ABSTRACT
STUDY DESIGN: This study is a retrospective evaluation of the surgical outcome by the patient satisfaction and Oswestry low back pain questionnaire. OBJECTIVE: The goal of this study was to evaluate the clinical correlations of various factors with the patient's satisfaction and with the surgical results in degenerative spinal stenosis. SUMMARY OF LITERATURE REVIEW: The patients satisfaction and surgical outcome of the degenerative spinal stenosis by the objective method have not been well described in the literature. MATERIAL AND METHODS: Mean follow-up period was 4.8 years after surgery in 114 patients. Outcome was based on subjective disability using Oswestry low back pain questionnaire. Patient satisfaction degree was rated to 'very satisfied(1)', 'somewhat satisfied(2)', 'somewhat dissatisfied(3)' and 'very dissatisfied(4)'. Several factors that might be associated with patient satisfac-tion and outcome were investigated. RESULTS: Of the one hundred and fourteen patients, 84(73.9%) were satisfied to the surgery and mean satisfaction degree was 1.94. Ninety two patients(80.7%) had excellent-to-good results with the mean Oswestry disability score 26.9. There were 7 complications including dural tear in 3 cases, pseudarthrosis in 1 case, dissociation between rod and screw in 1 case, pedicle screw breakage in 1 case and termination of operatin due to massive bleeding during operation in 1 case. CONCLUSION: Clinical results and patient satisfaction were better in the cases with short segments fusion than long segments fusion and the patients with preoperative leg symptom as major symptom had significantly lower Oswestry disability score.
Subject(s)
Humans , Follow-Up Studies , Hemorrhage , Leg , Low Back Pain , Patient Satisfaction , Pseudarthrosis , Surveys and Questionnaires , Retrospective Studies , Spinal StenosisABSTRACT
PURPOSE: To analyze the complications and improvement of neurologic injury after operative treatment in the fracture-dislocations of thoracic and lumbar spine in long-term follow-up. MATERIALS AND METHODS: A retrospective review of 39 patients, who were operated on for fracture-dislocations in thoracic and lumbar spine from May 1982 to May 1995 was conducted. We evaluated the result with Denis classification for type of fracture-dislocations and with Frankel classification for the neurologic injury. Average levels of fusion were 4.56 segments, ranging from 2 to 7 segments. RESULTS: According to the Frankel classification, the most common neurologic status at initial presentation was grade A in 28 cases (71.8%) and cases with complete paraplegia showed no improvement in long-term follow-up at all. Six other cases with incomplete paraplegia showed average neurologic improvement of 1.5 grade. Ischial sore was most common (13 cases) complication. CONCLUSIONS: Fracture-dislocations showed a higher incidence of neurologic injury than other spine fractures. Complete paraplegia was most common with no neurologic improvement in longterm follow-up. Incomplete paraplegia showed neurologic improvement. The cases of complete paraplegia had more complications than cases of incomplete paraplegia. The authors think that the postoperative care of complete paraplegia is important.
