Modified Tension Band Wiring using Cortical Screw for Medial Malleolar Fractures

PURPOSE: To evaluate the clinical results of modified tension band wire technique using cortical screw for treatment of displaced medial malleolar fractures of the ankle. MATERIALS AND METHODS: From January 2001 to January 2003, 24 patients were treated by modified tension band wiring using cortical screw for medial malleolar fracture. The follow-up period was 12~35 months (average 18 months). There were 13 males and 11 females, and the mean age was 46 years. Fractures were classified by Lauge-Hansen's classification. The results were analyzed by Meyer and Kumler's criteria. RESULTS: There were 13 cases (54%) of excellent, 9 cases (38%) of good, and one case of fair because of limitation of motion of the ankle joint and one case of poor which showed post-traumatic arthritis of the ankle. CONCLUSION: Modified tension band wire technique using cortical screw can be an effective operative method for the treatment of displaced medial malleolar fractures of the ankle.

Analysis of Correction Loss after Pedicle Subtraction Osteotomy in Patients with Sagittal Imbalance: Radiologic Aspects / 대한정형외과학회잡지

PURPOSE: To validate the surgical principles by analyzing the cause of a correction loss after pedicle subtraction osteotomy in patients with a sagittal imbalance in the radiological aspects, retrospectively. MATERIALS AND METHODS: Forty cases were analyzed radiographycally according to the presence (Group A) or absence (Group B) of the lower mobile segment and anterior column support performed (Group A2) or not (Group A1), respectively. RESULTS: The overall correction loss of the total fused part appeared to increase in group A (p=0.025) and the degree of lordosis of the osteotomy site showed an almost zero correction loss in group A and B. No statistic difference of the correction loss of the upper segment of the osteotomy site between the two groups was found (p=0.138). The correction loss of the lower segment of osteotomy site increased statistically more in goup A (p=0.014). The correction loss in group A occurred more in the lower segment than in the upper segment and the correction loss of the lower segment in group A1 appeared to have a better correlation than group A2 (p=0.012). CONCLUSION: Correction loss occurs at the intervertebral disc of the mobile segment. It is considered desirable to have anterior column support to all lower segment of the osteotomy site, because the correction loss increases more in the lower segment than in the upper segment.

Bone Cement Leakage in Vertebroplasty for Osteoporotic Compression Fractures / 대한정형외과학회잡지

PURPOSE: The purpose of this study was to classify the patterns of cement leakage that occurs during vertebroplasty for osteoporotic compression fractures, to evaluate the diagnostic values of simple radiographs for detecting leaks, and to find signs on simple radiographs that suggest leaks into the spinal canal. MATERIALS AND METHODS: First, leakage was classified based on the findings of CT scans and radiographs of 76 vertebrae in 49 patients. Second, the diagnostic values of simple radiographs for detecting leaks were evaluated by comparing the results of a review of simple radiographs with those of CT scans. Finally, warning signs of leakage into the spinal canal on lateral views were identified, and their positive predictive values assessed. RESULTS: Cement leaks were classified into three types according to their routes. Only 66% (50/76) of all leaks were found on simple radio-graphs. Of these, only 8% (2/25) of leaks into the spinal canal were correctly interpreted. Among the four identified warning signs, cement in the neural foramina was found to have the highest positive predictive value (86%). CONCLUSION: Since the sensitivity of radiographs for detecting leakage into the spinal canal is low, careful attention should be paid to identify it early. The four suggested warning signs help early detection.

The Results of Pedicle Subtraction Osteotomy in Iatrogenic Flat Back Syndrome / 대한정형외과학회잡지

PURPOSE: To analyze the results of radiologic and clinical outcomes after pedicle subtraction osteotomy in iatrogenic flat back syndrome. MATERIALS AND METHODS: We reviewed 12 surgical cases of iatrogenic flat back syndrome from January 1998 to July 2001 with a follow-up of more than 12 months. All cases were females and an average age was 59.8 years (48-66 years). An average follow-up period was20.4 months (12-37 months). Initial diagnosis were as follows: lumbar degenerative kyphosis, in 5 cases; spinal stenosis, in 5 cases; spondylolisthesis, in 2 cases. For clinical evaluation, 10-point pain scale and 5-point scale for activity level, cosmesis and subjective satisfaction were used. Lumbar lordotic angles and sagittal vertical axis (SVA) were measured. RESULTS: In radiologic results, an average lumbar lordotic angle at preoperative, postoperative and the last follow-up were 5.13+/-21.69 degree, -31.33+/-16.32 degree, -27.50+/-16.73 degree respectively. And average SVA at preoperative, postoperative and the last follow-up were 8.46+/-6.04 cm, 0.62+/-2.24 cm, 2.82+/-2.81 cm respectively. In clinical results, preoperative pain (6), activity (2) and cosmesis (1.8) were improved to 3.2, 3 and 3.2respectively at the last follow-up. Subjective satisfaction was 3.9. CONCLUSION: Pedicle subtraction osteotomy seemed to be very useful surgical option for improvement of clinical results through recovering of lumbar lordotic angle and sagittal balance in cases of iatrogenic flat back syndrome.

