The Result of Minimally Invasive Transforaminal Lumbar Interbody Fusion in Low Grade Spondylolisthesis - Minimum 2 Years Follow Up -

STUDY DESIGNS: A retrospective study. OBJECTIVES: To analyze the clinical and radiological outcomes of spontaneous reduction via minimally invasive transforaminal lumbar interbody fusion (Mini-TLIF) as the treatment for low-grade symptomatic spondylolisthesis. SUMMARY OF LITERATURE REVIEW: Although minimally invasive transforaminal lumbar interbody fusion is technically demanding, this procedure is an effective method for spontaneous reduction of low grade spondylolisthesis. MATERIALS AND METHODS: We analyzed consecutive series of 41 patients with low grade spondylolisthesis who underwent minimally invasive transforaminal lumbar interbody fusion, between April 2008 and July 2009. The minimum follow-up period was 2 years. Clinical evaluation was performed by an analysis of Visual Analogue Scale and Oswestry Disability Index. For the radiological evaluation, disc space height, slip percentage, and slip angle were analyzed. At the final follow-up, the fusion rate was analyzed according to the Bridwell's anterior fusion grade. RESULTS: For the evaluation of clinical outcomes, the Visual Analogue Scale for back pain decreased from 6.8+/-1.2 to 2.0+/-1.1, and that for radiating pain decreased from 7.9+/-1.3 to 1.7+/-1.1. Oswetry Disability Index decreased from 38.5+/-8.4 to 13.4+/-6.1. For the radiological evaluation, disc space height increased from 8.4+/-2.14mm to 11.8+/-1.54mm(P<0.05), slip percentage was reduced from 18.4+/-5.1% to 13.3+/-3.1%(P<0.05) and slip angle decreased from 10.6+/-4.5degrees to 6.2+/-3.4degrees (P<0.05). At the final follow-up, radiological union was obtained in 38 cases (92.7%). CONCLUSIONS: We conclude that minimally invasive transforaminal lumbar interbody fusion appears to be an effective method for spontaneous reduction of low grade spondylolisthesis if the surgeon becomes familiar with this method.

Conservative Treatment of Valgus Impacted Four-Part Fracture of the Proximal Humerus: A Case Report

For valgus impacted four part fracture of the proximal humerus, surgical stabilization and early mobilization of the joint can produce the best clinical outcomes. But, we have experienced a case of conservative treatment and gained good clinical results. We have reported this case and included a review of the relevant literatures.

Factor Analysis Affecting the Leakage of Bone Cement After Vertebroplasty

STUDY DESIGN: Retrospective study OBJECTIVE: This study examined the causative factors of cement leakage in an osteoporotic compression fracture that had received percutaneous vertebroplasty. SUMMARY OF LITERATURE REVIEW: Percutaneous vertebroplasty is simple and safe for the treatment of osteoporotic compression fractures. However, serious complications, such as pulmonary emboli and paraplegia, can occur if the bone cement leaks into the pulmonary artery or spinal canal. MATERIALS AND METHODS: Between Oct. 2002 and Apr. 2008, 95 patients (148 vertebral bodies) underwent percutaneous vertebroplasty for the treatment of an osteoporotic compression fracture. The presence of cement leakage was evaluated by plain radiography and computed tomography. The correlations between cement leakage and gender, age, level of fractured vertebra, fracture type, bone density, procedure, injecting amount, preoperative vertebral body compression rate, timing of surgery, and the existence of an intravertebral cleft on magnetic resonance imaging (MRI) were analyzed. RESULTS: Leakage was found in 37 bodies on plain radiography and 56 on the CT-scan. A comparison of the leakage and non-leakage groups revealed the bone density (p=0.046) and amount injected (p=0.000) to be related to cement leakage. Multivariate logistic regression showed that injecting more than 4.0ml was related to cement leakage with an odds ratio of 2.23(95% CI, 1.476~3.377). CONCLUSIONS: Cement leakage after percutaneous vertebroplasty is associated with the amount injected. Therefore, the cement volume should be restricted to the amount required for pain relief.

Textiloma Ten Years after a Lumbar Discectomy: A Case Report / 대한정형외과학회잡지

A paraspinal foreign body reaction is a rare condition that can cause severe neurological complications or death. However, the condition is often neglected. The authors report a case of a paraspinal textiloma that was diagnosed and treated with a surgical excision.

