퇴행성 척추 질환 환자에서 척추경 나사못을 이용한 후방기기고정술 연구: 전향적, 단일군, 치료적 탐색시험

신재원,박섭리,김순규,김학선 대한척추외과학회 2020 대한척추외과학회지 Vol.27 No.4

Study Design: Prospective study. Objectives: To evaluate the effectiveness and safety of posterior interbody fusion with a new type of pedicle screws after posterior decompression for degenerative spinal disease. Summary of Literature Review: There are no reports of surgical treatment results using the new type of pedicle screw (LumFix™) analyzed herein. We report the results of posterior interbody fusion with this new type of pedicle screw. Materials and Methods: Ten patients underwent surgical treatment for degenerative spinal disease and were followed up for at least 1 year. In all cases, fixation using pedicle screws and posterior interbody fusion were performed after posterior decompression. Visual analogue scale (VAS) and Oswestry Disability Index (ODI) scores were measured before surgery, at 3 months postoperatively, and at 12 months postoperatively. Bone union was investigated through simple radiographs and computed tomography (CT) at 12 months postoperatively. In addition, blood inflammation levels and basic vital signs were investigated preoperatively and at the last follow-up. Results: In all cases, preoperative symptoms improved, and the back pain VAS improved from 7.30±1.49 preoperatively to 2.70±1.64 at 3 months postoperatively and 1.80±1.40 at the final follow-up. Leg pain was 7.40±1.17 preoperatively and 2.60±2.17 at 3 months postoperatively. At the last follow-up, it improved to 2.40±1.96 (p<0.001). The ODI improved from 28.80±4.89 preoperatively to 15.60±5.04 at 3 months postoperatively and 16.90±6.61 (p=0.002) at the final follow-up. Bone union was achieved in all cases. Inflammation levels and vital signs were within the normal range both preoperatively and at 12 months postoperatively. Conclusions: The LumFix™ pedicle screws used in this study were fused in 100% of patients with degenerative spinal diseases. No complications were observed, and the VAS of back and leg pain and ODI of the lumbar spine significantly improved. There were no abnormal findings in blood tests or vital signs, demonstrating biocompatibility. Therefore, the type of new pedicle screw analyzed in this study can be used in fusion surgery for degenerative spinal diseases. 연구 계획: 전향적 연구목적: 단일의 새로운 척추경 나사못을 사용하여 퇴행성 척추 질환에 대해 후방 감압술 후 후방 추체간 유합술의 치료 결과를 분석하여 사용한 척추경 나사못의 유용성 및 안정성을 알아보고자 한다. 선행 연구문헌의 요약: 퇴행성 척추질환의 수술적 치료 방법은 많은 보고가 있으나 이번에 저자 들이 사용한 새로운 척추경 나사못 만을 이용한 수술적치료 결과 보고는 없다. 따라서 저자들은 새로운 척추경 나사못을 사용하여 후방 감압 후 척추경 나사못을 이용한 정복 및 후방 추체간 유합술을 시행한결과에 대한 보고를 하고자 한다. 대상 및 방법: 퇴행성 척추질환으로 수술적 치료를 받고 1년 이상 추시 가능하였던 10명을 대상으로 하였다. 전 예에서 후방 감압 후 척추경 나사못을 이용한 고정 및 후방 추체간 유합술을 시행하였다. 임상적으로 허리 부위의 통증과 하지부의 방사통에 대해 시각통증점수(visual analogue scale, VAS) 및척추 장애 지수(Oswestry Disability Index, ODI) 점수를 수술 전과 술 후 3개월 및 술 후 12개월 추시 때 측정하여 증상의 호전 유무를 조사하였으며, 방사선학적으로는 요추부 단순 방사선 추시 사진 및 술 후 12개월에 요추부 컴퓨터 촬영(CT, computerizes tomography)을 통하여 최종 골유합 여부를 판단하였다. 또한 새로운 기구의 생체 적합성을 알기 위하여 혈액 염증 수치 및 기본적인 활력 증후도 술 전 및 마지막 추시에서 조사하였다. 결과: 전 예에서 술 전 증상은 호전되었으며 VAS는 허리 통증은 술 전 7.30±1.49, 술 후 3 개월에 2.70±1.64 최종 추시 상 1.80±1.40로 호전되었으며, 다리 통증은 술 전 7.40±1.17, 술 후 3개월에 2.60±2.17 최종 추시 상 2.40±1.96로 호전되었다(p<0.001). ODI는 술 전 28.80±4.89, 술 후 3개월에15.60±5.04 최종 추시 상 16.90±6.61(p=0.002)로 호전되었으며 전례에서 9례에서 완전한 골유합 및 1례에서 부분유합으로 전체의 증례에서 골유합을 얻을 수 있었다. 혈액 검사에서 염증 수치와 활력 증후는 술 전 과 술 후 12개월에서 모두 정상 범위에 속하였다. 결론: 이 연구에서 사용한 새로운 척추경 나사못은 퇴행성 척추 질환의 유합술 사용에서 합병증 없이 전체 100%에서 유합 되었고, 허리 및 다리 통증의VAS와 요추의 ODI는 의미 있게 호전 되었으며, 특별한 혈액학적 이상 소견도 없었다. 따라서 이 연구에서 사용한 새로운 척추경 나사못은 퇴행성 척추질환의 유합술에서 안전하게 사용할 수 있는 척추경 나사못으로 사료된다. 약칭 제목: 새로운 척추경 나사못을 이용한 추체간 유합술의 수술 결과

