결핵성 뇌수막염 후에 발생한 척수염, 지주막염 및 척추염의 수술적 치료 결과 - 증례 보고 -

서승표,박동혁,김철웅,강창남 대한척추외과학회 2015 대한척추외과학회지 Vol.22 No.2

Study Design: A case report. Objectives: To report a rare case of a surgically treated tuberculous myelitis and arachnoiditis patient with incomplete paraplegia. Summary of Literature Review: Tuberculous myelitis and arachnoiditis is a rare disease with a high rate of neurologic deficit. This condition is treated using antituberculous medication and high-dose steroid therapy, but surgical treatment has rarely been reported and the outcomes vary. Material and Methods: A 29-year-old female had tuberculous myelitis and arachnoiditis. The patient was treated with antituberculous medication and high-dose steroid therapy, but the treatment failed and the patient could not walk because of incomplete paraplegia. The surgical treatment was performed twice; we decompressed by total laminectomy and debrided the infected arachnoid membrane. Four months after surgery, we performed anterior interbody fusion due to the development of spondylitis with kyphosis. Results: Three years after the first operation, the patient’s neurologic state improved and she could walk 90 m without assistance. Conclusions: Here, we report a very rare case of surgically treated tuberculous myelitis and arachnoiditis and provide a treatment option for this condition to spine surgeons. 연구 계획: 증례 보고목적: 불완전 하반신 마비를 동반한 결핵성 척수염 및 지주막염 환자에서 수술적 치료를 시행한 증례를 보고하는 바이다. 선행문헌의 요약: 결핵성 척수염 및 지주막염은 신경학적 결손의 발생이 높은 드문 질환이다. 항결핵약제 및 고용량 스테로이드 요법으로 치료하나 수술적 치료에 대한 보고가 드물고 결과가 다양하다. 대상 및 방법: 29세 여성으로 결핵성 척수염 및 지주막염으로 항결핵약제 및 고용량 스테로이드 요법을 시행 받았으나 실패하였으며 불완전 하반신 마비로 걸을 수 없게 되었다. 환자는 두 번 수술을 시행하였는데 처음에는 추궁판 전절제술로 감압술을 시행하고 감염된 지주막을 제거하였다. 4개월 뒤, 결핵성 척추염 및 후만변형이 발생하여 전방 추체간 유합술을 시행하였다. 결과: 첫 수술 3년 뒤 환자의 신경학적 상태는 호전되었으며 보조 없이 90미터를 걸을 수 있게 되었다. 결론: 결핵성 척수염 및 지주막염을 수술적으로 치료한 드문 증례로 치료 방법의 제공을 기대한다.

교통사고로 발생한 경추부 둔상에 의한 경추 골절과 브라운-세카르 증후군 - 증례 보고 -

서승표,최원락,강창남 대한척추외과학회 2017 대한척추외과학회지 Vol.24 No.4

Study Design: Case report Objectives: To report a case of Brown-Séquard syndrome after blunt cervical trauma. Summary of Literature Review: Brown-Séquard syndrome is a rare disease characterized by hemisection of the spinal cord, and it shows the best prognosis of the various types of incomplete spinal cord injuries. Materials and Methods: A patient with Brown-Séquard syndrome that occurred after a traffic accident was followed up for 2 years and 6 months. Results: We observed normal recovery of motor strength, but sensory impairment and deep tendon hyperreflexia remained. Conclusions: Brown-Séquard syndrome is known to have a good prognosis, but in this case, the neurological abnormality did not fully recover; therefore, we report this rare case and present a review of the literature. 연구 계획: 증례 보고목적: 경추부 둔상에 의해 발생한 브라운-세카르 증후군 증례를 보고하고자 한다. 선행 연구문헌의 요약: 브라운-세카르 증후군은 척수 반절단을 특징으로 하는 드문 질환으로, 불완전 척수손상 중 가장 좋은 예후를 보인다. 대상 및 방법: 교통사고로 발생한 브라운-세카르 증후군 환자를 2년 6개월간 추시하였다. 결과: 근력은 정상으로 회복되었으나 감각 저하와 심부건반사 항진은 지속되었다. 결론: 브라운-세카르 증후군은 좋은 예후를 보이는 것으로 알려져 있으나 본 증례에서는 신경학적 이상이 완전 회복되지 않아서 문헌 고찰과 함께 증례를 보고하는 바이다. 약칭 제목: 경추부 둔상에 의한 브라운-세카르 증후군