Subject(s)
Humans , Classification , Follow-Up Studies , Incidence , Paraplegia , Postoperative Care , Retrospective Studies , SpineABSTRACT
Posterior epidural migration of a sequestrated intervertebral lumbar disc is rare with only five cases ever reported in the literature so far. The objective of this paper is to report our experience of such a extremely rare case with a review the literature
ABSTRACT
STUDY DESIGN: A retrospective analysis of 166 patients was undertaken to observe radiologically the changes of adjacent segments at follow-up more than three years after lumbar fusion. OBJECTIVES: The purpose of this study is to analyse the changes of adjacent segments and to correlate these changes to the length of using level and to the degree of deviation from physiologic lumbar lordosis. The authors also correlate these radiologic changes to the clinical symptoms. MATERIALS AND METHODS: In simple x-ray, authors observed traction spur, disc space narrowing, endplate sclerosis and vacuum phenomenon of adjacent segments. Authors used Gelb's criteria in segmental lordosis angle(SLA) and Katz's classification in clinical results. RESULTS: The average age was 49.6 years old and the average follow-up period was 57.2 months(4 years and 9.2 months). We observed radiologically the traction spurs in 35 cases(21.1%), end-plate sclerosis in 32 cases(19.3%), disc space narrowing in 33 cases(19.9%) and the vacuum phenomenon in 10 cases(6.0%). The numbers of fusion segments and the degree of unphysiologic segmental lordosis angle in fusion segments were related with the frequency and degree of changes of adjacent segments(P<0.05). The clinical results showed satisfaction in 142 cases(85.5%), unsatisfaction in 24 cases(14.5%) and low back pain in 24 cases(14.5%), leg pain in 11 cases(6.6%) and extension of fusion level in 4 cases(2.4%). In low back pain patients more than two kinds of radiological changes were frequently observed than the patients without low back pain(P<0.05). CONCLUSIONS: The radiological changes of adjacent segments were more frequently observed in long fusion and in fusion with unphysiologic lumbar lordosis angle. And these changes are frequently associated with low back pain. Thus long fusion and fusion with unphysiologic lumbar lordosis angle should be avoided if possible.
Subject(s)
Animals , Humans , Classification , Follow-Up Studies , Leg , Lordosis , Low Back Pain , Retrospective Studies , Sclerosis , Spinal Fusion , Traction , VacuumABSTRACT
Smoking, obesity and diet are just a few of the multifactors which have been suggested to be associated with the risk of CHD. It is a common phenomenon that persons who stop smokin gain weight. This fear of gaining weight is often given as a reason for giving up to quit smoking. The purpose of this study is to find the effects of cessation of smoking on body weight and the difference of BMI distribution according to smoking habits. The subjects of this study were 72 techinical high school teachers in Seoul and Kyounggi-Do, 85 offical wokers of the S-Company and 81 auto industrial workers in PyoungTaek. The investigation for this study has been conducted from Oct. 27th to Oct. 31st 1997. The method was self-feported questionnaire survey which consists of general characterisics, smoking habits and its relevant questions. The questionnaires were revised after two-times of pre-tests, carried out for twenty subjects. The results are as follows ; 1. Smoking habits have significant relations with diet, exercise, drinking and the amount of daily smoking. 2. BMI among different smoking habits groups showed significant differences in following variables ; age, the interaction between exercise and smoking habits, drinking level, the interaction etween drinking level and smoking habits and the interaction between total smoking duration and smoking gabits. 3. The mean values of BMI are 23.5 in non-smoker, 23.8 in ex-smoker and 23.4 in current smoker. There are no statistically significant differencs among amoking habits. 4. The average of 2.14kg weight gain is witnessed after 6 months of the cessation of smoking. Current weight was high by 3.89kh in average compared to the pre-cessation weight(p=0.0001). 5. The odds ratio for gaining weight among ex-smokers is 8.94 in "increase or very increase" group in diet compared to those of "no change". 6. The multiple regression analysis has a significant model in current smoker(p=0.001). The mean BMI of those who were "very active" in exercise is higher than that of "inactive" or "active". The mean BMI of those who were "light or moderate ot heavy drinker" is lower than that of "non-drinker". The mean BMI of those who have the monthly income 1.5millions-1.99millions won is significantly higher than those having less than 1.5millions or more than 2.0millions won. The implication of this study could suggest that health education for smoking cessation needs new approches to minimize weight gain.
