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The Changes of Adjacent Intervertebral Discs after Lumbar Spine Immobilization in Rabbit
Rhyu, Kee Won,Kim, In CATHOLIC MEDICAL CENTER 1996 Bulletin of the Clinical Research Institute Vol.24 No.2
It has been known that the mechanical force loaded on spinal segments is changed after lumbar spinal immobilization. The abnormally high stress concentrated on the adjacent segments to the fused site results in degenerative changes of the intervertebral discs. In the present study, we investigated the changes following lumbar spinal immobilization in the spinal segment including intervertebral disc located just above the fused segment to relate the radiological findings of the spinal segment with the histopathological findings of the intervertebral disc using 20 adult rabbits, 4 control and 16 experimental group. Bilateral pedicular screw and plate were fixed at L6-7 spinal segment of experimental group. The experimental group were sacrificed 4, 8, 12 and 16 weeks after the operation. The results were as follows: 1. On the radiological examination of the L5-6 segment, the end plate sclerosis has been observed since 8th week after operation. At 12th week, the evidence of angular difference was seen. The more prominent findings for degenerative change such as anterior traction spur and angular difference were seen at 16th week. 2. Grossly, the mild discoloration of the intervertebral disc was seen at 4th week after operation. From 8th week, the degenerative changes such as discoloration, dehydration, and fibrosis were detected and were more prominent at 12th and 16th week. 3. Histologically, amorphous debris were seen from 4th week after operation in the nucleus pulposus. At 8th week, increased fibre bundles and chondroid cells were observed. The junction between the annulus fibrosus and nucleus pulposus were progressively distorted. From 12th week, the cluster of chondroid cells and chondroid metaplasia were formed. No definite demarcation between nucleus pulposus and annulus fibrosus was observed. These changes were more definite at 16th week. In the endplate cartilage, spindle shape of chondrocytes and loss of columnar cellular arrangement were detected from 8th week. At 12th week, the microfractures of endplate cartilage and osteoid formations were observed. At 16th week, it was unable to notice the borderline of the endplate cartilage and more osteoid formations were observed. On the stain for the mucopolysaccharides, the evidence of neutral mucopolysaccharides were observed. After 12th week, the neutral mucopolysaccharide and chondroid metaplasia were more prominent. 4. In intervertebral disc, more severe degenerative changes were noticed at the posterior parts of nucleus pulposus and annulus fibrosus. Above results suggest that the posterior spinal immobilization seems to accelerate the degenerative changes in the adjacent intervertebral disc above the immobilization. And these changes were more prominent at the posterior part of the intervertebral disc.
Lumbar Interbody Fusion and Osteobiologics for Lumbar Fusion
김영훈,Ha Kee-Yong,Kim Youn-Soo,Kim Ki-Won,Rhyu Kee-Won,Park Jong-Beom,Shin Jae-Hyuk,Kim Young-Yul,Lee Jun-Seok,Park Hyung-Youl,Ko Jaeryong,Kim Sang-Il 대한척추외과학회 2022 Asian Spine Journal Vol.16 No.6
Lumbar interbody fusion (LIF) is an excellent treatment option for a number of lumbar diseases. LIF can be performed through posterior, transforaminal, anterior, and lateral or oblique approaches. Each technique has its own pearls and pitfalls. Through LIF, segmental stabilization, neural decompression, and deformity correction can be achieved. Minimally invasive surgery has recently gained popularity and each LIF procedure can be performed using minimally invasive techniques to reduce surgery-related complications and improve early postoperative recovery. Despite advances in surgical technology, surgery-related complications after LIF, such as pseudoarthrosis, have not yet been overcome. Although autogenous iliac crest bone graft is the gold standard for spinal fusion, other bone substitutes are available to enhance fusion rate and reduce complications associated with bone harvest. This article reviews the surgical procedures and characteristics of each LIF and the osteobiologics utilized in LIF based on the available evidence.
Lumbar Interbody Fusion: Techniques, Pearls and Pitfalls
김영훈,Ha Kee-Yong,Rhyu Kee-Won,Park Hyung-Youl,Cho Chang-Hee,Kim Hun-Chul,이효진,김상일 대한척추외과학회 2020 Asian Spine Journal Vol.14 No.5
Lumbar interbody fusion (LIF) is an effective and popular surgical procedure for the management of various spinal pathologies, especially degenerative diseases. Currently, LIF can be performed with posterior, transforaminal, anterior, and lateral approaches by open surgery or minimally invasive surgery (MIS). Each technique has its own advantages and disadvantages. In general, posterior LIF is a well-established procedure with good fusion rates and low complication rates but is limited by the possibility of iatrogenic injury to the neural structures and paraspinal muscles. Transforaminal LIF is frequently performed using an MIS technique and has an advantage of reducing these iatrogenic injuries. Anterior LIF (ALIF) can restore the disk height and sagittal alignment but has inherent approach-related challenges such as visceral and vascular complications. Lateral LIF and oblique LIF are performed using an MIS technique and have shown postoperative outcomes similar to ALIF; however, these approaches carry a risk of injury to psoas, lumbar plexus, and vascular structures. Herein, we provide a detailed description of the surgical procedures of each LIF technique. We shall then consider the pearls and pitfalls, as well as propose surgical indications and contraindications based on the available evidence in the literatures.
