퇴행성 요추 질환에서 후방 요추체간 유합술과 후측방 유합술의 결과 비교

이진영,강정우,박현태,송경원,신성일,김갑래,현윤석,이정길 대한척추외과학회 2011 대한척추외과학회지 Vol.18 No.3

Study Design: A retrospective study. Objectives: The authors found that problems such as axial pain, donor site pain, loss of reduction, loosening or failure of fixation materials occurred relatively frequently after posterolateral fusion. For this, we had views on the ideas that the problems could be improved by an operation that fused vertebral bodies. Furthermore, we performed posterior lumbar interbody fusion and wanted to know the results. Summary of Literature Review: We performed posterior lumbar inter-body fusion as an alternative, due to complications of autoiliac bone graft that has complications, such as donor site pain. Materials and Methods: Sixty patients with single segment degenerative lumbar disease were treated with decompression,pedicle screws fixation, and spinal fusion. The patients were followed-up for more than 2 years. Thirty patients, who had undergone posterolateral fusion with autologous iliac bone graft, were classified as the “group 1”. The second 30 patients, who underwent posterior lumbar interbody fusion with cage and local bone graft, were classified as the “group 2”. The operation time, blood loss, fusion rate,lumbar lordotic angle, segmental angle were compared between the 2 groups. The clinical outcomes were evaluated by Kim’s functional evaluation scale. Results: The operation time was shorter in group 2 (142.74 minutes vs 171.64 minutes), there was a statistical difference between the 2groups. Intraoperative blood loss was more in group 2 (563.40 vs 551.78 mL), but total blood loss, including postoperative drained blood was less in group 2. The bony fusion rate was 90% in group 1, 97% in group 2. For the lumbar lordotic angle, the last outcome was less than the preoperative value. There was no statistical difference between the 2 groups. The segmental angle in group 1, the last outcome was less than the preoperative value. The segmental angle in group 2 was maintained the value through pre-operation to post-operation. Clinical outcomes were satisfactory in group 1 (96.67%) & in group 2 (100%). In group 1, 7 patients experienced pain at the iliac graft donor site. In group 2, there were 2 cases of retroposition of the cage. Conclusions: In the posterior lumbar interbody fusion group, operation time was shorter, total blood loss was less than in the posterolateral fusion group. Restoration and maintenance of the segmental angle in sagittal and coronal radiographs showed better outcomes, axial pain and iliac donor site pain were less. It is the authors’ position that posterior lumbar interbody fusion is an alternative operation to supplement the faults of posterolateral fusion. Key Words: Degenerative lumbar spinal disorders, Posterior lumbar interbody fusion, Posterolateral fusion 연구 계획: 후향적 연구목적: 후측방 유합술에서 요추부의 축성 동통 및 공여부의 동통, 방사선 소견상 정복의 소실, 내고정물의 이완이나 실패 등의 합병증이 비교적 흔하다. 따라서 추체를 유합시키는 방법으로서 후방 요추체간 유합술을 시행하여 그 결과를 알아보고자 하였다. 선행 문헌의 요약: 자가장골을 이용한 후측방 유합술의 경우 공여부 동통 등의 합병증이 발생 가능하므로, 최근 그 대안으로 국소골을 이용한 후방 요추체 간 유합술이 많이 시행되고 있다. 대상 및 방법: 단일 분절 퇴행성 요추 질환으로 감압술, 척추경 나사못 고정술, 요추 유합술을 시행받고 2년 이상 추시관찰이 가능했던 60명을 대상으로, 후측방 유합술을 실시한 30명(1군)과 케이지와 국소골을 이용한 후방 요추체간 유합술을 실시한 30명(2군)으로 구분하였다. 수술 시간, 실혈량, 수술전후 및 추시 중 방사선 사진상 골유합, 요추 전만각, 분절간 각을 비교하였고, 임상적 결과는 Kim 등의 기준으로 평가하였다. 결과: 수술 시간은 1군(171.64분)에 비해 2군(142.74분)이 통계학적으로 유의하게 짧았다. 수술 중 실혈량은 1군(551 ml)보다 2군(563.4 ml)에서 약간 많았으나 수술 후 배액량을 포함한 총 실혈량은 2군이 적었다. 골유합은 1군에서 90%, 2군에서 97%로 나타났다. 요추 전만각은 1군과 2군 모두 술 전에비해 술 후 증가하였다가 감소하는 양상으로 서로 차이가 없었다. 분절간 각은 1군에서 술 전에 비해 술 후 증가하였다가 추시 중 오히려 술 전보다 감소한 반면, 2군에서는 추시 기간 중 1군에 비해서 유지되는 양상이었다. 임상적 평가에서 1군(96.67%)과 2군(100%) 모두 양호한 결과를 보였으나, 합병증으로 1군에서 이식골 공여부 동통이 7예, 2군에서 케이지의 후방 전위가 2예 관찰되었다. 결론: 단일 분절 퇴행성 요추 질환에서 실시한 후방 요추체간 유합술은 후측방 유합술보다 수술 시간이 짧았으며, 총 실혈량이 적었다. 분절간 각의 회복과 유지에 있어서도 나은 결과를 보였으며, 축성 동통 및 공여부 동통이 적었다. 따라서 저자들은 후방 요추체간 유합술이 후측방 유합술의 단점을 보완할 수 있는 방법 중의 하나라고 생각한다. 색인 단어: 퇴행성 요추 질환, 후방 요추체간 유합술, 후측방 유합술약칭 제목: 퇴행성 요추 질환에서 후방 요추체간 유합술의 유용성

