척수내 농양 1예 보고 : A Case Report

장일태,김성학,박동빈,신규만 梨花女子大學校 醫科大學 醫科學硏究所 1986 EMJ (Ewha medical journal) Vol.9 No.1

A 31 year old male was admitted to our hospital with severe upper thoracic pain, paraplegia and urinary difficulty. The patient have no history of infection or operation. At admission, neurologic examination revealed alert mental state, hypoesthesia below the level of T6 sensory dermatome. All deep tendon reflexes were hypoactive. Myelographic examination disclosed total blockage of T5 body level. ACT scan of the lumbar spine performed immediately after myelogram verified an intramedullary enlargement of the spinal cord. Laminectomy was performed from the T3 to T5. Yellowish discolorated pus was founded at the epidural space, and exuded out through dura perforation. Dura was incised and the abscess was removed. The intramedullary abscess was encountered and fibrous granulation tissue was partially enveloped the abscess. The abscess removed by repeated antibiotics mixed saline and suction. The organism from the abscess was identified as staphylococcus coagulase positive. Antibiotic therapy was continued for four weeks and steroid postoperatively. The patient's condition was slight improved sensory level, but motor power was still hemiplegia on discharge time.

[인체를 받치는 기둥, 척추] 허리가 바로 서야 몸이 바로 선다

장일태 샘터사 2004 월간 샘터 Vol.408 No.-

천막상 뇌동정맥 기형에 대한 임상적 연구

장일태,김성학,박동빈,신규만 梨花女子大學校 醫科大學 醫科學硏究所 1987 EMJ (Ewha medical journal) Vol.10 No.1

Arteriovenous malformation of the brain is a congenital abnormal communication between arterial and venous channels without the interposition of the capillary system. A retrospective clinical study was performed on 20 patients with supratentorial arteriovenous malformation during the period from September 1984 to December 1986. The 20 patients were underwent surgical treatment using the operating microscope. Followings are the results: 1) The age range of presentation of supratentorial AVM(arteriovenous malformation) was to be from 30 months to 64 years, with peak incidence of fourth decade. 2) The presenting symptoms were hemorrhage, change of consciousness, seizure, headache in order of frequency. In hemorrhage, intracerebral hematoma was the most common type. 3) The most common sites of supratentorial AVM were frontal and parietal lobe. Most of the supratentorial AVM were fed by branches of the middle cerebral artery. 4) Computerized tomographical findings of AVM were intracerebral hemorrhage and mass effect. And after injection of contrast medium, 13 out of 20 AVM showed strong enhancement. 5) After operation, 13 patients were regained nearly total function.

허혈성 뇌부종이 뇌 Energy대사에 미치는 영향에 대한 실험적 연구

장일태,신규만 대한신경외과학회 1987 Journal of Korean neurosurgical society Vol.16 No.1

The author studied the effect of the recirculation on the energy metabolism in acute focal cerebral ischemia. Acute focal cerebral ischemia was produced by transorbital occlusion, of the left middle cerebral artery with a Heifetz clip under the operating microscope. The animals were divided into three groups according to the duration of the ischemia. Each group was reperfused for 1, 4 and 7 hours by removing the clip from the artery. In 1 - hour ischemic group ATP and GTP was reduced to 38% and IMP to 40% of the sham control. After 7-hour recirculation in this group ATP was resynthesized to 85%, GTP to 85%. and IMP to 180% of the sham control. In 3-hour ischemic group ATP was reduced to 19%, GTP to 23%, and IMP to 29% of the sham control. In this group ATP, GTP and IMP rose to 43 %, 49% and 84%, respectively after 7- hour recirculation ATP, GTP and IMP were markedly reduced in 5-hour ischemic group, and despite recirculation these substances continued to decrease and none of them were detected after 7-hours of recirculation. It was suggested that the restoration of the circulation must be accomplished within 1-hour or at least within 3-hour of the ischemic insult of the cats to prevent the irreversible brain infarction.