Kim, Ki-Won,Ha, Kee-Yong,Lee, Jun-Seok,Rhyu, Kee-Won,An, Howard S.,Woo, Young-Kyun Lippincott Williams & Wilkins 2007 Spine Vol.32 No.22
STUDY DESIGN.: Western blotting and flow cytometric analyses were performed using rat notochordal cells. OBJECTIVE.: To demonstrate the apoptotic effect of oxidative stress and the antiapoptotic effects of caspase inhibitors on rat notochordal cells. SUMMARY OF BACKGROUND DATA.: Although oxidative stress causes apoptosis in many cell types, its effect on the apoptosis of notochordal cell and antiapoptotic effects of caspase inhibitors on the oxidative stress-induced apoptosis are unknown. METHODS.: Cultured rat notochordal cells were exposed to oxidative stress [500 μmol/L of hydrogen peroxide (H2O2)]. To determine the oxidative stress-induced apoptotic pathways, activations of caspases (-3, -8, and -9) as well as cleavages of Bid and poly (ADP-ribose) polymerase (PARP) were evaluated with Western blotting 6 hours after oxidative stress. To elucidate the antiapoptotic effects of caspase inhibitors on the oxidative stress induced-apoptosis, apoptotic rates of notochordal cells with or without treatment of specific caspase inhibitors (z-IETD-fmk for caspase-8, z-LEHD-fmk for caspase-9, and z-DEVD-fmk for caspase-3) were quantified by flow cytometry. RESULTS.: Oxidative stress significantly increased apoptosis of rat notochordal cells (2.1% vs. 4.75%, P = 0.008) and led to activations of initiators of intrinsic (caspases-9) and extrinsic (caspase-8) pathways as well as their common executioner (caspase-3). It also caused cleavages of Bid and PARP. Flow cytometric analysis showed that inhibition of only one of the intrinsic and extrinsic pathways by caspase-9 inhibitor (4.75% vs. 3.56%, P = 0.31) and caspase-8 inhibitor (4.75% vs. 5.24%, P = 0.84) did not significantly suppress the oxidative stress-induced apoptosis. However, inhibition of both pathways by caspase-3 inhibitor significantly reduced the oxidative stress-induced apoptosis (4.75% vs. 2.64%, P = 0.008) to the control level (2.1% vs. 2.64%, P = 0.15). CONCLUSION.: Oxidative stress caused apoptosis of rat notochordal cells via both intrinsic and extrinsic (Type I and Type II) pathways. Because caspase inhibitors are being used in clinical trials, inhibition of both pathways using caspase inhibitors might be of future therapeutic importance in oxidative stress-induced apoptosis of notochordal cells. Our results suggest that inhibition of inappropriate or premature oxidative stress-induced apoptosis of notochordal cells may delay the starting point of disc degeneration.
Kim, Kyungsoo,Kim, Yoon Hyuk,Park, Won Man,Rhyu, Kee Hyung Informa UK Ltd 2010 Computer aided surgery Vol.15 No.4
<P>During computer navigated total knee arthroplasty, pin holes are drilled in the femur and tibia to allow the placement of navigation trackers, and fractures associated with these pin holes have recently been reported. We hypothesized that an increase in stress around the pin holes is one of the most relevant factors contributing to the fracture. In this study, we used finite element analysis to investigate the stresses around femoral pin holes with respect to the mode of pin penetration, the diameter of the pin holes, and the degree of osteoporosis. Our results indicate that increases in pin hole diameter and reduction in bone strength as a result of osteoporosis intensify the stresses around the pin holes, especially in cases of transcortical pin penetration.</P>
Amyloid Arthropathy of the Hip Joint Associated with Multiple Myeloma: A Case Report
( Yoon Je Cho ),( Young Soo Chun ),( Kee Hyung Rhyu ),( Yong Koo Park ),( Kyung Nam Ryu ),( Ji Seon Park ),( Huo Liang ),( Gwang Young Jung ),( Won Ju Shin ) 대한고관절학회 2016 Hip and Pelvis Vol.28 No.2
Amyloidosis is a disease characterized by the deposition of non-soluble fibrous protein in multiple tissues with a number of possible causes. This protein deposition can occur in any tissue, yet is most commonly seen in kidneys, heart, and gastrointestinal tracts. However, invasion to bone tissues is not often reported. The deposition of amyloid proteins in bone tissues may result in joint pain and pathological fractures; it is important to elucidate the causes and detect early to determine prognosis and treat optimally. In the present case report, with relevant literature review, the authors report a case of total hip arthroplasty in an amyloidosis patient.