• Journal of Korean Neurosurgical Society
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• v.56 no.4
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• pp.323-329
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• 2014

Objective : Vertebral body replacement following corpectomy in thoracic or lumbar spine is performed with titanium mesh cage (TMC) containing any grafts. Radiological changes often occur on follow-up. This study investigated the relationship between the radiological stability and clinical symptoms. Methods : The subjects of this study were 28 patients who underwent corpectomy on the thoracic or lumbar spine. Their medical records and radiological data were retrospectively analyzed. There were 23 cases of tumor, 2 cases of trauma, and 3 cases of infection. During operation, spinal reconstruction was done with TMC and additional screw fixation. We measured TMC settlement in sagittal plane and spinal angular change in coronal and sagittal plane at postoperative one month and last follow-up. Pain score was also checked. We investigated the correlation between radiologic change and pain status. Whether factors, such as the kind of graft material, surgical approach, and fusion can affect the radiological stability or not was analyzed as well. Results : Mean follow-up was 23.6 months. During follow-up, $2.08{\pm}1.65^{\circ}$ and $6.96{\pm}2.08^{\circ}$ of angular change was observed in coronal and sagittal plane, respectively. A mean of cage settlement was $4.02{\pm}2.83mm$. Pain aggravation was observed in 4 cases. However, no significant relationship was found between spinal angular change and pain status (p=0.518, 0.458). Cage settlement was seen not to be related with pain status, either (p=0.644). No factors were found to affect the radiological stability. Conclusion : TMC settlement and spinal angular change were often observed in reconstructed spine. However, these changes did not always cause postoperative axial pain.

• Transactions of the Korean Society of Machine Tool Engineers
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• v.15 no.3
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• pp.127-131
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• 2006

Existing orthopedic implants such as pedicle screw and spinal cage were designed to fix the spinal structure. But, nowadays, physicians want to rehabilitate there original functions. To achieve this request, we studied micro-movable structure for interspinous. As a first step, we designed interspinous structure by 3D CAD to join each spinous processes. Next, we simulate it with various factors such as the thickness of micro-movement structure and the design of clip. At last, we performed static compressive test to satisfy the failure load of 339N and dynamic endurance test of 1.2M cycle. As a result, we developed interspinous implant and did several surgery to evaluated its satisfaction.

• Journal of Korean Neurosurgical Society
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• v.55 no.3
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• pp.142-147
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• 2014

Objective : A thoracolumbar burst fracture is usually unstable and can cause neurological deficits and angular deformity. Patients with unstable thoracolumbar burst fracture usually need surgery for decompression of the spinal canal, correction of the angular deformity, and stabilization of the spinal column. We compared two struts, titanium mesh cages (TMCs) and expandable cages. Methods : 33 patients, who underwent anterior thoracolumbar reconstruction using either TMCs (n=16) or expandable cages (n=17) between June 2000 and September 2011 were included in this study. Clinical outcome was measured by visual analogue scale (VAS), American Spinal Injury Association (ASIA) scale and Low Back Outcome Score (LBOS) for functional neurological evaluation. The Cobb angle, body height of the fractured vertebra, the operation time and amount of intra-operative bleeding were measured in both groups. Results : In the expandable cage group, operation time and amount of intraoperative blood loss were lower than that in the TMC group. The mean VAS scores and LBOS in both groups were improved, but no significant difference. Cobb angle was corrected higher than that in expandable cage group from postoperative to the last follow-up. The change in Cobb angles between preoperative, postoperative, and the last follow-up did not show any significant difference. There was no difference in the subsidence of anterior body height between both groups. Conclusion : There was no significant difference in the change in Cobb angles with an inter-group comparison, the expandable cage group showed better results in loss of kyphosis correction, operation time, and amount of intraoperative blood loss.

• Journal of Korean Neurosurgical Society
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• v.48 no.3
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• pp.219-224
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• 2010

Objective : A minimally invasive transforaminal lumbar interbody fusion (MIS TLlF) has recently been introduced. However, MIS TLlF is a technically challenging procedure. The authors performed retrospective analysis about MIS TLlF using a single interbody cage. Methods : Twenty-eight consecutive patients were treated by MIS TLlF. Of these 28 patients, 20 patients were included in this retrospective study. Perioperative, clinical, and radiologic outcomes were assessed. Clinical outcomes were assessed using Oswestry Disability Index (ODI) and Visual Analogue Scores (VAS). Fusion rates and cross-sections of operated spinal canals were assessed by CT. Results : Twelve patients underwent MIS TLlF at one segment and 8 patients at two segments (L3/4: 4, L4/5: 17, L5/S1: 7). Operation time for a single segment was 131.7 min and for two segment was 201.4 min, and corresponding blood losses were 208.3 mL and 481.2 mL, respectively. ODI and VAS scores were significantly improved at 6 months postop (ODI from 30.32 to 15.54, VAS from 7.80 to 2.20, p = 0.001) Twenty-two segments (78.6%) achieved grade I fusion, 4 segments (14.3%) achieved grade II, 2 segments (7.1%) achieved grade III and 0 segments achieved grade IV at 12 months. Postoperatively at 12 months, spinal canal cross sectional areas at disc spaces significantly increased from 157.5 to $294.3\;mm^2$ (p = 0.012). Conclusion : MIS TLlF achieved good clinical outcomes and high fusion rates. Our findings show that MIS TLlF performed with a single Interbody cage and a tubular retractor system can be used as a standard MIS TLlF technique.

