상지의 신경초종의 적출술 후 신경학적 결손

강진우,이용석,김철규,신승한,정양국 대한수부외과학회 2017 대한수부외과학회지 Vol.22 No.1

Purpose: Neurologic deficits after enucleation of schwannoma are not rare. To evaluate the neurologic deficits after surgical enucleation of schwannoma in the upper extremity, we performed a retrospective review of patients with surgically treated schwannoma over a 14-year period at a single institution. Methods: Between March 2001 and September 2014, 103 patients underwent surgical enucleation for schwannomas; 36 patients of them had lesions in the upper extremity, and 2 out of 36 patients had multiple schwannomas. Each operation was performed by a single surgeon under loupe magnification. The postoperative neurological deficits were graded as major and minor in both immediate postoperatively and at last follow-up. The major deficit was defined as anesthesia or marked hypoesthesia, motor weakness of grade 3 or less and neuropathic pain. Minor deficit was defined as mild symptoms of mild hypoesthesia, paresthesia and motor weakness of grade 4 or more. Results: There were 2 major (2 mixed nerve) and 12 minor (4 motor, 7 sensory, 1 mixed nerve) neurologic deficits after surgery. At the last follow-up, one major mixed neurologic deficit remained as major motor and minor sensory, and other major ones changed to mixed minor. And all minor deficits except 1 sensory deficit were recovered spontaneously. Conclusion: Even though high incidence rate of neurologic deficit after enucleation of schwannoma in the upper extremity (38.9%), about three fourths of them were recovered spontaneously. There were 3 permanent neurologic deficits, and one of them was major one. In some cases, surgeon cannot avoid to encounter a neurological deficit. So we recommend more delicate microscopic surgical procedure and preoperative planning and counseling. And surgery is indicated for only symptomatic lesions. 목적: 신경초종의 적출술 후에 신경학적 결손이 발생하는 경우가 드물지 않다. 상지에서의 신경초종 적출술 후 신경학적 결손 발생 여부를 분석하고자, 저자들은 본원에서 14년 동안 수술적으로 절제한 신경초종 환자를 후향적으로 분석하였다. 방법: 2001년부터 2014년까지 103명의 환자가 신경초종 적출술을 시행 받았으며, 그 중에 36명이 상지에 병변이 있었고, 다발성 신경초종 환자는 2명이었다. 모든 수술은 한 명의 정형외과 전문의에 의해 확대경하에 시행되었다. 수술 후신경학적 합병증은 주 합병증과 부 합병증으로 구분하였으며 주 합병증은 상당한 정도의 감각 이상, 3등급 이하의 운동기능 저하, 신경성 통증이 있을 때로 정의하였다. 결과: 2명이 주 합병증, 12명이 부 합병증을 보였으며, 최종 추시에서 혼합신경(mixed nerve) 주 합병증을 보였던 한 명은 운동 기능 저하가 여전히 M3 이하였으나 감각 기능 저하는 경도로 호전되었고, 혼합신경 주 합병증을 보였던 다른한 명은 증상이 부분적으로 호전되어 혼합신경 부 합병증으로 평가되었다. 부 합병증을 보였던 12명 중 11명은 완전히회복되었고 한 명에서는 경도의 감각 신경 이상이 남았다. 결론: 신경초종의 적출술 후 신경학적 결손의 발생 가능성이 적지 않으므로 술자는 수술 전 환자와의 충분한 면담을 통해 수술을 계획하고 종양 절제의 섬세한 미세 수술적 술기를 사용하여야 한다. 또한 수술은 증상이 있을 때만 시행되어야 한다.

Delayed Neurological Deficits after Osteoporotic Vertebral Fractures: Clinical Outcomes after Surgery

