• Journal of Korean Neurosurgical Society
• /
• 제30권sup1호
• /
• pp.108-114
• /
• 2001

Objective : Posterior lumbar interbody fusion(PLIF) provides the favorable outcome to degenerative lumbar disease, especially isthmic spondylolisthesis. To determine the long-term effect of PLIF using psterior movable segment, we analysed the results of follow-up radiologic changes and surgical outcome retrospectively Patients and Method : During the past 11 years(1989. 1.-1999. 9.), 148 patients with symptomatic lumbar spondylolisthesis were managed at our department and the clinical wants were throughly recieved and final outcome is determined at last follow up. PLIF using antogenous bone(posterior movable segment, iliac bone and rib) were performed in 106 case. Results : After an average follow-up period of 33 months(range ; 15-58 months), the results were excellent in 66 cases, good in 37 cases, fair in 2 cases and poor in 1 cases. And the satisfactory results were 103 cases(98.2%) in PLIF,. Conclusion : In conclusion, patients who underwent PLIF with autologous bone graft had good clinical and radiological outcomes without significant neurological complications.

• Journal of Korean Neurosurgical Society
• /
• 제54권1호
• /
• pp.25-29
• /
• 2013

Objective : To clarify the landmark for deciding the entry point for C1 lateral mass screws via the posterior arch by using 3-dimensional (3D) computed images. Methods : Resnick insisted that the C1 posterior arch could be divided into pure posterior and lateral lamina (C1 pedicle). Authors studied where this transition point (TP) is located between the posterior lamina and the C1 pedicle and how it can be recognized. The 3D computed images of 86 cadaver C1s (M : F=45 : 41) were used in this study. Results : The superior ridge of the C1 posterior arch had 2 types of orientation. One was in the vertical direction in the C1 posterior lamina and the other was in the horizontal direction in the C1 pedicle. The TP was located at the border between the 2 areas, the same site as the posterior end of the groove of the vertebral artery. On posterior-anterior projection, the posterior arch was sharpened abruptly at TP. We were unable to identify the TP in 6.4% of specimens due to complete or partial osseous bridges. A total of 93.8% of the TP were located between the most enlarged point of the spinal canal and the medial wall of the vertebral artery. Conclusion : The anatomic entry zone of C1 lateral laminar screws was clarified and identified based on the TP by using preoperative 3D computed images.

• Journal of Korean Neurosurgical Society
• /
• 제30권3호
• /
• pp.358-365
• /
• 2001

Objectives : Although posterior lumbar fusion operations had been reported to accelerate spinal degeneration, there have been only a few studies for their biomechanical effects. We have studied the change of motion range at the vertebral joint one level above the fusion(UVJ) in pedicle screw fixation group(PSF)(n=13) where facet capsule was destroyed and in posterior lumbar interbody fusion group(PLIF)(n=8) where it was spared. Patients and Methods : The patients were divided into early(3 to 6 months) and late(over 12 months) according to postoperative follow-up period. The flexion, extension and flexion-extension angles(FA, EA, FEA) were measured at the UVJ with pre-operative, early and late post-operative films. Results : Mean age and male to female ratio were $52.7{\pm}9.3$ and 1 : 3.2. Mean follow-up periods were $144.1{\pm}30.0$ and $528.8{\pm}160.3$ days in early and late groups, respectively. The FEA and FA in the late PSF($11.8{\pm}3.1$, $8.5{\pm}2.9$) were significantly greater than pre-operative angles($7.8{\pm}3.9$, $5.1{\pm}3.7$)(p<0.01, p<0.05). All angles in the PLIF showed no significant changes with time. The FEA and FA in the late PSF($11.8{\pm}3.1$, $8.5{\pm}2.9$) were significantly greater than those of the late PLIF($7.6{\pm}2.3$, $3.4{\pm}2.0$)(p<0.01, p<0.001). All angles at early follow-up period were similar between PSF and PLIF. The EA showed no significant change in relation with follow-up period or fusion method. Conclusion : As a result, the facet capsule injury in pedicle screw fixation seems to be related with increased flexion angle or degeneration of the adjacent joint above the fused vertebra in the late phase.

