경추 및 요추 퇴행성 척추전위증의 병발성 유병률

박문수,황지효,김태환,오재근,장호근,김형준,박건태,임진규,K. Daniel Riew 대한척추외과학회 2018 대한척추외과학회지 Vol.25 No.4

Study Design: Retrospective radiographic study. Objective: To evaluate the characteristics of concurrent degenerative cervical and lumbar spondylolisthesis. Summary of Literature Review: Concurrent degenerative cervical and lumbar spondylotic diseases have been reported. Given that severe spondylosis can result in spondylolisthesis, one might expect that concurrent spondylolisthesis of the cervical and lumbar spines might also be prevalent. However, the incidence of spondylolistheses in the lumbar and cervical spines might differ due to anatomical differences between the 2 areas. Nonetheless, there is minimal information in the literature concerning the incidence of concurrent cervical and lumbar spondylolisthesis. Material and Methods: We evaluated standing cervical and lumbar lateral radiographs of 2510 patients with spondylosis. Concurrence, age group, gender, and direction of spondylolisthesis were evaluated. Lumbar spondylolisthesis was defined as at least Meyerding grade I and degenerative cervical spondylolisthesis was defined as over 2 mm of displacement on standing lateral radiographs. Results: Lumbar spondylolisthesis was found in 125 patients (5.0%) and cervical spondylolisthesis was found in 193 patients (7.7%). Seventeen patients had both degenerative cervical and lumbar spondylolistheses (0.7%). Lumbar spondylolisthesis is a risk factor for coexisting cervical spondylolisthesis. Lumbar spondylolisthesis was more common in females than males, independent of advancing age. In contrast, degenerative cervical spondylolisthesis was more common in older patients, independent of gender. Anterolisthesis was more common in the lumbar spine. Retrolisthesis was more common in the cervical spine. Conclusions: There was a higher prevalence of degenerative cervical spondylolisthesis in patients with degenerative lumbar spondylolisthesis. 연구 계획: 후향적 방사선 연구목적: 경추와 요추에 동시에 발생한 퇴행성 척추전위증을 알아보고자 한다. 선행 연구논문의 요약: 경추와 요추에 동시에 발생한 퇴행성 척추질환에 대한 여러 보고가 있었다. 퇴행성 척추전위증은 퇴행성 변화에 의하여 시발되므로 경추와 요추에 척추전위증이 병발할 것으로 추정된다. 반면에, 요추와 경추의 해부학적 구조가 서로 다르므로 두 질환의 진행이 동일하지 않을 것으로추정할 수도 있다. 그러나, 경추와 요추에 동시에 발생한 퇴행성 척추전위증에 대한 보고는 적었다. 대상 및 방법: 요추 및 경추 부위에 기립위 단순방사선 검사를 둘다 시행한 퇴행성 척추 질환 환자 2,510명을 대상으로 하였다. 병발여부, 나이, 성별, 전위증의 방향에 대하여 조사하였다. 퇴행성 요추전위증은 기립위 단순방사선영상에서 Meyerding 방법을 사용하여 grade 1 이상인 경우 진단하였으며 퇴행성 경추전위증은 기립위 단순방사선영상에서 2 mm 이상의 전위가 보이는 경우 진단하였다. 결과: 퇴행성 요추전위증은 125명에서 관찰되었으며(5.0%) 퇴행성 경추전위증은 193명에서 관찰되었다(7.7%). 요추전위증과 경추전위증은 17명에서같이 관찰되었다(0.7%). 요추전위증이 있는 환자가 없는 환자에 비하여 경추전위증이 더 많이 관찰되었다. 요추전위증은 남자보다 여자에서 더 흔하였으나, 모든 연령군에서 비슷하게 발생하였다. 경추전위증은 고령의 연령군에서 더 많이 발생하였으나, 남녀의 발생 비율이 비슷하였다. 요추전위증에서는전방으로 많이 발생하였고, 경추전위증에서는 후방으로 많이 발생하였다. 결론: 퇴행성 요추전위증이 있는 경우가 없는 경우에 비하여 퇴행성 경추전위증이 더 많이 발생하였다. 약칭 제목: 동시에 발생한 척추전위증