Yip-Kan Yeung,Sheung-Tung Ho 대한척추외과학회 2017 Asian Spine Journal Vol.11 No.6

Study Design: Retrospective cohort. Purpose: To review the clinical presentation of operated patients with delayed neurological deficits after osteoporotic vertebral fractures (OVFs). Overview of Literature: Delayed neurological deficits can occur from 1 week to 5.7 months after OVFs. Baba has reported 78% good-to-excellent improvement (i.e., ≥50%) after 20 posterior (Cotrel-Dubousset) and 7 anterior (Kaneda in 4, Zielke ventral derotational spondylodesis in 2, and un-instrumented anterior fusion in 1) fusions. Predictive factors for neurological deficits include burst type, vacuum sign, kyphosis, angular instability, and retropulsion. Methods: Patients with neurological deficits after OVF who received spinal operations between 2000 and 2016 were included. Results: Totally, 28 patients with a mean age of 77 years underwent surgery. Neurological deficits occurred at an average of 5.4 weeks after the onset of back pain. The most common site was L1. Burst fracture was present in 14 patients and vacuum sign in seven. Surgery was performed within an average of 3.9 days of the onset of neurological deficit. Baba’s score improved significantly from 5.96 to 9.81, with good-to-excellent improvement in 18 (64%) patients. Better outcomes based on Baba’s scores (improvement>60% [median]) were associated with compression fractures, preoperative retropulsion of <41%, and correction of >16%. Poor improvement in Baba’s scores (<25%) was associated with surgical complications and burst fracture type. Twenty-two patients (79%) regained walking ability, and seven of 15 (47%) patients demonstrated improved sphincter control at the latest follow-up. Six Frankel grade B patients did not achieve neurological recovery, four of whom exhibited postoperative surgical complications and died at 2 years because of medical problems. Implant migration occurred in six patients, albeit this was of no clinical significance. Conclusions: Although OVFs are commonly considered benign, delayed neurological deficits can occur. The significant improvement in clinical function after surgery for neurological deficits is associated with compression (and not burst) fractures, lack of surgical complications, and optimal restoration of retropulsion.

신경학적 증상을 동반한 흉요추 골절에서 후방 유합술: 유합술과 감압술 추가한 군과의 비교

손홍문,유재원,박상수,김보선,정성 대한척추외과학회 2016 대한척추외과학회지 Vol.23 No.1

Study Design: A retrospective study. Objectives: To understand the necessity of additional posterior decompression when treating a patient with posterior fusion for thoracolumbar fractures with a neurologic deficit. Summary of Literature Review: Additional posterior decompression is still controversial when treating a patient with posterior fusion for thoracolumbar fractures with neurologic a deficit. Materials and Methods: 40 patients who underwent posterior fusion surgery for thoracolumbar fractures with a neurologic deficit were evaluated. The posterior fusion group (Group 1) included 23 patients (M:F=14:9), and the posterior decompression with laminectomy and posterolateral fusion group (Group 2) included 17 patients (M:F=9:8). According to the Frankel grade, the most common neurologic deficit was grade D in both groups. Unstable burst fractures were the most commonly observed fractures in both groups according to the McAfee classification. A radiographic evaluation was carried out along with a comparison of the spinal canal encroachment and the kyphotic angle. We evaluated neurologic improvement as the clinical criterion. Results: The l-kyphotic angle at last follow-up was smaller than the preoperative kyphotic angle in both groups. The preoperative canal encroachment was 53.4% (Group 1) and 59.8% (Group 2). Further, neurologic improvement was observed in 19 cases (Group 1) and 14 cases (Group 2). There was no significant difference in the proportion of cases with neurologic improvement between the two groups (improvement in 19 cases in Group 1 and in 14 cases in Group 2) (p<0.05). Further, the preoperative canal encroachment, kyphotic angle, and final neurologic improvement showed no significant correlations between the two groups (p>0.05). Conclusion: We concluded that additional posterior decompression in the case of thoracolumbar fractures with neurologic deficit is not required for neurologic improvement. 연구 계획: 후향적 연구. 목적: 신경학적 증상이 있는 흉요추 골절환자에서 후방 유합술을 시행한 군과 추가적인 후방 감압술을 시행한 군을 비교하여 신경 증상의 호전을 위한 추가적인 후방 감압술의 필요성에 대해 알아보고자 하였다. 선행 문헌의 요약: 신경학적 증상이 있는 흉요추 골절환자에서 후방 감압술에 대한 명확한 적응증 및 일치된 의견은 확립되지 않았다. 대상 및 방법: 2004년 1월부터 2012년 6월까지 신경학적 증상을 동반한 흉요추부 골절로 수술적 치료를 시행받은 40예를 대상으로 하였다. 후방 유합술만시행 받은 23(남:여=14:9)예를 제 1군으로, 추가적인 후방 감압술을 시행 받은 17(남:여=9:8)예를 제 2군으로 하였다. 손상 부위는 두 군 모두 요추 1번이 가장많았으며 McAfee분류에 따른 골절 분류상 두 군 모두 불안정성 방출성 골절이 많았다. Frankel 등급에 따른 술 전 신경학적 증상은 등급 D 가 두 군 모두 가장많았다. 방사선학적 평가는 수상 당시와 술 후, 최종 추시때의 척추관 함입률과 후만각의 변화를 측정하였고 임상적 평가는 신경학적 호전 정도를 평가하였다. 결과: 후만각의 변화는 술전에 비해 최종 추시시 두 군 모두 호전되었으며 척추관 함입률은 제 1군에서 술전 53.4%, 제 2군에서 술전 59.8%였다. 최종 추시때 제 1군에서 신경 증상의 호전 19예, 제 2군에서 신경 증상의 호전 14예로 두 군간에 의의 있는 신경학적 호전의 차이는 없었다. 하지만 두 군에 따른 척추관 함입률 및 후만각의 변화와 최종 신경학적 증상 호전과의 상관 관계는 없었다(p>0.05). 결론: 신경학적 증상을 동반한 흉요추 골절에서 신경학적 호전을 위한 추가적인 후방 감압술은 반드시 필요한 술식은 아니라고 사료된다.

