Lumbar Interbody Fusion and Osteobiologics for Lumbar Fusion

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

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.

Comparison of Fixation Stability and Incidence of Extensor Tendon Injury according to the Screw Insertion Method in Volar Plate Fixation for Distal Radius Fractures / 대한정형외과학회잡지

PURPOSE: This retrospective study was aimed to analyze the differences in stability and extensor impairment after two different volar plating procedures to manage unstable distal radius fracture, which were the penetration of only near-cortex followed by screw fixation (Group 1) and perforation of dorsal cortex by drill-bit followed by fixation with the screws downsized after gauging (Group 2). MATERIALS AND METHODS: We reviewed the medical records of 491 patients with distal radius fracture treated with standard-sized, targeted distal radius plate in two institutions between April 2009 and May 2014. Finally, 341 patients with complete demographic data, records of AO classification of fractures, data on the lengths of inserted distal screws, radiologic parameters immediately and at 3 months after operation, as well as extensor impairments, were included in this study. There were 112 patients (98 women and 14 men) in Group 1, and 229 patients (171 women and 58 men) in Group 2. The mean age was 59.8 years for all the patients; 60.3 years in Group 1 and 59.5 years in Group 2. RESULTS: The mean length of the longest screws used in Group 2 was longer than that in Group 1; however, the mean length of the shortest screws used in Group 2 was shorter than that in Group 1. While the differences in changes for radial inclination measured immediately and at 3 months after the operation were statistically significant (p=0.019), the change of radial inclination in Group 2, which showed a greater change, was only 0.5 mm. There were two cases with extensor pollicis longus rupture in Group 1 and 2 respectively, and the difference in frequency according to each Group was not statistically significant (p=0.6). CONCLUSION: The superiority of one surgical procedure in terms of fracture stability on measured radiological parameters was not fully proven compared with the other one in this study. Therefore, it would be better to selectively use the surgical method of dorsal cortex perforation viadrill-bit followed by fixation only in limited circumstances.

Surgical Usage of a Cortical Bone Trajectory Pedicle Screw to Treat Lumbar Pyogenic Spondylodiscitis: Preliminary Report

STUDY DESIGN: Retrospective clinical study. OBJECTIVES: To assess the efficacy of a cortical bone trajectory pedicle screw (CBT-PS) for the treatment of lumbar pyogenic spondylodiscitis. SUMMARY OF LITERATURE REVIEW: Pedicle screws were used for surgical treatment of pyogenic spondylodiscitis to prevent instability and deformity. CTB-PS are typically inserted from the inferomedial to superolateral direction of the pedicle and have yielded satisfactory results in degenerative or osteoporotic spinal disorders. MATERIALS AND METHODS: Eight patients with single segment lumbar pyogenic spondylodiscitis were analyzed. At first, anterior debridements and interbody fusions were perfomed with autogenous strut bone grafts, followed by posterior fixations and fusions with CBT-PS. The lordotic angles of operated levels were checked at the preoperative, postoperative, and final follow-ups. Visual analogue scales (VAS) were checked at the preoperative and final follow-ups. RESULTS: Lesion sites were found at four L3-4, three L4-5, and one L2-3. Follow-ups were held at 26.13±8.23 months. The lordotic angles at preoperative, postoperative, and final follow-ups were 12.13±3.09°, 14.63±3.16°, and 12.75±3.99°, retrospectively. There were significant differences between results from the preoperative-postoperative and postoperative-final follow ups. There was no difference in the preoperative-final follow up. There was a significant difference between the VAS at the preoperative and final follow-ups (8.13±0.83 and 2.38±0.92, retrospectively). Complete bony unions of were observed at the final follow-up in all cases. CONCLUSIONS: The advantages of using a CBT-PS for lumbar pyogenic spondylodiscitis included the ability to minimize damage from the screw for both the posterior structure damage and the operated anterior area to prevent instability and deformity, and to achieve rigid bone union. CBT-PS is a potential surgical option for pyogenic spondylodiscitis.

