• Journal of Korean Neurosurgical Society
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• 제53권1호
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• pp.49-51
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• 2013

A case of traumatic spondyloptosis of the cervical spine at the C6-C7 level is reported. The patient was treated succesfully with a anterior-posterior combined approach and decompression. The patient had good neurological outcome after surgery. A-51-year-old female patient was transported to our hospital's emergency department after a vehicle accident. The patient was quadriparetic (Asia D, MRC power 4/5) with severe neck pain. Plain radiographs, computerize tomography and spinal magnetic resonance imaging (MRI) showed C6-7 spondyloptosis and C5, C6 posterior element fractures. Gardner-Wells skeleton traction was applied. Spinal alignment was reachived by traction and dislocation was decreased to a grade 1 spondylolisthesis. Then the patient was firstly operated by anterior approach. Anterior stabilization and fusion was firstly achieved. Seven days after first operation the patient was operated by a posterior approach. The posterior stabilization and fusion was achieved. Postoperative lateral X-rays and three-dimensional computed tomography showed the physiological realignment and the correct screw placements. The patient's quadriparesis was improved significantly. Subaxial cervical spondyloptosis is a relatively rare clinical entity. In this report we present a summary of the clinical presentation, the surgical technique and outcome of this rarely seen spinal disorder.

• Journal of Korean Neurosurgical Society
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• 제49권2호
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• pp.131-133
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• 2011

We performed a percutaneous vertebroplasty at the compressed L2 vertebral body of a 73-year-old female using a left-sided unilateral extrapedicular approach. She complained severe radiating pain and a tingling sensation in her left leg two hours after the vertebroplasty. Spinal computed tomographic scan showed a large retroperitoneal hematoma, and a subsequent spinal angiography revealed a left L2 segmental artery injury. Bleeding was successfully controlled by endovascular embolization. Recently, extrapedicular approaches have been attempted, allowing for the avoidance of facet and pedicle injury with only a unilateral approach. With this approach, however, the needle punctures the vertebral body directly. Therefore, this procedure carries the potential risk of a spinal segmental artery.

• Journal of Korean Neurosurgical Society
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• 제42권4호
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• pp.293-299
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• 2007

Objective : Thoracoscopic spinal surgery provides minimally invasive approaches for effective vertebral decompression and reconstruction of the thoracic and thoracolumbar spine, while surgery related morbidity can be significantly lowered. This study analyzes clinical results of thoracoscopic spinal surgery performed at our institute. Methods : Twenty consecutive patients underwent video-assisted thoracosopic surgery (VATS) to treat various thoracic and thoracolumbar pathologies from April 2000 to July 2006. The lesions consisted of spinal trauma (13 cases), thoracic disc herniation (4 cases), tuberculous spondylitis (1 case), post-operative thoracolumbar kyphosis (1 case) and thoracic tumor (1 case). The level of operation included upper thoracic lesions (3 cases), midthoracic lesions (6 cases) and thoracolumbar lesions (11 cases). We classified the procedure into three groups: stand-alone thoracoscopic discectomy (3 cases), thoracoscopic fusion (11 cases) and video assisted mini-thoracotomy (6 cases). Results : Analysis on the Frankel performance scale in spinal trauma patients (13 cases), showed a total of 7 patients who had neurological impairment preoperatively : Grade D (2 cases), Grade C (2 cases), Grade B (1 case), and Grade A (2 cases). Four patients were neurologically improved postoperatively, two patients were improved from C to E, one improved from grade D to E and one improved from grade B to grade D. The preoperative Cobb's and kyphotic angle were measured in spinal trauma patients and were $18.9{\pm}4.4^{\circ}$ and $18.8{\pm}4.6^{\circ}$, respectively. Postoperatively, the angles showed statistically significant improvement, $15.1{\pm}3.7^{\circ}$ and $11.3{\pm}2.4^{\circ}$, respectively(P<0.001). Conclusion : Although VATS requires a steep learning curve, it is an effective and minimally invasive procedure which provides biomechanical stability in terms of anterior column decompression and reconstruction for anterior load bearing, and preservation of intercostal muscles and diaphragm.

• Journal of Korean Neurosurgical Society
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• 제29권6호
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• pp.763-771
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• 2000