Comparison of Clinical and Radiological Results of Posterolateral Fusion and Posterior Lumbar Interbody Fusion in the Treatment of L4 Degenerative Lumbar Spondylolisthesis

Shugo Kuraishi,Jun Takahashi,Keijiro Mukaiyama,Masayuki Shimizu,Shota Ikegami,Toshimasa Futatsugi,Hiroki Hirabayashi,Nobuhide Ogihara,Hiroyuki Hashidate,Yutaka Tateiwa,Hisatoshi Kinoshita,Hiroyuki Kat 대한척추외과학회 2016 Asian Spine Journal Vol.10 No.1

Study Design: Multicenter analysis of two groups of patients surgically treated for degenerative L4 unstable spondylolisthesis. Purpose: To compare the clinical and radiographic outcomes of posterolateral fusion (PLF) and posterior lumbar interbody fusion (PLIF) for degenerative L4 unstable spondylolisthesis. Overview of Literature: Surgery for lumbar degenerative spondylolisthesis is widely performed. However, few reports have compared the outcome of PLF to that of PLIF for degenerative L4 unstable spondylolisthesis. Methods: Patients with L4 unstable spondylolisthesis with Meyerding grade II or more, slip of >10° or >4 mm upon maximum flexion and extension bending, and posterior opening of >5 degree upon flexion bending were studied. Patients were treated from January 2008 to January 2010. Patients who underwent PLF (n=12) and PLIF (n=19) were followed-up for >2 years. Radiographic findings and clinical outcomes evaluated by the Japanese Orthopaedic Association (JOA) score were compared between the two groups. Radiographic evaluation included slip angle, translation, slip angle and translation during maximum flexion and extension bending, intervertebral disc height, lumbar lordotic angle, and fusion rate. Results: JOA scores of the PLF group before surgery and at final follow-up were 12.3±4.8 and 24.1±3.7, respectively; those of the PLIF group were 14.7±4.8 and 24.2±7.8, respectively, with no significant difference between the two groups. Correction of slip estimated from postoperative slip angle, translation, and maintenance of intervertebral disc height in the PLIF group was significantly (p <0.05) better than those in the PLF group. However, there was no significant difference in lumbar lordotic angle, slip angle and translation angle upon maximum flexion, or extension bending. Fusion rates of the PLIF and PLF groups had no significant difference. Conclusions: The L4–L5 level posterior instrumented fusion for unstable spondylolisthesis using both PLF and PLIF could ameliorate clinical symptoms when local stability is achieved.

Comparison of Functional Outcomes following Surgical Decompression and Posterolateral Instrumented Fusion in Single Level Low Grade Lumbar Degenerative versus Isthmic Spondylolisthesis

Farzad Omidi-Kashani,Ebrahim Ghayem Hasankhani,Mohammad Dawood Rahimi,Reza Khanzadeh 대한정형외과학회 2014 Clinics in Orthopedic Surgery Vol.6 No.2

Background: The two most common types of surgically treated lumbar spondylolisthesis in adults include the degenerative and isthmic types. The aim of this study was to compare the functional outcomes of surgical decompression and posterolateral instrumented fusion in patients with lumbar degenerative and isthmic spondylolisthesis. Methods: In this retrospective study, we reviewed the clinical outcomes in surgically treated patients with single level, low grade lumbar degenerative, and isthmic spondylolisthesis (groups A and B, respectively) from August 2007 to April 2011. We tried to compare paired settings with similar initial conditions. Group A included 52 patients with a mean age of 49.2 ± 6.1 years, and group B included 52 patients with a mean age of 47.3 ± 7.4 years. Minimum follow-up was 24 months. The surgical procedure comprised neural decompression and posterolateral instrumented fusion. Pain and disability were assessed by a visual analog scale (VAS) and the Oswestry Disability Index (ODI), respectively. The Wilcoxon and Mann-Whitney U-tests were used to compare indices. Results: The most common sites for degenerative and isthmic spondylolisthesis were at the L4–L5 (88.5%) and L5–S1 (84.6%) levels, respectively. Surgery in both groups significantly improved VAS and ODI scores. The efficacy of surgery based on subjective satisfaction rate and pain and disability improvement was similar in the degenerative and isthmic groups. Notable complications were also comparable in both groups. Conclusions: Neural decompression and posterolateral instrumented fusion significantly improved pain and disability in patients with degenerative and isthmic spondylolisthesis. The efficacy of surgery for overall subjective satisfaction rate and pain and disability improvement was similar in both groups.

