단순 전후 면 방사선 촬영과 Ferguson 촬영에 의한 요천추 간 후외측 유합의 평가

이환모,박문수,이상훈,김기학,장준섭,문성환 대한척추외과학회 2001 대한척추외과학회지 Vol.8 No.3

연구목적 : 내고정 기기를 이용한 요천추 간 후외측 유합을 평가시 단순 전후 면 방사선 촬영과 퍼거슨 촬영의 신뢰도를 알기 위하여 관찰자간 및 관찰자내 재현성을 비교분석하였다. 대상 및 방법 : 자가 이식골과 내고정 기기를 이용하여 제 4 요추부터 제 1 천추까지 또는 제 5 요추에서 제 1 천추까지 후외측 골 유합술을 시행 받은 44명의 환자를 추시하고 단순 전후 면 방사선 사진을 관찰하여 곧 유합의 정도를 골 유합, 가관절 또는 판정 불가로 분류하였다. 이차 관찰은 2주 후 시행하였다. 관찰자간 및 관찰자내 재현성을 Fleiss방법을 이용하여 분석하였다. 결과 : 단순 전후면 방사선 촬영보다 퍼거슨 촬영에서 관찰자간 및 관찰자내 재현성이 우수하였다. 일차 및 이차 관찰 모두에서 관찰자간 재현성의 Kappa값은 단순 전후 면 방사선 촬영보다 퍼거슨 촬영에서 높았다. 또한 동일한 관찰자에 의한 일차 및 이차 관찰 간의 관찰자내 재현성의 Kappa값은 관찰자 모두에서 단순 전후 면 방사선 촬영보다 퍼거슨 촬영에서 높았다. 단순 전후면 방사선 촬영으로 평가시 판정 불가로 분류된 것 중 67%에서 퍼거슨 촬영으로 평가시 골 유합 또는 가관절로 분류되었다. 결론 : 퍼거슨 촬영이 단순 전후면 방사선 촬영보다 내고정 기기를 이용한 후외측 요천추 간 골 유합의 평가에 더 유용한 것으로 사료된다. Purpose : To evaluate the reliance of standard AP radiograph and Ferguson radiograph in assessment of instrumented lumbosacral fusion mass with interobserver and intraobserver reproducibilities. Materials and Methods : Postoperative standard AP radiograph and Ferguson radiograph were used to evaluate the fusion mass at the lumbosacral region of 44 consecutive patients who underwent posterolateral L4-S1 or L5-S1 instrumented fusion with pedicle screws & autogenous iliac bone graft. Ferguson radiograph was performed with the x-ray beam oriented toward the cranial portion at 40˚ relative to the x-ray table. All observations were performed independently by three observers. blinded to the history. diagnosis. and patient identity. The fusion mass was graded as solid. pseudarthrosis or questionable. A second review was repeated at 2 weeks after index review. lnterobserver and intraobserver reproducibilities were analyzed with Fleiss' method. Results : Ferguson radiographs were more reliable than standard AP radiographs in detecting the fusion mass. Kappa values with the interobserver reproducibility were higher in Ferguson radiographs than in the standard AP radiographs. Kappa values with the intraobserver reproducibility of all three observers were higher in Ferguson radiographs than in the standard AP radi0graphs. The questionable fusion masses in the standard AP radiographs were revealed solid or pseudarthrosis in Ferguson radiographs in 67%. Conclusion : Ferguson radiograph is a more reliable method than standard AP radiograph in evaluating instrumented posterolateral fusion mass in lumbosacral region.

Evaluation of Dimensions of Kambin's Triangle to Calculate Maximum Permissible Cannula Diameter for Percutaneous Endoscopic Lumbar Discectomy : A 3-Dimensional Magnetic Resonance Imaging Based Study

Pairaiturkar, Pradyumna Purushottam,Sudame, Onkar Shekhar,Pophale, Chetan Shashikant The Korean Neurosurgical Society 2019 Journal of Korean neurosurgical society Vol.62 No.4

