Prevalence Study of Adolescent Idiopathic Scoliosis in Ten-, Eleven-Year Olds for 10 Years / 대한정형외과학회잡지

PURPOSE: School screening for adolescent idiopathic scoliosis (AIS) was conducted for 10 years and the prevalence of scoliosis as well as the size and types of curvature were investigated. The outcomes and existing research results were comparatively analyzed and the usefulness of the moire topography as a screening tool was evaluated. MATERIALS AND METHODS: Moire topography was used in screening of 413,351 10- and 11-year-old from 2002 to 2011; simple standing entire spine x-rays of selected examinees were taken. When the Cobb angle was 10degrees or higher, the condition was deemed to be scoliosis, and the size, location, and types of curvature were recorded. RESULTS: The average prevalence over the 10 years was 0.4% (0.3%-0.5%) and the trends in yearly prevalence did not change significantly. The ratio of boys-to-girls prevalence rates for the 10 years was 1.0:3.8. The rate of those with scoliosis whose curvature was 10degrees-19degrees, 20degrees-29degrees, and 30degrees-39degrees was 71%, 24%, and 4%, respectively. King-Moe type III accounted for the largest portion at 45%, followed by type IV at 35%, type II at 11%, type I at 7%, and type V at 5%. CONCLUSION: The prevalence of scoliosis in the subjects was similar for the 10 years but differed from previous research results. The size, location, and types of curvature were similar to those reported in previous research. The differences in prevalence from existing research are considered to be due to the screening method used. Therefore, conduction of additional research on effective screening tests is necessary.

Spinal Arachnoid Cyst: Treated with Pars Osteotomy and Recapping Laminoplasty: Report of 5 Cases / 대한척추외과학회지

Spinal arachnoid cysts are a rare disease with an unknown origin. Because of their broad base, a total laminectomy with or without fusion has been the treatment of the choice. We encountered 5 patients with a spinal arachnoid cyst who were treated by recapping laminoplasty after pars osteotomy. This procedure has not been reported in Korea. All patients showed neurological recovery with no recurrence of the cyst. The findings on the stressed plain film confirmed bony union and stability of the posterior element.

The Comparison of Rigid and Semi-rigid Rod for the Correctability of the Thoracic Hypokyphosis of the Idiopathic Scoliosis / 대한척추외과학회지

STUDY DESIGN: The analysis was based on the sagittal and coronal correction of 64 cases of thoracic hyphokyphosis that were due to idiopathic scoliosis. PURPOSE: We wanted to compare the three pedicle screws and rod systems (using either a semirigid and rigid rod) from the view points of the coronal and sagittal plane correction during the surgical treatment of idiopathic scoliosis. SUMMARY OF LITERATURE REVIEW: There haven't been any reports that have compared the differences and their significance between the semirigid and rigid rod systems for correcting the thoracic hypokyphosis of idiopathic scoliosis. MATERIALS AND METHODS: After a minimum follow-up of 1 year, the results of the frontal and sagittal correction of each study group were compared. There were a total of 52 females and 12 males. The mean age at the time of surgical intervention was 16.4 (age range: 12~24). CD instrumentation with a rigid stainless steel rod (7 mm in diameter and 1200 N/mm for its stiffness) was used in group I (36 patients), and 4-CI instrumentation with a titanium alloy rod (6.35 mm in diameter and 1200 N/mm for its stiffness) was used in group II (18 patients). Xia instrumentation with a semi-rigid rod (6 mm in diameter and 600 N/mm for its stiffness) was used in group III (10 patients). For all patients undergoing the segmental pedicle screw fixation procedure, pedicle screws were inserted into every vertebra on the concave side, in the end of each vertebra and then alternately in every other vertebra on the convex side. We measured the preoperative and postoperative magnitude of the major and compensatory curves, the thoracic kyphotic angle on the standing radiographs and the flexibility of the curve. We statistically compared the correctability of thoracic kyphotic angle between the rigid and semi-rigid rods. RESULTS: The differences of preoperative and postoperative major curves in groups I, II and III were 47.3 degrees/12.7 degrees, 51.6 degrees/12.3 degrees and 49.6 degrees/13.3 degrees respectively. The thoracic kyphotic angle was 22.6 degrees/26.6 degrees, 22.0 degrees/26.9 degrees and 23.8 degrees/22.8 degrees, respectively. There was no significant difference for the correction of the coronal angle in each group, but groups I and II were superior to group III for the rate of correcting the kyphotic angle. CONCLUSION: The rod should be stiff enough to pull the spine posteromedially when using the derotation technique for the surgical treatment of idiopathic scoliosis.

