Herniation of Upper Lumbar Disc: Clinical Finding & Surgical Result

STUDY DESIGN: A retrospective study. OBJECTIVES: We attempted to establish an efficient diagnosis and treatment modality by analyzing clinical manifestations and operative results of upper lumbar disc herniations. SUMMARY OF LITERATURE REVIEW: Upper lumbar disc herniations represented a lower incidence but have become easier to diagnose by predictable clinical aspects and an MRI scan. The operative results have been satisfactory. MATERIALS AND METHODS: We evaluated 41 cases, which were operated with posterior laminectomy and discectomy from September, 1996 to November, 2009. We analyzed pre-operative history, clinical and MRI findings, and then assessed operative results by Kim's criteria and functional change in the follow up. RESULTS: The prevalence of upper lumbar disc herniations in all disc herniations was 8.8%. Pre-operative manifestations were lower back pain (85.4%), radiating pain (80.5%), sensory deficit (53.7%), motor deficit (53.7%), and depressed knee jerk (65.9%). The positive rate of the femoral stretching test (78.0%) was higher than the straight leg raising test (39.0%). The VAS score changed from preoperative 9.0+/-0.8 into postoperative 1.4+/-1.3 points. The operative results were excellent or good in 82.9%. The rate of resuming previous work, including slight modification was 90.2%. CONCLUSIONS: Predictable clinical aspects of the upper lumbar disc herniations are anterior thigh pain with lower back pain, variable motor deficit, sensory deficit, depressed knee jerk and the positive femoral nerve stretching test. Through careful examination and radiological evaluations such as MRI, operative treatment can obtain a symptomatic improvement and satisfactory results.

Comparison of Proximal Metatarsal Osteotomy andDistal Chevron Osteotomy for Correction of Hallux Valgus / 대한족부족관절학회지

PURPOSE: The purpose of this study is comparison of radiological and clinical outcomes between proximal metatarsal osteotomy and distal chevron osteotomy for the correction of hallux valgus. MATERIALS AND METHODS: In this retrospective study, we included subjects who underwent the correction of hallux valgus in our institution between March 2001 and August 2006, with a minimum follow-up of 12 months. The group of proximal metatarsal osteotomy was 23 patients (34 feet); the group of distal chevron osteotomy was 20 patients (26 feet). The group of proximal metatarsal osteotomy was composed of 26 severe cases (76.5%) and 8 moderate cases (23.5%); the group of distal chevron osteotomy was composed of 13 severe cases (50.0%) and 13 moderate cases (50.0%). RESULTS: Compared to preoperative values, the hallux valgus angle, the first-second intermetatarsal angle and the distance of first-fifth metatarsal head were significantly decreased in two groups (p<0.05). In each parameter, the hallux valgus angle was decreased 66.3% (proximal metatarsal osteotomy) versus 49.6% (distal chevron osteotomy), which were significant (p=0.037). The first-second intermetatarsal angle and the distance of first-fifth metatarsal head were not significant. Mayo clinic forefoot scoring system (FFSS) score was significantly improved in two groups (p<0.05). The ratio of improvement was not significant (p=0.762). In severe group, hallux valgus angle and the first-second intermetatarsal angle was significantly decreased in proximal metatarsal osteotomy group compared to distal chevron osteotomy group (p<0.05), but the difference of the distance of first-fifth metatarsal head and FFSS score was not significant in both groups. In moderate group, the difference of all parameters was not significant in both groups. CONCLUSION: Although both proximal metatarsal osteotomy and distal chevron osteotomy showed satisfactory result in FFSS, proximal metatarsal osteotomy was more proper operative technique than distal chevron osteotomy in severe group, because of superiority of correction in radiological parameters.

The Relationships between Homocysteine, Folate, MTHER and TSER Polymorphism for Osteoporotic Compression Fracture in Postmenopausal Women / 대한정형외과학회잡지

PURPOSE: To analyze the relationships between homocysteine, folate, MTHFR and TSER polymorphism for postmenopausal women with osteoporotic compression fractures. MATERIALS AND METHODS: Forty-three postmenopausal compression fracture patients and as many normal controls were included. The plasma homocysteine and folate levels were measured using a FPIA (fluorescent polarizing immunoassay) kit. The MTHFR and TSER genotypes were amplified by PCR (polymerase chain reaction) and separated by RFLP (restriction fragment length polymorphism) in a 3.5% agarose gel. RESULTS: The plasma folate level was significantly lower in the postmenopausal women with osteoporotic compression fractures, particularly in the MTHFR 677CT and TSER 2R (-) genotypes. However, the plasma homocysteine level and MTHFR C677T polymorphism were similar to the control group. CONCLUSION: A low folate level and the TSER 2R (-) genotype can be associated with osteoporotic compression fractures in postmenopausal women.

