• Journal of Korean Neurosurgical Society
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• v.47 no.3
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• pp.228-231
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• 2010

Posttraumatic syringomyelia may result from a variety of inherent conditions and traumatic events, or from some combination of these. Many hypotheses have arisen to explain this complex disorder, but no consensus has emerged. A 28-year-old man presented with progressive lower extremity weakness, spasticity, and decreased sensation below the T4 dermatome five years after an initial trauma. Magnetic resonance imaging (MRI) revealed a large, multi-septate syrinx cavity extending from C5 to L1, with a retropulsed bony fragment of L2. We performed an L2 corpectomy, L1-L3 interbody fusion using a mesh cage and screw fixation, and a wide decompression and release of the ventral portion of the spinal cord with an operating microscope. The patient showed complete resolution of his neurological symptoms, including the bilateral leg weakness and dysesthesia. Postoperative MRI confirmed the collapse of the syrinx and restoration of subarachnoid cerebrospinal fluid (CSF) flow. These findings indicate a good correlation between syrinx collapse and symptomatic improvement. This case showed that syringomyelia may develop through obstruction of the subarachnoid CSF space by a bony fracture and kyphotic deformity. Ventral decompression of the obstructed subarachnoid space, with restoration of spinal alignment, effectively treated the spinal canal encroachment and post-traumatic syringomyelia.

• Journal of Korean Neurosurgical Society
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• v.58 no.5
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• pp.494-498
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• 2015

Objective : To describe a novel spinous process-splitting hemilaminoplasty technique for the surgical treatment of intradural and posterior epidural lesions that promotes physiological restoration. Methods : The spinous process was split, the area of the facet lamina junction was drilled, and en bloc hemilaminectomy was then performed. After removing intradural and posterior epidural lesions, we fitted the previously en bloc-removed bone to the pre-surgery same shape, and held it in place with non-absorbable sutures. Surgery was performed on 16 laminas from a total of nine patients between 2011 and 2014. Bony union of the reconstructed lamina was assessed using computed tomography (CT) at 6 months after surgery. Results : Spinous process-slitting hemilaminoplasty was performed for intradural extramedullary tumors in eight patients and for ossification of the ligament flavum in one patient. Because we were able to visualize the margin of the ipsilateral and contralateral dura, we were able to secure space for removal of the lesion and closure of the dura. None of the cases showed spinal deformity or other complications. Bone fusion and maintenance of the spinal canal were found to be perfect on CT scans. Conclusion : The spinous process-splitting hemilaminoplasty technique presented here was successful in creating sufficient space to remove intradural and posterior epidural lesions and to close the dura. Furthermore, we were able to maintain the physiological barrier and integrity after surgery because the posterior musculature and bone structures were restored.

• Journal of Korean Neurosurgical Society
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• v.66 no.1
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• pp.33-43
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• 2023

Objective : To compare the outcomes of anterior lumbar interbody fusion (ALIF), oblique lumbar interbody fusion (OLIF), and transforaminal lumbar interbody fusion (TLIF) in terms of global sagittal alignment. Methods : From January 2007 to December 2019, 141 adult patients who underwent multilevel interbody fusion for lumbar degenerative disorders were enrolled. Regarding the approach, patients were divided into the ALIF (n=23), OLIF (n=60), and TLIF (n=58) groups. Outcomes, including local radiographic parameters and global sagittal alignment, were then compared between the treatment groups. Results : Regarding local radiographic parameters, ALIF and OLIF were superior to TLIF in terms of the change in the anterior disc height (7.6±4.5 mm vs. 6.9±3.2 mm vs. 4.7±2.9 mm, p<0.001), disc angle (-10.0°±6.3° vs. -9.2°±5.2° vs. -5.1°±5.1°, p<0.001), and fused segment lordosis (-14.5°±11.3° vs. -13.8°±7.5° vs. -7.4°±9.1°, p<0.001). However, regarding global sagittal alignment, postoperative lumbar lordosis (-42.5°±9.6° vs. -44.4°±11.6° vs. -40.6°±12.3°, p=0.210), pelvic incidence-lumbar lordosis mismatch (7.9°±11.3° vs. 6.7°±11.6° vs. 11.5°±13.0°, p=0.089), and the sagittal vertical axis (24.3±28.5 mm vs. 24.5±34.0 mm vs. 25.2±36.6 mm, p=0.990) did not differ between the groups. Conclusion : Although the anterior approaches were superior in terms of local radiographic parameters, TLIF achieved adequate global sagittal alignment, comparable to the anterior approaches.