Fusion Criteria for Posterior Lumbar Interbody Fusion with Intervertebral Cages : The Significance of Traction Spur

Kim, Kyung-Hoon,Park, Jeong-Yoon,Chin, Dong-Kyu The Korean Neurosurgical Society 2009 Journal of Korean neurosurgical society Vol.46 No.4

Objective : The purpose of this study was to establish new fusion criteria to complement existing Brantigan-Steffee fusion criteria. The primary purpose of intervertebral cage placement is to create a proper biomechanical environment through successful fusion. The existence of a traction spur is an essential predictable radiologic factor which shows that there is instability of a fusion segment. We studied the relationship between the existence of a traction spur and fusion after a posterior lumbar interbody fusion (PLIF) procedure. Methods : This study was conducted using retrospective radiological findings from patients who underwent a PLIF procedure with the use of a cage without posterior fixation between 1993 and 1997 at a single institution. We enrolled 183 patients who were followed for a minimum of five years after the procedure, and used the Brantigan-Steffee classification to confirm the fusion. These criteria include a denser and more mature bone fusion area than originally achieved during surgery, no interspace between the cage and the vertebral body, and mature bony trabeculae bridging the fusion area. We also confirmed the existence of traction spurs on fusion segments and non-fusion segments. Results : The PLIF procedure was done on a total of 251 segments in 183 patients (71 men and 112 women). The average follow-up period was $80.4{\pm}12.7$ months. The mean age at the time of surgery was $48.3{\pm}11.3$ years (range, 25 to 84 years). Among the 251 segments, 213 segments (84.9%) were fused after five years. The remaining 38 segments (15.1%) were not fused. An analysis of the 38 segments that were not fused found traction spur formation in 20 of those segments (52.6%). No segments had traction spur formation with fusion. Conclusion : A new parameter should be added to the fusion criteria. These criteria should be referred to as 'no traction spur formation' and should be used to confirm fusion after a PLIF procedure.