Femoral Head and Neck Fractures developed in Avascular Necrosis of the Femoral Head

Femoral head and neck fractures during the course of avascular necrosis are rare with only few reports in the English literature. Moreover, there are very few reports on an analysis of the patterns of these fractures. Four cases of femoral head fracture caused by minor trauma, which were quite different from the crescent fractures during the course of avascular necrosis were analyzed in regard to the underlying disease, causes, sites, types, directions, pattern of fractures and the injury mechanism of the fractures. The results are reported with special regard to the pattern of the stress fracture of the femoral head and neck during the course of avascular necrosis.

Reconstruction of Iliac Crest Donor Site Using 1/3 Tubular Plate / 대한척추외과학회지

STUDY DESIGN: This is a prospective study OBJECTIVES: The purpose of this study is to describe the technique for reconstruction of the iliac crest graft donor site and to determine the clinical results of its application. Summary of literature REVIEW: An iliac crest tricortical bone graft is frequently used for anterior interbody fusion of the spine. For preventing iliac crest graft donor site morbidity (pain, skin dimpling, etc), various graft materials have been used, for example, rib, cement, ceramic and so on. However, the rib needs another incision for lumbar or cervical fusion, the cement sometimes causes the wound infection, and the bioactive ceramic spacer has not had its long term results confirmed. MATERIALS AND METHODS: We prospectively analyzed 28 patients who underwent iliac crest reconstruction with a 1/3 tubular plate after bone harvesting between 1998 and 2004. Pain at postoperative 1 month, 6 months and 1 year was checked by the visual analogue scale (VAS). The cosmetic appearance, foreign body sense, overall satisfaction (according to the methods of Ito et al), complications and the radiologic evaluations were all analyzed as indicators of the outcome. RESULTS: The mean visual analogue scale was 3.5 and 0.1 at postoperative 1 and 12 months, respectively. For the cosmetic appearance, among the 28 patients, 24 patients felt a smooth and satisfactory outline (Excellent). 25 patients couldn't feel any foreign body sense. One patient experienced wound infection. No plate breakage or screw loosening were observed. CONCLUSIONS: Reconstruction of the iliac crest with a one-third tubular plate after tricortical bone graft harvest could be a favorable method. the screws during the consolidation of PMMA.

Relationships Between Canal Occlusion and Neurologic Deficits, and Between Kyphotic Deformities and Fracture Types in Unstable Thoracolumbar Burst Fractures / 대한척추외과학회지

STUDY DESIGN: A retrospective study. OBJECTIVES: To evaluate the relationships between spinal canal occlusion and neurologic deficits, and between spinal canal decompression and neurologic recovery in thoracolumbar burst fractures. Kyphotic deformities, based on the fracture types in short-segment instrumentation and fusion, were evaluated to determine effective operative methods. SUMMARY OF LITERATURE REVIEW: In thoracolumbar burst fractures, the relationship between spinal canal occlusion and neurologic deficits remains controversial; and definitive guidelines for short-segment instrumentation and fusion have not been established . MATERIALS AND METHODS: Surgically treated thoracolumbar burst fractures (N=112) were analyzed retrospectively. Spinal canal occlusion in both neurologically intact and deficient groups, and neurologic recovery as a result of spinal canal decompression, were evaluated based on Frankel's grades. Kyphotic deformities based on the Denis classification and McCormack's load sharing classification were evaluated in 86 short-segment instrumentation patients. RESULTS: Spinal canal occlusion in the neurologically deficient group (51.8%) was significantly higher than that in the neurologically intact group (31.4%) (p 0.05). Kyphotic deformities were increased significantly in Denis type A, B and groups with more than 7 points in the load sharing classification (p < 0.05). CONCLUSION: In thoracolumbar burst fractures, the degree of initial spinal canal occlusion was more significantly related with neurologic deficits than with postoperative spinal canal decompression. Extended instrumentation and fusion is recommended for reducing postoperative kyphotic deformities in Denis type A, B and groups with more than 7 points in the load sharing classification.

