Endoscopic Spine Surgery

Surgical treatment of the degenerative disc disease has evolved from traditional open spine surgery to minimally invasive spine surgery including endoscopic spine surgery. Constant improvement in the imaging modality especially with introduction of the magnetic resonance imaging, it is possible to identify culprit degenerated disc segment and again with the discography it is possible to diagnose the pain generator and pathological degenerated disc very precisely and its treatment with minimally invasive approach. With improvements in the optics, high resolution camera, light source, high speed burr, irrigation pump etc, minimally invasive spine surgeries can be performed with various endoscopic techniques for lumbar, cervical and thoracic regions. Advantages of endoscopic spine surgeries are less tissue dissection and muscle trauma, reduced blood loss, less damage to the epidural blood supply and consequent epidural fibrosis and scarring, reduced hospital stay, early functional recovery and improvement in the quality of life & better cosmesis. With precise indication, proper diagnosis and good training, the endoscopic spine surgery can give equally good result as open spine surgery. Initially, endoscopic technique was restricted to the lumbar region but now it also can be used for cervical and thoracic disc herniations. Previously endoscopy was used for disc herniations which were contained without migration but now days it is used for highly up and down migrated disc herniations as well. Use of endoscopic technique in lumbar region was restricted to disc herniations but gradually it is also used for spinal canal stenosis and endoscopic assisted fusion surgeries. Endoscopic spine surgery can play important role in the treatment of adolescent disc herniations especially for the persons who engage in the competitive sports and the athletes where less tissue trauma, cosmesis and early functional recovery is desirable. From simple chemonucleolysis to current day endoscopic procedures the history of minimally invasive spine surgery is interesting. Appropriate indications, clear imaging prior to surgery and preplanning are keys to successful outcome. In this article basic procedures of percutaneous endoscopic lumbar discectomy through transforaminal and interlaminar routes, percutaneous endoscopic cervical discectomy, percutaneous endoscopic posterior cervical foraminotomy and percutaneous endoscopic thoracic discectomy are discussed.

Targeted and effective photodynamic therapy for cancer using functionalized nanomaterials

Photodynamic therapy (PDT) is an emerging, non-invasive therapeutic strategy that involves photosensitizer (PS) drugs and external light for the treatment of diseases. Despite the great progress in PS-mediated PDT, their clinical applications are still hampered by poor water solubility and tissue/cell specificity of conventional PS drugs. Therefore, great efforts have been made towards the development of nanomaterials that can tackle fundamental challenges in conventional PS drug-mediated PDT for cancer treatment. This review highlights recent advances in the development of nano-platforms, in which various functionalized organic and inorganic nanomaterials are integrated with PS drugs, for significantly enhanced efficacy and tumor-selectivity of PDT.

A Case Report of "Spinal Cord Apoplexy" Elicited by Metastatic Intramedullary Thyroid Carcinoma

A 31-year-old man presented with acute onset of paraplegia. The patient's history was significant for thyroid carcinoma that had been treated 2 years earlier by thyroidectomy. A magnetic resonance imaging scan showed an enhancing intramedullary lesion at T7-8. Patient underwent surgical treatment and a tumor with hematoma was resected via posterior midline myelotomy. Postoperatively, the patient's motor weakness was improved to grade 3. The lesion showed typical histologic features consistent with papillary thyroid carcinoma. Early diagnosis and microsurgical resection can result in improvement in neurological deficits and quality of life of patients with an ISCM.

A Case Report of "Spinal Cord Apoplexy" Elicited by Metastatic Intramedullary Thyroid Carcinoma

A 31-year-old man presented with acute onset of paraplegia. The patient's history was significant for thyroid carcinoma that had been treated 2 years earlier by thyroidectomy. A magnetic resonance imaging scan showed an enhancing intramedullary lesion at T7-8. Patient underwent surgical treatment and a tumor with hematoma was resected via posterior midline myelotomy. Postoperatively, the patient's motor weakness was improved to grade 3. The lesion showed typical histologic features consistent with papillary thyroid carcinoma. Early diagnosis and microsurgical resection can result in improvement in neurological deficits and quality of life of patients with an ISCM.