Variations in Matrix Metalloproteinase Expression by Disc Location in Patients with Sequestrated Lumbar Disc Herniation

STUDY DESIGN: In vivo study OBJECTIVES: To evaluate variations in matrix metalloproteinase (MMP) expression levels according to the disc location in patients with sequestrated lumbar disc herniation. SUMMARY OF LITERATURE REVIEW: MMPs are considered to be the major catabolic enzymes in the intervertebral disc. MMPs have been known to be the primary mediators of extracellular matrix (ECM) degradation, to play major roles in disc degeneration by changing the collagens and the extracellular matrix, and to be involved in the processes of apoptosis and autoresorption of herniated disc materials by inducing inflammatory cytokines. MATERIALS AND METHODS: The sequestered and contained disc materials were removed from seven patients with sequestered lumbar disc herniations. The materials from the contained discs were classified into group 1 and those of the sequestered discs into group 2. Immunochemistry tests were conducted for the tissues of both groups. The expression levels of MMP-1, 3, and 13 were checked using a fluorescence microscope. The amount of expression of each MMP was calculated using the percentage of expressed cells and analyzed statistically. RESULTS: In the histological study, increased expression of MMP-1, 3, and 13 was found in group 2. In the statistical analysis after the quantification of MMP expression, the expression of all MMPs was found to have increased significantly in group 2 (p<0.05). CONCLUSIONS: The increased expression of MMP-1, 3, and 13 indicated that the inflammation and degeneration processes, and the spontaneous resorption by the surrounding tissues were more active in the sequestered disc group than in the contained disc group.

Pyogenic Arthritis of the Facet Joint with Concurrent Epidural and Paraspinal Abscess: A Case Report

Pyogenic arthritis of lumber spinal facet joints is an extremely rare condition. There are only 40 reported cases worldwide. Most cases were associated with history of paravertebral injection, which was not found in our patient. At the time of hospital admission, he had no abnormal magnetic resonance image findings. Two weeks later, he developed pyogenic facet joint arthritis associated with paravertebral and epidural abscess. This report is the first to describe delayed presentation of pyogenic arthritis associated with paravertebral abscess and epidural infection.

Recompression of Vertebral Bodies after Balloon Kyphoplasty for Vertebral Compression Fractures : Preliminary Report / 대한척추외과학회지

STUDY DESIGN: This is a retrospective and preliminary study. OBJECTIVES: We wanted to evaluate the characteristics of recompression of vertebral bodies without trauma after balloon kyphoplasty (KP) for treating osteoporotic vertebral compression fractures (VCF). SUMMARY OF THE LITERATURE REVIEW: KP has been used for fracture reduction, maintenance of vertebral height and relief of pain in VCF. Despite of numerous satisfactory results, several factors have been noted to affect the clinical results of KP. MATERIALS AND METHODS: Six patients with recompression of vertebral bodies without trauma after KP were reviewed. All the patients were female and their mean age was 75.9+/-4.1 years old. The follow-up period was 17.2+/-8.5 months. The compression rates of the operated vertebral bodies (CR) and the kyphotic angles (KA) were checked by using plain roentgenograms at the initial, postoperative and last follow-up periods. The preoperative MRIs were also reviewed. The clinical results were checked using the VAS. RESULTS: The CRs at the initial, postoperative and last follow-up periods were 33.7+/-14.8%, 13.4+/-7.6% and, 26.9+/- 9.9%, respectively. The KAs were 19.2+/-7.2degrees , 14.8+/-6.2degrees and 20.5+/-7.4degrees for each period, respectively. Statistically, the CR and KA at the initial-postoperative period and at the postoperative-last follow-up period showed significant differences (p < 0.05). Intervertebral clefts were found in all the cases on MRI. Normal bones superior or inferior to cement were also seen in all the cases after KP. The VAS scores were 8.5+/-0.5, 2.3+/-0.5 and 3.0+/-0.6, retrospectively, and there were significant differences between each periods (p<0.05). CONCLUSIONS: Recompression of a vertebral body without trauma after KP for treating VCF was observed in the cases with a intervertebral cleft seen on MRI and normal bones superior or inferior to the cement were observed after KP. The causes of recompression may be subsequent compression or resorption of the remaining vertebral body.

