Repair Using Conventional Implant for Ruptured Annulus Fibrosus after Lumbar Discectomy: Surgical Technique and Case Series

서보건,어재형,박상혁,이건우 대한척추외과학회 2015 Asian Spine Journal Vol.9 No.1

Study Design: A retrospective review of annulus fibrosus repair (AR) using a novel technique with a conventional implant. Purpose: The purpose of this study was to present the feasibility and clinico-radiological outcomes of a novel AR technique using a conventional implant to minimize recurrence following a lumbar discectomy (LD). Overview of Literature: Conventional repair techniques to prevent recurrence following LD have several drawbacks. The AR surgical technique has received little attention as an adjunct to LD. Methods: A total of 19 patients who underwent novel AR following LD, and who were available for follow-up for at least three years, were enrolled in this study. Several variables, including the type and size of disc herniation, and the degree of disc degeneration, were evaluated preoperatively. Postoperatively, the presence of clinical and radiological recurrence of disc herniation was evaluated from pain intensity and functional statuses, as well as an enhanced L-spine magnetic resonance imaging at the final follow-up. The presence of a peripheral hollow rim and inserted anchor mobilization were also evaluated during the follow-up. Results: During follow-ups, there were no recurrences of disc herniation or complications, including neurovascular complications. Pain and functional disability improved significantly after surgery, and the improvement was maintained throughout the three-year follow-up period. No mobilization or implant peripheral hollow rim was observed during the follow-up. Conclusions: This study examined the feasibility of a novel and easily available annulus implant technique following LD. These results suggest performing AR with this technique may be a valuable alternative for optimizing outcomes, if the procedure is performed in proper candidates.

Clinical and Imaging Features of Longus Colli Calcific Tendinitis: An Analysis of Ten Cases

서보근,어재형,신지훈 대한정형외과학회 2018 Clinics in Orthopedic Surgery Vol.10 No.2

Background: Longus colli calcific tendinitis (LCCT) exhibits characteristic clinical features; thus, misidentification can be avoided once it is learned. There is a lack of reports on this disease. In this study, we analyzed the imaging and clinical features of LCCT in 10 patients. Methods: We retrospectively reviewed the radiolographic findings, laboratory data and clinical features of 10 patients diagnosed with LCCT between January 2015 and June 2017. All patients were treated with medical treatment consisting of intravenous methylprednisolone 125 mg twice and oral nonsteroidal anti-inflammatory drug administration. Results: On clinical findings, all 10 patients complained of severe posterior neck pain and cervical motion limitation. Odynophagia was present in nine patients. The mean time from symptom onset to hospital visit was 2.9 days. The mean time to symptom relief was 4.6 days. Of the 10 patients, three patients were admitted through the emergency room. There were five patients in the medical records who were transferred from another hospital. On the laboratory data, the mean value of C-reactive protein and erythrocyte sedimentation rate were 2.08 mg/dL (reference range, < 0.30 mg/dL) and 36.9 mm/hr (reference range, < 20 mm/hr), respectively. Leukocytosis was found in only two patients and fever was not present all patients. On radiographic findings, calcification was present on computed tomography images of all patients. The calcification was located at the lower part of the C1 arch, except for one case where calcification occurred in the anterolateral aspect of the C4–5 disc space. The mean value of the retropharyngeal space was 7.2 mm. Conclusions: LCCT, a rare disease, has characteristic radiographic findings and clinical features. Understanding such characteristics of this disease can prevent unnecessary testing and misdiagnosis.

전방십자인대 파열 시 동반 손상의 빈도 및 양상

이정환,윤경호,배대경,어재형,김정원,박수연,Lee, Jung-Hwan,Yoon, Kyoung-Ho,Bae, Dae-Kyung,Eo, Jae-Hyoung,Kim, Jeong-Weon,Park, Soo-Yeon 대한관절경학회 2008 대한관절경학회지 Vol.12 No.1

