• Journal of Korean Neurosurgical Society
• /
• 제38권6호
• /
• pp.435-441
• /
• 2005

Objective : Expandable cage used for spinal reconstruction after corpectomy has several advantages over nonexpendable cages. Here we present our clinical experience with the use of this cage after anterior column corpectomy with an average of one year follow up. Methods : Ten patients underwent expandable cage reconstruction of the anterior column after single-level or multilevel corpectomy for various cervical spinal disorders. Anterior plating with or without additional posterior instrumentation were performed in all patients. Functional outcomes, complications, and radiographic outcomes were determined. Results : There was no cage-related complication. Functionally, neurological examination revealed improvement in 7 of 10 patients and no patient had neurological deterioration after the surgery. Immediate stability was achieved and maintained throughout the period of follow-up. There was minimal subsidence [<2mm] noticeable in three of the cases that underwent a two-level corpectomy. Subsidence was noted in osteoporotic patients and patients undergoing multi-level corpectomies. Average pre-operative kyphotic angle was 9 degrees. This was corrected to an average of 5.4 degrees in lordosis postoperatively. Conclusion : In conclusion, expandable cages are safe and effective devices for vertebral body replacement after cervical corpectomy when used in combination with anterior plating with or without additional posterior stabilization. The advantages of using expandable cages include its ability to easily accommodate itself into the corpectomy defect, its ability to tightly purchase into the end plates after expansion and thus minimizing the potential for migration, and finally, its ability to correct kyphosis deformity via its in vivo expansion properties.

• 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.

• 대한정형외과학회지
• /
• 제56권5호
• /
• pp.419-426
• /
• 2021

목적: 화농성 요추부 추체 감염의 수술적 치료 시 이환된 추체에 척추경 나사를 삽입하는 수술법은 균막의 형성 및 감염 치료 실패의 위험성으로 기피되었다. 저자들은 이환된 추체에 척추경 나사를 삽입하여 고정 분절수를 최소화하면서도 감염 치료에 성공하였는바, 이를 분석하여 해당 술식의 유용성에 대하여 알아보고자 하였다. 대상 및 방법: 2000년 1월부터 2018년 6월까지 본원 척추센터에서 제1저자에 의해 수술적으로 치료한 화농성 요추부 척추 감염 환자 중, 이환된 추체에 직접 척추경 나사를 삽입하여 유합술을 시행한 환자군을 그룹 A, 이환된 추체 척추경의 골파괴 소견으로 인접 정상 추체에 척추경 나사를 삽입하여 유합술을 시행한 환자군을 그룹B로 분류하여 임상적 결과를 후향적으로 연구하였다. 모든 환자들은 후방 접근법으로 수술하였으며, 이환된 추간판을 제거하고 부골화된 추체의 소파술 및 추체 간 자가 지주골 이식술 후 척추경 나사 고정술을 시행한 48예(그룹A 28예, 그룹B 20예)를 대상으로 두 그룹 간의 입원 기간, 수술 시간, 출혈량 및 수술 후 1개월째 EQ-5D 지수, 주사 항생제 투여 기간, 혈액학적 결과, 임상적 결과, 방사선학적 결과를 종합적으로 분석하였다. 결과: 그룹 A에서 고정 분절 수, 수술 시간, 출혈량 및 술 후 1개월째 EQ-5D 지수에서 그룹 B에 비하여 통계적으로 유의하게 향상된 결과를 보였으며, 항생제 사용 기간, 입원 기간, 방사선학적 골유합의 시기, 시상각의 교정률 및 재발률에서는 유의한 차이를 보이지 않았다. 결론: 후방 도달법을 통한 이환된 추체에 직접 척추경 나사를 삽입하는 최소 분절 고정술은 수술 시간 및 출혈량이 줄어들고, 고정분절을 최소화하여 요추부의 운동성을 보전하면서도, 감염의 확산이나 재발 없이 빠른 회복을 보였기에, 요추부 화농성 척추염 환자의 수술적 치료 시 권장할 만한 술식으로 생각된다.

• 대한골관절종양학회지
• /
• 제4권1호
• /
• pp.37-43
• /
• 1998

Between 1992 and 1996, 5 patients with the giant-cell tumor of the spine were treated. Four were female and one was male. The mean age was 34 years old, and the mean follow-up time was 36 months. The locations of the lesions were the cervical spine in 1, the thoracic spine in 3, and the lumbar spine in 1. Pain was the predominant presenting symptom in all cases and four had a neurological deficit. A combined anterior and posterior surgical approach wds as performed in all cases, which were also treated with AIF(anterior interbody fusion) and anterior and/or posterior instrumentation. Adjuvant radiation therapy was performed in 1 case of cervical spine. At the final follow-up, the pain and neurologic symptoms were improved. Radiologic examination showed no evidence of local recurrence and no failure of instrumentation of the spine.