Salmonella Pyomyositisina Multiple Myeloma Patient: A Case Report / 대한정형외과학회잡지

Pyomyositis is a bacterial infection of the skeletal muscle with Staphylococcus aureus being the most common pathogen. Pyomyositis by salmonella is quite rare accounting for less than 1% of the total pyomyositis, and has some different characteristics and a poor prognosis compared with those of the typical pyomyositis caused by other bacteria. Among these differences, an older age, other combined diseases, and an immune deficient condition are factors predisposing a patient to pyomyositis by salmonella. We experienced a very rare case of pyomyositis by salmonella at the inguinal area in a multiple myeloma patient. This is the first case reported in South Korea.

Comparison of Influenceon Displaced Femoral Neck Fractures in Young Adults : Fracture Level and Comminution, Time to Operation and Reduction / 대한정형외과학회잡지

PURPOSE: To analyze the influences of fracture level and comminution, time to operation and reduction quality on the results of displaced femoral neck fractures in young adults. MATERIALS AND METHODS: From January 1996 to January 2003, 39 of 51 cases of displaced femoral neck fractures that were treated with closed reduction and percutaneous internal fixation using cannulated screws, were evaluated after at least two years of follow-up with respect to the fracture level, comminution, time to operation, and reduction quality. RESULTS: The incidence of AVN and non-union were 6/39 (15.4%) and 3/39 (7.7%), respectively. The differences in the incidences of complications among subcapital, transcapital, and subcapital fractures was not significant (p=1 & p=1). There was a higher incidence of AVN (p=0.0066) and non-union (p=0.0219) with posterior comminutions than anterior ones. The time to operation was not an important factor in influencing the development of complications (p=0.4984 & p=1). Between acceptable and poor reductions, the differences in the incidences of AVN was significant (p=0.0105), but not in the incidences of non-unions (p=0.1011). CONCLUSION: We concluded that good quality of reduction is more important than the time to operation for achieving good results, and that comminution is a more important prognostic factor than is the fracture level.

Internal Fixation with Two Lowprofile Plates in Fractures of the Distal Tibia

PURPOSE: To evaluate the functional results after internal fixation with two low profile plates in fractures of the distal tibia. MATERIALS AND METHODS: From March 1998 to October 2002, twelve patients with fractures of the distal tibia were treated with internal fixation using two low profile plates and followed for at least one year. Fractures according to AO/OTA classification were one Type A1, four Type A2, two Type C1, two Type C2 and three Type C3. We analyzed the functional results by the Olerud and Molander ankle scoring system and the postoperative complications. RESULTS: The average functional score was 81.2 points and the results were three excellent, six good, one fair and two poor. Bony union was achieved in all cases. There was 1 case of superficial wound infection as a complication. CONCLUSION: Internal fixation with two low profile plates in fractures of the distal tibia may minimize the incidence of soft tissue complications and provide good bony union and functional results. Therefore, we consider internal fixation with two low profile plates as a good alternative treatment of the distal tibial fracture.

Clinical Distribution of Bilateral Non-contemporary Hip Fractures in Elderly Patients

PURPOSE: To evaluate the clinical distribution of bilateral non-contemporary hip fractures regarding to fractures type, risk factors and fractures interval in elderly patients. MATERIALS AND METHODS: 24 bilateral non-contemporary cases among 621 hip fractures from Sep. 1997 to Dec. 2004 were evaluated regarding to gender, age, incidence, Singh index, causes, interval, fracture pattern, operative methods and underlying diseases between the two fractures retrospectively. RESULTS: The distribution is as follows: males to females (5:19), incidence (3.86%), mean age (76.9 years and 78.9 years), average Singh index 2.5 degree (2~4) and 2.1 degree (1~3) respectively. 21 cases (87.5%) in both fractures suffered from minor slips and 19 cases (79.1%) occured within 3 years of the first fracture and 17 (68.1%) cases were same type fractures. Bipolar hemiarthroplasty was performed in 12 cases. All but one patient had underlying cardiovascular diseases and CVA sequales. CONCLUSION: To prevent the bilateral non-contemporary hip fractures, surgeons must bear in mind that osteoporosis treatment, control of underlying cardiovascular diseases and CVA sequales, and the effective rehabilitation is very important.

