• Journal of Korean Neurosurgical Society
• /
• v.51 no.6
• /
• pp.350-358
• /
• 2012

Objective : Life expectancy for humans has increased dramatically and with this there has been a considerable increase in the number of patients suffering from lumbar spine disease. Symptomatic lumbar spinal disease should be treated, even in the elderly, and surgical procedures such as fusion surgery are needed for moderate to severe lumbar spinal disease. However, various perioperative complications are associated with fusion surgery. The aim of this study was to examine perioperative complications and assess risk factors associated with lumbar spinal fusion, focusing on geriatric patients at least 70 years of age in the Republic of Korea. Methods : We retrospectively investigated 489 patients with various lumbar spinal diseases who underwent lumbar spinal fusion surgery between 2003 and 2007 at our institution. Three fusion procedures and the number of fused segments were analyzed in this study. Chronic diseases were also evaluated. Risk factors for complications and their association with age were analyzed. Results : In this study, 74 patients experienced complications (15%). The rate of perioperative complications was significantly higher in patients 70 years of age or older than in other age groups (univariate analysis, p=0.001; multivariate analysis, p=0.004). However, perioperative complications were not significantly associated with the other factors tested (sex, comorbidities, operation procedures, fusion segments involved). Conclusion : Increasing age was an important risk factor for perioperative complications in patients undergoing lumbar spinal fusion surgery whereas other factors were not significant. We recommend good clinical judgment and careful selection of geriatric patients undergoing lumbar spinal fusion surgery.

• Journal of Korean Neurosurgical Society
• /
• v.54 no.4
• /
• pp.323-328
• /
• 2013

Objective : The purpose of this study was to examine the efficacy and perioperative complications associated with lumbar spinal fusion surgery, focusing on geriatric patients in the Republic of Korea. Methods : We retrospectively investigated 485 patients with degenerative spinal diseases who had lumbar spinal fusion surgeries between March 2006 and December 2010 at our institution. Age, sex, comorbidity, American Society of Anesthesiologists (ASA) class, fusion segments, perioperative complications, and outcomes were analyzed in this study. Risk factors for complications and their association with age were analyzed. Results : In this study, 81 patients presented complications (16.7%). The rate of perioperative complications was significantly higher in patients 70 years or older than in other age groups (univariate analysis, p=0.015; multivariate analysis, p=0.024). The perioperative complications were not significantly associated with the other factors tested (sex, comorbidity, ASA class, and fusion segments). Post-operative outcomes of lumbar spinal fusion surgeries for the patients were determined on the basis of MacNab's criteria (average follow up period : 19.7 months), and 412 patients (85.0%) were classified as having "excellent" or "good" results. Conclusion : Increasing age was an important risk factor for perioperative complications in patients undergoing lumbar spinal fusion surgery, whereas other factors were not significant. However, patients' satisfaction or return to daily activities when compared with younger patients did not show much difference. We recommend good clinical judgment as well as careful selection of geriatric patients for lumbar spinal fusion surgery.

• Journal of Korean Clinical Nursing Research
• /
• v.17 no.3
• /
• pp.388-398
• /
• 2011

Purpose: This study was to develop a post-operative exercise program, apply it to patients undergone lumbar spinal fusion surgery, and evaluate the effectiveness of the program on pain and disability activities of daily living. Methods: Fifty six patients who had lumbar spinal fusion were enrolled in this study. The patients were divided into two groups; 28 patients in the intervention group completed post-operative lumbar exercise program including walking for four weeks and 28 patients in the control group only did walking exercises. The degrees of pain on low back and leg were evaluated using visual analog scale (VAS) and the functional outcome was evaluated using the Korean version of Oswestry Disability Index (KODI) before surgery and 5 weeks after surgery. The data were analyzed using descriptive statistics, Chi-square test, t-test with SPSS 18.0 program. Results: Low back and leg pain of the participants in both experimental and control groups were improved after surgery compared to pre-surgery pain. However, there was no statistically significant difference between the groups. KODI score in the intervention group was significantly lower than that of the control group (p=.014). Conclusion: The developed post-operative exercise program in patients with lumbar spinal fusion surgery seems to be a useful intervention to reduce disability in activities of daily living.

