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척추경 나사못 내고정기기를 이용한 척추질환의 치료시 발생되는 합병증
신병준,노영복,서유성,이병일,김연일,나수균,최창욱 대한척추외과학회 1994 대한척추외과학회지 Vol.1 No.2
The concept of pedicle screw fixation opened a new horizon of spinal surgery by providing rigid fixation of spine. But it is technically a demanding procedure which could produce lots of complications including general complications, hardware problems, technical problems and long term changes of junctional motion segments. The purpose of this paper is to analyse the complications and problems developed during and after pedicle screw fixation for various spinal disorders and tarumas. Hundred and four patients were treated by pedicle screw fixation during the 3 year period from June 1988 to June 1991, and 73 patients were followed more than 18 months. Average follow-up was 26.5 months. Threr were 44 degenerative conditions, 24 frac- tures and 5 moscellaneous disorder. Fixation segments were single in 25, two levels in 36 and more than three levels in 12. Total number of screw used were 392. Posterior fusion was done in 7, posterolateral in 36, combined A+P fusion in 11 and PLIF in 19. CDI was used in 69, Steffee plate in 3 and Diapason in 1. All the surgeries were done by one surgeon. The results were as follows: 1.94 complications were noted in 46 patients out of 73 patients(63%) studied. 2.Most complications did not show poor clinical progress except one case of dedp would infection which needed removal of hardware, one case of persistent CSF leakage and one case of thigh pain due to degeneration of upper junctional motion segment. 3.Usually more than two complications were noted in each patient. In conclusion, pedicle screw fixation itself is a nice procedure to treat many kinds of spinal problems but it also produces variable complications. So, we should always be careful to per- form precise procedure to prevent those problems. Complications could be prevented by precise diagnosis before the operation, correction of predisposing factors during the operation and care- ful postoperative care.
신병준,김준범,조영훈,권희,서유성,김연일,나수균,최창욱 대한척추외과학회 1997 대한척추외과학회지 Vol.4 No.2
Study Design : The authors retrospectively analysed the recovery of clinical symptoms after surgical treatment of lumbar HIVD. Objectives : To investigate the incidence of clinical symptoms, the recovery rate and time after surgical treatment and the difference between L4-5 and L5-S1 lesion. Summary of Literature Review : There are many reports concerning the clinical result of surgical treatment for the HIVD. They usually describe the result as excellent, good, fair and poor. We can't get any information about the recovery rate and recovery time of each clinical symptom from the reports. Materials and Methods : Thirty-eight patients were treated by one level open discectomy from march 1991 to december 1995. The clinical symptoms and signs including SLR, motor deficit, sensory deficit, change of DTR and severity of radiating pain were periodically followed up on the predesigned protocol, Results : In preoperative examination, SLR was positive in 82%, motor deficit in 76%, sensory deficit in 74%, DTR change in 50%, and radiating pain in 100%. The recovery rate of SLR was 96.8%, motor deficit ; 93.6%, sensory deficit ; 78.6%, DTR change ; 21 % and radiating pain ; 84.2%. The average recovery time of SLR was 3.4 months, motor deficit ; 1.9 months, sensory deficit ; 5.3 months, DTR change ; 4.1 months and radiating pain ; 3.2 months. Motor and sensory deficit was more frequent in L4-5 lesion but DTR change was usually noted in L5-S] lesion. The recovery rate and time showed no great difference between the two level. Conclusions : The recovery rate was higher in SLR, motor deficit and radiating pain rather than sensory deficit and DTR change. The recovery time was fastest in radiating pain but variable nature was noted in sensory deficit. Above results may be helpful to explain the prognosis of the lumbar HIVD.