Titanium Mesh Cage for Anterior Stabilization in Tuberculous Spondylitis : Is It Safe?

Bak, Koang-Hum,Cheong, Jin-Hwan,Kim, Jae-Min,Kim, Choong-Hyun,Kim, Seung-Bum The Korean Neurosurgical Society 2006 Journal of Korean neurosurgical society Vol.40 No.6

Objective : The safety of titanium metal cages in tuberculous spondylitis has not been investigated. We evaluated the outcome and complications of titanium mesh cages for reconstruction after thoracolumbar vertebrectomy in the tuberculous spondylitis. Methods : There were 17 patients with 18 operations on the tuberculous spondylitis in this study. Sixteen patients were operated with anterior corpectomy and reconstruction with titanium mesh cage followed by posterior transpedicular screw fixations on same day, two pateints were operated by either anterior or posterior approach only. After the affected vertebral body resection and pus drainage from the psoas muscle, titanium mesh cage, filled with morselized autogenous bone, was inserted. All the patients had antituberculosis medication for 18 months. The degree of kyphosis correction and the subsidence of cage were measured in the 15 patients available at a minimum of 2 years. Outcome was assessed with various cross-sectional outcome measures. Recurrent infection was identified by serial ESR[Erythrocyte Sedimentation Rate] and CRP[Cross Reactive Protein]. Results : There was no complication from the use of a titanium mesh cage. Recurrent infection was not detected in any case. Average preoperative of $9.2^{\circ}$ was reduced to $-2^{\circ}$ at immediate postoperative period, and on final follow up period kyphotic angle was measured to be $4.5^{\circ}$. Postoperatively, subsidence was detected in most patients especially at ambulation period, however further subsidence was prevented by the titanium mesh cage. Osseous union was identified in all cases at the final follow-up. Conclusion : The cylindrical mesh cage is a successful instrument in restoring and maintaining sagittal plane alignment without infection recurrence after vertebrectomy for tuberculous spondylitis.

내시경을 이용한 전방 경유 경추부 추간공 확대술

백광흠,오성훈,최일승,김재민,김충현,김남규 대한신경외과학회 1998 Journal of Korean neurosurgical society Vol.27 No.11

흉요추부 골절-탈구 환자의 치료 경험과 손상 기전에 따른 예후 분석

백광흠,정진환,김충현,오성훈,김재민,이철범 대한척추신경외과학회 2004 Neurospine Vol.1 No.1

Objective: The fracture-dislocation is the most unstable spinal injury with failure of all three columns and presents catastrophic neurological injury. The purpose of this study was to evaluate factors such as preoperative neurological status, causes of injury, time to operation, type of fracture-dislocation, and steroid therapy that might alter the prognosis of patients. Methods: A retrospective analysis on 26 patients of thoracolumbar fracture-dislocation was performed. Fracture-dislocation was classified into three different categories according to Denis' classification: flextion-rotation in 15 patients, shear in 5 patients, and flextion-distraction in 6 patients. The neurological status was classified according to Frankel's classification: A in 9 patients, B in 6, C in 5, D in 4, E in 2. Posterior reduction and transpedicular screw fixation with fusion was used in 18 cases, corpectomy and interbody fusion through retroperitoneal approach was used in 2, combined approach was used in 6. Results: Thirteen patients(54%) with neurological deficit improved after surgical treatment. Operations achieved reduction and neural decompression regardless of surgical approaches in most cases. The preoperative neurological status, type of fracture-dislocation, and interval between trauma and operation were closely correlated with the postoperative neurological status(p=0.001). But the causes of injury, mega-dose steroid therapy were not correlated with the neurological outcome statistically(p>0.05). Conclusion: Early surgical intervention should be considered for patients with thoracolumbar fracture-dislocation to achieve neurological improvement and early mobilization.