Interlocking Intramedullary Nailing in the Distal Metaphyseal Fractures of the Tibia

PURPOSE: To evaluate the clinical and radiographic results of interlocking intramedullary nailing for the distal metaphyseal fractures of the tibia and to identify the usefulness of the interlocking intramedullary nailing. MATERIALS AND METHODS: Thirty four patients who underwent interlocking intramedullary nailing for distal metaphyseal fractures of the tibia were reviewed with a follow-up period of more than 2 years. Clinical result was assessed using the Olerud score and this score was marked as percentage of prefracture state. Radiographic results were assessed with varus-valgus angle, anterior-posterior angle, and bone union time. We checked the cases of complication and need for additional surgery after interlocking intramedullary nailing. RESULTS: Clinically, Olerud score averaged 92.1% (76~100%). Radiographically, average varus-valgus angle was 1.6+/-2.9 degrees and average antero-posterior angle was 0.8+/-3.3 degrees. Bone union time averaged 18.7 weeks. As complications, there were one deep infection and two breakages of distal interlocking screw. In additional surgery, there were 1 debridement and soft tissue flap, and one dynamization of nail at postoperative 12 weeks. CONCLUSION: Interlocking intramedullary nailing is one of safe and reliable method for distal metaphyseal fractures of the tibia, considering less soft tissue injury, possibility of early range of motion exercise, high bone union rate, and low complications rate.

Usefulness of the Oblique Radiographic View in Ankle Fractures / 대한족부족관절학회지

PURPOSE: To compare the radiographic evaluations between two radiographic views (AP and lateral views) and four radiographic views (AP, lateral and both oblique views) in ankle fractures. MATERIALS AND METHODS: From January 2000 to June 2002, 60 cases of ankle fractures were treated with open reduction and internal fixation and its followed up periods were at least 2 years. All cases were classified into three groups according to the method of preoperative radiographic evaluation. Two radiographic views (AP and lateral views) were taken in group A and four radiographic views (AP, lateral and both oblique views) were taken in group B. 12 Cases were evaluated with three dimensional computed tomography (3D CT). Four radiographic views and 3D CT were taken in group C. All cases were classified according to the Danis-Weber and Lauge-Hansen classification. Displacement of fracture fragment of medial, lateral, posterior malleolus and size of fracture fragment of posterior malleous were measured using picture archiving communication system (PACS). RESULTS: Although kappa value between two or four radiographic views were good or excellent in Danis-Weber classification and Lauge-Hansen classification of ankle fractures, the displacements of medial and lateral malleoli were statistically different. Four radiographic views evalulated the degree of displacement of medial and lateral fragments more accurately compared to two radiographic views. CONCLUSION: Four radiographic views will be more useful than two radiographic views to decide the method of treatment and operation considering the displacement of fracture fragment.

The Effect of Fibular Malreduction on Ankle Joint after Tibial Interlocking IM Nailing of Tibial and Fibular Fractures

PURPOSE: To investigate the effect of fibular malreduction on ankle joint after tibia interlocking IM nailing of tibial and fibular fractures according to type of fibular fractures at preoperation. MATERIALS AND METHODS: Thirty-nine patients who had ipsilateral tibiofibular fracture were analyzed clinically and radiographically. The talocrural angle and the distance from joint line to the tip of fibular were measured on both ankle standing AP view. The difference of angle and distance of both ankle were analyzed by paired t-test and correlation between defference and AOFAS score by Spearman correlation coefficients. RESULTS: The difference of The talocrural angle and the distance from joint line to the tip of fibular of both ankle was statistically significant (p0.05). CONCLUSION: In tibia interlocking IM nailing of tibia and fibula fracture, malreduction of fibula could cause the change of ankle joint.

Reduction of Pediatric Forearm Diaphyseal Fractures by Pin Leverage Technique

PURPOSE: Although the majority of children's forearm diaphyseal fractures may be treated conservatively with closed reduction and cast immobilization, unstable or irreducible fractures are usually treated by surgical management. Authors performed percutaneous pin leverage reduction technique for irreducible displaced diaphyseal fractures. The aim of this study is to determine the efficacy of pin leverage technique in pediatric forearm diaphyseal fractures MATERIALS AND METHODS: In this retrospective study, we reviewed 22 cases of forearm diaphyseal fractures reduced by percutaneous pin leverage technique between 1997 and 2002. We analyzed radiographs, operation time, hospital stay and immobilization period, range of motion, postoperative complications and functional results by Thomas. RESULTS: Average length of follow up was 28 months with mean age of 10.5 years. All fractures in this series healed less than 2 degrees of diaphyseal angulation. Average operation time including anesthesia was 42 minutes and hospital stay was 4.6 days. Time to union was 49.6 days in average and range of motion and functional results were satisfactory in all cases except one case of congenital radioulnar synostosis. There was one case of superficial pin track infection as complication. CONCLUSION: In operative treatment of children's diaphyseal fractures of forearm bones, percutaneous pin leverage reduction technique is a good alternative method prior to open reduction in case of difficult closed reduction.