신경증상을 동반한 흉요추 이행부의 골다공증성 척추 골절의 수술적 치료 : 수술 방법에 따른 결과 분석 Comparative Analysis of the Results According to the Surgical Methods

김환정,강종원,염진섭,김규현,김갑종,이성훈,최원식 대한척추외과학회 2003 대한척추외과학회지 Vol.10 No.3

신경학적 증상을 동반한 흉요추 및 요추 골절에서 후방 감압술 후 추가적인 전방 감압술이 필요한가?

유재원,손홍문,박상수 대한척추외과학회 2012 대한척추외과학회지 Vol.19 No.2

Study Design: A retrospective study. Objectives: To understand the necessity of additional anterior decompression when treating with posterior decompression for thoracolumbar and lumbar fractures, with neurologic deficit. Summary of Literature Review: Additional anterior decompression is still a controversy after a posterior decompression Materials and Methods: We evaluated 38 patients who were treated with a decompression surgery for thoracolumbar and lumbar spine fractures with neurologic deficit. In the posterior decompression group, there were 26 patients, and there were 12 patients in the posterior and anterior decompression group. According to the Frankel grade, neurologic deficit was grade A 3, B 1, C 3, D 31, respectively. Unstable burst fractures were 22, flexion-distraction injuries 12, Chance fractures 2 and translational injuries 2 by the McAfee classification. Radiographic evaluation was carried out with comparison of the spinal canal encroachment and kyphotic angle. We evaluated the improvement of neurology, and compared with that of the preoperative canal encroachment. Results: During the posterior decompression, 5 neural injuries were found in the post. decompression group, and 4 in the post. and ant. decompression group. There was no significant difference of neurologic improvement between the two groups (improvement in 18(69%)and 8(67%), respectively) (p>0.05). Preoperative canal encroachment was 62% and 76%, respectively. But, preoperative canal encroachment and final neurologic improvement showed no significant correlations between the two groups (p>0.05). Conclusions: We could not find the difference of neurologic improvement between the post. decompression group and post. and ant. decompression group. We suggest that an additional ant. decompression for the thoracolumbar and lumbar spine fractures treated with post. decompression is not necessary. 연구계획: 후향적 연구목적: 신경학적 증상을 동반한 흉요추 및 요추 골절환자에서 후방 감압술로 치료한 후 신경증상의 호전을 위해서 전방 감압술이 추가적으로 필요한 지에 대해서 알아보고자 하였다. 선행문헌의 요약: 후방 감압술 후 척추관내 골편이 남아있는 경우 전방 감압술이 필요한지에 대한 일치된 의견은 확립되지 않았다. 대상 및 방법: 신경학적 증상을 동반한 흉요추부 및 요추 골절로 인해 수술적 치료를 받은 환자 중 1년 이상 추시 관찰이 가능하였던 38예를 대상으로하였다. 후방 감압술과 유합술만 받은 예는 26예, 전 후방 감압술을 받은 예는 12예 이었다. 신경학적 증상은 Frankel grade A가 3예, B가 1예, C가 3예,D가 31예 이었다. 골절의 분류는 McAfee 등의 분류에 따라 불안정성 방출성 골절 22예, 굴곡 신연 손상 12예, Chance 골절 2예, 전이성 손상 2예 이었다. 방사선학적 평가는 양군의 척추관 함입률과 후만각을 비교하였으며, 수술 전 척추관 함입률과 신경학적 호전의 정도를 비교하였다. 결과: 수술 소견상 신경근 손상은 후방 감압술군 5예에서, 전후방 감압술군 4예에서 확인되었다. 후방 감압술군에서 호전 18예(69%), 무변화 8예(31%)이었으며 전 후방 감압술 군에서 호전 8예(67%), 무변화 4예(33%)를 보여 두 군간에 의의 있는 신경학적 호전의 차이는 없었다(p>0.05). 수술 전 척추관함입률은 후방 감압술군 62%, 전후방 감압술군 67%로 전후방 감압술 군에서 척추관 함입이 많았으나, 수술 전 척추관 함입률과 최종 신경학적 증상의호전과는 두 군간에 의의 있는 차이는 없었다(p>0.05). 결론: 신경학적 증상을 동반한 흉요추 및 요추 골절의 치료에서 후방 감압술과 전후방 감압술의 신경 호전의 정도는 차이가 없었으며 신경 호전을 위한추가적인 전방 감압술은 꼭 필요한 술식은 아니라고 사료됩니다.

