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A Surgical Option for Multilevel Anterior Lumbar Interbody Fusion with Ponte Osteotomy to Achieve Optimal Lumbar Lordosis and Sagittal Balance

  • Suh, Loo-Ree;Jo, Dae-Jean;Kim, Sung-Min;Lim, Young-Jin
    • Journal of Korean Neurosurgical Society
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    • v.52 no.4
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    • pp.365-371
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    • 2012
  • Objective : To document lumbar lordosis (LL) of the spine and its change during surgeries with the different height but the same angle setting of the anterior cage. Additionally, we attempted to determine if sufficient LL is achieved at different cage heights and to quantify the change in LL during multi-level anterior lumbar interbody fusion (ALIF). Methods : The medical records and radiographs of 42 patients who underwent more than 2 level ALIFs between 2008 and 2009 were retrospectively reviewed. We evaluated 3 parameters seen on lateral whole spine radiographs : LL, pelvic incidence (PI), and sagittal vertical axis (SVA). The mean follow-up time was 28.1 months and the final follow-up radiographs of all patients were reviewed at least 2 years after surgery. Statistical analysis was performed using the paired t-tests. Results : Lumbar lordosis had changed up to 30 degrees immediately and 2 years after surgery (preoperative mean LL, SVA : 22.45 degrees, 112.31 mm; immediate postoperative mean LL, SVA : 54.45 degrees, 37.36 mm; final follow-up mean LL, SVA : 49.56 degrees, 26.95 mm). Our goal of LL is to obtain as much PI as possible, preoperative mean PI value was $55.38{\pm}3.35$. The pre-operative and two year post-surgery follow-up mean of the Japanese Orthopedic Association score were $9.2{\pm}0.6$ and $13.2{\pm}0.6$ (favorable outcome rate : 95%), respectively. In addition, we were able to obtain good clinical outcomes and sagittal balance with a subsidence rate of 22.7%. Conclusion : We were able to achieve sufficient LL, such that it was similar to the PI, utilizing multi-level ALIF with the use of a tall cage with the same angle setting of the cage. We have found out that achieving sufficient lumbar lordosis and sagittal balance require an anterior lumbar cage with high angle and height.

Anterior Cervical Discectomy and Fusion Using a Stand-Alone Polyetheretherketone Cage Packed with Local Autobone : Assessment of Bone Fusion and Subsidence

  • Park, Jeong-Ill;Cho, Dae-Chul;Kim, Kyoung-Tae;Sung, Joo-Kyung
    • Journal of Korean Neurosurgical Society
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    • v.54 no.3
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    • pp.189-193
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    • 2013
  • Objective : It remains debatable whether cervical spine fusion cages should be filled with any kind of bone or bone substitute. Cortical and subcortical bone from the anterior and posterior osteophytes of the segment could be used to fill the cage. The purposes of the present study are to evaluate the clinical outcomes and radiological outcomes including bone fusion and subsidence that occurred after anterior cervical discectomy and fusion using a stand-alone cage packed with local autobone graft. Methods : Thirty-one patients who underwent anterior cervical fusion using a stand-alone polyetheretherketone (PEEK) cage packed with local autobone graft from July 2009 to december 2011 were enrolled in this study. Bone fusion was assessed by cervical plain radiographs and computed tomographic scan. Nonunion was evaluated according to the absence of bony bridge on computed tomographic scan. Subsidence was defined as a ${\geq}2$ mm decrease of the interbody height at the final follow-up compared to that measured at the immediate postoperative period. Results : Subsidence was observed in 7 patients (22.6%). Of 7 patients with subsidence greater 2 mm, nonunion was developed in 3. Three patients with subsidence greater 2 mm were related with endplate damage during intraoperative endplate preparation. Solid bone fusion was achieved in 28 out of 31 patients (90.3%). Conclusion : With proper patient selection and careful endplate preparation, anterior cervical discectomy and fusion (ACDF) using a stand-alone PEEK cage packed with local autobone graft could be a good alternative to the standard ACDF techniques with plating.

Wedge Shape Cage in Posterior Lumbar Interbody Fusion : Focusing on Changes of Lordotic Curve

  • Kim, Joon-Seok;Oh, Seong-Hoon;Kim, Sung-Bum;Yi, Hyeong-Joong;Ko, Yong;Kim, Young-Soo
    • Journal of Korean Neurosurgical Society
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    • v.38 no.4
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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.

