• Journal of Trauma and Injury
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• 제34권1호
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• pp.31-38
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• 2021

Purpose: Traumatic vertebral injuries have a prevalence of 4-5% at level I centers. Studies have demonstrated that isolated thoracolumbar transverse process fractures (iTPF) rarely require brace or surgical interventions. We hypothesized that similarly isolated thoracolumbar spinous process fractures (iSPF) would have less need for bracing and operative interventions than SPFs with associated vertebral body (VB) fractures (SPF+VB). We performed a similar analysis for iTPF compared to transverse process fractures associated with VB injury (TPF+VB). Methods: In this single-center, retrospective study from 2012 to 2016, patients were classified into iSPF, SPF+VB, iTPF, and TPF+VB groups. Data including the fracture pattern, neurologic deficits, and operative intervention were obtained. The primary outcome studied was the need for bracing and/or surgery. A statistical analysis was conducted. Results: Of 98 patients with spinous process fractures, 21 had iSPF and 77 had SPF+VB. No iSPF patients underwent surgery, whereas 24 (31.17%) SPF+VB patients did undergo surgery (p=0.012). In the iSPF group, three patients (15%) received braces only for comfort, whereas 37 (48.68%) of the SPF+VB group required bracing (p=0.058). Of 474 patients with transverse process fractures, 335 had iTPF and 139 had TPF+VB. No iTPF patients underwent surgery, whereas 28 (20.14%) TPF+VB patients did (p≤0.001). Of the iTPF patients, six (1.86%) were recommended to receive braces only for comfort, while 68 (50.75%) of the TPF+VB patients required bracing (p<0.001). Conclusions: No patients with iSPF or iTPF required surgical intervention, and bracing was recommended to patients in these groups for comfort only. It appears that these injures may be safely managed without interventions, calling into question the need for spine consultation.

• 한국임상수의학회지
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• 제40권1호
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• pp.16-24
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• 2023

This study aimed to compare complete ruptured tendon healing between two different repair methods using the Achilles tendon of New Zealand white rabbits. Thoracolumbar fascia (TF) padded Kessler suture, polypropylene mesh (PM) padded Kessler suture, and Kessler suture only were performed on the completely transected lateral gastrocnemius tendon, and biomechanical and histologic characteristics were assessed after 8 weeks. For biomechanical assessment, the tensile strength of each repaired tendon was measured according to the established methods. For histomorphometric analysis, hematoxylin and eosin staining for general histology, and Masson's trichrome (MT) staining for collagen fibers, Alcian blue (AB) staining for proteoglycans were performed and analyzed. Significant increases in tensile strength with remarkable decreases in the abnormalities against nuclear roundness, cell density, fiber structure, and fiber alignment and significant decreases in the mean number of infiltrated inflammatory cells and AB-positive proteoglycan-occupied regions with increases in MT-positive collagen fiber-occupied regions were demonstrated in the Kessler suture with PM or TF padding groups as compared to those of the Kessler suture group. Both of PM and TF provided potent tensile strength and supported healing with the evidence of histological examinations. This means that augmentation with PM is useful for repairing a completely ruptured Achilles tendon, without additional surgery for autograft material harvesting.

• 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.

• 재활복지공학회논문지
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• 제6권1호
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• pp.45-50
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• 2012

흉 요추 보조기는 후만증 관련 증상의 진행을 예방하고 통증을 완화시키기 위한 목적으로 노인성 후만증 환자의 재활을 위하여 이용되고 있다. 최근 다양한 형태의 흉 요추 보조기가 개발되고 있으나 생체역학적 효과에 관한 연구가 미흡한 실정이다. 따라서 본 연구에서는 세 가지 형태 (Type 1, one-connecting frame type; Type 2, two-connecting frame type; Type 3, all-in-one type)의 흉 요추 보조기와 몸통 (trunk)의 유한요소 모델을 구현하여 보조기 착용 후 운동성 변화에 따른 몸통에서의 압력 분포 및 보조기의 응력을 비교 분석하였다. 신전 운동 시 몸통에서 확인되는 압력의 분산은 일체형의 형태를 가지는 Type 3에 의해서 가장 고르게 이루어졌으며 connecting frame 형태의 Type 1과 Type 2의 압력 분포 패턴은 크게 차이가 나지 않았다. 보조기 착용에 따른 몸통의 운동성은 Type 2 ($11.3{\sim}13.9^{\circ}$), Type 1 ($12.1{\sim}15.4^{\circ}$)와 비교하여 Type 3 ($8.5{\sim}9.4^{\circ}$)에 의하여 가장 크게 제한되었다. 모든 Type의 보조기는 20% 미만의 파단 가능성을 보였다. 따라서, 보조기 착용에 따른 등압 분포 및 운동성의 결과로 미루어 볼 때, 일체형의 흉 요추 보조기가 후만증 환자 재활에 있어 높은 효과를 제공할 것으로 사료된다.

• 한국임상수의학회지
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• 제25권6호
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• pp.529-532
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• 2008

The object of this study was to evaluate the durations from onset of neurological sign until surgery and regaining of the deep pain perception (DPP) after decompression as prognostic indicators for the outcome of decompression surgery in dogs with thoracolumbar intervertebral disc disease (IVDD). The compression lesions in the thoracolumbar vertebrae were localized by plain radiograph, computed tomography and neurological examination in 28 dogs with hindlimb paralysis. The follow up was carried out for 6 months after laminectomy. During the follow up, regaining DPP and walking ability were evaluated. Improvement to normal or paretic gait after surgery was judged as success of the surgical treatment.The success rate of surgical treatment was 70 % (7 out of 10 dogs) when surgical intervention was carried out within 24 hours but 38.9 % (7 out of 18) over 24 hours (P<0.05). The success rate of surgical treatment was 87.5 % (14 out of 16 dogs) when DDP was regained within 5 weeks after surgery but there was 0 % (0 out of 12 dogs) when DDP was not regained within 5 weeks after surgery (P<0.05). Other parameters such as compression rate in CT scan and laminectomy methods did not related with the success of the surgery. These results suggested that the time of surgery after onset and duration of regaining of DPP after decompression were useful parameter to predict the success of surgical treatment for thoracolumbar disc herniation in dogs.

