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이상호,임상락,이호연,전상협,한영미,정병주,Lee, Sang Ho,Lim, Sang Rak,Lee, Ho Yeon,Jeon, Sang Hyeop,Han, Young Mi,Jung, Byung Joo 대한신경외과학회 2000 Journal of Korean neurosurgical society Vol.29 No.12
Objectives : Among the various types of minimally invasive spine surgeries, thoracoscopic surgery is becoming more widely accepted and increasingly utilized. This report delineates our clinical experience using thoracoscopy to resect herniated thoracic discs in 16 patients who suffered from myelopathy or intolerable radiculopathy. Patients and Methods : Between Mar. 1997 and Sep. 1999, 16 consecutive patients underwent thoracoscopic discectomy for treatment of herniated thoracic discs. There were 12 men and 4 women(mean age 43.5 years ; range 18-61 years). Eleven patients presented with myelopathic signs and symptoms from spinal cord compression and 5 patients had incapacitating thoracic radicular pain without myelopathy. The surgical level was varied between T3 and T12. The pathology of specimen were 11 hard discs and 5 soft discs herniations. Thoracoscopic techniques were performed with long narrow spine instruments and high speed drill through 3 or 4 ports under one lung ventilated general anesthesia. During the operation three patients were converted to open thoracotomy due to intolerable one lung ventilation, excessive bleeding and inadequate operation field. The mean operation time was 264min.(range : 100-420min.), and postoperative mean admission period was 11 days. Results : Clinical and neurological outcomes were good in all patients(mean follow-up period 20 months). Among the eleven myelopathic patients, 8 improved neurologically, and 3 stabilized. Among the five radiculopathic patients, 4 recovered completely and no patient had worsened. Postoperative complications were pleural effusion in one case, intercostal neuralgia in one, delayed hemopneumothorax in one, prolonged air leakage in one and pneumonia in one case. Conclusions : Thoracoscopic discectomy needs a steep learning curve to be familiar to anatomical space and handling of endoscopic instruments. However, it is technically feasible and can be effectively performed with acceptable results.
요배부 수술 후 증후군에서 BAK Cage를 이용한 전방 요추체간 유합술
최건,김기준,임상락,이상호 대한신경외과학회 2003 Journal of Korean neurosurgical society Vol.33 No.6
Objective:To evaluate the role of anterior lumbar interbody fusion in treatment of failed back surgery syndrome, the authors present a retrospectively analysis of the clinical & radiological results of anterior lumbar interbody fusion. Methods:Between September 2000 and September 2001, twenty two patients underwent anterior lumbar interbody fusion for treatment of failed back surgery syndrome. We analyzed clinical & radiological changes. The mean follow-up period was 19 months. Results:Overall satisfactory outcome was 90%. The mean VAS was changed from 8.3 to 3.7. The mean Oswestry Disability Index(%) was changed from 70 to 33. The fusion rate was 86%. There were 2 complications; wound infection, sympathetic dysfunction. Conclusion:We conclude that the anterior lumbar interbody fusion seems to be a safe and favorable method in treating selective patients with failed back surgery syndrome. Key words:Failed back surgery syndrome;Anterior lumbar interbody fusion.
전방 접근 제 5 요추-제 1 천추간 융합술;복강경과 최소 개복 전방 추체간 융합술의 비교연구
정상기,이상호,임상락 대한신경외과학회 2003 Journal of Korean neurosurgical society Vol.33 No.2
Objective:To investigate the effectiveness and safety of the laparoscopic L5-S1 fusion, its perioperative parameters and long-term outcome are compared with those of open anterior surgical approach. Methods:Data of 54 consecutive patients who underwent anterior approach for L5-S1 fusion either by laparoscopic or open mini-anterior lumbar interbody fusion(ALIF) from 1997 to 1999 were analyzed. Among them, 47 cases were available with more than 2-years follow-up data. In all cases, carbon cage and autologous bone graft were used. Results:Twenty five patients underwent a laparoscopic procedure and twenty two a open mini-ALIF. Three laparoscopic procedures were converted to open ones. For perioperative parameter, only the operative time was statistically different(p=0.001)while length of postoperative hospital stay and blood loss were not. The incidence of operative complication was three in laparoscopic group and two in open mini-ALIF group. After the follow-up of at least two years, the two groups showed no statistical difference in visual analog scale for pain, Oswestry disability index, and patient satisfaction index. The fusion rate was 91% in each group. Conclusion:The findings of this study suggest that laparoscopic ALIF has similar effectiveness and safety with open mini-ALIF. However, the advantage of laparoscopic approach as a minimally invasive surgery should be reconsidered because no objective additional benefit was found. Key words:Laparoscopic ALIF;L5-S1 fusion;Carbon cage.