• Journal of Korean Neurosurgical Society
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• 제61권6호
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• pp.669-679
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• 2018

Objective : To compare the spinal bone fusion properties of activin A/BMP2 chimera (AB204) with recombinant human bone morphogenetic protein (rhBMP2) using a rat posterolateral spinal fusion model. Methods : The study was designed to compare the effects and property at different dosages of AB204 and rhBMP2 on spinal bone fusion. Sixty-one male Sprague-Dawley rats underwent posterolateral lumbar spinal fusion using one of nine treatments during the study, that is, sham; osteon only; $3.0{\mu}g$, $6.0{\mu}g$, or $10.0{\mu}g$ of rhBMP2 with osteon; and $1.0{\mu}g$, $3.0{\mu}g$, $6.0{\mu}g$, or $10.0{\mu}g$ of AB204 with osteon. The effects and property on spinal bone fusion was calculated at 4 and 8 weeks after treatment using the scores of physical palpation, simple radiograph, micro-computed tomography, and immunohistochemistry. Results : Bone fusion scores were significantly higher for $10.0{\mu}g$ AB204 and $10.0{\mu}g$ rhBMP2 than for osteon only or $1.0{\mu}g$ AB204. AB204 exhibited more prolonged osteoblastic activity than rhBMP2. Bone fusion properties of AB204 were similar with the properties of rhBMP2 at doses of 6.0 and $10.0{\mu}g$, but, the properties of AB204 at doses of $3.0{\mu}g$ exhibited better than the properties of rhBMP2 at doses of $3.0{\mu}g$. Conclusion : AB204 chimeras could to be more potent for treating spinal bone fusion than rhBMP2 substitutes with increased osteoblastic activity for over a longer period.

• Journal of Yeungnam Medical Science
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• 제24권2호
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• pp.262-274
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• 2007

AdBMP-2와 AdBMP-7을 형질도입 시킨 사람 섬유아세포와 사람 골수기질세포를 면역결핍 생쥐의 척추 옆 근육으로 주입하여 척추 유합을 유도한 결과, AdBMP-7/BMSC가 AdBMP-2/BMSC 또는 AdBMP-7/HuFb와 AdBMP-2/HuFb 보다 골 형성능이 우수하였으며, 척추 유합을 잘 유도하였음을 확인하였다.

• Asian Spine Journal
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• 제12권6호
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• pp.1010-1016
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• 2018

Study Design: Retrospective cohort study. Purpose: To report on spinal fusion assessment using computed tomography (CT) after adult spinal deformity (ASD) surgery using ultra-low dose recombinant human bone morphogenetic protein 2 (RhBMP-2). Overview of Literature: The reported dose of RhBMP-2 needed for successful spinal posterolateral fusion in ASD ranges from 10 to 20 mg per spinal level. This study reports the use of ultra-low dose of RhBMP-2 (0.07 mg per facet) to achieve spinal fusion in multilevel ASD surgery. Methods: Consecutive patients who underwent ASD surgery using ultra-low dose RhBMP-2 were recruited. Routine postoperative CT analysis for spinal fusion was performed by two spine surgeons. Inter-observer agreement was calculated for facet fusion (FF) and interbody fusion (IBF) at 6 and 12 months after the procedure. Results: Six consecutive ASD patients with a mean age of 62 years (28-72 years) were examined. Each patient received a total dose of 12 mg with an average dose of $0.69{\pm}0.2mg$ (0.42-1 mg) per single FF and $1.38{\pm}0.44mg$ (0.85-2 mg) for IBF. Total 131 FF and 15 IBF were examined in the study, with 88 FFs and nine IBFs being analyzed specifically at 6 months after the surgery. FF and IBF reported by surgeons A and B at 6 months were 97.7% vs. 91.9% FF, respectively (${\kappa}=0.95$) and 100% vs. 100% IBF, respectively (${\kappa}=1$). Two patients underwent longitudinal follow-up CT at 12 months, and the FF rates reported by surgeons A and B were 100% vs. 95.8%, respectively (${\kappa}=0.96$). Five out of nine facet (56%) non-unions were identified at the cross-links. The remaining four facet pseudarthrosis were noted at 1-2 spinal levels caudal to the cross-links. At the final clinical follow-up, there was no rod breakage, deformity progression, neurological deficit, or symptom recurrence. The Oswestry Disability Index improved by an average of $32.8{\pm}6.3$, while the mental component summary of the 36-item Short-Form Health Survey improved by an average of $4.7{\pm}2.1$, and physical component summary improved by an average of $10.5{\pm}2.1$. Conclusions: To our knowledge, this is the first study to report a CT that defined 92%-98% FF and 100% IBF using the lowest reported dose of RhBMP-2 in multilevel ASD surgery. The use of ultra-low dose RhBMP-2 reduces the RhBMP-2 related complications and healthcare costs.

