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        • KCI등재후보

          퇴행성 요추부 질환에 대한 치료에서 척추 고정술과 동반된 인접부 극돌기간 기구 삽입술의 유용성에 대한 예비 보고

          최우진,장상근,김동천 대한척추신경외과학회 2009 대한척추신경외과학회지 Vol.6 No.3

          Objective: Posterior lumbar or lumbosacral spinal fusion in degenerative lumbar disease has the problems of adjacent level disease as well as surgical complications. An interspinous device used for dynamic stabilization can also be applied to the adjacent segment for spinal fusion to reduce the severity of these problems. The authors reviewed the adjacent interspinous stabilization using an interspinous spacer (CoflexTM paradigm spine, Germany) combined with posterior lumbar or lumbosacral spinal fusion in degenerative lumbar disease. Method: From January 2007 to July 2008, ten patients with degenerative lumbar disease underwent posterior lumbar or lumbosacral spinal fusion with adjacent interspinous stabilization using CoflexTM. The indications for this type were adjacent segmental disc protrusion, adjacent segmental degenerative changes or high surgical risk groups, such as elderly patients or osteoporotic patients undergoing multiple leveled fusions. CoflexTM was inserted into the adjacent segmental interspinous space. The control group consisted of fifteen patients, who underwent posterior lumbar or lumbosacral spinal fusion without interspinous stabilization. The radiological parameters and clinical outcomes were compared. All patients were followed-up for more than twelve months. Results: The visual analogue scale (VAS) in both groups postoperatively and at the twelve month follow-up were improved. In the CoflexTM group, the postoperative and twelve month follow-up X-ray showed no significant change in posterior disc height, interpedicular height, segmental lordotic angle, flextion-extension angulation and translation and no significant segmental instability. The control group showed a higher level of segmental lordotic angle, translation and a lower posterior disc height, interpedicular height, flextion-extension angulation and three patients showed adjacent segmental instability. Conclusion: CoflexTM can be used to stabilize the adjacent segment of spinal fusion in degenerative lumbar disease and might be effective in preventing adjacent segmental degeneration. However, further study will be needed to confirm this observation. Objective: Posterior lumbar or lumbosacral spinal fusion in degenerative lumbar disease has the problems of adjacent level disease as well as surgical complications. An interspinous device used for dynamic stabilization can also be applied to the adjacent segment for spinal fusion to reduce the severity of these problems. The authors reviewed the adjacent interspinous stabilization using an interspinous spacer (CoflexTM paradigm spine, Germany) combined with posterior lumbar or lumbosacral spinal fusion in degenerative lumbar disease. Method: From January 2007 to July 2008, ten patients with degenerative lumbar disease underwent posterior lumbar or lumbosacral spinal fusion with adjacent interspinous stabilization using CoflexTM. The indications for this type were adjacent segmental disc protrusion, adjacent segmental degenerative changes or high surgical risk groups, such as elderly patients or osteoporotic patients undergoing multiple leveled fusions. CoflexTM was inserted into the adjacent segmental interspinous space. The control group consisted of fifteen patients, who underwent posterior lumbar or lumbosacral spinal fusion without interspinous stabilization. The radiological parameters and clinical outcomes were compared. All patients were followed-up for more than twelve months. Results: The visual analogue scale (VAS) in both groups postoperatively and at the twelve month follow-up were improved. In the CoflexTM group, the postoperative and twelve month follow-up X-ray showed no significant change in posterior disc height, interpedicular height, segmental lordotic angle, flextion-extension angulation and translation and no significant segmental instability. The control group showed a higher level of segmental lordotic angle, translation and a lower posterior disc height, interpedicular height, flextion-extension angulation and three patients showed adjacent segmental instability. Conclusion: CoflexTM can be used to stabilize the adjacent segment of spinal fusion in degenerative lumbar disease and might be effective in preventing adjacent segmental degeneration. However, further study will be needed to confirm this observation.