Anterior Release and Fusion followed by Posterior Correction in Scoliosis: A Comparison of Open Thoracotomy and the Thoracoscopic Approach / 대한정형외과학회잡지

PURPOSE: To compare the results of the thoracoscopic approach and open thoracotomy retrospectively for scoliosis requiring anterior release and fusion followed by posterior correction. MATERIALS AND METHODS: Of 22 rigid scoliosis patients, 10 open thoracotomy cases (group I) were compared with 12 thoracoscopic cases (group II) in terms of blood loss, operation time, and chest pain (visual analogue scale, VAS), as checked 1 week after operation and final follow-up, correction ratio of major curve and complications. Posterior correction was performed 2 weeks after anterior release. Statistical analysis of group differences was performed using the t-test or the Mann-Whitney. RESULTS: Blood loss was higher in group I, 268.0 mL (200-530) than in group II, 195.0 mL (100-280) (p=0.047). The operation time was shorter in group I, 108.0 minutes (90-180) than in group II, 175.0 minutes (120-240) (p=0.001), and chest pain (visual analogue scale, VAS) which was checked at 1 week after operation and at final follow-up was milder in group II, 3.9 (3-6), 1.6 (0-3) than in group I, 5.8 (4-8), 3.1 (1-5) (p=0.005, p=0.013, respectively). The correction ratios of the major curve between two groups were similar. The cosmetic aspects of the thoracoscopic approach were favorable. The postoperative complications were 1 pneumothorax in each group and 3 chronic chest pain in group I. CONCLUSIONS: The results of thoracoscopic approach for anterior release were compared favorably with standard open thoracotomy in terms of blood loss, chest pain both postoperatively and at final follow-up, and cosmetics, but unfavorably for operation time.

A Case Report of Missed Cervicothoracic Fracture-Dislocation in Plain Radiographs / 대한척추외과학회지

A complete fracture dislocation at the cervicothoracic junction is rare and accompanied by severe spinal cord injury. This region is difficult to image with plain radiography, and to immobilize with external orthosis due to the biomechanical forces exerted in this transitional portion of the spinal column. We experienced a rare case in 52-year-old male victim of a car accident. He sustained paraplegia, and complained of dyspnea and neck pain of 10 days duration at another hospital. The delayed clinical rediagnosis was a C6 and 7 spinous process fracture and a cervicothoracic fracture dislocation, with complete transection of spinal cord, which was based on a clinical examination, simple radiography, CT and MRI. Skeletal traction was immediately applied, followed by a posterior pedicle screw to stabilize the spine and secure the grafts. Rehabilitation was initiated and the dysphagia and dyspnea, due to aspiration pneumonia, were improved, but no neurologic recovery was made after the 1st postoperative year.

Comparision of the pulmonary function between open anterior release and thoracoscopic anterior release / 대한척추외과학회지

