Treatment of Scaphoid Nonunions with Autogenous Cancellous Bone Grafting Combined with Threaded K-wire Fixation

PURPOSE: To evaluate the results of surgical treatment of autogenous cancellous bone grafting combined with threaded K-wire fixation for scaphoid nonunions. MATERIALS AND METHODS: We retrospectively reviewed the 13 patients with scaphoid nonunion, which was follow up at least 12 months from March 1999 to June 2003. According to the Mayo classification, two cases were type P (proximal third), eight cases were type W (waist) and three cases were type D (distal third). According to the Russe classification, eight cases showed horizontal oblique type, another two cases were transverse, and last three belonged to vertical oblique type. We assessed the radiologic bony union, correction of humpback deformity and lateral intrascaphoid angle and degenerative change of radioscaphoid joint, clinical results were evaluated using assessment of Maudsley. RESULTS: Radiologic union was obtained in all cases, mean time of union was 15.4 weeks (13~17.4 weeks), and there was no radiological evidence of postoperative humpback deformity, intercarpal instability, proximal osteonecrosis and degenerative changes. According to assessment of Maudsley, there were 7 excellent cases, 4 good cases, 1 fair case and 1 poor case among these 13 cases. The final clinical results were 11 excellent cases, 2 good case in the aspect of wrist pain and tenderness. All range of motion was satisfactory to patients except 4 cases (3 fair, 1 poor) and every patients could return to work except 1 poor case. CONCLUSION: The surgical treatment using a autogenous cancellous bone grafting combined with threaded K-wire fixation for scaphoid nonunion was a relatively straightforward technique, which provides simplicity, and high union rate.

Undercorrection of the Thoracolumbar Kyphotic Deformity in the Osteoporotic Spine Fractures / 대한척추외과학회지

STUDY DESIGN: A retrospective study. OBJECTIVES: To assess the efficiency of undercorrection and transpedicular screw fixation through a posterior approach in osteoporotic spine fractures with a thoracolumbar kyphotic deformity. SUMMARY OF LITERATURE REVIEW: The surgical treatment of osteoporotic spine fractures with a thoracolumbar kyphotic deformity requires extensive surgical procedures to obtain complete restoration of the sagittal alignment, but it has a few technical limitations due to insufficient mechanical stability at the bone-screw interface. A special strategy is essential for transpedicular screw fixation for osteoporotic spine fractures with a thoracolumbar kyphotic deformity. MATERIALS AND METHODS: We reviewed 14 osteoporotic spine fracture cases, with a thoracolumbar kyphotic deformity, which had undergone undercorrection and transpedicular screw fixation through a posterior approach, between March 2000 and June 2003, with an average follow-up period of 15. 2 months. According to the Jikei grade of the osteoporosis, 9 and 5 cases were grades 2 and 3, respectively. As a radiographic assessment, we measured the kyphotic angles of the fused segments on the preoperative, postoperative and last follow up thoracolumbar lateral views on standing using Cobb's method, and also assessed the kyphotic angle correction (KAC). The clinical results were evaluated at the last follow-up. RESULTS: The kyphotic angles at the preoperative, postoperative and last follow-up were 33.5 degrees +/- 9.3, 22.4 degrees +/- 6.9 and 24.7 degrees +/- 6.8, respectively. We obtained a mean KAC gain of 11.1 degrees postoperatively (p0.05). The clinical results were analyzed as good, fair and poor in 8, 5 and 1 case, respectively. Fusions were achieved in all cases. CONCLUSIONS: Undercorrection and transpedicular screw fixation for a thoracolumbar kyphotic deformity in osteoporotic spine fractures can be one of the alternatives to avoid fixation failure and an extensive surgical procedure.

Surgical Treatment of Intractable Lateral Epicondylitis with Nirschl Procedure / 대한정형외과학회잡지

PURPOSE: This study was performed to evaluate the results of surgical treatment of Nirschl procedure for intractable lateral epicondylitis of the elbow. MATERIALS AND METHODS: We retrospectively reviewed the functional records of surgically treated 21 cases from the 196 cases of lateral epicondylitis, which had been followed up at least 12 months from March 2000 to May 2003. Surgery was generally considered to be indicated if six months of conservative treatments since the first diagnosis had led to no improvement of the symptoms. The patients were evaluated by assessing of Pain Analog Scales (PAS) score. The objective outcomes of all patient after surgery were investigated according to the criteria by Roles and Maudsley. RESULTS: The mean PAS score followed up for 12 months postoperatively, had indicated significant improvements (p<0.001): 0.31 points (range, 0-2) at rest, 1.22 points (range, 0-3) at daily activities, and 2.25 points (range, 0-5) at sports and occupational activities. According to the Roles and Maudsley scores, there were 12 excellent, 7 good, 2 fair from the total of 21 cases; therefore, 19 (90%) cases showed the satisfactory results. CONCLUSION: The surgical treatment using the Nirschl procedure for intractable lateral epicondylitis of the elbow is considered as one of recommendable methods for the cases of no response at the conservative treatment.

