• Journal of Korean Neurosurgical Society
• /
• v.43 no.5
• /
• pp.221-226
• /
• 2008

Objective : The aim of the present study was to assess the safety and efficacy of the dynamic stabilization system in the treatment of degenerative spinal diseases. Methods : The study population included 20 consecutive patients (13 females, 7 males) with a mean age of $61{\pm}6.98$ years (range 46-70) who underwent decompression and dynamic stabilization with the Dynesys system between January 2005 and August 2006. The diagnoses included spinal stenosis with degenerative spondylolisthesis (9/20, 45%), degenerative spinal stenosis (5/20, 25%), adjacent segmental disease after fusion (3/20, 15%), spinal stenosis with degenerative scoliosis (2/20, 10%) and recurrent intervertebral lumbar disc herniation (1/20, 5%). All of the patients completed the visual analogue scale (VAS) and the Korean version of the Oswestry Disability Index (ODI). The following radiologic parameters were measured in all patients : global lordotic angles and segmental lordotic angles (stabilized segments, above and below adjacent segments). The range of motion (ROM) was then calculated. Results : The mean follow-up period was $27.25{\pm}5.16$ months (range 16-35 months), and 19 patients (95%) were available for follow-up. One patient had to have the implant removed. There were 30 stabilized segments in 19 patients. Monosegmental stabilization was performed in 9 patients (47.3%), 9 patients (47.3%) underwent two segmental stabilizations and one patient (5.3%) underwent three segmental stabilizations. The most frequently treated segment was L4-5 (15/30, 50%), followed by L3-4 (12/30, 40%) and L5-S1 (3/30, 10%). The VAS decreased from $8.55{\pm}1.21$ to $2.20{\pm}1.70$ (p<0.001), and the patients' mean score on the Korean version of the ODI improved from $79.58%{\pm}15.93%$ to $22.17%{\pm}17.24%$ (p<0.001). No statistically significant changes were seen on the ROM at the stabilized segments (p=0.502) and adjacent segments (above segments, p=0.453, below segments, p=0.062). There were no patients with implant failure. Conclusion : The results of this study show that the Dynesys system could preserve the motion of stabilized segments and provide clinical improvement in patients with degenerative spinal stenosis with instability. Thus, dynamic stabilization systems with adequate decompression may be an alternative surgical option to conventional fusion in selected patients.

• Neurospine
• /
• v.15 no.4
• /
• pp.296-305
• /
• 2018

Cervical disc arthroplasty (CDA), or total disc replacement, has emerged as an option in the past two decades for the management of 1- and 2-level cervical disc herniation and spondylosis causing radiculopathy, myelopathy, or both. Multiple prospective randomized controlled trials have demonstrated CDA to be as safe and effective as anterior cervical discectomy and fusion, which has been the standard of care for decades. Moreover, CDA successfully preserved segmental mobility in the majority of surgical levels for 5-10 years. Although CDA has been suggested to have long-term efficacy for the reduction of adjacent segment disease in some studies, more data are needed on this topic. Surgery for CDA is more demanding for decompression, because indirect decompression by placement of a tall bone graft is not possible in CDA. The artificial discs should be properly sized, centered, and installed to allow movement of the vertebrae, and are commonly 6 mm high or less in most patients. The key to successful CDA surgery includes strict patient selection, generous decompression of the neural elements, accurate sizing of the device, and appropriately centered implant placement.

• Journal of Korean Neurosurgical Society
• /
• v.56 no.2
• /
• pp.162-165
• /
• 2014

Idiopathic hypertrophic spinal pachymeningitis (IHSP) is a chronic, progressive, inflammatory disorder characterized by marked fibrosis of the spinal dura mater with unknown etiology. According to the location of the lesion, it might induce neurologic deficits by compression of spinal cord and nerve root. A 58-year old female with a 3-year history of progressive weakness in both lower extremities was referred to our institute. Spinal computed tomography (CT) scan showed an osteolytic lesion involving base of the C6 spinous process with adjacent epidural mass. Magnetic resonance imaging (MRI) revealed an epidural mass involving dorsal aspect of cervical spinal canal from C5 to C7 level, with low signal intensity on T1 and T2 weighted images and non-enhancement on T1 weighted-enhanced images. We decided to undertake surgical exploration. At the operation field, there was yellow colored, thickened fibrous tissue over the dura mater. The lesion was removed totally, and decompression of spinal cord was achieved. Symptoms improved partially after the operation. Histopathologically, fibrotic pachymeninges with scanty inflammatory cells was revealed, which was compatible with diagnosis of idiopathic hypertrophic pachymeningitis. Six months after operation, motor power grade of both lower extremities was normal on physical examination. However, the patient still complained of mild weakness in the right lower extremity. Although the nature of IHSP is generally indolent, decompressive surgery should be considered for the patient with definite or progressive neurologic symptoms in order to prevent further deterioration. In addition, IHSP can present as an osteolytic lesion. Differential diagnosis with neoplastic disease, including giant cell tumor, is important.