Surgical Excision of the Lumbar Disc Herniation in Elementary School Age

STUDY DESIGN: A retrospective study. PURPOSE: To assess the radiological, clinical features and surgical outcomes of six patients of elementary school age with lumbar disc herniation (LDH). OVERVIEW OF LITERATURE: LDH is common in people in their fourth and fifth decades. However, the condition is extremely rare in children of elementary school age. Moreover, the clinical symptoms and treatments are different from those of adults. METHODS: We reviewed a series of 6 patients under the age of 12 years, who underwent surgery for LDH at our institution between 1992-2002. Initially, all patients were treated conservatively. The indications for surgery were failure of conservative treatment for 3 months, intractable pain and/or progressive neurological impairment. RESULTS: The surgical findings revealed a protruding disc in five cases and a ruptured disc in one. In addition, separation of the vertebral ring apophysis was observed in 3 cases. The symptoms had disappeared completely at the last follow-up. At the last follow-up, the Japanese Orthopaedic Association score was 10 points in 5 cases and 9 points in 1, and the Kirkaldy-Willis criteria was excellent in all patients. No intervertebral disc space narrowing was observed in any patient at last follow up. In addition, there were no degenerative changes in the vertebral endplate and facet joint. CONCLUSIONS: Patients with symptoms that persist for more than 3 months or those with a progressive neurological deficit must be considered for surgical discectomy.

The Immediately Postoperative Changes of Creatine Phosphokinase After Microendoscopic Discectomy / 대한척추외과학회지

STUDY DESIGN: A retrospective study OBJECTIVES: To evaluate postoperative muscle damage after microendoscopic discectomy (MED) and open discectomy (OD), using analysis of serum creatine phosphokinase (CPK) levels. SUMMARY OF LITERATURE REVIEW: Paravertebral muscle damage after retraction during posterior lumbar surgery can cause postoperative back pain. Serum CPK level is elevated in these patients and may indicate postoperative muscle damage. MATERIALS AND METHODS: We examined 35 cases with MED (group 1) and 11 cases with OD (group 2). Serum CPK levels were checked preoperatively and postoperatively at day 1 and day 3. We analyzed intra-group and inter-group differences in CPK levels according to sex, age, and operation time. Surgical outcomes were evaluated with a visual analog scale (VAS) preoperatively and 1 year postoperatively. RESULTS: CPK levels at postoperative 1 day were increased significantly and decreased significantly at postoperative 3 day in both groups (p<0.05), with levels in group 1 significantly lower than in group 2 (p<0.05). There were no differences in CPK levels according to sex, age, or operation time, except between the 3rd and 5th decades of age at postoperative 1 day in group 2. VAS was significantly different in intra-group analysis (p<0.05) with no significant differences in intergroup analysis. CONCLUSIONS: MED induced a lower increase in serum CPK than OD with similar VAS outcomes. MED results in less postoperative muscle damage than OD, with similar surgical outcomes.

Notochordal Cells Induce Chemotaxis of Cartilage-Endplate Chondrocytes in In Vitro Motility Assays / 대한척추외과학회지

