• Journal of Korean Neurosurgical Society
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• v.38 no.4
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• pp.320-322
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• 2005

A 45-year-old man presented with lower back pain and pain in the right leg of 3years duration. A plain radiographic examination revealed grade I isthmic spondylolisthesis, with instability at L4-5. Computed tomography and magnetic resonance imaging demonstrated bilateral foraminal stenosis, with soft foraminal disc herniation on the right side at the L4-5 level. He underwent anterior lumbar interbody fusion[ALIF] with percutaneous posterior fixation[PF] at the L4-5 level. Without removing the posterior bony structures, removal of foraminal disc herniation and reduction of spondylolisthesis were successfully performed using ALIF with percutaneous PF. When there is no hard disc herniation or lateral recess stenosis, ALIF with percutaneous PF can be one of the treatment options for isthmic spondylolisthesis, even in the presence of foraminal disc herniation, as in our case.

• Journal of Korean Neurosurgical Society
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• v.30 no.sup2
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• pp.247-253
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• 2001

Objective : In general, to perform posterior lumbar interbody fusion(PLIF), it has been used more invasive procedure than simple discectomy. However we try to perform PLIF with TFC with smaller invasion almost same as in simple discectomy. This study is about its procedure and clinical results. Materials and Methods : The authors retrospectively analyzed 43 cases of minimally invasive PLIF with TFC from July 1998 to May 2000. Operative procedure, operative complication, change of disc height, blood loss, ambulation time, hospitalization period, clinical success rate, and bony fusion rate were analyzed. Results : 40 patients were capable to walk on the 2nd day of the post-operation. The average hospitalization period is 5.6 days. The average blood loss was 0.19L/level with no transfusion or wound drainage. The height of disc changed from 8.84mm to 13.54mm. Clinical success rate is 95% when evaluated by the Prolo's scale. The complication was delayed wound infection(2) and transient paresthesis(1). The bony fusion was shown in 17 patients (94.4%) out of 18 patients who passed one year. Conclusion : As a result of minimally invasive PLIF, pain was decreased and early ambulation and short hospitalization was possible. Complication was similar or lower than other studies, and the bony fusion rate and clinical success rate were also similar during follow-up.

• Journal of Korean Neurosurgical Society
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• v.50 no.5
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• pp.441-445
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• 2011

Objective : There are technical limitations of multi-level posterior pedicle screw fixation performed by the percutaneous technique. The purpose of this study was to describe the surgical technique and outcome of minimally invasive multi-level posterior lumbar interbody fusion (PLIF) and to determine its efficacy. Methods : Forty-two patients who underwent mini-open PLIF using the percutaneous screw fixation system were studied. The mean age of the patients was 59.1 (range, 23 to 78 years). Two levels were involved in 32 cases and three levels in 10 cases. The clinical outcome was assessed using the visual analog scale (VAS) and Low Back Outcome Score (LBOS). Achievement of radiological fusion, intra-operative blood loss, the midline surgical scar and procedure related complications were also analyzed. Results : The mean follow-up period was 25.3 months. The mean LBOS prior to surgery was 34.5, which was improved to 49.1 at the final follow up. The mean pain score (VAS) prior to surgery was 7.5 and it was decreased to 2.9 at the last follow up. The mean estimated blood loss was 238 mL (140-350) for the two level procedures and 387 mL (278-458) for three levels. The midline surgical scar was 6.27 cm for two levels and 8.25 cm for three level procedures. Complications included two cases of asymptomatic medial penetration of the pedicle border. However, there were no signs of neurological deterioration or fusion failure. Conclusion : Multi-level, minimally invasive PLIF can be performed effectively using the percutaneous transpedicular screw fixation system. It can be an alternative to the traditional open procedures.

• Journal of Korean Neurosurgical Society
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• v.50 no.4
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• pp.363-369
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• 2011