[행복일기] 그 남자의 취미생활

서승표 샘터사 2013 월간 샘터 Vol.519 No.-

Old and New Fashion: Luque 지지대와 추궁하 철사 고정술 및 후외방 유합술 후상위 인접 분절 척추관 협착증의 최소 침습법을 이용한 수술적 치료

서승표,강창남,이재원 대한척추외과학회 2014 대한척추외과학회지 Vol.21 No.4

Study Design: A case report. Objectives: To report a rare case of minimally invasive spine surgery after sublaminar wiring fixation with Luque rods. Summary of Literature Review: In the past, sublaminar wiring fixation with Luque rods was believed to be an effective fixationmethod; however, the development of transpedicular fixation resulted in the discontinuation of this method. Currently, instead of classicalsurgery using a broad incision, minimally invasive spine surgery is performed, which has a multitude of advantages. Material and Methods: Initially, the patient underwent Luque sublaminar wiring and posterolateral fusion. After 25 years, minimallyinvasive TLIF and percutaneous transpedicular fixation were performed for the adjacent segmental spinal stenosis. Results: A good bone union is developing with an excellent clinical outcome, 14 months after the surgery. Conclusions: We report a very rare case of a patient who underwent Luque sublaminar wiring and then, 25 years later, had spinesurgery with minimally invasive techniques. 연구 계획: 증례보고목적: 루끼 강선 결박술 후 최소 침습적인 척추 수술을 시행한 증례를 보고하는 바이다. 선행문헌의 요약: 과거에 루끼 강선 결박술은 효과적인 고정이라는 장점으로 많이 이용되었지만 척추경 나사못 고정술의 발달로 현재는 거의 이용되지않는다. 최근에는 광범위 절개가 아닌 최소 침습적인 방법으로 척추 수술을 하려는 노력들이 활발히 시도되고 있으며 이를 통해 다양한 장점들을 기대하고 있다. 대상 및 방법: 이 증례는 척추 전방 전위증으로 루끼 강선 결박술 및 자가 장골을 이용한 후외방 유합술을 시행하였으며 25년 후, 인접 분절의 퇴행성 척추관 협착증에 대하여 최소 침습적 척추 수술을 시행하였다. 결과: 수술 후 14개월에 골 유합이 양호하게 진행되고 있으며 우수한 임상 경과를 얻었다. 결론: Luque 지지대를 이용한 추궁하 철사 고정술은 최근에 매우 보기 힘든 드문 증례로 인접 분절의 최소 침습적 고정술을 시행한 사례를 보고한다.

Height Restoration after Balloon Kyphoplasty in Rheumatoid Patients with Osteoporotic Vertebral Compression Fracture