Comparison of Functional Recovery between Internal Fixation and Hemiarthroplasty in Basal Intertrochanteric Fracture in the over Eighties / 대한정형외과학회잡지

PURPOSE: To compare functional recovery and clinical outcome for internal fixation and hemiarthroplasty groups over eighty years old for basal intertrochanteric fracture. MATERIALS AND METHODS: Forty-two cases among 62 treated from Aug. 1997 to May 2001 (22 internal fixation-group A and 20 hemiarthroplasty-group B) were retrospectively evaluated to assess walking level, activity of daily living, mental status, dementia, chronic illness and complications after at least a one year follow up. RESULTS: Partial weight bearing was started at a postoperative 14.5 and 9.5 days and full weight bearing at 10 and 3 weeks in group A and B, respectively. Walking level changed from 3.5 to 2.2 in group A, from 3.0 to 2.5 in group B, and the daily living activity scale from 4.8 to 7.9, and from 4.6 to 6.2. Mental status reduced from 22.8 to 18.2, and from 22.8 to 19.7 in each group. Newly developed dementia occurred in 6 and 5, and the index of chronic illness increased from 2.09 to 2.27, and from 2.05 to 2.25 in each group. Other postoperative complications showed no significant difference between the groups. CONCLUSION: The authors suggest bipolar hemiarthroplasty shows better functional recovery in terms of walking level, activity of daily living, and mental status, but same recovery for dementia, postoperative delirium and chronic illness compared to the internal fixation group. Therefore, the authors suggest that bipolar hemiarthroplasty in an effective surgical method in the over eighties.

Bipolar Hemiarthroplasty for the Femur Neck Fractures in Patients Aged Around Ninety

PURPOSE: To evaluate the functional changes, postop delirium and complications after cemented bipolar hemiarthroplasty for the femur neck fractures in patients aged around ninety. MATERIALS AND METHODS: Between May 1995 and April 2002, of the twenty seven patients, 17 who follow-up for at least one year were included in this study. Walking ability, activity of daily living, mental status, chronic illness, postoperative delirium and complications were evaluated retrospectively using Yoon's walking class, ADL scale, MMSE-K score, ASA classification, DSM IV respectively. RESULTS: The walking ability was decreased to 2.4 from 3.3 tendency of reliance in ADL scale was increased to 8.3 from 4.5, MMSE-K score was decreased to 15.9 from 21.7. There was no significant change in status of chronic illness. Postoperative delirium occurred in eight (47%) cases and all of them recovered completely. complications included bladder problem in eleven (66%) cases, temporary respiratory distress in two (12%) cases, hip dislocation in two (12%) cases, infection in one (6%) case. Overall thirteen (78%) cases were able to walk with supports. CONCLUSION: This study indicates that physicians treation femur neck fractures in patients aged around ninety must anticipate worsening of the functional changes more especially in regard to walking level, activity of daily living and mental status, little changes of chronic disease status, complete recovery of postop delirium and high complication rate

Treatment of the Distal Radius Intraarticular Fractures with Percutaneous Pinning and External Fixator / 대한정형외과학회잡지

PURPOSE: We reviewed the functional and radiological results of unstable intraarticular fractures of the distal radius treated by percutaneous pinning with an external fixator. MATERIALS AND METHODS: Twenty-seven cases of unstable intraarticular fractures of the distal radius were treated by percutaneous pinning and external fixation between October 1996 and September 1999, and followed up for more than 1 year. We classified them using the Frykman classification and evaluated functional and radiological results according to the subjective point system of Cole & Obletz and the objective evaluation by Scheck. RESULTS: Subjectively, we obtained the following results: excellent in 7 cases, good in 13 cases, fair in 6 cases and poor in 1 case, and objectively, 8 cases were excellent, 14 cases were good, 4 cases were fair and 1 case was poor. Radiographically, mean volar tilt, radial inclination and radial length were 9.5degrees, 22.1degrees and 10.3 mm respectively on the last follow-up. Two cases of reflex sympathetic dystrophy and one of each of skin necrosis, pin tract infection, joint stiffness and metacarpal bone fracture occurred during the follow-up period. CONCLUSION: Percutaneous pinning and external fixation is a useful method for reducing mal-alignment and radial length maintenance, preventing reduction loss and restoring the articular surface and function of the distal radius in cases of intraarticular comminution, open fracture with soft tissue injury and multiple injury.