• Neurospine
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• v.15 no.4
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• pp.296-305
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• 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 Yeungnam Medical Science
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• v.38 no.2
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• pp.152-156
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• 2021

Diplopia is a rare complication of spine surgery. The abducens nerve is one of the cranial nerves most commonly related to diplopia caused by traction injury. We report a case of a 71-year-old woman who presented with diplopia developing from abducens nerve palsy after C1-C2 fixation and fusion due to atlantoaxial subluxation with cord compression. As soon as we discovered the symptoms, we suspected excessive traction by the instrument and subsequently performed reoperation. Subsequently, the patient's symptoms improved. In other reported cases we reviewed, most were transient. However, we thought that our rapid response also helped the patient's fast recovery in this case. The mechanisms by which postoperative diplopia develops vary and, thus, remain unclear. We should pay attention to the fact that the condition is sometimes an indicator of an underlying, life-threatening condition. Therefore, all patients with postoperative diplopia should undergo thorough ophthalmological and neurological evaluations as well as careful observation by a multidisciplinary team.

• Journal of Yeungnam Medical Science
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• v.14 no.1
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• pp.209-219
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• 1997

Objectives: Anterior approach to achieve arthrodesis of the cervical spine has become a widely accepted and often-used approach since its earliest reports by Bailey and Badgley, Smith and Robinson and Cloward. However, anterior interbody fusion in the presence of the posterior instability may be complicated by the bone graft dislodgement, kyphotic defomity or nonunion. As an attemp to prevent this undesirable complication, additional methods such as skeletal traction, halo appratus or even posterior fusion has been utilized. Therefore, The cervical spine locking plate(CSLP) with the anterior intervertebral body bone grafting provide immediate cervical stabilization and widely successful in achieving fusion. Material and methods: This study analysed 14 patients who underwent a single anterior procedure and application of CSLP for the treatment of the cervical spinal disorder. Eleven patients were disc herniations and three patients were traumatic lesion. The average age of the patient was 47 years and the mean follow up periods was 20 months ranging from 13 to 27 months. Results: Ambulation was started 2nd day after the operation with the aid of the Philadelpia orthoses. Bone union was observed 13 cases on average 12 weeks after operation. The one case was nonunion with plate breakage without clinical symptom. Conclusion: Anterior fusion with CSLP are thought to be a safe and valuable method for treating cervical spine disorder.

• Journal of Korean Neurosurgical Society
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• v.67 no.3
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• pp.354-363
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• 2024

Objective : This study aims to determine the optimal dose of recombinant-human bone morphogenic protein-2 (rhBMP-2) for successful bone fusion in minimally invasive lateral lumbar interbody fusion (MIS LLIF). Previous studies show that rhBMP is an effective alternative to autologous iliac crest bone graft, but the optimal dose remains uncertain. The study analyzes the fusion rates associated with different rhBMP doses to provide a recommendation for the optimal dose in MIS LLIF. Methods : Ninety-three patients underwent MIS LLIF using demineralized bone matrix (DBM) or a mixture of rhBMP-2 and DBM as fusion material. The group was divided into the following three groups according to the rhBMP-2 usage : group A, only DBM was used (n=27); group B, 1 mg of rhBMP-2 per 5 mL of DBM paste (n=41); and group C, 2 mg of rhBMP-2 per 5 mL of DBM paste (n=25). Demographic data, clinical outcomes, postoperative complication and fusion were assessed. Results : At 12 months post-surgery, the overall fusion rate was 92.3% according to Bridwell fusion grading system. Groups B and C, who received rhBMP-2, had significantly higher fusion rates than group A, who received only DBM. However, there was no significant increase in fusion rate when the rhBMP-2 dosage was increased from group B to group C. The groups B and C showed significant improvement in back pain and Oswestry disability index compared to the group A. The incidence of screw loosening was decreased in groups B and C, but there was no significant difference in the occurrence of other complications. Conclusion : Usage of rhBMP-2 in LLIF surgery leads to early and increased final fusion rates, which can result in faster pain relief and return to daily activities for patients. The benefits of using rhBMP-2 were not significantly different between the groups that received 1 mg/5 mL and 2 mg/5 mL of rhBMP-2. Therefore, it is recommended to use 1 mg of rhBMP-2 with 5 mL of DBM, taking both economic and clinical aspects into consideration.