STUDY DESIGN: In vitro motility assays were carried out using rat intervertebral discs (IVDs). OBJECTIVES: To demonstrate the motile properties of the cartilage endplate (CE) chondrocytes and the effect of notochordal cells on this property. LITERATURE REVIEW: Although previous in vivo studies have provided evidence for the migration of CE chondrocyte from hyaline CEs into the notochordal nucleus pulposus (NP), it is unclear if CE chondrocytes of the IVD actually have motile properties. In addition, the effect of notochordal cells on these properties has not been reported. MATERIALS AND METHODS: Notochordal cells and CE chondrocytes were harvested from three-month-old male Wistar rats and cultured separately. The motility was assayed in quadruplicate using a 48-well microchemotaxis chamber and a gelatin-coated 8-micrometer polycarbonate membrane filter. The control medium (serum-free culture medium), notochordal cells (4x, 2x, 1x and 0.5x10(6)) and concentrated conditioned medium (10-, 50-fold) where notochordal cells were cultured were loaded into the wells of the lower chamber, and CE chondrocytes were added to the wells of the upper chamber. At the end of the assays, the CE chondrocytes that migrated to the bottom side of the membrane filter were stained, counted, and compared. RESULTS: Compared with the control medium, the notochordal cells (N = 4x, 2x, 1x and 0.5x10(6)) and concentrated conditioned medium (10- and 50-fold) significantly increased the chemotactic motility of the CE chondrocytes in a number- and concentration-dependent manner (p<0.05). CONCLUSION: The CE chondrocytes of the intervertebral disc are motile, and soluble factors produced by notochordal cells induce the chemotaxis of CE chondrocytes.

Bacterial Contamination of Allografts from Living Donors / 대한정형외과학회잡지

PURPOSE: To analyze the rate of allograft contamination from living donors using a swab culture method and to determine the necessity of antibacterial processing. MATERIALS AND METHODS: From September 2001 to June 2004, 334 allografts were obtained from living donors undergoing total joint arthroplasty. Two hundred and fourteen allografts were obtained from the femoral heads, 86 from the knee joint, and 34 from other sources. All allografts from donors with inflammatory diseases were discarded. After retrieving the graft, the entire surface of the allograft was carefully swabbed, and the specimen was inoculated and cultured on blood agar for 48 hours. A bacterial culture with the entire tissue was also carried out on discarded allografts, and the rate of contamination was compared with that of used allografts. RESULTS: Of the 334 allografts, 20 (6%) allografts were culture positive using swab method. 132 allografts were discarded. The reasons for discarding were a prior medical history in 26, no informed consent in 54 and a positive blood test in 10. The rate of contamination of the discarded allografts was 15% (20/132) using the swab method, and 19% (25/132) using entire tissue culture method. The sensitivity of the swab culture technique was only 44%. CONCLUSION: The low sensitivity implies that the swab method is unsuitable for detecting bacterial contamination. Unprocessed swab-culture-negative grafts may be contaminated with organisms that can cause infections. Therefore, additional antibiotic processing such as gamma-irradiation will be required.

Thoracoscopic Anterior Release of the Spine in Total en Bloc Spondylectomy for Primary Thoracic Spinal Tumor : A case report / 대한흉부외과학회지

A combined anterolateral and posterior approach with thoracotomy has been recommended as the traditional surgical approach for the tumors of the thoracic spine. Recently, because of the morbidity associated with open thoracotomy, the thoracoscopically assisted surgical technique was introduced successfully in thoracic spinal surgery. Herein, we report a combined surgical technique for giant cell tumor of the thoracic spine (T10) consisting of bilateral thoracoscopic anterior release of the spine followed by a posterior en bloc spondylectomy and reconstruction by orthopedic surgeons. The thoracoscopic spinal surgery is safe and effective alternative for other open thoracotomic procedures in the approach to the anterior thoracic spine, avoiding the disadvantage inherent to thoracotomy.