• Journal of Korean Neurosurgical Society
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• v.40 no.6
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• pp.471-475
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• 2006

Complete vertebral tumor resection is important in order to prevent local recurrence. Among the available techniques for total spondylectomy, the total en bloc spondylectomy has been accepted as the most sophisticated one. After a total en bloc spondylectomy, anterior and posterior column reconstruction is mandatory in order to achieve stability. We experienced the usefulness of an expandable cage for anterior column reconstruction especially in this surgery. The chance of cutting the nerve root and damaging the spinal cord is minimized because the size of the expandable cage is initially small enough to be inserted into the anterior column. The technical details of total vertebral body replacement with an expandable cage after an en bloc lumbar spondylectomy are described herein.

• Journal of Korean Neurosurgical Society
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• v.66 no.6
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• pp.703-715
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• 2023

Objective : This retrospective study investigated the factors that affect cage obliquity angle despite orthogonal maneuvers performed during oblique lateral interbody fusion (OLIF) and assessed the relationship between cage obliquity angle and radiological outcomes post-surgery. Methods : Twenty-nine males who underwent L4-L5 OLIF for lumbar degenerative disease between 2019 and 2021 with a followup duration greater than 12 months were analyzed. Radiological parameters were measured including psoas muscle volume, total psoas area index (total psoas muscle area [cm²]/height squared [m²]), distance from the iliac artery to the origin of the psoas muscle (DIAPM), angle between the origin of the psoas muscle and the center of the vertebral disc (APCVD), iliac crest height, disc height, lumbar flexibility (lumbar flexion angle minus extension angle), cage location ratio, cage-induced segmental lumbar lordosis (LL) (postoperative index level segmental LL minus used cage angle), foraminal height changes, fusion grade. Results : DIAPM, APCVD, iliac crest height, postoperative index level segmental LL, and cage-induced segmental LL were significantly correlated with OLIF cage obliquity angle. However, other radiological parameters did not correlate with cage obliquity. Based on multiple regression analysis, the predictive equation for the OLIF cage obliquity angle was 13.062-0.318×DIAPM+0.325×1APCVD+0.174×iliac crest height. The greater the cage obliquity, the smaller the segmental LL compared to the cage angle used. Conclusion : At the L4-L5 level, OLIF cage obliquity was affected by DIAPM, APCVD, and iliac crest height, and as the cage obliquity angle increases, LL agnle achievable by the used cage could not be obtained.

• Journal of Korean Neurosurgical Society
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• v.42 no.4
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• pp.317-325
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• 2007

Objective : The purpose of the study was to determine the clinical effects of anterior radical debridement on a series of patients with spontaneous spinal infection. Methods : We retrospectively analyzed the clinical characteristics of 32 patients who underwent surgical treatment from January 2000 to December 2005 in our department. The average follow-up Period was 33.4 months (range, 6 to 87 months). Thirty-two patients presented with the following : 23 cases with pyogenic spondylitis, eight with tuberculous spondylitis and one with fungal spondylitis. The indications for surgery were intractable pain, failure of medical management, neurological impairment with or without an associated abscess, vertebral destruction causing spinal instability and/or segmental kyphosis. Results : The study included 15 (46.9%) males and 17 (53.1%) females ranging in age from 26 to 75 years (mean, 53.1 years). Diabetes mellitus (DM) and pulmonary Tbc were the most common predisposing factors for pyogenic spondylitis and tuberculous spondylitis. Staphylococcus aureus (13%) was the main organism isolated. The most prevalent location was the lumbar spine (75%). Changes in the pain score, Frankel's classification, and laboratory parameters demonstrated a significant clinical improvement in all patients. However, there were recurrent infections in two patients with tuberculous spondylitis and inappropriate debridement and intolerance of medication and noncompliance. Autologous rib, iliac bone and allograft(fibular) were performed in most patients. However, 10 patients were grafted using a titanium mesh cage after anterior radical debridement. There were no recurrent infections in the 10 cases using the mesh cage with radical debridement. Conclusion : The findings of this study indicate that surgery based on appropriate surgical indications is effective for the control of spinal infection and prevention of recurrence with anterior radical debridement, proper drug use and abscess drainage.