• Journal of Korean Neurosurgical Society
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• 제45권2호
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• pp.81-84
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• 2009

Objective : Many biomechanical and clinical studies on adjacent segment degeneration (ASD) have addressed cranial segment. No study has been conducted on caudal segment degeneration after upper segment multiple lumbar fusions. This is a retrospective investigation of the L5-S1 segment after spinal fusion at and above L4-5, which was undertaken to analyze the rate of caudal ASD at L5-S1 after spinal fusion on and above L4-5 and to determine that factors that might have influenced it. Methods : The authors included 67 patients with L4-5, L3-5, or L2-5 posterior fusions. Among these patients, 28 underwent L4-5 fusion, 23 L3-5, and 16 L2-5 fusions. Pre- and postoperative radiographs were analyzed to assess degenerative changes at L5-S1. Also, clinical results after fusion surgery were analyzed. Results : Among the 67 patients, 3 had pseudoarthrosis, and 35 had no evidence of ASD, cranially and caudally. Thirteen patients (19.4%) showed caudal ASD, 23 (34.3%) cranial ASD, and 4 (6.0%) both cranial and caudal ASD. Correlation analysis for caudal ASD at L5-S1 showed that pre-existing L5-S1 degeneration was most strongly correlated. In addition, numbers of fusion segments and age were also found to be correlated. Clinical outcome was not correlated with caudal ASD at L5-S1. Conclusion : If caudal and cranial ASD are considered, the overall occurrence rate of ASD increases to 50%. The incidence rate of caudal ASD at L5-S1 was significantly lower than that of cranial ASD. Furthermore, the occurrence of caudal ASD was found to be significantly correlated with pre-existing disc degeneration.

• 대한의료기공학회지
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• 제19권1호
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• pp.99-115
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• 2019

Introduction : In patient with ankylosing spondylitis, when bone formation progresses, spinal fusion occurs and joint motion is severely limited. We performed Medical Gi-gong and Korean medical therapies in patient with advanced ankylosing spondylitis with spinal fusion. Case : 46-year-old male with extensive spinal fusion at the cervical and lumbar spine complains of back pain, hip pain, joint stiffness, eye pain, and digestive problems. HLA-B27 (+), mSASSS is 70. Medical Gi-gong was done 311 days for 340 days. Acupuncture, cupping, and manual treatment were performed once every 5.9 days for one year. BASDAI improved from 5.3 to 4.3, BASFI from 4.3 to 3.7, and BASMI from 6.8 to 5.8. mSASSS did not change. Conclusions : Patients with advanced ankylosing spondylitis were treated with Medical Gigong and Korean medical therapies to achieve a slight improvement.

• 임상간호연구
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• 제17권3호
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• pp.388-398
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• 2011

Purpose: This study was to develop a post-operative exercise program, apply it to patients undergone lumbar spinal fusion surgery, and evaluate the effectiveness of the program on pain and disability activities of daily living. Methods: Fifty six patients who had lumbar spinal fusion were enrolled in this study. The patients were divided into two groups; 28 patients in the intervention group completed post-operative lumbar exercise program including walking for four weeks and 28 patients in the control group only did walking exercises. The degrees of pain on low back and leg were evaluated using visual analog scale (VAS) and the functional outcome was evaluated using the Korean version of Oswestry Disability Index (KODI) before surgery and 5 weeks after surgery. The data were analyzed using descriptive statistics, Chi-square test, t-test with SPSS 18.0 program. Results: Low back and leg pain of the participants in both experimental and control groups were improved after surgery compared to pre-surgery pain. However, there was no statistically significant difference between the groups. KODI score in the intervention group was significantly lower than that of the control group (p=.014). Conclusion: The developed post-operative exercise program in patients with lumbar spinal fusion surgery seems to be a useful intervention to reduce disability in activities of daily living.

• Journal of Korean Neurosurgical Society
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• 제46권1호
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• pp.45-51
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• 2009

Objective : To evaluate the potential effects of risedronate (RIS) which shows a higher anti-resorptive effect among bisphosphonates, after a posterolateral lumbar intertransverse process spinal fusion using both autograft and allograft in a rat model. Methods : A totoal of 28 Sprague-Dawley rats were randomized into 2 study groups. A posterolateral lumbar intertransverse process spinal fusion was peformed using both autograft and allograft in a rat model. Group I (control) received 0.1 mL of steril saline (placebo) and Group II (treatment) received risedronate, equivalent to human dose (10 ${\mu}g$/kg/week) for 10-weeks period. Results : The fusion rates as determined by manual palpation were 69% in the group I and 46% in the group II (p = 0.251). According to radiographic score, the spinal segment was considered to be fused radiographically in 7 (53%) of the 13 controls and 9 (69%) of the 13 rats treated with RIS (p = 0.851). The mean histological scores were 5.69 ${\pm}$ 0.13 and 3.84 ${\pm}$ 0.43 for the control and treatment groups, respectively. There was a significant difference between the both groups (p = 0.001). The mean bone density of the fusion masses was 86.9 ${\pm}$ 2.34 in the control group and 106.0 ${\pm}$ 3.54 in the RIS treatment group. There was a statistical difference in mean bone densities of the fusion masses comparing the two groups (p=0.001). Conclusion : In this study, risedronate appears to delay bone fusion in a rat model. This occurs as a result of uncoupling the balanced osteoclastic and osteoblastic activity inherent to bone healing. These findings suggest that a discontinuation of risedronate postoperatively during acute fusion period may be warranted.

