• Journal of Korean Neurosurgical Society
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• v.55 no.5
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• pp.248-254
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• 2014

Objective : According to the recent development of minimally invasive spinal surgery, direct lumbar interbody fusion (DLIF) was introduced as an effective option to treat lumbar degenerative diseases. However, comprehensive results of DLIF have not been reported in Korea yet. The object of this study is to summarize radiological and clinical outcomes of our DLIF experience. Methods : We performed DLIF for 130 patients from May 2011 to June 2013. Among them, 90 patients, who could be followed up for more than 6 months, were analyzed retrospectively. Clinical outcomes were compared using visual analog scale (VAS) score and Oswestry Disability Index (ODI). Bilateral foramen areas, disc height, segmental coronal and sagittal angle, and regional sagittal angle were measured. Additionally, fusion rate was assessed. Results : A total of 90 patients, 116 levels, were underwent DLIF. The VAS and ODI improved statistically significant after surgery. All the approaches for DLIF were done on the left side. The left and right side foramen area changed from $99.5mm^2$ and $102.9mm^2$ to $159.2mm^2$ and $151.2mm^2$ postoperatively (p<0.001). Pre- and postoperative segmental coronal and sagittal angles changed statistically significant from $4.1^{\circ}$ and $9.9^{\circ}$ to $1.1^{\circ}$ and $11.1^{\circ}$. Fusion rates of 6 and 12 months were 60.9% and 87.8%. Complications occurred in 17 patients (18.9%). However, most of the complications were resolved within 2 months. Conclusion : DLIF is not only effective for indirect decompression and deformity correction but also shows satisfactory mechanical stability and fusion rate.

• Journal of Korean Neurosurgical Society
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• v.52 no.4
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• pp.281-287
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• 2012

Objective : To evaluate the effect of calcium supplementation on spinal bone fusion in ovariectomized (OVX) rats. Methods : Sixteen female Sprague Dawley rats underwent bilateral ovariectomy at 12 weeks of age to induce osteoporosis and were randomly assigned to two groups : control group (n=8) and calcium-supplemented group (OVX-Ca, n=8). Autologous spinal bone fusion surgery was performed on both groups 8 weeks later. After fusion surgery, the OVX-Ca group was supplemented with calcium in drinking water for 8 weeks. Blood was obtained 4 and 8 weeks after fusion surgery. Eight weeks after fusion surgery, the rats were euthanized and the L4-5 spine removed. Bone fusion status and fusion volume were evaluated by manual palpation and three-dimensional computed tomography. Results : The mean fusion volume in the L4-5 spine was significantly greater in the OVX-Ca group ($71.80{\pm}8.06mm^3$) than in controls ($35.34{\pm}8.24mm^3$) (p<0.01). The level of osteocalcin, a bone formation marker, was higher in OVX-Ca rats than in controls 4 weeks ($610.08{\pm}10.41$ vs. $551.61{\pm}12.34$ ng/mL) and 8 weeks ($552.05{\pm}19.67$ vs. $502.98{\pm}22.76$ ng/mL) after fusion surgery (p<0.05). The level of C-terminal telopeptide fragment of type I collagen, a bone resorption marker, was significantly lower in OVX-Ca rats than in controls 4 weeks ($77.07{\pm}12.57$ vs. $101.75{\pm}7.20$ ng/mL) and 8 weeks ($69.58{\pm}2.45$ vs. $77.15{\pm}4.10$ ng/mL) after fusion surgery (p<0.05). A mechanical strength test showed that the L4-5 vertebrae in the OVX-Ca group withstood a 50% higher maximal load compared with the controls (p<0.01). Conclusion : Dietary calcium given to OVX rats after lumbar fusion surgery improved fusion volume and mechanical strength in an ovariectomized rat model.

