경추 전방 추간공 감압 수술 후 뇌척수액 누출의 Surgicel®과 Fibrin glue를 이용한 간접 봉합 - 증례 보고 -

최동혁,이지원,김철환,최용수 대한척추외과학회 2016 대한척추외과학회지 Vol.23 No.3

Study Design: A case report. Objectives: To report a case of indirect repair of cerebrospinal fluid (CSF) leakage after cervical anterior foraminotomy using Surgicel® and fibrin glue. Summary of Literature Review: There is no single modality that is best practice for this type of case because it is difficult to apply primary repair for a case of CSF leakage after cervical anterior decompression. Materials and Methods: A 49-year-old female patient was diagnosed with CSF leakage on the second day after cervical anterior foraminotomy. We performed coverage with Surgicel® and fibrin glue at the CSF leak site. Results: The patient was treated with indirect repair of CSF leakage without any complications. The clinical and radiological outcomes were excellent upon follow-up 1 year postoperatively. Conclusions: Indirect repair using Surgicel® and fibrin glue is an effective treatment for postoperative CSF leakage after cervical anterior foraminotomy. 연구 계획: 증례 보고. 목적: 경추 전방 추간공 감압술 후 뇌척수액 누출의 Surgicel®과 fibrin glue를 이용한 간접 봉합의 치험 사례를 보고 한다. 선행문헌의 요약: 경추 전방 감압 수술 후 발생한 뇌척수액 누출에 치료 방법이 확립되어 있지 않다. 대상 및 방법: 49세 여자 환자의 제 5-6경추 추간공 감압술후 2일째 수술 부위에 발적을 동반한 부종과 배액관에 뇌척수액이 배액 되어 뇌척수액 누출이진단되었고, 추간공 누출부에 Surgicel®과 fibrin glue를 도포하여 치료하였다. 결과: 뇌척수액 누출의 간접 봉합 후 합병증 없이 치료되었고, 1년 추시 임상적 및 방사선학적 결과 우수하였다. 결론: Surgicel®과 fibrin glue를 이용한 간접 봉합은 경추 전방 추간공 감압술 후 뇌척수액 누출에 대한 치료의 하나로 사료된다.

천골 골절 후 발생한 지연성 신경 손상의 경복막 도달법을 통한 수술적 치료 -증례 보고-

이종석 ( Jong Seok Lee ),장영수 ( Young Soo Jang ),최재혁 ( Jae Hyuk Choi ),배성주 ( Sung Ju Bae ),배찬일 ( Chan Il Bae ) 대한골절학회 2013 대한골절학회지 Vol.26 No.1

This study reviews a case of sacral fracture with delayed onset neurological deficit that showed good results after decompressive surgery. The delayed neurological deficit appeared at 4 weeks after injury and it was treated with anterior decompression through transperitoneal approach. A 23-year-old woman was injured in a car accident and had bilateral pubic rami fractures and fractures of the sacral ala on the right side. She was treated with external fixation devices for approximately four weeks, but complained of pain and numbness. The dorsiflexion and plantalflexion of the right ankle was weakened and graded as grade 2. Preoperative pelvic and sacral radiographs, computed tomography, magnetic resonance imaging and electromyelography, and nerve conduction study were performed to identify the region of neurological deficit, and we decided to implement neurological decompression. By transperitoneal approach, we performed bone curratage and decompression around the region of sacral alar slope and S1 foramen. The pain and numbness of the right foot cleared up. Dorsiflexion and plantalflexion of the right ankle improved to grade 5. Anterior decompression by transperitoneal approach proved to bring satisfactory results in a patient, who presented delayed neurological deficit after sacral fracture.