퇴행성 하요추부 질환에서 PEEK Cage와 척추경 나사못 고정을 통한 후방 추체간 유합술의 유용성 - 최소 3년 이상 추시 결과 -

송경진,이광복,함동훈 대한척추외과학회 2011 대한척추외과학회지 Vol.18 No.4

Study Design: A retrospective study. Objectives: To evaluate the three-plus year follow-up results of patients who underwent posterior lumbar interbody fusion with PEEK cage and pedicle screw fixation for lumbar degenerative disease. Summary of Literature Review: There are few previous reports addressing posterior lumbar interbody fusion using PEEK cage with mid-term follow up periods. Materials and Methods: 260 patients who underwent posterior lumbar interbody fusion with PEEK cage and pedicle screw fixation for lumbar degenerative disease were enrolled. We classified patients into three groups according to their fusion level: group A (n=151) had one-level fusion, and group B (n=91) had two-level fusion, and group C (n=18) had three-level fusion. Clinical outcomes were evaluated by pre- and post-operative Visual analogue scale (VAS) scores, the Oswestry Disability Index (ODI), and complication and reoperation rates. Radiologic outcomes were measured by the fusion rate, sagittal alignment, disc height and changes. Results: VAS (pre-operative to final follow-up) changed from 7.62±2.03 (5-10) to 3.19±1.94 (1-8) in group A, from 6.83±2.28(4-9)to 4.51±2.18(2-9) in group B and from 7.17±2.46 (5-10) to 4.63±1.97(1-9) in group C. Final follow-up ODI also decreased in group A (17.6±8.56%), group B (15.4±5.46%) and group C (24.7±7.46%). This corresponds to scores of 94.7% in group A, 92.3% in group B and 94.4% in group C. There were significant differences between preoperative, post-operative and final follow-up lumbar lordosis [p=0.042(group A), 0.036(group B), 0.045(group C)], segmental lordosis [p=0.036(group A), 0.039(group B), 0.047(group C)]. Reoperation was performed in patients 8 group A, 4 group B, and 1 group C, and there is no significant diffrence between groups. Adjacent segmental change was found in all reoperation patients, but showed no correlation with clinical results. Conclusions: Posterior lumbar interbody fusion with PEEK cage and pedicle screw fixation in lumbar degenerative disease showed excellent clinical results and fusion rates, regardless of patient fusion levels. 연구 계획: 후향적 연구목적: 하요추부 퇴행성 질환에서 PEEK cage와 척추경 나사못 고정으로 후방 추체간 유합술을 시행한 환자들의 3년 이상 추시 결과에 대해 알아보고자하였다. 선행문헌의 요약: PEEK cage를 이용한 후방 추체간 유합술의 중기 추적 관찰에 대한 연구가 거의 없다. 대상 및 방법: 퇴행성 요추부 질환으로 PEEK cage을 이용한 후방 추체간 유합술 및 척추경 나사못 고정술을 시행한 환자들 중 추시 가능 260명을 대상으로 하였다. 단분절에만 시행한 151명을 A군, 이분절에서 시행한 91명을 B군, 삼분절에서 시행한 18명을 C군으로 분류하였다. 임상적 결과 판정은 수술 전후의 Visual analogue scale(VAS), Oswestry Disability Index(ODI) 평가 기준을 통해 판정하였고, 방사선학적 분석을 통해 골 유합, 시상면 배열, 추간판 간격 및 인접분절의 변화를 평가하였다. 또한 합병증과 재수술 여부와 원인에 대해서 분석하였다. 결과: VAS는 수술전과 수술 후 3년에서 A군 7.62±2.03(5~10)점에서 3.19±1.94(1~8)점, B군 6.83±2.28(4~9)점에서 4.51±2.18(2~9)점,C군 7.17±2.46(5~10)점에서 4.63±1.97(1~9)점으로 감소되었으며, ODI에서는 3년 추시에서 A군 17.6±8.56%, B군 15.4±5.46%,C군 24.7±7.46%로 감소된소견을 확인하였다. A군 94.7%, B군 92.3%, C군 94.4%의 골 유합 소견을 보였다. 요추부 전만도(p=0.042(A군), 0.036(B군), 0.045(C군)), 분절간 전만도(p=0.036(A군), 0.039(B군), 0.047(C군)) 는 수술 후 술 전에 비해 의미있게 증가되었고, 최종 추시에서도 의의있게 증가되었다. 재수술은 A, B 군에서만 나타났고, 이들 모두에서 수술 후 인접분절 변화를 관찰할 수 있었지만 임상적 결과와의 연관성을 보이지 않았다. 결론: 퇴행성 요추 질환에서 PEEK 케이지를 이용한 후방 추체간 유합 및 나사못을 이용한 고정술은 중기간 추시에서 각 유합 분절 수에 따른 치료 결과와 상관없이 우수한 임상적 결과와 골유합을 얻을 수 있어 추천될 만한 수술 방법이라고 생각한다.

