• Journal of Korean Neurosurgical Society
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• 제46권4호
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• pp.292-299
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• 2009

Objective : Clinical and radiological results of posterior dynamic stabilization using interspinous U (ISU, $Coflex^{TM}$, Paradigm Spine $Inc.^{(R)}$, NY, USA) were analyzed in comparison with posterior lumbar interbody fusion (PLIF) in degenerative lumbar spinal stenosis (LSS). Methods : A retrospective study was conducted for a consecutive series of 61 patients with degenerative LSS between May 2003 and December 2005. We included only the patients completed minimum 24 months follow up evaluation. Among them, 30 patients were treated with implantation of ISU after decompressive laminectomy (Group ISU) and 31 patients were treated with wide decompressive laminectomy and posterior lumbar interbody fusion (PLIF; Group PLIF). We evaluated visual analogue scale (VAS) and Oswestry Disability Index (ODI) for clinical outcomes (VAS, ODI), disc height ratio disc height (DH), disc height/vertebral body length ${\times}100$), static vertebral slip (VS) and depth of maximal radiolucent gap between ISU and spinous process) in preoperative, immediate postoperative and last follow up. Results : The mean age of group ISU ($66.2{\pm}6.7$ years) was 6.2 years older than the mean age of group PLIF ($60.4{\pm}8.1$ years; p=0.003). In both groups, clinical measures improved significantly than preoperative values (p<0.001). Operation time and blood loss was significantly shorter and lower in group ISU than group PLIF (p<0.001). In group ISU, the DH increased transiently in immediate postoperative period ($15.7{\pm}4.5%{\rightarrow}18.6{\pm}5.9%$), however decreased significantly in last follow up ($13.8{\pm}6.6%$, p=0.027). Vertebral slip (VS) of spondylolisthesis in group ISU increased during postoperative follow-up ($2.3{\pm}3.3{\rightarrow}8.7{\pm}6.2$, p=0.040). Meanwhile, the postoperatively improved DH and VS was maintained in group PLIF in last follow up. Conclusion : According to our result, implantation of ISU after decompressive laminectomy in degenerative LSS is less invasive and provides similar clinical outcome in comparison with the instrumented fusion. However, the device has only transient effect on the postoperative restoration of disc height and reduction of slip in spondylolisthesis. Therefore, in the biomechanical standpoint, it is hard to expect that use of Interspinous U in decompressive laminectomy for degenerative LSS had long term beneficial effect.

• Journal of Korean Neurosurgical Society
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• 제54권6호
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• pp.537-539
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• 2013

Charcot spinal arthropathy is a rare, progressive type of vertebral joint degeneration that occurs in the setting of any preexisting condition characterized by decreased afferent innervation to the extent that normal protective joint sensation in the vertebral column is impaired. The authors report on a case of Charcot arthropathy of the lower lumbar spine mimicking a spinal tumor following cervical cord injury.

• Journal of Korean Neurosurgical Society
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• 제64권5호
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• pp.837-842
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• 2021

An atlantoaxial subluxation from the unstable Os odontoideum by the failure of proper integrations between the embryological somites might be a commonly reported pathology. However, its suspicious origin or paralleled occurrence with other congenital anomalies of vertebral body might be a relatively rare phenomenon. The authors present two cases, who simply presented with clinical signs of prolonged, intractable cervicalgia without any neurological deficits, revealed this rare feature of C1-2 subluxation from the unstable, orthotropic type of Os odontoideum that coincide with congenitally fused cervical vertebral bodies between C2-3. Surprisingly, in one case, when traced from the lower cervical down to the thoracic-lumbar levels during the preoperative work-up process, was also compromised with multi-level butterfly vertebrae formations. Presented cases highlight the association of various congenital vertebrae anomalies and the rationale to fuse only affected joints.