STUDY DESIGN: Retrospective study OBJECTIVES: To evaluate the results of a serial pulmonary function test in severe scoliosis that required an anterior release and posterior fusion SUMMARY OF LITERACTURE REVIEW: There are a few reports on the pulmonary function after an anterior release and posterior fusion in severe scoliosis. MATERIALS AND METHODS: Twenty two cases of severe scoliosis requiring an anterior release and posterior fusion were followed up more than 2 years. The patients were divided into two groups (group 1: 10 cases of open thoracotomy and posterior fusion, group 2: 12 cases of thoracoscopic release and posterior fusion). The forced vital capacity (FVC), forced expiratory volume 1 (FEV1), total lung capacity (TLC), the predicted FVC, predicted FEV1 and predicted TLC in the preoperative, 3 month, 6 month, 1 year, 2 year postoperative period in the two groups were compared. Statistical analysis was performed using a paired T-test. RESULTS: The average preoperative FVC in groups 1 and 2 were checked as 2.20 L and 2.30 L, respectively. The postoperative 3 month FVC were checked as 1.60 L and 1.81 L, respectively, which were the lowest levels throughout the serial follow-up. The postoperative 6 month FVC were 1.70 L and 2.15 L, respectively. The postoperative 2 year FVC were 2.17 L and 2.18 L, respectively, which were 98.6% and 94.8% of the preoperative FVC. The average preoperative FEV1 of group 1 was 1.95 L. The post-operative 3 month FEV1 were at the lowest level and the postoperative 2 year FEV1 was 1.80 L (92.3% of preoperative value). The average preoperative FEV1 of group 2 was 2.05 L. The postoperative 6 month FEV1 was 1.90 L (92.7% of preoperative value). The TLC of group 2 showed a faster recovery than that of group 1. The predicted FVC, FEV1 and TLC of both groups at 2 years after surgery were 2 ~4% lower than the baseline. The recovery pattern in group 1 was steady for 2 years. The postoperative 6-month value was similar to the postoperative 2-year value in group 2. CONCLUSIONS: In severe scoliosis with a decreased pulmonary function, those undergoing thoracoscopic anterior release had a faster pulmonary function recovery than those undergoing an open thoracotomy.

Result of Traction Thoracolumbosacral Orthosis in Idiopathic Scoliosis / 대한척추외과학회지

STUDY DESIGN: A retrospective study of the effectiveness of traction thoracolumbosacral orthosis (TLSO) in idiopathic scoliosis. OBJECTIVE: To compare the results of traction TLSO and conventional TLSO. SUMMARY OF LITERATURE REVIEW : No report has been published about longitudinal traction and lateral force before cast molding in the nonoperative treatment of idiopathic scoliosis. MATERIALS AND METHODS: Twenty-one cases of traction TLSO (group I) and 17 cases of conventional TLSO (group II) were studied. Traction TLSO was made as follows: 1. Cervical traction was applied to the patient standing under the frame with application of lateral force with compression pad. 2. Cast molding. 3. Fabrication of plastic jacket and application of pads. The mean age of group I was 12 years and of group II, 13 years. We evaluated the effectiveness of traction TLSO with Cobb`s angle reduction, trunk pain and dyspnea. Statistical analysis was made with SPSS. RESULTS: In group I, mean pre-brace Cobb`s angle was 31.1 degrees and in group II, 29.6 degrees. Flexibility of the curves was 78% and 75%, respectively. Mean reduction rate of Cobb`s angle after 3 days of brace application was 59.5% and 15.4%, respectively. One year later, reduction of Cobb`s angle was 15.4 degrees in group I and 2.7 degrees in group II. Reduction rate of Cobb`s angle after 1 year of brace application was 54.2% and 7.9%, respectively. Post-brace pain and dyspnea were similar in both groups. CONCLUSION: Traction TLSO was superior to conventional TLSO in terms of angle reduction, but was similar in subjective symptoms.

The Change of Cobb Angle According To Position in Adolescent Idiopathic Scoliosis / 대한척추외과학회지