The Effects of TWEAK, Fn14, and TGF-beta1 on Degeneration of Human Intervertebral Disc

OBJECTIVE: The purpose of this study is to explain the effect and reciprocal action among tumor necrosis factor (TNF) like weak inducer of apoptosis (TWEAK), fibroblast growth factor-inducible 14 (Fn14), and transforming growth factor-beta1 (TGF-beta1) on degeneration of human intervertebral disc (IVD). METHODS: Human intervertebral disc tissues and cells were cultured with Dulbecco's Modified Eagle's Medium/Nutrient F-12 Ham (DMEM/F-12) media in 37degrees C, 5% CO2 incubator. When IVD tissues were cultured with TWEAK, Fn14 that is an antagonistic receptor for TWEAK and TGF-beta1, the level of sulfated glycosaminoglycan (sGAG) was estimated by dimethyl methyleneblue (DMMB) assay and sex determining region Y (SRY)-box 9 (Sox9) and versican messenger ribonucleic acid (mRNA) levels were estimated by reverse transcriptase polymerase chain reaction (RT-PCR). RESULTS: When human IVD tissue was cultured for nine days, the sGAG content was elevated in proportion to culture duration. The sGAG was decreased significantly by TWEAK 100 ng/mL, however, Fn14 500 ng/mL did not change the sGAG production of IVD tissue. The Fn14 increased versican and Sox9 mRNA levels decreased with TWEAK in IVD tissue TGF-beta1 20 ng/mL elevated the sGAG concentration 40% more than control. The sGAG amount decreased with TWEAK was increased with Fn14 or TGF-beta1 but the result was insignificant statistically. TGF-beta1 increased the Sox9 mRNA expression to 180% compared to control group in IVD tissue. Sox9 and versican mRNA levels decreased by TWEAK were increased with TGF-beta1 in primary cultured IVD cells, however, Fn14 did not show increasing effect on Sox9 and versican. CONCLUSION: This study suggests that TWEAK would act a role in intervertebral disc degeneration through decreasing sGAG and the mRNA level of versican and Sox9.

Percutaneous Endoscopic Lumbar Discectomy (PELD) / 한양의대학술지

The percutaneous endoscopic lumbar discectomy (PELD) is already being applied to treat almost all types of lumbar disc herniations, ranging from soft contained disc herniation, to migrated disc herniation, and eventually to foraminal and extraforaminal disc herniations. Its concept has already shifted from an indirect central decompression to a direct epidural targeted fragmentectomy with its clinical outcomes comparable to those of conventional open surgery. However, despite the good surgical outcomes reported for this endoscopic procedure for various lumbar spinal pathologies, its procedure still appears to be somewhat complicated for most spine surgeons. This phenomenon might be attributable to the fact that, apart from the technical aspect of the procedure, the surgeons are not familiar with the proper selection of patients. In this article, we have dealt with the basic principle and technique for various surgical conditions. Although these descriptions are totally based on our experiences and therefore have not been statistically analyzed.

Percutaneous Endoscopic Interlaminar Discectomy for L5-S1 Disc Herniation: Axillary Approach and Preliminary Results

OBJECTIVE: The purpose of this study was to describe a surgical technique of axillary approach of percutaneous endoscopic interlaminar discectomy for L5-S1 disc herniation and its preliminary results. METHODS: From July 2002 to September 2003, 101 patients with lumbar radiculopathy due to L5-S1 disc herniation, who were treated by percutaneous interlaminar endoscopic discectomy, were retrospectively reviewed. There were 57 males and 44 females with a mean age of 44.8 years (range, 18 to 62 years). The surgery consisted of needle insertion into the epidural space via the interlaminar space, sequential dilatation, and endoscopic discectomy through the axillary area of the S1 root. RESULTS: The mean follow-up period was 14.5 months and the average surgical time was 41 min. According to the modified Macnab criteria, 44 patients (43.6%) had excellent outcomes, 49 (48.5%) had good results and only 8 (7.8%) had fair or poor outcomes. Four patients had a revision microdiscectomy due to incomplete removal of disc fragment. There were no major complications related to this surgical approach. CONCLUSION: Axillary approach of percutaneous endoscopic interlaminar discectomy is safe and effective procedure for the treatment of L5-S1 disc herniation. It combines the advantages of MED and conventional percutaneous endoscopic discectomy.