Does a Radiolucent Zone Surrounding the Pedicle Screws mean Nonunion? / 대한정형외과학회잡지

PURPOSE: We wanted to retrospectively evaluate the clinical significance of radiolucent zones surrounding the pedicle screws after spinal fusion. MATERIALS AND METHODS: Spinal surgery was performed between May 2003 and December 2005 on elective patients with degenerative lumbar disorders and they underwent transpedicular screw fixation and posterolateral fusion and these patients were the subjects of the study. There were 124 cases with more than 2 years of follow up. Determination of the radiolucent zones around pedicle screws was done using simple x-rays and the cases were divided in to 4 different groups: segmental fixation with short (2 or less segments) or, long (3 or more segments) segmental fixation and those cases with or without sacral fixation. Comparative analysis was done according to osteoporosis, the location of the pedicle screws, the degree of bony-union and fixation of the anterior cortex of the sacrum. RESULTS: Among the 124 cases and 846 pedicle screws, 189 pedicle screws (22%) had radiolucent zones; 151 of the 189 pedicle screws with a radiolucent zone (27%) were in the sacral fixed group, while 38 of the 189 pedicle screws with a radiolucent zone (13%) were in the non-sacral fixed group, and the difference was significant (p=0.001). In the case of anterior cortical fixation in the sacral fixed group and the complete bony-union, the radiolucent zones had a significantly lower incidence, while the group of patients with osteoporosis (a T score lower than -2.5) had a higher incidence of radiolucent zones. CONCLUSION: The radiolucent zones surrounding the pedicle screws after spinal fusion were closely related to spinal fusion with sacral fixation and pseudarthrosis, and these radiolucent zones mostly occurred before complete bony-union. The existence of osteoporosis and the techniques of sacral fixation and many different contributing factors must be considered, and careful monitoring is needed even if the radiolucent zone progressive after complete bony-union.

Long Term Use of Glucocorticoid Induced Osteoporotic Multiple Compression Fractures in Autoimmune Diseases / 대한류마티스학회지

Reduced bone mineral density precedes the development of vertebral fractures in patients under long term glucocorticoid therapy. Osteoporosis is a frequent complication in steroid-dependent patients, and the risk of developing vertebral fractures in these patients is much higher than involutional osteoporosis. We described a 54-year-old patient who presented with autoimmune hepatitis and had a 6-year history of steroid medication. The patient had multiple compression fractures (T10~L5) without trauma, and was treated successfully with multi-level vertebroplasty and an intravenous injection of bisphosphonate without complications.

Treatment of Combined Degenerative Lumbar Disease and Adjacent Vertebral Fracture / 대한척추외과학회지

STUDY DESIGN: Retrospective study OBJECTIVE: To analyze the treatment results of vertebroplasty in patients who suffered osteoporotic compression fractures during conservative treatments for pre-existing degenerative lumbar disease. SUMMARY AND LITERATURE REVIEW: Whilst spinal fusion has shown satisfactory clinical results, solid fusion has been reported to accelerate the degenerative changes at the unfused adjacent levels. Therefore, the level of spinal fusion in patients with compression fractures and pre-existing degenerative lumbar disease is controversial. Few studies have evaluated the outcomes of spinal fusion and adjacent segment vertebroplasty. MATERIALS AND METHODS: A retrospective review was carried out on 28 patients who suffered the osteoporotic compression fractures during conservative treatment for pre-existing degenerative lumbar disease. Posterolateral fusion and vertebroplasty were performed for degenerative disease and compression fractures. The average fusion level was 1.82. The mean compressed vertebral bodies were 1.68. The radiology results were evaluated to determine the progression of the compression rate and fractures in the adjacent segment. The clinical results were evaluated using the Denis pain scale for compression fractures and Katz satisfaction scale for degenerative lumbar disease. RESULTS: The average compression rate was 30.2% preoperatively, 21.4% postoperatively, and 24.6% at the final follow-up. There was no fracture in the adjacent segment. Clinically, the preoperative Denis score was P3 and P4 in 8 and 20 patients, respectively. On the other hand, the postoperative Denis score was P1, P2 and P3 in 8, 19 and 1 patients, respectively. In regard to degenerative diseases, the overall satisfaction was 82.1%. CONCLUSION: The stability of fracture sites in vertebroplasty of patients with pre-existing lumbar disease was confirmed. However, further compression of the fractured vertebral body was observed after vertebroplasty in long fusion. Therefore, a followup study of more cases will be necessary to confirm the changes in the vertebroplasty site.

