A Retrospective Study of the Fusion Rate and Clinical Outcome after Mini-open ALIF using Paired Stand-alone Rectangular Cages

OBJECTIVE: We conduct a study to determine the fusion rate and clinical outcome after mini-open anterior lumbar interbody fusion(ALIF) in selected patients with a degenerative lumbar disc disease. METHODS: Ninety-four patients underwent the ALIF procedure between November 2000 and June 2002. The subjects were 23 men and 71 women, with a mean age of 52 years(range, 25-72). The mean follow-up duration was 21 months(range, 13-32). Clinical outcome was assessed using the modified Japanese Orthopedic Association(JOA) low back pain score and the 10-point visual analogue scale(VAS). Radiologic evaluation was performed using plain radiographs. The intervertebral disc height was measured and expressed as the percentage of the total disc height to the AP diameter of the vertebral body. RESULTS: The overall fusion rate in our series was 88.3%. The mean preoperative JOA score was 8.3+/-1.6. At the last follow up visit, the mean JOA score was increased to 13.1+/-1.1, respectively(p<0.001). VAS showed a similar result to JOA score(p<0.001). The preoperative intervertebral disc height was 36.7+/-9.9%. Postoperatively, the disc height spread to 53.3+/-10.8% one month after surgery, but diminished to 46.6+/-11.9% at the last follow-up. CONCLUSION: Our study shows that ALIF using stand-alone rectangular cages remains effective for the indicated conditions in patients with a degenerative lumbar disc disease.

Multiple Thoracic Disc Herniations: Report of 2 Cases

The authors describe 2 cases of multiple thoracic disc herniations in the level of T5~6, T6~T7, T7~8 and T8~9, T9~10, T10~11. Thoracic disc herniations is rare and occurs in less than 4% of all diseases. Moreover, multiple thoracic disc herniations is very rare and only 7 cases were reported in the literatures, which occurred at two levels in 6 cases and five levels in one case. The lesions were determined by thoracic CT myelogram and MRI study. A microsurgical posterolateral approach made them curative. Surgical instruments such as downbite curette and surgical microscope were essential for successful treatment.

Surgical Management of the Distal Anterior Cerebral Artery Aneurysms

The authors described different type of aneurysms in the distal anterior cerebral artery(DACA), which is difficult to approach surgically. there are anomalies of distal anterior cerebral artery in about one fourth and narrow space, which made more careful surgical dissection. We experienced 7 cases of DACA aneurysm, 6 cases of which were treated surgically through the interhemispheric approach via the unilateral frontal paramedian craniotomy on the non-dominant side. Surgical results were anatomical complexities, modern microsurgical technique aided by microscope make the approach more exactly and safely.

Management of Cervical Spine Injuries without Fracture or Dislocation

The authors analized the 98 cases of cervical spine injuries without fracture or dislocation by hyperflexion/hyperextension of the neck. The peak incidence of the age was in the second to fourth decades(69.4%). There was a male preponderance with a sex ratio of. 1.8 : 1. Sources of trauma were motor vehicle accident, object falling on and motorcycle accident in the order of frequency. The common mechanisms of injury were flexion-extension, extension and flexion injury in the order of frequency. There were 10 cases of cervical cord injury without fracture or dislocation and operative management was given in 6 cases of them. The most common preexisting disease was congenital cervical stenosis. Surgical modality such as laminectomy, laminoplasty and anterior decompressive procedure made them improved. The authors discuss the mechanism of injury and surgical management of the patients with cervical cord injury in the absence of concomittent fracture or dislocation.

Microsurgical Posterolateral Approach for a Thoracic Disc Herniation

The authors describe the case of a man who presented with T2-T3 disc herniation. The lesion was successfully identified by computed tomography with iopamidol myelogram and other radiological examinations. A posterolateral approach was tried and made successful result by the aids of microsurgical divices.