• Journal of Korean Neurosurgical Society
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• 제56권4호
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• pp.323-329
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• 2014

Objective : Vertebral body replacement following corpectomy in thoracic or lumbar spine is performed with titanium mesh cage (TMC) containing any grafts. Radiological changes often occur on follow-up. This study investigated the relationship between the radiological stability and clinical symptoms. Methods : The subjects of this study were 28 patients who underwent corpectomy on the thoracic or lumbar spine. Their medical records and radiological data were retrospectively analyzed. There were 23 cases of tumor, 2 cases of trauma, and 3 cases of infection. During operation, spinal reconstruction was done with TMC and additional screw fixation. We measured TMC settlement in sagittal plane and spinal angular change in coronal and sagittal plane at postoperative one month and last follow-up. Pain score was also checked. We investigated the correlation between radiologic change and pain status. Whether factors, such as the kind of graft material, surgical approach, and fusion can affect the radiological stability or not was analyzed as well. Results : Mean follow-up was 23.6 months. During follow-up, $2.08{\pm}1.65^{\circ}$ and $6.96{\pm}2.08^{\circ}$ of angular change was observed in coronal and sagittal plane, respectively. A mean of cage settlement was $4.02{\pm}2.83mm$. Pain aggravation was observed in 4 cases. However, no significant relationship was found between spinal angular change and pain status (p=0.518, 0.458). Cage settlement was seen not to be related with pain status, either (p=0.644). No factors were found to affect the radiological stability. Conclusion : TMC settlement and spinal angular change were often observed in reconstructed spine. However, these changes did not always cause postoperative axial pain.

• Journal of Korean Neurosurgical Society
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• 제42권4호
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• pp.271-275
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• 2007

Objective : Although a significant correction of local kyphosis has been reported previously, only a few studies have investigated whether this correction leads to an improved overall sagittal alignment. The study objective was to determine whether an improvement in the local kyphotic angle improves the overall sagittal alignment. We examined and compared the effects of thoracic and lumbar level kyphoplasty procedures on local versus overall sagittal alignment of the spine. Methods : Thirty-eight patients with osteoporotic vertebral compression fractures who showed poor response to conventional, palliative medical therapy underwent single-level kyphoplasty. The pertinent clinical data of these patients, from June 2006 to November 2006, were reviewed retrospectively. We measured preoperative and postoperative vertebral body heights, which were classified as anterior, middle, or posterior fractured vertebral body heights. Furthermore, the local and overall sagittal angles after polymethylmethacrylate deposition were measured. Results : More height was gained at the thoracic level, and the middle vertebral height regained the most. A significant local kyphosis correction was observed at the fractured level, and the correction at larger spanning segments decreased with the distance from the fractured level. Conclusion : The inflatable balloon kyphoplasty procedure was the most effective in regaining the height of the thoracic fractured vertebra in the middle vertebral body. The kyphosis correction by kyphoplasty was mainly achieved in the fractured vertebral body. Sagittal angular correction decreased with an increase in the distance from the fractured vertebra. No significant improvement was observed in the overall sagittal alignment after kyphoplasty. Further studies in a larger population are required to clarify this issue.

• 대한핵의학회지
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• 제38권6호
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• pp.522-527
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• 2004