Changes in Sagittal Alignment Following Short-Level Lumbar Interbody Fusion: Comparison between Posterior and Lateral Lumbar Interbody Fusions

Hiroaki Nakashima,Tokumi Kanemura,Kotaro Satake,Yoshimoto Ishikawa,Jun Ouchida,Naoki Segi,Hidetoshi Yamaguchi,Shiro Imagama 대한척추외과학회 2019 Asian Spine Journal Vol.13 No.6

Study Design: Retrospective case-control study. Purpose: We aimed to compare radiologic outcomes between posterior (PLIF) and lateral lumbar interbody fusion (LLIF) in short-level spinal fusion surgeries. Overview of Literature: Although LLIF enables surgeons to insert large lordotic cages, it is unknown whether LLIF more effectively corrects local and global sagittal alignments compared with PLIF in short-level spinal fusion surgeries. Methods: Radiographic data acquired from patients with lumbar interbody fusion (≤3 levels) using PLIF or LLIF for degenerative lumbar diseases were analyzed. The following radiographic parameters were evaluated preoperatively and at 2 years postoperatively: segmental lordotic angle, disk height, lumbar lordosis (LL), pelvic tilt (PT), C7 sagittal vertical axis, and thoracic kyphosis (TK). Results: In total, 144 patients with PLIF (193 fused levels) and 101 with LLIF (159 fused levels) were included. Patients’ backgrounds and preoperative radiographic parameters for any level of fusion did not differ significantly between PLIF and LLIF procedures. The LLIF group exhibited significantly greater changes at 1-level fusion compared to the PLIF group in the parameters of segmental lordotic angle (5.1°±5.8° vs. 2.1°±5.0°, p<0.001), disk height (4.2±2.3 mm vs. 2.2±2.0 mm, p<0.001), LL (7.8°±7.6° vs. 3.9°±8.6°, p=0.004), and PI–LL (−6.9°±6.8° vs. −3.6°±10.1°, p=0.03). While, a similar trend was observed regarding 2-level fusion, significantly greater changes were only observed in LL (12.1°±11.1° vs. 4.2°±9.1°, p=0.047) and PI–LL (−11.2°±11.3° vs. −3.0°±9.3°, p=0.043), PT (−6.4°±4.9° vs. −2.5°±5.3°, p=0.049) and TK (7.8°±11.8° vs. −0.3°±9.7°, p=0.047) in the LLIF group at 3-level fusion. Conclusions: LLIF provides significantly better local sagittal alignment than PLIF in 1- or 2-level fusion cases and improves spinopelvic alignment and local alignment for 3-level fusion cases. Thus, LLIF was demonstrated to be a useful lumbar interbody fusion technique, constituting a powerful tool for achieving sagittal realignment with minimal surgical invasiveness.

제 4-5 요추간 유합술 후 수술 방법에 따른 인접 분절의 퇴행성 변화

안동기(Dong Ki Ahn),이송(Song Lee),정기웅(Ki Woong Jeong),최대정(Dae Jung Choi),차상규(Sang Kyu Cha),조근호(Kun Ho Cho) 대한정형외과학회 2006 대한정형외과학회지 Vol.41 No.2