• Journal of Biomedical Engineering Research
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• v.27 no.5
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• pp.210-217
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• 2006

Many types of interspinous distraction devices (IDDs) have been recently developed as an alternative surgical treatment to laminectomy and fusion with pedicle screws for the treatment of the lumbar spinal stenosis (LSS). They are intended to keep the lumbar spine in a slightly flexed posture to relieve pain caused by narrowing of the spinal canal and vertebral foramen. However, their biomechanical efficacies are not well known. In this study, we evaluated the kinematic behaviors and changes in intradiscal pressure (IDP) of the porcine lumbar spine implanted with IDD. For kinematics analysis, five porcine lumbar spines (L2-L6) were used and the IDD was inserted at L4-L5. Three markers (${\phi}{\le}0.8mm$) were attached on each vertebra to define a rigid body motion for stereophotogrammetric assessment of the spinal motion in 3-D. A moment of 7.5Nm in flexion-extension, lateral bending, and axial rotation were imparted with a compressive force of 700N. Then, IDD was implanted at L3-L4. IDPs were measured using pressure transducer under compression (700N) and additional extension moment (700N+7.5Nm). In kinematic behaviors, insertion of IDD resulted in statistically significant decrease 42.8% at the implanted level in extension. There were considerable changes in ROM at the adjacent levels, but statistically insignificant. In other motions, there were no significant changes in ROM as well regardless of levels. IDPs at the surgical level (L3-L4) under compression and extension moment decreased by 12.9% and 18.8% respectively after surgery (p<0.05). At the superiorly adjacent levels, IDPs increased by 19.4% and 12.9% under compression and extension, respectively (p<0.05). Corresponding changes at the inferiorly adjacent levels were 29.4% and 6.9%, but they were statistically insignificant (p>0.05). The magnitude of pressure changes due to IDD, both at the operated and adjacent levels, were far less than the previously reported values with conventional fusion techniques. Our experimental results demonstrated the IDDs can be very effective in limiting the extension motion that may cause narrowing of the spinal canal and vertebral foramens while maintaining kinematic behaviors and disc pressures at the adjacent levels.

• Journal of Korean Neurosurgical Society
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• v.62 no.1
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• pp.96-105
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• 2019

Objective : The aims in the management of thoracolumbar spinal fractures are not only to restore vertebral column stability, but also to obtain acceptable alignment of the thoracolumbar junction (T-L junction) to prevent complications. However, insufficient surgical correction of the thoracolumbar spine would be likely to cause late progression of abnormal kyphosis. Therefore, we identified the surgical factors that affected unfavorable radiologic outcomes of the thoracolumbar spine after surgery. Methods : This study was conducted in a single institution from January 2007 to December 2013. A total of 98 patients with unstable thoracolumbar spine fracture were included. In these patients, fixation was done through transpedicular screws with rods by three surgical patterns. We reviewed digital radiographs and analyzed the images preoperatively and postoperatively during follow-up visits to compare the change of the thoracolumbar Cobb angle with radiologic parameters and clinical outcomes. The unfavorable radiologic group was defined as the patients who were measured as having greater than 20 degrees of thoracolumbar Cobb angle on the last follow-up, or who underwent kyphotic progression of thoracolumbar Cobb angle greater than 10 degrees from the immediate postoperative state to final follow-up, or who had overt instrument failure with/without additional surgery. We assessed the risk factors that affected the unfavorable radiologic outcomes. Results : We had 43 patients with unfavorable radiologic outcomes, including 35 abnormal thoracolumbar alignments and 14 instrumental failures with/without additional surgery. The multivariate logistic regression test showed that immediate postoperative T-L junction Cobb angle less than 10.5 degrees was a statistically significant risk factor, as well as the presence of osteoporosis (p=0.017 and 0.049, respectively). Conclusion : Insufficient correction of thoracolumbar kyphosis was considered to be a major factor of an unfavorable radiological outcome. The spinal surgeon should consider that having a T-L junction Cobb angle larger than 10.5 degrees immediately after surgery could result in an unfavorable radiological outcome, which is related to a poor clinical outcome.

• Journal of Korean Clinical Nursing Research
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• v.22 no.3
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• pp.345-351
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• 2016

Purpose: The specific aims of this study were to investigate the incidence, time of occurrence, intervention methods and related causes of abdominal discomfort after scoliosis corrective surgery. Methods: A retrospective review was carried out on all patients with diagnosis of adolescent idiopathic scoliosis (n=420) who received a posterior spinal fusion between January 2012 and December 2014. Logistic regression analysis was used to identify significant related factors. Results: One hundred eighty five of the patients in the study (44.0%) reported abdominal discomfort (AD group). The discomfort was worst on 2nd days after operation (31.4%), and 3rd days (27.0%). Ninety seven patients (52.4%) in the AD group received enema treatment. Significant related factors for developing abdominal discomfort were distal fusion levels (OR=2.43, p<.006) and increased operative blood loss (OR=1.03, p<.001). Conclusion: The incidence of abdominal discomfort after scoliosis corrective surgery in this study was 44%. Abdominal discomfort, therefore, is a main concern in reference to scoliosis corrective surgery, and solutions need to be searched and reported in future research.