• 한방재활의학과학회지
• /
• 제31권1호
• /
• pp.165-173
• /
• 2021

Objectives The objective of this study is to propose postoperative rehabilitation for spondylolisthesis after posterior lumbar interbody fusion (PLIF) in Korean medicine and to report its effectiveness. Methods There were two patients who were received Korean medicine with acupuncture, herbal medicine, cupping and exercise treatment after PLIF. Patients were evaluated numeric rating scale (NRS), Oswestry disability index (ODI), pain free walking distance (PFWD), Korean modified index (K-MBI), EuroQol-5 dimension (EQ-5D) index. Results Case 1 was improved NRS from 7 to 3, Case 2 was improved NRS from 7 to 2. Also, ODI, PFWD, K-MBI, EQ-5D score were improved in both cases. Conclusions This study suggests that Korean medicine rehabilitation could be effective for spondylolisthesis after PLIF.

• Journal of Korean Neurosurgical Society
• /
• 제45권4호
• /
• pp.213-218
• /
• 2009

Objective : This study is a retrospective clinical study over more than 4 years of follow up to understand the mechanism of load sharing across the graft-bone interface in the static locking plate (SLP) fixation compared with non-locking plate (NLP). Methods : Orion locking plates and Top non-locking plates were used for SLP fixation in 29 patients and NLP fixation in 24 patients, respectively. Successful interbody fusion was estimated by dynamic X-ray films. The checking parameters were as follows : screw angle (SA) between upper and lower screw, anterior and posterior height of fusion segment between upper and lower endplate (AH & PH), and upper and lower distance from vertebral endplate to the end of plate (UD & LD). Each follow-up value of AH and PH were compared to initial values. Contributions of upper and lower collapse to whole segment collapse were estimated. Results : Successful intervertebral bone fusion rate was 100% in the SLP group and 92% in the NLP group. The follow-up mean value of SA in SLP group was not significantly changed compared with initial value, but follow-up mean value of SA in NLP group decreased more than those in SLP group (p=0.0067). Statistical analysis did not show a significant difference in the change in AH and PH between SLP and NLP groups (p>0.05). Follow-up AH of NLP group showed more collapse than PH of same group (p=0.04). The upper portion of the vertebral body collapsed more than the lower portion in the SLP fixation (p=0.00058). Conclusion : The fused segments with SLP had successful bone fusion without change in initial screw angle, which was not observed in NLP fixation. It suggests that there was enough load sharing across bone-graft interface in SLP fixation.

• 대한골관절종양학회지
• /
• 제17권2호
• /
• pp.106-110
• /
• 2011

요추부 척추관 협착증과 경막내 종양이 동반되어 있는 환자에서, 척추관 협착증에 대한 수술적 치료만 시행하였다가 수술 후 증상이 잔존할 수 있다. 본 증례는 척추 신경이 척추관 협착증으로 인한 외적인 압박과 함께, 종양의 공간 점유로 경막내 압박을 동반하였던 경우로, 신경 감압술과 경막내 종양의 제거를 동시에 시행하여 성공적으로 치료되었기에 문헌 고찰과 함께 보고하는 바이다. 71세 여자환자가 하부 요통 및 양측 하지로의 방사통을 주소로 내원하였다. 자기 공명 영상에서 제 4-5 요추부는 척추관 협착증 소견과 함께 제 5 요추-제 1 천추부에 경도의 척추 전방 전위증 소견이 관찰되었고, 제 4 요추체 부위에서 타원형의 경막내 공간의 대부분을 점유하는 종괴가 관찰되었다. 후방 도달법으로 감압술 및 유합술을 시행한 다음, 정중 경막 절개술을 통해 종괴를 제거하였다. 조직 검사상 신경초종으로 진단되었고, 수술 후 증상은 현저히 호전되었다.