목적: 요추부 유합술 후 발생되는 인접 분절의 퇴행성 변화에 있어서 후외측 유합술과 후방 추체간 유합술 간에 차이가 있는가를 조사하고자 하였다. 대상 및 방법: 퇴행성 요추질환으로 제4, 5요추의 유합술을 시행받고 3년 이상 추시가 가능했던 환자 157예 중 척추경 나사못을 이용하여 후외측 유합술을 시행한 86예를 Ⅰ군으로, 척추경 나사못과 cage를 이용하여 후방 추체간 유합술을 시행한 71예를 Ⅱ군으로 하여 후향적으로 조사하였다. 양 군 간에 성별, 연령, 수술 전 인접 분절의 퇴행정도, 최종 추시에서 유합 분절의 시상각 그리고 추시기간에서 표집 오차가 있는가를 조사하고 근위 및 원위 인접분절의 퇴행성 변화와 재수술의 비율에 차이가 있는가를 조사하였다. 그리고, 인접 분절의 퇴행성 변화가 있는 군과 없는 군을 대조하여 추체간 유합술 여부를 포함한 상기 비교 인자들 중 실질적인 위험인자를 다중 로지스틱 희귀분석을 이용하여 조사하였다. 결과: 수술 전 근위 인접 분절의 퇴행정도(p=0.036)를 제외하고는 표집 오차는 없었다. 근위부 퇴행성 변화는 Ⅰ군 31/86 (36%), Ⅱ군 26/71 (37%)이었으며 재수술은 Ⅰ군 8/86 (9%), Ⅱ군에서 6/71 (8%)로 유의한 차이가 없었다(p=0.541, 0.536). 원위부 퇴행성 변화는 Ⅰ군 9/86 (10%), Ⅱ군 8/71 (11%)이었으며 재수술은 Ⅰ군 4/86 (5%), Ⅱ군 2/71 (3%)로 유의한 차이가 없었다(p=0.536, 0.435). 양측 인접 분절 중 일측 이상 퇴행성 변화가 발생한 군(65/157, 41%)과 발생하지 않은 군(92/157, 58%)을 대조한 결과 고연령과 부족한 유합 분절 시상각이 유의하게 위험성을 증가시켰다(p=0.024, 0.001). 결론: 척추경 나사못을 이용한 제4, 5 요추간 분절 유합술 후 발생하는 인접 분절의 퇴행성 변화는 후외측 유합술을 시행한 군과 후방 추체간 유합술을 시행한 군 간에 차이가 없었다. 추체간 유합술 여부보다는 고연령과 적은 유합 분절 시상각이 인접 분절의 퇴행성 변화를 증가시켰다. Purpose: We wanted to investigate the difference in the incidence of post-fusion adjacent segment degeneration between performing posterolateral fusion and posterior lumbar interbody fusion. Materials and Methods: One hundred fifty seven patients who underwent L4-5 fusion using pedicle screws for degenerative lumbar disease and followed up more than three years were analyzed retrospectively. Eighty-six cases of posterolateral fusion (group Ⅰ) and 71 cases of posterior lumbar interbody fusion (group Ⅱ) were compared. Sampling bias was evaluated by comparing gender, age, the preoperative degeneration of adjacent segments, the sagittal angle of fusion segments on the last follow up and the follow-up period. The differences of adjacent segments degeneration and the revision rate between the two groups were investigated multilaterally. The actual risk factors for such degeneration were investigated by performing multiple logistic regression test, which contrasted the degeneration group with the non-degeneration group for all the above factors, including whether interbody fusion was done or not. Results: Sampling bias was excluded except for the preoperative proximal adjacent segments degeneration (p=0.036). There was no statistical difference in the final proximal degeneration (31/86, 36% in group Ⅰ, 26/7.1, 37% in group Ⅱ, p=0.536) and revision (8/86, 9% in group Ⅰ, 6/71, 8% in group Ⅱ, p=0.536). There was no statistical difference in the final distal degeneration (9/86, 10% in group Ⅰ, 8/71, 11% in group Ⅱ, p=0.536) and revision (4/86, 5% in group Ⅰ, 2171, 3% in group Ⅱ, p=0.435). When comparing those cases who developed degeneration on either side with the non-degeneration cases, the odds ratio of old age and an insufficient sagittal angle of the fusion segments reached statistical significance (p=0.024, 0.001). Conclusion: There were no differences in adjacent segments degeneration between the postero-lateral fusion group and the posterior lumbar interbody fusion group. Rather than the operation methods, old age and insufficient sagittal angle of the fusion segments were the actual risk factors of such degeneration.