Semi-Circumferential Decompression: Microsurgical Total en-bloc Ligamentum Flavectomy to Treat Lumbar Spinal Stenosis with Grade I Degenerative Spondylolisthesis

이영상,최준철,오상훈,박섭리,박상준,조남익 대한정형외과학회 2015 Clinics in Orthopedic Surgery Vol.7 No.4

Background: To describe and assess clinical outcomes of the semi-circumferential decompression technique for microsurgical enbloc total ligamentum flavectomy with preservation of the facet joint to treat the patients who have a lumbar spinal stenosis with degenerative spondylolisthesis. Methods: We retrospectively analyzed the clinical and radiologic outcomes of 19 patients who have a spinal stenosis with Meyerding grade I degenerative spondylolisthesis. They were treated using the “semi-circumferential decompression” method. We evaluated improvements in back and radiating pain using a visual analogue scale (VAS) and the Oswestry Disability Index (ODI). We also evaluated occurrence of spinal instability on radiological exam using percentage slip and slip angle. Results: The mean VAS score for back pain decreased significantly from 6.3 to 4.3, although some patients had residual back pain. The mean VAS for radiating pain decreased significantly from 8.3 to 2.5. The ODI score improved significantly from 25.3 preoperatively to 10.8 postoperatively. No significant change in percentage slip was observed (10% preoperatively vs. 12.2% at the last follow-up). The dynamic percentage slip (gap in percentage slip between flexion and extension X-ray exams) did not change significantly (5.2% vs. 5.8%). Slip angle and dynamic slip angle did not change (3.2o and 8.2o vs. 3.6o and 9.2o, respectively). Conclusions: The results suggested that semi-circumferential decompression is a clinically recommendable procedure that can improve pain. This procedure does not cause spinal instability when treating patients who have a spinal stenosis with degenerative spondylolisthesis.

요추 경막외 공기 가성낭종 - 증례 보고 -

김우성,이영상,김태현,박섭리 대한척추외과학회 2014 대한척추외과학회지 Vol.21 No.4

Study Design: Case report. Objectives: We report two cases regarding epidural air pseudocyst at the lumbar spine. Summary of Literature Review: Epidural air pseudocyst at the lumbar spine that provokes radiating pain and neurologic symptomscan be misdiagnosed as an epidural tumor or HIVD. Consequently, proper diagnosis and treatment of the epidural air pseudocyst at thelumbar spine is necessary. Materials and Methods: We report on two patients with radiculopathy and neurologic symptoms resulting from epidural airpseudocysts. In one patient, the epidural air pseudocyst was found within the epidural ligament flavum area on an MRI, and fluoroscopicguidedFNA (fine needle aspiration) was performed. In the other, the epidural air pseudocyst was found behind the posterior longitudinalligament and was accompanied by spinal stenosis. In this patient, we conducted open cystectomy and posterior decompression surgery. Results: After treatment, all patients have showed symptom improvement and they are currently living without discomfort. Conclusions: Due to frequent misdiagnosis, the careful diagnosis of lumbar epidural air pseudocyst is necessary. Physicians shouldselect a proper treatment plan concerning the patient’s condition and the location of the lesion. 연구 계획: 증례 보고목적: 요추 경막 외 공기 가성낭종을 진단 및 치료하였던 2예를 경험하였기에 이를 보고하고자 한다. 선행문헌의 요약: 요추에 발생한 경막외 공기 가성낭종은 방사통 및 신경학적 증상을 유발시켜 경막 외 종양이나 추간판 탈출과 혼동될 수 있다대상 및 방법: 공기 가성낭종에 의한 방사통 및 신경학적 증상이 발생한 2명의 예에 대하여 시행한 자기공명영상장치 촬영상 경막외 황색인대 부위에위치한 경막외 공기 가성 낭종을 보이는 예에서는 X-ray 투시하에 세침 흡입술을 시행하였고, 후종인대 후방에 경막 외 공기 가성낭종 소견 보이며 타분절에도 척추관 협착증 소견 동반되어 있는 예에서는 개방적 방법으로 낭종 제거술 및 타 분절 후방 감압술을 시행하였다. 결과: 치료 후 증상은 현저히 호전되어 현재 일상생활에 불편감 없이 생활 중이다. 결론: 요추 경막 외 공기 가성낭종은 다른 질병으로 혼돈될 수 있으므로 진단에 있어서 주의가 필요하고, 환자나 상황에 따라 적절한 치료 방법을 선택해야 할 것이다.

