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.

Intracranial Arteriovenous Malformation Associated Intracranial Aneurysms

The simultaneous occurrence of one or more intracranial aneurysm and an intracranial arteriovenous malformation(AVM) in a patient is unusual. Four cases of intracranial aneurysm associated with cerebral arteriovenous malformation(AVM) were found in a total of 67 patients with cerebral malformation(AVM). The site of aneurysm was related anatomically to the arterial supplying arteriovenous malformation(AVM) in 3 cases and the bleeding source was aneurismal rupture in all four cases(100%). It is generally accepted that aneurysm is caused by hemodynamic stress result from the presence of an arteriovenous malformation(AVM). The management of the unusual problem is controversial which are surgical obliteration of both vascular lesion in one stage(2 cases) and surgical obliteration of both vascular lesion in two stages(1 case) were accomplinished with good surgical result.

Ischemic and Hemorrhagic Cerebral Lesion of the Newborn

Stroke in infant was relatively rare. But recently, development of diagnostic tools and infantile intensive care unit were introduced. So, early detection and follow up study were easily performed and the motality of infant stroke was improved. The pathophysiologic factor was multiple such as structural, development and physiological aspects of brain circulation and cardiorespiratory perinatal accidents, which are the cause of several neuropathology. So, preventable secondary factors such as perinatal asphyxia, respiratory manipulation during daily care should be removed thus, mortality and morbidity were decreased. Therefore, the anthors analysized 16 patient, with storke whom age were younger less than 1 year for searching of preventable secondary factors.

Surgical Experience of the Distal Internal Carotid Artery Aneurysm

Bifucation of the internal carotid artery aneurysms are rare. But they are paticulary difficult to treat surgically because of perforating arteries surrounding and adherent to the aneurysm. In this series, fourteen patients with bifucation of internal carotid artery aneurysms were treated with direct surgery. Tweleve patients of these were treated with clipping, two were treated with coating. 57% of the patients had a good or excellent result and there was a 7% mortality.