정형외과 연구의 동물모델: 척추유합술모델

이재협(Jae Hyup Lee),남윤진(Yunjin Nam),이지호(Ji-Ho Lee) 대한정형외과학회 2017 대한정형외과학회지 Vol.52 No.4

퇴행성 척추질환이나 외상 등의 증가로 인해 척추유합술이 증가하고 있으며, 다양한 내고정장치나 골이식재의 개발도 이에 동반해서 증가하고 있다. 척추유합술 동물모델은 새로운 척추 고정기기나 골이식재의 효능을 평가하는 데 매우 유용한 술식이다. 척추유합술 동물모델은 크게 후외방 유합술모델, 후방 유합술모델, 전방 유합술모델이 있으며 주로 이용되는 동물에는 마우스, 랫드, 가토와 같은 소동물부터 개, 돼지, 염소, 양 및 영장류 등 중, 대동물도 있다. 소동물모델은 자가골이나 골이식재를 이식한 후 내고정 없이 유합을 평가하는 것이 일반적이다. 그러나 중동물이나 대동물은 척추경 나사못을 이용한 내고정술을 추가로 이용할 수 있으며 케이지를 이용한 추체간 유합술을 시행할 수도 있다. 소동물모델은 크기가 작아 다루기 쉽지만 인체와 해부학적이나 생역학적인 반응이 다르다. 중동물이나 대동물모델은 인체와 유사한 특성을 갖고 있지만 다루기 힘들거나 윤리적 문제가 있다. 척추유합술에 대한 유합결과 평가는 도수 촉진이나 인스트론 등의 기계를 이용한 기계적 측정, 컴퓨터 단층촬영이나 마이크로 컴퓨터 단층촬영 등을 이용한 영상평가, 그리고 비탈석회화 조직슬라이드를 이용한 조직학적 평가가 있다. 골유합률이나 골유합에 소요되는 기간은 종이나 해부학적 위치에 따라 다르며 대부분의 척추유합술 동물모델에서 골이식재를 삽입하지 않을 경우 유합을 기대할 수 없다. 이에 본 종설에서는 대표적으로 이용되고 있는 척추유합술 동물모델의 특징과 차이점에 대해 기술하고자 한다. The incidence of spinal fusion surgery has increased due to an increase in the incidence of degenerative spinal disease or trauma. Moreover, the development of various kinds of implants and bone graft substitutes has also increased. The animal models of spinal fusion are useful methods in evaluating the effectiveness of the newly developed spinal implants or bone graft substitutes. The most widely used animal models of spinal fusion are posterolateral fusion model, posterior fusion model, and anterior interbody fusion model. Mice, rats, rabbits, dogs, pigs, goats, sheep, and primates are frequently used in animal models of spinal fusion. Small animals are implanted with a bone graft substitute without internal fixation; however middle- or large-sized animals are implanted with a bone graft substitute using pedicle screws or cages. Small animals are easy to handle due to their size, but have different anatomical or biomechanical reactions with the human body. Middle- or large-sized animals have characteristics like the human body, but they are difficult to handle or there is an ethical problem. The fusion status is evaluated by manual palpation, mechanical testing using Instron, and radiologic techniques such as computed tomography, micro-computed tomography or undecalcified histology. The fusion rate and duration required for successful fusion differ according to the species and anatomical site. We have identified and reviewed several typical animal models of spinal fusion.

Comparison of Different Approaches in Lumbosacral Spinal Fusion Surgery: A Systematic Review and Meta-Analysis

Lenz Maximilian,Mohamud Kaliye,Bredow Jan,Oikonomidis Stavros,Eysel Peer,Scheyerer Max Joseph 대한척추외과학회 2022 Asian Spine Journal Vol.16 No.1