Objectives : Thoracolumbar burst fractures(TBLF) result in not only compressive deformity of vertebral body but also spinal cord compression by bony fragments. Many thoracolumbar burst fractures demand both anterior decompression and intervertebral fusion. Most of spinal surgeons use anterior instrumentation for anteior intervertebral bony fusion. The use of Z-plate has been increased recently, however there has been only a few reports regarding its clinical long-term strength. We studied nineteen patients with TBLF to find out the long-term stability of Z-plate. Methods : We have operated 19 patients from March 1996 to August 1998. They were treated with anterior decompression through either a transthoracic, retroperitoneal extrapleural or retroperitoneal approach. Retropulsed bony fragments were removed completely by corpectomy. Iliac bone graft was used for interbody fusion in all of the cases. They were evaluated by plain X-ray films including flexion and extention lateral films. Cobbs angle was used to evaluate kyphotic and lateral wedging deformity. Results : Burst fractured sites were T11 in two, three T12, nine L1, and five L2. Mean follow-up duration was fifteen months. Preoperative average kyphotic angle was 23.7 degree. Immediate postoperative kyphotic angle was 10.2 degree. Follow-up resluts of average kyphotic angles revealed 14 degrees. Four patients(21%), including two spinal 3-column injury, showed increasement of kyphotic angle more than 5 degree or breakage of intrumentation. Two patients showed the difference of kyphotic angle more than 3 degree. Five patients(26%) revealed lateral wedging deformity more than 3 degrees. Postoperative complications were two meralgia parestheticas, one pulmonary atelectasis and two donor site infections. Four of the eight patients, who initially showed incomplete spinal cord deficits, were nerologically improved by Frankel's grade. Conclusion : Z-plate fixation and iliac bone graft after anterior decompression in thoracolumbar burst fractures is a safe and easy method. Immediate postoperative results revealed excellent correction of posttraumatic kyphosis, but long-term follow-up evalution showed insufficient strength. Therefore we believe that use of Z-plate should be carefully decided, especially in the case of large lumbar fracture or 3-column injury.

• Journal of Korean Neurosurgical Society
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• 제30권7호
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• pp.907-915
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• 2001

Objective : Percutaneous vertebroplasty is often complicated by the presence of multiple fractures or non-localizing pain in the patients with osteoporotic vertebral fractures. The purpose of this study is to estimate the value of preoperative radiologic studies in the localization of symptomatic vertebrae and to determine the factors which can influence on the clinical results. Materials and Methods : We retrospectively reviewed the clinical and radiologic data of 57 vertebrae in 30 patients underwent percutaneous vertebroplasty for osteoporotic vertebral compression fractures. Inclusion criteria was severe pain(McGill-Melzack score 3, 4 or 5) associated with the acute vertebral fractures and absence of spinal nerve root or cord compression sign. Acute symptomatic vertebral fracture was determined by the presence of signal change on MR images or increased uptake on whole body bone scan. Results : Pain improvement was obtained immediately in all patients and favorable result was sustained in 26 patients(86.7%) during the mean follow-up duration of 4.7 months(5 complete pain relief, 21 marked pain relief). Those who underwent vertebroplasty for all acute symptomatic vertebrae had significantly better clinical result than those who did not. Further vertebral collapse and eventual bursting fracture occurred in 1 vertebra which showed intradiskal leakage of bone cement and disruption of cortical endplate on postoperative CT scan. Conclusion : Preoperative MR imaging and whole body bone scan are very useful in determining the symptomatic vertebrae, especially in the patients with multiple osteoporotic vertebral fractures. To obtain favorable clinical result, the careful radiologic evaluation as well as clinical assessment is required. Control of PMMA volume seems to be the most critical point for avoiding complications.

• Journal of Korean Neurosurgical Society
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• 제30권2호
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• pp.163-167
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• 2001

Objective : Percutaneous vertebroplasty has recently been introduced as an interesting therapeutic alternative for the treatment of thoracolumbar vertebral body fractures in elderly persons with osteoporosis. The authors present the early results of this method. Method and Material : From July 1999 to April 2000, percutaneous transpedicular technique was used in 20 patients (2 men and 18 women) whose mean age was 67.5 years old(range 59-79) with painful vertebral compression(22) and burst(2) fractures. The interval between fracture and vertebroplasty ranged 1 day to 4 months. The procedure involved percutaneous puncture of the injured vertebra via transpedicular approach under fluoroscopic guidance, followed by injection of polymethylmetacrylate(PMMA) into the vertebral body through a disposable 11-guage Jamshidi needle. Result : The most common cause of fracture was slip down and the most frequent injured level was the twelfth thoracic spine. The procedure was technically successful bilaterally in 18 patients(9 thoracic and 15 lumbar spines) with an average injection amount of 7.7ml PMMA in each level. Seventeen(94.4%) patients reported significant pain relief immediately after treatment. Two leaks of PMMA were detected with postoperative CT in spinal epidural space and extravertebral soft tissue without clinical symptoms. Conclusion : Although this study represents the early results, percutaneous vertebroplasty seems to be valuable tool in the treatment of painful osteoporotic vertebral body fractures in elderly, providing acute pain relief and early mobilization.

• 대한정형외과학회지
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• 제55권3호
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• pp.266-270
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• 2020

뇌전증에 의한 전신 발작 시 발생한 강력한 근육 수축에 의한 근골격계 손상이 발생할 수 있다. 외상 및 기저질환 없이 전신 발작 후 발생한 다발성 흉추 골절에 대한 국외 증례는 많지만 국내의 연구나 증례보고는 없다. 이전에 골다공증이나 특이 질환이 없는 42세 남자 환자의 수면 중 전신 간대성 발작에 의한 다발성 흉추 골절을 진단하였기에 증례를 보고하는 바이다.