목적 : 본 연구는 골다공증에 의한 척추 골절 환자를 대상으로 골SPECT를 시행하고 골 섭취 증가 병변의 형태와 분포를 분석하여, 척추 골절에서 골SPECT의 유용성을 알아보고자 하였다. 대상 및 방법: 골다공증에 의한 척추 골절이 있었던 32명의 환자를 대상으로 하였다. 평균 연령은 $67{\pm}8$세였으며, 남자 5명, 여자 27명이었다. 79개의 척추골절이 발견되었으며, 병소는 흉부 및 흉요추부 척추가 38개, 요추부 척추가 41개였다. 척추체의 골절 형태는 압박 형태에 따라 쐐기형, 양요형, 압박형으로 분류하였고, SPECT 상 척추체의 골 섭취 증가 병변은 국소성 혹은 미만성, 대칭성 혹은 비대칭성으로 분류하였다. 척추 후방부의 SPECT 소견은 척추경, 척추 후관절, 관절간부, 극상 돌기의 골섭취 증가 병변 유무로 분류하였다. 척추체 골절 형태와 골절 척추의 위치에 따른 골 SPECT소견에 차이가 있는지를 분석하였다. 결과: 79개의 척추제 압박 골절 중 쐐기형 병소가 47개, 양요형 병소가 20개, 압박형 병소가 12개이었다. 골 SPECT에서는 척추체의 섭취 증가가 모든 예에서 관찰되었으며, 골절의 형태와 관계없이 국소형 보다는 미만형이, 대칭성 보다는 비대칭성 골 섭취 증가가 많았다. 척추 후방부에 병소가 발견된 경우는 69개(87.3%) 였으며, 쐐기형이 40개(85.1%), 양요형 17개(85.0%), 압축형 12개(100%)에서 관찰되었다. 흉부 및 흉요추부 척추에서는 쐐기형 골절이 많은 반면, 요추부 척추에서는 골절형태 분포가 비교적 균일한 것으로 나타났다(p=0.04). 극상돌기의 골섭취는 흉부 및 흉요추부 골절의 5예(13.2%)에서 있었던 반면 요추부 척추 골절에서는 16개(39.0%)에서 발견되어 분포의 차이가 있었다(p=0.009). 요추부 척추에서 발생한 양요형 골절에서 척추 후관절에 골 섭취 증가를 보인 경우가 12개(92.3%)인데 반해 흉부 및 흉요추부 척추에 발생한 경우 4개(57.1%) 에서만 골섭취 증가 병변이 있었다. 극상돌기의 골섭취에도 차이가 있어서 요추가 8개(38.5%)인데 비해 흉부 및 흉요추부 척추에서는 1개(14.3%)에서만 골섭취가 있었다(p=0.043). 결론: 골SPECT는 골다공증에 의한 척추 골절 진단에 유용하며, 특히 척추 후방부의 골 섭취 증가 병변의 평가에 유용하였다.

• Journal of Korean Neurosurgical Society
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• 제57권3호
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• pp.178-184
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• 2015

Objective : Posterior vertebral translation as a type of spondylolisthesis, retrolisthesis is observed commonly in patients with degenerative spinal problems. Nevertheless, there is insufficient literature on retrolisthesis compared to anterolisthesis. The purpose of this study is to clarify the clinical features of retrolisthesis, and its developmental mechanism associated with a compensatory role in sagittal imbalance of the lumbar spine. Methods : From 2003 to 2012, 230 Korean patients who underwent spinal surgery in our department under the impression of degenerative lumbar spinal disease were enrolled. All participants were divided into four groups : 35 patients with retrolisthesis (group R), 32 patients with simultaneous retrolisthesis and anterolisthesis (group R+A), 76 patients with anterolisthesis (group A), and 87 patients with non-translation (group N). The clinical features and the sagittal parameters related to retrolisthesis were retrospectively analyzed based on the patients' medical records. Results : There were different clinical features and developmental mechanisms between retrolisthesis and anterolisthesis. The location of retrolisthesis was affected by the presence of simultaneous anterolisthesis, even though it predominantly manifest in L3. The relative lower pelvic incidence, pelvic tilt, and lumbar lordosis compared to anterolisthesis were related to the generation of retrolisthesis, with the opposite observations of patients with anterolisthesis. Conclusion : Retrolisthesis acts as a compensatory mechanism for moving the gravity axis posteriorly for sagittal imbalance in the lumbar spine under low pelvic incidence and insufficient intra-spinal compensation.

• 해부∙생물인류학
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• 제31권4호
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• pp.151-158
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• 2018