STUDY DESIGN: Consecutive, prospective, radiographic review of adolescent idiopathic scoliosis (AIS) patients. OBJECTIVE: To analyze the change of Cobb angle according to position in AIS. SUMMARY OF BACKGROUND DATA: Cobb angle on standing radiographs was corrected spontaneously while the patients were in the supine position. However, there are few reports on Cobb angle in standing versus supine position in AIS. MATERIALS AND METHODS: We checked AP plain radiographs of 101 AIS patients, 18 male and 83 female, in standing and supine position. Sixty-three cases were under Risser stage V and 38 were Risser stage V. In standing plain radiograph, 27 cases were in Cobb angle 10-19 degrees, 35 in 20-29 degrees, 15 in 30-39 degrees, and 24 over 40 degrees. According to curve pattern, 31 curves were classified as King type I, 32 as type II, 8 as type III, 11 as type IV, 17 as type V, 1 thoracolumbar curve and 1 lumbar curve. Cobb angle reduction was measured on AP radiographs from each group, according to sex, maturation, Cobb angle and curve pattern. RESULTS: Average reduction of Cobb angle was 8.2 degrees(range, 1-21 degrees ), 6.4 degrees for male and 8.6 degrees for female (p=0.19). The reduction value according to maturation was 8.3 degrees for the growing group and 8.0 degrees for the grown group (p=0.73). The average reduction value in Cobb angle 10-19 degrees was 5.4 degrees(40.3%), 20-29 degrees was 7.1 degrees(30.9%), 30-39 degrees was 8.6 degrees(25.7%) and over 40 degrees was 12.8 degrees (23.6%) (p=0.001). The reduction rate decreased in proportion to Cobb angle measured in standing position. The reduction value was 8.2 degrees in King type I curves, 8.6 degrees in type II, 9.1 degrees in type III, 9.1 degrees in type IV and 6.2 degrees in type V (p=0.238). CONCLUSION: An average 8 degrees Cobb angle reduction in supine position, compared with standing position, can influence treatment strategy in AIS patients, because a Cobb angle change more than 5-6 degrees is a threshold value to decide curve worsening. Thus, serial Cobb angle measurement should be performed in standing position.

Comparison of Two Surgeries in Active Thoracolumbar Tuberculous Spondylitis: One Stage Anterior Debridement with Anterior Instrumentation and Two Stage Operation of Anterior Debridement and Posterior Instrumentation / 대한척추외과학회지

STUDY DESIGN: Thirty-eight patients with thoracolumbar spinal tuberculosis were evaluated according to the surgical treatment method, either a one or two stage anterior debridement, with anterior or posterior instrumentation, respectively. PURPOSE: The aim of this study was to compare the effects of the one stage anterior debridement, with anterior instrumentation, to the two stage anterior debridement, with posterior instrumentation MATERIALS AND METHODS: Thirty-eight patients, with tuberculous spine, were divided into two groups depending on the surgical method. One group consisted of 21 patients treated with anterior debridement combined with anterior instrumentation, and the other group consisted of 17 patients treated by a two stage operation of anterior debridement combined with posterior instrumentation. The clinical outcomes were evaluated from the hematological laboratory findings, bone union in radiographs, change of kyphotic angle, duration of hospital stay and the medical cost during hospitalization. RESULTS: There were no recurrences of infection in either group and bone union was obtained within 6 months of the operation for all cases in both groups. The preoperative, postoperative and final follow-up kyphotic angle in the two groups were 18/20, 7/9 and 10/11 degrees, respectively. There was no significant difference in the decrease of the kyphotic angle between the two groups (p>0.05). However, group I was superior to group II in relation to the duration of hospital stay and the medical cost. CONCLUSION: We concluded that the one stage operation was the better of the operative methods for the treatment of active tuberculous spondylitis in a thoracolumbar spine.

An analysis of adolescent idiopathic scoliosis according to Coonrad classification / 대한정형외과학회잡지

PURPOSE: To establish the interobserver and intraobserver reliability of the Coonrad classification for an idiopathic coronal curve pattern. MATERIALS AND METHODS: Radiographs of 257 idiopathic scoliosis patients that had a rib humping of more than 1 cm and a Cobb angle of more than 10 were reviewed. The interobserver and intraobserver reliability was assessed by a comparison of the classification of the curves between four observers. RESULTS: In the Coonrad classification, a 1A type-curve occurred in 37 cases, the 1B type-curve occurred in 27 cases, the 2A type-curve occurred in 70 cases, a 2B type-curve occurred in 22 cases, a 3 type-curve occurred in 44 cases, a 4 type-curve occurred in 6 cases, a 5 type-curve occurred in 15 cases, a 6 type-curve occurred in 22 cases, a 7 type-curve occurred in 13 cases and a 8 type curve occurre in 1 case. The interobserver reliability for the Coonrad classification was 0.60 and the intraobserver reliability was 0.71. CONCLUSION: The Coonrad classification proved to be relatively reliable, but revealed some confusion, particularly between type 2A and type 3. Also, there seemed to be no advantage in using this method of determining the treatment modality compared with the conventional scoliosis classification system.

