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김홍태,천동욱,김형표,안혁수,전홍배 대한척추외과학회 1994 대한척추외과학회지 Vol.1 No.2
An instability is expected when the posterolateral bony components of a spine are excised for the treatment of a benign tumor in the region or for the decompression of a far lateral nerve root compression. In such a case there are to enough bony beds on the side of excision upon which to fuse, and also the spinal nerve is usually exposed on that side where the bone grafting is hesi- tated over the unprotected nerve. So the unilateral posterolateral spinal fusion can be applied in the other side. Four patients of unilateral posterolateral spinal fusions of the lumbosacral segment were reviewed. They were two men and two women having ages from 51 to 58 years. The follow-up time ranged from 8 months to 4 years and 3 months with an average of 28 months. All patients had far lateral herniation of the lumbosacral disc and the facet joint of that side were completely excised for discectomy. The fusions were performed on the other side using iliac bone graft without internal fixation/extension lateral views in all patients. Sumptoms were improved and there was no considerable low back pain in all patients except one who complained multiple pain of psychogenic origin. In conclusion, the unilateral posterolateral spinal fusion cas stabelize an unstable lumbosacral segment.
김홍태,박봉훈,천동욱,김형표,정재호 대한척추외과학회 1995 대한척추외과학회지 Vol.2 No.1
A lumbar fusion may influence biomechanically on the remained unfused segments to take over the lost motions. The adjacent segments to fusion particulatly will experience an additional motional stress following a fusion, and then various late complications can occur. Moreover, the amount of this stress may differ according to the levels and extents of the fusions. The aim of this study is to evalu- ate this motional stress in different levels of fusion. A retrospective review of flexion and extension lateral radiograghs was undertaken for 142 consec- utive patients who had undergone various fusions in the lumbar region. Included in this study were the patients who had performed active daily livings after surgery and followed for minimum of two years. They were 60 males and 82 females, having mean age of 46.7(range 14-72). There were three posterior fusions, 123 lateral fusions, and 16 interbody fusions. The extent of fusions were one seg- ment in 71, two segments in 53, three segments in 16, and four segments in two patients. The follow- up period was 53 months in average(range 2-15 years). The intervertebral angles were measured on the flexion/extension lateral radiographs, and then the calculated intervertebral angular motions at follow-up periods were compared with those of preoperative values. The average increases of angular motion at the adjacent segments to fusions were 2.3˚at L1-2 seg- ment(ranging 0˚to 5˚increase),2.5˚at L2-3 segment(ranging 1˚decrease to 8˚increase), 2.9˚at L3-4 segment (ranging 3˚decrease to 12˚increase), 6.7˚at L4-5 segment(ranging 2˚to 18˚ increase), and 1.5˚at L5-S1 segment(ranging 5˚decrease to 7˚increase). The average increases of the above and below adjacent segments to fusions were 3.3˚(ranging 3˚decrease to 18˚increase) and 1.7˚(ranging 5˚decrease to 12˚increase) respectively. There were no significant differences in the changes of angular motion according to the extents of fusion and during these follow-up periods. In conclusion, the angular motions at the adjacent segment to fusions increased most signficantly at L4-5 segment regardless of the fusion sites whether it is below or above a fusion. Excluding the L4-5 segment, the angular motions at the above adjacent segments to fusion increased significantly compared to those at the below adjacent segments. The late complications at adjacent segments to lumbar fusions are expected to appear preferably at these segments.
김홍태,박봉훈,천동욱,이형석,전홍배 대한척추외과학회 1994 대한척추외과학회지 Vol.1 No.1
Adequate pain drawings obtained from 119 patients who were surgically treated for a low back disordir during 1992 were analysed to evalutae the possibility of using the pain drawings in the initial diagnosis at first visit, in the assessment of psycho- logical status of patients, and in the prediction of the treatments results. An initial diagnostic impression was made at a glance over the pain drawing into five cate- gories and the results were compared with the final diagnosis after surgery. The penalty score of pain drawings evaluated by Ransford's scoring system were com- pared with the MMPI scores of 14 patients and with the treatment results of 79 patients who were followed more than one year after surgery. The initial impressions were five benign back pains, 53 disc herniations, 44 spinal stenosis, eight significant underlying disorders, and nine psychogenic back pain. The final diagnosis were 59 disc herniations, 42 spinal stenosis, and 18 significant under- lying disorders. Concerning the disc herniation, spinal stenosis, and significant underlying disorder there were statistically significant relationship between the intial impression and the final diagnosis. 84 pain drawings were evaluated as low penalty scores of two or less and 35 pain drawings as high penalty scores of three to 12. MMPI scores evaluated for 12 patients with high penalty score revealed more than 70 of hypochondriasis or hysteria scores in nine patients, but in all patients with low penalty scores revealed normal MMPI. A satisfactory clinical results of treatments without sinificant pain or disability was obtained in 53(96.4%) of 55 patients with low penalty scores and 18(75%) of 24 patients with high penalty scores. In conclusions a pain drawing was considered to be useful for the initial diagnostic screening, for the psychological assessment of patients, and for the prediction of treatment results.
김현민,정진욱,천동욱,이근일 대한슬관절학회 1997 대한슬관절학회지 Vol.9 No.2
This case report draws attention to the possibility of symptomatic and asymptomatic intraarticular ganglion cyst which was situated adjacent to the insertion sites of the anterior or posterior cruciate ligament. In many reports and our case, MR imaging is recommended as the modality of choice in diagnosing method and the cyst, if encountered, is successfully treated with arthroscopic technique. We report one case of symptomatic ganglion cyst of the posterior cruciate ligament with review of literatures.