The Changes of Adjacent Segments after Fusions (above 3-levels to L5) in Degenerative Lumbar Spinal Disorders / 대한척추외과학회지

STUDY DESIGN: A retrospective study. OBJECTIVE: To evaluate the usefulness of MRI grading of disc degeneration in determining whether L5-S1 fusion is necessary in degenerative lumbar spinal disorders. SUMMARY OF LITERATURE REVIEW: Changes in adjacent segments are not well understood, after floating fusion has been performed. MATERIALS AND METHODS: We reviewed 16 surgical cases of degenerative lumbar spinal disorders from July 1996 to February 2000 with an average follow-up of 41 months. Fusion was done in patients without instability, pathology and narrowing of L5-S1. We measured the disc degeneration of adjacent segments in preoperative MRIs using the Modified Pearce classification. In spine AP, lateral and flexion-extension radiographs, we measured disc height, angular motion and instability changes and correlated these with disc degeneration. RESULTS: Disc height changes decreased in the upper and lower adjacent segments and preoperative disc degeneration above grade IV, decreased more in lower adjacent segment. A statistical correlation was found between disc degeneration and disc height changes in the lower segment (P=0.046), but not in the upper segment (P=0.649). The angular-motion was unchanged in the upper and lower adjacent segments, and no statistical correlation was found between disc degeneration and angular-motion changes (P=0.819, 0.208). Postoperative instability was found in the upper adjacent segment in 2 patients, but no statistical cor-relation was found between disc degeneration and instability (P=0.083, P=1.000). CONCLUSION: L5-S1 might be saved when free of pathology, and when disc degeneration is below grade III and balanced sagit-tally. However, further study is needed because of the short-term follow up and low number of cases in this study.

Percutaneous Vertebroplasty: Short-term Results of 38 Cases / 대한정형외과학회잡지

PURPOSE: To evaluate the clinical outcome of vertebroplasty, and to analyze the causes of poor results. MATERIALS AND METHODS: The radiological and clinical results of thirty-eight patients who were followed for more than one year after vertebroplasty for painful osteoporotic compression fractures were retrospectively analyzed. RESULTS: There were 10 recollapses and 6 fractures of adjacent vertebrae. Most of these occurred in the thoracolumbar junction (9 and 5 respectively). Pain was significantly improved in the immediate postoperative period, that is, from 9.3+/-0.7 points on a 10-point pain scale preoperatively to 2.0+/-0.7 points postoperatively (p<0.001). However, at the last follow-up, this was aggravated to 3.9+/-3.3, and eleven (29%) patients had moderate (5-7 points) or severe (8-10) pain. The main causes of aggravation of pain were recollapses (5 cases) and/or fractures of adjacent vertebrae (5). CONCLUSION: Vertebroplasty resulted in excellent relief from pain in the immediate postoperative period, but the more-than-one-year follow-up results were less satisfactory, and this was particularly true in the thoracolumbar junction. The possibility of recollapse or of fractures of adjacent vertebrae must be kept in mind.

The Relationship between Sagittal Spinal Alignment and Surgical Results in Degenerative Lumbar Scoliosis with Spinal Stenosis / 대한척추외과학회지