• Korean Journal of Adult Nursing
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• v.28 no.1
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• pp.43-52
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• 2016

Purpose: The aim of this study was to identify demographic, clinical, physical, and psychosocial factors affecting discharge delay in lumbar spinal surgery patients who were treated according to a critical pathway. Methods: A sample of 170 patients with lumbar spinal surgery agreed to participate in the study, between April 1, 2014 and August 30, 2015. Data were analyzed by mean, standard deviation, t-test, ${\chi}^2$-test, ANCOVA, and logistic regression analysis using SPSS 22.0 program. Results: Approximately fifty-nine percent of the participants was delayed discharge. On logistic regression analysis, female gender (OR=2.63, 95% CI=1.40~4.94), age (OR=1.03, 95% CI=1.01~1.05), spondylolisthesis (OR=4.49, 95% CI=1.90~10.61), and spinal fusion operation (OR=4.14, 95% CI=1.89~9.05) were significant factors predicting discharge delay of the participants. However, discharge delay was not related with pain, physical function, depression, or family support. Conclusion: An analysis of discharge delay may assist in evaluating and revising critical pathway for optimal care. In addition, nurses need to understand the factors affecting discharge delay of the given population who were treated according to a critical pathway.

• Journal of Korean Neurosurgical Society
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• v.30 no.5
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• pp.605-610
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• 2001

Objective : The authors investigated the efficacy of the calcium sulfate(OsteoSet$^{(R)}$ pellets) as an autograft extender when used to perform posterolateral lumbar fusions. Patients and Methods : Twenty patients who underwent lumbar posterolateral arthrodesis for various spinal diseases between October 1999 and March 2000 were evaluated. Arthrodesis was performed by transpedicular screw fixation and bone grafting with a mixture of autograft + calcium sulfate in a 1 : 1 ratio. At time intervals of 1, 2, 3, and 6 months, postoperative radiographs were obtained to review the resorption of calcium sulfate and the evidence of fusion. A modified Lenke scale was used to assess the status of the fusion. Results : At 2 months after operation, the average modified Lenke scale score for the OsteoSet$^{(R)}$ pellets group was 3.8. However at 6 months after operation, the average modified Lenke scale score for the OsteoSet$^{(R)}$ pellets group was 1.8. Resorption of calcium sulfate pellets was revealed in all cases at 6 months after surgery. Conclusion : It is presumed that a combination of calcium sulfate and autograft can play a role as an effective autograft extender in the posterolateral spinal fusion.

• The Korean Journal of Pain
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• v.18 no.1
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• pp.34-38
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• 2005

Background: Over the years, disc surgery has progressively evolved in the direction of decreasing trauma and its invasiveness. Conventional open surgery has many complications, such as scarring, instability, bleeding and a relative high mortality rate. Minimally invasive spinal surgery is now an alternative to a traditional discectomy. Herein, we present an operative technique, and the early results, for a percutaneous endoscopic lumbar discectomy in herniated lumbar disc disease. Methods: 43 patients, including 27 men and 16 women, with ages ranging from 18 to 66 years, were enrolled in this study. All the patients showed a protruded or extruded soft disc herniation at the lumbar level on magnetic resonance imaging and computed tomography. A percutaneous endoscopic lumbar discectomy was applied to the patients, and clinical responses evaluated using MacNab's criteria. Results: 40 patients were regarded as showing successful responses (93.1%), and there were no severe complications, such as a hematoma, nerve injury, postoperative dysesthesia or death. One patient underwent fusion surgery for remnant back pain six month later. Conclusions: We conclude that, in properly selected patients, a percutaneous endoscopic lumbar discectomy is a safe, noninvasive and effective treatment modality for herniated lumbar intervertebral disc disease.

