• Title/Summary/Keyword: Posterolateral approach

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High Lumbar Disc Herniation Treated with A Modified Posterolateral Approach - Case Report - (상위 요추간판 탈출증에 대한 후측방 접근술 - 증 례 보 고 -)

  • Hwang, Hyung Sik
    • Journal of Korean Neurosurgical Society
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    • v.30 no.1
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    • pp.114-117
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    • 2001
  • Generally, the posterolateral approach had been recommended in case of extraforaminal disc herniation or lateral stenosis but it has been speculated that this procedure may be feasible to posterolateral disc herniation at the high lumbar levels of the L1-L2 interspace. Topographically, a posterolateral approach should be able to access anteromedial side of the spinal canal without the risk of the bony instability and damage to the neural structures. During the past one year period, three patients with high lumbar discs at the L1-L2 level were treated by the modified posterolateral approach. This article describeds the details of this approach with pertinent literature review.

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Anterior and Posterior Stabilization by One Stage Posterolateral Approach in the Unstable Fracture of Thoracolumbar and Lumbar Spine

  • Lee, Young-Min;Cho, Yang-Woon;Kim, Joon-Soo;Kim, Kyu-Hong;Lee, In-Chang;Bae, Sang-Do
    • Journal of Korean Neurosurgical Society
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    • v.40 no.1
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    • pp.22-27
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    • 2006
  • Objective : The purpose of this study is to investigate the clinical results of anterior and posterior stabilization by one stage posterolateral approach for the unstable fracture of thoracolumbar and lumbar spine. Methods : By posterolateral approach with curved skin incision, unilateral facet and pedicle were removed. Through this route, corpectomy was performed, and then this space was replaced with mesh cage filled up with autologous bone graft. Both side pedicle screw fixation was followed to upper and lower levels. Results : Six of seven patients of this study showed neurological improvement. The other one patient showed no neurological change. One patient had postoperative infection, another patient had postoperative kyphosis. The other patient had epidural hematoma on operation site after surgery. And all patinets on this study made to have spinal stability except one patient happened postoperative kyphosis. Conclusion : In the unstable fracture of thoracolumbar and lumbar spine, one stage anterior and posterior stabilization and fusion by posterolateral approach seems to be an effective procedure, if we have more care and supplementation.

Tumor resection from retromolar trigone, posterolateral maxilla, and anterior mandibular ramus using lower cheek flap approach: a case report and review of literature

  • Kang, Young-Hoon;Byun, June-Ho;Sung, Su-Jin;Park, Bong-Wook
    • Journal of the Korean Association of Oral and Maxillofacial Surgeons
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    • v.43 no.3
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    • pp.186-190
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    • 2017
  • A surgical approach involving the retromolar trigone, posterolateral maxilla, and pterygoid region is the most challenging in the field of maxillofacial surgery. The upper cheek flap (Weber-Ferguson incision) with subciliary extension and the maxillary swing approach have been considered as alternatives; however, neither approach provides sufficient exposure of the pterygoid region and the anterior portion of the mandibular ramus. In this report, we describe two cases in which a lower cheek flap approach was used for complete tumor resection in the retromolar trigone and the anterior mandibular ramus. This approach allows full exposure of the posterolateral maxilla and the pterygoid region as well as the retromolar trigone without causing major sensory disturbances to the lower lip. A mental nerve anastomosis after tumor resection was performed in one patient and resulted in approximately 90% sensory recovery in the lower lip. The lower cheek flap approach provides adequate exposure of the posterolateral maxilla, including the pterygoid, retromolar trigone, and mandibular ramus areas. If the mental nerve can be anastomosed during flap approximation, postoperative sensory disturbances to the lower lip can be minimized.

A New Method of Approach for Percutaneous Thoracic Vertebroplasty in Vertebral Compression Fracture -Case report- (흉추 압박골절환자를 위한 경피적 척추성형술의 새로운 접근법 -증례 보고-)

  • Shin, Keun-Man
    • The Korean Journal of Pain
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    • v.13 no.2
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    • pp.237-241
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    • 2000
  • Vertebral compression fractures commonly afflict the elderly. Some patients suffer from severe mechanical pain in spite of treatments with strong analgesics and bracing. Vertebroplasty, which was originally used for vertebral hemangioma, is effective for patients who do not respond to these more conservative treatments. However, the procedure has some risk. Leaks of bone cement into perineural tissues can be a serious complication. In contrast to the lumbar vertebrae, the outer margin of the pedicle of the thoracic vertebrae is almost in line with the outer margin of the body. This, combined with the thinner pedicle of the thoracic vertebrae, makes proper needle placement difficult. The posterolateral approach is preferred to the transpedicular approach in order to avoid the danger of destroying the inner cortex of the pedicle. But there can be a problems with the standard posterolateral approach. The rib can be broken, the pleura can be punctured. A new and safer approach is possible. Before penetrating the bone, the needle is positioned at the upper margin of the transverse process, 5 mm away from the pedicle. To achieve this positioning, the needle must puncture the skin 1~1.5 cm laterally and 3~5 mm cranially to the target point on the bone. This approach was used for 10 patients and we achieved good results with no serious complication.