• Journal of Korean Neurosurgical Society
• /
• v.29 no.9
• /
• pp.1184-1187
• /
• 2000

Spontaneous spinal epidural hematoma is rare disease and usually presents with a progressive neurological syndrome for which surgical decompression is usually indicated. The cause of bleeding in epidural hematoma remains unknown in most of the cases. The most frequently identified risk factor is coagulopathy or treatment with anticoagulants. Recently, authors experienced a case of spontaneous spinal epidural hematoma with intraoperative profuse bleeding at the cervicothoracic location. Laboratory examination showed no evidence of coagulopathy or hepatic disease. On neurologic examination, left hemiparesis(Grade : II) and left side sensory change were noted. On MRI scan, there was a mass of high signal intensity in T2WI and isosignal intensity in T1WI compressing the cord to left side. The patients had good surgical outcome after decompressive laminectomy and hematoma removal.

• Journal of Korean Neurosurgical Society
• /
• v.30 no.10
• /
• pp.1163-1169
• /
• 2001

Objective : To assess the surgical outcome for patients with primary spondylitis who were treated surgically. Materials and Methods : We retrospectively analyzed the clinical characteristics of 19 patients who underwent surgical treatment from september 1997 to October 1999 in our department. Results : The 19 patients presented 13 tuberculous spondylitis and 6 pyogenic spondylitis. The male to female ratio was 1.4 : 1 and average age 48.4 years(range 15-68 years). The most prevalent location was thoracic region(47%) and paraparesis was frequently seen in patients with middle and lower spinal lesions. Operative approaches were either anterior(13) or posterior(6). All patients with neurologic deficits improved after surgery. Autogenous rib and/or iliac strut bone grafting was performed, followed by spinal instrumentation. Solid bone fusion was obtained in all patients. There was no need for prolongation of duration of antituberculous drug therapy and no increased incidence of secondary infection due to spinal instrumentation. Conclusion : From the results, it may be advised that patients of primary spondylitis who had neurologic deficit should receive an aggressive opeation in their early stage.

• Journal of Korean Neurosurgical Society
• /
• v.61 no.3
• /
• pp.415-423
• /
• 2018

Objective : To identify the perioperative factors associated with instrument failure in patients undergoing a partial corpectomy with instrumentation (PCI) for spinal metastasis. Methods : We assessed the one hundred twenty-four patients with who underwent PCI for a metastatic spine from 1987 to 2011. Outcome measure was the risk factor related to implantation failure. The preoperative factors analyzed were age, sex, ambulation, American Spinal Injury Association grade, bone mineral density, use of steroid, primary tumor site, number of vertebrae with metastasis, extra-bone metastasis, preoperative adjuvant chemotherapy, and preoperative spinal radiotherapy. The intraoperative factors were the number of fixed vertebrae, fixation in osteolytic vertebrae, bone grafting, and type of surgical approach. The postoperative factors included postoperative adjuvant chemotherapy and spinal radiotherapy. This study was supported by the National Research Foundation grant funded by government. There were no study-specific biases related to conflicts of interest. Results : There were 15 instrumentation failures (15/124, 12.1%). Preoperative ambulatory status and primary tumor site were not significantly related to the development of implant failure. There were no significant associations between insertion of a bone graft into the partial corpectomy site and instrumentation failure. The preoperative and operative factors analyzed were not significantly related to instrumentation failure. In univariable and multivariable analyses, postoperative spinal radiotherapy was the only significant variable related to instrumentation failure (p=0.049 and 0.050, respectively). Conclusion : When performing PCI in patients with spinal metastasis followed by postoperative spinal radiotherapy, the surgeon may consider the possibility of instrumentation failure and find other strategies for augmentation than the use of a bone graft for fusion.