• 대한의용생체공학회:의공학회지
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• 제44권2호
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• pp.139-146
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• 2023

Osteoporosis is a disease in which the risk of bone fractures increases due to a decrease in bone density caused by aging. Osteoporosis is diagnosed by measuring bone density in the total hip, femoral neck, and lumbar spine. To accurately measure bone density in the lumbar spine, the vertebral region must be segmented from the lumbar X-ray image. Deep learning-based automatic spinal segmentation methods can provide fast and precise information about the vertebral region. In this study, we used 695 lumbar spine images as training and test datasets for a deep learning segmentation model. We proposed a lumbar automatic segmentation model, CM-Net, which combines the center point of the spine and the modified U-Net network. As a result, the average Dice Similarity Coefficient(DSC) was 0.974, precision was 0.916, recall was 0.906, accuracy was 0.998, and Area under the Precision-Recall Curve (AUPRC) was 0.912. This study demonstrates a high-performance automatic segmentation model for lumbar X-ray images, which overcomes noise such as spinal fractures and implants. Furthermore, we can perform accurate measurement of bone density on lumbar X-ray images using an automatic segmentation methodology for the spine, which can prevent the risk of compression fractures at an early stage and improve the accuracy and efficiency of osteoporosis diagnosis.

• Journal of Korean Neurosurgical Society
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• 제50권3호
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• pp.224-230
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• 2011

Objective : This study aimed to show the possibility of neural canal enlargement and restoration of bony fragments through laminectomy and minimal facetectomy without pediculectomy or an anterior approach, and also to prove the adequacy of posterior stabilization of vertebral deformities after thoracolumbar bursting fracture. Methods : From January 2003 to June 2009, we experienced 45 patients with thoracolumbar burst fractures. All patients enrolled were presented with either a neural canal compromise of more than 40% with a Benzel-Larson Grade of VI, or more than 30% compromise with less than a Benzel-Larson Grade of V. Most important characteristic of our surgical procedure was repositioning retropulsed bone fragments using custom-designed instruments via laminectomy and minimal facetectomy without removing the fractured bone fragments. Beneath the dural sac, these custom-designed instruments could push the retropulsed bone fragments within the neural canal after the decompression and bone fragment repositioning. Results : The mean kyphotic deformities measured preoperatively and at follow-up within 12 months were 17.7 degrees (${\pm}6.4$ degrees) and 9.6 degrees (${\pm}5.2$ degrees), respectively. The mean midsagittal diameter improved from 8.8 mm (${\pm}2.8$ mm) before surgery to 14.2 mm (${\pm}1.6$ mm) at follow-up. The mean traumatic vertebral body height before surgery was 41.3% (${\pm}12.6%$). At follow-up assessment within 12 months, this score showed a statistically significant increase to 68.3% (${\pm}12.8%$). Neurological improvement occurred in all patients. Conclusion : Though controversy exists in the treatment of severe thoracolumbar burst fracture, we achieved effective radiological and clinical results in the cases of burst fractures causing severe canal compromise and spinal deformity by using this novel custom-designed instruments, via posterior approach alone.

• Journal of Korean Medical Science
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• 제33권48호
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• pp.316.1-316.10
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• 2018

Background: Water pressure and muscle contraction may influence bone mineral density (BMD) in a positive way. However, divers experience weightlessness, which has a negative effect on BMD. The present study investigated BMD difference in normal controls and woman free-divers with vertebral fracture and with no fracture. Methods: Between January 2010 and December 2014, traditional woman divers (known as Haenyeo in Korean), and non-diving women were investigated. The study population was divided into osteoporotic vertebral fracture and non-fracture groups. The BMD of the lumbar spine and femoral neck was measured. The radiological parameters for global spinal sagittal balance were measured. Results: Thirty free-diving women and thirty-three non-diving women were enrolled in this study. The mean age of the divers was $72.1{\pm}4.7$ years and that of the controls was $72.7{\pm}4.0$ years (P = 0.61). There was no statistical difference in BMD between the divers and controls. In divers, cervical lordosis and pelvic tilt were significantly increased in the fracture subgroup compared to the non-fracture subgroup (P = 0.028 and P = 0.008, respectively). Sagittal vertical axis was statistically significantly correlated with cervical lordosis (Spearman's rho R = 0.41, P = 0.03), and pelvic tilt (Spearman's rho R = 0.46, P = 0.01) in divers. Conclusion: BMD did not differ significantly between divers and controls during their postmenopausal period. When osteoporotic spinal fractures develop, compensation mechanisms, such as increased cervical lordosis and pelvic tilt, was more evident in traditional woman divers. This may be due to the superior back muscle strength and spinal mobility of this group of women.