• Journal of Korean Neurosurgical Society
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• 제42권3호
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• pp.168-172
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• 2007

Objective : Hirabayashi's open-door laminoplasty is a good procedure to use to treat patients with myelopathy of the cervical spine; however, the authors have experienced problems in maintaining an open-window in cervical spines after the surgery. The authors developed a modified method of the expanded open-door laminoplasty and compared the radiological and clinical results with those of the classical method. Methods : In the modified method, wiring fixation with lateral mass screws on the contra lateral-side instead of fixing the paraspinal muscle or facet joint, as in the classical methods, was used in the open window of the cervical spine. Fifteen patients with cervical myelopathy were treated using the classical method and 12 patients were treated using the modified method. Preoperative and postoperative clinical conditions were assessed according to the Japanese Orthopedic Association (JOA) score. The radiological results were compared with the preoperative and postoperative computed tomography (CT) findings. Results : In both methods, the clinical results revealed a significant improvement in neurological function (p<0.001). Image analysis revealed that the cervical canals were continuously expanded in patients treated using the modified methods. However, authors have observed restenosis during the follow-up periods in 4 patients treated using the original method. Progression to deformity and spinal instability were not observed in any of the patients in the radiological results. Conclusion : Although analysis with a larger population and a longer follow-up period needs to be undertaken, our modified open-door laminoplasty has shown an advantage in better maintaining an open window in comparison with the Hirabayashi's open-door laminoplasty.

• Journal of Korean Neurosurgical Society
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• 제47권2호
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• pp.107-111
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• 2010

Objective : It has been demonstrated that cervical laminoplasty is an effective and safe method of treating multi-level cervical spondylotic myelopathy and ossification of the posterior longitudinal ligament. However, recent reports have suggested that axial neck pain is frequently encountered after cervical laminoplasty. The aim of the present study was to determine clinical significance of the C7 spinous process on axial neck pain after cervical laminoplasty. Methods : A total of 31 consecutive patients that underwent cervical laminoplasty between March 2002 and December 2008 were reviewed. The authors evaluated and compared axial neck pain and lordotic angle in patients that underwent C7 spinous process preserving surgery (group 1, n=16) and in patients in which the C7 spinous process was sacrificed (group 2, n=15). Results : Severe or moderate early axial pain occurred in 56.2% of patients in group 1 and in 86.6% in group 2. Severe or moderate late axial pain occurred in 12.5% in group 1 and in 73.3% in group 2. Eighty-Six percent of patients in group 2 and 43% in group 1 experienced aggravation of their axial neck pain during the early postoperative period. Aggravation of axial neck pain during early postoperative period was less common in group 1 but not statistically significant (p=0.073). Sixty-six percent of patients in group 2 and 12% in group 1 had aggravated axial neck pain at late postoperative period and aggravation of late axial neck pain was significantly less common in group 1 (p=0.002). Conclusion : The present study demonstrates that C7 spinous process preserving laminoplasty decreases the incidence of aggravated axial neck pain after cervical laminoplasty.

• Journal of Korean Neurosurgical Society
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• 제52권1호
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• pp.27-31
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• 2012

Objective : Although hydroxyapatite (HA) spacer has been used for laminoplasty, there have been no reports on factors associated with fusion and on the effects of HA shape. Methods : During January 2004 and January 2010, 45 patients with compressive cervical myelopathy underwent midline-splitting open door laminoplasty with winged (33 cases) and wingless (12 cases) HAs by a single surgeon. Minimal and mean follow up times were 12 and 28.1 months, respectively. Japanese Orthopedic Association (JOA) score was used for clinical outcome measurement. Cervical X-rays were taken preoperatively, immediately post-operatively, and after 3, 6, and 12 months and computed tomography scans were performed preoperatively, immediately post-operatively and after 12 months. Cervical lordosis, canal dimension, fusion between lamina and HA, and affecting factors of fusion were analyzed. Results : All surgeries were performed on 142 levels, 99 in the winged and 43 in the wingless HA groups. JOA scores of the winged group changed from $10.4{\pm}2.94$ to $13.3{\pm}2.35$ and scores of the wingless group changed from $10.8{\pm}2.87$ to $13.8{\pm}3.05$. There was no significant difference on lordotic and canal dimensional change between two groups. Post-operative 12 month fusion rate between lamina and HA was significantly lower in the winged group (18.2 vs. 48.8% p=0.001). Multivariate analysis showed that ossification of the posterior longitudinal ligament, male gender, and wingless type HA were significantly associated with fusion. Conclusion : Clinical outcome was similar in patients receiving winged and wingless HA, but the wingless type was associated with a higher rate of fusion between HA and lamina at 12 months post-operatively.