Objective : To evaluate 3-dimensional magnetic resonance imaging (MRI) of Kambin's safe zone to calculate maximum cannula diameter permissible for safe percutaneous endoscopic lumbar discectomy. Methods : Fifty 3D MRIs of 19 males and 31 females (mean, 47 years) were analysed. Oblique, axial and sagittal views were used for image analysis. Three authors calculated the inscribed circle (cannula diameter) individually, within the neural (original) and bony Kambin's triangle in oblique views, disc heights on sagittal views and root to facet distances at upper and lower end plate levels on axial views and their averages were taken. Results : The mean root to facet distances at upper end plate level measured on axial sections increased from $3.42{\pm}3.01mm$ at L12 level to $4.57{\pm}2.49mm$ at L5S1 level. The mean root to facet distances at lower end plate level measured on axial sections also increased from $6.07{\pm}1.13mm$ at L12 level to $12.9{\pm}2.83mm$ at L5S1 level. Mean maximum cannula diameter permissible through the neural Kambin's triangle increased from $5.67{\pm}1.38mm$ at L12 level to $9.7{\pm}3.82mm$ at L5S1 level. The mean maximum cannula diameter permissible through the bony Kambin's triangle also increased from $4.03{\pm}1.08mm$ at L12 level to $6.11{\pm}1mm$ at L5S1 level. Only 2% of the 427 bony Kambin's triangles could accommodate a cannula diameter of 8mm. The base of the bony Kambin's triangle taken in oblique view (3D MRI) was significantly higher than the root to facet distance at lower end plate level taken in axial view. Conclusion : The largest mean diameter of endoscopic cannula passable through "bony" Kambin's triangle was distinctively smaller than the largest mean diameter of endoscopic cannula passable through "neural" Kambin's triangle at all levels. Although proximity of exiting root to the facet joint is always taken into consideration before PELD procedure, our 3D MRI based anatomical study is the first to provide actual maximum cannula dimensions permissible in this region.

Efficacy of Transforaminal Endoscopic Lumbar Discectomy in Elderly Patients Over 65 Years of Age Compared to Young Adults

손성,유병래,김희정,송성규,안용 대한척추신경외과학회 2023 Neurospine Vol.20 No.2

Objective: Spine surgery rates are increasing in the elderly population due to social aging, and it is known that prognoses related to surgery are worse for the elderly compared to younger individuals. However, minimally invasive surgery, such as full endoscopic surgery, is considered safe with low complication rates due to minimal damage to surrounding tissues. In this study, we compared outcomes of transforaminal endoscopic lumbar discectomy (TELD) in elderly and younger patients with disc herniation in the lumbosacral region. Methods: We retrospectively analyzed the data of 249 patients who underwent TELD at a single center between January 2016 to December 2019, with a minimum follow-up of 3 years. Patients were allocated to 2 groups: a young group aged ≤ 65 years (n = 202) or an elderly group aged > 65 years (n = 47). We evaluated baseline characteristics, clinical outcomes, surgery-related outcomes, radiological outcomes, perioperative complications, and adverse events during the 3-year follow-up period. Results: Baseline characteristics, including age, general condition based on American Society of Anesthesiologist physical status classification grade, age-Charlson Comorbidity Index, and disc degeneration, were worse in elderly group (p < 0.001). However, except for leg pain at 4 weeks after surgery, overall outcomes, including pain improvement, radiological change, operation time, blood loss, and hospital stay, were not different between the 2 groups. Furthermore, the rates of perioperative complications (9 patients [4.46%] in the young group and 3 patients [6.38%] in the elderly group, p = 0.578) and adverse events over the 3-year follow-up period (32 patients [15.84%] in the young group and 9 patients [19.15%] in the elderly group, p = 0.582) were comparable in the 2 groups. Conclusion: Our findings suggest that TELD produces similar outcomes in both elderly and younger patients with a herniated disc in the lumbosacral region. TELD can be considered a safe option for appropriately selected elderly patients.

Comparison of international medical costs for interventional pain treatment: a focus on Korea and Japan

( Eun Young Lee ),( Hyung-sun Won ),( Miyoung Yang ),( Hyungtae Kim ),( Yeon-dong Kim ) 대한통증학회 2024 The Korean Journal of Pain Vol.37 No.1

Background: The rise in national health care costs has emerged as a global problem given the ever-aging population and rapid development of medical technology. The utilization of interventional pain management has, similarly, shown a continued rise worldwide. This study evaluates the differences in the medical costs in the field of interventional pain treatment (IPT) between two countries: Korea and Japan. Methods: Korean medical insurance costs for 2019 related to pain management focused on IPT were compared to those of Japan. Purchasing power parity (PPP) was used to adjust the exchange rate differences and to compare prices in consideration of the respective societies’ economic power. Results: The cost of trigger point injections in Japan was 1.06 times higher than that of Korea, whereas the perineural and intraarticular injection prices were lower in Japan. The cost of epidural blocks was higher in Japan compared to Korea in both cervical/thoracic and lumbar regions. As for blocks of peripheral branches of spinal nerves, the cost of scapular nerve blocks in Japan was lower than that in Korea, given a PPP ratio 0.09. For nerve blocks in which fluoroscopy guidance is mandatory, the costs of epidurography in Japan were greater than those in Korea, given a PPP ratio 1.04. Conclusions: This is the first comparative study focusing on the medical costs related to IPT between Korea and Japan, which reveals that the costs differed along various categories. Further comparisons reflecting more diverse countries and socio-economic aspects will be required.

