• Journal of Korean Neurosurgical Society
• /
• 제29권12호
• /
• pp.1677-1681
• /
• 2000

Microsurgical transthoracic extrapleural approach for thoracic discectomy in three cases were modified and simplified in order to achieve better exposure of ventral extradural space than posterolateral extrapleural(lateral extracavitary) approach and less pulmonary complications than transthoracic transpleural approach. These approaches were optimized by microscope and video-assistance. Surgery was followed by clinical improvement in all patients. The results of treatment seem to support the use of these modified techniques as adequate surgical treatment of thoracic disc herniations without any complications.

• Journal of Chest Surgery
• /
• 제36권11호
• /
• pp.883-885
• /
• 2003

보존적 치료로 해결되지 않는 유미흉의 전통적인 수술적 치료방법은 우측 개흉술을 통한 흉관 결찰술이다. 저자들은 늑막외층 접근법을 이용한 새로운 흉관 결찰법을 소개하고자 한다. 이 수술의 장점은 통상적인 개흉술에 비해 환자에게 덜 침습적이며, 술후 새로운 흉관을 넣을 필요가 없고, 흉관을 찾기가 더 쉽다는 점이다. 저자들은 새로운 수술 방법으로 유미흉을 치험하였기에 문헌 고찰과 함께 보고하는 바이다.

• Journal of Korean Neurosurgical Society
• /
• 제29권6호
• /
• pp.763-771
• /
• 2000

Objectives : Thoracolumbar burst fractures(TBLF) result in not only compressive deformity of vertebral body but also spinal cord compression by bony fragments. Many thoracolumbar burst fractures demand both anterior decompression and intervertebral fusion. Most of spinal surgeons use anterior instrumentation for anteior intervertebral bony fusion. The use of Z-plate has been increased recently, however there has been only a few reports regarding its clinical long-term strength. We studied nineteen patients with TBLF to find out the long-term stability of Z-plate. Methods : We have operated 19 patients from March 1996 to August 1998. They were treated with anterior decompression through either a transthoracic, retroperitoneal extrapleural or retroperitoneal approach. Retropulsed bony fragments were removed completely by corpectomy. Iliac bone graft was used for interbody fusion in all of the cases. They were evaluated by plain X-ray films including flexion and extention lateral films. Cobbs angle was used to evaluate kyphotic and lateral wedging deformity. Results : Burst fractured sites were T11 in two, three T12, nine L1, and five L2. Mean follow-up duration was fifteen months. Preoperative average kyphotic angle was 23.7 degree. Immediate postoperative kyphotic angle was 10.2 degree. Follow-up resluts of average kyphotic angles revealed 14 degrees. Four patients(21%), including two spinal 3-column injury, showed increasement of kyphotic angle more than 5 degree or breakage of intrumentation. Two patients showed the difference of kyphotic angle more than 3 degree. Five patients(26%) revealed lateral wedging deformity more than 3 degrees. Postoperative complications were two meralgia parestheticas, one pulmonary atelectasis and two donor site infections. Four of the eight patients, who initially showed incomplete spinal cord deficits, were nerologically improved by Frankel's grade. Conclusion : Z-plate fixation and iliac bone graft after anterior decompression in thoracolumbar burst fractures is a safe and easy method. Immediate postoperative results revealed excellent correction of posttraumatic kyphosis, but long-term follow-up evalution showed insufficient strength. Therefore we believe that use of Z-plate should be carefully decided, especially in the case of large lumbar fracture or 3-column injury.