퇴행성 요추 질환에서 후방경유 추체간 유합술과 360° 고정술의 비교

이녹영,오성훈,이우택,배재성,이형중,김영수,고용,김광명,오석전,Lee, Nok Young,Oh, Seong Hoon,Rhee, Woo Tack,Bae, Jae Seong,Yi, Hyeong Joong,Kim, Young Soo,Ko, Yong,Kim, Kwang Myung,Oh, Suck Jun 대한신경외과학회 2001 Journal of Korean neurosurgical society Vol.30 No.10

Objectives : The goal of operation for degenerative lumbar diseases is to relieve radiculopathy and low back pain and to prevent further degeneration. The authors analyzed the surgical results of posterior lumbar interbody fusion(PLIF) and $0^{\circ}$ fixation to evaluate the proper treatment policy in spinal stenosis, degenerative spondylolisthesis and low grade isthmic spondylolisthesis. Material and Methods : The authors performed PLIF on 92 patients and $0^{\circ}$ fixation on 138 patients with spinal stenosis, degenerative spondylolisthesis and low grade isthmic spondylolisthesis. We retrospectively studied clinical outcomes and subjective satisfaction of these patients by several criteria such as visual analog scale(VAS), Prolo's economic and functional outcome scale, medication usage after operation and questionaire for overall outcome. Result : Pre- and postoperative VAS on back pain and leg pain showed decrease of pain from 6.5, 6.7 to 2.2, 2.4 in PLIF group and from 7.0, 7.2 to 2.5, 2.7 in $0^{\circ}$ fixation group. Excellent and good outcomes on Prolo's scale were 81.5% in PLIF group and 82.6% in $0^{\circ}$ fixation group. Medication usage after operation was reduced in 79.3% of PLIF group and in 78.3% of $0^{\circ}$ fixation group. Patients' self-reported overall success of their procedure showed 82% in PLIF group and 84% in $0^{\circ}$ fixation group. Conclusion : Both PLIF and $0^{\circ}$ fixation showed good outcomes and provided biomechanically stable fusion in spinal stenosis, degenerative spondylolisthesis and low grade isthmic spondylolisthesis. Therefore, only PLIF seems necessary and considered a proper surgical treatment for these disorders.

퇴행성 요추 전위증 수술 치료시 임상 결과에 영향을 주는 인자들

이규열,손성근,김성완,강민수 대한척추외과학회 2003 대한척추외과학회지 Vol.10 No.1

Clinical and Radiological Comparison between Three Different Minimally Invasive Surgical Fusion Techniques for Single-Level Lumbar Isthmic and Degenerative Spondylolisthesis: Minimally Invasive Surgical Posterolateral Fusion versus Minimally Invasive Sur

Mohamed Elmekaty,Yoshihisa Kotani,Emad El Mehy,Yohan Robinson,Ahmed El Tantawy,Ivan Sekiguchi,Ryo Fujita 대한척추외과학회 2018 Asian Spine Journal Vol.12 No.5

