• Journal of Korean Neurosurgical Society
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• 제40권2호
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• pp.84-89
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• 2006

Objective : The purpose of this study is to compare the outcomes of two methods for stabilization and fusion : Postero-Lateral Fusion [PLF, pedicle screw fixation with bone graft] and Posterior Lumbar Interbody Fusion [PLIF, cage insertion] for spinal stenosis and recurred disc herniation except degenerative spondylolisthesis. Methods : Seventy one patients who underwent PLF [n=36] or PLIF [n=35] between 1997 and 2001 were evaluated prospectively. These two groups were compared for the change of interbody space, the range of segmental angle, the angle of lumbar motion, and clinical outcomes by Prolo scale. Results : The mean follow-up period was 32.6 months. The PLIF group showed statistically significant increase of the interbody space after surgery. However, the difference in the change of interbody space between two groups was insignificant [P value=0.05]. The range of segmental angle was better in the PLIF group, but the difference in the change of segmental angle was not statistically significant [P value=0.0l7]. Angle of lumbar motion was similar in the two groups. Changes of Prolo economic scale were not statistically significant [P value=0.193]. The PLIF group showed statistically significant improvement in Prolo functional scale [P value=0.003]. In Prolo economic and functional scale, there were statistically significant relationships between follow-up duration [P value<0.001]. change of interbody space [P value<0.001], and range of segmental angle [P value<0.001]. Conclusion : Results of this study indicate that PLIF is superior to PLF in interbody space augmentation and clinical outcomes by Prolo functional scale. Analysis of clinical outcomes showed significant relationships among various factors [fusion type, follow-up duration, change of interbody space, and range of segmental angle]. Therefore, the authors recommend instrumented PLIF to offer better clinical outcomes in patients who needed instrumented lumbar fusion for spinal stenosis and recurred disc herniation.

• Journal of Korean Neurosurgical Society
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• 제37권5호
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• pp.340-344
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• 2005

Objective: Posterior lumbar interbody fusion(PLIF), the current leading method of pedicle screw fixation combined with interbody fusion via posterior route, sometimes requires too much destruction of the facet joint than expected especially for the patient with a narrow spine. On the other hand, tranforaminal lumbar interbody fusion(TLIF) technique provides potential advantages over PLIF and can be chosen as a better surgical alternative to more traditional fusion methods in certain surgical conditions. Methods: From October 1999, 99 PLIF and 29 TLIF procedures were done for the patients with spinal stenosis and instability. Radiological data including the interpedicular distance and the size of the pedicles as well as the clinical parameters were collected retrospectively. The degree of resection of the inferior articular process was compared with the interpedicular distance in each patient who received PLIF. Results: No significant differences were found between PLIF and TLIF regarding the operation time, blood loss, duration of hospital stay, or short term postoperative clinical result. There were no complication with TLIF, but PLIF resulted in 9(9.1%) complications. During PLIF procedure, all patients(n=24) except one with the interpedicular distance shorter than 27mm required near complete or complete resection of the inferior articular processes, whereas only 6(31.5%) of 19 patients with the interpedicular distances longer than 30mm required the similar extent of resection. Conclusion: TLIF is better than PLIF in terms of the complication rate. The patient who had narrow interpedicular distance(<27mm) might be better candidate for TLIF.

• Journal of Korean Neurosurgical Society
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• 제37권5호
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• pp.389-391
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• 2005

We report a case of T4 bursting fracture with paraparesis that recovered by posterior approach. A 47-year-old man presented with paraparesis (grade III) which had progressed rapidly after motor cycle accident. After sacrificing the T4 nerve root (right), posterior interbody fusion using cage following T4 corpectomy and T3-4, T4-5 discectomy was performed. After operation, lower extremities motor power improved and he could walk after one month. And this is the first report of posterior approach using cage by corpectomy and two level discectomy in case of upper thoracic burst fracture in Korea.

• 대한정형외과학회지
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• 제54권3호
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• pp.203-210
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• 2019

