• Journal of Korean Neurosurgical Society
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• v.62 no.6
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• pp.671-680
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• 2019

Objective : We introduce innovative method of cervical column reconstruction and performed the reconstruction with a flanged titanium mesh cage (TMC) instead of a plate after anterior corpectomy for cervical spondylotic myelopathy (CSM) and an ossified posterior longitudinal ligament (OPLL). Methods : Fifty patients with CSM or OPLL who underwent anterior cervical reconstruction with a flanged TMC were investigated retrospectively. Odom's criteria were used to assess the clinical outcomes. The radiographic evaluation included TMC subsidence, fusion status, and interbody height. Thirty-eight patients underwent single-level and 12 patients underwent two-level corpectomy with a mean follow-up period of 16.8 months. Results : In all, 19 patients (38%) had excellent outcomes and 25 patients (50%) had good outcomes. Two patients (4%) in whom C5 palsy occurred were categorized as poor. The fusion rate at the last follow-up was 98%, and the severe subsidence rate was 34%. No differences in subsidence were observed among Odom's criteria or between the single-level and two-level corpectomy groups. Conclusion : The satisfactory outcomes in this study indicate that the flanged TMC is an effective graft for cervical reconstruction.

• Journal of Yeungnam Medical Science
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• v.6 no.2
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• pp.141-146
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• 1989

In an attempt to eliminate some negative aspects of conventional extensive laminectomy, 4 cases of multiple level of cervical compression myelopathy, 1 OPLL(ossification of posterior longitudinal ligament) and 3 cervical stenosis, were treated with a technique of expansive laminoplasty. Operative results in all patients were satisfactory without surgical complications and all patients had a neurological improvement. We suggest that our technique is more effective one for cervical canal enlargement with preservation of stability for treating multiple level of cervical canal stenosis, OPLL, and spondylosis than conventional extensive laminectomy.

• Journal of Korean Neurosurgical Society
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• v.38 no.2
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• pp.102-106
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• 2005

Objective : The purposes of this study are to evaluate the efficacy of en bloc open-door laminoplasty and to investigate the validity of various factors as prognotic indicators in patients with multisegmental spondylotic myelopathy and ossification of posterior longitudinal ligament[OPLL]. Methods : The authors reviewed 43 cases in whom laminoplasty were performed for cervical myelopathy between January 2000 and December 2002. Clinical symptoms and results were evaluated using the Japanese Orthopaedic Association[JOA] scale. The recovery rate was calculated and then assessed for prognostic factors such as preoperative JOA scores, ages, history of previous trauma, duration of symptoms and signal change in cord on T2-weighted magnetic resonance Image. Results : In cervical stenosis, canal widening of antero-posterior diameter and dimension after laminoplasty is 4.16mm, $87.43mm^2$ and in OPLL is 6.20mm, $117.61mm^2$. In all cases there wasn't neurologic deterioration, mild postoperative complications developed in seven cases. Four patient had a limitation of range of neck motion and the other one showed kyphotic change and another two showed C5 radiculopathy. The recovery rate of JOA score in cervical stenosis and OPLL was 62% and 68% respectively. Duration of symptoms, the severity[preoperative JOA score], and signal change in cord on T2-weighted magnetic resonance image had close relationship to the clinical outcomes. Conclusion : Unilateral en bloc laminoplasty is simultaneous expansile and decompressive method. And preoperative JOA score, symptom duration and high signal intensity on T2-weighted magnetic resonance image can be used to predict prognosis.

• Journal of Korean Neurosurgical Society
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• v.60 no.5
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• pp.577-583
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• 2017

