• Journal of Korean Neurosurgical Society
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• v.62 no.6
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• pp.691-699
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• 2019

Objective : Lumbar discectomy is an effective treatment for lumbar disc herniation (LDH); however, up to 2-18% of patients with LDH have experienced recurrent disc herniation. The purpose of this study was to evaluate the efficacy of a novel annular closure device (ACD) for preventing LDH recurrence and re-operation compared with that of conventional lumbar discectomy (CLD). Methods : In this prospective randomized controlled trial, we compared CLD with discectomy utilizing the $Barricaid^{(R)}$ (Intrinsic Therapeutics, Inc., Woburn, MA, USA) ACD. Primary radiologic outcomes included disc height, percentage of preoperative disc height maintained, and re-herniation rates. Additional clinical outcomes included visual analog scale (VAS) scores for back and leg pain, Oswestry Disability Index (ODI) scores, and 12-item short-form health survey (SF-12) quality of life scores. Outcomes were measured at preoperation and at 1 week, 1, 3, 6, 12, and 24 months postoperation. Results : Sixty patients (30 CLD, 30 ACD) were enrolled in this study. At 24-month follow-up, the disc height in the ACD group was significantly greater than that in the CLD group ($11.4{\pm}1.5$ vs. $10.2{\pm}1.2mm$, p=0.006). Re-herniation occurred in one patient in the ACD group versus six patients in the CLD group (${\chi}^2=4.04$, p=0.044). Back and leg VAS scores, ODI scores, and SF-12 scores improved significantly in both groups compared with preoperative scores in the first 7 days following surgery and remained at significantly improved levels at a 24-month follow-up. However, no statistical difference was found between the two groups. Conclusion : Lumbar discectomy with the $Barricaid^{(R)}$ (Intrinsic Therapeutics, Inc.) ACD is more effective at maintaining disc height and preventing re-herniation compared with conventional discectomy. Our results suggest that adoption of ACD in lumbar discectomy can help improve the treatment outcome.

• Journal of the Korean Orthopaedic Association
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• v.52 no.1
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• pp.59-64
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• 2017

Purpose: To analyze the result of a repeat discectomy for ipsilateral recurrent lumbar disc herniation and to investigate the potential factors that influenced the outcomes for this surgery. Materials and Methods: Fifty-nine patients, who underwent reoperation after lumbar discectomy with a minimum follow-up period of 2 years, were reviewed. The surgical outcome was assessed using the visual analogue scale (VAS) and Macnab classification, and the recovery rate was calculated in accordance with VAS. A statistical analysis was carried out by SPSS to evaluate the possible factors that may have influenced the outcomes of the reoperation. Results: The rate of reoperation after lumbar disc surgery due to the recurrent disc herniation was 6.0% (59/983 cases). The average recovery rate of VAS from the 1st operation was approximately 77%, and from the 2nd operation was 71%. According to the Macnab criteria, the results were "excellent" or "good" in 96% of cases. Statistical analysis revealed that there was no difference of the average recovery rate (p<0.05). There is no additional instability after repeat discectomy. Factors, such as smoking, precipitating traumatic events, and diabetes mellitus did not have much influence on the average recovery rate after repeat discectomy for ipsilateral recurrent lumbar disc herniation. Conclusion: The outcomes of repeat discectomy were satisfactory. Moreover, factors, smoking, trauma history and diabetic mellitus, only had a minor impact on the outcomes of a repeat discectomy.

• Journal of Nutrition and Health
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• v.32 no.2
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• pp.150-157
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• 1999

This study explored the effects of dietary calcium levels and/or ovariectomy on bone formation, bone composition and calcium metabolism using female Sprague-Dawley weanling rats(mean body weight$\pm$SEM : 232.3$\pm$6.7g) as a model. Rats received high(1.5%) calcium diets for eight weeks during the growth period and were randomly assigned to ovariectomy and sham groups. The two groups were than each randomly divided into three sub-groups and fed 0.1%, 0.5% and 1.5% calcium diets for eight weeks after operation. The results indicate that body weight gain was higher in ovariectomy groups than sham groups regardless of dietary calcium levels and food intakes. Serum Ca concentration was decreased in low Ca groups after operation and serum P concentration increased in ovariectomy groups. Serum Ca concentration was decreased in low Ca groups after operation and serum P concentration increased in ovariectomy groups. Serum alkaline phosphatase activity was increased in ovariectomy groups and was not influenced by dietary calcium levels after operation. Urinary hydroxyproline decreased in high Ca intake groups regardless of whether rats had received an ovariectomy or not. The weight, length and breaking force of the femur were not significantly different in all groups. Ash, calcium, phosphate and magnesium contents in the femur and lumbar were not significantly different regardless of ovariectomy operation and dietary calcium levels. But high/normal calcium intake after ovariectomy and sham operation increased the weight and calcium content in bone. Therefore, high calcium intake influenced the formation of peak bone mass during the growth period and calcium levels and calcium levels and calcium levels continued to influence bone growth and composition after ovariectomy.