최소 침습적 외측 요추체간 유합술의 최신 지견에 대하여 알아보고자 하였다. 아직 도입된 지 얼마 되지 않았으나 근래에 각광받고 있는 최소 침습적 외측 요추체간 유합술에 대한 적응증 및 임상 결과와 유합률, 그리고 합병증에 대하여 문헌 고찰을 하였다. 외측 요추간 유합술의 적응증은 퇴행성 요추부 질환에서 고식적인 전방, 후방 추체간 유합술의 적응증과 거의 유사하다. 특히 척추관 협착증 및 퇴행성 척추 전방 전위증, 퇴행성 척추 변형, 퇴행성 추간판 질환, 인접 분절 퇴행성 질환에서 최소 침습적 수술로서 효과적이다. 또한 고식적 요추부 유합술과 비교하여 임상적 결과 및 유합률이 대등한 것으로 보고되고 있다. 하지만 수술 접근 및 과정에서 발생하는 수술 후 고관절 굴곡근 약화 및 신경 손상, 혈관 손상, 장기 손상, 케이지 침강, 위탈장 등의 비특이적 합병증들이 보고되고 있다. 외측 추체간 유합술은 고식적인 전방 또는 후방 추체간 유합술의 장점을 취합하고 단점을 보완한 수술이며 그 임상 결과나 유합률에도 큰 차이가 없어 퇴행성 요추부 질환의 치료에 최소 침습 수술로서 유용한 치료법이다. 하지만 수술 과정에서 발생하는 비특이적 합병증들을 개선해야 하는 것이 향후 과제이다.

• Journal of Korean Neurosurgical Society
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• 제29권3호
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• pp.360-364
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• 2000

Objective : To investigate the prognostic factors associated with outcome in patients with ossification of posterior longitudinal ligament. Method : During the past 4 years, we have operated on 35 patients with cervical OPLL. Anterior cervical decompression(total or subtotal corpectomy, discectomy, and removal of the OPLL) and interbody fusion with iliac bone were performed in all patients. Results : Eight cases(22.9%) were continuous type, 11(31.4%) segmental, 13(37.1%) Mixed, and 3(8.6%) localized type. Thirty-two patients(91.4%) showed an excellent or good results. Conclusion : These results indicate that surgical treatment should be considerated in case of clinical grading higher than II and the surgical outcome is worse when duration of preoperative symptom is longer and when percentage of spinal narrowing is higher. Anterior cervical decompression and interbody fusion seems to be a better method in patients with lesions limited to one or two level. Age at surgery did not significantly affect the outcom.

• Journal of Korean Neurosurgical Society
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• 제38권4호
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• pp.255-258
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• 2005

Objective : Lumbar lordotic curve on L4 to S1 level is important in maintaining spinal sagittal alignment. Although there has been no definite report in lordotic value, loss of lumbar lordotic curve may lead to pathologic change especially in degenerative lumbar disease. This study examines the changes of lumbar lordotic curve after posterior lumbar interbody fusion with wedge shape cage. Methods : We studied 45patients who had undergone posterior lumbar interbody fusion with wedge shape cage and screw fixation due to degenerative lumbar disease. Preoperative and postoperative lateral radiographs were taken and one independent observer measured the change of lordotic curve and height of intervertebral space where cages were placed. Segmental lordotic curve angle was measured by Cobb method. Height of intervertebral space was measured by averaging the sum of anterior, posterior, and midpoint interbody distance. Clinical outcome was assessed on Prolo scale at 1month of postoperative period. Results : Nineteen paired wedge shape cages were placed on L4-5 level and 6 paired same cages were inserted on L5-S1 level. Among them, 18patients showed increased segmental lordotic curve angle. Mean increased segmental lordotic curve angle after placing the wedge shape cages was $1.96^{\circ}$. Mean increased disc height was 3.21mm. No cases showed retropulsion of cage. The clinical success rate on Prolo's scale was 92.0%. Conclusion : Posterior lumbar interbody fusion with wedge shape cage provides increased lordotic curve, increased height of intervertebral space, and satisfactory clinical outcome in a short-term period.

• Journal of Korean Neurosurgical Society
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• 제46권4호
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• pp.328-332
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• 2009

Objective : The purpose of this study was to establish new fusion criteria to complement existing Brantigan-Steffee fusion criteria. The primary purpose of intervertebral cage placement is to create a proper biomechanical environment through successful fusion. The existence of a traction spur is an essential predictable radiologic factor which shows that there is instability of a fusion segment. We studied the relationship between the existence of a traction spur and fusion after a posterior lumbar interbody fusion (PLIF) procedure. Methods : This study was conducted using retrospective radiological findings from patients who underwent a PLIF procedure with the use of a cage without posterior fixation between 1993 and 1997 at a single institution. We enrolled 183 patients who were followed for a minimum of five years after the procedure, and used the Brantigan-Steffee classification to confirm the fusion. These criteria include a denser and more mature bone fusion area than originally achieved during surgery, no interspace between the cage and the vertebral body, and mature bony trabeculae bridging the fusion area. We also confirmed the existence of traction spurs on fusion segments and non-fusion segments. Results : The PLIF procedure was done on a total of 251 segments in 183 patients (71 men and 112 women). The average follow-up period was $80.4{\pm}12.7$ months. The mean age at the time of surgery was $48.3{\pm}11.3$ years (range, 25 to 84 years). Among the 251 segments, 213 segments (84.9%) were fused after five years. The remaining 38 segments (15.1%) were not fused. An analysis of the 38 segments that were not fused found traction spur formation in 20 of those segments (52.6%). No segments had traction spur formation with fusion. Conclusion : A new parameter should be added to the fusion criteria. These criteria should be referred to as 'no traction spur formation' and should be used to confirm fusion after a PLIF procedure.

