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In this study, we compared the paramedian interfascial approach (PIA) and the traditional midline approach (MA) for lumbar fusion to determine which approach resulted in the least amount of postoperative back muscle atrophy. We performed unilateral transforaminal posterior lumbar interbody fusion via MA on the symptomatic side and pedicle screw fixation via PIA on the other side in the same patient. We evaluated the damage to the paraspinal muscle after MA and PIA by measuring the preoperative and postoperative paraspinal muscle volume in 26 patients. The preoperative and postoperative cross-sectional area, thickness, and width of the multifidus muscle were measured by computed tomography. The degree of postoperative paraspinal muscle atrophy was significantly greater on the MA side than on the contralateral PIA side (-20.7% and -4.8%, respectively, p<0.01). In conclusion, the PIA for lumbar fusion yielded successful outcomes for the preservation of paraspinal muscle in these 26 patients. We suggest that the success of PIA is due to less manipulation and retraction of the paraspinal muscle and further studies on this technique may help confirm whether less muscle injury has positive effects on the long-term clinical outcome.
Objective : To improve pedicle screw placement accuracy with minimal radiation and low cost, we developed specially designed K-wire with a marker. To evaluate the accuracy of thoracolumbar pedicle screws placed using the novel guide-pin and portable X-rays. Methods : Observational cohort study with computerized tomography (CT) analysis of in vivo and in vitro pedicle screw placement. Postoperative CT scans of 183 titanium pedicle screws (85 lumbar and 98 thoracic from T1 to L5) placed into 2 cadavers and 18 patients were assessed. A specially designed guide-pin with a marker was inserted into the pedicle to identify the correct starting point (2 mm lateral to the center of the pedicle) and aiming point (center of the pedicle isthmus) in posteroanterior and lateral X-rays. After radiographically confirming the exact starting and aiming points desired, a gearshift was inserted into the pedicle from the starting point into the vertebral body through the center of pedicle isthmus. Results : Ninety-nine percent (181/183) of screws were contained within the pedicle (total 183 pedicle screws : 98 thoracic pedicle screws and 85 lumbar screws). Only two of 183 (1.0%) thoracic pedicle screws demonstrated breach (1 lateral in a patient and 1 medial in a cadaver specimen). None of the pedicle breaches were associated with neurologic or other clinical sequelae. Conclusion : A simple, specially designed guide-pin with portable X-rays can provide correct starting and aiming points and allows for accurate pedicle screw placement without preoperative CT scan and intraoperative fluoroscopic assistance.
Objective : The goal of this study was to determine the effect of short-term usage of tranexamic acid (TXA), which is an antifibrinolytic agent, on patients with aneurysmal subarachnoid hemorrhage (aSAH). Methods:Weprospectivelyanalyzed80consecutivepatientswho had undergone surgery for aSAH between January 2004 and December 2006. The patients were placed either in the TXA group for those who were treated with TXA (N=38) or in the n-TXA group for those who were not (N=42). The incidences of rebleeding and vasospasm (with using the transcranial Doppler (TCD) criteria), symptomatic vasospasm and hydrocephalus were compared between the two groups. Results : Preoperative rebleeding occurred only in one patient in each group (2.6% of the TXA group and 2.3% of the n-TXA group (p>0.05). Vasospasm developed in 18 (47.4%) of the TXA patients and in 20 (47.6%) of the n-TXA patients (p>0.05). Among the patients with vasospasm, the number of symptomatic vasospasms was 16 (89%) in the TXA group and 11 (55%) in the n-TXA group (p<0.05). The patients with symptomatic vasospasm in the TXA group seemed to have worse outcomes than those in the n-TXA group (p>0.05). The incidence of hydrocephalus was not different between the two groups. Conclusion:Weconcludethatthepreoperativeshort-termuse of TXA can increase the risk of postoperative symptomatic vasospasm, although the incidence of vasospasm was not different between the two groups. According to our results, we recommend being very cautious of vasospasm and ischemic events when TXA is used preoperatively in patients with aSAH. (KorJCerebrovascularSurgery12(1):5-9,2010)
Iatrogenic spinal cord herniation is a rare complication following spinal surgery. We introduce a posterior trans-dural repair technique used in a case of thoracic spinal cord herniation through a ventral dural defect following resection of ossification of the posterior longitudinal ligament (OPLL) in the cervicothoracic spine. A 51-year-old female was suffering from paraplegia after laminectomy alone for cervicothoracic OPLL. Magnetic resonance imaging revealed a severely compressed spinal cord with pseudomeningocele identified postoperatively. Cerebrospinal fluid leak and iatrogenic spinal cord herniation persisted despite several operations with duroplasty and sealing agent. Finally, the problems were treated by repair of the ventral dural defect with posterior trans-dural duroplasty. Several months after surgery, the patient could walk independently. This surgical technique can be applied to treat ventral dural defect and spinal cord herniation.
