• Title/Summary/Keyword: Locked facet

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Analysis of Surgical Treatment and Factor Related to Closed Reduction Failure for Patients with Traumatically Locked Facets of the Subaxial Cervical Spine (축추 이하 경추손상 환자에서 외상성 탈구에 의한 도수 정복의 실패 요인의 분석과 수술적 치료에 대한 분석)

  • Paeng, Sung Hwa
    • Journal of Trauma and Injury
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    • v.25 no.1
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    • pp.7-16
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    • 2012
  • Purpose: Cervical dislocations with locked facets account for more than 50% of all cervical injuries. Thus, investigating a suitable management of cervical locked facets is important. This study examined factors of close reduction failure in traumatically locked facets of the subaxial cervical spine patients to determine suitable surgical management. Methods: We retrospectively analyzed of the case histories of 28 patients with unilateral/bilateral cervical locked facets from Nov. 2004 to Dec. 2010. Based on MRI evaluation of disc status at the injury level, we found unilateral dislocations in 9 cases, and bilateral dislocations in 19 cases, The patients were investigated for neurologic recovery, closed reduction rate, factors of the close reduction barrier, fusion rate and period, spinal alignment, and complications. Results: The closed reduction failed in 23(82%) patients. Disc herniation was an obstacle to closed reduction (p=0.015) and was more frequent in cases involving a unilateral dislocation (p=0.041). The pedicle or facet fracture was another factor, although some patients showed aggravation of neurologic symptoms, most patients had improved by the last follow up. The kyphotic angle were statistically significant (p=0.043). Sixs patient underwent anterior decompression/fusion, and 15 patients underwent circumferential fusion, and 7 patients underwent posterior fusion. All patients were fused at 3 months after surgery. The complications were 1 case of CSF leakage and 1 case of esphageal fistula, 1 case of infection. Conclusion: We recommend closed reduction be performed as soon as possible after injury to maximize the potential for neurological recovery. Patients fot whom closed reduction of the cervical locked facets have a higher incidence of anatomic obstacles to reduction, including facet fractures and disc herniation. Immediate direct open anterior reduction or circumferential fixation/fusion of locked cervical facets is recommended as a treatment of choice for traumatic locked cervical facet patients after closed reduction failure.

Management of Unilateral Facet Dislocation of the Cervical Spine

  • Baek, Geum-Seong;Lee, Woo-Jong;Koh, Eun-Jeong;Choi, Ha-Young;Eun, Jong-Pil
    • Journal of Korean Neurosurgical Society
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    • v.41 no.5
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    • pp.295-300
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    • 2007
  • Objective : Unilateral facet dislocation of the cervical spine occurs by flexion and rotation injuries and cannot be easily reduced by axial traction. We analyzed 14 consecutive patients with unilateral facet dislocation of the cervical spine to increase knowledge about anatomical reduction of locked facet and factors for successful reduction. Methods : Fourteen patients [10 men and 4 women] with unilateral facet dislocation of the cervical spine were retrospectively analyzed. Plain X-ray, computerized tomography scan, and magnetic resonance imaging were performed. All patients underwent manual reduction and surgery with anterior interbody fusion and plate fixation. The manual reduction was performed by neck flexion and rotation to the opposite side of dislocation, followed by rotation and flexion of the head toward the side of dislocation and extension with relaxation of traction. Mean follow-up period was 17 months. The level of spine, amount of subluxation, combined facet fracture, and time from injury to initial reduction were analyzed using the data obtained from medical records. Results : Thirteen [93%] patients were reduced successfully. Immediate reduction was achieved in 7 patients but failed in 7 patients. Seven patients underwent delayed closed reduction under general anesthesia, and successful reduction was achieved in 6 patients. Only one patient with bone chips between articular facets failed to achieve anatomical reduction. Conclusion : In order to reduce the locked facet more easily and safely, we recommend manipulative traction with anterior interbody fusion and plate fixation under general anesthesia after being aware of spinal cord injury with magnetic resonance imaging.