Comparison of the Effect of Hydroxyapatite and Allogenous Bone as an Adjunct to Autogenous Iliac Bone Grafting in Posterolateral Spinal Fusion / 대한정형외과학회잡지

PURPOSE: We wanted to analyze the efficacy of hydroxyapatite as a bone graft extender and we wanted to compare the bone fusion rate between hydroxyapatite and allogenous bone as an adjunct to autogenous iliac bone graft in posterolateral spinal fusion. MATERIALS AND METHODS: Our study included 19 patients who were treated with decompression and posterolateral spinal fusion using hydroxyapatite on right side and frozen allogenous bone on left side as an adjunct to autogenous iliac bone graft, and all the procedures were performed between May 2003 and August 2004. Fusion was determined by the final radiographic findings with using Christiansen's classification. RESULTS: There were 3 male and 16 female patients. Their average age was 65.5 years (range: 48-81) and the average follow-up period was 21.5 months (range: 12-36). Fusion was performed in 3.4 segments (range: 2-6) on average per patient. Of all the 65 segments that underwent fusion, 63 segments (96.9%) in group using hydroxyapatite and 54 segments (83.1%) in group using allogenous bone were determined to be fused, and the difference was not statistically significant (p=0.074). CONCLUSION: Hydroxyapatite as adjunct to autogenous iliac bone for use in posterolateral spinal fusion showed a high fusion rate and it seemed to be useful as a bone graft extender for reducing the volume of the autogenous iliac bone.

Clinical Results and Changes of Adjacent Segment after Whole Lumbosacral Fusion / 대한정형외과학회잡지

PURPOSE: To analyze the clinical and radiological results of whole lumbosacral fusion, and to identify whether an extension of the fusion level is required. MATERIALS AND METHODS: A retrospective review was carried out on 40 patients who had undergone whole lumbosacral fusion. The adjacent segment changes were evaluated by the radiological findings including intervertebral space narrowing, traction spur, endplate sclerosis and vacuum phenomenon. The clinical results were evaluated using a visual analogue scale (VAS) and Oswestry disability index (ODI). RESULTS: The mean age was 63.8 years and the mean follow-up period was 41.7 months. At the last follow-up, adjacent segment changes were observed in 12 cases of intervertebral space narrowing, 15 cases of traction spur, 20 cases of endplate sclerosis and 8 cases of vacuum phenomenon. In the clinical results, the VAS was improved to 4.0 points from 7.6 points, and the ODI improved to 43.9% from 86.0%. There were no revision cases due to adjacent segment problems. CONCLUSION: Whole lumbosacral fusion in spinal stenosis with degenerative lumbar scoliosis was concomitant with some adjacent segment problems, but presented favorable outcomes. For the prevention of junctional problem, caution should be taken when extending the fusion level to the proximal level in whole lumbosacral fusion.

Paraparesis due to Posterior Migration of Ruptured Disc in the Adjacent Segment after Spinal Fusion: Unusual Junctional Problem / 대한척추외과학회지

Posterior epidural migration of sequestered lumbar disc fragments is an uncommon event. We present here an especially uncommon case involving a patient with paraparesis that was due to posterior migration of a ruptured disc in the adjacent segment after spinal fusion. The patient had a herniated lumbar disc in a diseased spinal junction with sequestered fragments that were located posterior to the thecal sac.

Tumoral Calcinosis at Lumbar Region: A Case Report / 대한척추외과학회지

Tumoral calcinosis is a rare disease involving the ectopic calcifications in the major juxtaarticular sites that was first described by Inclan Alberto in 1943. The etiology of tumoral calcinosis is still obscure. A disturbance of the phosphate metabolism in the kidney has been considered a major cause. However, some patients have no laboratory abnormalities. Tumoral calcinosis in the spine has not been reported in Korea. Recently, we encountered a case of tumoral calcinosis in the lumbar region. The clinical and pathological findings are discussed with a review of the relevant literature.