Image Study of the Thoracolumbar Spine Fracture / 대한척추외과학회지

An accurate assessment of injuries to the spinal column and the neural tissues will facilitate the management of patients with injuries to the thoracic and lumbar spine. Routine radiological investigations are essential, but newer techniques are now available that define the extent of injuries in exquisite detail, providing a better understanding of not only the bony injuries, but also the extent of the soft tissue lesion, including the nervous system. The referring physician and the radiologist have many imaging techniques available for the diagnosis of the extent of thoracolumbar spine fracture. These include plain film radiography, computed tomography(CT), conventional polydirectional tomography, bone scan, magnetic resonance image(MRI), and myelography. These techniques are used alone or in combination to arrive at the correct diagnosis. It behooves the examining physician to be extremely thorough in identifying additional lession, not only for medicolegal reasons, but also to ensure that other potentially unstable lesions are not overlloked, since this could lead to neurological compromise if unsuspected. We describe the integrated use of multiple imaging techniques.

Types and Associated Anomalies of Congenital Scoliosis / 대한척추외과학회지

STUDY DESIGN: Analysis was based on radiographic appearance of 57 cases of congenital scoliosis and associated anomaly PURPOSE: The aim of the present study was to assess the incidence, morphology and the associated anomalies of the congenital spinal scoliosis. SUMMARY OF LITERATURE REVIEW: Hemivertebra is the most common type of congenital scoliosis and urogenital, musculoskeletal and cardiac anomalies are strongly associated. MATERIALS AND METHODS: The authors analysed the morphology and the associated anomalies of 57 cases of congenital scoliosis from 1994 to 2000. RESULTS: It was more common in male(32 males and 25 females). The bony anomalies were classified as failure of formation(40cases, 70.2%), failure of segmentation(11cases, 19.3%) and mixed type(6cases, 10.5%). Of the failure of formation, there were 36 cases(63.2%) of hemivertebra, 2 cases of posterior quadrant vertebra and 2 cases of wedge vertebra. We found associated anomalies in 26 patients(45.6%). Associated cardiac anomalies were 2 dextrocardia, ventricular septal defect, atrial septal defect and patent ductus arteriosus. Associated musculoskeletal anomalies were 5 rib fusion, 2 developmental dysplastic hip, 3 Klippel-Feil syndrome, Achondroplasia, Arnold-Chiari malformation, spinal dysraphism with sacral hair patch, cleft palate with congenital anklyloglossia. Associated neurogenic anomalies were 2 cases of syringomyelia and 3 mental retardation. There were unilateral renal agenesis and undescended testicle in urogenital anomalies. CONCLUSIONS: Common type of the congenital scoliosis was hemivertebra(63.2%) caused by the failure of formation(70.2%). Associated anomalies were found in 26 patients(45.6%).

Posterior Lumbar Interbody Fusion in the Pyogenic Discitis / 대한척추외과학회지

STUDY DESIGN: To present preliminary results of PLIF (Posterior lumbar interbody fusion) and pedicle screw fixation in the lum-bar pyogenic discitis. OBJECTIVES: To evaluate the advantages and effects of PLIF and posterior instrumentation over recurrence of infection in lum-bar pyogenic discitis which are resistant to antibiotics. SUMMARY OF LITERATURE REVIEW: To the date, anterior removal of the focus followed by interposing autogenous bone graft without additional instrumentation and postoperative long-term immobilization has been the standard operative procedure. MATERIALS AND METHODS: 10 consecutive patients who had lumbar pyogenic discitis were treated by posterior approach from October 1997 to March 1999. RESULTS: Based on MRI or CT finding, 9 solid union at 3-4 months after operation and 1 suspicious union at 1 year after opera-tion were observed. The mean preoperative lordotic angle of the affected segments was 9 degree compared to 20 degree after postoperation and 17 degree at last follow up. As for functional result of Kirkaldy-Willis, outcome was excellent in 3, good in 5, fair in 2, none poor case. The duration of postoperative bed rest period was an average of 3 days. CONCLUSIONS: PLIF with instrumentation in lumbar pyogenic discitis is a useful treatment in posterior epidural abscess,coexis-tent spinal stenosis and lower lumbar level where anterior fixation is impossible. It is especially indicated in the case of scanty antevertebral abscess with minimal bone destruction. Its main advantage is early ambulation.