서승표,김철웅,조영훈,강창남 대한척추외과학회 2015 Asian Spine Journal Vol.9 No.4

Study Design: Retrospective study. Purpose: This study was conducted to compare vertebral body height restoration rate in rheumatoid arthritis (RA) patients who had undergone percutaneous balloon kyphoplasty (KP) with that of control group who had matched age, sex, body mass index, and bone mineral density. Overview of Literature: There is no report on result of KP in RA patients. Methods: Postoperative height restoration rate of RA group consisting of 15 patients (18 vertebral bodies) who had undergone KP due to osteoporotic vertebral compression fracture with a 30% or higher vertebral compression rate between May 2005 and January 2013 were compared to control group consisting of 38 patients (39 vertebral bodies) who had matched age, sex, body mass index, and bone mineral density. Results: No statically significant difference in age (p =0.846), sex (p =0.366), body mass index (p =0.826), bone mineral density (p =0.349), time to surgery (p =0.528), polymethylmethacrylate injection time (p =0.298), or amount (p =0.830) was found between the RA group and the control group. However, preoperative compression rate in the RA group was significantly (p =0.025) higher compared to that in the control group. In addition, postoperative height restoration rate showed significant correlation with the RA group (p =0.008). Although higher incidence of recollapse occurred in the RA group compared to that in the control group, the difference was not statistically significant (p =0.305). Conclusions: Compared to the control group, RA patients showed higher compression rate and higher vertebral restoration rate after KP, indirectly indicating weaker bone quality in patients with RA. Higher incidence of recollapse occurred in the RA group compared to that in the control group, although it was not statistically significant.

제 11흉추 - 제 12흉추간 비디오 흉강경과 직접 측면 추체간 유합술 기구를 이용한 미세 침습 전방 추체간 유합술 - 증례 보고 -

서승표,심지훈,신태양,김준국,강창남 대한척추외과학회 2016 대한척추외과학회지 Vol.23 No.3

Study Design: Case report Objectives: To report a case of video-assisted thoracoscopic (VAT) minimally invasive anterior interbody fusion of the T11-T12 level using direct lateral interbody fusion (DLIF) devices. Summary of Literature Review: Interbody fusion of the thoracolumbar junction (especially T11-T12) is technically challenging from anterior, lateral, or posterior approaches. A VAT anterior interbody fusion approach using DLIF devices is a safe, minimally invasive alternative approach to the thoracolumbar spine. Materials and Methods: A 37-year-old male pedestrian was struck by a car sustaining fracture-dislocation at the T11-T12 level. The accident resulted in complete paraplegia of both lower extremities and multiple lower extremity fractures. A classical instrumented posterolateral fusion from T8 to L3 and staged VAT anterior interbody fusion at the T11-T12 level were performed. Results: At one year postoperatively, he was capable of independent ambulation using a wheelchair without back pain, and plain radiographs and CT scans showed a solid fusion at the T11-T12 level. Conclusions: VAT anterior interbody fusion using DLIF devices provides excellent access to the anterior spinal column with the added benefits of an improved field of view and can be a safe and effective alternative to open thoracotomy in the management of various thoracolumbar junction problems. 연구 계획: 증례 보고. 연구 목적: 제 11흉추-제 12흉추 골절-탈구에서 비디오 흉강경과 직접 측면 추체간 유합술 기구를 이용한 최소 침습 전방 추체간 유합술로 수술한 증례를 보고한다. 선행문헌의 요약: 흉요추 이행부, 특히 제 11흉추-제 12흉추간 추체간 유합술은 전방, 측방 또는 후방으로 수술하기에 기술적으로 어려움이 있다. 흉요추이행부에서 비디오 흉강경과 직접 측면 추체간 유합술 기구를 이용한 최소 침습 전방 추체간 유합술은 입원기간과 합병증을 줄일 수 있는 안전한 최소침습적 술식이다. 대상 및 방법: 37세 남자 환자로 보행자 교통사고로 인해 완전 하지 마비를 동반한 제 11흉추-제 12흉추 골절-탈구와 다발성 외상으로 내원하였다. 제 8 흉추부터 제 3요추까지 후방 기기고정술 및 후외방 유합술을 시행하였고, 단계적으로 제 11흉추-제 12흉추간 비디오 흉강경과 직접 측면 추체간 유합술기구를 이용한 최소 침습 전방 추체간 유합술을 시행하였다. 결과: 수술 1년 후, 환자는 통증 없이 단독으로 휠체어 거동이 가능하였고, 추시 단순 방사선 사진 및 컴퓨터 단층 촬영에서 만족할 만한 전방 유합을 확인하였다. 결론: 비디오 흉강경과 직접 측면 추체간 유합술 기구를 이용한 최소 침습 전방 추체간 유합술은 전방 추체로 효과적으로 접근할 수 있고, 시야확보가 용이하며 고식적인 개흉술을 대체할 안전하고 효과적인 술기라 사료된다.