• Journal of Korean Neurosurgical Society
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• v.41 no.2
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• pp.88-94
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• 2007

Objective : The aim of this study is to investigate predictable risk factors for radiologic degeneration of adjacent segment after lumbar fusion and preoperative radiologic features of patients who underwent additional surgery with adjacent segment degeneration. Methods : Between January 1995 and December 2002, 201 patients who underwent lumbar fusion for degenerative conditions of lumbar spine were evaluated. We studied radiologic features, the method of operation, the length of fusion, age, sex, osteoporosis, and body mass index. Special attention was focused on, preoperative radiologic features of patients who required additional surgery were studied to detect risk factors for clinical deterioration. Results : Follow-up period ranged from 3 to 11 years. In our study, 61 [30%] patients developed adjacent segment degeneration, and 15 [7%] patients required additional surgery for neurologic deterioration. Age, the postoperative delay, facet volume, motion range, laminar inclination, facet tropism, and preexisting disc degeneration of adjacent segment considered as possible risk factors. Among these, laminar inclination and preexisting disc degeneration of adjacent segment were significantly correlated with clinical deterioration. Conclusion : The radiologic degeneration of adjacent segment after lumbar fusion can be predicted in terms of each preoperative radiologic factor, age and the postoperative delay. Laminar inclination and preexisting disc degeneration of adjacent segment have shown as strong risk factors for neurologic deterioration. Thus, careful consideration is warranted when these risk factors are present.

• Journal of Nutrition and Health
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• v.31 no.3
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• pp.279-288
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• 1998

This study explored the effect of calcium levels and/or ovariectomy on bone metabolism using female Sprague-Dawley weanling rats as a model . Rats received a low (0.1%) calcium diet for 8 weeks. The rats were then divided into three subgroups that were fed 0.1% ,0.5% and 1.5% calcium diets for 8 weeks after operation. The results of this experiment indicate that body weight gin was higher in ovariectomy groups than in sham groups regardless of calcium level and food intake. Serum Ca and P concentrations were of normal level regardless of calcium level and ovariectomy. Estrogen concentration was low in the ovariectomized group. Serum alkaline phophatase activity and urinary hydroxyproline have been used as markers of bone formation and resorption. These values were increased in ovariectomized groups. The weight, length and breaking force of femur were not significantly different between the groups. Ash, Ca, P and total lipid contents in femur and lumbar were decreased in the groups fed low calcium . Mg content was decreased in the ovariectomy and total protein content was not affected by calcium level and ovariectomy. The effect groups of ovarectomy on calcium contents of bone was more prominent in lumbar than in femur. In conclusion, though low calcium intakes during growth period may retard the attainment of peak bone mass, calcium supplementation after this period increased bone growth and mineral contents, but not significant effect in three calcium levels. Furthermore, calcium intake was shown to have a greater influence on the mineral contents of femur than of lumbar, and removal of endogenous estrogen production by ovariectomy was shown to be more deleterious on the ash and calcium contents of the lumbar than of femur.

• Journal of Korean Neurosurgical Society
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• v.29 no.9
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• pp.1262-1266
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• 2000

Objective : Flat back syndrome constitutes a syndrome complex characterized by the loss of normal lumbar lordosis. Various techniques of correction for flat back syndrome have been reported. Posterior extension osteotomy has certain drawbacks. Forceful hyperextension of the spine may result in vascular complications such as rupture of the aorta or the inferior vena cava and stretching of superior mesenteric artery, and pseudoarthrosis. We describe a rationale and technique of transvertebral posterior extension osteotomy to avoid complications of posterior extension osteotomy and to achieve an correction of 30 degrees of flat back syndrome. Method : A 63-year-old woman with degenerative lumbar kyphosis presented with low back pain, thigh pain, knee pain and walking difficulty. Transpedicular fixation from L1 vertebra to S1 vertebra was accomplished for lumbar degenerative kyphosis. After 6 months, the patient presented with flat back syndrome. A second operation was performed with transvertebral posterior extension osteotomy. Result : With short segemental fusion, early bone fusion and correction of 30 degrees were achieved. Conclusion : Transvertebral posterior extension osteotomy provide an 30-60 degrees of correction of flat back syndrome. This technique is considered to be good method for the revision of lumbar degenerative kyphosis.

