Minimally Invasive Transforaminal Lumbar Interbody Fusion / 대한척추외과학회지

STUDY DESIGN: A retrospective study OBJECTIVES: To introduce the technique of minimally invasive transforaminal lumbar interbody fusion and examine its clinical and radiologic results. SUMMARY OF LITERATURE REVIEW: Transforaminal lumbar interbody fusion with a mini-incision using a tubular retractor was recently developed. The aim of this procedure is to reduce the approach-related morbidity and achieve better results in an effective and safe manner. MATERIALS AND METHODS: Thirty eight patients were followed up for more than 1 year. Their mean age was 57 years and the mean follow-up was 19 months. The diagnosis was spinal stenosis, spondylolisthesis and recurred herniated nucleus pulposus in 22, 14 and 2 patients, respectively. The Oswestry disability index, intervertebral disc space height, fusion rate and complications were evaluated. RESULTS: The Oswestry disability index improved from 30 points (range, 50~16 points) to 10 points (range, 2-24 points) at the last follow-up. Thirty-four patients (90%) showed excellent or good results. The intervertebral disc space height increased from 8.7 mm to 10.8 mm. Two cases showed nonunion but the clinical results were good. Complications included one case of infectious spondylitis requiring antibiotics, one case of cage dislodgement requiring additional surgery and one case of a pedicle screw malposition showing no clinical symptoms. CONCLUSIONS: Minimally invasive transforaminal lumbar interbody fusion reduced the soft tissue injury and blood loss and shortened the recovery period compared to the traditional open techniques.

Large Aneurysmal Bone Cyst of the Posterior Archofa Lumbar Vertebraina Child Treated with En Bloc Excision: A Case Report / 대한정형외과학회잡지

We present a case of an 8 year-old girl with a large aneurysmal bone cyst (ABC) of the 4th lumbar vertebra that involved the adjacent posterior element and which was treated by an en bloc excision. An aneurysmal bone cyst is an uncommon lesion. Among lesions that involve the extremities, standard treatment with curettage and a bone graft or other alternatives, such as embolization and radiation therapy, may be sufficient; but those that involve the spinal column require special consideration because of its anatomical and biomechanical complexity. We removed a large aneurysmal bone cyst from the posterior element of the lumbar spine with an en bloc excision without fusion or instrumentation and the clinical result was satisfactory. At the 1-year follow-up, there was no evidence of clinical recurrence or radiological instability. We describe a case of a large aneurysmal bone cyst of a lumbar vertebra of a child and present a review of the pertinent literature.

Monitoring Method for Deep Infection after TKA: Significance of Intraoperative Synovial Fluid Culture and Postoperative Suction Drainage Tip Culture / 대한정형외과학회잡지

PURPOSE: The aim of this study was to evaluate the usefulness of the intra-operative synovial fluid culture and post-operative suction drainage tip culture as a method for predicting the development of a deep infection after primary TKA. MATERIALS AND METHODS: Between July 1998 and July 2002, 324 primary total knee arthroplasty procedures were performed and aerobic and anaerobic bacterial cultures for intra-operative synovial fluid and post-operative suction drainage tip were obtained. The results of culture of intra-operative synovial fluid and post-operative suction drainage tip of total 324 primary TKA cases were analyzed. The sensitivity, specificity and predictive value were calculated. positive culture rate for osteoarthritis was compared with rheumatoid arthritis and the results of a single TKA was compared with both simultaneous TKA. RESULTS: 14 out of 324 knees showed a positive intra-operative synovial fluid culture and 10 cases showed a positive post-operative suction drainage tip culture. Only 1 case out of the 4 deep infection cases showed a positive on suction drainage tip culture with S. aureus being isolated. The specificity of the intra-operative synovial culture was 95.6% and the negative predictive value was 98.7%. The sensitivity of the post-operative suction drainage tip culture was 25%, the specificity was 97%, the positive predictive value was 10% and the negative predictive value was 99%. The positive culture rate was similar in the osteoarthritis and rheumatoid arthritis cases (respectively p=0.4717, p=0.6550). However, the culture positive rate between single and both simultaneous TKA was numerically different, approximately 2 times (3.2% vs 6.31% for intra-operative synovial culture and 4.0% vs 9.47% for post-operative suction drainage tip culture) but it was not statistically significant (respectively p=0.311, p=0.1051). CONCLUSION: In primary TKA, a culture of intra-operative synovial fluid and post-operative suction drainage tip cannot predict a postoperative deep wound infection. It is recommended that careful observation for other signs of a deep infection be examined when a clinically significant true pathogen isisolated.

Treatment of Osteoporotic Unstable Intertrochanteric Fractures: Comparative Study between using Dynamic Hip Screw and Additional Trochanter Stabilizing Plate / 대한정형외과학회잡지

PURPOSE: To compare the effectiveness of a trochanter stabilizing plate with a dynamic hip screw, with using a dynamic hip screw only in the treatment of an unstable intertrochanteric fracture of elderly patients. MATERIALS AND METHODS: From January 2000 to December 2004, 70 patients, who were treated surgically for unstable intertrochanteric fractures, were evaluated. The patient s age were above 65 years and the T-score 0.05), but the postoperative functional loss of the hip joint was significantly lower in the group 2 (p<0.05), who required additional surgery due to reduction loss or metal failure. CONCLUSION: Although it is a relatively simple technique, the use of DHS with TSP is more effective for the buttress effect on proximal fragment and additional fixation of great trochanter than just DHS only. It decreases the excessive slippage of the lag screw, lateral displacement of the greater trochanter and postoperative functional loss of the hip joint. Therefore, it may be a useful treatment for unstable or comminuted intertrochanteric fractures in elderly patients with osteoporosis.

Survival Analysis of Posterior Short Fusion in Thoracolumbar Fracture: Significance of Load-Sharing Score and Bone Mineral Density-Changseop / 대한척추외과학회지

STUDY DESIGN: A retrospective study. OBJECTIVES: To evaluate the fixation survival rate and the radiologic prognostic factors of posterior short fusion in thoracolumbar fracture. SUMMARY OF BACKGROUND DATA: Posterior short fusion has the advantage of saving motion segments in spite of high fixation failure rate. The high load-sharing score is well known as a cause of fixation failure, but the effect of osteopenia is not evaluated. MATERIALS AND METHODS: Authors evaluated 27 patients treated surgically with posterior short fusion using pedicle screws as thoracolumbar fractures from 1995 to 1999. The median follow-up was 20.5 months (6-54). The survivorship using Kaplan-Meier method and the radiologic prognostic factors were evaluated. RESULTS: The sagittal index was preoperatively 16.7 dgree (+/-7.9 SD), immediate postoperatively 6.9 dgree (+/-4.6), and at last follow-up 10.6 dgree (+/-6.9). The fixation failures were detected in 4 patients, and the failure time was ranged from 6 months to 11(median 7.5). The overall survival rate was 82.3% at the last follow-up. The significant prognostic variables were load-sharing score, Jikei grade, compression percent and age in uni-variate analysis, but the load-sharing score and Jikei grade were significant prog-nostic factors in multivariate analysis. CONCLUSIONS: In decision to perform posterior short fusion, the load-sharing score and evidence of osteopenia should be consid-ered as a prognostic factors to avoid fixation failure in thoracolumbar fracture.