Subject(s)
Adult , Humans , Male , Body Weight , Diet , Drinking , Health Education , Obesity , Odds Ratio , Seoul , Smoke , Smoking Cessation , Smoking , Weight Gain , Surveys and QuestionnairesABSTRACT
Operative reduction is not essential for mild to moderate spondylolisthesis, but some authors agree that reduction of spondylolisthesis is beneficial for widening of intervertebral canal and consequently for decompression of neural tissue even though the degree of slippage is grade I or II. In our institute, we sometimes reduced the slippage for these reasons. But at follow up study we would find redisplacement and the degree of it seemed to be associated with the kind of instruments. So we analyzed redisplacement rate according to the kind of instruments in 59 cases of spondylolisthesis that were followed more than one year. The conclusions were as follow; 1. There was no significant correlation between reduction and redisplacement rate with pathologic type, lesion site, age,iscectomy and clinical result at least in grade I or II spondylolisthesis (P>0.05). 2. The pedicle screw system was more useful in reduction and its maintenance than the Luque ring system (P<0.001). 3. Redisplacement was occurred mainly within 2 months after operation, 4. The cause of redisplacement after reduction seems to be associated with mechanical insecurity before consolidation of the grafted bone takes place.
Subject(s)
Decompression , Follow-Up Studies , Spondylolisthesis , TransplantsABSTRACT
The present study has been undertaken to pursue the cytotoxic effects of cis-Platin on the osteoid formation in metaphysis of rat tibia. By using the immunohistological staining method for type I collagen in rat tibial osteoid, the author detected the deposition of type I collagen, which is the collagenous constituent of endochondral osteoid, after administration of cis-Platin in experimental animals. For the immunological reactions of type I collagen, we used the rabbit anti-rat collagen type I polyclonal antibody as primary antibody and biotinylated goat anti-rabbit IgG as secondary antibody. The distributions of immunohistological reactions in the each of metaphyseal osteoids were analyzed with an image analyzer, and we studied the variances of type I collagens by statistical probabilities. In 12 hours after cis-Platin injection, immunoreactive area in the osteoid of metaphysis was distinctly decreased. Immunoreactive area of type I collagen in osteoids of 1 day and 3 days group metaphysis was increased more than that of 12 hours group and the type I collagen in the metaphysis showed weak immunoreactions of type I collagens with an image analyzer. In the osteoids of 7 days group after cis-Platin injection, the immunoreactive area was similar to that of control group. It is consequently suggested that cis-Platin would induce the decrease of type I collagen in the osteoid. But the type I collagen in tibial osteoid shows the increase from a few days after cis-Platin injection.
Subject(s)
Animals , Rats , Collagen , Collagen Type I , Goats , Immunoglobulin G , TibiaABSTRACT
The goals of treatment of the slipped capital femoral eiphysis(SCFE) are to stabilize the slipped epiphysis, prevent further slipping and induce early closure of the epiphyseal plate. Mutiple pinning was used for the treatment but in recent years, percutaneous in-situ fixation technique with 1 or 2 cannulated screws is preferred due to the advantages of low rate of complication such as pin penetration. We report the results of experimental study and the functional results after percutaneous pinning. The purpose of the experimental study was the investigation for changes of the screw length and the site of screw entry point according to the degree of slipping by bony model. The entry point of the screw was changed toward anterior and proximal portion of femoral neck and the length of inserting screw was changed to be shorter according to the degree of slip. We have treated 10 patients(13 hips) with slipped capital femoral epiphysis(SCFE) at our department since Jan. 1989. Among them, 6 patients(7 hips) could be followed for more than 2 years. There were 5 boys and 1 girl. One case was affected on the both hip. The average age at operation was 11.8 year old. All cases were obese. Degree of slipping was showed 6 cases in mild and 1 case in moderate. The slipping of acute onset was 3 cases, acute-on chronic 3 cases and chronic 1 case. In radiographic results, 6 cases were showing in Grade 0, 1 case was in Grade II. In functional results, 3 cases were excellent, 3 cases in good and 1 case in poor. One poor functional result was a case complicated by chondrolysis.
Subject(s)
Female , Humans , Epiphyses , Femur , Femur Neck , Growth Plate , Hip , Slipped Capital Femoral EpiphysesABSTRACT
No abstract available.