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RISS 인기검색어
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- 저자 : Chee Kean Lee (검색결과 4 건)
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Chee Kean Lee,Tiam Siong Tan,Chris Yin Wei Chan,Mun Keong Kwan 대한척추외과학회 2017 Asian Spine Journal Vol.11 No.2
Study Design: Clinical imaging study. Purpose: To study the surgical morphometry of C1 and C2 vertebrae in Chinese, Indian, and Malay patients. Overview of Literature: C1 lateral mass and C2 pedicle screw fixation is gaining popularity. However, there is a lack of C1–C2 morphometric data for the Asian population. Methods: Computed tomography analysis of 180 subjects (60 subjects each belonging to Chinese, Indian, and Malay populations) using simulation software was performed. Length and angulations of C1 lateral mass (C1LM) and C2 pedicle (C2P) screws were assessed. Results: The predicted C1LM screw length was between 23.2 and 30.2 mm. The safe zone of trajectories was within 11.0°±7.7° laterally to 29.1°±6.2° medially in the axial plane and 37.0°±10.2° caudally to 20.9°±7.8° cephalically in the sagittal plane. The shortest and longest predicted C2P screw lengths were 22.1±2.8 mm and 28.5±3.2 mm, respectively. The safe trajectories were from 25.1° to 39.3° medially in the axial plane and 32.3° to 45.9° cephalically in the sagittal plane. Conclusions: C1LM screw length was 23–30 mm with the axial safe zone from 11° laterally to 29° medially and sagittal safe zone at 21° cephalically. C2P screw length was 22–28 mm with axial safe zone from 26° to 40° medially and sagittal safe zone from 32° to 46° cephalically. These data serve as an important reference for Chinese, Indian, and Malay populations during C1–C2 instrumentation.
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Chee Kean Lee,Chris Yin Wei Chan,Mun Keong Kwan 대한척추외과학회 2015 Asian Spine Journal Vol.9 No.6
Managing multiple level spinal metastases is challenging. We report the case of a 58-year-old female with advanced lung cancer who presented with multiple pathological fractures of the thoracic spine (T5, T6, T7, and T8 vertebrae). She was treated with palliative radiotherapy. Her resting pain improved, but the instability pain persisted. One month later, she had a trivial fall leading to a pathological fracture of the L2 vertebra with cauda equine syndrome. The patient was treated surgically with minimally invasive decompression of the L2 and with percutaneous instrumented stabilization using an ultra-long construct from T3 to L5 (15 spinal levels), spanning the previously radiated zone and the decompression site. Postoperatively, she had significant improvements in pain and neurology. There were no surgical complications. Ultra long construct minimally invasive spinal stabilization is the ideal approach for symptomatic multicentric spinal metastasis with poor prognostic scores. Using this technique, the goals of spinal stabilization and direct neural decompression can be achieved with minimal morbidity.
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Mun Keong Kwan,Chee Kean Lee,Chris Yin Wei Chan 대한척추외과학회 2016 Asian Spine Journal Vol.10 No.1
Study Design: Prospective cohort study. Purpose: To report the outcome of 50 patients with spinal metastases treated with minimally invasive stabilization (MISt) using fluoroscopic guided percutaneous pedicle screws with/without minimally invasive decompression. Overview of Literature: The advent of minimally invasive percutaneous pedicle screw stabilization system has revolutionized the treatment of spinal metastasis. Methods: Between 2008 and 2013, 50 cases of spinal metastasis with pathological fracture(s) with/without neurology deficit were treated by MISt at our institution. The patients were assessed by Tomita score, pain score, operation time, blood loss, neurological recovery, time to ambulation and survival. Results: The mean Tomita score was 6.3±2.4. Thirty seven patients (74.0%) required minimally invasive decompression in addition to MISt. The mean operating time was 2.3±0.5 hours for MISt alone and 3.4±1.2 hours for MISt with decompression. Mean blood loss for MISt alone and MISt with decompression was 0.4±0.2 L and 1.7±0.9 L, respectively. MISt provided a statistically significant reduction in visual analog scale pain score with mean preoperative score of 7.9±1.4 that was significantly decreased to 2.5±1.2 postoperatively (p =0.000). For patients with neurological deficit, 70% displayed improvement of one Frankel grade and 5% had an improvement of 2 Frankel grades. No patient was bed-ridden postoperatively, with the average time to ambulation of 3.4±1.8 days. The mean overall survival time was 11.3 months (range, 2–51 months). Those with a Tomita score <8 survived significantly longer than those a Tomita score ≥8 with a mean survival of 14.1±12.5 months and 6.8±4.9 months, respectively (p =0.019). There were no surgical complications, except one case of implant failure. Conclusions: MISt is an acceptable treatment option for spinal metastatic patients, providing good relief of instability back pain with no major complications.
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Quan You Li,이오성,한호성,김강운,Chee Kean Lee,강성식,이명호,조현국,김호중,염진섭 대한척추외과학회 2015 Asian Spine Journal Vol.9 No.6
Study Design: Retrospective fusion level(s)-, age-, and gender-matched analysis. Purpose: To determine whether the application of a topical gelatin-thrombin matrix sealant (Floseal) at the end of anterior cervical discectomy and fusion (ACDF) can reduce the amount of postoperative hemorrhage. Overview of Literature: The effect of the matrix sealant in decreasing postoperative hemorrhage following ACDF has not been reported. Methods: Matrix sealant was (n=116, study group) or was not applied (n=58, control group) at the end of ACDF. Patients were selected by 1:2 matching criteria of fusion level(s), age, and gender. Seven parameters described below were compared between the two groups. Results: The total drain amount for the first 24 hours (8±9 versus 27±22 mL), total drain amount until the 8-hour drainage decreased to ≤10 mL (8±10 versus 33±26 mL), and the total drain amount until 6 AM on the first postoperative day (7±8 versus 24±20 mL) were significantly lower in the study group than the control group (all p <0.001). The time for the 8-hour drainage to decrease to ≤10 mL was significantly lower in the study group (10±5 versus 26±14 hours, p <0.001). The 8-hour drainage decreased to ≤10 mL on the operation day in most patients (88%) in the study group versus mostly on the first (48%) or second (33%) postoperative day in the control group (p <0.001). The total drain amount until 6 AM on the first postoperative day was 0 mL in 43% of patients in the study group and in 7% in the control group (p <0.001). No patient in either group required hematoma evacuation. Conclusions: Application of the topical matrix sealant at the end of ACDF can significantly reduce the amount of postoperative hemorrhage.
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