Surgical Correction of Fixed Kyphosis

STUDY DESIGN: A retrospective review was carried out on 23 patients with rigid fixed kyphosis who underwent surgical correction for their deformity. PURPOSE: To report the results of surgical correction of fixed kyphosis according to the surgical approaches or methods. OVERVIEW OF LITERATURE: Surgical correction of fixed kyphosis is more dangerous than the correction of any other spinal deformity because of the high incidence of paraplegia. METHODS: There were 12 cases of acute angular kyphosis (6 congenital, 6 healed tuberculosis) and 11 cases of round kyphosis (10 ankylosing spondylitis, 1 Scheuermann's kyphosis). Patients were excluded if their kyphosis was due to active tuberculosis, fractures, or degenerative lumbar changes. Operative procedures consisted of anterior, posterior and combined approaches with or without total vertebrectomy. Anterior procedure only was performed in 2 cases, while posterior procedure only was performed in 8 cases. Combined procedures were used in 13 cases, including 4 total vertebrectomies. RESULTS: The average kyphotic angle was 71.8degrees preoperatively, 31.0degrees postoperatively, and the average final angle was 39.2degrees. Thus, the correction rate was 57% and the correction loss rate was 12%. In acute angular kyphosis, correction rate of an anterior procedure only was 71%, correction rate of the combined procedures without total vertebrectomy was 49% and correction rate of the combined procedures with total vertebrectomy was 60%. In round kyphosis, correction rate of posterior procedure only was 65% and correction rate of combined procedures was 59%. The clinical results according to the Kirkaldy-Willis scale demonstrated 17 excellent outcomes, 5 good outcomes and one poor outcome. CONCLUSIONS: Our data indicates that the combined approach and especially the total vertebrectomy showed the safety and the greatest correction rate if acute angular kyphosis was greater than 60 degrees.

Change in the Expression of p75 Neurotrophin Receptor and TRPV1 in the Spinal Cord and Dorsal Root Ganglion after an Injury to the Spinal Nerves in Rats / 대한정형외과학회잡지

PURPOSE: To determine the relationship between change in the expression of the p75 neurotrophin receptor (NTR) and transient receptor potential vanilloid 1 (TRPV1) after a spinal nerve injury with time. MATERIALS AND METHODS: The L5 and L6 spinal nerve of the rats were cut unilaterally. The spinal cord and dorsal root ganglion (DRG) were subjected to immunohistochemistry for p75 NTR and TRPV1. RESULTS: The immunoreaction (IR) for p75 NTR in the neuronal cytoplasm was persistently lower on the ipsilateral L5 and L6 DRG but higher in the satellite cells and fibers. The colocalization between p75 NTR and TRPV1 was increased temporarily in the L4 DRG in both sides. In the spinal cord, p75 NTR-IR decreased temporalily in the ipsilateral dorsal horn of the L4-L6 level and had recovered at 28 days after injury. CONCLUSION: These results show that a differential change in the expression of p75 NTR and TRPV1 is related to the different functional recovery of the sensory and motor system, and that increased colocalizations between p75 NTR and TRPV1 in a non-injured DRG might be related to the development of neuropathic pain after a peripheral nerve injury.

Long-segment Posterolateral Fusion with Instrumentation of the Multi-level Spinal Stenosis: Long-term Followup over the 5 Years / 대한정형외과학회잡지

PURPOSE: To evaluate the long-term results, and to analyze the clinical and radiological results of long-segment posterolateral fusion with instrumentation in multi-level spinal stenosis. MATERIALS AND METHODS: A retrospective review was carried out on 62 patients, who had undergone long-segment posterolateral fusion with instrumentation for the treatment of multi-level spinal stenosis from June, 1990 to May, 1998 with a minimal follow up of 5 years. The clinical outcomes were evaluated using the Katz's classification and the Oswestry disability scoring system (ODI). The radiological results were evaluated by monitoring the changes in the adjacent segments and the Lenke's grade for bony union. RESULTS: The mean follow-up duration was 94 (61-156) months. There were 14 males and 48 females. The mean age was 58.7 (37-78) years. The mean number of fused segments per person were 3.97 (3-8) and the fusion techniques used in this study were either the fixed fusion for 60 cases or floating fusion for 2. 48 (77.4%) cases showed results beyond 'satisfaction'. The mean ODI was 30.0 (6-88%), which means moderate disability. The ODI according to the number of fusion segments was checked for good results. Good results were observed in 25.8%, 33.6%, and 25.9% of patients with 3, 4 or more than 5 fusion segments, respectively. There was no statistical difference. Regarding the changes in the adjacent segments, disc space narrowing, traction spur, endplate sclerosis and vacuum phenomenon was observed in 25 (40.3%), 26 (41.9%), 22 cases (35.5%) and 7 cases (11.3%), respectively. 34 (55.0%) cases had more than one change in the adjacent segments but the ODI was 38.0% for "good results" and 25 (74.0%) cases were "satisfied". In all cases except for one, bony union showed Lenke's A or B degree by radiographs. Pseudarthrosis was detected in 1 (1.6%) case. CONCLUSION: In the analysis of long-term clinical and radiological results for multi-level spinal stenosis treatment, posterolateral fusion with instrumentation might be good results irrespective of the fusion level and the change in adjacent segment.