Endoscopic Anterior Release and Posterior Total Spondylectomy for Primary Tumors of Spine / 대한척추외과학회지

STUDY DESIGN: A retrospective study. OBJECTIVES: To introduce an endoscopic anterior release and posterior total spondylectomy, and the evaluation of its clinical efficacy. SUMMARY OF LITERATURE REVIEW: A total spondylectomy was introduced for the treatment of primary and metastatic tumors of the spine, with many authors having reported favorable clinical results with its use. Endoscopic surgery has been used for various spinal disorders, including disc diseases or scoliosis, and has been widely used as it offers a minimally invasive technique, with a small surgical incision and very few complications. MATERIAL AND METHODS: Three primary spinal tumor cases were reviewed. The first case was a patient with a Ewing's sarcoma of the sacrum; the second was a giant cell tumor of the sacrum and the last was a giant cell tumor of the T10 vertebra. An endoscopic anterior release was initially performed, including the ligation and release of blood vessels, and soft tissue release, using laparoscopies for the 2 sacral tumors and a thoracoscopy for the thoracic tumor. The total spondylectomy were performed via a posterior approach. In two cases, the one with the Ewing's sarcoma of sacrum and the other with the giant cell tumor of the T10 vertebra, the reconstructions were performed using strut allografts and instrumentations. The average follow-up period was 19 months. RESULTS: Intraoperatively, the endoscopic anterior release made it possible to successful finish the anterior releases, with minimal incisions and blood losses. It also allowed a safer and faster posterior total spondylectomy, without significant complication. At the last follow-up, all patients had favorable clinical results, with no local recurrence in any case or fusions in the two cases that had to undergo reconstruction. CONCLUSION: Endoscopic anterior release and a posterior total spondylectomy was a favorable surgical procedure for primary tumors of spine. It made possible the safe and efficient finish the anterior release and posterior total excision of the affected vertebrae, using small incisions and with no complications.

Endoscopic Anterior Release and Posterior Total Spondylectomy for Primary Tumors of Spine / 대한척추외과학회지

STUDY DESIGN: A retrospective study. OBJECTIVES: To introduce an endoscopic anterior release and posterior total spondylectomy, and the evaluation of its clinical efficacy. SUMMARY OF LITERATURE REVIEW: A total spondylectomy was introduced for the treatment of primary and metastatic tumors of the spine, with many authors having reported favorable clinical results with its use. Endoscopic surgery has been used for various spinal disorders, including disc diseases or scoliosis, and has been widely used as it offers a minimally invasive technique, with a small surgical incision and very few complications. MATERIAL AND METHODS: Three primary spinal tumor cases were reviewed. The first case was a patient with a Ewing's sarcoma of the sacrum; the second was a giant cell tumor of the sacrum and the last was a giant cell tumor of the T10 vertebra. An endoscopic anterior release was initially performed, including the ligation and release of blood vessels, and soft tissue release, using laparoscopies for the 2 sacral tumors and a thoracoscopy for the thoracic tumor. The total spondylectomy were performed via a posterior approach. In two cases, the one with the Ewing's sarcoma of sacrum and the other with the giant cell tumor of the T10 vertebra, the reconstructions were performed using strut allografts and instrumentations. The average follow-up period was 19 months. RESULTS: Intraoperatively, the endoscopic anterior release made it possible to successful finish the anterior releases, with minimal incisions and blood losses. It also allowed a safer and faster posterior total spondylectomy, without significant complication. At the last follow-up, all patients had favorable clinical results, with no local recurrence in any case or fusions in the two cases that had to undergo reconstruction. CONCLUSION: Endoscopic anterior release and a posterior total spondylectomy was a favorable surgical procedure for primary tumors of spine. It made possible the safe and efficient finish the anterior release and posterior total excision of the affected vertebrae, using small incisions and with no complications.

Surgical Treatment for Lumbar Spinal Stenosis with Fracture in Multiple Osteoporotic Compression Fractures / 대한척추외과학회지