Objective : We investigated the clinical and radiological advantages of unilateral laminectomy in posterior lumbar interbody fusion (PLIF) procedure comparing with bilateral laminectomy, under the same procedural condition including bilateral instrumentation and insertion of two cages, in patients with degenerative lumbar disease with unilateral leg symptoms. Methods : We retrospectively reviewed 124 consecutive cases of PLIF via unilateral or bilateral approach between January 2006 and April 2010. In 80 cases (bilateral group), two cages were inserted via bilateral laminectomy, and in 44 cases (unilateral group), via unilateral laminectomy. The average follow-up duration was 29.5 months. The clinical outcomes were evaluated with the Visual Analogue Scale (VAS) and the Oswestry disability index (ODI). The fusion rates and disc space heights were determined by dynamic standing radiographs and/or computed tomography. Operative times, intra-operative and post-operative blood losses and hospitalization periods were also evaluated. Results : In clinical evaluation, the VAS and ODI scores showed excellent outcomes in both groups. There were no significant differences in term of fusion rate, but the perioperative blood loss and the operative time of the unilateral group were lower than that of the bilateral group. Conclusion : Unilateral laminectomy can minimize the operative time and perioperative blood loss in PLIF procedure. However, the different preoperative disc height between two groups is a limitation of this study. Despite this limitation, solid fusion and satisfactory symptomatic improvement could be achieved uniquely by our surgical method. This surgical method can be an alternative surgical technique in patients with unilateral leg pain.

• Journal of Korean Neurosurgical Society
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• v.56 no.4
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• pp.315-322
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• 2014

Objective : Posterior accessed lumbar interbody fusion (PALIF) has a clear objective to restore disc height and spinal alignment but surgeons may occasionally face the converse situation and lose lumbar lordosis. We analyzed retrospective data for factors contributing to a postoperative flat back. Methods : A total of 105 patients who underwent PALIF for spondylolisthesis and stenosis were enrolled. The patients were divided according to surgical type [posterior lumbar inter body fusion (PLIF) vs. unilateral transforaminal lumbar interbody fusion (TLIF)], number of levels (single vs. multiple), and diagnosis (spondylolisthesis vs. stenosis). We measured perioperative index level lordosis, lumbar lordosis, pelvic tilt, sacral slope, pelvic incidence, and disc height in standing lateral radiographs. The change and variance in each parameter and comparative group were analyzed with the paired and Student t-test (p<0.05), correlation coefficient, and regression analysis. Results : A significant perioperative reduction was observed in index-level lordosis following TLIF at the single level and in patients with spondylolisthesis (p=0.002, p=0.005). Pelvic tilt and sacral slope were significantly restored following PLIF multilevel surgery (p=0.009, p=0.003). Sacral slope variance was highly sensitive to perioperative variance of index level lordosis in high sacral sloped pelvis. Perioperative variance of index level lordosis was positively correlated with disc height variance ($R^2=0.286$, p=0.0005). Conclusion : Unilateral TLIF has the potential to cause postoperative flat back. PLIF is more reliable than unilateral TLIF to restore spinopelvic parameters following multilevel surgery and spondylolisthesis. A high sacral sloped pelvis is more vulnerable to PALIF in terms of a postoperative flat back.

• Journal of Korean Neurosurgical Society
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• v.46 no.1
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• pp.65-67
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• 2009

The authors report two cases of spontaneous regression of disc herniation at the level adjacent to the anterior lumbar interbody fusion (ALIF) level. This phenomenon may be due to the increased tension on the posterior longitudinal ligament (PLL) by appropriate restoration of the disc height and lumbar lordosis, which is a mechanism similar to ligamentotaxis applied to the thoracolumbar burst fracture.

• Journal of Korean Neurosurgical Society
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• v.42 no.4
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• pp.251-257
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• 2007

Objective : This multi-center clinical study was designed to determine the long-term results of patients who received a one-level posterior lumbar interbody fusion with expandable cage ($Tyche^{(R)}$ cage) for degenerative spinal diseases during the same period in each hospital. Methods : Fifty-seven patients with low back pain who had a one-level posterior lumbar interbody fusion using a newly designed expandable cage were enrolled in this study at five centers from June 2003 to December 2004 and followed up for 24 months. Pain improvement was checked with a Visual Analogue Scale (VAS) and their disability was evaluated with the Oswestry Disability Index. Radiographs were obtained before and after surgery. At the final follow-up, dynamic stability, quality of bone fusion, interveretebral disc height, and lumbar lordosis were assessed. In some cases, a lumbar computed tomography scan was also obtained. Results : The mean VAS score of back pain was improved from 6.44 points preoperatively to 0.44 at the final visit and the score of sciatica was reduced from 4.84 to 0.26. Also, the Oswestry Disability Index was improved from 32.62 points preoperatively to 18.25 at the final visit. The fusion rate was 92.5%. Intervertebral disc height, recorded as $9.94{\pm}2.69\;mm$ before surgery was increased to $12.23{\pm}3.31\;mm$ at postoperative 1 month and was stabilized at $11.43{\pm}2.23\;mm$ on final visit. The segmental angle of lordosis was changed significantly from $3.54{\pm}3.70^{\circ}$ before surgery to $6.37{\pm}3.97^{\circ}$ by 24 months postoperative, and total lumbar lordosis was $20.37{\pm}11.30^{\circ}$ preoperatively and $24.71{\pm}11.70^{\circ}$ at 24 months postoperative. Conclusion : There have been no special complications regarding the expandable cage during the follow-up period and the results of this study demonstrates a high fusion rate and clinical success.