경마경력에 따른 요천추부 각도차이와 요부재활운동이 경마기수의 요천추부 각도, 요부 근력 및 요통에 미치는 영향

김남우(NamWooKim),윤진호(JinHoYoon),김영주(YoungJooKim),김알찬(AlChanKim),오재근(JaeKeunOh) 한국체육학회 2010 한국체육학회지 Vol.49 No.4

이 연구는 신인기수(n=8)와 경력 5년차 기수(n=8)의 요천추부 각도를 cobb`s 방법을 이용하여 측정하였다. 또한 요통을 호소하는 한국경마기수협회 소속 경마기수(n=16)를 대상으로 8주간의 요부재활운동에 따른 통증정도의 변화에 관하여 미치는 영향을 알아보고자 실시하였다. 이 연구의 결과는 다음과 같다; 신인기수들과 5년차 기수들의 요천추부 각도의 차이는 천골각에서 집단 간에 유의한 차이가 있는 것으로 나타났으며( p<.05), 요추 전만각, 요천추각에서는 집단 간에 유의한 차이가 없었다. 또한 요천추부 각도는 요추 전만각에서 운동 전·후 시기 간에 유의한 차이가 있는 것으로 나타났으며( p<.01), 운동 집단 내 시기 간에도 유의한 증가가 있었다( p<.001). 등척성 요부 신전근력은 0°를 제외한 모든 각도에서 운동 전·후 시기 간에 유의한 차이가 있는 것으로 나타났으며, 운동 집단 내 시기 간에도 유의한 증가가 있었다. 등속성 요부 신전 체중 당 최대우력은 각속도 90°/sec에서 운동 집단 내 시기 간에 유의한 증가가 있었다( p<.001). 좌, 우측 요부 체열 차이는 운동 전·후 시기 간에 유의한 차이가 있는 것으로 나타났으며( p<.001), 운동 집단 내 시기 간에도 유의한 감소가 있었다( p<.001). 따라서 이 연구 결과 요통을 가진 경마기수들에 있어서 요부재활운동은 요통을 개선시키는 것으로 사료되며, 요통을 예방하기 위해 요부 신전근력 강화에 중점을 둔 요부재활운동이 필요하다고 사료된다. This study is to investigate the difference of lumbosacral region angle according to horse racing career and effects of lumbar rehabilitation exercise during 8 weeks on lumbosacral region angle, lumbar strength and low back pain in jockeys. Subjects were divided into two group; rookies(n=8) and 5 years of experienced jockeys(n=8). We measured the lumbosacral region angle by using cobb`s method. The results are as follows; The difference of lumbosacral region angle between two groups was showed significantly between groups in sacral angle(p<.05), and it didn`t show a significant difference between groups in lumbar lordosis angle and lumbosacral angle. Also, lumbosacral region angle in lumbar lordosis angle showed a significant difference between periods before and after exercise(p<.01), and it appeared to have a significant increase between periods in exercise group(p<.001). Isometric lumbar extension strength in all angles except 0 degree appeared to have a significant difference between periods before and after exercise, and it appeared to have a significant increase between periods in exercise group. Isokinetic lumbar extension peak torque % body weight in angular velocity of 90 degrees/sec showed a significant increase between periods in exercise group(p<.001). The difference between left and right side lumbar body heat was showed significantly between periods before and after exercise(p<.001), and it appeared to have a significant decrease between periods in exercise group(p<.001). Consequently, this study suggests that the lumbar rehabilitation exercise improved low back pain and jockeys needs lumbar rehabilitation exercise which is focused on improvement of lumbar extension strength in order to protect low back pain.

Lumbosacral Sagittal Alignment in Association to Intervertebral Disc Diseases

Zohreh Habibi,Farid Maleki,Ali Tayebi Meybodi,Ali Mahdavinezhad,Hooshang Saberi 대한척추외과학회 2014 Asian Spine Journal Vol.8 No.6