STUDY DESIGN: A retrospective study. OBJECTIVES: To analyze the correlation between clinical results and sagittal vertical axis, clinical results and total lumbar lordosis in degenerative lumbar scoliosis with spinal stenosis. SUMMARY OF LITERATURE REVIEW: There has been no report about the relation between sagittal spinal alignment and surgical outcome of degenerative lumbar scoliosis. MATERIALS AND METHODS: We reviewed 38 surgical cases of degenerative lumbar scoliosis from February 1997 to February 2001 with an average follow-up of 35 months. In whole spine standing AP and lateral radiographs, scoliotic angle(Cobb method), total lumbar lordosis(L1-S1) and the sagittal vertical axis(C7 plumb line) were measured. In lumbar flexion-extension and standing side bending views, the lateral translation was measured and instability was determined. Clinical results were evaluated based on the Kirkaldy-Willis criteria. RESULTS: The scoliotic angles at preoperative, postoperative and follow-up were 15.0+/-4.9, 5.3+/-3.1 and 7.1+/-3.7 degrees retro-spectively. Total lumbar lordosis were 28.7+/-6.1, 40.6+/-7.3 and 35.1+/-10.2 degrees retrospectively. Sagittal vertical axis at preoperative and the last follow-up were 3.3+/-3.2 and 0.1 +/-3.3 cm retrospectively. According to Kirkaldy-Willis criteria, 6 cases were excellent, 24 cases good, 7 cases fair and 1 case poor. There was no statistical correlation between total lumbar lordosis and the clinical results (r=-0.061, p=0.717). Sagittal vertical axis was significantly correlated with the clinical results (r=0.519, p=0.001). CONCLUSIONS: For improvement of surgical outcome of degenerative lumbar scoliosis, the sagittal vertical axis should be used as a parameter of sagittal alignment rather than the total lumbar lordosis.

Clinical Analysis of Failed Lumbar Disc Surgery / 대한정형외과학회잡지

PURPOSE: To estimate the prognosis of surgical treatment through the comparative analysis of patients who had reoperation for failed lumbar disc surgery space (FLDS). MATERIALS AND METHODS: 31 patients who had a surgical operation for sciatica due to recurrent disc herniation or fibrous tissue adhesion were analyzed. Clinical features and surgical results of both groups were evaluated. RESULTS: In clinical analysis, a positive SLR test of less than 40, pain upon coughing, and a reduced walking capacity were common in recurrent herniation. Satisfactory postoperative results were achieved in 12 cases (80%) of the recurrent disc herniation group, 2 cases (50%) of the diffuse type and in 8 cases (67%) of the focal type of fibrous tissue adhesion group. CONCLUSION: In term of clinical signs, the SLR test is one of the most important factors in differentiating the preoperative cause of FLDS. Although them was no difference in the statistics, the surgical outcome in patients with focal root compression is more satisfactory than in the diffuse type in the fibrous tissue adhesion group.

Anterior Discectomy and Fusion With or Without Plate Fixation for One Level Cervical Disc Herniation / 대한척추외과학회지

STUDY DESIGN: A retrospective study was performed in patients with one level cervical disc herniation who had undergone anterior discectomy and fusion with or without plate fixation. OBJECTIVES: This study was performed in order to analysis the result of anterior discectomy and fusion, and to assess the benefits of the supplemental anterior cervical plate in the treatment of one level cervical disc herniation. MATERIALS AND METHODS: 35 surgically treated patients for one level disc herniation were reviewed. The Smith Robinson with autologous iliac crest bone graft was performed in both groups. Group A consisted of 14 patients who had supplemental anterior cervical fixation performed. Group B consisted of 21 patients treated without plate fixation. Radiologic parameters included the bone union and changes of intervertebral space. Clinical results were classified using the criteria of Robinson. RESULTS: In radiologic analysis, decreases in intervertebral space were common in group B, especially in older than 61 years old age group, and the bone union time was same in both groups. The overall clinical success rate was 86% in group A and 90% in group B. This difference between group A and group B is not significant. CONCLUSIONS: When selectively used in osteoporotic patient, supplemental anterior cervical plate fixation allows an early return to activities of daily living for patients and prevent deformities in graft bone. However, further studies are needed to confirm this result. Although many advantages of anterior plate stabilization have been previously reported, the plate osteosynthesis after one level fusion for radiculopathy was not thought to be a major advantage.

A Comparative Study of Anterior Interbody Fusion with and without Posterior Instrumentation in Infection of the Lumbar Spine / 대한척추외과학회지