• Journal of Korean Neurosurgical Society
• /
• v.38 no.2
• /
• pp.136-140
• /
• 2005

The authors describe two cases of Brown-Sequard syndrome associated with cervical disc herniation. In both cases, magnetic resonance images of the cervical spine showed a large paramedian disc herniation at C5-C6 with ipsilateral severe spinal cord compression. Microsurgical removal of the herniated disc via anterior foraminotomy was performed and complete decompression of the spinal cord was achieved. Postoperatively, the neurological symptoms recovered rapidly and both patients experienced a complete remission of their symptoms. Although Brown-Sequard syndrome is rarely associated with degenerative cervical spine disease, cervical disc herniation should be kept in mind and prompt evaluations are mandatory. To the best of our knowledge, these are the first reported case of Brown-Sequard syndrome produced by cervical disc herniation which was treated by anterior foraminotomy.

• Journal of Korean Neurosurgical Society
• /
• v.29 no.1
• /
• pp.87-94
• /
• 2000

Objective : Various surgical approaches have been implemented to fulfill the ideal goals of treatment for cervical spondylotic lesions. Conventional approaches are represented by anterior approach with or without fusion and posterior approach. The authors has applied newly developed anterior cervical microforaminotomy for these lesions on minimally invasive basis. Materials and Method : Twenty-one patients, with cervical HIVD, or stenosis, or both, underwent anterior cervical microforaminotomy between March, 1998 and April, 1999. Fifteen patients underwent unilateral decompression, and 6 bilateral decompression via unilateral foraminotomy. Operation of one level was performed in 16 patients, 2 levels in 4 patients, and 3 in 1 patient. The foraminotomy was accomplished by resecting the uncovertebral joint. Through this hole, compressed nerve root was decompressed by removing the spondylotic spur or disc fragment, and diagonal removing of posterior osteophyte from foraminotomy site to begining of contralateral nerve root made spinal cord decompression. Results : The outcome was excellent in 17 patients(81%) and good in 4 patients(19%) based on Odom's criteria. No complication was encounterd, and average post-operation hospital stay was 3.7 days. Conclusions : These results indicate that anterior cervical microforaminotomy provide adequate neural decompression, minimum postoperative discomfort and fast recovery.

• Journal of Korean Neurosurgical Society
• /
• v.67 no.5
• /
• pp.550-559
• /
• 2024

Objective : This study focuses on identifying potential complications following oblique lumbar interbody fusion (OLIF) through routine magnetic resonance (MR) scans. Methods : From 650 patients who underwent OLIF from April 2018 to April 2022, this study included those with MR scans taken 1-week post-operatively, and only for indirect decompression patients. The analysis evaluated postoperative MR images for hematoma, cage insertion angles, and indirect decompression efficiency. Patient demographics, post-operatively symptoms, and complications were also evaluated. Results : Out of 401 patients enrolled, most underwent 1- or 2-level OLIF. Common findings included approach site hematoma (65.3%) and contralateral psoas hematoma (19%). The caudal level OLIF was related with less orthogonality and deep insertion of cage. Incomplete indirect decompression occurred in 4.66% of cases but did not require additional surgery. Rare but symptomatic complications included remnant disc rupture (four cases, 1%) and synovial cyst rupture (four cases, 1%). Conclusion : This study has identified potential complications associated with OLIF, including approach site hematoma, contralateral psoas hematoma, cage malposition risk at caudal levels, and radiologically insufficient indirect decompression. Additionally, it highlights rare, yet symptomatic complications such as remnant disc rupture and synovial cyst rupture. These findings contribute insights into the relatively under-explored area of OLIF complications.

• Journal of Korean Neurosurgical Society
• /
• v.29 no.8
• /
• pp.1080-1084
• /
• 2000

Spinal neurenteric cyst results from the persistence of an abnormal communication between endodermal and ne-uroectodermal layer. Embryologically, neurenteric cyst is derived from endoderm that is fused with the developing notochord during the third week of gestation. It is a rare malformation that lead to spinal cord compression. The patient is 19-year-old male presented with chest pain, paresthesia and progressive weakness in his low extremities(grade II/II). Preoperative MR imaging revealed intradural extramedullary cyst with intracystic hemorrhage in T1 and T2 level that is ventrally located and compressed the spinal cord. Involved vertebral bodies were scalloped and fused. The cystic tumor were totally removed through costotransversectomy approach. Postoperatively, motor weakness of the low extremities were improved to the level of grade IV/V. And chest pain and paresthesia were gradually disappeared. Postoperative MR imaging showed the decompression of the thoracic spinal cord. Histologic examination revealed a ciliated columnar epithelial neurenteric cyst. The pre- and postoperative clinical, radiological features of a case of upper thoracic neurenteric cyst is described with review of literature.