• Journal of Korean Neurosurgical Society
• /
• v.62 no.1
• /
• pp.53-60
• /
• 2019

Objective : The purpose of this study was to determine the efficacy of intra-operative cell salvage system (ICS) to decrease the need for allogeneic transfusions in patients undergoing major spinal deformity surgeries. Methods : A total of 113 consecutive patients undergoing long level posterior spinal segmental instrumented fusion (${\geq}5$ levels) for spinal deformity correction were enrolled. Data including the osteotomy status, the number of fused segments, estimated blood loss, intra-operative transfusion amount by ICS (Cell $Saver^{(R)}$, $Haemonetics^{(C)}$, Baltimore, MA, USA) or allogeneic blood, postoperative transfusion amount, and operative time were collected and analyzed. Results : The number of patients was 81 in ICS group and 32 in non-ICS group. There were no significant differences in demographic data and comorbidities between the groups. Autotransfusion by ICS system was performed in 53 patients out of 81 in the ICS group (65.4%) and the amount of transfused blood by ICS was 226.7 mL in ICS group. The mean intra-operative allogeneic blood transfusion requirement was significantly lower in the ICS group than non-ICS group (2.0 vs. 2.9 units, p=0.033). The regression coefficient of ICS use was -1.036. Conclusion : ICS use could decrease the need for intra-operative allogeneic blood transfusion. Specifically, the use of ICS may reduce about one unit amount of allogeneic transfusion in major spinal deformity surgery.

• Journal of Korean Neurosurgical Society
• /
• v.50 no.4
• /
• pp.392-395
• /
• 2011

Idiopathic hypertrophic spinal pachymeningitis (IHSP) is a rare inflammatory disease characterized by hypertrophic inflammation of the dura mater and various clinical courses that are from myelopathy. Although many associated diseases have been suggested, the etiology of IHSP is not well understood. The ideal treatment is controversial. In the first case, a 55-year-old woman presented back pain, progressive paraparesis, both leg numbness, and voiding difficulty. Initial magnetic resonance imaging (MRI) demonstrated an anterior epidural mass lesion involving from C6 to mid-thoracic spine area with low signal intensity on T1 and T2 weighted images. We performed decompressive laminectomy and lesional biopsy. After operation, she was subsequently treated with steroid and could walk unaided. In the second case, a 45-year-old woman presented with fever and quadriplegia after a spine fusion operation due to lumbar spinal stenosis and degenerative herniated lumbar disc. Initial MRI showed anterior and posterior epidural mass lesion from foramen magnum to C4 level. She underwent decompressive laminectomy and durotomy followed by steroid therapy. However, her conditions deteriorated gradually and medical complications occurred. In our cases, etiology was not found despite through investigations. Initial MRI showed dural thickening with mixed signal intensity on T1- and T2-weighted images. Pathologic examination revealed chronic nonspecific inflammation in both patients. Although one patient developed several complications, the other showed slow improvement of neurological symptoms with decompressive surgery and steroid therapy. In case of chronic compressive myelopathy due to the dural hypertrophic change, decompressive surgery such as laminectomy or laminoplasty may be helpful as well as postoperative steroid therapy.

• Journal of Korean Neurosurgical Society
• /
• v.57 no.5
• /
• pp.367-370
• /
• 2015

Bone cement augmentation procedures have been getting more position as a minimally invasive surgical option for osteoporotic spinal fractures. However, complications related to these procedures have been increasingly reported. We describe a case of bone cement dislodgement following cement augmentation procedure for osteoporotic spinal fracture by reviewing the patient's medical records, imaging results and related literatures. A 73-year-old woman suffering back and buttock pain following a fall from level ground was diagnosed as an osteoporotic fracture of the 11th thoracic spine. Percutaneous kyphoplasty was performed for this lesion. Six weeks later, the patient complained of a recurrence of back and buttock pain. Radiologic images revealed superior dislodgement of bone cement through the 11th thoracic superior endplate with destruction of the lower part of the 10th thoracic spine. Staged anterior and posterior fusion was performed. Two years postoperatively, the patient carries on with her daily living without any significant disability. Delayed bone cement dislodgement can occur as one of complications following bone cement augmentation procedure for osteoporotic spinal fracture. It might be related to the presence of intravertebral cleft, lack of interdigitation of bone cement with the surrounding trabeculae, and possible damage of endplate during ballooning procedure.