터키안결절 수막종의 치료 결과 분석

김주평(Joo Pyung Kim),박봉진(Bong Jin Park),임영진(Young Jin Lim) 대한두개저학회 2008 대한두개저학회지 Vol.3 No.2

Instruction : The most important factors for treatment of tuberculum sellae meningioma is complete resection of the tumor without provoking symptoms such as decreased visual acuity and visual field defect. We retrospectively analyzed patients with tuberculum sellae meningioma with regard to postoperative tumor control and visual outcomes. Material and Method : From 1994 to 2008, 17 patients with tuberculum sellae meningioma underwent surgical treatment. Mean age was 49.8 years, mean symptom duration was 12.5 months. The mean follow up period was 67.2 months. 13 patients underwent surgery through extradural anterior clinoidectomy with optic nerve decompression. Subfrontal approach was performed in 2 patients and orbitozygomatic approach in 2 patients. Result : Twelve patients presented with symptoms of optic nerve compression, and hypopituitarism symptoms in 1 patient. Four patients were found incidentally as tuberculum sellae meningioma. Ten patients who presented with visual acuity disturbance before operation, 6 with visual field defect and optic nerve atropy in 5 patient. Gross total resection was achieved in 13 patients. Simpson grade I in 1 case, grade II in 8 cases, grade III in 4 cases and subtotal resectionl in 4 cases. Of the 12 patients with preoperative optic nerve compression symptoms pre-operatively, 8 patients(66.7%) were improved and 4 were unchanged(33.3%). There were no further visual deteriorations for the patients with no visual disturbances before operations. Conclusion : We obtained good outcome via the extradural anterior clinoidectomy with optic nerve decompression. We think that this approach was suitable access to patients with visual deterioration and reduces the risk of intraoperative optic nerve injury.

신경학적 증상을 동반한 흉요추 및 요추 골절에서 후방 감압술 후 추가적인 전방 감압술이 필요한가?

유재원,손홍문,박상수 대한척추외과학회 2012 대한척추외과학회지 Vol.19 No.2

Study Design: A retrospective study. Objectives: To understand the necessity of additional anterior decompression when treating with posterior decompression for thoracolumbar and lumbar fractures, with neurologic deficit. Summary of Literature Review: Additional anterior decompression is still a controversy after a posterior decompression Materials and Methods: We evaluated 38 patients who were treated with a decompression surgery for thoracolumbar and lumbar spine fractures with neurologic deficit. In the posterior decompression group, there were 26 patients, and there were 12 patients in the posterior and anterior decompression group. According to the Frankel grade, neurologic deficit was grade A 3, B 1, C 3, D 31, respectively. Unstable burst fractures were 22, flexion-distraction injuries 12, Chance fractures 2 and translational injuries 2 by the McAfee classification. Radiographic evaluation was carried out with comparison of the spinal canal encroachment and kyphotic angle. We evaluated the improvement of neurology, and compared with that of the preoperative canal encroachment. Results: During the posterior decompression, 5 neural injuries were found in the post. decompression group, and 4 in the post. and ant. decompression group. There was no significant difference of neurologic improvement between the two groups (improvement in 18(69%)and 8(67%), respectively) (p>0.05). Preoperative canal encroachment was 62% and 76%, respectively. But, preoperative canal encroachment and final neurologic improvement showed no significant correlations between the two groups (p>0.05). Conclusions: We could not find the difference of neurologic improvement between the post. decompression group and post. and ant. decompression group. We suggest that an additional ant. decompression for the thoracolumbar and lumbar spine fractures treated with post. decompression is not necessary. 연구계획: 후향적 연구목적: 신경학적 증상을 동반한 흉요추 및 요추 골절환자에서 후방 감압술로 치료한 후 신경증상의 호전을 위해서 전방 감압술이 추가적으로 필요한 지에 대해서 알아보고자 하였다. 선행문헌의 요약: 후방 감압술 후 척추관내 골편이 남아있는 경우 전방 감압술이 필요한지에 대한 일치된 의견은 확립되지 않았다. 대상 및 방법: 신경학적 증상을 동반한 흉요추부 및 요추 골절로 인해 수술적 치료를 받은 환자 중 1년 이상 추시 관찰이 가능하였던 38예를 대상으로하였다. 후방 감압술과 유합술만 받은 예는 26예, 전 후방 감압술을 받은 예는 12예 이었다. 신경학적 증상은 Frankel grade A가 3예, B가 1예, C가 3예,D가 31예 이었다. 골절의 분류는 McAfee 등의 분류에 따라 불안정성 방출성 골절 22예, 굴곡 신연 손상 12예, Chance 골절 2예, 전이성 손상 2예 이었다. 방사선학적 평가는 양군의 척추관 함입률과 후만각을 비교하였으며, 수술 전 척추관 함입률과 신경학적 호전의 정도를 비교하였다. 결과: 수술 소견상 신경근 손상은 후방 감압술군 5예에서, 전후방 감압술군 4예에서 확인되었다. 후방 감압술군에서 호전 18예(69%), 무변화 8예(31%)이었으며 전 후방 감압술 군에서 호전 8예(67%), 무변화 4예(33%)를 보여 두 군간에 의의 있는 신경학적 호전의 차이는 없었다(p>0.05). 수술 전 척추관함입률은 후방 감압술군 62%, 전후방 감압술군 67%로 전후방 감압술 군에서 척추관 함입이 많았으나, 수술 전 척추관 함입률과 최종 신경학적 증상의호전과는 두 군간에 의의 있는 차이는 없었다(p>0.05). 결론: 신경학적 증상을 동반한 흉요추 및 요추 골절의 치료에서 후방 감압술과 전후방 감압술의 신경 호전의 정도는 차이가 없었으며 신경 호전을 위한추가적인 전방 감압술은 꼭 필요한 술식은 아니라고 사료됩니다.