Subperiosteal Ganglion Cyst of the Tibia Communicationg with the Knee: A Case Report

Subperiosteal ganglion is a rare lesion. It is reported that the lesion is developed at femur, radius, ilium and tibia. 64-year-old male visited our hospital complaining of exudate on leg. He had been treated at private clinic about soft tissue mass on anteromedial aspect of the leg. After MRI study, we performed arthroscopic examination. It is comfirmed that a communication is present between subperiosteal ganglion cyst and knee joint. Arthroscopic synovectomy and meniscectomy were performed. The cyst was excised. The clinical result was satisfactory.

Interbody Fusion using Iliac Crest Allograft in Global Spinal Fusion / 대한정형외과학회잡지

PURPOSE: To analyze the efficacy of iliac tricortical allograft (Tutoplast (r) ) as an anterior load sharing construct in global fusion consisting of interbody fusion, transpedicular screw fixation and posterolateral fusion. MATERIALS METHODS: We followed up 40 levels in 27 patients who had undergone interbody fusion using iliac tricortical allograft (Tutoplast (r) ) and added transpedicular screw fixation and poterolateral fusion from Dec. 1995 to Dec. 1996. They were followed up for more than 2 years. The disease entities included 11 patients with spondylolisthesis, 8 patients with spinal stenosis with lumbar intervertebral discs herniation, 6 patients with degenerative lumbar kyphoscoliosis and 2 patients with pseudoarthrosis. Anterior interbody fusion was performed in 11 cases and posterior lumbar interbody fusion in 16 cases. RESULTS: The radiological union rate of interbody fusion was 90% (36/40) , and collapsed union was 7.5% (3/40) ranging from 11% to 28% collapses of initial graft height. The non-union occurred at level 1, which showed radiolucent line on host-graft interface but did not reveal instability on stress views. The radiologic union rate of the posterolateral fusion was 100%. Complications such as metal failure and infection were not noted. Satisfactory clinical results were 88.9%. CONCLUSION: Iliac tricortical allograft was a good substitute for an anterior load sharing construct in interbody fusion combined with transpedicular screw fixation and posterolateral fusion.

Titanium Mesh Cylinder as an Anterior Strut in Reconstructive Spinal Surgery / 대한척추외과학회지

STUDY DESIGN: A retrospective study. OBJECTIVES: To evaluate the efficiency of titanium mesh cylinder as an anterior strut in reconstructive spinal surgery. SUMMARY OF LITERATURE REVIEW: Biomechanically, 80 to 85% of the axial forces on the upright spine are distributed through the anterior column. Reconstruction of the anterior column using load sharing construct is essential for normal spinal biomechanics in various anterior column deficiency conditions. Titanium mesh cylinder as an anterior strut has advantages in these surgical conditions, and may be an effective alternative to strut bone graft. MATERIALS AND METHODS: From October 1993 to May 1998, 22 patients received reconstructive spinal surgery using titanium mesh cylinder-bone graft composite. Average follow up period was 3(1/2)years(range: 1(1/2)to 6 years). 20 of them were male and 2 were female and average age was 45 years(range: 21 to 69 years). The diagnoses were kyphosis/kyphoscoliosis, burst fracture/ fracture-dislocation, revision surgery, tumor, and multiple thoracic HNP. Radiographs were taken preoperatively, postoper-atively at 2 weeks, 4, 6, 9, 12, 18, 24 months, and yearly thereafter, these were read for change of sagittal angle correction, anterior bony fusion, settling of the titanium mesh cylinder-bone graft composite, or instrument failure. RESULTS: Radiologic union between titanium mesh cylinder & vertebra appeared at (1/2)to 1 (1/2)years follow-up period. 81.8%(18 of 22 cases) showed definite bony trabeculation, and 18.2%(4 of 22 cases) showed immature bony trabeculation. Sagittal angle correction loss was measured by average 7.6 .(range: 5 .to 9 .) in 8 of 22 cases, all of which appeared at 4 months to 1 year follow-up period. Correction loss was associated with penetration of spikes of titanium mesh cylinder into endplates of adjacent vertebral bodies until internal rings contact endplates, but was not accompanied with implant failures, dislodgement or migration of titanium mesh cylinder. CONCLUSIONS: Titanium mesh cylinder can be used as a good substitute of anterior strut in combination with rigid spinal fixa-tion in reconstructive spinal surgery.