Immuno-expression of Type IV Collagen in the Intervertebral Disc / 대한척추외과학회지

STUDY DESIGN: In vitro studies using human intervertebral disc for the localization of the type IV collagen. OBJECTIVE: 1) To study the distribution pattern and immunoexpression of type 4 collagen in the intervertebral disc, 2) To study the function of type IV collagen in the intervertebral disc. SUMMARY OF BACK GROUND: The correlations of degeneration changes and collagens in the dics have not been determined. The reports for type IV collagen were few. So far, the histologic analysis for the expression of type IV collagen in the intervertebral disc has not been done. There was no report to study the function of the type IV collagen in the intervertebral disc. METHODS: Fifty-four disc blocks obtained during anterior interbody fusion of the lumbar spine were used to observe the expression pattern of the type IV collagen with immunochemical stain. For the observation of the myxomatous degeneration in the intervertebral disc, the alcian blue stain with periodic acid-schilff was done. For the control group, 22 neonate intervertebral disc blocks were obtained at autopsy. RESULTS: The immunoreactions for type IV collagen were associated blood vessels in the anulus fibrosus in the disc. There was no statistical significant difference of the type IV collagen expression between the control and disease groups. Myxomatous degenerations were observed as the irregular form in the degenerative intervertebral disc. CONCLUSION: The immunoreactions for the type IV collagen were observed in the intervertebral discs and associated with the formation of the blood vessels, especially in anulus fibrosus.

Anatomy and Physiology of Lumbar Spine / 대한척추외과학회지

The spinal column is separated into the 7 cervical vertebra, the 12 thoracic vertebra, the 5 lumbar vertebra, the 5 sacral vertebra and the 4 coccygeal vertebra. The cervical, thoracic and lumbar vertebra are named as the movable vertebra and the sacral and coccygeal vertebra are named as the fixed vertebra. The lumbar spine includes five large vertebra situated between the rela-tively immobile rib cage and the pelvis. A typical lumbar vertebra has 2 main structures which are vertebral body and vertebral arch. The vertebral body is the anterior portion of a vertebra and the vertebral arch is the posterior portion of it and surrounds the vertebral foramen. In contrast to thoracic vertebra, lumbar vertebra has a wide disc space, sagittally oriented facets, and suf-ficient space between its lamina to permit a considerable range of motion. This report will explains some important normal anatomic features of the lumbar spine and sacrum including with their musclatures and neurovascular structures.

Comparison of the Results between Standard Discectomy and Microdiscectomy of the Herniated Lumbar Disc / 대한척추외과학회지

STUDY DESIGN: This study is a prospective evaluation of the results of the standard discectomy and microdiscectomy of the herniated lumbar disc. OBJECTIVES: The purpose of this study is to compare the clinical results between the standard discectomy and microdiscectomy groups in the herniated lumbar disc. SUMMARY OF LITERATURE REVIEW: Many spine surgeons believe that everything that can be accomplished through the standard discectomy can be accomplished more easily with the assistance of the microscope. So the standard laminectomy and discectomy is gradually being replaced by the microdiscectomy. MATERIALS AND METHODS: One hundred and seventy-three patients with lumbar disc herniations were evaluated. Ninty-six patients were operated through the standard method and seventy-seven patients were operated with the aim of the microscope. These operations were taken by one surgeon and the clinical results were undertaken by a doctor who was not involved in the operation using a proven outcome assessment scale. RESULTS: There were significant differences between the standard discectomy and the microdiscectomy groups in terms of complications and revision rates. In microdiscectomy group, clinical result was less favorable than standard discectomy group. CONCLUSION: In microdiscectomy groups the incidence of infection and rate of revision operation were higher than in standard discectomy groups. The standard discectomy is still thought better than the microdiscectomy in the operative treatment of herniated lumbar disc.