The Effect of Tumor Characteristics on the Repeated Nondiagnostic Fine-needle Aspiration Biopsy Results in Thyroid Nodules / 대한내분비외과학회지

PURPOSE: The management of nondiagnostic fine-needle as-piration biopsy (FNAB) of thyroid nodules has not been determined because the significance of persistent nondiagnostic FNAB has been underestimated. The purposes of the present study were to estimate the likelihood of malignancy in patients with nondiagnostic FNAB results and to evaluate whether tumor factors could affect the nondiagnostic FNAB results. METHODS: 2,400 FNABs were performed for thyroid nodules at our institution from 2001 to 2005. A total 294 patients who had initial nondiagnostic results were the subjects of this study. We retrospectively reviewed the age, gender, tumor size, the sonographic findings, the FNAB results and the pathologic reports. RESULTS: The initial nondiagnostic rate was 12.3% (294/2,400). Among the 294 initial nondiagnosted patients, FNAB was secondarily performed in only 99 patients. Seventy patients (70.7%) were diagnostic and 29 (29.3%) remained nondiagnosed. Twenty of seventy diagnosed patients had malignant FNAB results, including atypical cells, and the other 50 patients were benign. The causes of nondiagnostic FNAB results by pathologic descriptions were 43.1%: scanty cellularity, 29.2%: blood, 13.2%: fluid or colloid, 11.1%: inconclusive, and 3.5%: dry artifact. There are no differences in the nondiagnostic rate according to tumor size (P=0.2) and calcification (P=0.7). When the sonographic results could predict the pathologic results, no difference was noted according to the sonographic findings that determined malignancy (P=0.4). Ten percent of the initial nondiagnostic FNAB results were finally reported as malignancy. CONCLUSION: Scanty cellularity and blood aspiration were the major causes of nondiagnostic FNAB results (43.1% and 29.2%, respectively). Tumor characteristics such as tumor size, the presence of calcification and sonographic findings did not predict nondiagnostic FNAB results. Reaspiration biopsy for the initially nondiagnostic FNAB in the thyroid nodules had a high probability of achieving a nondiagnositc result. Because nondiagnostic FNAB of the thyroid nodules may be associated with a relatively high probability of thyroid malignancy, a nondiagnostic FNAB should not be considered as benign. So, if reaspiration biopsy is nondiagnostic, it should be the subject of concern or the patient might be considered for surgery with taking into account the other characteristics, in particularily malignant sonographic findings.

Effect of PDN(R)(Prosthetic Disc Nucleus) on the Mobility and Height of the Intervertebral Disc: Preliminary Report

OBJECTIVE: The purpose of the current study is to investigate the effect of the prosthetic disc nucleus replacement on the mobility and height of the intervertebral disc and adjacent segments. METHODS: Thirteen patients who underwent L4-L5 prosthetic disc nucleus replacement were included in this study. A retrospective review of clinical and radiological data was conducted. The L4-L5 disc height and sagittal rotation angle of L3-L4, L4-L5, L5-S1 were measured in the static and dynamic lateral radiographs pre- and postoperatively. RESULTS: There were seven men and six women whose mean age was 37 years(range, 24-49 years). The mean follow-up period was nine months(range, 6-14 months). In all cases the L4-L5 motion segment demonstrated angular motion between flexion and extension with a mean of 4degrees(+/-2.3degrees) of sagittal rotation angle. The disc height increased from preoperative levels by 117%. There was no difference in angular motion of adjacent segments between pre- and postoperative data. CONCLUSION: The prosthetic disc nucleus replacement after discectomy is shown to restore the disc height and maintain segmental mobility.

Anterior Lumbar Interbody Fusion Using BAK Cage for Treatment of Failed Back Surgery Syndrome

OBJECTIVE: To evaluate the role of anterior lumbar interbody fusion in treatment of failed back surgery syndrome, the authors present a retrospectively analysis of the clinical & radiological results of anterior lumbar interbody fusion. METHODS: Between September 2000 and September 2001, twenty two patients underwent anterior lumbar interbody fusion for treatment of failed back surgery syndrome. We analyzed clinical & radiological changes. The mean follow-up period was 19 months. RESULTS: Overall satisfactory outcome was 90%. The mean VAS was changed from 8.3 to 3.7. The mean Oswestry Disability Index(%) was changed from 70 to 33. The fusion rate was 86%. There were 2 complications; wound infection, sympathetic dysfunction. CONCLUSION: We conclude that the anterior lumbar interbody fusion seems to be a safe and favorable method in treating selective patients with failed back surgery syndrome.

Percutaneous Vertebroplasty with Polymethymethacrylate in the Treatment of Osteoporotic Vertebral Body Compression Fractures: Preliminary Report

No abstract available.