허혈성 뇌부종으로 인한 뇌 Energy 대사변화에 대한 Methylprednisolone의 효과

장일태,김성학,박동빈,신규만,한중수 대한신경외과학회 1987 Journal of Korean neurosurgical society Vol.16 No.1

The purpose of this study is to investigate the effect of methylprednisolone(M.P.) on the alterations of ATP, sum of adenosine nucleotides, adenylate energy charge (E.G.), glucose and lactate in the cats with acute focal ischemic cerebral edema. The acute occlusion of left middle cerebral artery (MCA) of forty cats for 1, 3 and 5 hours respectively were accomplished by applying Heifetz clip through the transorbital approach operating microscope. Twelve cats were not recirculated as a untreated group, twelve cats were recirculated for 2 hours as a recirculation group and twelve cats were recirculated for 2 hours and given M.P.(15㎎/㎏) at 30 minutes after occlusion initially, and then every one and a half hour as a treatment group. The experimental results are as follows. 1) In 1-hour untreated group, ATP was reduced to 34.0%, sum of adenosine nucleotides reduced to 72.2%, adenylate E.C. reduced to 60.6%, glucose reduced to 67.3% and lactate increased to 156.6% of the control value. In the recirculation group, ATP was reduced to 42.0%, sum of adenosine nucleotides reduced to 82.4%, adenylate E.C. reduced to 74.3%, glucose increased to 552.7% and lactate decreased to 79.8%. In the treatment group, ATP was increased to 143.9%, sum of adenosine nucleotides increased to 153.9%, adenylate E.C. decreased to 92.9%, glucose increased to 3334.5% and lactate decreased to 74.6%. 2) In 3-hour untreated group, ATP was decreased to 24.9%, sum of adenosine nucleotides reduced to 22.9%, adenylate E.C. reduced to 58.6%, glucose decreased to 45.5% and lactate increased to 161.3% of the control value. In the recirculation group, ATP reduced to 32.9%, sum of adenosine nucleotides reduced to 28.6%, adenylate E.C. reduced to 71.4%, glucose rose to 520.0% and lactate to 135.3% of the control value. In the treatment group, ATP reduced to 99.5%, sum of adenosine nucleotides increased to 103.5 %, adenylate E.C. decreased to 84.3 %, glucose rose to 1187.3% and lactate increased to 101.2%. 3) In 5-hour untreated group, ATP decreased to 5.3%, sum of adenosine nucleotides reduced to 9.0%, adenylate E.C. reduced to 58.6%, glucose decreased to 25.5% and lactate increased to 187.9%. In the recirculation group, ATP decreased to 4.4%, sum of adenosine nucleotides decreased to 5.8%, adenylate E.C. decreased to 57.1%. In the treatment group, ATP was reduced to 11.2%, sum of adenosine nucleotides and adenylate E.C. reduced to 70.0%, glucose rose to 103.6% and lactate to 157.2% of the control value. As the results shown above, the therapeutic beneficial effects of M.P. were observed in cats of 1 or 3-hour occlusion of MCA with 2-hour recirculation.

Analysis of Adjacent Fractures after Two-Level Percutaneous Vertebroplasty: Is the Intervening Vertebral Body Prone to Re-fracture?

한석,장일태 대한척추외과학회 2018 Asian Spine Journal Vol.12 No.3

Study Design: Retrospective study. Purpose: This retrospective study aimed to determine the incidence of adjacent level new fractures in a sandwich constellation (one or two untreated vertebrae between two cemented vertebrae) compared with that in other constellations formed by two-level percutaneous vertebroplasty (PVP). It also aimed to investigate the potential factors contributing to adjacent new fractures in a sandwich constellation. Overview of Literature: There are few studies regarding the intervening intact vertebral body between two cemented vertebrae. Clinical data from previous studies investigation this sandwich situation, too, have been vague. Methods: Clinical data were obtained from 132 patients who had two cemented vertebral bodies, irrespective of whether they had undergone one or two PVP sessions between January 2013 and June 2016 at a single institution. Cases with one or two intact vertebral levels between the two cemented vertebrae were classified into group 1 (n=47), and cases with two consecutive cemented bodies or more than three levels of intervening configurations were classified into group 2 (n=85). Demographic data and radiological parameters for new fractures after PVP were compared between the two groups, and the rates of subsequent adjacent fractures were investigated. Results: The incidence of single-level sandwich constellations was quite uncommon (7.7%). The overall incidences of adjacent fracture were 29.8% (14/47) in group 1 and 14.1% (12/85) in group 2. This difference was statistically significant (p =0.03). Approximately 80% (11/14) of the adjacent new fractures in group 1 developed at an intervening level. The patient demographics and radiological parameters for subsequent fractures after PVP did not statistically correlate with the risk of adjacent new fractures in group 1. Conclusions: Because they were subjected to double-load shifts, sandwich constellations were prone to re-fractures after PVP. These vertebral configurations required more aggressive management for osteoporosis.