• Journal of Korean Neurosurgical Society
• /
• 제37권1호
• /
• pp.39-43
• /
• 2005

Objective: For Posterior lumbar interbody fusion(PLIF) various cages or iliac bone dowels are used with or without pedicle screw fixation(PSF). To evaluate and compare the clinical and radiological results of different fusion methods, we intend to verify the effect of added PSF on PLIF, the effect of bone cages and several factors which are thought to be related with the postoperative prognosis. Methods: One hundred and ninety seven patients with lumbar spinal stenosis and instability or spondylolisthesis underwent various fusion operations from May 1993 to May 2003. The patients were divided into five groups, group A (PLIF with autologous bone dowels, N=24), group B (PLIF with bone cages, N=13), group C (PLIF with bone dowels and PSF, N=37), group D (PLIF with bone cages and PSF, N=30) and group E (PSF with intertransverse bone graft, N=93) for comparison and analyzed for the outcome and fusion rate. Results: Outcome was not significantly different among the five groups. In intervertebral height (IVH) changes between pre- and post-operation, Group B ($2.42{\pm}2.20mm$) was better than Group A ($-1.33{\pm}2.05mm$). But in the Group C, D and E, the IVH changes were not different statistically. Fusion rate of group C, D was higher than that of Group A and B. But the intervertebral height(IVH) increased significantly in group B($2.42{\pm}2.20mm$). Fusion rate of group C and D were higher than that of group A and D. Conclusion: Intervertebral cages are superior to autologous iliac bone dowels for maintaining intervertebral height in PLIF. The additional pedicle screw fixation seems to stabilize the graft and improve fusion rates.

• 대한족부족관절학회지
• /
• 제14권1호
• /
• pp.66-72
• /
• 2010

Purpose: To evaluate the clinical efficacy of the minimally invasive posterior approach for the surgical treatment of intraarticular fracture of calcaneus. Materials and Methods: From March 2006 to October 2008, we studied retrospectively 45 patients, 56 cases who were treated with minimally invasive reduction and pin fixation treatment for displaced intraarticular calcaneal fracture and were followed up for more than 1 year. The clinical results were evaluated with Creighton-Nebraska score and AOFAS score, circle draw test after 1 year. We checked simple AP, lateral, axial and Broden's view preoperatively and 1 year after surgery, and compared Bohler angle and Gissane angle. Results: By Creighton-Nebraska score, Sanders type 1 was 81, type 2 was 75, type 3 was 69, type 4 was 61. By AOFAS score, Sanders type 1 was 88, type 2 was 82, type 3 was 78, type 4 was 63. And by circle draw test, type 1 was 8.8 cm, type 2 was 8.5 cm, type 3 was 8 cm, type 4 was 6.6 cm. Preoperative Bohler angle and Gissane angle were $7.2^{\circ}$, $98^{\circ}$, and it increased to $21.2^{\circ}$, $116^{\circ}$ after postoperative 1 year. Conclusion: Minimally invasive reduction and pin fixation treatment for displaced intraarticular calcaneal fracture was considered to be an effective treatment modality.