Study Design: Retrospective cohort study. Purpose: Comparison between three different minimally invasive surgical (MIS) fusion techniques for single-level lumbar spondylolisthesis. Overview of Literature: There has been an increase in the development and utilization of MIS techniques for lumbar spine fusion. No study has compared the efficacy of MIS-posterolateral fusion (MIS-PLF), MIS-transforaminal lumbar interbody fusion (MIS-TLIF), and midline lumbar fusion (MIDLF) with modified cortical bone trajectory screws for lumbar spondylolisthesis. Methods: Fifty-nine patients with single-level lumbar spondylolisthesis and a minimum follow-up period of 1 year were included in this study. The MIS-PLF, MIS-TLIF, and MIDLF groups included 22, 15, and 22 patients, respectively. The average age of the groups was 70.6, 49.3, and 62.7 years, respectively. The evaluation parameters were operation time, intraoperative bleeding, serum C-reactive protein (CRP) value, creatine kinase (CK) value, and overall functional outcome as per the Japanese Orthopedic Association Back Pain Evaluation Questionnaire (JOABPEQ) score. The changes in the lumbar lordosis angle (LLA), segmental disc angle (SDA), and disc height were measured. Fusion rate, screw loosening, and loss of correction were also assessed. Results: MIDLF showed a significantly shorter operation time (111 min), less bleeding amount (112.5 mL), and lower values of CRP and CK than the other two techniques. There was no significant difference in the JOABPEQ scores of the three groups. MIDLF resulted in a greater increase in the LLA and SDA postoperatively. MIDLF and MIS-TLIF resulted in a significant increase in the middle disc height compared with MIS-PLF. MIDLF showed a lower loss of correction after 6 months postoperatively (2.6%) than MIS-PLF (5.2%) and MIS-TLIF (4.2%). The fusion rate was 100% in the MIDLF and MIS-TLIF groups and 90% in the MIS-PLF group. Screw loosening occurred in 10% of the MIS-PLF cases, 7.14% of the MIS-TLIF cases, and 4.76% of the MIDLF cases. Conclusions: MIDLF was the least invasive, and there was no significant difference between the three groups in terms of fusion, screw loosening, and clinical outcomes.

Radiological Evaluation of the Initial Fixation between Cortical Bone Trajectory and Conventional Pedicle Screw Technique for Lumbar Degenerative Spondylolisthesis

Koshi Ninomiya,Koichi Iwatsuki,Yu-Ichiro Ohnishi,Toshiki Yoshimine 대한척추외과학회 2016 Asian Spine Journal Vol.10 No.2

Study Design: Retrospective study. Purpose: To compare initial fixation using the cortical bone trajectory (CBT) technique versus conventional pedicle screws (PS) in radiographs of postsurgical lumbar degenerative spondylolisthesis. Overview of Literature: Few reports have documented the holding strength of CBT technique for spondylolisthesis cases. Methods: From October 2009 to June 2014, 21 cases of degenerative spondylolisthesis were surgically treated in our institution. Ten were treated with conventional PS technique and 11 of with CBT technique. Mean lumbar lordosis and percent slippage were evaluated preoperatively, immediately after surgery, and 6 months and 1 year postoperatively using radiographs. We also investigated percent loss of slip reduction. Results: There were statistically significant differences between preoperative percent slippage and postoperative slippage in both PS and CBT procedures over 1 year, and both techniques showed good slip reduction. On the other hand, lumbar lordosis did not change significantly in either the PS or CBT groups over 1 year. Conclusions: CBT technique showed similarly good initial fixation compared with the PS procedure in the treatment of lumbar degenerative spondylolisthesis.

A Retrospective Study of the Effect of Spinopelvic Parameters on Fatty Infiltration in Paraspinal Muscles in Patients With Lumbar Spondylolisthesis

Jia-Chen Yang,Jia-Yu Chen,Yin Ding,Yong-Jie Yin,Zhi-Ping Huang,Xiu-Hua Wu,Zu-Cheng Huang,Yi-Kai Li,Qing-An Zhu 대한척추신경외과학회 2024 Neurospine Vol.21 No.1