• 한방재활의학과학회지
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• 제20권4호
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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.

• 대한관절경학회지
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• 제4권1호
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• pp.49-53
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• 2000

목적 :. 만성 견관절 충돌증후군에 대한 수술적 치료로서 사용한 관절경적 전방 견봉 성형술의 치료 결과를 분석하고 임상적 효용성을 평가하고자 하였다. 대상 및 방법 : 1995년 7월부터 1997년 12월까지 만성 견관절 충돌증후군 환자 중 6개월 이상 보존적 치료에도 불구하고 증상이 호전되지 않아 관절경을 이용하여 전방 견봉 성형술을 시행한 26명의 환자, 27례의 견관절들을 대상으로 하였다. 심한 퇴행성 관절염 회전근 개 전층 파열 및 견관절 비출구 충돌증후군 (nonoutlet impingement) 등은 모두 연구 대상에서 제외하였다. 평균 추시 기간은 2년 3개월(범위, 1년 7개월-3년 11개월)이었다. 임상적인 결과 판정은 UCLA 견관절 평가지수를 이용하였다. 결과 : 27례 중 23례$(85.2\%)$에서 매우 우수 또는 우수한 결과를 보였으며, 4례$(14.8\%)$에서 양호의 결과를 나타내었다. 환자의 만족도는 27례 중 26례$(96.3\%)$에서 주관적인 만족을 나타내었고, 1례 $(3.7\%)$에서 불만족을 나타내었으며 이 경우 Parkinson 증후군과 경추 후종인대 골화증 및 제 5-6번 경추의 척추 협착증이 동반된 환자였다. 결론 : 관절경적 전방 견봉 성형술은 특히 술전 동통의 정도가 술후 현저히 개선되는 등 증상 완화에 우수한 결과를 예상할 수 있는 만성 견관절 충돌증후군의 효율적 치료법이지만, 견관절 및 그 주위의 병변이나 전신 질환 등이 동반될 경우 치료 결과에 영향을 미칠 수 있다.

• Journal of Korean Neurosurgical Society
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• 제60권5호
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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 Trauma and Injury
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• 제32권2호
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• pp.80-85
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• 2019

Purpose: To compare the time intervals to magnetic resonance imaging (MRI) and surgical treatment in patients having traumatic cervical spinal cord injury (SCI) with and without bony lesions. Methods: Retrospectively analyzed adult patients visited Kyungpook National University Hospital and underwent surgical treatment for cervical SCI within 24 hours. The patients who were suspected of having cervical SCI underwent plain radiography and computed tomography (CT) upon arrival. After the initial evaluation, we evaluated the MRI findings to determine surgical treatment. Waiting times for MRI and surgery were evaluated. Results: Thirty-four patients were included. Patients' mean age was 57 (range, 23-80) years. Patients with definite bony lesions were classified into group A, and 10 cases were identified (fracture-dislocation, seven; fracture alone, three). Patients without bony lesions were classified into group B, and 24 cases were identified (ossification of the posterior longitudinal ligament, 16; cervical spondylotic myelopathy, eight). Mean intervals between emergency room arrival and start of MRI were 93.60 (${\pm}60.08$) minutes in group A and 313.75 (${\pm}264.89$) minutes in group B, and the interval was significantly shorter in group A than in group B (p=0.01). The mean times to surgery were 248.4 (${\pm}76.03$) minutes in group A and 560.5 (${\pm}372.56$) minutes in group B, and the difference was statistically significant (p=0.001). The American Spinal Injury Association scale at the time of arrival showed that group A had a relatively severe neurologic deficit compared with group B (p=0.046). There was no statistical significance, but it seems to be good neurological recovery, if we start treatment sooner among patients treated within 24 hours (p=0.198). Conclusions: If fracture or dislocation is detected by CT, cervical SCI can be easily predicted resulting in MRI and surgical treatment being performed more rapidly. Additionally, fracture or dislocation tends to cause more severe neurological damage, so it is assumed that rapid diagnosis and treatment are possible.