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나화엽,김영태,안형선,김기용 대한척추외과학회 1994 대한척추외과학회지 Vol.1 No.1
Although a few reports have described the histopathologic findings of the removed disc material after lumbar discectomy, the interrelationship of the histologic, radio- logic and clinical findings is rarely recognized. We performed a retrospective histopathologic, radiographic and clinical review of the results for patients who had a discectomy for the treatment of herniated lumbar intervertebral disc to find out any prognostic factors. We analysed ninety five patients who had been treated by partial laminectomy and discectomy for intervertebral disc herniation from Jun. 1989 to Apr. 1992 at Department of Orthopedic Surgery, Asan Medical Center. The mean follow up duration was 18 months(range, 12-36 months). The results were as follows: In 69 histopathological studies, all cases included the component of annulus fibro- sus, but none of them contained the component of nucleus pulopsus alone. An avul- sion type of the herniated disc materials composed of cartilage end plate and annu- lus fibrosus was 62% (43/69) of the cases, and we could not find any statistically significant correlation between age and the incidences of avulsion type, but we could find a statistically significant correlation between types on preoperative magnetic resonance imaging and the incidences of avulsion type(p<0.05). That is to say, avul- sion type was significantly more common in non-contained type than contained type. 2.The space-occupying ratio of herniated disc mass to spinal canal averaged 34. 3%, and it was correlated with the weight of removed disc material(p<0.05), but not with the postoperative clinical results. 3.The reduction of the heights of operated disc levels at the latest follow-up radiograph in comparison with preoperative radiograph averaged 5.1%, and this post- operative disc height change did not have any statistically significant correlation with either weight of removed disc material or clinical results. 4.The weight of removed disc material averaged 1.6 grams per level, and it didn't show any statistically significant correlation with the postoperative clinical results. That is to say, the more increased weight of removed disc material didn' guarantee the better clinical results.
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김기용,김영태,강준순,나화엽 울산대학교 의과대학 1992 울산의대학술지 Vol.1 No.1
Lumbar spinal stenosis was defined as any type of narrowing of the vertebral canal, nerve root canals or intervertebral foramina. Complete decompression of the dural sac and nerve root is a primary objective of surgery, but stabilization of the unstable spine created by the decompression is as important as the decompression itself in the treatment of spinal stenosis. This study was performed to evaluate the effectiveness of transpedicular screw fixation in stabilization after decompression and in reduction of spondylolisthesis with concomittent posterolateral fusion. 36 patients with lumbar spinal who were treated by decompression, transpedicular screw fixation and posterolateral fusion during the period from Sep. 1989 to Jun. 1991 were analysed and following results were obtained. The patients were followed for a mean of 18.5 months(range, 12-35). 1. The etiologic factors of lumbar spinal stenosis of 36 patients were spondylolisthesis in 21 patients(58.3%), degenerative in 13 patients(36.1%) and iatrogenic in 2 patients(5.5%). 2. In cases of spondylolisthesis, the average gain of reduction of slippage was 13.0% and the average loss of reduction was 2.0% in final followed up films. 3. 34 patients(94.4%) showed solid union of posterolateral bone graft at the mean of 3.5 months after operation(range, 3.0-4.5). 4. Symptomatic reliefs after operation were not significantly influenced by the level, site and etiology of the stenosis. So, complete decompression is essential in the treatment of the spinal stenosis. 5. The clinical results were excellent in 16 patients(44.4%), good in 15 patients(41.7%) and fair in 5 patients(13.9%). 6. Segmental spinal instrumentation with transpedicular screws is not only a reliable method of stabilization after wide decompression but also a good method of reduction and maintenance in the treatment of spondylolisthesis. Instrumentation allows better postoperative care and early ambulation.
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