Effect of Pressurized Cement Insertion on Cardiopulmonary Parameters during Cemented Hip Hemiarthroplasty: A Randomized Prospective Study

송우석,최준철,김태현,오상훈,박섭리,박병학 대한고관절학회 2014 Hip and Pelvis Vol.26 No.4

Purpose: We aimed to investigate the cardiopulmonary effects of pressurized cement insertion in elderly patients undergoing cemented hip hemiarthroplasty. Materials and Methods: We conducted a randomized prospective study on elderly patients undergoing cemented hip hemiarthroplasty. Patients were divided into pressurized and non-pressurized groups based on the pressure application during cement insertion. We measured mean arterial blood pressure (MAP), systolic blood pressure (SBP), diastolic blood pressure (DBP), heart rate (HR), arterial blood gases and serotonin concentration in blood. These variables were measured before bone cement insertion, and 3 and 5 minute after insertion. They were also measured immediately and 15 minutes after reduction. Results: In cemented hip hemiarthroplasty, there were no significant change in MAP (P=0.92), SBP (P=0.85), DBP (P=0.98), HR (P=0.97) and serotonin concentration over time. There were no statistically significant difference between the two groups in MAP, SBP, DBP, HR, PO2, PaCO2, SaO2 and serotonin concentration, though three minutes after cement insertion, both groups showed decreases in SBP, DBP and MBP. Conclusion: The pressurization method in cemented hip hemiarthroplasty was not found to be related with development of bone cement syndromes in elderly patients.

재발성 요추 추간판 탈출증에 대한 추간판 재절제술의 결과

김우성(Woo-Sung Kim),나화엽(Hwa-Yeop Na),오상훈(Sang-Hoon Oh),박섭리(Sub-Ri Park),손의영(Eui-Young Son) 대한정형외과학회 2017 대한정형외과학회지 Vol.52 No.1

목적: 재발성 추간판 탈출증에 대하여 추간판 재절제술의 결과를 분석하고 수술결과에 영향을 줄 만한 요인에는 어떤 것이 있는지 제시하였다. 대상 및 방법: 59명이 재발성 추간판 탈출증에 대하여 추간판 재절제술을 시행받았고 최소 2년 이상 추시관찰하였다. 수술 결과는 visual analogue scale (VAS) 및 Macnab 분류에 따라서 평가하였고, 회복률은 VAS 변화에 따라 계산하였다. 그리고 SPSS를 이용하여 치료결과에 영향을 미치는 요인들에 대한 통계적 분석을 시행하였다. 결과: 재발성 추간판 탈출증으로 인한 수술률은 일차 추간판 절제술을 시행한 전체 환자의 6.0% (59/983예)를 차지하였다. VAS에 따른 첫 번째 수술의 임상적 호전 비율은 77%, 두 번째 수술에서는 71%로 측정되었다. 통계적으로 첫 번째와 두 번째의 평균 임상적 호전 비율 사이에 유의한 차이는 없었다. Macnab 분류에 따르면 96%의 환자가 excellent 또는 good 판정을 받았다. 추간판 재절제술 후 추가적으로 요추 불안정성이 발생된 증례는 없었다. 재수술 시 흡연, 외상력, 당뇨의 요인에 따른 수술 후 임상적 호전 정도에는 일차 수술과 비교하여 유의한 차이가 없었다. 결론: 재발성 추간판 탈출증에 대해 시행한 추간판 재절제술은 일차 추간판 절제술만큼 좋은 임상 결과를 보였다. 흡연, 외상력, 당뇨의 요인들은 추간판 재절제술의 결과에 영향을 거의 미치지 않았다. Purpose: To analyze the result of a repeat discectomy for ipsilateral recurrent lumbar disc herniation and to investigate the potential factors that influenced the outcomes for this surgery. Materials and Methods: Fifty-nine patients, who underwent reoperation after lumbar discectomy with a minimum follow-up period of 2 years, were reviewed. The surgical outcome was assessed using the visual analogue scale (VAS) and Macnab classification, and the recovery rate was calculated in accordance with VAS. A statistical analysis was carried out by SPSS to evaluate the possible factors that may have influenced the outcomes of the reoperation. Results: The rate of reoperation after lumbar disc surgery due to the recurrent disc herniation was 6.0% (59/983 cases). The average recovery rate of VAS from the 1st operation was approximately 77%, and from the 2nd operation was 71%. According to the Macnab criteria, the results were “excellent” or “good” in 96% of cases. Statistical analysis revealed that there was no difference of the average recovery rate (p<0.05). There is no additional instability after repeat discectomy. Factors, such as smoking, precipitating traumatic events, and diabetes mellitus did not have much influence on the average recovery rate after repeat discectomy for ipsilateral recurrent lumbar disc herniation. Conclusion: The outcomes of repeat discectomy were satisfactory. Moreover, factors, smoking, trauma history and diabetic mellitus, only had a minor impact on the outcomes of a repeat discectomy.

