Survivor Ship Analysis of Lumbar Microdiscectomy / 대한정형외과학회잡지

PURPOSE: To analyze the post-operative clinical results of lumbar microdiscectomy with respect to time, and to evaluate the causes of fail-ure by survivor ship analysis. MATERIALS AND METHODS: The clinical results of 162 patients were evaluated using MacNab's criteria and the survival rate was analyzed by using Kaplan-Meier survivor ship analysis. Several factors suspected of influencing survival were evaluated. RESULTS: Survival was 93.7% at 12 months after the operation, and showed annual decrements to reach 84.7% at 60 months but did not change thereafter until the final follow up. There were total 18 failed cases and the failure rate after 5 years was 0%. Statistically significant factors influencing the survival rate were, the type and level of disc herniation. The causes of early failure, which occurred within 12 months of surgery, were usually due to residual or recurrent radiating pain, whereas the major cause of late failure, which occurred after 12 months, was usually residual back pain. CONCLUSION: The failure rate was relatively high during the early post-operative period, but this decreased with time. Since long-term survival was relatively high, lumbar microdiscectomy could be considered an effective and satisfactory surgical technique.

Massive Rotator Cuff Tear / 대한정형외과학회잡지

PURPOSE: To report our experience of massive rotator cuff tear and evaluate the final outcome and factors influencing the final results. MATERIALS AND METHODS: We have performed 25 repairs (24 patients) of the massive rotator cuff tear. The average age 58 years old, mean follow-up was 22 months. Acromioplasty alone was performed in 7 cases and acromioplasty with direct repair was performed in 18 cases. We statistically analyzed the results by Student's T-test. RESULTS: Postoperative pain and UCLA score improved 2.2, 32 from 7.4, 14 respectively. The gain of 32 degrees in forward flexion, 8 degrees in external rotation could be obtained. Six (24%) was excellent, sixteen (64%) was good and three (12%) was poor and eigthy-four percent of our series was satisfied. Preoperative range of motion (P=0.040) , the degree of degeneration and the magnitude of tendon retraction (P=0.013) influenced the final results, but age (P=0.232) , duration and severity of pain (P=0.370) did not. There was a significant difference between acromioplasty only and acromioplasty with direct repair even though this discrepancy is very small (P=0.046) . Retear was revealed in 8 cases (44%) among repaired rotator cuff. CONCLUSION: Acromioplasty by itself could get a pain relief and functional improvement and a patient satisfaction in the treatment of massive rotator cuff tear regardless a reparability, but a more favorable result could be expected when a torn rotator cuff was repaired if possible.