목적: 전방십자인대 파열 시 손상 시기와 원인에 따른 동반 손상의 빈도 및 양상을 비교하여 평가하고자 하였다. 대상 및 방법: 전방십자인대 재건술을 시행하였던 547례의 슬관절을 대상으로 손상 시기(급성과 만성), 손상 원인(운동과 비운동) 및 운동 종목에 따라 동반 손상의 빈도와 양상을 후향적으로 비교 분석하였다. 결과: 손상 시기에 따라 수상 후 3개월 이내는 급성으로, 3개월 이후는 만성으로 분류하였으며 급성 손상군에서 내측 측부 인대 손상 및 골 좌상이 많았고 만성 손상군에서는 내측 및 외측 반월상 연골 손상의 빈도가 유의하게 높았다(p=0.014, 0.029). 연골 손상은 급성 손상군의 경우 대퇴 활차부에(p=0.027), 만성 손상군의 경우 대퇴 내과에 많았고(p=0.011), Grade I, II의 연골 손상은 급성 손상군에(p=0.016), Grade III, IV의 손상은 만성 손상군에(p=0.017) 많았다. 손상 원인에 따른 차이로는 운동 손상군에서 외측 반월상 연골 손상의 빈도가 높았으며(p=0.035) 비운동 손상군에서 대퇴 내과의 연골 손상이(p=0.010) 유의하게 많았다. 운동 종목 별로는 스키에서 내측 측부 인대 손상이(p=0.005), 체조에서 연골 손상이(p=0.017) 다른 종목에 비해 많았다. 결론: 내측 및 외측 반월상 연골 손상, 심한 연골 손상의 빈도는 만성 손상군에서 높았고 손상 원인과 운동 종목에 따른 동반 손상의 빈도 및 양상에 차이가 있었다. Purpose: We purposed to analyze the incidence and the patterns of the injuries associated with anterior cruciate ligament(ACL) tears. Materials and Methods: We retrospectively reviewed 547 knees that had undergone ACL reconstructions and compared the associated injuries according to the time of injury(acute vs. chronic), the cause of injury(sports vs. non-sports) and the type of sports. Results: Medial collateral ligament(MCL) injury and bone contusion were more in acute injury group less than 3 months after trauma(p=0.001, 0.019) and the injuries of medial or lateral meniscus were more in chronic injury group more than 3 months after trauma(p=0.014, 0.029). The trochlea in acute injury group(p=0.027) and the medial femoral condyle in chronic injury group(p=0.011) had higher incidence of chondral injury. Grade I, II chondral injury was frequent in acute injury group(p=0.016) and grade III, IV chondral injury was frequent in chronic injury group(p=0.017). Lateral meniscus injury was frequent in sports injury group(P=0.035). Medial collateral ligament injury was frequent in ski(P=0.005), and chondral injury was in gymnastics(P=0.017). Conclusions: The incidences of medial and lateral meniscus tears and grade III, IV chondral defects were high in chronic injury group. According to the causes of the tears and the types of sports, some differences in the incidence and pattern of associated injuries were found.

A Sternum-Disk Distance Method to Identify the Skin Level for Approaching a Surgical Segment without Fluoroscopy Guidance during Anterior Cervical Discectomy And Fusion

이근우,안면환,신지훈,박재우,어재형,박종호,이지훈,김동욱,Jin S. Yeom,서보건 대한척추외과학회 2017 Asian Spine Journal Vol.11 No.1

Study Design: A retrospective review of prospectively collected data. Purpose: To introduce the sternum-disk distance (SDD) method for approaching the exact surgical level without C-arm guidance during anterior cervical discectomy and fusion (ACDF) surgery and to evaluate its accuracy and reliability. Overview of Literature: Although spine surgeons have tried to optimize methods for identifying the skin level for accessing the operative disk level without C-arm guidance during ACDF, success has rarely been reported. Methods: In total, 103 patients who underwent single-level ACDF surgery with the SDD method were enrolled. The primary outcome measure was the accuracy of the SDD method. The secondary outcome measures were the mean SDD value at each cervical level from the cranial margin of the sternum in the neutral and extension positions of the cervical spine and the inter- and intra-observer reliability of the SDD outcome determined using repeated measurements by three orthopedic spine surgeons. Results: The SDD accuracy (primary outcome measure) was indicated in 99% of the patients (102/103). The mean SDD values in the neutral-position magnetic resonance imaging (MRI) were 108.8 mm at C3–C4, 85.3 mm at C4–C5, 64.4 mm at C5–C6, 44.3 mm at C6– C7, and 24.1 mm at C7–T1; and those in the extension-position MRI were 112.9 mm at C3–C4, 88.7 mm at C4–C5, 67.3 mm at C5–C6, 46.5 mm at C6–C7, and 24.3 mm at C7–T1. The Cohen kappa coefficient value for intra-observer reliability was 0.88 (excellent reliability), and the Fleiss kappa coefficient value for inter-observer reliability as reported by three surgeons was 0.89 (excellent reliability). Conclusions: Based on the results of the present study, we recommend performing ACDF surgery using the SDD method to determine the skin level for approaching the surgical cervical segment without fluoroscopic guidance.