추궁절제수술후에 발생한 의인성 가성수막척수류 : 증례보고 Report of Cases

백광흠,김용석,김재민,고용,오성훈,오석전,김남규,김광명,박동우 대한신경외과학회 1996 Journal of Korean neurosurgical society Vol.25 No.10

Two unique cases of delayed nerve root herniation and entrapment into the pseudomeningocele through an unrepaired dural laceration at lumbar laminectomy were reported. Both patients presented with recurred radiculopathy. 3 and 6 years after first operation respectively. Lumbar myelography showed an extradural pseudomeningocele pouch in case 1 while showing no abnormality in case 2. Lumbar MRI in case 1 showed tangled herniated nerve root in the pouch of pseudomeningocele. Lumbar myelographic CT of case 2 showed delayed partial filling of the pseudomeningocele pouch only.

환추축성 불안정증에 대한 경관절 나사못 고정법의 임상적, 생체역학적 분석평가

백광흠,오성훈,신형식,김재민,김광명 대한신경외과학회 1996 Journal of Korean neurosurgical society Vol.25 No.2

Transarticular screw fixation augmented with interspinous wiring technique for atlantoaxial instability was analyzed to provide immediate multidirectional rigid fixation and increase likelihood of fusion of C1-2 for atlantoaxial instability in several biomechanical studies. Transarticular screw fixation eliminates anterior, posterior translation at C1-2 and reduce flexion and extension movement. Interspinous wiring eliminates the residual flexion and extension movement. 13 patients with atlantoaxial instability were operated with posterior atlantoaxial facet screws fixation augmented with an interspinous C1-2 strut graft and posterior wire fixation technique. One patient died postoperatively from cardiac problem. All surviving patients restored C1-2 alignment and stability without complication due to instrumentation and osseous unions have developed even 2 cases of screw breakage developed. This technique was analyzed to be superior to wiring or clamp fixation biomechanically and leads to success without external orthosis in several series. But precaution is needed to avoid the vertebral artery injury.

경추부 확장성 나사못의 인장 항력 : 생체역학적 연구 Biomechanical Study

백광흠,이규석,오성훈,정진환,김재민,김충현 대한척추신경외과학회 2004 Neurospine Vol.1 No.1

Objective: Many factors have been studied to increase the pullout strength of spinal screws. Expansive screws from many manufacturers have been developed to increase the pullout strength in cervical and thoracolumbar screw fixation. The objective of this study is to determine how much an expansive cervical screw design could improve biomechanical fixation in cervical spine. Methods: There were 72 DOC^(?)(Depuy Acromed, Cleveland, USA) cervical screws that have a configuration of 12 mm in length and 4.0mm in diameter: There were 36 expansive screws and 36 regular non-expansive screws for control group. After pilot holes were either drilled or awled, the 36 screws in each group were inserted into the synthetic cancellous material in either 0˚ 20˚ 30˚ angle. The screws were extracted axially at a rate of 2.4mm/min using a servohydraulic machine. Pullout strength was recorded with a digital oscilloscope. The synthetic bone was underwent macroscopic examination after pullout. Results: The mean pullout force of the expansive screws was 371.42N ± 94.87 and the non-expansive screws was 362.99N ± 78.55. There was no statistical significance in pullout resistance between two groups. Also there was an evidence of crack in grain structure of synthetic bone that expansive screws were inserted. Conclusion: Expansive screw design does not increase pullout strength in cervical screws. The data represent only the primary stability of the screw because the present study design precluded any cycling testing.

극외측 추간판 탈출증에 대한 복합 접근 수술법

백광흠,신형식,김재민,오성훈,김광명 대한신경외과학회 1996 Journal of Korean neurosurgical society Vol.25 No.2

A technique combining usual interlaminar approach and paraspinal intertransverse approach for exposing far-lateral disc herniations without disrupting the facet is described. This approach is useful because disc fragments can be removed from both intraspinal and paraspinal route with easy retraction and under short skin incision. This approach prevents reherniation by complete removing of residual nucleus pulposus. At the end of procedure the foramen can be explored in order to verify that foramen is opened. This approach is useful especially in operating the double herniations and extruded far lateral disc herniations.