• Journal of Korean Neurosurgical Society
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• 제50권3호
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• pp.205-208
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• 2011

Objective : Retrospective analysis to compare the effect and complication of epidural patient-controlled analgesia (epidural PCA) with intravenous patient-controlled analgesia (IV PCA) for the treatment of the post-operative pain after posterior lumbar instrumented fusion. Methods : Sixty patients who underwent posterior lumbar instrumented fusion for degenerative lumbar disease at our institution from September 2007 to January 2008 were enrolled in this study. Out of sixty patients, thirty patients received IV PCA group and thirty patients received epidural PCA group. The pain scale was measured by the visual analogue scale (VAS) score. Results : There were no significant difference between IV PCA group and epidural PCA group on the PCA related complications (p=0.7168). Ten patients in IV PCA group and six patients in epidural PCA group showed PCA related complications. Also, there were no significant differences in reduction of VAS score between two groups on postoperative 2 hours (p=0.9618) and 6 hours (p=0.0744). However, postoperative 12 hours, 24 hours and 48 hours showed the significant differences as mean of reduction of VAS score (p=0.0069, 0.0165, 0.0058 respectively). Conclusion : The epidural PCA is more effective method to control the post-operative pain than IV PCA after 12 hours of spinal fusion operation. However, during the first twelve hours after operation, there were no differences between IV PCA and epidural PCA.

• Journal of Korean Neurosurgical Society
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• 제59권4호
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• pp.363-367
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• 2016

Objective : To compare the fusion rate of a hydroxyapatite demineralized bone matrix (DBM) with post-laminectomy acquired autograft in lumbar interbody fusion surgery and to evaluate the correlation between fusion rate and clinical outcome. Methods : From January 2013 to April 2014, 98 patients underwent lumbar interbody fusion surgery with hydroxyapatite DBM (HA-DBM group) in our institute. Of those patients, 65 received complete CT scans for 12 months postoperatively in order to evaluate fusion status. For comparison with autograft, we selected another 65 patients who underwent lumbar interbody fusion surgery with post-laminectomy acquired autograft (Autograft group) during the same period. Both fusion material groups were matched in terms of age, sex, body mass index (BMI), and bone mineral density (BMD). To evaluate the clinical outcomes, we analyzed the results of visual analogue scale (VAS), Oswestry Disability Index (ODI), and Short Form Health Survey (SF-36). Results : We reviewed the CT scans of 149 fusion levels in 130 patients (HA-DBM group, 75 levels/65 patients; Autograft group, 74 levels/65 patients). Age, sex, BMI, and BMD were not significantly different between the groups (p=0.528, p=0.848, p=0.527, and p=0.610, respectively). The HA-DBM group showed 39 of 75 fused levels (52%), and the Autograft group showed 46 of 74 fused levels (62.2%). This difference was not statistically significant (p=0.21). In the HA-DBM group, older age and low BMD were significantly associated with non-fusion (61.24 vs. 66.68, p=0.027; -1.63 vs. -2.29, p=0.015, respectively). VAS and ODI showed significant improvement after surgery when fusion was successfully achieved in both groups (p=0.004, p=0.002, HA-DBM group; p=0.012, p=0.03, Autograft group). Conclusion : The fusion rates of the hydroxyapatite DBM and Autograft groups were not significantly different. In addition, clinical outcomes were similar between the groups. However, older age and low BMD are risk factors that might induce non-union after surgery with hydroxyapatite DBM.

• Journal of Korean Neurosurgical Society
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• 제53권1호
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• pp.19-25
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• 2013

Objective : We compared the results of two surgical techniques by retrospective study of 60 elderly patients (65 years or older) who underwent either decompression alone or fusion for the treatment of two-level or more lumbar spinal stenosis. Methods : During the period of 2003 and 2008, two-level or more decompression alone or fusion was performed for lumbar spinal stenosis by three surgeons at our institution. Patients were allocated to two groups by surgical modality, namely, to a decompression group (31 patients) or a fusion group (29 patients). Overall mean age was 71.1 years (range, 65-84) and mean follow-up was 5.5 years (range, 3-9). A retrospective review of clinical, radiological, and surgical data was conducted. Results : No significant difference between the two groups was found with respect to age, follow-up period, surgical levels, or preoperative condition. At the last follow-up, correction of lumbar lordotic angle (determined radiologically) was better in the fusion group. However, clinical outcomes including visual analogue scale, Oswestry Disability Index, and the Odom's criteria were not significantly different in the two groups. On the other hand, surgical outcomes, such as, operation time, estimated blood loss, and surgical complications were significantly better in the decompression alone group. Conclusion : Our findings suggest that decompressive laminectomy alone achieves good outcomes in patients with two-level or more lumbar spinal stenosis, associated with an advanced age, poor general condition, or osteoporosis.