Cervical Stand-Alone Polyetheretherketone Cage versus Zero-Profile Anchored Spacer in Single-Level Anterior Cervical Discectomy and Fusion : Minimum 2-Year Assessment of Radiographic and Clinical Outcome

  • Cho, Hyun-Jun;Hur, Junseok W.;Lee, Jang-Bo;Han, Jin-Sol;Cho, Tai-Hyoung;Park, Jung-Yul
    • Journal of Korean Neurosurgical Society
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    • v.58 no.2
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    • pp.119-124
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    • 2015
  • Objective : We compared the clinical and radiographic outcomes of stand-alone polyetheretherketone (PEEK) cage and Zero-Profile anchored spacer (Zero-P) for single level anterior cervical discectomy and fusion (ACDF). Methods : We retrospectively reviewed 121 patients who underwent single level ACDF within 2 years (Jan 2011-Jan 2013) in a single institute. Total 50 patients were included for the analysis who were evaluated more than 2-year follow-up. Twenty-nine patients were allocated to the cage group (m : f=19 : 10) and 21 for Zero-P group (m : f=12 : 9). Clinical (neck disability index, visual analogue scale arm and neck) and radiographic (Cobb angle-segmental and global cervical, disc height, vertebral height) assessments were followed at pre-operative, immediate post-operative, post-3, 6, 12, and 24 month periods. Results : Demographic features and the clinical outcome showed no difference between two groups. The change between final follow-up (24 months) and immediate post-op of Cobb-segmental angle (p=0.027), disc height (p=0.002), vertebral body height (p=0.033) showed statistically better outcome for the Zero-P group than the cage group, respectively. Conclusion : The Zero-Profile anchored spacer has some advantage after cage for maintaining segmental lordosis and lowering subsidence rate after single level anterior cervical discectomy and fusion.

Long-Term Follow-Up Radiologic and Clinical Evaluation of Cylindrical Cage for Anterior Interbody Fusion in Degenerative Cervical Disc Disease

  • Kim, Su-Hyeong;Chun, Hyoung-Joon;Yi, Hyeon-Joong;Bak, Koang-Hum;Kim, Dong-Won;Lee, Yoon-Kyoung
    • 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.

Dissolved Oxygen Budget in Floating Net Cage of Fish Farm at the Coastal Area -In case of yellow tail farm in Konli-Do- (해산 어류 양식장 가두리의 DO수지 -곤리도 방어 양식장의 경우-)

  • KIM Yong Sool
    • Korean Journal of Fisheries and Aquatic Sciences
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    • v.21 no.1
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    • pp.30-34
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    • 1988
  • In roastal fish farms the farmers, especialy engaging in dealing with the floating cage culture, going to know about relationships between holding capacity and water quality in cage. Some of water quality managers and specialists studing physiological ecology understand that the key of water quality management concerned fish farming is budget of dissolved oxygen. This paper deals with oxygen budget in floating cage of the yellow tail farms at southern coastal area in Korea. The sampling station is located at Konli-Do fish farm near Chungmu, and the data is collected for 24 hours from 3:00 p.m. 8th September 1987. In result, the needed oxygen coming after the consumption by the rearing fish had been supplied with the tide current exchange, the sum of oxygen produced by phytoplankton photosynthesis and diffused from atmosphere are no more that $43\%$ for the needs of sea water consumption included respiration of planktons and decomposition of organic matters. The optimum holding capacity of cage is possible to compute with the calculation of minimum diurnal water exchange rate $[Qin{\cdot}V^{-1}\;(C-\bar{c})]$ through net mesh of cage.

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Comparative Study on Biomechanical Behavior of Various Cervical Stand-Alone Cage Designs (경추용 일체형 추간체 유합 보형재의 디자인 변화에 따른 생체역학적 효과 비교 연구)

  • Park, Kwang Min;Jung, Tae Gon;Jeong, Seung Jo;Lee, Sung Jae
    • Journal of the Korean Society for Precision Engineering
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    • v.33 no.11
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    • pp.943-950
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    • 2016
  • The purpose of this study was to evaluate and compare by finite element analysis the biomechanical performance, in terms of cervical stand-alone cage screw insert angle (Type 3 - 5: 2 Screws) and screw arrangement (Type 6 and 7: 3 Screws / Type 8 and 9: 4 Screws), and the range of motion (ROM) of traditional anterior cervical discectomy of a fusion device (Type 1: Cage / Type 2: Cage + ACP). Our study suggests that the biomechanical behavior of a postoperative cervical spine could indeed be influenced by design features, such as screw angle and number of screws. In particular, ROM and the risk of subsidence were more sensitive during extension about type 5 (Insert Angle $20^{\circ}$). Our study also suggested that the number of screw asymmetries between up and down for type 6 and 7 could result in differences in the risk of screw fracture manifesting in different clinical aspects.

