrosis. The cage was removed and exchanged by new cage through anterior approach, and screws were replaced with larger size ones and cement augmentation was added. At postoperative 2 days of revision surgery, computed tomography (CT) showed fracture on lateral pedicle and body wall of L5 vertebra. He underwent surgery again for paraspinal decompression at L4-5 and extension of instrumentation to S1 vertebra. His back and leg pains improved significantly after final revision surgery and symptom relief was maintained during follow-up period. At 6 months follow-up, CT images showed solid fusion at L4-5 level. Careful cage selection for TLIF must be done for treatment of spondylolisthesis accompanied with deformed LSTV, especially when reduction will be attempted. Banana-shaped cage should be positioned anteriorly, but anterior dislodgement of cage and reduction failure may occur in case of a highly unstable spine. Revision surgery for the treatment of an anteriorly dislodged cage may be effectively performed using an anterior approach.

• Journal of Korean Neurosurgical Society
• /
• 제38권3호
• /
• pp.206-210
• /
• 2005

Objective : Our aim is to evaluate the early changes of biologic markers such as white blood cell[WBC] count, erythrocyte sedimentation rate[ESR] and C-reactive protein[CRP] in early diagnosis of postoperative infection and to differentiate infection from inflammatory reaction in lumbar spine surgery. Methods : We reviewed 330patients who had undergone spinal operations between May 1999 and October 2001. For this study, the patients were classified into two groups, which include a group that underwent spinal decompressive surgery without instrumentation[SD], and the other group that underwent fusion surgery with spinal instrumentation[SI]. And each group was also subdivided into two groups respectively, one with infection and the other without infection. We retrospectively analyzed the WBC count, ESR and CRP preoperatively and postoperatively, according to their operation type and postoperative infection history. Results : Inflammatory indices were physiologically affected by instrumentation itself. But ESR and CRP elevations were more prolonged and sustained under infection. In SD patients without infection, ESR and CRP were stabilized 5 days after surgery. In SI patients without infection, CRP was stabilized about 7days after surgery, but ESR showed sustained and variously elevated. In both SD and SI groups, the stabilization of CRP was the most reliable behavior of surgery without infection. Conclusion : C-reactive protein is most sensitive parameter for postoperative spine infection. The knowledge of the inflammatory indices and their relatively uniform patterns with or without infection offers surgeons the ability to infer the state of surgical wound.

• Journal of Korean Neurosurgical Society
• /
• 제41권3호
• /
• pp.157-160
• /
• 2007

Objective : The purpose of this study was to evaluate the efficacy and safety of the surgical treatment for lumbar spinal stenosis in elderly patients. Methods : The authors reviewed the medical records of 49 patients older than 65 years of age with lumbar spinal stenosis who underwent surgical treatment from January 2002 to December 2004 in our institute. Results : Average age of patients was 70 years old [32 women, 17 men]. Twenty-four patients had chronic medical disorders. All patients were operated under the general anesthesia of these, 29 patients underwent decompressive laminectomy and decompressive laminectomy with instrumentation and fusion in 20 patients. The mean operation time was 193.5 minutes, mean estimated blood loss was 378cc and mean postoperative hospital stay length was 15.3 days. The mean follow-up duration was 11.9 months. The evaluation of outcome was assessed by Macnab classification. At first month after operation, the outcome showed excellent in 7 [14.3%]. good in 35 [71.4%], fair in 5 [10.2%], and poor in 2 [4.1%]. And at 6 months after operation, 17 patients were lost in follow-up, the outcome showed excellent in 4 [12.5%], good in 25 [78.1%], fair in 3 [9.4%], and no poor cases. There was no significant difference between outcome of laminectomy alone and that of laminectomy with fusion. Six patients [12.2%] experienced postoperative complications which included wound infection [3], nerve root injury [1], disc herniation [1], and reoperation due to insufficient decompression [1]. There were no deaths related to operation. Conclusion : We conclude that the surgical treatment for lumbar spinal stenosis in elderly patients can provide good results with acceptable morbidity when carefully selected. In addition, decision on lumbar spinal fusion should not be against solely on advanced age.