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Charcot Spine Treated Using a Single Staged Posterolateral Costotransversectomy Approach in a Patient with Traumatic Spinal Cord Injury

  • Kim, Tae-Woo;Seo, Eun-Min;Hwang, Jung-Taek;Kwak, Byung-Chan
    • Journal of Korean Neurosurgical Society
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    • v.54 no.6
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    • pp.532-536
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    • 2013
  • Charcot spine is a progressive and destructive process that affects the vertebral bodies, intervertebral discs, and posterior facets. It is the result from repetitive microtrauma in patients who have decreased joint protective mechanisms due to loss of deep pain and proprioceptive sensation, typically because of spinal cord injury. The objective of the study is to report an unusual case of Charcot spine, as a late complication of traumatic spinal cord injury, treated by a circumferential arthrodesis performed with a single staged posterolateral costotransversectomy approach.

Os Trigonum Syndrome with Posterolateral Osteochondral Lesion of Talus (A Case Report) (후외측 거골 골연골 병변을 동반한 삼각골 증후군 (1예 보고))

  • Cho, Se-Hyun;Nam, Dae-Cheol;Jeong, Soon-Taek;Kim, Dong-Hee;Moon, Dong-Kyu
    • Journal of Korean Foot and Ankle Society
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    • v.14 no.2
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    • pp.190-193
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    • 2010
  • Both os trigonum syndrome and osteochondral lesion of talus (OLT) are common causes of ankle pain and usually affect ballet dancers or athletes. Lateral osteochondral lesions, which usually result from traumatic event, are mostly located anterolateral talar dome but rare central or posterolateral. Moreover, there are technical difficulties such as position of patient or additional posterior portal to address posterolateral lesion by arthroscopy. Meanwhile, treatment of os trigonum syndrome using arthroscopic approach has been reported in many literatures recently. However, it has not been reported to diagnose both os trigonum syndrome and posterolateral OLT together and treat arthroscopically at one stage. The authors report a case of male patient who was diagnosed as os trigonum syndrome with posterolateral OLT and treated simultaneously by hindfoot arthroscopy. Symptom was improved immediately after the operation, and radiological findings at postoperative 16 months verified remarkable healing.

Ideal Insertion Position of Ankle Syndesmosis Screw (경비 인대 결합 나사못의 이상적인 삽입부위)

  • Park, Hong-Gi;Moon, Seon-Sang
    • Journal of Korean Foot and Ankle Society
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    • v.6 no.1
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    • pp.60-65
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    • 2002
  • Purpose: The purposes of the present study were to find the ideal insertion position syndesmosis screw and relation to the surrounding anatomical structures when indirectly inserting the screw anteriorly at a 30 angle at 3 cm proximal portion of the ankle join t. Materials and Methods: We performed computed tomography from the axial view in 20 normal individuals at 3 cm proximal portion of the ankle joint and divided the lateral side of the fibula into 4 sections. We drew a line from the middle of each of these 4 sections to the posterolateral tibia at a 30 angle and determined the relationship between each of these lines and the surrounding anatomical structures and confirmed the site at which each of these 4 lines passed through the posterolateral tibia which divided into 3 sections and the site of the fibula at which each of these lines passed through the middle 1/3 portion of the tibia. Results: The posterior 3/4 portion of the fibula that passed through the middle 1/3 portion of the posterolateral tibia in 18 cases. The portion did not approach the surrounding anatomical structures(Peroneal vessels and the muscular portion of FHL). Conclusion: The ideal insertion position of syndesmosis screw at 3 cm proximal portion of the ankle joint at a 30 angle is the posterior 3/4 portion of the lateral side of the fibula, and injury to the surrounding anatomical structures could be avoided when the screw passes through the middle 1/3 portion of the posterolateral tibia.

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Comparative Study of Vertical Axillary Muscle Sparing and Posterolateral Thoracotomy (수직액와 근육보존 개흉술과 후측방개흉술의 비교연구)

  • Seong, Suk-Hwan;Won, Tae-Hui
    • Journal of Chest Surgery
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    • v.27 no.12
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    • pp.1008-1014
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    • 1994
  • Increased interest in alternative approach to thoractomy has developed because of the considerable morbidity associated with the standard posterolateral thoracotomy[ST]. Muscle sparing thoracotomy is appeared as excellent alternative because of less postoperative pain and morbidity than standard posterolateral one. Vertical axillary muscle sparing thoracotomy[VM] is the newly revised modified muscle sparing thoracotomy that overcomes the disadvantages of previous lateral muscle sparing thoracotomy such as seroma, cosmetic problems, and need of subcutaneous drains. We conducted a prospective study of 45 consecutive patients to compare postoperative pain, muscle strength of serratus anterior and latissimus dorsi, and range of motion of the shoulder girdle between ST and VM group. There were no difference in preoperative status, surgical procedure, morbidity, mortality and hospital stay between two groups. But there were significant less postoperative narcotics requirements, more preserved latissimus dorsi and serratus anterior muscle strength, nd larger range of motion of shoulder girdle [ especially flexion and internal rotation in VM group. The opening time was prolonged[p<0.01] but closing time was less in VM group [p<0.01]. The sum of opening and closing time was not different in two group. The length of incision line was shorter in VM group. The vertical skin incision was concealed by the upper arm.In conclusion vertical axillary muscle sparing thoracotomy is good alternative for various intrathoracic procedures with less postoperative pain, well preserved muscle strength,increased range of motion of the shoulder girdle and impressive cosmetic outcome.

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