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퇴행성 요추질환에서 척추 나사못 기기술후 요추 전만각의 소실에 대한 고찰
김응하,우병철,조덕연 대한척추외과학회 1997 대한척추외과학회지 Vol.4 No.1
Posterolateral fusion using transpedicular screw fixation is widely used in the surgical treatment of degenerative lumbar diseases with good restoration of lumbar lordosis. The purpose of this study is to define the causes of the loss of the normal lumar lordosis after instrumentation of the degenerative lumbar diseases. The authors analyzed 38 patients showing the no significant restoration or definite postoperative loss of the restored lumbar lordosis within fused and/or unfused segments in a total of 138 surgical cases of degenerative lumbar diseases who underwent posterolateral fusion using segmental transpedicular screws from Jan. 1989 to Dec. 1993. The results from this study are as follows: 1. By standard Cobb lateral measurements, thirty-eight patients(28%) in a total of 138 patients showed the no significant restoration postoperatively or definite loss of lumbar lordosis (> 4˚) during follow up period. 2. The no significant restoration within fused segments was noted in 15 cases and caused by distraction in during operation(7 cases), stiff kyphosis(4 cases), pseudo spondylolisthesis(3 cases) and inappropriate operation position (1 case). 3. The loss within fused segments during follow up period was noted in I I cases and due to implant loosening(2 cases), rod-screw locking failure(6 cases) and use of the flexible rods(3 cases). 4. The loss within unfused segments was noted in 24 segments of 22 cases and due to acceleration of existing degenerative changes(14 segments), instability(3 segments), compression fracture(1 segment) and acceleration of existing degenerative changes with instability(6 segments), but newly developed degenerative changes was not noted during this follow-up. We concluded that in surgical intervention of degenerative lumbar spines, surgeons shoud consider above factors for the restoration of the lumbar lordosis and improvement of sagittal balance.
김응하,우병철,조덕연 대한척추외과학회 1997 대한척추외과학회지 Vol.4 No.1
The patients who are related with compensation showed more unsatisfactory surgical outcome compairing with those who are not related with compensation in lumbar disc surgery. The authors retrospectively reviewed the medical records of 254 patients who were given the open disectomy for lumbar dics herniation from Jan, 1985 to Dec. 1994 to anaylize prognostic factors influencing surgical outcome in compensated and noncompensated patient groups. Factors such as age, tender, level of the disc herniation, physical findings and duration of symptoms had no correlation with surgical outcome in this study. The occupation, histroy of injury and compensation were statistically related to poor surgical outcome. The definite disc heniation with correlated symptom and physical findings predicted an significantly better outcome in both compensated and noncompensated patient groups. On the basis of these studies, we concluded that the surgical outcome of the compensated patients was less satisfactory than the noncompensated, but better surgical outcome in compensated patients was expected with proper case selection and strict surgical indication.