        • KCI등재
        • KCI등재후보

          SB Charite III ® 인공 추간판이 설치된 기능 척추 단위의 하중 분포: 유한 요소 분석 연구

          윤상훈,김현집 대한척추신경외과학회 2010 대한척추신경외과학회지 Vol.7 No.4

          Objective: To evaluate the effects of SB Charite III® artificial disc implantation on the biomechanics of functional spinal units. Methods: A nonlinear intact osteoligamentous three-dimensional finite element model of L4-L5 was developed using 1-mm CT scan data from a human volunteer, and the material properties of each element were determined. The model was validated using biomechanical data. A model that was implanted with SB Charite III® artificial discs via an anterior approach was also developed. The stresses and strains of the vertebral bodies and surrounding spinal ligaments were investigated. The implanted model was compared to the intact model in terms of range of motion, force on facet joints with flexion-exten- sion, lateral bending, and axial rotation under 400N preloading. Results: There were no significant differences between the findings of this finite element study and other reports in the literature. Our analytical method proved useful method for the biomechanical evaluation of the effects of artificial disc implan- tation. The implanted model revealed an increased range of motion in flexion-extension, lateral bending, and axial rotation compared to the intact model. The stresses on facets were greater in the implanted model than in the intact model. Conclusion: The model that was implanted with artificial discs showed increased segmental motion and stress on the facet joints compared to the intact model. We hypothesize that the removal of the anterior longitudinal ligament is the major cause of increased segmental motion and stress on the facet joints in the implanted model. The development of new artificial discs should focus on compensating for these unwanted results. Objective: To evaluate the effects of SB Charite III® artificial disc implantation on the biomechanics of functional spinal units. Methods: A nonlinear intact osteoligamentous three-dimensional finite element model of L4-L5 was developed using 1-mm CT scan data from a human volunteer, and the material properties of each element were determined. The model was validated using biomechanical data. A model that was implanted with SB Charite III® artificial discs via an anterior approach was also developed. The stresses and strains of the vertebral bodies and surrounding spinal ligaments were investigated. The implanted model was compared to the intact model in terms of range of motion, force on facet joints with flexion-exten- sion, lateral bending, and axial rotation under 400N preloading. Results: There were no significant differences between the findings of this finite element study and other reports in the literature. Our analytical method proved useful method for the biomechanical evaluation of the effects of artificial disc implan- tation. The implanted model revealed an increased range of motion in flexion-extension, lateral bending, and axial rotation compared to the intact model. The stresses on facets were greater in the implanted model than in the intact model. Conclusion: The model that was implanted with artificial discs showed increased segmental motion and stress on the facet joints compared to the intact model. We hypothesize that the removal of the anterior longitudinal ligament is the major cause of increased segmental motion and stress on the facet joints in the implanted model. The development of new artificial discs should focus on compensating for these unwanted results.

        • KCI등재

          한국 성인의 경추부 추간판 높이와 깊이에 대한 연구

          이상호,장의성,정승은,신송우,강호영 대한척추신경외과학회 2004 대한척추신경외과학회지 Vol.1 No.1

          Objective: Currently, normal data of cervical disc height and depth of Korean adults are not available. The objective of this study is to compile a Korean normative database of the disc height and depth of the cervical spine, valid for healthy Korean adults. Methods: All the volunteers were attached a coin on the anterior midline of the neck. From the lateral X-ray films of the cervical spine, anterior and middle disc height and anteroposterior disc depth from C2-3 to C6-7 were measured. The magnification of radiographic films as compared with real measurement of the coin was taken into consideration. Analysis of data was done by use of independent sample t-test, Pearson's correlation, and one-way analysis of variance(ANOVA). Results; A normal database for the dimensions of cervical discs was compiled from 42 lateral views of healthy Korean adults. There were 20 males(mean age, 29,6 years; mean height, 174.3 cm) and 22 females(mean age, 27,4 years; mean height, 161.2 cm). The means of anterior height, middle height and anteroposterlor depth of cervical disc space were 4.09mm, 5,82mm, and 16,86mm for men and 3,40 mm, 5.30 mm, and 14.86 mm for women, respectively, The height of C4-5 disc space was highest at the middle disc space from C2-3 to C6-7. Conclusion: This study will contribute to the clinical diagnosis, treatment and development of instruments of cervical disc diseases for Korean patients with cervical disc diseases.

        • KCI등재

          골다공성 척추 압박골절 환자에 대한 경피적 척추체성형술 : 최근 2년간 경험 Recent 2-year Experience

          김상대,박정율,김세훈,서중근,이태수,채수원 대한척추신경외과학회 2004 대한척추신경외과학회지 Vol.1 No.1

          Objective: To describe the therapeutic outcome of percutaneous vertebroplasty for the treatment of osteoporotic vertebral compression fractures(OVCF) in recent years with review of literature. Methods: The authors have retrospectively reviewed a consecutive group of patients who underwent percutaneous vertebroplasty in our institution between May 2000 and October 2002. The procedures were performed with Jamshidi needle via transpedicular approach followed by injection of polymethyl- methacrylate(PMMA) into the involved vertebral bodies. Prolo's economic and functional rating scale was used for therapeutic outcome assessments. Results: There were 91 patients(69 female, 22 male) with OVCF, with involvement of 147 vertebral bodies. The mean age was 72 years. The average BMD t-score was -3.78, indicative of severe osteoporosis. Minimal follow-up period was three months. And among these patients, 82.5% of patients were maintained over good condition. Extrusion of PMMA cement beyond the confines of the vertebral body was obseved in 13 cases(8.8%). Although most of them improved with conservative treatments without morbidities, two developed serious complications, one being pulmonary embolism and the other paraparesis. Conclusion: Percutaneous vertebroplasty is one of the effective minimal invasive treatment modalities in OVCF. However, proper biomechanical studies supporting these procedures are not fully evidenced. Serious complications, although rare, should be prevented with the aid of improved techniques and newer biocompatible materials along with better understanding of biodynamic and biomechanical impact on normal and already compromised vertebraes.