Objective: The effect on fat infiltration (FI) of paraspinal muscles in degenerative lumbar spinal diseases has been demonstrated except for spinopelvic parameters. The present study is to identify the effect of spinopelvic parameters on FI of paraspinal muscle (PSM) and psoas major muscle (PMM) in patients with degenerative lumbar spondylolisthesis. Methods: A single-center, retrospective cross-sectional study of 160 patients with degenerative lumbar spondylolisthesis (DLS) and lumbar stenosis (LSS) who had lateral full-spine x-ray and lumbar spine magnetic resonance imaging was conducted. PSM and PMM FIs were defined as the ratio of fat to its muscle cross-sectional area. The FIs were compared among patients with different pelvic tilt (PT) and pelvic incidence (PI), respectively. Results: The PSM FI correlated significantly with pelvic parameters in DLS patients, but not in LSS patients. The PSM FI in pelvic retroversion (PT > 25°) was 0.54 ± 0.13, which was significantly higher in DLS patients than in normal pelvis (0.41 ± 0.14) and pelvic anteversion (PT < 5°) (0.34 ± 0.12). The PSM FI of DLS patients with large PI ( > 60°) was 0.50 ± 0.13, which was higher than those with small ( < 45°) and normal PI (0.37 ± 0.11 and 0.36 ± 0.13). However, the PSM FI of LSS patients didn’t change significantly with PT or PI. Moreover, the PMM FI was about 0.10–0.15, which was significantly lower than the PSM FI, and changed with PT and PI in a similar way of PSM FI with much less in magnitude. Conclusion: FI of the PSMs increased with greater pelvic retroversion or larger pelvic incidence in DLS patients, but not in LSS patients.

요추부 척추전방전위증 환자에서 후방경유 추체간 골유합술 후 시상면 균형과 하부요통 간의 관계 분석

김 희열,주 창일,이 승명 조선대학교 의학연구원 2017 The Medical Journal of Chosun University Vol.42 No.2

Measures of radiographic pelvic and spinal parameters of sagittal balance analysis have become of considerable importance for reconstructive surgery of the spine, particularly in cases of degenerative spondylolisthesis. The authors conducted a retrospective study of clinical outcomes and a radiological review on 231 patients with one or two level degenerative spondylolisthesis. First, patients were classified using preoperative pelvic parameters and evaluations were conducted using mean values of pre- and postoperative spinopelvic parameters. Second, patients were divided into two study groups, that is, Group A (n=105; exhibited no improvement (increase or no change) in pelvic tilt postoperatively) and Group B (n=126; exhibited pelvic tilt improvement (decrease) postoperatively). Clinical outcomes in the two groups were compared using Visual Analogue Pain Scores (VAS) and Oswestry disability index (ODI). All preoperative pelvic parameters show restoration tendency after PLIF surgery for spondylolisthesis, and greater deviations of preoperative pelvic parameters from normality showed greater recovery postoperatively. VAS and ODI improvements at follow-up were poorer in group A than in group B.

Threaded Fusion Cage(TFC)를 이용한 요추체 후방융합술

김영수,윤도흠,박형천,조용은,노성우 대한신경외과학회 1993 Journal of Korean neurosurgical society Vol.22 No.4

Of all fusion techniques in the lumbar spines, posterior lumbar interbody fusion(PLIF) has the best theoretical opportunity to achieve fusion by way of compression loading of the bone graft between the well vascularized vertebral bodies. Even though the rationale for the PLIF is quite reasonable, it has been a very technically demanding procedure and frequent problems have been reported which include protrusion of bone grafts, settling of the interspace and pseudoarthrosis. A new device. Threaded Fusio Cage(TFC) seems to be an ideal solution for the various technical problems which hindered greater success of PLIF in the past. Maintenance of stability and absence of loss of disc height are assured due to the threaded metal tube concept. We have operated PLIF with TFC in 60 patients since last December. The preoperative diagnoses were 27 degenerative disc diseases, 25 degenerative spondylolisthesis, 7 spondyloysis & listhesis and 1 FBSS. Our initial experience with the clinical results show that the most of the patient have marked improvement of low back pain and reduction is possible in almost cases of the spondylolisthesis. Long term follow up is needed as to the future of the threaded cage, but it would appear that once they have been in a stable position and fusion with the patients' own bone has occurred. In our opinion, the use of TFC in the future will be widely spread and represents an ideal method for the treatment of chronic low back pain and spinal instability.