Loss of Sagittal Balance and Clinical Outcomes following Corrective Osteotomy for Lumbar Degenerative Kyphosis / 대한정형외과학회잡지

PURPOSE: To report the loss of correction of a sagittal imbalance and the clinical outcomes after a corrective osteotomy for lumbar degenerative kyphosis. MATERIALS AND METHODS: This study analyzed the radiological parameters, surgical techniques, and clinical outcomes of 23 patients, who underwent corrective osteotomy for lumbar degenerative kyphosis. The patients were divided into groups I (>5 cm loss of correction of sagittal imblance, 12 patients) and II (3.5 out of 5, 11 patients) was compared with group B (low satisfaction score group <3.5 out of 5, 12 patients). RESULTS: The sagittal imbalance was corrected by performing a Smith-Petersen osteotomy (SPO) in 11 cases and Pedicle subtraction osteotomy (PSO) in 12. The mean preoperative sagittal imbalance was improved from 26.4 cm to 4.05 cm, postoperatively, and 11.2 cm at the last follow up. The mean loss of correction was 11.2 cm in group I and 2.3 cm in group II. The mean satisfaction score was 4.56 in group A and 2.18 in group B. The presence of an old compression fracture was found to be related to the loss of correction, and the preoperative symptomatic spinal stenosis was related to poor clinical outcomes. CONCLUSION: After mean 45 month follow up, the mean loss of sagittal correction was 38.3%, which mainly occurred at the proximal unfused segment. The clinical success rate was 45.5%, regardless of the loss of sagittal balance correction.

Outcome Analysis of Single Level Anterior Cervical Fusion using Interbody PEEK Cage with Autologous Iliac Bone Graft / 대한정형외과학회잡지

PURPOSE: Anterior cervical fusion with a tricortical iliac bone graft is a well established procedure for treating degenerative cervical spine disease. An interbody cage has been used to prevent donor site morbidity but there are few reports on the clinical and radiological outcome. MATERIALS AND METHODS: Thirty eight patients, who underwent single level ACDF with PEEK interbody Solis(R)cage (Stryker spine, South Allendale, NJ, USA), were enrolled in this study. This study evaluated Odom's criteria and visual analogue scale (VAS) for the neck, arm and donor site pain, and the radiological findings, including the disk height, cage subsidence, and sagittal alignment of cervical spine. RESULTS: The mean disk height loss was 1.1 mm during the follow up period. Case subsidence >2 mm developed in 17 cases (44.7%). The mean subsidence of this group was 3.09 mm. The bone union rate was 95% at 12 weeks. There was no significant change in the sagittal alignment of the cervical spine. The VAS for neck, arm, and donor site pain improved all cases. Only 9 patients complained of mild discomfort at the donor site CONCLUSION: Single-level ACDF using PEEK interbody cage has a lack of donor site morbidity, excellent clinical outcomes and bone union. However, more study of the factors related to postoperative cage subsidence will be needed.

Neurotization of Brachial Plexus Injury / 대한정형외과학회잡지

PURPOSE: The aim of this study was to determine the result of neurotization on brachial plexus injury. MATERIALS AND METHODS: 51 patients (87 procedures) who were observed for more than 18 months after neurotization were chosen as subjects. The average follow-up period was 62.8 months, the mean age of patients was 27.8 years, and the average time between the injury and operation was 6.1 months. We performed 60 procedures of the whole arm type, 26 procedures of the upper arm type and 1 procedure of the lower arm type. The intercostal nerve, spinal accessory nerve, the contralateral 7th cervical (C7) nerve, and the phrenic nerve were used as donor nerves. The British Research Council System was used to evaluate the extent of recovery of upper limb function, and the time to first recovery of the muscle was noted. We also analysed results according to the type of injury, time between injury and surgery, and age. RESULTS: 30 procedures showed excellent results, 34 procedures good, 9 procedures fair and 14 procedures poor. In 64 procedures (73.6%) recovery of muscle strength was good or better, and in 73 procedures (83.9%) a recovery of muscle contraction was observed. The earliest evidence of recovery of muscle contraction was observed 6.4 months after using the intercostal nerve. When the contralateral C7 nerve was used, muscle contraction was most delayed. Surgery performed soon after injury and in younger patients produced the best clinical outcomes. CONCLUSION: We report that more than 2/3rds of the patients who received neurotization achieved at least a good result, which allowed a certain level of daily activity.