• Proceedings of the KSME Conference
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• 2003.11a
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• pp.1364-1367
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• 2003

These days, spinal interbody arthrodesis using fusion cage is very popular. The cage used for the spinal interbody arthrodesis is mainly inserted from the posterior of the spine. Accordingly, there could possibly occur damages at posterior and results in instability of structure. Moreover, one or two cages are inserted depending on the patients. In this study, it is attempted to evaluate the stability quantitatively by comparing two cases where one and two cages are inserted. For this purpose, a very fine 3-dimensional finite element model of vertebra is generated from the MRI data. From this vertebra model, two models are made: one with one cage and the other with two cages. Finally, finite element analys is performed for these two models and both of the mechanical behaviors are examined In addition, the effect on the stability is evaluated and compared quantitatively.

• Journal of Korean Neurosurgical Society
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• v.46 no.4
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• pp.322-327
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• 2009

Objective : Posterior lumbar interbody fusion (PLIF) is considered to have the best theoretical potential in promoting bony fusion of unstable vertebral segments by way of a load sharing effect of the anterior column. This study was undertaken to investigate the efficacy of PLIF with cages in chronic degenerative disc disease with Modic degeneration (changes of vertebral end plate). Methods : A total of 597 patients underwent a PLIF with threaded fusion cages (TFC) from 1993 to 2000. Three-hundred-fifty-one patients, who could be followed for more than 3 years, were enrolled in this study. Patients were grouped into 4 categories according to Modic classification (no degeneration : 259, type 1 : 26, type 2 : 55, type 3 : 11). Clinical and radiographic data were evaluated retrospectively. Results : The clinical success rate according to the Prolo's functional and economic outcome scale was 86% in patients without degeneration and 83% in patients with Modic degeneration. The clinical outcomes in each group were 88% in type 1, 84% in type 2, and 73% in type 3. The bony fusion rate was 97% in patients without degeneration and 83% in patients with Modic degeneration. The bony fusion rate in each group was 81% in type 1, 84% in type 2, and 55% in type 3. The clinical success and fusion rates were significantly lower in patients with type 3 degeneration. Conclusion : The PLIF with TFC has been found to be an effective procedure for lumbar spine fusion. But, the clinical outcome and bony fusion rates were significantly low in the patients with Modic type 3. The authors suggest that PLIF combined with pedicle screw fixation would be the better for them.

• Journal of Korean Neurosurgical Society
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• v.52 no.2
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• pp.107-113
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• 2012

Objective : Various procedures have been introduced for anterior interbody fusion in degenerative cervical disc disease including plate systems with autologous iliac bone, carbon cages, and cylindrical cages. However, except for plate systems, the long-term results of other methods have not been established. In the present study, we evaluated radiologic findings for cylindrical cervical cages over long-term follow up periods. Methods : During 4 year period, radiologic findings of 138 patients who underwent anterior cervical fusion with cylindrical cage were evaluated at 6, 12, 24, and 36 postoperative months using plain radiographs. We investigated subsidence, osteophyte formation (anterior and posterior margin), cage direction change, kyphotic angle, and bone fusion on each radiograph. Results : Among the 138 patients, a minimum of 36 month follow-up was achieved in 99 patients (mean follow-up : 38.61 months) with 115 levels. Mean disc height was 7.32 mm for preoperative evaluations, 9.00 for immediate postoperative evaluations, and 4.87 more than 36 months after surgery. Osteophytes were observed in 107 levels (93%) of the anterior portion and 48 levels (41%) of the posterior margin. The mean kyphotic angle was $9.87^{\circ}$ in 35 levels showing cage directional change. There were several significant findings : 1) related subsidence [T-score (p=0.039) and anterior osteophyte (p=0.009)], 2) accompanying posterior osteophyte and outcome (p=0.05). Conclusion : Cage subsidence and osteophyte formation were radiologically observed in most cases. Low T-scores may have led to subsidence and kyphosis during bone fusion although severe neurologic aggravation was not found, and therefore cylindrical cages should be used in selected cases.