환축추의 불안정증을 동반한 경추부의 섬유성 이형성증 : 증례보고 Case Report

백광흠,고인관,김재민,김충현,김남규,태경 대한신경외과학회 1997 Journal of Korean neurosurgical society Vol.26 No.5

Changes in Disc Height as a Prognostic Factor in Patients Undergoing Microscopic Discectomy

Myeonggeon Kweon,Koang-Hum Bak,Hyeong-Joong Yi,Kyu-Sun Choi,Myung-Hoon Han,Min-Kyun Na,Hyoung-Joon Chun 대한신경외과학회 2024 Journal of Korean neurosurgical society Vol.67 No.2

Objective : Some patients with disc herniation who underwent discectomy complain of back pain after surgery and are unsatisfied with the surgical results. This study aimed to evaluate the relationship between preoperative disc height (DH), postoperative DH, and pain score 12 months after surgery in patients who underwent microdiscectomy for herniated lumbar disc. Methods : This study enrolled patients who underwent microdiscectomy at a medical center between January 2012 and December 2020. Patients with X-ray or computed tomography and pain score assessment (visual analog scale score) prior to surgery, immediately post-op, and at 1, 6, and 12 months after surgery were included. The DH index was defined as DH/overlying vertebral width. The DH ratio was defined as the postoperative DH/preoperative DH. Simple linear regression and multivariate linear regression analyses were applied to assess the correlation between DHs and leg pain scores 12 months after surgery. Results : A total of 118 patients who underwent microdiscectomy were included. DH decreased up to 12 months after surgery. The DH ratio at 1, 6, and 12 months after discectomy showed a significant positive correlation with the pain scores at 12 months after discectomy (1 month : p=0.045, B=0.52; 6 months : p=0.008, B=0.78; 12 months : p=0.005, B=0.69). Multivariate linear regression analysis revealed that the level of surgery, sex, age, and body mass index had no significant relationship with back pain scores after 12 months. Conclusion : In patients who underwent microdiscectomy, the DH ratios at 1, 6, and 12 months after surgery were prognostic factors for back pain scores at 12 months after surgery. Aggressive discectomy is recommended for lower postoperative DH ratios and Visual analog scale scores, leading to improved patient satisfaction.

뇌 동맥류 진단에 대한 MIP와 SSD 영상의 비교분석

김재민,백광흠,오성훈,김광명,박동우 대한신경외과학회 1996 Journal of Korean neurosurgical society Vol.25 No.10

There is an increasing tendency to use three dimensional computed tomograpic angiography(CTA) in diagnosis of intracranial aneurysm. The authors have planned to get a better CTA image through comparing of the maximum intensity projection(MIP) and shaded surface display(SSD) techniques. Eighteen patients were evaluated who had been studied with conventional cerebral angiography(CCT). CTA and received aneurysmal surgery. all together. Original spiral CT images were studied with helical CT scanner with 120ml on non-ionic contrast material. 3ml/sec injection rate. 1mm collimation and 1mm reconstruction interval. MIP and SSD images of CTA were reconstructed with deiting by using a standard processing algorithm of volume rendering technique and three dimensional technique. There wer 3 cases(12%) of false negatives in both MIP and SSD images among the total 25 cases of saccular aneurysms. There were 2 cases(8%) of false positives in SSD images that were actually negative for aneurysm in MIP and CCA. Our results have demonstrated that CTA is a quick. reliable and relatively simple diagnostic tool for screening of intracranial aneurysms. and superior to CCA in evaluating configuration. direction and its associated vascular anatomy. The MIP image was better to reveal vasospasm. calcification. neck shape and adjacent vascular anatomy. On the other hand. the SSD image showed higher false positive rate due to pseudo-saccular fusion and superior to glance over the exernal configuration and for planning of surgery.