Anterior Approach Following Intraoperative Reduction for Cervical Facet Fracture and Dislocation

  • Kim, Seul Gi;Park, Seon Joo;Wang, Hui Sun;Ju, Chang Il;Lee, Sung Myung;Kim, Seok Won
    • Journal of Korean Neurosurgical Society
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    • v.63 no.2
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    • pp.202-209
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    • 2020
  • Objective : The purpose of this study was to evaluate the efficacy of the anterior approach following intraoperative reduction under general anesthesia in patients with cervical facet fracture and dislocation. Methods : Twenty-three patients with single level cervical facet fracture and dislocation who were subjected to the anterior approach alone following immediate intraoperative reduction under general anesthesia from March 2013 to December 2017 were enrolled in this study. Neurological status, clinical outcome, and radiological studies were evaluated preoperatively, postoperatively, and during the follow-up period. Results : The cohort comprised 15 men and eight women with a mean age of 57 years (from 24 to 81). All patients were operated on within the first 8 hours following the injury. After gentle manual reduction or closed reduction with Gardner-Wells traction, under general anesthesia monitored by somatosensory-evoked potentials, all operations were successfully completed using the anterior approach alone except in two patients, who had a risk of over-distraction. In them, a satisfactory gentle manual reduction or closed reduction was not possible, and required open posterior reduction of the locked facets followed by anterior cervical discectomy and fusion. In one patient, screw retropulsion was observed in 1 month after surgery. There were no reduction-related complications or neurological aggravations after surgery. All patients showed evidence of stability at the instrumented level at the final follow-up (mean follow-up, 12 months). Conclusion : Anterior approach following intraoperative reduction monitored by somatosensory-evoked potentials under general anesthesia for cervical dislocation and locked facets is a relatively safe and effective alternative when cervical alignment is achieved by intraoperative reduction.

WDM-PON Based on Wavelength Locked Fabry-Perot LDs

  • Lee, Chang-Hee;Mun, Sil-Gu
    • Journal of the Optical Society of Korea
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    • v.12 no.4
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    • pp.326-336
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    • 2008
  • A WDM-PON has been considered as an ultimate solution for access networks. However, there were many technical and practical issues for commercial deployment. These issues were solved with wavelength locked F-P LD and the WDM-PONs employing this optical source were commercialized. These WDM-PON systems have been deployed in Korea, Europe, and US. We reviewed wavelength locking technology and WDM-PON achievements. When we inject spectrum sliced broadband light into an F-P LD, the multimode output is changed to a quasi single mode. Then, we can use the single mode light for WDM signal transmission. The broad spectral gain of the semiconductor gain medium enables a color-free operation of WDM-PON, i.e., an identical ONT can be used for each user. The wavelength locking properties depend on many parameters, especially alignment of injection wavelength to a lasing mode, passband profile of AWG and front facet reflectivity of F-P LD. However, these dependencies can be reduced by proper design of the laser and the injection bandwidth. Thus, WDM-PON systems have been achieved with color-free operation.

Time-domain Large-signal Modeling of Injection-locked Fabry-Perot Laser Diode for WDM-PON (WDM-PON용 주입 잠금 패브리-페롯 레이저 다이오드의 시영역 대신호 모델링)

  • Lee, Seung-Hyun;Kim, Gun-Woo;Chung, Young-Chul
    • Korean Journal of Optics and Photonics
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    • v.21 no.2
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    • pp.74-81
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    • 2010
  • A modeling methodology for the analysis of injection-locked Fabry-Perot laser diodes (FP-LDs), promising for cost-effective WDM-PON sources, is proposed. The time-domain large-signal model that is used is found to provide quite similar results to some experimental ones. With our methodology, we model characteristics of FP-LDs, such as influence of reflectivity at a facet and detuning on injection-locking. The eye diagram characteristics are also investigated. It is observed that the facet reflectivity at the injection side should be lower than 1% to provide stable operation in terms of good side-mode suppression ratio and independence from detuning between narrow-band injection noise and LD modes. It is also observed that good eye opening can be obtained for 155 Mbps modulation while the parameters such as the active region thickness should be properly optimized to obtain reasonable eye opening at 1.25 Gbps.