척추사이구멍은 인접한 두 척추뼈와 그 사이의 척추사이원반으로 구성된다. 이전의 척추사이구멍에 대한 연구들은 다양한 방법으로 수행이 되었다. 이번 연구에서는 실리콘 주형을 이용해서 척추사이구멍의 특징을 알아보았다. 시신18구를 해부하여 허리의 척추사이구멍을 해부하였다. 첫째로는 척수신경의 위치를 측정하였다. 둘째로는 척추사이구멍을 덮고있는 모든 조직을 제거하여 척추사이구멍 단면의 가장 좁은 부위를 측정하였다. 조직이 제거된 척추사이구멍은 실리콘주형으로 채워졌다. 실리콘주형이 굳어진 다음에는 구멍에서 분리되었다. 단면으로 잘린 실리콘주형을 종이 위에 도장처럼 찍고, 그것을 컴퓨터에 저장하였다. 척추사이구멍의 주형의 면적, 둘레, 높이, 폭이 컴퓨터에서 분석되었다. 허리의 다섯 개 척추사이구멍에서 면적과 둘레는 통계학적인 차이를 보이지 않았다. 하지만 둘째에서 다섯째 허리뼈에 걸쳐서 높이는 낮아지는 경향, 폭은 넓어지는 경향을 보였다. 또한 높이와 폭은 다섯째 구멍에서 유의미한 차이가 있었다. 높이는 다른 구멍들 중에서 가장 낮았고, 폭은 가장 넓었다. 척수신경은 첫째에서 넷째허리뼈에서는 척추사이원반 근처를 지나갔고, 다섯째허리뼈에서는 척추사이원반 아래쪽으로 지나갔다. 이번 연구는 척추사이구멍의 3차원적 입체 구조를 실리콘주형으로 확인하였다. 기존의 평면적 연구에서 관찰되지 않았던 다른 성질들을 확인할 수 있었다. 즉, 허리척추뼈에서 척추사이구멍의 면적과 둘레는 일정하였으나 높이와 폭은 전체적으로 변화하는 양상을 보였다.

• Journal of Korean Neurosurgical Society
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• 제30권2호
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• pp.173-179
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• 2001

Purpose : To assess therapeutic effects of percutaneous polymethylmethacrylate(PMMA) vertebroplasty on the pain caused by osteoporotic thoracic and lumbar vertebral body compression fractures in a large scale of a prospective clinical design, and to determine clinical factors influencing its therapeutic effects. Methods : A prospective clinical study was carried out in 349 vertebral levels of 159 patients between April 1998 and July 1999. The compression fractures were confirmed with bone scan and spine CT, and bone marrow density was measured. Visual analogue scale(VAS) score was used for pre- and post-operative assessments of the pain. All 159 patients were assessed immediately after surgery, and 140 patients of them were followed-up for about 6 months in average. Results : Partial and complete pain relief was sustained immediately after operation in 73%, through follow-up period in 88% of the patients. Pain relief was not proportional to the amount of PMMA or the rate of increase in the height of the compressed vertebral body. It appears that 3 to 6cc of PMMA was proper enough to sustain pain relief. Better clinical improvement was achieved in the patients treated within 6 months after occurrence of vertebral body fracture. The most frequent surgical complication was epidural leakage of PMMA, and the most serious complication was extravertebral leakage into the paravertebral muscles, which appeared to exert the worst influence on the outcome. However, surgery was not required in these patients. Conclusion : Therapeutic effects of PMMA percutaneous vertebroplasty on osteoporotic vertebral body compression fractures were confirmed in a relatively large scale of prospective clinical study. It appears that good outcome can be achieved in patients treated within 6 months after fracture, treated each level with 3 to 6cc of PMMA in amount. without serious complications.

• 한국임상수의학회지
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• 제27권5호
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• pp.588-592
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• 2010

15년 령의 중성화 수컷 요크셔 테리어가 양측 후지의 보행 장애로 내원하였다. 5개월 전부터 후구 부전마비가 시작되어 점점 진행되었고, 4일 전부터는 증상이 빠르게 악화되었다. 후구 부전마비를 일으킬 수 있는 신경 질환을 감별하기 위해 컴퓨터 단층 촬영과 자기 공명 영상이 실시되었다. 컴퓨터 단층 촬영을 통해 4번 요추의 골 결손과 인접 부위의 연부 조직 종괴를 확인하였다. 자기 공명 영상을 통해서는 4번 요추의 왼쪽에서 T1강조 영상에서의 등신호종괴와 T2강조 영상에서의 고신호 종괴가 척수를 압박하는 것을 확인하였다. T1강조 영상에서 조영제 주입 후 종괴의 신호가 균일하게 증가하였다. 종괴의 절제 후 통증은 완화되었다. 조직병리학적 검사를 통해 병변이 척추 골육종임을 확인하였다. 컴퓨터 단층 촬영과 자기 공명 영상은 개에서 척추 골육종을 진단하고 수술적 제거를 위한 계획을 세우는데 유용하게 이용될 수 있다.