Copulation Environment Favorable for colony development of the European Bumblebee, Bombus terrersis

  • Yoon, Hyung-Joo;Kim, Sam-Eun;Lee, Kyeong-Yong;Lee, Sang-Beom;Park, In-Gyun
    • International Journal of Industrial Entomology and Biomaterials
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    • v.16 no.1
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    • pp.7-13
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    • 2008
  • We investigated mating conditions about care temperature of queen before mating, mating period, and number of queen per mating cage to improve mating rate of Bombus terrestris. Among $19^{\circ}C$, $22^{\circ}C$ and $25^{\circ}C$, care temperatures of queen before mating, queen cared at $19^{\circ}C$ was more effective than those at $22^{\circ}C$ and $25^{\circ}C$ in death rate during care and mating periods, and colony development In case of mating period, oviposition rate and preoviposition periods at queen mated during 3 days were 89.3% and 11.4 days, respectively, which was higher and earlier than those of queen mated during 5 days and 7 days. The rate of worker emergence, colony foundation and progeny-queen production at 3 days-mated queen were also 2.0-11.6% higher than those at queen mated during 5 days and 7 days. In number of queen per mating cage, the rate of worker emergence, colony foundation and progeny-queen production queen mated at mating cage with 10 queens and 30 males were 41.5%, 25.9% and 23.2%, respectively. These values correspond to 1.5-6.8 folds those queen mated at cage with 20 queens and 30 queens. Therefore, we supposed that care temperature favorable for B. terrestris queen was $19^{\circ}C$ and the period need to mating was 3 days, and the number of queen per mating cage ($55{\times}45{\times}65\;cm$) was 10.

Experiment and Analysis of Mooring System for Floating Fish Cage (해상 양식시설의 계류시스템 실험 및 해석)

  • KIM Jin-Ha;KIM Hyeon-Ju;HONG Sup
    • Korean Journal of Fisheries and Aquatic Sciences
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    • v.34 no.6
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    • pp.661-665
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    • 2001
  • This paper deals with optimal mooring system to secure fish cage in a desired location, Through field investigation and paper works, we surveyed disasters by breakdown of cage frame and mooring system due to higher wave attack and selected compliant buoy mooring method for shallow water mooring system against severe coastal external forces. To analyze interaction between external forces and compliant buoy mooring system, theoretical model has developed as quasi-static nonlinear analysis. After verifying the feasibility of the numerical model compared with experiment, static analysis has tried for various mooring systems with different angle of array, number of mooring points, length of horizontal and inclined rope. Optimal mooring method using compliant buoy has selected for fish cage through numerical simulation. This results can apply for preliminary design for cage mooring system.

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Improving the Endurance Life of Deep Groove Ball Bearings for Automotive Transmission (자동차 변속기용 깊은 홈 볼 베어링의 내구수명 향상)

  • Baek, Hye-Yeon;Pyun, Jung-Min;Lee, Dae-Yong;Park, Tae-Jo
    • Tribology and Lubricants
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    • v.31 no.6
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    • pp.281-286
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    • 2015
  • Automotive transmission systems are assembled with a large number of gears and shafts, and rolling bearings are used to ensure their smooth operation. Gear oil in the gear box contains solid particles such as wear debris from contacting gears and metallic chips. This particle-enriched lubricating oil can cause premature failure of the rolling bearings. Research aimed at improving the service life of these rolling bearings has been confined mainly to design and lubrication of the inner/outer rings and the rolling elements. In this paper, we redesigned the shape of the cage pocket of a deep groove ball bearing to reduce the premature failure due to particle contamination. Test bearings are assembled with this new cage design containing a hole punched in the cage pocket. Endurance tests are carried out using the contaminated lubricating oil with miracle grid as hard particle. The duration and damaged bearing component shapes are compared for two different cages. The B10 life of bearing with new cage is increased by about 66% compared to the conventional cage. This is because the hard particles can be easily discharged through the pocket hole without staying for a long time in the lubrication regions. This greatly decreases abrasive wear and dents on the highly stressed ball bearing surfaces. Therefore, the cage design of this study, containing a pocket hole, can significantly delay the premature failure of rolling bearings and improve the endurance life.