• Journal of Korean Neurosurgical Society
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• v.60 no.2
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• pp.225-231
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• 2017

Objective : Solid bone fusion is an essential process in spinal stabilization surgery. Recently, as several minimally invasive spinal surgeries have developed, a need of artificial bone substitutes such as demineralized bone matrix (DBM), has arisen. We investigated the in vivo bone growth rate of DBM as a bone void filler compared to a local autologous bone grafts. Methods : From April 2014 to August 2015, 20 patients with a one or two-level spinal stenosis were included. A posterior lumbar interbody fusion using two cages and pedicle screw fixation was performed for every patient, and each cage was packed with autologous local bone and DBM. Clinical outcomes were assessed using the Numeric Rating Scale (NRS) of leg pain and back pain and the Korean Oswestry Disability Index (K-ODI). Clinical outcome parameters and range of motion (ROM) of the operated level were collected preoperatively and at 3 months, 6 months, and 1 year postoperatively. Computed tomography was performed 1 year after fusion surgery and bone growth of the autologous bone grafts and DBM were analyzed by ImageJ software. Results : Eighteen patients completed 1 year of follow-up, including 10 men and 8 women, and the mean age was 56.4 (32-71). The operated level ranged from L3/4 to L5/S1. Eleven patients had single level and 7 patients had two-level repairs. The mean back pain NRS improved from 4.61 to 2.78 (p=0.003) and the leg pain NRS improved from 6.89 to 2.39 (p<0.001). The mean K-ODI score also improved from 27.33 to 13.83 (p<0.001). The ROM decreased below 2.0 degrees at the 3-month assessment, and remained less than 2 degrees through the 1 year postoperative assessment. Every local autologous bone graft and DBM packed cage showed bone bridge formation. On the quantitative analysis of bone growth, the autologous bone grafts showed significantly higher bone growth compared to DBM on both coronal and sagittal images (p<0.001 and p=0.028, respectively). Osteoporotic patients showed less bone growth on sagittal images. Conclusion : Though DBM alone can induce favorable bone bridging in lumbar interbody fusion, it is still inferior to autologous bone grafts. Therefore, DBM is recommended as a bone graft extender rather than bone void filler, particularly in patients with osteoporosis.

• Journal of Korean Neurosurgical Society
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• v.55 no.6
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• pp.331-336
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• 2014

Objective : The purpose of this study was to evaluate the differences in sagittal spinopelvic alignment between lumbar degenerative spondylolisthesis (DSPL) and degenerative spinal stenosis (DSS). Methods : Seventy patients with DSPL and 72 patients with DSS who were treated with lumbar interbody fusion surgery were included in this study. The following spinopelvic parameters were measured on whole spine lateral radiographs in a standing position : pelvic incidence (PI), pelvic tilt (PT), sacral slope (SS), lumbar lordosis angle (LL), L4-S1 segmental lumbar angle (SLL), thoracic kyphosis (TK), and sagittal vertical axis from the C7 plumb line (SVA). Two groups were subdivided by SVA value, respectively. Normal SVA subgroup and positive SVA subgroup were divided as SVA value (<50 mm and ${\geq}50mm$). Spinopelvic parameters/PI ratios were assessed and compared between the groups. Results : The PI of DSPL was significantly greater than that of DSS (p=0.000). The SVA of DSPL was significantly greater than that of DSS (p=0.001). In sub-group analysis between the positive (34.3%) and normal SVA (65.7%), there were significant differences in LL/PI and SLL/PI (p<0.05) in the DSPL group. In sub-group analysis between the positive (12.5%) and normal SVA (87.5%), there were significant differences in PT/PI, SS/PI, LL/PI and SLL/PI ratios (p<0.05) in the DSS group. Conclusion : Patients with lumbar degenerative spondylolisthesis have the propensity for sagittal imbalance and higher pelvic incidence compared with those with degenerative spinal stenosis. Sagittal imbalance in patients with DSPL is significantly correlated with the loss of lumbar lordosis, especially loss of segmental lumbar lordosis.