재활병동으로 전과된 뇌종양 환자들의 특징과 기능 회복: 뇌경색과 비교

김하정,전민호,이숙정,김대열 대한재활의학회 2010 Annals of Rehabilitation Medicine Vol.34 No.3

Objective: To compare and discuss functional outcome and neurologic deficits of patients with either brain tumor or ischemic stroke after inpatient rehabilitation. Method: Sixty-two, brain tumor patients (32 benign and 30 malignant) admitted for inpatient rehabilitation during a five-year period and 70 acute ischemic stroke patients were enrolled. We retrospectively investigated their functional status at admission and discharge, the functional gain as measured by the Korean version of modified Bathel index (K-MBI) instrument, and their common neurologic deficits. Results: The K-MBI score at discharge was significantly improved in both groups (70.2 vs. 61.5). However, the K-MBI score at admission was found to be higher in the brain tumor group (45.3 vs. 35.5), whereas no significant differences were found in the K-MBI score at discharge or in the gain or efficiency of the K-MBI score. In the tumor group, the K-MBI score at discharge and the gain of the K-MBI score were significantly higher in the benign brain tumor patients. The most common neurologic deficit was motor weakness, followed by impaired cognition and cranial nerve palsy. The frequency of these deficits was more common in the ischemic stroke patients, although there were no differences between benign and malignant brain tumor groups. Brain tumor patients not receiving radiation therapy and having higher K-MBI scores at admission showed greater functional improvement (p<0.01). Conclusion: Brain tumor patients can achieve comparable functional outcomes to ischemic stroke patients, and our study supports the benefits of comprehensive rehabilitation irregardless of a patient’s tumor type. (J Korean Acad Rehab Med 2010; 34: 290-296) Objective: To compare and discuss functional outcome and neurologic deficits of patients with either brain tumor or ischemic stroke after inpatient rehabilitation. Method: Sixty-two, brain tumor patients (32 benign and 30 malignant) admitted for inpatient rehabilitation during a five-year period and 70 acute ischemic stroke patients were enrolled. We retrospectively investigated their functional status at admission and discharge, the functional gain as measured by the Korean version of modified Bathel index (K-MBI) instrument, and their common neurologic deficits. Results: The K-MBI score at discharge was significantly improved in both groups (70.2 vs. 61.5). However, the K-MBI score at admission was found to be higher in the brain tumor group (45.3 vs. 35.5), whereas no significant differences were found in the K-MBI score at discharge or in the gain or efficiency of the K-MBI score. In the tumor group, the K-MBI score at discharge and the gain of the K-MBI score were significantly higher in the benign brain tumor patients. The most common neurologic deficit was motor weakness, followed by impaired cognition and cranial nerve palsy. The frequency of these deficits was more common in the ischemic stroke patients, although there were no differences between benign and malignant brain tumor groups. Brain tumor patients not receiving radiation therapy and having higher K-MBI scores at admission showed greater functional improvement (p<0.01). Conclusion: Brain tumor patients can achieve comparable functional outcomes to ischemic stroke patients, and our study supports the benefits of comprehensive rehabilitation irregardless of a patient’s tumor type. (J Korean Acad Rehab Med 2010; 34: 290-296)