Study Design: A cross-sectional case-control study was designed to compare the sagittal alignment of lumbosacral regions in two groups of patients suffering from low back pain, one with intervertebral disc pathologies and one without. Purpose: To evaluate the correlation between lumbosacral sagittal alignment and disc degeneration. Overview of Literature: Changes in lumbar lordosis and pelvic parameters in degenerative disc lesions have been assessed in few studies. Overall, patients with discopathy were shown to have lower lumbar lordosis and more vertical sacral profiles. Methods: From patients with intractable low back pain undergoing lumbosacral magnetic resonance imaging, 50 subjects with disc degeneration and 50 controls with normal scans were consecutively enrolled. A method was defined with anterior tangent-lines going through anterior bodies of L1 and S1 to measure global lumbosacral angle, incorporating both lumbar lordosis and sacral slope. Global lumbosacral angle using the proposed method and lumbar lordosis using Cobb’s method were measured in both groups. Results: Lumbar lordosis based on Cobb’s method was lower in group with discopathy (20°–67°; mean, 40.48°±9.89°) than control group (30°–62°; mean, 44.96°±7.68°), although it was not statistically significant. The proposed global lumbosacral angle in subject group (53°–103°; mean, 76.5°±11.018°) was less than control group (52°–101°; mean, 80.18°±9.95°), with the difference being statistically significant (p =0.002). Conclusions: Patients with intervertebral disc lesions seem to have more straightened lumbosacral profiles, but it has not been proven which comes first: disc degeneration or changes in sagittal alignment. Finding an answer to this dilemma demands more comprehensive long-term prospective studies.

요골반 안정화 운동이 만성요통환자의 요천추부 각도, 동적균형, 체간신전근지구력 및 통증지표에 미치는 영향

이호성(Lee, Ho-Seong) 한국체육과학회 2014 한국체육과학회지 Vol.23 No.2

The purpose of this study was to determine the effects of lumbopelvic stabilization exercise on chronic low back pain, lumbosacral region angle, dynamic balance, trunk extensor endurance and pain index in middle aged women with chronic low back pain. Twelve middle aged women with chronic low back pain(Duration≥3month, visual analogue scale; VAS≥4, oswestry disability index; ODI≥7) were randomly divided into lumbopelvic stabilization exercise group(LSG, n=6) and control group(CON, n=6). Lumbopelvic stabilization exercise was performed for 60 min(warm up 10 min, exercise 40 min, cool down 10 min), three times a week for 8 weeks, with abdominal bracing. Lumbosacral region angle(lumbar lordotic angle; LLA, lumbosacral angle; LSA, sacrohorizontal angle; SHA), dynamic balance, trunk extensor endurance and pain index(VAS, ODI) were measured before and after 8-week exercise each groups. In results, lumbar lordotic angle(p=000) and lumbosacral angel(p=.041) showed significant interaction with groups and times in the LSG after exercise. Dynamic balance of Forward(p=.011, Backward(p=.008), Left(p=.001), Right(p=.OOQ), Left-Forward(p=.000), Right-Forward(p=.035), Left-Backward(p=.004) and Right-Backward(p=.000) showed significant interaction with groups and times in the LSG after exercise. Trunk extensor endurance showed significant interaction with groups and times in the LSG after exercise(p=.011). VAS showed significant interaction with groups and times in the LSG after exercise (p=.000). ODI showed significant interaction with groups and times in the LSG after exercise(p=.004). These results confirms that lumbopelvic stabilization exercise improve lumbosacral region angle and increased both dynamic balance and trunk extensor endurance, and decreased low back pain.

The Effects of Spinopelvic Parameters and Paraspinal Muscle Degeneration on S1 Screw Loosening

Kim, Jin-Bum,Park, Seung-Won,Lee, Young-Seok,Nam, Taek-Kyun,Park, Yong-Sook,Kim, Young-Baeg The Korean Neurosurgical Society 2015 Journal of Korean neurosurgical society Vol.58 No.4

Objective : To investigate risk factors for S1 screw loosening after lumbosacral fusion, including spinopelvic parameters and paraspinal muscles. Methods : We studied with 156 patients with degenerative lumbar disease who underwent lumbosacral interbody fusion and pedicle screw fixation including the level of L5-S1 between 2005 and 2012. The patients were divided into loosening and non-loosening groups. Screw loosening was defined as a halo sign larger than 1 mm around a screw. We checked cross sectional area of paraspinal muscles, mean signal intensity of the muscles on T2 weight MRI as a degree of fatty degeneration, spinopelvic parameters, bone mineral density, number of fusion level, and the characteristic of S1 screw. Results : Twenty seven patients showed S1 screw loosening, which is 24.4% of total. The mean duration for S1 screw loosening was $7.3{\pm}4.1$ months after surgery. Statistically significant risk factors were increased age, poor BMD, 3 or more fusion levels (p<0.05). Among spinopelvic parameters, a high pelvic incidence (p<0.01), a greater difference between pelvic incidence and lumbar lordotic angle preoperatively (p<0.01) and postoperatively (p<0.05). Smaller cross-sectional area and high T2 signal intensity in both multifidus and erector spinae muscles were also significant muscular risk factors (p<0.05). Small converging angle (p<0.001) and short intraosseous length (p<0.05) of S1 screw were significant screw related risk factors (p<0.05). Conclusion : In addition to well known risk factors, spinopelvic parameters and the degeneration of paraspinal muscles also showed significant effects on the S1 screw loosening.