Outcomes of Revision Surgery Following Instrumented Posterolateral Fusion in Degenerative Lumbar Spinal Stenosis: A Comparative Analysis between Pseudarthrosis and Adjacent Segment Disease

서승표,조영훈,정해원,최원락,강창남 대한척추외과학회 2017 Asian Spine Journal Vol.11 No.3

Study Design: Retrospective study. Purpose: We examined the clinical and radiological outcomes of patients who received revision surgery for pseudarthrosis or adjacent segment disease (ASD) following decompression and instrumented posterolateral fusion (PLF). Overview of Literature: At present, information regarding the outcomes of revision surgery for complications such as pseudarthrosis and ASD following instrumented PLF is limited. Methods: This study examined 60 patients who received PLF for degenerative lumbar spinal stenosis and subsequently developed pseudarthrosis or ASD leading to revision surgery. Subjects were divided into a group of 21 patients who received revision surgery for pseudarthrosis (Group P) and a group of 39 patients who received revision surgery for ASD (Group A). Clinical outcomes were evaluated using the visual analogue scales for back pain (VAS-BP) and leg pain (VAS-LP), the Korean Oswestry disability index (K-ODI), and each patient’s subjective satisfaction. Radiological outcomes were evaluated from the extent of bone union, and complications in the two groups were compared. Results: VAS-LP at final follow-up was not statistically different between the two groups (p =0.353), although VAS-BP and K-ODI at final follow-up were significantly worse in Group P than in Group A (all p <0.05), and only 52% of the patients in Group P felt that their overall well-being had improved following revision surgery. Fusion rates after the first revision surgery were 71% (15/21) in Group P and 95% (37/39) in Group A (p =0.018). The rate of reoperation was significantly higher in Group P (29%) than in Group A (5%) (p =0.021) due to complications. Conclusions: Clinical and radiological outcomes were worse in patients who had received revision surgery for pseudarthrosis than in those who had revision surgery for ASD. Elderly patients should be carefully advised of the risks and benefits before planning revision surgery for pseudarthrosis.

간과된 흉요추부 삼주 손상의 운명

서승표(Seung-Pyo Suh),김철웅(Chul-Woong Kim),강창남(Chang-Nam Kang) 대한정형외과학회 2013 대한정형외과학회지 Vol.48 No.4

흉요추부 골절에서 척추의 불안정성에 대한 정확한 진단은 적절한 치료방법의 선택과 추후 일어날 수 있는 합병증을 예방하기 위해 중요하며, 척추 불안정성에 대한 다양한 연구에서 후방 인대 복합체의 파열 여부가 척추 불안정성을 결정하는 데 매우 중요한 인자로 받아들여지고 있다. 불안정성 흉요추부 골절에 대해 보존적 치료를 할 경우, 흉요추부의 후만 변형을 유발하여 만성 동통의 원인을 제공하고 기능적 손실 및 하지 마비의 합병증이 발생할 수 있기 때문에 수술적 치료의 개념이 잘 정립되어 있으며, 후방 인대 복합체의 손상을 간과하여 보존적 치료를 시행하게 되는 경우에는 결과가 좋지 않은 것으로 되어 있다. 이에 저자들은 타 의료기관에서 불안정성 흉요추부 골절을 간과하여 수술적 치료 시기를 놓치고, 보존적 치료를 시행한 후 지속되는 통증과 척추의 후만 변형이 발생하여 본원으로 전원된 2예를 경험하였기에 간과된 흉요추부 삼주 손상의 운명에 대하여 재차 상기하고자 문헌적 고찰과 함께 보고하는 바이다. In a thoracolumbar fracture, accurate diagnosis of spinal stability is necessary in deciding on appropriate treatment options and for prevention of complications that can subsequently occur. In various reports for spinal stability, rupture of the posterior ligament complex is generally accepted as a very important factor of spinal stabiliby. In cases of conservative treatment for unstable thoracolumbar fractures, the progressive kyphotic deformity can cause chronic pain and functional disability, and neurologic deterioration in severe cases. Therefore, the concept of surgical treatment for unstable thoracolumbar fracture has been well established. We report on two cases of neglected three column injury in the thoracolumbar spine, which were treated conservatively due to misdiagnosis at other hospitals, and finally underwent delayed operation in our hospital because of chronic back pain and progressive kyphotic deformity.