정신분열병 환자의 인지 기능 장애와 연성 신경학적 징후

김재경,이상익,홍경수,안소연,김지혜,김이영 大韓神經精神醫學會 2001 신경정신의학 Vol.40 No.5

연구목적 : 정신분열병 환자는 인지 기능의 장애와 연성 신경학적 징후의 이상 소견을 보이며, 이는 병태 생리 과정에서 중추신경계의 기질적 이상을 시사하는 소견으로 받아들여져 왔다. 본 연구는 인지 기능 장애와 연성 신경학적 징후가 정신분열병 환자에서 임상 상태나 치료 약물과는 독립적인 질병특성 표지자로서 나타나는지를 확인하고자 하였다. 또한 인지 기능 장애와 연성 신경학적 징후가 고위 인지 기능의 조정곤란 현상으로 상관관계가 있는지의 여부를 검증하고자 하였다. 방 법 : 정신병적 증상을 나타내고 있는 20명의 정신분열병 환자를 대상으로, 항정신병 약물 치료 전과3주 이상 치료 후 각각 Trail Making A, B, Stroop Test, Word Fluency Test로 인지 기능을 평가하고, Cambridge Neurological Inventory(Part 2)를 이용하여 연성 신경학적 징후를 측정하였다. 임상 증상은 Positive and Negative Syndrome Scale(PANSS)과 Clinical Global Impression(CGI)으로, 추체외로계 부작용은 Extrapyramidal Symtoms Rating Scale로 평가하였다. 대조군으로는 환자와 성별, 연령, 학력 및 지능 수준이 같은 정상인 20명을 선정하여 환자군에서와 같은 방법으로 인지 기능 및 연성 신경학적 징후를 평가하였다. 결 과 : 정신분열병 환자군은 치료 전 평가 결과, 인지 기능검사에서는 Trail Making A, B, Stroop Test, Word Fluency Test 모든 항목에서 대조군에 비해 유의하게 낮은 성적을 나타내었다. 연성 신경학적 징후 평가에서는 Grasp reflex, Go/no-go, Finger thumb opposition, Rhythm tapping, Finger agnosia, Fist-edge-palm, Left-right orientation, Extinction의 8가지 항목에서 대조군에 비해 유의한 장애를 나타내었다. 환자군에서 임상 증상은 치료 전후에 유의한 호전을 보였으나 인지 기능에서는 모든 항목에서 유의한 차이를 보이지 않았으며, 연성 신경학적 징후에서도 치료 전 대조군과 차이를 보였던 8개 항목 중에 Go/no-go, Finger agnosia 항목을 제외한 6개 항목에서 유의한 차이를 보이지 않았다. 연성 신경학적 징후 중 Rhythm tapping이 치료 전후로 인지 기능과 유의한 상관관계를 나타내었다. 결 론 : 연성 신경학적 징후와 인지적 조정곤란은 정신분열병에서 임상 증상 및 약물에 의해 영향을 받지 않는 질병특성 표지자임이 시사되었다. Rhythm tapping에서 이들 두 가지 결함의 관련성이 시사되었다. Objectives : Clinical studies have shown cognitive dysfunctions and soft neurological signs in schizophrenic patients and these findings have been suggested as evidence of organic bases in the pathophysiology of schizophrenia. This study was intended to investigate the characteristics of cognitive deficits and soft neurological signs in schizophrenia and, to determine whether any abnormality in these functions can be regarded as a trait marker of the illness which is independent of antipsychotic treatment and clinical improvement. We also investigated the correlation between cognitive deficits and soft neurological signs reflecting cognitive dysmetria, respectively. Methods : Twenty schizophrenic patients were assessed for the soft neurological signs and cognitive functions before and after neuroleptic treatment. The patients had been medicated for at least 3 weeks with one of the atypical neuroleptics. Cognitive functions were evaluated by Trail making A, B, Stroop test and Word fluency test. Soft neurological signs were assessed by Cambridge Neurological Inventory(Part 2). Positive and Negative Syndrome Scale(PANSS) and Clinical Global Impression(CGI) were used to assess the clinical severity and Extrapyramidal Symtoms Rating Scale was used to estimate the extrapyramidal symptoms. Cognitive functions and soft neurological signs of twenty normal controls were assessed with the same scale. Results : Before treatment, schizophrenic patients showed significant impairments on cognitive function tests(Trail Making A, B, Stroop Test) and soft neurological sign tests(8 items : Grasp reflex, Go/no-go, Finger thumb opposition, Rhythm tapping, Finger agnosia, Fist-edge-palm, Left-right orientation, Extinction). Although significant clinical improvements were observed after the treatment, there were no significant changes in cognitive functions and soft neurolo-gical signs(except for Go/no-go test and Finger agnosia). Among the soft neurological signs of the patients, abnormality in Rhythm tapping was significantly correlated with cognitive deficits. Conclusion : Schizophrenic patients showed characteristic cognitive deficits and soft neurological signs which were independent of medication and clinical symptoms. And these two characteristics were partly correlated with each other.