Clinical study of Simultaneous Correction of Bone and Soft Tissue Deformities in Hemifacial Microsmia

Hemifacial microsomia is a common congenital craniofacial deformity involving bone and soft-tissue. Mandibular hypoplasia is the most obvious skeletal manifestation of hemifacial microsomia. In the past, complete realignment of the skeleton was preferred to soft-tissue correction, which was clearly second choice. However, in this study, simultaneous correction of bone and soft tissue deformities were equally important in treatment of hemifacial microsomia. One-stage and simultaneous bone and soft tissue reconstruction is possible and staged operations of the skeleton and soft tissue are no longer necessary, except in special cases. Even in children and adolescents, good results and normal growth potential can be achieved with simultaneous correction of bone and soft tissue.

Selection of Surgical Treatment for Warthin's Tumors of Parotid: Experience in 20 Cases / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: The Warthin's tumor is characterized by its frequent occurrence in the parotid tail and multifocal presentation. Superficial or total parotidectomy was advocated by many surgeons due to its multifocal nature. Recently, with the advancement of various radiologic diagnostic methods, more conservative surgical management with low morbidities can be considered since an accurate pattern and site of the tumor can be determined. MATERIALS AND METHODS: Authors retrospectively studied 20 cases of pathologically diagnosed Warthin's tumor for clinical pattern, tumor site in parotid gland, recurrence and complication rate according to different surgical methods. Patients were divided into two groups: Group II received enucleation and Group II received either superficial parotidectomy or total parotidectomy. RESULTS: Post operative complication rate was low in enucleation group, compared with parotidectomy. There was no difference in the recurrence between the two groups. CONCLUSION: Enucleation is an effective method in treatment of solitary or multifocal Warthin's tumors.

Expression of Matrix-Metalloproteinase-2, Urokinase-Type Plasminogen Activator and Plasminogen Activator Inhibitor-1 in Invasion Mode and Lymph Node Metastasis of Laryngeal Squamous Cell Carcinoma / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Metastatic process of carcinoma cells involves dissolution of tumor matrix and penetration of the basement membrane (BM) which involves the active proteolysis of type IV collagen, proteoglycan, laminin, and fibronectin. The hallmark of invasion is the penetration of epithelial BM by serine protease and matrix metalloproteinase. Matrix metalloproteinases (MMP) include type IV collagenase, interstitial collagenase, and stromelysin, where MMP-2 and MMP-9 are considered to be the most important in tumor invasion. Urokinase-type plasminogen activator (u-PA) promotes conversion of plasminogen to active plasminogen causing degradation of fibrin, fibronectin, proteoglycan, and laminin. Plasminogen activator inhibitor (PAI-1) is a specific inhibitor of u-PA, and it is involved in defense from tumor invasion through metastasis. In this thesis, the expression patterns of MMP-2, u-PA and PAI-1 were investigated in laryngeal squamous cell carcinoma in tumor invasion and lymph node metastasis. MATERIALS AND METHODS: Tumor tissue from 50 cases of laryngeal cancer paraffin block specimens were used from the archives of Department of Pathology in Korea University hospital to study the expression pattern of MMP-2, u-PA, and PAI-1. RESULTS: The results have shown that in laryngeal cancer, the positive expression rate for MMP-2 was 54%, u-PA 72%, and PAI-1 46%. The expression of MMP-2 was related with lymph node metastasis, and u-PA expression increased according to the increase of primary tumor staging. There were no significant relationship between the expression rates of MMP-2, u-PA, and PAI-1 with histopathologic grading and invasion mode. These results suggest that u-PA could be used as a biological marker for tumor size and MMP-2 for lymph node metastasis, whereas PAI-1 is not a significant marker for tumor invasion or lymph node metastasis.

Repair of radial forearm free flap donor defect using ulnar forearm flap

The purpose of this study is to introduce a new method to reduce the donor morbidity of radial forearm free flap using ulnar forearm flap, and to evaluate its usefulness and results. 6 patients underwent radial forearm free flap designed by authors and we repaired radial forearm flap donor defect using ulnar forearm flap following ablative surgery for oropharyngeal cancers from June 1995 to February 1997. Radial forearm flap was designed just proximal to wrist crease, and its vascular pedicle was placed in the center of flap. Donor defect was repaired with V-Y fashion closure using ulnar artery axial pattern fasciocutaneous flap. Mean closing time of donor site was 30 minutes. and mean healing period of donor site was 10 days. There was no difficulty in closure. All donor sites healed completely without complication. Limitation of motion was not noticed in the wrist and forearm. We conclude that repair of radial forearm flap donor defect using ulnar forearm flap is new excellent method to prevent the prominent scar of forearm in cases of conventional skin graft for donor defect, and provide rapid healing of wound with low risk of complication