        • KCI등재후보

          강직성 척추염 환자에서 발생한 척추 골절

          박태식,이동열,허원,송준석,정세헌,여만수,박화성 대한척추신경외과학회 2009 대한척추신경외과학회지 Vol.6 No.2

          Ankylosing spondylitis (AS) is a chronic inflammatory rheumatic disease. Pathologic changes occurred in patients with AS result in a weakened vertebral column with increased susceptibility to fractures, even though a trivial injury. Fractures usually tends to involve the lower cervical spine, but rarely, they are also occurred in thoracolumbar spine. We present our experiences of three cases of spinal fracture in patients with AS, cervical, thoracic, and lumbar spine, with a review of literatures. Ankylosing spondylitis (AS) is a chronic inflammatory rheumatic disease. Pathologic changes occurred in patients with AS result in a weakened vertebral column with increased susceptibility to fractures, even though a trivial injury. Fractures usually tends to involve the lower cervical spine, but rarely, they are also occurred in thoracolumbar spine. We present our experiences of three cases of spinal fracture in patients with AS, cervical, thoracic, and lumbar spine, with a review of literatures.

        • KCI등재

          추간공 경유 경막외 차단술 환자의 합병증에 대한 조사 연구

          최선주,배성열,서성화,김상대,김세훈,박정율 대한척추신경외과학회 2004 대한척추신경외과학회지 Vol.1 No.1

          Objective: To study on the incidence of complications from C-arm guided lumbar transforarninal epidural injections in patients with radiculopathy caused by either lumbar spinal stenosis or herniated intervertebral disc. Materials & Methods: A total of 1200 patients with back/leg pain for more 3 months and received therapeutic injections in recent 1-year period was evaluated. All procedures were performed by one neurosurgeon with careful monitoring by nursing staffs during and after the procedures. Two party observers reviewed medical charts including immediate postprocedure complications using standardized questionnaire. Results: Average 1.9 injections per patient were done. Complications per injection seen included 12 transient headaches (0.9%), 5 increased back pain(0.4%), 4 increased leg pain(0.3%), 4 facial flushing(0.3%), 2 increased blood sugar in an insulin-dependent diabetic(0.2%), I vasovagal reaction(0.08%), and I hypertension(0.08%). All of these complications resolved within several hours to 2 weeks and there were no need for further specific management. There were no major or permanent complications. The incidence of minor complications was 2.3% per injection. All reactions resolved without morbidity. Conclusion: Although effectiveness varies with different pathologies, the C-arm guided lumbar transforaminal epidural injection seems to be a safe and effective procedure for these patients when carefully performed and closely observed with appropriate nursing care.

        • KCI등재후보

          한 분절 요추부 후측방 유합술에서 국소 자가 골편의 사용에 대한 연구

          박기수,성주경,박진우 대한척추신경외과학회 2009 대한척추신경외과학회지 Vol.6 No.3

          Objective: The purpose of this study is to investigate the efficacy of the local bone graft from laminectomy and facetectomy in one level lumbar posterolateral arthrodesis. Methods: Sixty six patients who underwent one level lumbar posterolateral arthrodesis for degenerative lumbar diseases between January 2005 and June 2008 were evaluated retrospectively. Arthrodesis was performed by transpedicular screw fixation and grafting with autologous local bone chips from laminectomy and facetectomy instead of autologous iliac bone, allograft bone or biosynthetic composite bone grafts. Postoperative radiographs were obtained to review the evidence of fusion. A modified Lenke score was used to assess the status of the fusion. Results: Sixty six patients consist of 29 males and 37 females with mean age 60.7 years old and 22.5 months mean follow-up period. A mean amount of the local bone chips from laminectomy and facetectomy was 13.4 g. At 12 months after operation, the average Lenke score was 1.5 and spinal bone fusion rate was 95.4%. There were three patients with failed fusion and all of them were heavy smokers. Conclusion: The local bone graft from laminectomy and facetectomy in the one level lumbar posterolateral arthrodesis is reliable and effective enough to replace the graft from autologous iliac bone, allograft bone or biosynthetic composite bone grafts. Objective: The purpose of this study is to investigate the efficacy of the local bone graft from laminectomy and facetectomy in one level lumbar posterolateral arthrodesis. Methods: Sixty six patients who underwent one level lumbar posterolateral arthrodesis for degenerative lumbar diseases between January 2005 and June 2008 were evaluated retrospectively. Arthrodesis was performed by transpedicular screw fixation and grafting with autologous local bone chips from laminectomy and facetectomy instead of autologous iliac bone, allograft bone or biosynthetic composite bone grafts. Postoperative radiographs were obtained to review the evidence of fusion. A modified Lenke score was used to assess the status of the fusion. Results: Sixty six patients consist of 29 males and 37 females with mean age 60.7 years old and 22.5 months mean follow-up period. A mean amount of the local bone chips from laminectomy and facetectomy was 13.4 g. At 12 months after operation, the average Lenke score was 1.5 and spinal bone fusion rate was 95.4%. There were three patients with failed fusion and all of them were heavy smokers. Conclusion: The local bone graft from laminectomy and facetectomy in the one level lumbar posterolateral arthrodesis is reliable and effective enough to replace the graft from autologous iliac bone, allograft bone or biosynthetic composite bone grafts.