Intradiscal Gene Therapy: Therapeutic Implications in Degenerative Disc Disease / 대한척추외과학회지

STUDY DESIGN: In vitro and in vivo studies to determine the anabolic effects of intervertebral disc (IVD) to adenovirus-mediated therapeutic gene transfer. OBJECTIVES: To quantify the anabolic effect of human IVD cells in vitro and rabbit IVD in vivo to therapeutic gene transfer. SUMMARY OF LITERATURE REVIEW: An alternative possibility to delivery of growth factors, in continuous manner, is the genetic modification of disc cells through gene transfer. Contemplating to extend this approach to treatment of disc degeneration, it is necessary to demonstrate anabolic effect of human IVD cells and rabbit disc to therapeutic gene transfer. MATERIALS AND METHODS: In vitro: IVD tissue was obtained from twelve patients. IVD cells were then isolated, cultured, and transduced with Ad/TGF-beta1. Genetically modified disc cells were incorporated into alginate beads and cultured. In vivo: Fifteen skeletally mature New Zealand white rabbit were used. 15ul of saline containing Ad/TGF-beta1 were injected into the nucleus pulposus of the disc in six rabbits. All rabbits were sacrificed 6 weeks after surgery. Nucleus pulposus tissues were harvested, weighted, and cultured. Conditioned medium of alginate bead and rabbit disc tissue cultures were subjected to ELISA to detect TGF-beta1 production. Newly synthesized proteoglycan were analyzed using chromatography on Sephadex G-25 in PD-10 columns after S35-sulfate incorporation. RESULTS: Concentration of TGF-beta1 increased over time in alginate beads cultures transduced with Ad/TGF- beta1. At 6 weeks nucleus pulposus tissue from the disc injected with Ad/TGF-beta1 exhibited 200% (p<0.05) increase in TGF- beta1 production. There was statistically significant 290% increase in newly synthesized proteoglycan in alginate cultures transduced with Ad/TGF- beta1 (p<0.05) compared to control. At 6 weeks nucleus pulposus tissue from the disc injected with Ad/TGF- beta1 exhibited 85% increase in proteoglycan synthesis (p<0.05) over that of intact control. CONCLUSION: In this study, we observed the robust upregulation of proteoglycan synthesis in gene transferred disc cells in vitro and in vivo - indicating good prospects for biologic effects of therapeutic gene therapy in the disc using adenovirus-mediated approach.

Neurologic Injury and Recovery Patterns in the Spinal Fractures by Denis Classification / 대한척추외과학회지

PURPOSE: To determine whether there was a preponderance of a fracture type associated with early and late neurologic deterioration. MATERIALS AND METHODS: The review of all the surgically managed spinal fractures from October 1989 to July 1999 was performed. Of the 83 surgically managed patients, 39 had spinal cord injury. The other 44 patients in this consecutive series had no spinal cord injury. Charts, operative notes, preoperative and postoperative plain radiographs, computed tomography scans, and follow up records of all patients were reviewed carefully from the time of surgery until last follow-up assessment. The classification of Denis had been used prospectively for all patients before their surgery to determine the fracture morphology. Frankel Scale and American Spinal Injury Association Spinal Cord Injury Assessment Form(ASIA) were obtained during follow-up evaluation for all patients. RESULTS: All patients were observed over mean 57.4 months except 1 patient who died of pulmonary thromboembolism 1 week after surgery. In Denis classification, the most common injuries were burst fracture and fracture-dislocation. The degree of neurologic injury when first seen and at the latest follow up was different between burst fracture and fracture-dislocation. The extent of neurologic recovery was not different between burst fracture and fracture-dislocation. The fracture-dislocation was common in thoracic spine and the degree of neurologic injury was most severe in thoracic spine. Instead, the burst fracture was more common in lumbar spine and the degree of neurologic injury was relatively mild in lumbar spine. CONCLUSIONS: The severity of initial posttraumatic and the last follow up neurologic injuries were correlated with the fracture patterns by Denis classification, but the extent of neurologic recovery was not correlated with the fracture patterns by Denis classification. The lumbar fracture, injuring the cauda equina and the sacral nerve roots, shows greater recovery patterns than thoracic spine fractures.

Anatomic Consideration of Lumbar Spinal Stenosis / 대한척추외과학회지

No abstract available.

Change of Lumbar Lordosis According to the Different Operative Positions / 대한척추외과학회지

No abstract available.