혈액학적 불안정과 신경증상이 동반된 요추부 골절-탈구 환자에서 최소침습적 수술 - 증례보고 -

민상혁,박영호 대한척추외과학회 2013 대한척추외과학회지 Vol.20 No.4

Study Design: A case report. Objectives: In patients with fracture-dislocation of the lumbar spine with neurologic deficit and hemodynamic instability, minimally invasive surgery made/produced good clinical results. So the authors have reported the results with literature review Summary of Literature Review: In patients with unstable lumbar spine fracture-dislocation, early surgical treatment has been preferred due to its many advantages of anatomical reduction, nerve decompression, recovery of nerve function, and early rehabilitation, etc. But for patients with unstable lumbar spine fracture-dislocation and who are hemodynamically unstable, the surgical treatment is generally delayed, so there are many cases that cannot fulfill the expectation of neurologic recovery. Materials and Methods: In patients with unstable lumbar 2-3 spine fracture-dislocation and who are hemodynamically unstable, applying the concept of stage operation, postural reduction and minimal invasive percutaneous pedicle screw fixation were conducted as soon as possible. Then after recover of general condition, decompression and posterior fusion were conducted as a second stage operation. Results: After the first stage operation, motor grade was improved from 3 to 4 below the L3 spine level in postoperative physical examination. The second stage operation was conducted two weeks later and neurologic symptom was more improved after the second stage operation. Conclusions: In patients with lumbar spine fracture-dislocation having hemodynamic instability and neurologic deficit, early minimally invasive fixation for reducing complications of open reduction and internal fixation may contribute to improving general conditions and recovery of neurologic deficits. 연구 계획: 증례 보고. 목적: 혈액학적 불안정과 신경증상이 동반된 요추 골절-탈구 환자에서 최소침습적 고정수술로 좋은 임상결과를 얻었기에 문헌고찰과 함께 보고하는 바이다. 선행문헌의 요약: 불안정성 요추 골절-탈구 환자에서 빠른 수술적 치료는 해부학적 정복, 신경 압박에 대한 감압, 신경기능의 회복, 조기 재활 등의 장점이 있어 선호되고 있다. 하지만 혈액학적으로 불안정한 요추 골절-탈구 환자에서는 수술적 치료가 지연되고, 그로 인해 만족할 만한 신경학적 회복의 기대를 이루지 못하는 경우가 많다. 대상 및 방법: 혈액학적으로 불안정한 제2-3 요추 골절-탈구 환자에서 최소침습적 방법으로 가능한 한 조기에 일차적 수술로 체위 정복술 및 경피적 척추경 나사못 고정술 시행하였으며, 전신상태가 회복된 후 이차적으로 신경 감압술 및 척추체 유합술을 시행하였다. 결과: 일차적 수술 후 이학적 검사상 요추 3번 이하로 motor grade 3에서 4로 호전되는 양상을 보였다. 술 후 2주째 이차적으로 수술을 행하였으며, 술후 신경학적 증상이 좀더 호전되었다. 결론: 혈액학적 불안정과 신경증상이 동반된 요추 골절-탈구 환자에서 개방적 정복술과 내고정술로 인한 전신적인 합병증을 줄이기 위해서 조기에 최소침습적 고정 수술은 환자의 전신상태를 호전시키고 신경학적 증상의 회복에도 도움을 줄 수 있을 것으로 생각된다.