• Journal of Korean Neurosurgical Society
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• 제59권3호
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• pp.276-281
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• 2016

Objective : Although trunk muscles in the lumbar spine preserve spinal stability and motility, little is known about the relationship between trunk muscles and spinal fusion rate. The aim of the present study is to evaluate the correlation between trunk muscles cross sectional area (MCSA) and fusion rate after posterior lumbar interbody fusion (PLIF) using stand-alone cages. Methods : A total of 89 adult patients with degenerative lumbar disease who were performed PLIF using stand-alone cages at L4-5 were included in this study. The cross-sectional area of the psoas major (PS), erector spinae (ES), and multifidus (MF) muscles were quantitatively evaluated by preoperative lumbar magnetic resonance imaging at the L3-4, L4-5, and L5-S1 segments, and bone union was evaluated by dynamic lumbar X-rays. Results : Of the 89 patients, 68 had bone union and 21 did not. The MCSAs at all segments in both groups were significantly different (p<0.05) for the PS muscle, those at L3-4 and L4-5 segments between groups were significantly different (p=0.048, 0.021) for the ES and MF muscles. In the multivariate analysis, differences in the PS MCSA at the L4-5 and L5-S1 segments remained significant (p=0.048, 0.043 and odds ratio=1.098, 1.169). In comparison analysis between male and female patients, most MCSAs of male patients were larger than female's. Fusion rates of male patients (80.7%) were higher than female's (68.8%), too. Conclusion : For PLIF surgery, PS muscle function appears to be an important factor for bone union and preventing back muscle injury is essential for better fusion rate.

• Journal of Korean Neurosurgical Society
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• 제30권sup1호
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• pp.108-114
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• 2001

Objective : Posterior lumbar interbody fusion(PLIF) provides the favorable outcome to degenerative lumbar disease, especially isthmic spondylolisthesis. To determine the long-term effect of PLIF using psterior movable segment, we analysed the results of follow-up radiologic changes and surgical outcome retrospectively Patients and Method : During the past 11 years(1989. 1.-1999. 9.), 148 patients with symptomatic lumbar spondylolisthesis were managed at our department and the clinical wants were throughly recieved and final outcome is determined at last follow up. PLIF using antogenous bone(posterior movable segment, iliac bone and rib) were performed in 106 case. Results : After an average follow-up period of 33 months(range ; 15-58 months), the results were excellent in 66 cases, good in 37 cases, fair in 2 cases and poor in 1 cases. And the satisfactory results were 103 cases(98.2%) in PLIF,. Conclusion : In conclusion, patients who underwent PLIF with autologous bone graft had good clinical and radiological outcomes without significant neurological complications.

• Journal of Korean Neurosurgical Society
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• 제64권6호
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• pp.922-932
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• 2021

Objective : It is challenging to make solid fusion by posterior screw fixation and laminectomy with posterolateral fusion (PLF) in thoracic and thoracolumbar (TL) diseases. In this study, we report our experience and follow-up results with a new surgical technique entitled posterior thoracic cage interbody fusion (PTCIF) for thoracic and TL spine in comparison with conventional PLF. Methods : After institutional review board approval, a total of 57 patients who underwent PTCIF (n=30) and conventional PLF (n=27) for decompression and fusion in thoracic and TL spine between 2004 and 2019 were analyzed. Clinical outcomes and radiological parameters, including bone fusion, regional Cobb angle, and proximal junctional Cobb angle, were evaluated. Results : In PTCIF and conventional PLF, the mean age was 61.2 and 58.2 years (p=0.46), and the numbers of levels fused were 2.8 and 3.1 (p=0.46), respectively. Every patient showed functional improvement except one case of PTCIF. Postoperative hematoma as a perioperative complication occurred in one and three cases, respectively. The mean difference in the regional Cobb angle immediately after surgery compared with that of the last follow-up was 1.4° in PTCIF and 7.6° in conventional PLF (p=0.003), respectively. The mean durations of postoperative follow-up were 35.6 months in PTCIF and 37.3 months in conventional PLF (p=0.86). Conclusion : PTCIF is an effective fusion method in decompression and fixation surgery with good clinical outcomes for various spinal diseases in the thoracic and TL spine. It provides more stable bone fusion than conventional PLF by anterior column support.