척추경 나사못을 이용하여 골유합을 얻은 척추경 단열-증례보고-

김진수,김기택,석경수,이정희,이상훈,어재형 대한척추외과학회 2008 대한척추외과학회지 Vol.15 No.2

There is a broad range of lumbar pedicular and neural arch anomalies, with spina bifida occulta and spondylolysis being especial-ly common. It is very rare for a pedicular cleft to be associated with contralateral spondylolysis in the same vertebral segment. Weobserved L4 spondylolisthesis, clefting of the left L4 hypertrophied pedicle associated with contralateral spondylolysis, and spinalstenosis on a radiographic study of the lumbar spine. Operative treatment was performed, with posterior decompression, partialremoval of the hypertrophied pedicle, posterior lumbar interbody fusion using a cage, and posterior instrumentation. The patient’sneurologic symptoms resolved after operative treatment. Fusion of the left pedicle cleft was observed on 6-month follow-up CT.We report one case of pedicular cleft fusion using pedicle screw fixation and present a review of the relevant literature.

Feasibility Study of Free-Hand Technique for Pedicle Screw Insertion at C7 without Fluoroscopy-Guidance

이건우,김호중,Jin S Yeom,어재형,박종호,이지훈,김동욱,서보건 대한척추외과학회 2016 Asian Spine Journal Vol.10 No.1

Study Design: Retrospective interventional study. Purpose: To introduce a free-hand pedicle screw (PS) insertion technique without fluoroscopic guidance in the C7 vertebra and evaluate the procedure’s feasibility and radiologic outcomes. Overview of Literature: Although PS insertion at C7 has been recognized as a critical procedure in posterior cervical fusion surgery, conventional techniques for C7 PS have several limitations. Methods: Thirty two patients (64 screws) who underwent PS insertion in C7 with the novel technique were included in this study. Postoperative clinical and radiological outcomes were evaluated. Special attention was paid to the presence of any problems in the screw position including cortical breaches of the PS and encroachment of the PS into the spinal canal or the vertebral foramen. This novel technique for PS insertion in C7 without fluoroscopy guidance had three key elements. First, the ideal PS entry point was chosen near the C6–7 facet joint using preoperative images. Second, the convergent angle distance was measured at axial computed tomography (CT) imaging, which defined the distance between the tip of C7 spinous process and the extended line passing through the pedicle axis from the ideal entry point. Third, the cranial-caudal angle distance was measured in sagittal CT images, which defined the distance between the tip of the C7 spinous process and the extended line passing through the pedicle axis. Results: Cortical breach on postoperative CT images was observed in three screws. All violated only the lateral wall of the affected pedicle. The breached screws occurred in the initial five cases. Postoperative neurologic deterioration was not observed in any patient, regardless of cortical breaching. Conclusions: The novel technique successfully allows for C7 PS to be placed and is associated with a low rate of cortical breach.

Prognostic Factors for Postsurgical Recovery of Deltoid Palsy due to Cervical Disc Herniations

정재윤,박종범,장한,송경진,김진혁,홍창화,이정섭,이상훈,송광섭,양재준,어재형,김영태,이재민 대한척추외과학회 2015 Asian Spine Journal Vol.9 No.5

Study Design: Retrospective multicenter study. Purpose: We aimed to investigate prognostic factors affecting postsurgical recovery of deltoid palsy due to cervical disc herniation (CDH). Overview of Literature: Little information is available about prognostic factors affecting postsurgical recovery of deltoid palsy due to CDH. Methods: Sixty-one patients with CDH causing deltoid palsy (less than grade 3) were included in this study: 35 soft discs and 26 hard discs. Average duration of preoperative deltoid palsy was 11.9 weeks. Thirty-two patients underwent single-level surgery, 22 two-level, four three-level, and three four-level. Patients with accompanying myelopathy, shoulder diseases, or peripheral neuropathy were excluded from the study. Results: Deltoid palsy (2.4 grades vs. 4.5 grades, p <0.001) and radiculopathy (6.4 points vs. 2.1 points, p <0.001) significantly improved after surgery. Thirty-six of 61 patients (59%) achieved full recovery (grade 5) of deltoid palsy, with an average time of 8.4 weeks. Longer duration of preoperative deltoid palsy and more severe radiculopathy negatively affected the degree of improvement in deltoid palsy. Age, gender, number of surgery level, and disc type did not affect the degree of improvement of deltoid palsy. Contrary to our expectations, severity of preoperative deltoid palsy did not affect the degree of improvement. Due to the shorter duration of preoperative deltoid palsy, in the context of rapid referral, early surgical decompression resulted in significant recovery of more severe grades (grade 0 or 1) of deltoid palsy compared to grade 2 or 3 deltoid palsy. Conclusions: Early surgical decompression significantly improved deltoid palsy caused by CDH, irrespective of age, gender, number of surgery level, and disc type. However, longer duration of deltoid palsy and more severe intensity of preoperative radiating pain were associated with less improvement of deltoid palsy postoperatively.