Limbus Vertebra Demonstrated by Computed Tomography or Magnetic Resonance Image / 대한척추외과학회지

STUDY DESIGN: We studied retrospectively the limbus vertebra by computed tomography or magnetic resonance image. OBJECTIVES: To analyze the clinical and radiologic characteristics of the limbus vertebra and to distinguish it from a fracture, infection or tumor. SUMMARY OF LITERATURE REVIEW: The limbus vertebra is common. However, the clinical manifestations including the level, symptoms and radiologic characteristics of the limbus vertebra are not understood exactly in the literatures. MATERIALS AND METHODS: We presented 25 cases of the limbus vertebra that were confirmed by plain roentgenogram combined with computed tomography (CT) or magnetic resonance imaging (MRI). Of the 25 patients, 18 were males and 7 females. RESULTS: The levels of the limbus vertebra were L3 (2 cases), L4 (13 cases), and L5 (8 cases). There were two cases of 2 level involvement (L3/4 and L4/5). All cases showed the lower lumbar lesion and complained of the lower back pain. The accompanying diseases included 10 cases of herniated intervertebral discs, 2 cases of ankylosing spondylitis, 2 cases of spinal stenosis and one spondylolisthesis. Three patients were first diagnosed as tuberculous spondylitis and 2 patient as spine fracture on plain roentgenograms. But they can be confirmed by demonstrating the herniation of disc material between the anterosuperior bony fragment and the rest of the body in CT or MRI. CONCLUSIONS: The CT or MRI could be great diagnostic modalities. The pathogenesis is thought to be the herniation of disc material into the vertebral body such as Schmorl's node and disc degeneration. Most limbus vertebra was found at the lower lumbar region and accompanied with disc bulging and degeneration. The correlation between the limbus vertebra and lower back pain is not certain.

Spinal Cord Tension And Mifration in Spine Flexion in Human Cadaver / 대한정형외과연구학회지

No Abstract Available.

Clinieal Values of Single Photon Emission Computed Tomography ( SPECT ) in Ankylosing Spondylitis / 대한정형외과학회잡지

Now that ankylosing spondylitis is known to be relatively common, it is important that mild cases should be diagnosed earlier to avoid inappropriate investigation and unhelpful non-specific therapy and to improve social rehabilitation. However, difficulties in the diagnosis of ankylosing spondylitis are often encountered. To establish the clinical values of SPECT in ankylosing spondylitis, a study of radiologic evaluation, quantitative bone scan and SPECT have been carried out in 34 patients who were firmly suspected as having ankylosing spondylitis by other tests. This study showed that SPECT could improve the applicability of the imaging modality in the diagnosis and the assessment of disease activity and the capacity of early diagnosis in patients with ankylosing spondylitis. We believe that improved three dimensional localization in and around the sacroiliac joints by SPECT might overcome several diagnostic difficulties. Especially when radiographic abnormalities are not present in the early period, the diagnostic values of SPECT may be more potential.

Bilateral Jumped Thoracic Facets Dislocation: A Case Report / 대한척추외과학회지

Bilateral jumped facets dislocation in upper thoracic spine is rare injury because the thoracic spine is relatively immobile structure. We experienced a case of T2-3 dislocation without fracture and successfully reduced the dislocation after partial resection of the superior articular process of the third thoracic spine and performed fixation and fusion from T1 to T4 with pedicle screw system.

Arthrodesis of charcot knee using ilizarov external fixator: a case report

No abstract available.

Comparative study of computed tomography and bone scan in the patient with anterior knee pain

No abstract available.

Traumatic lumbosacral dislocation: A case report and review of the literature / 대한정형외과학회잡지

No abstract available.