Objective : Laminoplasty is an effective surgical method for treating cervical degenerative disease. However, postoperative complications such as kyphosis, restriction of neck motion, and instability are often reported. Despite sufficient preoperative lordosis, this procedure often aggravates the lordotic curve of the cervical spine and straightens cervical alignment. Hence, it is important to examine preoperative risk factors associated with postoperative kyphotic alignment changes. Our study aimed to investigate preoperative radiologic parameters associated with kyphotic deformity post laminoplasty. Methods : We retrospectively reviewed the medical records of 49 patients who underwent open door laminoplasty for cervical spondylotic myelopathy (CSM) or ossification of the posterior longitudinal ligament (OPLL) at Pusan National University Yangsan Hospital between January 2011 and December 2015. Inclusion criteria were as follows : 1) preoperative diagnosis of OPLL or CSM, 2) no previous history of cervical spinal surgery, cervical trauma, tumor, or infection, 3) minimum of one-year follow-up post laminoplasty with proper radiologic examinations performed in outpatient clinics, and 4) cases showing C7 and T1 vertebral body in the preoperative cervical sagittal plane. The radiologic parameters examined included C2-C7 Cobb angles, T1 slope, C2-C7 sagittal vertical axis (SVA), range of motion (ROM) from C2-C7, segmental instability, and T2 signal change observed on magnetic resonance imaging (MRI). Clinical factors examined included preoperative modified Japanese Orthopedic Association scores, disease classification, duration of symptoms, and the range of operation levels. Results : Mean preoperative sagittal alignment was $13.01^{\circ}$ lordotic; $6.94^{\circ}$ lordotic postoperatively. Percentage of postoperative kyphosis was 80%. Patients were subdivided into two groups according to postoperative Cobb angle change; a control group (n=22) and kyphotic group (n=27). The kyphotic group consisted of patients with more than $5^{\circ}$ kyphotic angle change postoperatively. There were no differences in age, sex, C2-C7 Cobb angle, T1 slope, C2-C7 SVA, ROM from C2-C7, segmental instability, or T2 signal change. Multiple regression analysis revealed T1 slope had a strong relationship with postoperative cervical kyphosis. Likewise, correlation analysis revealed there was a statistical significance between T1 slope and postoperative Cobb angle change (p=0.035), and that there was a statistically significant relationship between T1 slope and C2-C7 SVA (p=0.001). Patients with higher preoperative T1 slope demonstrated loss of lordotic curvature postoperatively. Conclusion : Laminoplasty has a high probability of aggravating sagittal balance of the cervical spine. T1 slope is a good predictor of postoperative kyphotic changes of the cervical spine. Similarly, T1 slope is strongly correlated with C2-C7 SVA.

• Journal of Korean Medicine Rehabilitation
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• v.20 no.4
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• pp.139-146
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• 2010

Objectives : To compare the differences between the symptoms and the findings of MRI(magnetic resonance imaging) and x-ray, we studied the patients with neck pain or radiating pain, which has been diagnosed as cervical herniated disc recently. Methods : We randomly selected among the 143 patients with x-ray and cervical spine(C-spine) MRI films who have visited Ja-seng hospital with neck pain and neck and radiating pain from April 1 of 2010 to May 1. We used SPSS 13.0 for windows in analyzing statistical data of study results and the level of significance was below 0.05. Results : 1. There were no significant differences between the presence of radiating pain and the amount of cervical herniation(p>0.05). 2. If the finding of a x-ray showed narrowing, based on MRI findings, the amount of herniation was more severe(p>0.05). 3. There were no significant differences between the presence of radiating pain and the findings of x-ray(p>0.05). 4. Among the 143 cases, which showed findings beside HIVD(herniation of intervertebral disc) were 13 cases. 88 cases of straightening(61.5%). 78 cases of uncovertebral joint arthrosis(54.5%). 25 cases of stenosis(17.5%), 13 cases of retrolisthesis(9.1%), 8 cases of osteophyte(6.6%), 4 cases of spondylolisthesis(2.8%), 2 cases of hemangioma(1.4%), 3 cases of OPLL(ossification of posterior longitudinal ligament)(2.1%), 2 cases of block vertebrae(1.4%), 2 cases of spondylitis(1.4%), 1 case of kyphosis(0.1) and 1 case of ligamentum flavum hypertrophy(0.1%). Conclusions : The findings from this study suggest that there was no relation between radiating pain and radiological result. On the other hand, diagnosis of x-ray and MRI showed significant relevance. The narrower disc space there were, the severer the state of herniation there existed.

• Journal of the Korean Arthroscopy Society
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• v.4 no.1
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• pp.49-53
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• 2000

Purpose : The purpose of this study was to evaluate clinical efficacy of the arthroscopic anterior acromioplasty for the treatment of chronic impingement syndrome of the shoulder. Materials and Methods : Between July 1995 and December 1997, twenty seven consecutive shoulders of 26 patients with chronic impingement syndrome of the shoulder were treated by arthroscopic anterior acromioplasty. The patients who had severe osteoarthritis of the shoulder full thickness tear of the rotator cuff, and nonoutlet impingement were excluded. The clinical results were evaluated by using UCLA shoulder rating scale. The average follow-up was 2years 3months(range, 1year 7months to 3years 1 11months). Results : Twenty three patients$(85.2\%)$ were rated as excellent or good results, while four patients$(14.8\%)$ were fair. Twenty six cases$(96.3\%)$ were satisfied with the results of the operations, while one case$(3.7\%)$, who had Parkinsonian syndrome, ossification of posterior longitudinal ligament(OPLL) of the cervical spine, and spinal stenosis of the 5th and 6th cervical spine was not satisfied. Conclusion : Arthroscopic anterior acromioplasty was an effective treatment method, especially for relief of pain, for the treatment of chronic impingement syndrome of the shoulder. If the patient has the combined lesions in the cervical spine and the shoulder, and systemic lesions, these lesions may influence the results of treatment after operation, and cause the unpredictable results.