• The Journal of Korean Medicine
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• v.37 no.2
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• pp.93-103
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• 2016

Objectives: The purpose of this study was to report Four cases of Failed Back Surgery Syndrome (FBSS) patients after spinal fusion surgery who showed significant improvement in pain and function with Complex Korean medical treatment. Methods: This study was a retrospective observational study. We reviewed medical records of Four patients with lumbar pain or radiating leg pain, who have received spinal fusion surgery in the past. All Four patients took complex treatments of Mokhuri Neck and Back hospital which involes Acupuncture, Pharmaco-acupuncture, Gangchuk herbal medicine, Chuna and Physical therapy during about four-week of admission treatment. Visual Analogue Scale (VAS), Oswestry disability index (ODI), Pain Free Walking Distance (PFWD) scores were assessed before and after treatments. Results: The average of hospitalization period was 28.5 days. Mean VAS scores decreased from 6.5 to 2.3, Oswestry Disability Index (ODI) scores decreased from 56.25 to 38.25 and Pain Free Walking Distance (PFWD) also improved from 10m to 166.6m. Conclusion: This study implies that a combination of Korean medical treatments might be effective in relieving pain, and improving the functional status of FBSS patients. Further studies are needed to fully understand the mechanisms underlying the effects.

• Journal of Korean Neurosurgical Society
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• v.60 no.6
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• pp.684-690
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• 2017

Objective : As increasing the size of the geriatric population, the number of elderly patients, who need the surgery for painful degenerative spinal stenosis has been increasing. The geriatric population may be relatively high complications, because of age and age-associated medical conditions. However, there is a lack of studies addressing the perioperative complications and outcomes in elderly patients with posterior lumbar inter body fusion with screw augmentation (PLIF). Methods : We retrospectively reviewed the medical records and radiographic studies of geriatric patients who had spine surgery of PLIF due to spinal stenosis for 11 years. We divided into 2 groups (A; 70-75 years, B; over then 76 years) according to the age. Surgical level of each groups, hospital day and postoperative day, co-morbidities, complications, clinical outcomes were analyzed. Operative reports, hospital and outpatient clinic charts, and radiographic studies were reviewed. Results : Group A was composed of 80 patients, their mean age was 72.21 and female dominant (n=46), and their mean surgically fused level was 1.52 level. Group B was 36 patients, their mean age was 78.83 and female dominant (n=20), and their mean surgically fused level was 1.36 level. Comparing between two groups, complications, postoperative hospital stay were slightly increase in group B and co-morbidity was statistically high in group B, however clinical outcomes were similar between two groups. Conclusion : Increasing age might be an important risk factor for complications in patients undergoing PLIF, however, we would like to recommend that if the situation of spine of extreme geriatric patients need PLIF, it should be in the surgeon's consideration after careful selection and clinical judgement.

• Journal of Korean Neurosurgical Society
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• v.38 no.3
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• pp.206-210
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• 2005

Objective : Our aim is to evaluate the early changes of biologic markers such as white blood cell[WBC] count, erythrocyte sedimentation rate[ESR] and C-reactive protein[CRP] in early diagnosis of postoperative infection and to differentiate infection from inflammatory reaction in lumbar spine surgery. Methods : We reviewed 330patients who had undergone spinal operations between May 1999 and October 2001. For this study, the patients were classified into two groups, which include a group that underwent spinal decompressive surgery without instrumentation[SD], and the other group that underwent fusion surgery with spinal instrumentation[SI]. And each group was also subdivided into two groups respectively, one with infection and the other without infection. We retrospectively analyzed the WBC count, ESR and CRP preoperatively and postoperatively, according to their operation type and postoperative infection history. Results : Inflammatory indices were physiologically affected by instrumentation itself. But ESR and CRP elevations were more prolonged and sustained under infection. In SD patients without infection, ESR and CRP were stabilized 5 days after surgery. In SI patients without infection, CRP was stabilized about 7days after surgery, but ESR showed sustained and variously elevated. In both SD and SI groups, the stabilization of CRP was the most reliable behavior of surgery without infection. Conclusion : C-reactive protein is most sensitive parameter for postoperative spine infection. The knowledge of the inflammatory indices and their relatively uniform patterns with or without infection offers surgeons the ability to infer the state of surgical wound.