Factors Affecting Early and 1-Year Motor Recovery Following Lumbar Microdiscectomy in Patients with Lumbar Disc Herniation: A Prospective Cohort Review

Vibhu Krishnan Viswanathan,Rajasekaran Shanmuganathan,Siddharth Narasimhan Aiyer,Rishi Kanna,Ajoy Prasad Shetty 대한척추외과학회 2019 Asian Spine Journal Vol.13 No.1

Study Design: Prospective cohort study. Purpose: The study was aimed at evaluating clinicoradiological factors affecting recovery of neurological deficits in cases of lumbar disc herniation (LDH) treated by lumbar microdiscectomy. Overview of Literature: The majority of the available literature on neurological recovery following neurodeficit is limited to retrospective series. The literature is currently limited regarding variables that can help predict the recovery of neurodeficits following LDH. Methods: A prospective analysis was performed on 70 consecutive patients who underwent lumbar microdiscectomy (L1–2 to L5–S1) owing to neurological deficits due to LDH. Patients with motor power ≤3/5 in L2–S1 myotomes were considered for analysis. Followup was performed at 2, 6, and 12 months to note recovery of motor deficits. Clinicoradiological parameters were compared between the recovered and nonrecovered groups. Results: A total of 65 patients were available at the final follow-up: 41 (63%) had completely recovered by 2 months; four showed delayed recovery at the 6-month follow-up; and 20 (30.7%) showed no recovery at 1 year. Clinicoradiological factors, including diabetes, complete initial deficit, areflexia, multilevel disc prolapse, longer duration since initial symptoms, and ≥2 previous symptomatic episodes were associated with a significant risk of poorer recovery (p <0.05 for all). Age, sex, occupation, smoking, level/type or location of disc herniation, primary canal stenosis, disc fragment dimensions, precipitating factors, bladder involvement, bilaterality of symptoms, and the presence or absence of anal reflex did not affect neurological recovery (p >0.05 for all). Diabetes mellitus (p =0.033) and complete initial motor deficit (p =0.028) were significantly associated with delayed recovery in the multivariate analysis. Conclusions: The overall neurological recovery rate in our study was 69%. Diabetes mellitus (p =0.033) and complete initial motor deficit were associated with delayed motor recovery.

Surgical Treatment for Degenerative Lumbar Disease With Neurologic Deficits: Comparison Between Oblique Lumbar Interbody Fusion and Posterior Lumbar Interbody Fusion

Gyu Hyun Kang,Dong Wuk Son,Jun Seok Lee,Su Hun Lee,Sung Hyun Bae,Sang Weon Lee,Geun Sung Song 대한신경손상학회 2022 Korean Journal of Neurotrauma Vol.18 No.2

Objective: This study aimed to compare the radiological and clinical outcomes of oblique lumbar interbody fusion (OLIF) and posterior lumbar interbody fusion (PLIF) surgeries and to confirm the effects of additional partial laminectomy on the surgical outcomes of OLIF. Methods: This retrospective study included 130 patients who underwent OLIF or PLIF for single-level fusion. Among them, 42 patients underwent PLIF and open pedicle screw fixation and 88 underwent OLIF and percutaneous pedicle screw fixation. In the OLIF group, 42 patients received additional neural decompression through partial laminectomy and discectomy (direct OLIF), whereas the remaining 46 patients did not (indirect OLIF). To measure the neurological deficits, the clinical outcomes were evaluated using a visual analog scale for back and leg pain and the Oswestry Disability Index. Radiologic outcomes were evaluated based on the disc and foraminal heights as well as the segmental lordotic and lumbar lordotic angles. Results: The improvement in the clinical outcomes did not differ significantly among the 3 groups. Radiologically, the 2 OLIF groups showed statistically significant improvements in the disc and foraminal heights when compared with the PLIF group. The PLIF group showed a significant decrease in the disc height and segmental lordotic angle when compared with the OLIF group in the postoperative 1-year period. Conclusion: Both OLIF and PLIF showed similar clinical outcomes in the single-level lumbar fusion. However, OLIF grafts showed an advantage over PLIF with respect to the radiographic outcomes and complication rates. Additionally, partial laminectomy did not significantly affect the radiological results.