Operative Risk Assessment of Degenerative Spinal Disorder Comparing with Total Hip Replacement

STUDY DESIGN: Retrospective study. OBJECTIVES: To assess the operative risks and complications of posterior decompression and fusion for degenerative spine disorders, we compared single level posterior decompression and posterolateral fusion of lumbar spine with total hip arthroplasty which have been evaluated in many reports and articles on complications and operative risks. SUMMARY OF LITERATURE REVIEW: There has been no study comparing the relative risks of spinal surgery with total hip arthroplasty. MATERIALS AND METHODS: One hundred and thirty-six subjects (mean age 69.6 years) who received single level posterior decompression and posterolateral fusion for degenerative lumbar disorders from February 2000 to May 2010 were selected as group A, and 136 subjects (mean age 67.2 years) who received total hip arthroplasty during the same period were selected as group B. A comparative analysis was performed according to age, gender, pre-operative ASA status based on their underlying medical conditions, total operative time, blood loss, hospitalization period, incidence of major and minor complications and functional recovery at the time of final follow up using retrospective and statistical manners from medical records and radiologic evaluations. RESULTS: The total operative time and blood loss were longer in group A with statistical significance (P<0.01). Major complications were frequent in group B with 16 cases and in group A with 6 cases (P<0.05). There were no significant differences in the total hospitalization period, incidence of minor complications and post-operative functional recovery. CONCLUSIONS: The present study revealed no increased operative risks for surgery for degenerative lumbar disorders compared with total hip arthroplasty in similar age groups.

A Comparative Study of Behavioral and immunohistological Changes after Spinal Cord Injury between Young and Adult Rats / 대한정형외과학회잡지

PURPOSE: The aim of this study was to compare the behavioral and immunohistochemical changes in a spinal cord injury (SCI) between young and adult rats and to clarify the differences in the mechanism underlying the changes in a SCI between young and adult rats. MATERIALS AND METHODS: A total of 25 young and 25 adult male Sprague-Dawley rats (5 weeks and 16 weeks old) were used. The rats were anesthetized with pentobarbital and laminectomies were carried out at the level of the 11th and 12th thoracic vertebra. Using a modified New York University Impactor, a SCI was induced by dropping a 10 gm weight at a height of 20 mm. The bladders were emptied manually twice a day to prevent urinary problems. The animals that received no surgery were used as the normal controls. Behavior tests were performed using the Basso-Beatti-Bresnahan (BBB) scoring system, 1 and 7 days after the weight drop injury. The difference in the BBB score between the young and adult rats were analyzed by a paired t-test with a p value <0.05 considered significant. The injured spinal cords were dissected at 1 and 7 days after surgery. H-E stain and immunohistochemistry for c-Jun and GFAP were performed in the spinal cord sections. The immunoreactions were visualized by incubation for 1 hour at RT in an avidin-biotin-peroxidase complex in PBS and 5-10 min in 0.05% 3, 3 -diaminobenzidine and 0.01% H2O2 in 0.1 M PBS. RESULTS: The hind limbs of young rats were paralyzed 1 day after surgery, but had recovered partially 7 days after surgery. However, the adult rats remained in the paralyzed status 7 days after surgery. The c-Jun expression level increased in the gray matter up to 7 days after the weight-drop injury in adult rats. The c-Jun expression level increased significantly in the gray matter 1 day after the injury in the young rats. However, the c-Jun expression level decreased significantly in the gray matter 7 days after the injury in the young rats compared with that of the 1 day post-injury. The GFAP expression level in the gray matter increased 1 day after the weigh-drop injury in the adult rats. However, it decreased in the necrotic region 7 days after the injury in the adult rats. GFAP expression in the gray matter increased gradually up to 7 days after the injury in the young rats. CONCLUSION: These results suggest that lack of recovery from a SCI in adult rats may be related to the continuous upregulation of c-Jun expression and/or the downregulation of GFAP after the weight-drop injury. In contrast, the upregulation of GFAP expression and/or the downregulation of c-Jun expression in the spinal cord might be related to a partial recovery in young rats after a weight-drop injury.

Intraoperative Straight Leg Raising Test During Arthroscopic Microdiscectomy / 대한척추외과학회지

STUDY DESIGN: A prospective study. PURPOSE: To assess the effectiveness of the straight leg raising test during an arthroscopic microdiscectomy. MATERIALS AND METHODS: 52 patients, 38 men and 14 women, took part in this experiment. The mean followed up and age were 21, ranging from 13 to 41 months, and 26.4, ranging from 13 to 42 years old. There were 19, 28 and 9 cases between the 3rd- 4th lumbar vertebrae, between the 4-5th lumbar vertebrae between the 5th lumbar vertebra and the 1st sacral vertebra, respectively. 41 patients were able to perform the SLRT (straight leg raising test) procedure, and were called group I, and 11 patients could not perform the test, and were classed as group II. In order to perform the intraoperative SLRT, a lateral decubitus position was adopted. After the disc removal, the SLRT was carried out. When the test result gave an angle of 70 degrees or greater, the surgery was carried out on a pertinent domain. The success of the surgery was graded by the JOA score. RESULTS: In group I, after removal of the disc, the first 31 patients were checked over a 4 week period to assess their recoveries. A year after the surgery, their follow up results were better than Good. In 9 patients, there were little improvements from the first SLRT, so they were re-tested after a 2nd discectomy, which resulted in improvements., with better than good results. 1 patient, whose test result was fair after four weeks and one year, was diagnosed with spinal stenosis, so underwent an operation. In group II, the SLRT during surgery was untestable, due to overweight and uncooperative patients. The results in 3 patients were fair, and in another 8 they better than good. Overall, 97.6% of the patients in group I showed a rapid recovery, but in the group II, only 72.2% showed a rapid recovery. CONCLUSION: From the short term follow up, the use of a SLRT during surgery is very effective. Further research is required to give more precise results.