Objective : The purpose of this study was to evaluate radiographic/clinical outcomes of adolescent idiopathic scoliosis (AIS) patients treated by a Korean neurosurgeon. Methods : Ten AIS patients were treated by a single neurosurgeon between January 2011 and September 2013 utilizing segmental instrumentation with pedicle screws. Basic demographic information, curve pattern by Lenke classification, number of levels treated, amount of correction achieved, radiographic/clinical outcomes [by Scolisis Resarch Society (SRS-22r) questionnaire] and complications were evaluated to determine the surgical results. Pulmonary function test was utilized to assess forced vital capacity (FVC) and forced expiratory volume in one second (FEV1) before and after surgery. Results : The average percentage of correction of the major structural curve was 73.6% (ranged from 64% to 81.5%). Preoperative and final postoperative absolute FVC averaged 3.03 L and 3.76 L (0.73 L increase, p=0.046), and absolute FEV1 averaged 2.63 L and 3.49 L (0.86 L increase, p=0.021). Preoperative and final postoperative average self-image and function scores of SRS-22r were, 2.6±0.5, 3.3±0.1, 4.0±0.5, and 4.6±0.0, respectively. There was a significant improvement of the self-image and function scores of SRS-22r questionnaires before and after surgery (p<0.05). There was no case of neurological deficit, infection and revision for screw malposition. One patient underwent a fusion extension surgery for shoulder asymmetry. Conclusion : Radiographic/clinical outcomes of AIS patients treated by a Korean neurosurgeon were acceptable. Fundamental understanding of pediatric spinal deformity is essential for the practice of AIS surgery.
. Objectives: The aim of this study is to determine interaction between obesity and grip strength in health-related quality of life (HRQOL). Methods: This study analyzed the data of 4,119 Korean men and women aged 65 years or older who participated in Korea Health and Nutrition Examination Survey, 2016-2018. Body mass index was divided into normal and obesity. Grip strength was defined as the maximum value of the measured data. Sarcopenia was considered as the average of grip strength less than 26 kg in men and 18 kg in women. HRQOL was measured based on the Euro quality of life-5 dimensions questionnaire. We conducted a linear regression analysis to examine interaction effect between obesity and grip strength, and to estimate the interaction term between obesity and sarcopenia in HRQOL. Results: We identified that obesity interacted with grip strength to affect HRQOL (p= 0.022) in aged people. Obese elderly men and women were more likely to have lower HRQOL scores compared to those who had normal weight among participants with low grip strength values. However, there was no significant difference between obesity and normal weight at high grip strength (34.3 kg52.7 kg) in HRQOL significantly (p= 0.41). Moreover, we identified interaction effect between obesity and sarcopenia (p= 0.019). Participants who had sarcopenia with normal weight were not different from those who were obese in HRQOL (p= 0.61). Conclusions: Obesity and grip strength were associated with HRQOL. Also, those two factors were interacted to affect HRQOL. Obesity was interacted with sarcopenia to shape HRQOL. Therefore, we need to give a more attention to the elderly who were obese with low grip strength.
The purpose of this review is the current understanding of proximal junctional kyphosis (PJK) and proximal junctional failure (PJF) following adult spinal deformity (ASD) surgery. We carried out a systematic search of PubMed for literatures published up to September 2017 with “proximal junctional kyphosis,” “proximal junctional failure,” and “adult spinal deformity” as search terms. A total of 98 literatures were searched. The 37 articles were included in this review. PJK is multifactorial in origin and likely results from variable risk factors. PJF is a progressive form of the PJK spectrum including bony fracture, subluxation between UIV and UIV+1, failure of fixation, neurological deficit, which may require revision surgery for proximal extension of fusion. Soft tissue protections, adequate selection of the UIV, prophylactic rib fixation, hybrid instrumentation such as hooks, vertebral cement augmentation at UIV and UIV+1, adequate selection material of rods and age-appropriate spinopelvic alignment goals are strategies to minimize PJK and PJF. The ability to perform aggressive global realignment of spinal deformities has also led to the discovery of new complications such as the PJK and PJF. Continuous research on PJK and PJF should be proceeded in order to comprehend the pathophysiology of these complications.
Objective: To compare and identify risk factors for distal adding-on (AO) or distal junctional kyphosis (DJK) in adolescent idiopathic scoliosis (AIS) treated by anterior- (ASF) and posterior spinal fusion (PSF) to L3. Methods: AIS patients undergoing ASF versus PSF to L3 from 2000–2010 were analyzed. Distal AO and DJK were deemed poor radiographic results. New stable (SV) and neutral vertebra (NV) scores were defined for this study. The total stability (TS) score was the sum of the SV and NV scores. Results: Twenty of 42 (ASF group: 47.6%) and 8 of 72 patients (PSF group: 11.1%) showed poor radiographic outcome. Fused vertebrae, correction rate of main curve, coronal reduction rate of L3 were significantly higher in PSF group. Multiple logistic regression results indicated that preoperative SV-3 at L3 in standing and side benders (odds ratio [OR], 2.7 and 3.7, respectively), TS score -5, -6 at L3 (OR, 4.9), rigid disc at L3–4 (OR, 3.7), lowest instrumented vertebra (LIV) rotation >15° (OR, 3.3), LIV deviation >2 cm from center sacral vertical line (OR, 3.1) and ASF (OR, 13.4; p<0.001) were independent predictive factors. There was significant improvement of the Scoliosis Research Society (SRS)-22 average scores only in PSF group. Furthermore, the ultimate scores of PSF group were significantly superior to ASF group. Conclusion: The prevalence of AO or DJK at ultimate follow-up for AIS with LIV at L3 was significantly higher in ASF group. Ultimate SRS-22 scores were significantly better in PSF group.