• Journal of Trauma and Injury
• /
• 제33권1호
• /
• pp.18-22
• /
• 2020

Purpose: Damage control laparotomy has contributed to improved survival rates for severe abdominal injuries. A large part of severe abdominal injury occurs with a concomitant pelvic bone fracture. The safety and effectiveness of internal fixation of pelvic bone fracture(s) has not been established. The aim of the present study was to evaluate infection risk in the pelvic surgical site in patients who underwent emergent abdominal surgery. Methods: This single-center retrospective observational study was based on data collected from a prospectively maintained registry between January 2015 and June 2019. Patients who underwent laparotomy and pelvic internal fixation were included. Individuals <18 and ≥80 years of age, those with no microbiological investigations, and those who underwent one-stage abdominal surgery were excluded. Comprehensive statistical comparative analysis was not performed due to the small number of enrolled patients. Results: A total of six patients met the inclusion criteria, and the most common injury mechanism was anterior-posterior compression (67%). The average duration of open abdomen was 98 hours (range, 44-98), and the time interval between abdominal closure and pelvic surgery was 98 hours. One patient (16.7%) died due to multi-organ dysfunction syndrome. Micro-organisms were identified in the abdominal surgical site in five patients (83%), with no micro-organisms in pelvic surgical sites. There was no unplanned implant removal. Conclusions: Internal fixation of pelvic bone fracture(s) could be performed in the state of open abdomen, and the advantages of early fixation may countervail the risks for cross contamination.

• Journal of Korean Neurosurgical Society
• /
• 제37권6호
• /
• pp.416-421
• /
• 2005

Objective: Despite general agreement on the goals of surgical treatment in thoracolumbar burst fractures, considerable controversy exists regarding the choice of operative techniques. This study is to evaluate the efficacy of short-segment fixation for thoracolumbar burst fractures after long-term follow-up and to analyze the causes of treatment failures. Methods: 48 out of 60 patients who underwent short-segment fixation for thoracolumbar burst fractures between January 1999 and October 2002 were enrolled in this study. Their neurological status, radiological images, and hospital records were retrospectively reviewed. Simple radiographs were evaluated to calculate kyphotic angles and percentages of anterior body compression (%ABC). Results: The average kyphotic angles were $20.0^{\circ}$ preoperatively, $9.6^{\circ}$ postoperatively, and $13.1^{\circ}$ at the latest follow-up. The average %ABC were 47.3% preoperatively, 31.2% postoperatively, and 33.3% at the latest follow-up. The treatment failure, defined as correction loss by $10^{\circ}$ or more or implant failure, was detected in 6 patients (12.5%). 5 out of 6 patients had implant failures. 2 out of 5 patients were related with osteoporosis, and the other 2 were related with poor compliance of spinal bracing. 3 patients with poor initial postoperative alignment had implant failure. 4 patients with screws only on the adjacent vertebrae and not on the injured vertebra itself showed poor initial and overall correction. Conclusion: With proper patient selection, adequate intraoperative reduction with screw fixation involving the injured vertebra, and strict postoperative spinal bracing, the short-segment fixation is an efficient and safe method in the treatment of thoracolumbar burst fracture.

• Journal of Korean Neurosurgical Society
• /
• 제48권4호
• /
• pp.342-346
• /
• 2010

Objective : This study assessed the efficacy of anterior cervical discectomy and fusion (ACDF) with cage alone compared with ACDF with plate instrumentation for radiologic and clinical outcomes in two-level cervical degenerative disease. Methods : Patients with cervical degenerative disc disease from September 2004 to December 2009 were assessed retrospectively. A total of 42 patients received all ACDF at two-level cervical lesion. Twenty-two patients who underwent ACDF with cage alone were compared with 20 patients who underwent ACDF with plate fixation in consideration of radiologic and clinical outcomes. Clinical outcomes were assessed using Robinson's criteria and posterior neck pain, arm pain described by a 10 point-visual analog scale. Fusion rate, subsidence, kyphotic angle, instrument failure and the degenerative changes in adjacent segments were examined during each follow-up examination. Results : VAS was checked during each follow-up and Robinson's criteria were compared in both groups. Both groups showed no significant difference. Fusion rates were 90.9% (20/22) in ACDF with the cage alone group, 95% (19/20) in ACDF with the plate fixation group (p = 0.966). Subsidence rates of ACDF with cage alone were 31.81% (7/22) and ACDF with plate fixation were 30% (6/20) (p = 0.928). Local and regional kyphotic angle difference showed no significant difference. At the final follow-up, adjacent level disease developed in 4.54% (1/22) of ACDF with cage alone and 10% (2/20) of ACDF with plate fixation (p= 0.654). Conclusion : In two-level ACDF, ACDF with cage alone would be comparable with ACDF with plate fixation with regard to clinical outcome and radiologic result with no significant difference. We suggest that the routine use of plate and screw in 2-level surgery may not be beneficial.