Minimally Invasive Anterior Decompression Technique without Instrumented Fusion for Huge Ossification of the Posterior Longitudinal Ligament in the Thoracic Spine : Technical Note And Literature Review

Yu, Jae Won,Yun, Sang-O,Hsieh, Chang-Sheng,Lee, Sang-Ho The Korean Neurosurgical Society 2017 Journal of Korean neurosurgical society Vol.60 No.5

Objective : Several surgical methods have been reported for treatment of ossification of the posterior longitudinal ligament (OPLL) in the thoracic spine. Despite rapid innovation of instruments and techniques for spinal surgery, the postoperative outcomes are not always favorable. This article reports a minimally invasive anterior decompression technique without instrumented fusion, which was modified from the conventional procedure. The authors present 2 cases of huge beak-type OPLL. Patients underwent minimally invasive anterior decompression without fusion. This method created a space on the ventral side of the OPLL without violating global thoracic spinal stability. Via this space, the OPLL and anterior lateral side of the dural sac can be seen and manipulated directly. Then, total removal of the OPLL was accomplished. No orthosis was needed. In this article, we share our key technique and concepts for treatment of huge thoracic OPLL. Methods : Case 1. 51-year-old female was referred to our hospital with right lower limb radiating pain and paresis. Thoracic OPLL at T6-7 had been identified at our hospital, and conservative treatment had been tried without success. Case 2. This 54-year-old female with a 6-month history of progressive gait disturbance and bilateral lower extremity radiating pain (right>left) was admitted to our institute. She also had hypoesthesia in both lower legs. Her symptoms had been gradually progressing. Computed tomography scans showed massive OPLL at the T9-10 level. Magnetic resonance imaging of the thoracolumbar spine demonstrated ventral bony masses with severe anterior compression of the spinal cord at the same level. Results : We used this surgical method in 2 patients with a huge beaked-type OPLL in the thoracic level. Complete removal of the OPLL via anterior decompression without instrumented fusion was accomplished. The 1st case had no intraoperative or postoperative complications, and the 2nd case had 1 intraoperative complication (dural tear) and no postoperative complications. There were no residual symptoms of the lower extremities. Conclusion : This surgical technique allows the surgeon to safely and effectively perform minimally invasive anterior decompression without instrumented fusion via a transthoracic approach for thoracic OPLL. It can be applied at the mid and lower level of the thoracic spine and could become a standard procedure for treatment of huge beak-type thoracic OPLL.

경추 척수증에서 불충분한 전방 감압술후 추궁판 성형술 5례 보고

서정국,김정훈 인제대학교 백병원 2002 仁濟醫學 Vol.23 No.2

Objective: We have analyzed the clinical and radiological outcomes in 5 patients who showed no improvement after anterior decompression so that underwent laminoplasty. Materials and Methods: We studied retrospectively 5 patients who underwent laminoplasty after anterior decompression between January 1998 and April 1999. The mean age was 55.4 years (46 to 60). The mean duration from anterior decompression to laminoplasty was 39 months (12 to 90). We evaluated clinical symptoms and signs. Plain radiogram and MRI were taken before and after surgery. In evaluating the clinical results, the evaluation system established by the Japanese Orthopedic Association (JOA score) and Hirabayashi recovery rate was employed. Results: Postoperative radiograms showed an incresasement of body to canal ratios(average 0.79 pre-op, to 1.15 post-op.) and the mean JOA score increased from 11.8 preoperatively to 14.4 at the final follow-up with a mean recovery rate of 48%. Conclusion: It is better to do anterior decompression in patients who have one or two segments involved. Otherwise, patients who involve more than 3 segments can be managed using laminoplasty. Laminoplasty for patients who underwent incomplete ant, decompression may be useful method.