경한 둔상에 의하여 발생한 경골 동맥의 경골비골동체의 가성동맥류

서승표(Seung-Pyo Suh),황석하(Seok-Ha Hwang),홍성하(Sung-Ha Hong),김재남(Jae-Nam Kim) 대한정형외과학회 2020 대한정형외과학회지 Vol.55 No.5

주로 고에너지 손상이나 관통상에 의해서 발생하는 가성동맥류는 진단이 지연되면 심각한 결과를 초래할 수 있다. 저자들은 계단에서 넘어져 다친 후 처음에는 단순 타박 및 피부 열상으로 진단되었다가 증상이 악화되어 수상 2주일 후 시행한 자기공명영상 검사와 컴퓨터 단층촬영 혈관 조영술에서 경골 동맥의 경골비골동체의 가성동맥류로 뒤늦게 진단된 63세 남자를 치험하였다. 경한 둔상에 의하여 경골비골동체에 가성동맥류가 발생한 예는 아직까지 국내에 보고된 바 없어 이에 저자들은 문헌고찰과 함께 보고하고자 한다. Pseudoaneurysm which is usually caused by high energy trauma or penetrating injury results in serious complications if the diagnosis is delayed. The authors experienced a 63-year-old patient who slipped on the stairs with simple contusion and skin laceration. But, he was finally diagnosed with pseudoaneurysm of tibioperoneal trunk of tibial artery on magnetic resonance imaging and 3-dimensional computed tomography angiogram performed in two weeks due to aggravation of the symptoms. To the best of my knowledge, pseudoaneurysm of tibio-peroneal trunk caused by minor blunt trauma has not been reported till now in Korea. So we report this case with a review of the relevant literature.

요추 유합술 전후 고려해야 할 사항

박상민,서승표,백종민,권기연,장해동,임수택,최소침습 척추치료 연구그룹 대한척추외과학회 2023 대한척추외과학회지 Vol.30 No.3

Study Design: Review article. Objectives: The purpose of this study was to review the perioperative considerations for lumbar fusion surgery. Summary of Literature Review: With an aging population, degenerative lumbar spine diseases are on the rise. The number of patients who have comorbidities and undergo complex lumbar spine surgery is also increasing. There are many points to consider before and after lumbar fusion surgery. Materials and Methods: Review of the relevant articles. Results: In spine surgery, conservative treatment is often considered before surgical treatment because symptoms often improve with conservative treatment. If conservative treatment fails, surgical treatment is then considered. Once the decision to operate has been made, the patient's past medical history is taken, and medical conditions are assessed before surgery. The severity of osteoporosis is also assessed to determine the surgical approach. If severe osteoporosis is present, osteoporosis treatment may be considered first, and if it is very severe, various pedicle screw fixation techniques should be considered. Finally, a multidisciplinary approach to surgery is necessary to ensure rapid recovery. Enhanced recovery after surgery (ERAS) protocols have recently been applied to lumbar fusion surgery. Conclusions: Adequate and appropriate conservative treatment should be implemented before spine surgery. Medical risk factors (diabetes, smoking, osteoporosis, kidney disease, medications, etc.) should be identified and corrected preoperatively. In addition, early patient recovery with perioperative ERAS should be considered, as ERAS protocols may have a positive effect in older patients with a higher frequency of postoperative complications.