• Journal of Korean Neurosurgical Society
• /
• v.61 no.2
• /
• pp.251-257
• /
• 2018

Objective : The aim of this study was to investigate clinical and radiological outcomes of patients who underwent posterior vertebral column resection (PVCR) by a single neurosurgeon in a single institution. Methods : Thirty-four consecutive patients with severe spinal deformities who underwent PVCR between 2010 and 2016 were enrolled. The radiographic measurements included a kyphotic angle of PVCR levels (VCR angle), sagittal vertical axis (SVA), thoracic kyphosis, lumbar lordosis (LL), and spinopelvic parameters. The data of surgical time, estimated blood loss, duration of hospital stay, complications, intraoperative neurophysiologic monitoring, and the Scoliosis Research Society (SRS)-22 questionnaire were collected using a retrospective review of medical records. Results : The VCR angle, LL, and SVA values were significantly corrected after surgery. The VCR and LL angle were changed from the average of $38.4{\pm}32.1^{\circ}$ and $-22.1{\pm}39.1^{\circ}$ to $-1.7{\pm}29.4^{\circ}$ (p<0.001) and $-46.3{\pm}23.8^{\circ}$ (p=0.001), respectively. The SVA was significantly reduced from $103.6{\pm}88.5mm$ to $22.0{\pm}46.3mm$ (p=0.001). The clinical results using SRS-22 survey improved from $2.6{\pm}0.9$ to $3.4{\pm}0.8$ (p=0.033). There were no death and permanent neurological deficits after PVCR. However, complications occurred in 19 (55.9%) patients. Those patients experienced a total of 31 complications during- and after surgery. Sixteen reoperations were performed in twelve (35.3%) patients. The incidence of transient neurological deterioration was 5.9% (two out of 34 patients). Conclusion : Severe spinal deformities can be effectively corrected by PVCR. However, the PVCR technique should be utilized limitedly because surgery-related serious complications are relatively common.

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

• The Korean Journal of Pain
• /
• v.19 no.1
• /
• pp.101-103
• /
• 2006

Oral prostaglandin E1 (PGE1) is a medicine that is clinically applied during a treatment of patients suffering with vascular disease with chronic arterial obstruction because it has vasodilation and anti-platelet effects. The mechanisms of lumbosacral symptoms associated with spinal stenosis probably include vascular insufficiency with hypoxic injury to the cauda equina and the nerve roots. Thus, increasing the blood supply would be beneficial to improve the pathophysiologic condition. Several studies on the improvement of clinical symptoms of spinal stenosis by PGE1 treatment have been reported on. In this case, 47-year old female underwent posterior compression and posterolateral fusion with a cage at L2-4 due to L3 compression fracture, and she did not show improvement of the radiating pain of her right leg after the operation. Therefore, she received repetitive epidural catheterization and adhesiolysis, epidural block and physical therapy, but her symptoms deteriorated after temporary improvement. Finally, she was given PGE1 and the radiculopathy was completely improved, although some muscle weakness still remained.

• Journal of Trauma and Injury
• /
• v.32 no.2
• /
• pp.80-85
• /
• 2019

Purpose: To compare the time intervals to magnetic resonance imaging (MRI) and surgical treatment in patients having traumatic cervical spinal cord injury (SCI) with and without bony lesions. Methods: Retrospectively analyzed adult patients visited Kyungpook National University Hospital and underwent surgical treatment for cervical SCI within 24 hours. The patients who were suspected of having cervical SCI underwent plain radiography and computed tomography (CT) upon arrival. After the initial evaluation, we evaluated the MRI findings to determine surgical treatment. Waiting times for MRI and surgery were evaluated. Results: Thirty-four patients were included. Patients' mean age was 57 (range, 23-80) years. Patients with definite bony lesions were classified into group A, and 10 cases were identified (fracture-dislocation, seven; fracture alone, three). Patients without bony lesions were classified into group B, and 24 cases were identified (ossification of the posterior longitudinal ligament, 16; cervical spondylotic myelopathy, eight). Mean intervals between emergency room arrival and start of MRI were 93.60 (${\pm}60.08$) minutes in group A and 313.75 (${\pm}264.89$) minutes in group B, and the interval was significantly shorter in group A than in group B (p=0.01). The mean times to surgery were 248.4 (${\pm}76.03$) minutes in group A and 560.5 (${\pm}372.56$) minutes in group B, and the difference was statistically significant (p=0.001). The American Spinal Injury Association scale at the time of arrival showed that group A had a relatively severe neurologic deficit compared with group B (p=0.046). There was no statistical significance, but it seems to be good neurological recovery, if we start treatment sooner among patients treated within 24 hours (p=0.198). Conclusions: If fracture or dislocation is detected by CT, cervical SCI can be easily predicted resulting in MRI and surgical treatment being performed more rapidly. Additionally, fracture or dislocation tends to cause more severe neurological damage, so it is assumed that rapid diagnosis and treatment are possible.