Rod Fracture Causing Relief of Back Pain That Developed After Adult Lumbar Degenerative Flat-Back Correction Surgery: A Case Report

최정훈,장지수,장일태 대한척추신경외과학회 2019 Neurospine Vol.16 No.4

A 73-year-old woman underwent deformity correction surgery (anterior lumbar interbody fusion of L2-L3-L4-L5-S1, pedicle subtraction osteotomy at L4, and posterior screw fixation from T10 to the pelvis) due to lumbar degenerative flat-back. Following the operation, the patient experienced pain in her back and buttocks, for which she regularly took medications. She reported frequently feeling a heavy and stretched sensation of pain after the operation in those areas, which made her regret undergoing the operation. However, at 33 months postoperatively, she reported that one day, while getting up from a chair, she felt a crack in her back, which was followed by an improvement in her back and buttock pain; thereafter, she stopped taking pain medications. Follow-up radiography revealed a bilateral rod fracture at the L4–5 level on the right side and at the L3–4 level on the left side. The overall pelvic parameters, except pelvic incidence, slightly changed after the rod fracture. Therefore, the broken rod was replaced and another rod was added to the broken rod area; however, the changed pelvic parameters were not corrected further during the reoperation. Following the reoperation, the patient showed improvements and she no longer required pain medication.

Commentary on “Complications and Management of Endoscopic Spinal Surgery”

김현성,Pang Hung Wu,장일태 대한척추신경외과학회 2023 Neurospine Vol.20 No.1

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A Narrative Review of Development of Full-Endoscopic Lumbar Spine Surgery

Pang Hung Wu,김현성,장일태 대한척추신경외과학회 2020 Neurospine Vol.17 No.sup.

In the first phase of development of lumbar endoscopic spine surgery, the focus was on removal of soft disc material through the working corridor of Kambin’s triangle using transforaminal endoscopic lumbar discectomy. With the introduction of the interlaminar approach and increased interest from both industry and surgeons, there has been an exponential development of endoscopic surgical equipment and a corresponding expansion of endoscopic techniques. Endoscopic treatment strategies are applied to conditions ranging from contained prolapsed intervertebral discs to noncontained migrated herniated discs, hard calcified discs, spinal stenosis in the central or lateral recess and the foraminal and extraforaminal region, and other combinations of degenerative conditions requiring decompression or fusion surgery. The further expansion of endoscopic surgical management involving complicated spinal cases and the final quartet of trauma, infections, tumors, and possibly deformities could be the future stage of endoscopic spine surgery development. This article covers the full range of current treatment strategies and presents possible future developments of endoscopic spine surgery for the management of lumbar spinal conditions.

Lumbar Endoscopic Unilateral Laminotomy for Bilateral Decompression Outside-In Approach: A Proctorship Guideline With 12 Steps of Effectiveness and Safety

김현성,Pang Hung Wu,장일태 대한척추신경외과학회 2020 Neurospine Vol.17 No.sup.

Minimally invasive spinal surgery in particular lumbar endoscopic unilateral laminotomy with bilateral decompression becomes popular as it can be performed with regional anesthesia, soft tissue damages are minimized as endoscopic visualization and instruments can be brought close to operating area bypassing much of the intervening soft tissues for sufficient spinal decompression with ligamentum flavum resection despite less bony resection compared to open surgery. Overall, when well executed, it preserves spinal stability. Outside-in technique of decompression is also known as over the top decompression in minimally invasive literature. It involves maintaining deep layer of ligamentum flavum integrity till satisfactory bony decompression is achieved. Deep layer of ligamentum flavum is removed as final step of decompression. Preservation of the deep layer of ligamentum flavum protects the neural elements, allowing drills and sharp equipment to be used safely to perform bony decompression.In this study, we demonstrate the technical details of outside-in approach lumbar endoscopic unilateral laminotomy with bilateral decompression (LEULBD). LE-ULBD Outside-in Technique is an effective and safe procedure in relieving lumbar spinal stenosis with favorable results with a follow-up for more than 1 year.