Posterior Interspinous Fusion Device for One-Level Fusion in Degenerative Lumbar Spine Disease : Comparison with Pedicle Screw Fixation - Preliminary Report of at Least One Year Follow Up

OBJECTIVE: Transpedicular screw fixation has some disadvantages such as postoperative back pain through wide muscle dissection, long operative time, and cephalad adjacent segmental degeneration (ASD). The purposes of this study are investigation and comparison of radiological and clinical results between interspinous fusion device (IFD) and pedicle screw. METHODS: From Jan. 2008 to Aug. 2009, 40 patients underwent spinal fusion with IFD combined with posterior lumbar interbody fusion (PLIF). In same study period, 36 patients underwent spinal fusion with pedicle screw fixation as control group. Dynamic lateral radiographs, visual analogue scale (VAS), and Korean version of the Oswestry disability index (K-ODI) scores were evaluated in both groups. RESULTS: The lumbar spine diseases in the IFD group were as followings; spinal stenosis in 26, degenerative spondylolisthesis in 12, and intervertebral disc herniation in 2. The mean follow up period was 14.24 months (range; 12 to 22 months) in the IFD group and 18.3 months (range; 12 to 28 months) in pedicle screw group. The mean VAS scores was preoperatively 7.16+/-2.1 and 8.03+/-2.3 in the IFD and pedicle screw groups, respectively, and improved postoperatively to 1.3+/-2.9 and 1.2+/-3.2 in 1-year follow ups (p<0.05). The K-ODI was decreased significantly in an equal amount in both groups one year postoperatively (p<0.05). The statistics revealed a higher incidence of ASD in pedicle screw group than the IFD group (p=0.029). CONCLUSION: Posterior IFD has several advantages over the pedicle screw fixation in terms of skin incision, muscle dissection and short operative time and less intraoperative estimated blood loss. The IFD with PLIF may be a favorable technique to replace the pedicle screw fixation in selective case.

Robot-assisted Resection of Paraspinal Schwannoma

Resection of retroperitoneal tumors is usually perfomed using the anterior retroperitoneal approach. Our report presents an innovative method utilizing a robotic surgical system. A 50-yr-old male patient visited our hospital due to a known paravertebral mass. Magnetic resonance imaging showed a well-encapsulated mass slightly abutting the abdominal aorta and left psoas muscle at the L4-L5 level. The tumor seemed to be originated from the prevertebral sympathetic plexus or lumbosacral trunk and contained traversing vessels around the tumor capsule. A full-time robotic transperitoneal tumor resection was performed. Three trocars were used for the robotic camera and working arms. The da Vinci Surgical System(R) provided delicate dissection in the small space and the tumor was completely removed without damage to the surrounding organs and great vessels. This case demonstrates the feasibility of robotic resection in retroperitoneal space. Robotic surgery offered less invasiveness in contrast to conventional open surgery.

Current and Future of Spinal Robot Surgery

OBJECTIVE: To review the current applications of robotics in spinal surgery. METHODS: We reviewed the literature on robotic surgery identified by searching Pubmed. Articles reporting clinical results of robotic surgeries using the da Vinci surgical system(R) were analyzed. Descriptions of our trials and comparisons with the conventional techniques were added to the review. RESULTS: Several surgical robots have been developed however, most of the robots are currently unavailable for practical use. Most of publications regarding spinal surgical robots merely suggested its feasibility. The da vinci surgical system(R) is the popular robotic system designed for use in various surgical fields. However, clinical applications of this innovative instrument in spinal surgery seem to be in the experimental phase. According to our research, the advantages of robotic surgery using the da Vinci surgical system(R) were maximized in cases of paravertebral or presacral tumors however, its use in other types of spinal surgeries such as the transoral craniovertebral junction approach andanterior lumbar interbody fusion will be feasible in the near future despite the current limitations. CONCLUSION: Clinical application of robotic surgery in the spinal surgical field is currently confined to the treatment of some specific diseases or procedures however, robotic surgery is expected to play a practical future role as a minimally invasive surgical instrument in spinal surgery.

Rapid Recurrence of Spinal Idiopathic Hypertrophic Pachymeningitis: A Case Report

Idiopathic hypertrophic pachymeningitis is a rare inflammatory disorder of the dura mater. Spinal involvement is extremely rare and there are few case reports. We present a 36 year-old female of idiopathic hypertrophic spinal pachymeningitis compressing thoracic spinal cord which showed rapid recurrence.

The Effect of Bromocriptine Treatment for Invasive Prolactinoma

OBJECTIVE: The prolactinoma is the most common pituitary tumor and sometimes shows severe invasiveness to the adjacent cavernous sinus, especially in the male patient. The dopamine agonist can be used as an alternative treatment modality to surgery. But, the transsphenoidal or transcranial approach for tumor removal has been more preferred treatment option of neurosurgeons in invasive prolactinoma. Especially rapid decompression of mass effect and resolution of the neurologic deficit is demanded. The prospective study is done in order to identify the therapeutic efficacy of bromocriptine as an initial treatment option for the invasive prolactionomas. METHODS: Twenty patients with invasive prolactinoma were studied. Preoperative neurological and endocrinological evaluations were done, and size and invasiveness of the tumor was estimated on MRI. Bromocriptine was administrated by increasing dose planning reaching maximum dose at 1month of treatment, with close neurological and endocrinological monitoring. At 3months after treatment, MRI was taken and decision was made whether to continue bromocriptine or to have surgical intervention. RESULTS: Thirteen patients showed excellent result with only bromocriptine treatment. These patients showed not only marked reduction of tumor volume and prolactin level, but also, improving clinical symptoms and other hormonal deficits. 13patients who had visual field defect and decreased visual acuity had all improved visual symptoms. But, the remaining 4patients required surgical treatment due to insufficient reduction of tumor size inspite of normalized prolactin level within 3months. Remaining 2patients had 20~30% of tumor size reduction, but prolactin level was not normalized. One patient required radiation therapy. CONCLUSION: Bromociptine can be used as initial treatment for the invasive prolactinomas with careful monitoring of the neurological and endocrinological status. It should be carefully followed up for tumor size reduction within 3 months after initiation of treatment.

Posterior Fossa Decompression for Hypertensive Cerebellar Encephalopathy: Case Report / 대한뇌혈관외과학회지

Hypertensive encephalopathy is a medical emergency that is usually presented with manifestating headache, nausea, and visual disturbance. The disease predominantly involves the parieto-occipital white matter. Although cerebellar lesion accompanying hydrocephalus has been occasionally described in the literature, medical management has been sufficient for relieving the posterior fossa hypertension. In the present case, we report a patient who was diagnosed with primary hypertensive cerebellar encephalopathy refractory to medical management and who was successfully treated by surgical decompression of the posterior fossa. A pathologic microscopic inspection of the tissue specimen confirmed hypertensive vascular change.