• Journal of Korean Neurosurgical Society
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• v.50 no.4
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• pp.348-356
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• 2011

Objective : The safety and efficacy of various fusion substitutes in pyogenic osteomyelitis has not been investigated. We evaluated and compared the cadaveric allograft and titanium cages used to reconstruct, maintain alignment and achieve fusion in the management of pyogenic spinal infection. Methods : There were 33 patients with pyogenic osteomyelitis underwent fusion in this study. Fifteen of the 33 patients were operated on by fusion with allografts (cadaveric patella bones) and 18 of those were operated with titanium mesh cages filled with autologous cancellous iliac bone. After the affected disc and vertebral body resection with pus drainage, cadaveric allograft or titanium cages were inserted into the resected space. Posterior transpedicular screw fixation and rod compression in resected space, where cadaveric allograft or titanium cages were inserted, was performed to prevent the malposition in all patients except in 1 case. Recurrent infection was identified by serial erythrocyte sedimentation rate and cross reactive protein follow-up. Osseous union and recurred infection available at a minimum of 2 years following operation was identified. The amount of kyphosis correction and the subsidence were measured radiographically. Results : Spinal fusion was achieved in 29 of 33 patients. In the cadaveric allograft group, 93.3% of patient (14 of 15) showed the osseous union while 83.3% of patient (15 of 18) in the titanium cage group showed union. Subsidence was noted in 12 of the patients. Twelve patients (36.3%) showed unsettling amounts of subsidence postoperatively whereas 46.6% of patients in the cadaveric allograft group and 37.7% of patients in the titanium cage group showed similar subsidence, respectively. There were statistical difference in the fusion rate (p=0.397) and subsidence rate (p=0.276) between the two groups. There was significant statistical difference in the postoperative improvement of segmental kyphosis between the two groups (p=0.022), that is the improvement in sagittal alignment was greater in the titanium cage group than in the cadaveric allograft group. There was no case of recurred infection. Conclusion : The cadaveric allograft and titanium cages are effective and safe in restoring and maintaining sagittal plane alignment without increased incidence in infection recurrence in pyogenic osteomyelitis. The postoperative improvement of segmental kyphosis was better in the cage group.

• Journal of Trauma and Injury
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• v.36 no.3
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• pp.290-294
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• 2023

Generally, patients with severe burst fractures, instability, or neurological deficits require surgical treatment. In most cases, circumferential reconstruction is performed. Surgical methods for three-column reconstruction include anterior, lateral, and posterior approaches. In cases involving an anterior or lateral approach, collaboration with general or thoracic surgeons may be necessary because the adjacent anatomical structures are unfamiliar to spinal surgeons. Risks include vascular or lumbar plexus injuries and cage displacement, and in most cases, additional posterior fusion surgery is required. However, the posterior approach is the most common and anatomically familiar approach for surgeons performing spinal surgery. We present a case in which three-column reconstruction was performed using only the posterior approach to treat a patient with a severe lumbar burst fracture.

• Neurospine
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• v.15 no.4
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• pp.368-375
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• 2018

Objective: To evaluate the results of operative management of subaxial spine injuries managed with 2-level anterior cervical corpectomy and fusion with a cervical locking plate and autologous bone-filled titanium mesh cage. Methods: This study included 23 patients with a subaxial spine injury who matched the inclusion criteria, underwent 2-level anterior cervical corpectomy and fusion at our institution between 2013 and 2016, and were followed up for neurological recovery, axial pain, fusion, pseudarthrosis, and implant failure. Results: According to Allen and Ferguson classification, there were 9 cases of distractive extension; 4 of compressive extension; 3 each of compressive flexion, vertical compression, and distractive flexion; and 1 of lateral flexion. Sixteen patients had a score of 6 on the Subaxial Injury Classification system, and the rest had a score of more than 6. The mean follow-up period was 19 months (range, 12-48 months). Neurological recovery was observed in most of the patients (78.21%). All patients experienced relief of axial pain. None of the patients received a blood transfusion. Twenty-one patients (91.3%) showed solid fusion and 2 (8.69%) showed possible pseudarthrosis, with no complications related to the cage or plate. Conclusion: Two-level anterior cervical corpectomy and fusion, along with stabilization with a cervical locking plate and autologous bone graft-filled titanium mesh cage, can be considered a feasible and safe method for treating specific subaxial spine injuries, with the benefits of high primary stability, anatomical reduction, and direct decompression of the spinal cord.