Anterior Decompression and Fusion for the Treatment of Cervical Myelopathy Caused by Ossification of the Posterior Longitudinal Ligament: A Narrative Review

Park Sehan,Lee Dong-Ho,이춘성,Hwang Chang-Ju,Yang Jae Jun,Cho Jae Hwan 대한척추외과학회 2023 Asian Spine Journal Vol.17 No.3

Occasionally, ossification of the posterior longitudinal ligament (OPLL) causes cord compression, resulting in cervical myelopathy. OPLL differs from other causes of cervical spondylotic myelopathy in several ways, and the surgical strategy should be chosen with OPLL’s characteristics in mind. Although both the anterior and posterior approaches are effective surgical methods for the treatment of OPLL cervical myelopathy, they each have their own set of benefits and drawbacks. Anterior decompression and fusion (ADF) may improve neurological recovery, restore lordosis, and prevent OPLL mass progression. The benefits can be seen in patients with a high canal occupying ratio or kyphotic alignment. We discussed the benefits, limitations, indications, and surgical techniques of ADF for the treatment of OPLL-induced cervical myelopathy in this narrative.

흉·요추 불안정성 척추 손상 환자에서 전방 감압술과 전방기기 및 Surgical Titanium Mesh를 이용한 내고정술 (장기적 추적 검사 결과)

박환민,이승명,조하영,신호,정성헌,송진규,장석정,Park, Hwan Min,Lee, Seung Myung,Cho, Ha Young,Shin, Ho,Jeong, Seong Heon,Song, Jin Kyu,Jang, Seok Jeong 대한신경외과학회 2000 Journal of Korean neurosurgical society Vol.29 No.1

Objective : Thoracolumbar junction is second most common level of injury next to cervical spine. The object of this study is to study the usefulness of surgical titanium mesh instead of bone graft, as well as to evaluate the correction of spinal deformity and safety of early ambulation in patients with injury at thoracolumbar junction. Patients and Methods : This review included 51 patients who were operated from July 1994 to December 1997. The injured spine is considered to be unstable, if it shows involvement of two or more columns, translatory displacement more than 3.5mm, decrease more than 35% in height of vertebral body and progression of malalignment in serial X-ray. The decision to operate was determined by (1) compression of spinal cord or cauda eguina, (2) unstable fracture, (3) malalignment and (4) fracture dislocation. The procedure consisted of anterior decompression through corpectomy and internal fixation with anterior instrument and surgical titanium mesh which was impacted with gathered bone chip from corpectomy. Results : Fifty-one patients were followed up for at least 12 months. The main causes of injury were fall and vehicle accident. The twelfth thoracic and the first and the second lumbar vertebrae were frequently involved. Complete neural decompression was possible under direct vision in all cases. Kyphotic angulation occurred in a patient. Radiologic evaluation showed correction of deformity and no distortion or loosening of surgical titanium mesh with satisfactory fixation postoperatively. Conclusions : We could obtain neurological improvement, relief of pain, immediate stabilization and early return to normal activities postoperatively. Based on these results, authors recommend anterior decompression and internal fixation with surgical titanium mesh in thoracolumbar unstable spine injuries.

두개저 함입증을 동반한 제 1형 Chiari 기형환자의 단계적 감압술 -증례보고 -

강석구,전신수,이일우,박춘근,홍용길,김문찬,강준기 대한신경외과학회 1998 Journal of Korean neurosurgical society Vol.27 No.10

척추 전방 유합술 및 전방기기 고정술로 치료한 흉·요추 결핵 6례

장수찬,강동수,정환영,이상구,한기수,김영보,박철완,이언 대한신경외과학회 1997 Journal of Korean neurosurgical society Vol.26 No.4