STUDY DESIGN: A retrospective study. OBJECTIVE: To analyze the outcome of the surgical treatment for lumbar spinal stenosis with fracture in multiple osteoporotic vertebral body compression fractures. SUMMARY OF LITERATURE REVIEW: An osteoporotic vertebral compression fracture, without neurological symptom, has mainly been treated with conservative care. Sometimes, vertebroplasty or kyphoplasty has been used as a surgical treatment. In the case of a single thoracolumbar fracture with neurological symptoms, not improved by conservative care, decompression, fusion and instrumentation through an anterior or a posterior approach has been attempted. MATERIALS AND METHODS: 10 patients, who had received surgical treatment for symptomatic lumbar spinal stenosis with fracture out of those with multiple osteoporotic vertebral body compression fractures, and over the age of 60, were assessed. The surgical treatment was performed on the patient with all of the following five criteria; (1) severe back pain caused by fractures, (2) neurological symptoms of lumbar spinal stenosis, (3) radiological evidences of stenosis by lumbar fracture, (4) no response to conservative treatment for over 3 months, and (5) adequate physical ability for daily living without a severe medical condition. The surgical procedure included: decompressive laminectomy, posterior instrumentation using pedicle screw fixation, and fusion in situ. The pedicle screws were located 2-3 above and below the most cephalad and caudad fractured vertebral bodies. RESULTS: Clinically, favorable results were obtained in 8 of the 10 patients. In the roentgenographic assessment, the operated states were well maintained, without the metallic failure or instability. Halos around the pedicle screws were seen in 4 patients, but there was no significant evidence of loosening. There were no serious medical and systemic complications in the peri- and postoperative periods. Additional vertebral body fractures and pain were seen in 5 patients, but they had been well managed, conservatively. CONCLUSION: Favorable clinical results could be expected for the surgical treatment of lumbar spinal stenosis, with fracture, in the patients with multiple osteoporotic vertebral fractures, as long as the surgical treatment was indicated exactly and carefully.

Insufficiency Fractures of the Femoral Shaft Associated with Osteoporosis

PURPOSE: To present a clinical experience of the insufficiency fractures of the femoral shaft associated with osteoporosis MATERIALS AND METHODS: From January 1995 to December 2002, four patients (8 cases, four females) more than 1-year follow up were reviewed retrospectively. The mean age was 61 years (range, 55 to 73). Medical records and roentgenograms were reviewed. RESULTS: The fractures were bilateral. Plain film revealed fracture line in six among seven cases excluding 1 displaced fracture at initial presentation. All cases presented osteoporosis, anterolateral bowing of the femur, and hot spot in bone scan. Five cases (four displaced, one impending displaced fracture) underwent interlocking intramedullary nailing and all five of them manifested no evidence of delayed union. The preoperative thigh and knee joint pain improved postoperatively. CONCLUSION: Femoral shaft insufficiency fracture could occur rarely in patients with anterolateral bowing of the femur and postmenopausal osteoporosis. Careful history taking, radiography and bone scan are necessary, and bone scan is helpful for early diagnosis. Once diagnosed as the insufficiency fracture with fracture-related symptoms, prophylactic nailing may be necessary lest complete displaced fracture should occur.

Ring-Shaped Lateral Meniscus

PURPOSE: To investigate the clinical characteristics and the results of treatment of ring-shaped lateral meniscus. MATERIALS AND METHODS: From 1984 to 2003, We treated 6 patients with ring-shaped lateral meniscus who were diagnosed during surgery. Among them, five cases were symptomatic. The follow-up period ranged from 12 to 60 months (average 31). All patients were assessed by Lysholm score. RESULTS: There were 5 men and 1 women. Mean age was 27 years. The mean interval from onset of symptoms to surgery was 22 months. Absent or minimal trauma appeared responsible in 5 cases. All patients had excellent results at last follow-up. CONCLUSION: Ring-shaped lateral meniscus was a very rare congenital anomaly which occurred mostly in the lateral meniscus and could present with symptomatic case due to tear.