• Journal of Korean Neurosurgical Society
• /
• v.58 no.1
• /
• pp.65-71
• /
• 2015

Objective : Lumbar spinal stenosis is conventionally treated with surgical decompression. However, bilateral decompression and laminectomy is more invasive and may not be necessary for lumbar stenosis patients with unilateral radiculopathy. We aimed to report the outcomes of unilateral laminectomy and bilateral pedicle screw fixation with fusion for patients with lumbar spinal stenosis and unilateral radiculopathy. Methods : Patients with lumbar spinal stenosis with unilateral lower extremity radiculopathy who received limited unilateral decompression and bilateral pedicle screw fixation were included and evaluated using visual analog scale (VAS) pain and the Oswestry Disability Index (ODI) scores preoperatively and at follow-up visits. Ligamentum flavum thickness of the involved segments was measured on axial magnetic resonance images. Results : Twenty-five patients were included. The mean preoperative VAS score was $6.6{\pm}1.6$ and $4.6{\pm}3.1$ for leg and back pain, respectively. Ligamentum flavum thickness was comparable between the symptomatic and asymptomatic side (p=0.554). The mean follow-up duration was 29.2 months. The pain in the symptomatic side lower extremity (VAS score, $1.32{\pm}1.2$) and the back (VAS score, $1.75{\pm}1.73$) significantly improved (p=0.000 vs. baseline for both). The ODI improved significantly postoperatively ($6.60{\pm}6.5$; p=0.000 vs. baseline). Significant improvement in VAS pain and ODI scores were observed in patients receiving single or multi-segment decompression fusion with fixation (p<0.01). Conclusion : Limited laminectomy and unilateral spinal decompression followed by bilateral pedicle screw fixation with fusion achieves satisfactory outcomes in patients with spinal stenosis and unilateral radiculopathy. This procedure is less damaging to structures that are important for maintaining posterior stability of the spine.

• Journal of the Korean Orthopaedic Association
• /
• v.56 no.2
• /
• pp.178-182
• /
• 2021

Spinal hematomas are a rare but serious complication that is typically observed in the epidural space. Spinal subdural hematomas are a dangerous clinical situation because of their potential to cause significant compression of the neural elements and can be mistaken easily for spinal epidural hematomas. This paper reports a case of a severe whole lumbar subdural hematoma after a simple epidural injection that was treated with surgical decompression with excellent clinical results.

• Journal of Trauma and Injury
• /
• v.36 no.3
• /
• pp.290-294
• /
• 2023

Generally, patients with severe burst fractures, instability, or neurological deficits require surgical treatment. In most cases, circumferential reconstruction is performed. Surgical methods for three-column reconstruction include anterior, lateral, and posterior approaches. In cases involving an anterior or lateral approach, collaboration with general or thoracic surgeons may be necessary because the adjacent anatomical structures are unfamiliar to spinal surgeons. Risks include vascular or lumbar plexus injuries and cage displacement, and in most cases, additional posterior fusion surgery is required. However, the posterior approach is the most common and anatomically familiar approach for surgeons performing spinal surgery. We present a case in which three-column reconstruction was performed using only the posterior approach to treat a patient with a severe lumbar burst fracture.

• Journal of Trauma and Injury
• /
• v.30 no.4
• /
• pp.212-215
• /
• 2017

The choice of the most appropriate treatment for thoracolumbar or lumbar spine burst fracture remains controversial from conservative treatment to fusion through a posterior or anterior approach. There are many cases where ligamentotaxis is used to reduce the burst fracture. However, indirect reduction using ligamentotaxis is often limited in the magnitude of the reduction that it can achieve. In our patient with severe burst fracture, we were able to restore an almost normal level of vertebral height and secure spinal canal widening by using only ligamentotaxis by posterior instrumentation. Before the operation, the patient had more than 95% encroachment of the spinal canal. This was reduced to less than 10% after treatment.