추궁판 절제술, 측괴 나사못 고정술 및 후방 유합술을 이용한 경추 척수증의 치료

석경수(Kyung-Soo Suk),김기택(Ki-Tack Kim),이정희(Jung-Hee Lee),이상훈(Sang-Hun Lee),김진수(Jin-Soo Kim),어재형(Jae-Hyung Uh) 대한정형외과학회 2009 대한정형외과학회지 Vol.44 No.1

목적: 경추 척수증의 추궁판 절제술 및 측괴 나사못 고정술을 이용한 후방 유합술의 치료결과를 알아보고자 하였다. 대상 및 방법: 경추 척수증 환자로 추궁판 절제술 및 측괴 나사못 고정술을 이용한 후방 유합술이 계획되었던 26명의 환자를 대상으로 연구를 시행하였다. 측괴 나사못 고정술의 적응증, 술 전 MRI상 척수내 고신호 강도 병변의 유무를 조사하였다. JOA 접수, 수지 굴신 검사, 수지 도피 징후, Hoffman 반사에 대하여 조사하였다. 술 전 T2 강조 시상면 MRI상 척수내 고신호 강도 유무, 술 전 후만변형 유무 및 분절간 불안정성 유무에 따른 임상 결과를 분석하였다. 결과: 측괴 나사못 고정술의 적응증은 후만 변형, 분절간 불안정성, 또는 황색인대 골화증이었다. MRI상 척수내 고신호 강도 병변이 있는 경우는 17예였다. 술 후 및 2년 추시 시 JOA 점수, 수지 굴신 검사 및 수지 도피 정후는 통계적으로 유의하게 향상되었다. Hoffman 반사는 술 전 17예에서 양성이였으며, 술 후 및 추시 시에도 변화가 없었다. MRI상 척수내 고신호 강도 병변이 있는 경우와 분절간 불안정성이 있는 경우 그렇지 않은 경우에 비하여 상대적으로 임상 결과가 유의하게 불량하였다. 결론: 후만 변형, 분절 불안정성 및 황색인대 골화증을 동반한 경추 척수증의 수술적 치료로서 측괴 나사못을 이용한 경추부 후방 감압술 및 유합술은 후방감압술 후 후만변형을 방지하고 척수를 감압할 수 있는 안전하고 효과적인 술식으로 생각되었다. Purpose: This prospective study was designed to investigate the outcomes of laminectomy and fusion with using lateral mass screw (LMS) fixation for the treatment of cervical myeolpathy. Materials and Methods: We studied a series of 26 consecutive patients with cervical myelopathy and who were planned to undergo laminectomy and fusion with using LMS fixation. MRI was done to investigate the high signal intensity lesion (HSIL) in the cord on the T2 weighted sagittal images. The JOA score, the grip and release test, the finger escape sign, and Hoffman's sign were checked. We analyzed the clinical outcomes depending on the high signal intensity lesion in the cord, the preoperative kyphosis, and the preoperative instability. Results: The indications for lateral mass screw fixation was kyphotic deformity, segmental instability or ossification of the ligament flavum (OLF). Patients with HSIL on the T2-weighted sagittal MRI was found in 17 patients. The JOA score, the grip and release test, and the finger escape sign were significantly improved after the operation and at the 2 year follow up. The patients with HSIL on the T2-weighted sagittal MRI or segmental instability had a significantly lower preoperative JOA score and a poor postoperative recovery as assessed by the JOA score. Conclusion: Laminectomy and fusion using lateral mass screw fixation for the surgical treatment of cervical myelopathy, which is associated with kyphotic deformity, instability or OLF, is considered a safe and effective treatment option to prevent postoperative kyphosis.