STUDY DESIGN: Twenty patients with spinal infection(tuberculous+pyogenic) in the lumbar spine were evaluated according to the surgical treatment methods using posterior instrumentation(pedicle screw) and conventional anterior curettage and interbody fusion method without posterior instrumentation. OBJECTIVE: The purpose of this study is to evaluate the efficacy of the method consisting of posterior instrumentation using pedicle screw and anterior lumbar interbody fusion. SUMMARY OF LITERATURE REVIEW: It has been reported that patients ended up with kyphosis had a higher incidence of back pain. MATERIALS AND METHODS: Twenty patients with spine infection in the lumbar spine divided into two groups depending on their use of posterior instrumentation in surgical treatment methods. One group consisted of 10 cases which were treated by conventional anterior curettage and anterior lumbar interbody fusion only(Group A) and the other groups consisted of 10 cases were treated by conventional anterior curettage and anterior lumbar interbody fusion with posterior instrumentation using pedicle screw(Group B) by a single surgeon. The clinical outcomes were evaluated using Macnab's classification and the radiographys were analyzed with respect to fusion status and sagittal angle. RESULTS: A solid bony fusion was obtained in Group B. But in Group A, 2 cases of bony resorption were occurred. The preoperative, immediate postoperative, and final follow-up sagittal angle in both groups were -7.4degree/ - 0 . 8degree, -19.0degree/ - 1 2 . 4degreeand -5.9degree/ - 8 . 6degree, respectively. There is a significant statistical difference in loss of sagittal angle correction between two groups(P0.05), but exellent result was more common in Group B. CONCLUSION: This method which consist of conventional curettage and anterior lumbar interbody fusion with posterior instrumentation appears to be effective in stabilizing the vertebrae, and restoration and maintenance of physiologic lumbar lordosis. we would suggested this method for the surgical treatment in infection of lumbar spine.

The results of the Posterior Lumbar Interboby Fusion using Titanium mesh cage for Spondylolisthesis / 대한척추외과학회지

STUDY DESIGN: This is a retrospective study analysing and comparing what between posterior lumbar interbody fusion plus posterior lateral fusion(PLIF+PLF) and PLF alone for Spondylolisthesis(Degenerative type+Isthmic type). Thirty patients were treated by posterior lumbar interbody fusion(PLIF) using Harms' cage and posterolateral fusion(PLF) with transpedicular screw fixation. Forty-nine patients were treated by posterolateral fusion with transpedicular screw fixation. OBJECTIVES: This is to verify the advantages of adding posterior lumbar interbody fusion using Harms' cage to the usual posterolateral fusion with transpedicular screw fixation SUMMARY OF BACKGROUND DATA: Interbody fusions have certain distinct mechanical advantages over posterolateral ones. Autologous cancellous bone is the preferred graft material, but might be soft to maintain the disc space during fusion. METHODS: Union rate, slip reduction, sagittal angle correction, disc height restoration, and clinical results by Lin's criteria were analysed. RESULTS: Nonunion was observed in 5 PLF cases(10%) and one PLIF case(3%). Loss of slip reduction was 0.7% in PLIF and 2.59% in PLF(P<0.05). Loss of sagittal angle correction was 1.27degreein PLIF and 3.65degreein PLF(P<0.05). Loss of disc height restoration was 2.6% in PLIF and 7.6% in PLF(P<0.05). Clinical evaluation in PLIF+PLF was excellent in 67%, good in 30%, and fair in 3%. Clinical evaluation in PLF was excellent in 59%, good in 33%, and fair in 8%. More excellent results were noted in PLIF+PLFcases. CONCLUSIONS: Adding posterior lumbar interbody fusion using Harms' cage showed better radiological results and more excellent clinical results compared to posterolateral fusion with transpedicular screw fixation.

Modular Hemiarthroplasty for the Treatment of Complex Fractures of the Proximal Humerus / 대한정형외과학회잡지

From 1993 to 1996, we have used a new modular shoulder prosthesis for the treatment of acute complex fracture of the proximal humerus. The purpose of this study is to evaluate function, pain relief, and patient satisfaction after moduiar hemiarthroplasty for proximal humerus fractures. The stucly included 12 patients (J2 shoulders) with an average age of 68.5 years (range, 60 to 84 years). According to the Neer classification system, there were 3 four-part fracture-dislocations, 5 four-part fractures, 3 three-part fractures, and #I head splitting fracture. 'fhe hemiarthroplasty was pert'ormed at an average of 4 days (range, 3 to 10 days) following injury. Deltopectoral approach was used in all patients, and the prostheses were implanted with cement in ten cases. Follow-up evaluation, at an average of 32 months post-surgery, included clinical and radio- graphic examination. Active forward elevation averaged 120 degrees; external rotation, 35 degrees; and internal rotation, to the first lumbar vertebra. All of patients, except two who had poor results, were graded as good or excellent according to UCLA shoulder rating scale. Complications consisted of one tuberosity dispiacement, one peri-operative death and one loosening of uncemented humeral prosthesis. We concluded that Modular hemiarthroplasty for acute complex fracture of the proximal humerus especially in severely osteoporotic elderly patients facilitated the restoration of humeral length, anatomic repositioning of tuberosities, and precise soft tissue balance, thereby allowing earliermotion to prevent the developement of painful shoulder stiffness.

Lumbar Epidural Lipomatosis: Three Cases Report / 대한척추외과학회지

No abstract available.