• 대한족부족관절학회지
• /
• 제24권1호
• /
• pp.25-30
• /
• 2020

Purpose: Generally, the treatment of ankle trimalleolar open fractures is divided into two stages: external fixation and debridement; and secondary internal fixation. On the other hand, this two-stage operation takes considerable treatment time and is challenging in procedures requiring reduction. The purpose of this study was to evaluate the radiologic and clinical results of an immediate one-stage internal fixation operation considering the wound conditions to overcome two stage operation disadvantages. Materials and Methods: From September 2009 to January 2018, 24 cases of ankle trimalleolar open fractures, who underwent immediate internal fixation and were followed up for at least one year, were studied retrospectively. The open wound was divided into the Gustilo-Anderson classification. Open reduction and internal fixation were performed on every medial and lateral malleolar fracture. On the other hand, with posterior malleolar fractures, surgical or conservative treatment was performed depending on the fragment size. The radiologic outcome was evaluated using the Burwell and Charnley criteria and American Orthopaedic Foot and Ankle Society (AOFAS) scores, and complications, such as infection and posttraumatic arthritis, were used for the clinical evaluation. Results: The wound was classified into eight cases (33.3%) of type I, 11 cases (45.8%) of type II, and five cases (20.8%) of type IIIa. The degree of reduction was anatomical, fair, and poor in 16 cases (66.7%), six cases (25.0%), and two cases (8.3%), respectively. The mean AOFAS score was 79 points, and there were complications, such as infection in three cases (12.5%) and post-traumatic arthritis in two cases (8.3%). Conclusion: Satisfactory results were obtained through immediate surgical treatment in ankle trimalleolar open fractures of types I, II, and IIIa.

• Journal of Korean Neurosurgical Society
• /
• 제50권1호
• /
• pp.17-22
• /
• 2011

Objective : In the present study, authors retrospectively reviewed the clinical outcomes of halo-vest immobilization (HVI) versus surgical fixation in patients with odontoid fracture after either non-surgical treatment (HVI) or with surgical fixation. Methods : From April 1997 to December 2008, we treated a total of 60 patients with upper cervical spine injuries. This study included 31 (51.7%) patients (22 men, 9 women; mean age, 39.3 years) with types II and III odontoid process fractures. The average follow-up was 25.1 months. We reviewed digital radiographs and analyzed images according to type of injury and treatment outcomes, following conservative treatment with HVI and surgical management with screw fixation. Results : There were a total of 31 cases of types II and III odontoid process fractures (21 odontoid type II fractures, 10 type III fractures). Fifteen patients underwent HVI (10 type II fractures, 5 type III fractures). Nine (60%) out of 15 patients who underwent HVI experienced successful healing of odontoid fractures. The mean period for bone healing was 20.2 weeks. Sixteen patients underwent surgery including anterior screw fixation (6 cases), posterior C1-2 screw fixation (8), and transarticular screw fixation (2) for healing the odontoid fractures (11 type II fractures, 5 type III fractures). Fifteen (93.8%) out of 16 patients who underwent surgery achieved healing of cervical fractures. The average bone healing time was 17.6 weeks. Conclusion : The overall healing rate was 60% after HVI and 93.8% with surgical management. Patients treated with surgery showed a higher fusion rate and shorter bony healing time than patients who received HVI. However, prospective studies are needed in the future to define better optimal treatment and cost-effective perspective for the treatment of odontoid fractures.