• Journal of Korean Neurosurgical Society
• /
• v.44 no.4
• /
• pp.265-267
• /
• 2008

Angiolipomas in the lumbar spinal region are extremely rare. The present report describes the identification of such a tumor and its removal, and discusses the tumor characteristics and prognosis. A 74-year-old woman was presented with a 5-month history of lower back pain. Severe radiculopathy was experienced in the left leg for 5 days prior to the presentation, and there were no neurological deficits. Magnetic resonance (MR) images showed an approximately 3.5 cm heterogeneously enhanced and elongated mass at the left L5-S1 level. A portion of the mass appeared with high signal intensity on T2-weighted MR images, with low signal intensity on T1-weighted images, and with high signal intensity on T1 fat suppression enhancement images. Resection of the tumor was approached via an L5 and S1 laminectomy. A fibrous sticky yellowish hypervascular tumor was identified. Histological study revealed the tumor as an angiolipoma. Symptoms were relieved after tumor excision, and there were no neurological sequelae. Although extremely rare, lumbar epidural angiolipoma should be considered in the differential diagnosis of lumbar spinal epidural lesions. The prognosis after surgical management of this lesion is favorable.

• Journal of Korean Neurosurgical Society
• /
• v.46 no.5
• /
• pp.501-504
• /
• 2009

Remote cerebellar hemorrhage (RCH) is rare but potentially lethal as a complication of spinal surgery. We recently experienced a case of RCH in a 61-year-old man who showed mental deterioration after lumbar spinal surgery. There was dural tearing with subsequent cerebrospinal fluid (CSF) loss during the surgery. Brain computed tomography scan revealed cerebellar hemorrhage, 3rd and 4th ventricular hemorrhage and pneumocephalus. He underwent suboccipital craniectomy and hematoma removal. The most important pathomechanism leading to RCH after spinal surgery has been known to be venous bleeding due to caudal sagging of cerebellum by rapid leak of large amount of CSF which seems to be related with this case. Dural repair and minimizing CSF loss after intraoperative dural tearing would be helpful to prevent postoperative RCH.

• Journal of Korean Neurosurgical Society
• /
• v.56 no.3
• /
• pp.206-210
• /
• 2014

Objective : Lumbar spinal stenosis is a common degenerative spine disease that requires surgical intervention. Currently, there is interest in minimally invasive surgery and various technical modifications of decompressive lumbar laminectomy without fusion. The purpose of this study was to present the author's surgical technique and results for decompression of spinal stenosis. Methods : The author performed surgery in 57 patients with lumbar spinal stenosis between 2006 and 2010. Data were gathered retrospectively via outpatient interviews and telephone questionnaires. The operation used in this study was named central decompressive laminoplasty (CDL), which allows thorough decompression of the lumbar spinal canal and proximal two foraminal nerve roots by undercutting the lamina and facet joint. Kyphotic prone positioning on elevated curvature of the frame or occasional use of an interlaminar spreader enables sufficient interlaminar working space. Pain was measured with a visual analogue scale (VAS). Surgical outcome was analyzed with the Oswestry Disability Index (ODI). Data were analyzed preoperatively and six months postoperatively. Results : The interlaminar window provided by this technique allowed for unhindered access to the central canal, lateral recess, and upper/lower foraminal zone, with near-total sparing of the facet joint. The VAS scores and ODI were significantly improved at six-month follow-up compared to preoperative levels (p<0.001, respectively). Excellent pain relief (>75% of initial VAS score) of back/buttock and leg was observed in 75.0% and 76.2% of patients, respectively. Conclusion : CDL is easily applied, allows good field visualization and decompression, maintains stability by sparing ligament and bony structures, and shows excellent early surgical results.