• Journal of Korean Neurosurgical Society
• /
• 제30권5호
• /
• pp.600-604
• /
• 2001

Objective : The authors report the microsurgical anterolateral tunnel approach for the treatment of the cervical disc diseases and its postoperative surgical results. Methods : All surgical procedures followed the method of classical microsurgical anterior discectomy. Small tunnel(7-8mm) was made on the disc space reaching to the posterior longitudinal ligament. The disc materials and bony spurs were removed through this tunnel. Thirty-one patients of cervical disc herniation(24 cases with pure disc herniation, 7 cases with combined cervical spondylosis) were evaluated on the symptoms, conformation in plain X-ray, C-T, and MRI. The follow up time was over 2 years. Results : Postoperatively the result(following the out come scale) was excellent and good in Twenty-nine patients. One with fair result showed remnant disc particle and spur and another one is combined with cord contusion. One patient with lesion in C 3-4 space and two cervicothoracic junction showed excellent result. Two patients with osteoporosis also showed good results. Cervical spine curvature and disc space height were not changed on the plain X-ray and MRI in all patients. Twenty-nine patients were discharged within 3 days after surgery without any postoperative complications. Conclusions : The microsurgical anterolateral tunnel approach could be indicated for the treatment of patients with cervical disc diseases and with difficulty in achieving interbody fusion(the higher cervical level and cervicothoracic junction, osteoporosis etc.).

• Journal of Trauma and Injury
• /
• 제35권1호
• /
• pp.12-18
• /
• 2022

Purpose: Pedicle screw fixation provides 3-column stabilization, multidimensional control, and a higher rate of interbody fusion. Although computed tomography (CT) is recommended for the postoperative assessment of pedicle screw fixation, its use is limited due to the radiation exposure dose. The purpose of this preliminary retrospective study was to assess the clinical usefulness of low-dose mobile cone-beam CT (CBCT) for the postoperative evaluation of pedicle screw fixation. Methods: The author retrospectively reviewed postoperative mobile CBCT images of 15 patients who underwent posterior pedicle screw fixation for spinal disease from November 2019 to April 2020. Pedicle screw placement was assessed for breaches of the bony structures. The breaches were graded based on the Heary classification. Results: The patients included 11 men and four women, and their mean age was 66±12 years. Of the 122 pedicle screws, 34 (27.9%) were inserted in the thoracic segment (from T7 to T12), 82 (67.2%) in the lumbar segment (from L1 to L5), and six (4.9%) in the first sacral segment. Although there were metal-related artifacts, the image of the screw position (according to Heary classification) after surgery could be assessed using mobile CBCT at all levels (T7-S1). Conclusions: Mobile CBCT was accurate in determining the location and integrity of the pedicle screw and identifying the surrounding bony structures. In the postoperative setting, mobile CBCT can be used as a primary modality for assessing the accuracy of pedicle screw fixation and detecting postoperative complications.

• 동서간호학연구지
• /
• 제11권1호
• /
• pp.33-41
• /
• 2005

This study was conducted to identify the effect of meridian acupressure on defecation of patients with post spinal operation. The nonequivalent control group posttest only design was used. The data were obtained from 77 post spinal operative patients, 34 in the experimental 43 in control group in Y Hospital, Seoul, Korea. The neurosurgical unit A and B ward, assigned by matched sample by the name of operation such as laminectomy and posterior lumbar interbody fusion are performed. Meridian acupressure meant the method that an examiner presses response points distributed in the pass of energy vessel. In this study, meridian acupressure program was performed on as points in order of Hegue (LI-4), Zhigou (TE-6), Zusanli (S-36), Shangjuxu (S-37), Xiajuxu (S-39), Tianshu (S-25), Taichong (L-3) which was known to be related to large intestine. Data were collected from 1, July 2003 to 1, September 2003. Meridian acupressure program was carried out for 20 minutes 4 hours after operation twice daily. In order to evaluate the effect of meridian acupressure intervention, they were asked time of bowel recovery, gas passing, and defecation though questionnaire method. Data were analyzed by the SPSS/ WIN 11.0 program. The results of this study were summarized as follows; 1. Homogeneity tests of general characteristics and operation related characteristics of the experimental group and the control group were performed. General characteristics included age, sex, defecation habit, eating pattern, fluid intake, life style, activity, usage of laxative and etc. 2. Hypotheses were verification as follows; 1) Recovery of bowel sound of the experimental group who received meridian acupressure intervention was faster than that of the control group after spinal operation (t=-6.770,P=.000). 2) Time of gas passing of the experimental group who received meridian acupressure program was faster than that of the control group after spinal operation (t=-8.003, P=.000). 3) Time to defecation of the experimental group who received meridian acupressure program was faster than that of the control group after spinal operation (t=-9.026, P=.000). 4) Abdominal discomfort due to defecation of the experimental group who received meridian acupressure program was lesser than that of the control group after spinal operation (t=-3.431, P=.001). From these results, meridian acupressure intervention was effective for recovery of bowel sound, reduce time to gas passing, time to defecation and lessen abdominal discomfort due to defecation on post spinal operative patients. And therefore this intervention can probably considered on clinical practice.