        • KCI등재

          외측성 요추 척추관 협착증의 수술적 결과

          김찬,이승명 대한척추신경외과학회 2004 대한척추신경외과학회지 Vol.1 No.1

          Object: The purposes of this study were to evaluate the efficacy of sublaminar decompressive ligamentectomy in patients with lateral stenosis of lumbar spine. Methods: The authors reviewed the cases of 15 cases in whom sublaminar decompressive ligamentectomy was performed for lateral stenosis of lumbar spine during the period between January 2000 and July 2002. The operation procedure was simple decompressive method without bone fusion. The evaluation included used of the Oswestry Disability Index(ODI) and a visual analog pain scale(VAPS) preoperatively and postoperatively. And Prolo's outcome scale is evaluated. Results: The mean follow-up period was 11.3months. The mean operation time was 60 minutes / I level and the average estimated blood loss was below 100 ml. The clinical result according to Prolo's scale was achieved to above 7 points. And mean preoperative scores on the ODI and visual analog pain scale were 58.7 and 7.8 respectively. Postoperatively, these scores decreased to 21.1 and 2.3 respectively, and both decreases were significant(p<0.05). There were 1 case of intraoperative complication(dura tear ; primary closure with 5~0 monoflament is performed) and 2 patients of postoperative complications such as temporary parasthetica(conservative treatment is performed). And average correction rate of dural sac cross - sectional area was noted to 46%. Conclusions: This procedure has been found to be an effective and safe procedure with rare complication. To be compared with fusion, less operation time and less blood loss was noted; better postoperative motion of the back enables the patient to sit and ambulate at an early postoperative stage. In the absence of preoperative radiological evidence of instability, fusion is not required, but surgical result is similar to fusion. And the scores on the ODI and visual analog pain scale also improved postoperatively.

        • KCI등재

          요추 추간판 절제술 후 발생한 화농성 척추염에 대한 Chuinard & Peterson 골 이식술을 이용한 전방 유합술 및 경피적 후관절 나사못 고정술

          장상범,이상호,이승철,신송우,김원중 대한척추신경외과학회 2004 대한척추신경외과학회지 Vol.1 No.1

          Objective: To describe the surgical techniques and the preliminary results of anterior fusion with Chuinard & Peterson bone graft and posterior percutaneous facet screw fixation for pyogenic spondylitis following lumbar discectomy. Methods: From April to October 2003, five consecutive patients underwent anterior lumbar interbody fusion with Chuinard & Peterson bone graft and posterior percutaneous facet screw fixation for the treatment of pyogenic spondylitis that developed after primary lumbar disc surgery. There were three males and two females. The mean age was 49.8 years(range, 28-75 years). Three patients had persistent inflammation with neurologic deterioration and two had severe back pain despite of less invasive interventions. The mean interval from the primary operation to fusion was 3.3 months(range, 1.5~7 months). All patients were allowed to ambulate immediate postoperatively with a lumbar orthosis, which was kept for three months. Intravenous and oral antibiotics were continued until hematologic profiles normalized. All patients were followed up clinically and radiologically. Results: The mean operating time, blood loss, and post-operative hospital stay were 210 mins, 890 ml, and 27 days, respectively. Four patients showed a solid fusion at 3 monthes and one patient showed fusion at 4 monthes postoperatively. M patients showed remission of infection and significant clinical improvement of back pain. Conclusions: Anterior fusion using Chuinard & Peterson bone graft and posterior facet screw fixation may be employed for postoperative pyogenic spondylitis without prolonged cast immobilization or risk of persistent infection caused by instrumentation.

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