• 대한한의학회지
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• 제44권2호
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• pp.149-169
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• 2023

Objectives: This study was designed to statistically analyze patients hospitalized for thoracolumbar compression fractures at Daejeon University Daejeon Korean Medicine Hospital from January 1, 2017 to December 31, 2021. Methods: A total of 62 patients were analyzed through electronic medical records in this study. The extracted data was analyzed using IBM SPSS ver.27.0. Results: 1. Traffic accident patients were more likely to reduce pain by more than half compared to falls and other patients. Patients without spinal disease were more likely to reduce pain by more than half compared to those without. The shorter the absolute bed rest and the longer the hospital stay, the higher the probability of pain reduction by more than half. 2. The duration of pain half-reduction was longer in patients with diabetes than in patients without diabetes. 3. The longer the hospitalization period and the shorter the absolute bed rest period, the less pain was reported upon discharge. Males complained of less pain at discharge than females, and patients without spinal disease complained less than those without. Patients who did not receive absolute bed rest complained of less pain upon discharge than those who did not. Conclusions: This study included patients hospitalized for thoracolumbar compression fractures and showed that etiology, absolute bed rest period, hospitalization period, gender, spinal disease, diabetes statistically affected the degree of pain reduction.

• 한국임상수의학회:학술대회논문집
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• 한국임상수의학회 2006년도 춘계학술대회
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• pp.93-93
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• 2006

• Journal of Korean Neurosurgical Society
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• 제44권5호
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• pp.334-337
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• 2008

Spinal intradural extramedullary teratoma is a rare condition that develops more commonly in children than in adults and may be associated with spinal dysraphism. We report a rare case of adult-onset intradural extramedullary teratoma in the thoracolumbar spinal cord with no evidence of spinal dysraphism and without the history of prior spinal surgery. The patient was a 38-year-old male whose chief complaint was urinary incontinence. X-ray images of the thoracolumbar spine showed the widening of the interpedicular distance and posterior marginal erosion of the vertebral bodies and pedicles at the T11, T12, and L1 level. Magnetic resonance imagings of the lumbar spine showed a lobulated inhomogeneous high signal intradural mass ($87{\times}29{\times}20mm$) between T11 and L1 and a high signal fluid collection at the T11 level. Laminectomy of the T11- L1 region was performed, and the mass was subtotally excised. The resected tumor was histopathologically diagnosed as a mature cystic teratoma. The patient's symptom of urinary incontinence was improved following the surgery.

• Journal of Korean Neurosurgical Society
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• 제64권6호
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• pp.843-852
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• 2021

The purpose of this review was to synthesize the research on global spinal alignment and reciprocal changes following cervical or thoracolumbar reconstruction surgery. We carried out a search of PubMed, EMBASE, and Cochrane Library for studies through May 2020, and ultimately included 11 articles. The optimal goal of a truly balanced spine is to maintain the head over the femoral heads. When spinal imbalance occurs, the human body reacts through various compensatory mechanisms to maintain the head over the pelvis and to retain a horizontal gaze. Historically, deformity correction has focused on correcting scoliosis and preventing scoliotic curve progression. Following substantial correction of a spinal deformity, reciprocal changes take place in the flexible segments proximal and distal to the area of correction. Restoration of lumbar lordosis following surgery to correct a thoracolumbar deformity induces reciprocal changes in T1 slope, cervical lordosis, pelvic shift, and lower extremity parameters. Patients with cervical kyphosis exhibit different patterns of reciprocal changes depending on whether they have head-balanced or trunk-balanced kyphosis. These reciprocal changes should be considered to in order to prevent secondary spine disorders. We emphasize the importance of evaluating the global spinal alignment to assess postoperative changes.

• Journal of Acupuncture Research
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• 제32권4호
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• pp.147-156
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• 2015

Objectives : This study aims to evaluate the effectiveness and safety of Korean medicine for a thoracolumbar compression fracture. Methods : We searched six Korean databases (DBPIA, Korean Studies Information Service System, Oriental Medicine Advanced Searching Integrated System, National Digital Science Library, Research Information Sharing Service, KoreaMed) (up to June 2015) and the Journal of Korean Acupuncture and Moxibustion Society. Unpublished studies were also searched. Clinical research, other than case reports involving less than 10 patients, were eligible. The effectiveness and safety of Korean Medicine was analyzed. The 'Risk of Bias' was assessed using the 'Risk of Bias' assessment tool for non-randomized studies as well as the Cochrane Collaboration's 'Risk of Bias' tool. Results : We found 12 before-after studies (374 patients). There was no randomized trial. All studies combined at least three different types of Korean medicine treatments. The period of treatment varied between less a week and 154 days. All the included studies reported improvements in pain, functional disability related to lower back pain, global assessment, and benefits in the compression ratio of a fractured vertebrae and skin temperature measured by digital infrared thermal imaging in comparison with the baseline. However, all studies had a high risk of bias and three studies reported mild adverse events. Conclusions : There is no randomized trial for the role of Korean medicine for patients with a thoracolumbar compression fracture. The effectiveness and safety of Korean medicine for this population remains unclear. Findings in this review are seriously biased due to observational design and a high risk of bias included in the studies. Future high-quality randomized trials are warranted.