Repair of radial forearm free flap donor defect using ulnar forearm flap

The purpose of this study is to introduce a new method to reduce the donor morbidity of radial forearm free flap using ulnar forearm flap, and to evaluate its usefulness and results. 6 patients underwent radial forearm free flap designed by authors and we repaired radial forearm flap donor defect using ulnar forearm flap following ablative surgery for oropharyngeal cancers from June 1995 to February 1997. Radial forearm flap was designed just proximal to wrist crease, and its vascular pedicle was placed in the center of flap. Donor defect was repaired with V-Y fashion closure using ulnar artery axial pattern fasciocutaneous flap. Mean closing time of donor site was 30 minutes. and mean healing period of donor site was 10 days. There was no difficulty in closure. All donor sites healed completely without complication. Limitation of motion was not noticed in the wrist and forearm. We conclude that repair of radial forearm flap donor defect using ulnar forearm flap is new excellent method to prevent the prominent scar of forearm in cases of conventional skin graft for donor defect, and provide rapid healing of wound with low risk of complication

Mandibular Contouring Surgery by Angle-Splitting Ostectomy

No abstract available.

Symptomatic Intrasacral Extradural Cyst:"Occult Sacral Meningocele" and "Tarlov's Cyst"

Twenty eight year-old male with 3 year history of radiating pain to both thighs and thirty six year-old female with one year history of perineal hypesthesia and constipation were presented. The clinical features, radiologic features, surgical techniques and complications are described. In both cases, postoperative cerebrospinal fluid leakage was developed and managed successfully with lumbar drainage and rest respectively. The preoperatively presented symptoms were completely disappeared after surgery.

Intracranial Infection in Head Injury

We analyzed 12 cases of intracranial infection retrospectively among 951 patients admitted for head injury in Kyungpook University Hospital during the last 7 years. Overall infection rate was 1.3%. Among 259 patients who had basal skull fracture, 6 cases(2.3%) were infected. Craniotomies were performed on 488 patients for various reasons. Among them 2 patients(0.4%) were infected due to the craniotomy. Ninety one patients had compound comminuted depressed skull fracture(FCCD). No one was infected due to FCCD. Two patients were infected after ventriculoperitoneal shunt to treat the posttraumatic hydrocephalus, and one case after burr hole trephination and drainage of intracerebral hematoma. The intracranial infection were as follows:7 cases of meningitis, 3 subdural or epidural empyema, one ventriculitis, and one brain abscess. In conclusion, basal skull fracture was the main cause of intracranial infection. As for craniotomy and FCCD, intracranial infection could be effectively prevented with appropriate management. Intracranial infection was a serious complication of the head injury prolonging hospital days and leading to sequelae.

The Surgical Results of C-T Guided Stereotactic Early Aspiration with Urokinase Irrigation on Deep Seated Spontaneous Intracerebral Hemorrhage

C-T guided stereotactic early burr hole aspirations performed on 106 spontaneous deep intracerebral hematoma patients in the Department of Neurosurgery, Kyungpook University Hospital, between January 1992 and December 1993. For average five days following the operation, continual urokinase(UK) irrigation was done for complete removal of the remaining hematoma. Of the patients, 73 who were operated on within three days of bleeding ictus were chosen for analyses and evaluation by factors believed to affect the final results. Eighty six percent was found to have hypertension as it's cause. The hematoma was removed completely in 13.7% of all the patients on post operation 1st day and 45% within 7 days by urokinase irrigation. The site of hematoma in thalamocapsulo-lenticular area showed a rather poor remission rate compared with those in other locations along with a higher mortality rate. By comparison between the time of admission and discharge, the state of consciousness of patients showed much improvement with 440% of the number of alert patients on discharge:motor function also showed significant improvement with 450% good patients number. In case of poor state of consciousness or motor function on admission, the mortality rate was higher. Rebleeding after aspiration was found in 6.8% and in all the cases except one the operation was done within 24 hours of bleeding, which resulted in poor postoperative outcome without improvement. Pneumonia was most common complication during admission followed by hydrocephalus. Mortality rate was 8.2%, most of which resulted from direct brain damage through bleeding. This surgical method is simple, safe and efficient in treating spontaneous deep intracerebral hematoma with no significant outcome difference when compared with early craniotomy.