Meniscal Cysts of the Knee

PURPOSE: To investigate the clinical characteristics and the results of arthroscopic treatment of meniscal cysts. MATERIALS AND METHODS: From 1995 to 2002, 16 patients with meniscal cysts were treated by arthroscopic partial meniscectomy and cyst decompression. Five men and eleven women comprised the study group and had an average age of 31.9 years. The follow-up period ranged from 12 to 52 months (average 27). All patients were assessed by modified Ryu and Ting's method. RESULTS: The mean interval from onset of symptoms to surgery was 30 months. Minimal or absent trauma appeared responsible in 87.5% of all case. Eight of the cysts were lateral and eight were medial. It was difficult to palpate the cyst in three cases. All were noted to have a meniscal tear with horizontal tear at the time of surgery. There have been no recurrences, and all patients returned to their previous level of activity and were satisfied to their results. CONCLUSIONS: Meniscal cysts occur predominantly in women and almost same as often in the medial compartment as in the lateral compartment. Parameniscal cysts may result from synovial fluid tracking through a cyst tract of horizontal cleavage component. Satisfactory results can be expected from only arthroscopic partial meniscectomy and decompression of meniscal cysts without repair.

Functional Outcome of the Surgical Correction of Neuromuscular Scoliosis / 대한척추외과학회지

STUDY DESIGN: A retrospective study of functional outcome after surgical correction of neuromuscular scoliosis. OBJECTIVES: To assess functional outcomes and their significances after the surgical correction of neuromuscular scoliosis. SUMMARY OF LITERATURE REVIEW: The surgical correction of neuromuscular scoliosis has been used to stabilize the trunk for balanced sitting, to improve cardiopulmonary function, and the function of the upper extremities. Many authors have reported favorable surgical results, but few studies have been undertaken on functional assessment after surgery. MATERIALS AND METHODS: Eighteen adult patients with neuromuscular scoliosis underwent surgical correction. Functional assessments were performed in terms of impairments, disabilities, and handicaps. The impairments included sitting ability, coronal Cobb's angle, pain after surgery, and cosmesis after surgery. The disabilities included dressing, feeding, toilet/bathing, locomotion, and the use of both hands, and the handicaps included the effort and time to care for patients. Each parameter was checked preoperatively, 6 months after surgery, and at the last follow-up. RESULTS: In terms of impairments, sitting ability, coronal Cobb's angle, pain, and cosmesis were improved by surgery. In terms of disabilities, dressing, toilet/bathing, and locomotion were not improved after surgical correction. However, the feeding and use of both hands were significantly improved. And, in terms of handicaps, both the effort and the time required for care were reduced post-surgically. CONCLUSIONS: We conclude that impairments, handicaps, and the functions of the upper extremities were improved after surgical intervention to stabilize the trunk and spine in cases of neuromuscular scoliosis, but that overall disabilities were unaffected. This latter apparent shortcoming is attributed to the inability of surgery to treat previous systemic disease affecting physical disabilities of lower extremities. However, surgical correction of neuromuscular scoliosis was found to be clinically significant in terms of improving the functions of the trunk and of the upper extremities.

Clinical Outcome After Surgical Correction of Severe Scoliosis / 대한정형외과학회잡지

PURPOSE: To determine the radiological, functional, and subjective outcome after stabilization in adult patients with severe scoliosis. MATERIALS AND METHODS: Eighteen adult patients with severe scoliosis underwent surgical correction. The radiological outcome was assessed by coronal and sagittal Cobb's angle, apical vertebral translation, and trunk deviation. The functional outcome was assessed by physical ability, locomotion, activities of daily living, and use of both hands. The subjective outcome was assessed by cosmetic satisfaction and costo-pelvic pain. RESULTS: Radiologically, mean correction of coronal curves were 28.7% in thoracic curves and 30.2% in lumbar. Average correction of sagittal curves were 29.4% and 16.8%, retrospectively. Mean correction of apical vertebral translation were 35% and 52.3%, retrospectively. Average correction of trunk deviation was 42.8%. In functional outcome, feeding ability and function of both extremities were improved significantly. 94.4% and 88.9% of patients were satisfactory significantly in cosmetic features and pain sensation. CONCLUSIONS: In this series, the surgical correction and stabilization of adult severe scoliosis resulted in much improvement in balancing of the trunk, improving function of upper extremities, and subjective satisfaction in the aspect of costo-pelvic pain and cosmesis.