We aimed to systematically review the literature to analyze the differences in posterior lumbar interbody fusion (PLIF), anterior lumbar interbody fusion (ALIF), and transforaminal lumbar interbody fusion (TLIF), focusing on the complications, risk factors, and fusion rate of each approach. Spinal fusion surgery is a well-established surgical procedure for a variety of indications, and different approaches developed. The various approaches and their advantages, as well as approach-related pathology and complications, are well investigated in spinal surgery. Focusing only on lumbosacral fusion, the comparative studies of different approaches remain fewer in numbers. We systematically reviewed the literature on the complications associated with lumbosacral interbody fusion. Only the PLIF, ALIF, or TLIF approaches and studies published within the last decade (2007–2017) were included. The exclusion criteria in this study were oblique lumbar interbody fusion, extreme lateral interbody fusion, more than one procedure per patient, and reported patient numbers less than 10. The outcome variables were indications, fusion rates, operation time, perioperative complications, and clinical outcome by means of Visual Analog Scale, Oswestry Disability Index, and Japanese Orthopaedic Association score. Five prospective, 17 retrospective, and two comparative studies that investigated the lumbosacral region were included. Mean fusion rates were 91,4%. ALIF showed a higher operation time, while PLIF resulted in greater blood loss. In all approaches, significant improvements in the clinical outcome were achieved, with ALIF showing slightly better results. Regarding complications, the ALIF technique showed the highest complication rates. Lumbosacral fusion surgery is a treatment to provide good results either through an approach for various indications as causes of lower back pain. For each surgical approach, advantages can be depicted. However, perioperative complications and risk factors are numerous and vary with ALIF, PLIF, and TLIF procedures, as well as with fusion rates.

Clinical and Radiological Results of Microsurgical Posterior Lumbar Interbody Fusion and Decompression without Posterior Instrumentation for Lateral Recess Stenosis

Mehmet Demirayak,Lokman Şişman,Faik Türkmen,Duran Efe,Oğuzhan Pekince,Recep Gani Göncü,Cem Sever 대한척추외과학회 2015 Asian Spine Journal Vol.9 No.5

Study Design: A single-center, retrospective patient review of clinical and radiological outcomes of microsurgical posterior lumbar interbody fusion and decompression, without posterior instrumentation, for the treatment of lateral recess stenosis. Purpose: This study documented the clinical and radiological results of microsurgical posterior lumbar interbody fusion and decompression of the lateral recess using interbody cages without posterior instrumentation for the treatment of lateral recess stenosis. Overview of Literature: Although microsurgery has some advantages, various complications have been reported following microsurgical decompression, including cage migration, pseudoarthrosis, neurologic deficits, and persistent pain. Methods: A total of 34 patients (13 men, 21 women), with a mean age of 56.65±9.1 years (range, 40–77 years) confirmed spinal stability, and preoperative radiological findings of lateral recess stenosis, were included in the study. Interbody polyetheretherketone cages and auto grafts were used in all patients. Posterior instrumentation was not used because of limited resection of the posterior lumbar structures. Preoperative and postoperative radiographs, computed tomography scans, and magnetic resonance imaging were assessed and compared to images taken at the final follow-up. Functional recovery was also evaluated according to the Macnab criteria at the final follow-up. Results: The average follow-up time was 35.05±8.65 months (range, 24–46 months). The clinical results, operative time, intraoperative blood loss, and duration of hospital stay were similar to previously published results; the fusion rate (85.2%) was decreased and the migration rate (5.8%) was increased, compared with prior reports. Conclusions: Although microsurgery has some advantages, migration and pseudoarthrosis remain challenges to achieving adequate lumbar interbody fusion.

Methyl Methacrylate (Acrylic Plastic) 를 이용한 경추후방융합술

김선호,최중언,김영수,이규성,정상섭,이규창 대한신경외과학회 1983 Journal of Korean neurosurgical society Vol.12 No.1

The principle of the treatment of cervical spine injury should be directed first toward relief of spinal cord compression and reduction of the deformity, then toward adequate immobilization. Until this time, posterior wire fusion, posterior bone graft with wire fixation, acrylic posterior fusion and external immobilization method have been used for the adequate immobilization. The authors experienced 3 cases of acrylic posterior cervical fusion. Two patients were the odontoid process fracture and one patient was a congenital occipito-atlantal assimilation. Authors thought this procedure is more simple and there is no problem of donor site pain and infection which can be possible in the posterior fixation with iliac bone and rib graft. The acrylic fusion offers certain advantage over other form of fixation or fusion because of its rapid and solid fixation, permitting immediate rehabilitation.

요부 변성 후만증에서 Wedged Cage(SynCage^�]를 이용한 전후방 수술적 치료

김응하,김선우 대한척추외과학회 2003 대한척추외과학회지 Vol.10 No.3