Direct Internal Fixation for Unstable Atlas Fractures

신재원,석경수,김학선,양재호,권지원,이환모,문성환,이병호,박상준,박섭리,김선규 연세대학교의과대학 2022 Yonsei medical journal Vol.63 No.3

Purpose: To investigate the radiologic and clinical outcomes of direct internal fixation for unstable atlas fractures. Materials and Methods: This retrospective study included 12 patients with unstable atlas fractures surgically treated using C1 lateralmass screws, rods, and transverse connector constructs. Nine lateral mass fractures with transverse atlantal ligament (TAL)avulsion injury and three 4-part fractures with TAL injury (two avulsion injuries, one TAL substance tear) were treated. Radiologicoutcomes included the anterior atlantodental interval (AADI) in flexion and extension cervical spine lateral radiographs at 6months and 1 year after treatment. CT was also performed to visualize bony healing of the atlas at 6 months and 1 year. Visual AnalogScale (VAS) scores for neck pain, Neck Disability Index (NDI) values, and cervical range of motion (flexion, extension, androtation) were recorded at 6 months after surgery. Results: The mean postoperative extension and flexion AADIs were 3.79±1.56 (mean±SD) and 3.13±1.01 mm, respectively. Thenmean AADI was 3.42±1.34 and 3.33±1.24 mm at 6 months and 1 year after surgery, respectively. At 1 year after surgery, 11 patientsshowed bony healing of the atlas on CT images. Only one patient underwent revision surgery 8 months after primary surgery dueto nonunion and instability findings. The mean VAS score for neck pain was 0.92±0.99, and the mean NDI value was 8.08±5.70. Conclusion: C1 motion-preserving direct internal fixation technique results in good reduction and stabilization of unstable atlasfractures. This technique allows for the preservation of craniocervical and atlantoaxial motion.

전완 피부 신경을 침범한 신경림프종증

정유훈(Yu-Hun Jung),송우석(Woo-Suk Song),박섭리(Sub-Ri Park),백소야(So-Ya Paik) 대한정형외과학회 2016 대한정형외과학회지 Vol.51 No.4

신경 림프종증(neurolymphomatosis)은 림프종세포가 말초 신경계를 침범하는 것을 일컫는다. 일반적으로 림프종은 여러 연구에서 보고된 것처럼 말초 신경계를 침범하는 경우는 드문 것으로 알려져 있다. 신경 림프종증은 그 증상이 비특이적이고, 진단하는 데 있어서도 명확하게 정립된 바가 없어 치료하는 데에도 어려움이 많다. 특별한 증상 없이 전완 피부신경에 발생한 종괴에 대해 적출술을 시행하고 미만성 큰 B세포 림프종 진단 후 추가 치료하면서 경과관찰하였으나 동측 전완부 척골 신경에 재발한 림프종 1예를 경험하여 문헌 고찰과 함께 이를 보고하는 바이다. The term neurolymphomatosis has included infiltration of the peripheral nervous system by lymphoma. In generally, direct invasion of the peripheral nervous system is rare. The difficulty in treatment of neurolymphomatosis is due to unclassified characteristic symptoms and diagnosis. We performed excision of mass on the antebrachial cutaneous nerve with no specific symptoms. After diagnosis of diffuse large B cell lymphoma, further treatment and observation were followed. However, recurrence of the lymphoma was found in the ipsilateral forearm ulnar nerve, therefore we described a case of neurolymphomatosis with a brief review of the literature.