Fusion Length Requiring Spinopelvic Fixation in Lumbosacral Fusion with Anterior Column Support at L5–S1: Assessment of Fusion Status Using Computed Tomography

Sung Cheol Park,Sangjun Park,Do-Hyung Lee,Jinew Seo,Jae Hyuk Yang,Min-Seok Kang,Yunjin Nam,Seung Woo Suh 대한정형외과학회 2024 Clinics in Orthopedic Surgery Vol.16 No.1

Background: The lumbosacral (LS) junction has a higher nonunion rate than other lumbar segments, especially in long-level fusion. Nonunion at L5–S1 would result in low back pain, spinal imbalance, and poor surgical outcomes. Although anterior column support at L5–S1 has been recommended to prevent nonunion in long-level LS fusion, fusion length requiring additional spinopelvic fixation (SPF) in LS fusion with anterior column support at L5–S1 has not been evaluated thoroughly. This study aimed to determine the number of fused levels requiring SPF in LS fusion with anterior column support at L5–S1 by assessing the interbody fusion status using computed tomography (CT) depending on the fusion length. Methods: Patients who underwent instrumented LS fusion with L5–S1 interbody fusion without additional augmentation and CT > 1 year postoperatively were included. The fusion rates were assessed based on the number of fused segments. Patients were divided into two groups depending on the L5–S1 interbody fusion status: those with union vs. those with nonunion. Binary logistic regression analyses were performed to identify risk factors for LS junctional nonunion. Results: Fusion rates of L5–S1 interbody fusion were 94.9%, 90.3%, 80.0%, 50.0%, 52.6%, and 43.5% for fusion of 1, 2, 3, 4, 5, and ≥ 6 levels, respectively. The number of spinal levels fused ≥ 4 (p < 0.001), low preoperative bone mineral density (BMD; adjusted odds ratio [aOR], 0.667; p = 0.035), and postoperative pelvic incidence (PI) – lumbar lordosis (LL) mismatch (aOR, 1.034; p = 0.040) were identified as significant risk factors for nonunion of L5–S1 interbody fusion according to the multivariate logistic regression analysis. Conclusions: Exhibiting ≥ 4 fused spinal levels, low preoperative BMD, and large postoperative PI–LL mismatch were identified as independent risk factors for nonunion of anterior column support at L5–S1 in LS fusion without additional fixation. Therefore, SPF should be considered in LS fusion extending to or above L2 to prevent LS junctional nonunion.

Complication Profiles Associated with Sacral Alar Iliac Screw Fixation in Patients with Adult Spinal Deformity: A Comparative Analysis to the Conventional Iliac Screw Fixation

Park Ga-On,Choi Un-Yong,Kim Kyung Hyun,Park Jeong Yoon,Chin Dong Kyu,Kim Keun Su,Cho Yong Eun 대한말초신경학회 2021 The Nerve Vol.7 No.2

Objective: This study aimed to compare the radiographic and clinical outcomes between sacral alar iliac (SAI) screw fixation and conventional iliac (CI) screw fixation with a particular focus on the rate of reoperation, surgical site infection (SSI), sacroiliac joint pain, instrument failure, and screw prominence.Methods: Patients who underwent sacropelvic fixation in the authors’ institution from June 2011 to May 2017 were retrospectively investigated. Forty-three patients with SAI screw fixation and 25 with CI screw fixation were included. Preoperative patient and surgical characteristics and postoperative outcomes and complications were analyzed between the SAI and CI groups. Radiographic parameters were analyzed before and after surgery.Results: Lumbosacral fusion rates showed no statistically significant difference between the SAI group and CI groups (90.7% vs. 92.0%, p=0.878). The SAI group showed a significantly good result with regard to SSI compared to the CI group (0% vs. 16%, p=0.016), but had a significantly higher rate of distal screw fracture than the CI group (16.3% vs. 0%, p=0.042).Conclusion: The SAI screw fixation technique could achieve good outcomes of pain relief, deformity correction, and lumbosacral fusion rate with relatively lower complications such as the rates of reoperation, SSI, and screw prominence as compared to the CI screw fixation technique. However, distal instrument failure was observed more frequently in the SAI group, requiring further biomechanical studies.