• Advances in pediatric surgery
• /
• v.17 no.1
• /
• pp.65-71
• /
• 2011

Currarino syndrome is a hereditary syndrome characterized by the triad of a sacral bony defect, presacral mass and anorectal malformation. We retrospectively reviewed 13 Currarino syndrome patients who were treated in our center between 1997 and 2010. Demographic data, initial symptoms, initial diagnosis. pathologic diagnosis of presacral mass, associated anomalies and managements were analyzed. There were 8 boys and 5 girls. Four patients were diagnosed as Currarino syndrome immediately after birth with failure of passage of meconium and abdominal distension. Four patients underwent surgery for imperforate anus immediately after birth and W8re diagnosed as Currarino syndrome later and underwent reoperation. Three patients were diagnosed during work-up and management with of the tentative diagnosis of Hirschsprung's disease. Diagnosis of the remaining two patients was at the age of 26 months and 9 years and anorectal malformation was not associated. Twelve patients showed hemi-sacrum and one patient showed bilateral sacral subtotal agenesis. Two patients without anorectal malformation underwent presacral mass excision, untethering of spinal cord and repair of myelomeningocele. Six out of 8 patients, excluding 3 that expired or were lost to follow up, with anorectal malformation underwent colostomy, presacral mass excision, untethering of spinal cord, repair of myelomeningocele, posterior sagittal anorectoplasty and colostomy repair. One patient underwent only posterior sagittal anorectoplasty after colostomy. One waits the scheduled operation only with Hegar dilatation. Pathologic examation of presacral masses showed myelomeningoceles in 4 patients, lipomyelomeningoceles in 3 patients and dermoid Cyst in one patient. Teratoma was combined in 2 patients. Eight patients needed neurosurgical operation for spinal cord problems. Seven patients had urologic anomalies and two of them underwent operation. Currarino syndrome should be considered as a differential diagnosis in pediatric patients with abdominal distension, constipation and anorectal malforlnation. For proper evaluation and treatment, a multi-disciplinary approach is recommended.

• Journal of Korean Neurosurgical Society
• /
• v.29 no.7
• /
• pp.904-909
• /
• 2000

Objectives : Most cases of cervical ossification of the posterior longitudinal ligament(OPLL) present with myelopathy or myeloradiculopathy, which sometimes is further complicated by minor trauma to the spinal cord. The main purpose of surgery in these patients is the alleviation symptoms but also as protection against further deterioration. The purpose of this study is to analyze the influence of trauma on the surgical outcome in patients with cervical OPLL. Methods : Over the past 13 years, we have operated on 123 patients with myelopathy associated with cevical OPLL. Among these, thirty patients had cervical cord injury associated with major or minor trauma and their clinical and radiographic data were reviewed retrosepctively. Results : As to cause of trauma, seventeen were related with traffic accident and 13 were related with minor slipping injury. The pre- and post-operative motor power were significantly weaker in the patients with trauma, but the degree of motor improvement was significantly higher(trauma group : $0.90{\pm}1.49$, non-trauma group : $0.41{\pm}0.80$). Conclusion : These results indicate that even indirect minor trauma to the cervical spine can cause irreversible changes to the spinal cord if this is associated with underlying cervical stenosis with OPLL. Although less favorable results may be anticipated in patients with trauma, operative decompression could improve motor power and protect further deterioration.

• Journal of Korean Neurosurgical Society
• /
• v.40 no.2
• /
• pp.84-89
• /
• 2006

Objective : The purpose of this study is to compare the outcomes of two methods for stabilization and fusion : Postero-Lateral Fusion [PLF, pedicle screw fixation with bone graft] and Posterior Lumbar Interbody Fusion [PLIF, cage insertion] for spinal stenosis and recurred disc herniation except degenerative spondylolisthesis. Methods : Seventy one patients who underwent PLF [n=36] or PLIF [n=35] between 1997 and 2001 were evaluated prospectively. These two groups were compared for the change of interbody space, the range of segmental angle, the angle of lumbar motion, and clinical outcomes by Prolo scale. Results : The mean follow-up period was 32.6 months. The PLIF group showed statistically significant increase of the interbody space after surgery. However, the difference in the change of interbody space between two groups was insignificant [P value=0.05]. The range of segmental angle was better in the PLIF group, but the difference in the change of segmental angle was not statistically significant [P value=0.0l7]. Angle of lumbar motion was similar in the two groups. Changes of Prolo economic scale were not statistically significant [P value=0.193]. The PLIF group showed statistically significant improvement in Prolo functional scale [P value=0.003]. In Prolo economic and functional scale, there were statistically significant relationships between follow-up duration [P value<0.001]. change of interbody space [P value<0.001], and range of segmental angle [P value<0.001]. Conclusion : Results of this study indicate that PLIF is superior to PLF in interbody space augmentation and clinical outcomes by Prolo functional scale. Analysis of clinical outcomes showed significant relationships among various factors [fusion type, follow-up duration, change of interbody space, and range of segmental angle]. Therefore, the authors recommend instrumented PLIF to offer better clinical outcomes in patients who needed instrumented lumbar fusion for spinal stenosis and recurred disc herniation.