• Journal of Korean Neurosurgical Society
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• v.53 no.1
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• pp.19-25
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• 2013

Objective : We compared the results of two surgical techniques by retrospective study of 60 elderly patients (65 years or older) who underwent either decompression alone or fusion for the treatment of two-level or more lumbar spinal stenosis. Methods : During the period of 2003 and 2008, two-level or more decompression alone or fusion was performed for lumbar spinal stenosis by three surgeons at our institution. Patients were allocated to two groups by surgical modality, namely, to a decompression group (31 patients) or a fusion group (29 patients). Overall mean age was 71.1 years (range, 65-84) and mean follow-up was 5.5 years (range, 3-9). A retrospective review of clinical, radiological, and surgical data was conducted. Results : No significant difference between the two groups was found with respect to age, follow-up period, surgical levels, or preoperative condition. At the last follow-up, correction of lumbar lordotic angle (determined radiologically) was better in the fusion group. However, clinical outcomes including visual analogue scale, Oswestry Disability Index, and the Odom's criteria were not significantly different in the two groups. On the other hand, surgical outcomes, such as, operation time, estimated blood loss, and surgical complications were significantly better in the decompression alone group. Conclusion : Our findings suggest that decompressive laminectomy alone achieves good outcomes in patients with two-level or more lumbar spinal stenosis, associated with an advanced age, poor general condition, or osteoporosis.

• Journal of Nutrition and Health
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• v.34 no.5
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• pp.532-540
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• 2001

This study explored the effect of calcium levels and/or ovariectomy on bone composition and its related factors using the female Sprague-Dawley rats which achieved peak bone mass in normal(0.5%) calcium intake during growth period. The rats were randomly divided into six groups and fed 0.1%, 0.5% and 1.5% calcium diets for 8 weeks after ovariectomized and sham operation. The results indicated that body weight gain was higher in ovariectomized groups than sham groups, regardless of dietary calcium levels and food intakes. Serum Ca and P concentrations were normal level regardless of dietary calcium levels and operation. Estrogen concentration was decreased in ovariectomized rat groups. Serum alkaline phosphatase activity and urinary hydroxyproline were increased in ovariectomized groups. When rats were fed normal Ca diet during growing period, weight, length and breaking force of femur were not significantly different in all groups but increased the same level. Generally, lipid contents in lumbar and femur were lower in low calcium groups and this effect was more pronounced in femur. In case of femur, the significant decrease in Ca contents of bone was observed in a relatively short period of feeding low Ca diet, even though it appeared th desirable peak bone mass had achieved through the growing period by supplementing the adequate amount of calcium. The marked decrease of estrogen levels after ovariectomy did not seem to influence greatly bone parameters measured except bone wet weight. Therefore, this study indicated that lower intake of Ca might be more important determinating factor against osteoporosis than postmenopausal state stimulated by ovariectomy in female rats. With normal or high intake of Ca it appears possible to prevent bone loss in postmenopausal period, and this might apply only in case of achieving peak bone mass in the growing with the adequate intake of calcium. (Korean J Nutrition 34(5) : 532∼540, 2001)

• Journal of Korean Neurosurgical Society
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• v.40 no.3
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• pp.175-179
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• 2006

Objective : The surgical outcome of anterior lumbar interbody fusion[ALlF] with pedicle screw fixation for elderly isthmic spondylolisthesis was analyzed. Methods : Consecutive nineteen elderly patients [aged 65 years or more] with isthmic spondylolisthesis [Grade I or II] who underwent single level ALIF with pedicle screw fixation in 2002 were analyzed. Using clinical chart and mailed questionnaires, preoperative and postoperative Visual Analogue Scale[VAS] of back and leg pain and postopertive Macnab criteria were evaluated. Results : The mean age at the time of operation was 68.4 years [range 65 to 78 years]. Twelve patients underwent ALIF with percutaneous pedicle screw fixation. Seven patients underwent ALIF followed by posterior decompression and pedicle screw fixation. The postoperative complication rate was 10.5% [wound dehiscence in 1 patient and incisional hernia in 1 patient]. There was no postoperative major morbidity or mortality. At a mean follow-up duration of 30.7 months [range 25 to 35 months], 93.3% [14/15] of the patients showed excellent or good outcomes in terms of Macnab criteria. The mean VAS scores of back pain and leg pain significantly decreased after surgery. Conclusion : ALIF with pedicle screw fixation yielded favorable results for elderly isthmic spondylolisthesis in selected cases.

• Journal of Korean Neurosurgical Society
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• v.40 no.1
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• pp.22-27
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• 2006

Objective : The purpose of this study is to investigate the clinical results of anterior and posterior stabilization by one stage posterolateral approach for the unstable fracture of thoracolumbar and lumbar spine. Methods : By posterolateral approach with curved skin incision, unilateral facet and pedicle were removed. Through this route, corpectomy was performed, and then this space was replaced with mesh cage filled up with autologous bone graft. Both side pedicle screw fixation was followed to upper and lower levels. Results : Six of seven patients of this study showed neurological improvement. The other one patient showed no neurological change. One patient had postoperative infection, another patient had postoperative kyphosis. The other patient had epidural hematoma on operation site after surgery. And all patinets on this study made to have spinal stability except one patient happened postoperative kyphosis. Conclusion : In the unstable fracture of thoracolumbar and lumbar spine, one stage anterior and posterior stabilization and fusion by posterolateral approach seems to be an effective procedure, if we have more care and supplementation.