High Lumbar Disc Herniations / 대한척추외과학회지

STUDY DESIGN: This study is a retrospective evaluation of the high lumbar disc herniations. OBJECTIVE: The purposes of this study is to observe the clinical and radiological findings and out-comes of the high lumbar disc herniations, thus providing a guideline for making diagnosis and for proper treatment modality. SUMMARY OF LITERATURE REVIEW: High lumbar disc herniations at the L1 -2, L2-3 and L3-4 levels represent less than 5% of all disc herniations. The location of pain was highly complected. The represented symptoms and signs such as motor, sensory and reflex changes were variable and potentially misleading in suggesting a level of the disc herniation. MATERIAL AND METHODS: Thirty-one patients with high lumbar disc herniations were retrospectively evaluated. Seventeen patients were treated conservatively and fourteen patients underwent surgery. Review of results was undertaken by an independent observer using a proven outcome assessment measure. RESULTS: The incidence of high lumbar disc herniation is 4.7%(L1-2: 13%, L2-3: 29%, L3-4: 58%) with declining frequency as the level ascends. The peak age incidence is 6th decade in male and 5th decade in female. The positive rate of femoral nerve stretching test(74%) is higher than that of straight leg raising test(51%). In fourteen operative cases, the positive rate of straight leg raising test is 86%. The accuracy of MRI findings in predicting the type of herniated disc is 93%. In results of operation thirteen cases showed more than fair grade(93%). CONCLUSION: The age incidence of the high lumbar disc herniation is older than that of the lower lumbar disc herniation. The femoral nerve stretching test is more useful than straight leg raising test in making diagnosis of high lumbar disc herniations. The prognosis after treatment is comparable with high lumbar disc herniations.

Herniated Lumbar disc in Patients over the Age of Sixty / 대한척추외과학회지

No abstract available.

A Report of Intraocular Lens Implantations in Korea

The implantation of intraocular lens(IOL) has now been routinely used in cataract surgery and its indication has more extended gradually. Improvement of surgical methods, IOL designs and dvelopment of viscoelastic substance have accelerated the implantation of IOLs. In Korea, 20 IOL Study Club also was organized in 1984. And in 1988, domestic mode IOL named UNI-PCL was finally approved from ROK government. This report is concernd to investigate the datas of IOL implantations in Korea by use of questionnaire method which was conducted by prof. Dr. Jae Ho Kim. The brief summary on 21,779 IOL cases from 1975 to May 31, 1988 is as follows. 1. Cases of Primary IOL implantation were 21,093(973%) among 21,779 cases and posterior chamber lens(PCL) implantation was done in 20,242 case(95%) among primary IOL implantation. 588 cases(2.7%) were secondary IOL implantation, among them, cases of ACL implantation were 361(61.4%). 2, PCL implantation was done in 20,269 cases(91.1%) and ACL implantation in 1,412 cases(6.4%). It shows that PCL implantation has increased in number annually. 3. J-loop type of PCL including modified J-loop type was most comonly used and the use of C-Ioop type was gradually increased. 4. Posterior capsule rupture was the most common complication in intraoperative period, However, the transient intraocular pressure rise and after cataract were the most common complications in early and late postoperative period. 5. The most common cause of blindness after IOL implantation was bullous keatopathy. 6. In this study, number of surgeons who performed IOL implantation were 120 and IOL implantation was thought to be performed more than 75 hospitals including general hospital and offices.

A Report of Intraocular Lens Implantations in Korea

The implantation of intraocular lens(IOL) has now been routinely used in cataract surgery and its indication has more extended gradually. Improvement of surgical methods, IOL designs and dvelopment of viscoelastic substance have accelerated the implantation of IOLs. In Korea, 20 IOL Study Club also was organized in 1984. And in 1988, domestic mode IOL named UNI-PCL was finally approved from ROK government. This report is concernd to investigate the datas of IOL implantations in Korea by use of questionnaire method which was conducted by prof. Dr. Jae Ho Kim. The brief summary on 21,779 IOL cases from 1975 to May 31, 1988 is as follows. 1. Cases of Primary IOL implantation were 21,093(973%) among 21,779 cases and posterior chamber lens(PCL) implantation was done in 20,242 case(95%) among primary IOL implantation. 588 cases(2.7%) were secondary IOL implantation, among them, cases of ACL implantation were 361(61.4%). 2, PCL implantation was done in 20,269 cases(91.1%) and ACL implantation in 1,412 cases(6.4%). It shows that PCL implantation has increased in number annually. 3. J-loop type of PCL including modified J-loop type was most comonly used and the use of C-Ioop type was gradually increased. 4. Posterior capsule rupture was the most common complication in intraoperative period, However, the transient intraocular pressure rise and after cataract were the most common complications in early and late postoperative period. 5. The most common cause of blindness after IOL implantation was bullous keatopathy. 6. In this study, number of surgeons who performed IOL implantation were 120 and IOL implantation was thought to be performed more than 75 hospitals including general hospital and offices.