Comparison of the Result of Vertebroplasty and Conservative Treatment in Osteoporotic Vertebral Compression Fracture

PURPOSE: To evaluate the results of vertebroplasty and conservative treatment in osteoporotic vertebral compression fractures. MATERIALS AND METHODS: Patients were divided randomly into 2 groups; Group I (conservative treatment) and Group II (vertebroplasty). There are 14 cases in group I and 16 cases in group II. Radiologically, the progression of compression was observed. Clinical evaluation was done using Denis pain scale. In both groups, prolonged pain with nonunion or avascular necrosis that resulted in surgical intervention was evaluated as complication. In group II, the complication associated the procedures were evaluated. RESULTS: Group II was superior to conservative treatment in terms of maintaining vertebral height radiologically. The characteristics of symptom improvement were the same in two groups. There were cement leakage among group II but they did not influence to the results. In group I, 2 subjects needed surgery due to prolonged pain. In group II, 1 subject needed surgery due to prolonged pain and there were 3 cement leakage cases which were insignificant. CONCLUSION: In vertebroplasty group, complications associated the procedures were noted. In conservative treatment group, more patients needed operation. Therefore, we should be very prudent when we choose the treatment of the osteoporotic vertebral compression fracture.

Arthroscopically Assisted En Bloc Resection of the Distal Clavicle in the Acromioclavicular Joint Lesion / 대한정형외과학회잡지

PURPOSE: To evaluate the clinical results of arthroscopically assisted operation of the acromioclavicluar joint lesion with the rotator cuff lesion. MATERIALS AND METHODS: We evaluated the clinical results in eighteen consecutive patients with osteoarthritis of the acromioclavicular joint and rotator cuff lesion, who were treated arthroscopically assisted en bloc resection of the distal clavicle and arthroscopic acromioplasty. The average age of the patients at the time of operation was fifty six years. The average duration of follow-up was one year and ten months. The UCLA shoulder rating scale was used to evaluate the clinical results. RESULTS: Pain score was improved from 2.1+/-1.1 preoperatively to 9.2+/-1.0 postoperatively. Function score was improved from 4.2+/-1.7 to 9.4+/-0.9, active forward flexion score, from 3.7+/-0.5 to 5 and strength score, from 4.0+/-0.9 to 4.9+/-0.2. On follow-up radiographic examination, there was no specific complication, including heterotopic ossification, remnant bony fragment of distal clavicle, and superior migration of the clavicle. CONCLUSION: It is considered that arthroscopically assisted en bloc resection of the distal clavicle and acromioplasty is recommendable method for symptomatic acromioclavicular joint lesion and rotator cuff lesion, which could get the satisfactory clinical results.

The Changes of Adjacent Segments after Long Segment Posterolateral Fusion: Comparative Study of 3 year versus over the 7 year Follow-up Patients / 대한정형외과학회잡지

PURPOSE: To compare the 3 year and over the 7 year results after long-segment posterolateral fusion and to analyze the changes of adjacent segments and the changes according to the segmental lordosis angle of the fusion segments. MATERIALS AND METHODS: A retrospective review was carried out 62 patients of long segment fusion for 7 years follow up and compared that of the 3 year and over the 7 year results. The changes of adjacent segments were evaluated by simple radiography for disc space narrowing, traction spur, endplate sclerosis and vacuum phenomenon.In last follow-up, segmental lordosis angle of fusion level was evaluated by Gelb's criteria and clinical results were analyzed by Katz's classification. RESULTS: In the changes of adjacent segments, disc space narrowing was increased 27.4% to 38.7%, traction spur was 22.6% to 35.5%, endplate sclerosis was 19.4% to 32.2% and vacuum phenomenon was 8.1% to 12.9%. The changes of adjacent segments were observed that from 3.4% to 20.7% in physiologic group and from 33.3% to 90.9% in un-physiologic group. The clinical results showed 83.9% satisfaction and 16.1% un-satisfaction. CONCLUSION: In long-term follow up of long-segment posterolateral fusion, physiologic segmental lordosis angle should be preserved for decrease of changes of adjacent segments in long-segment posterolateral fusion.

Relevancy of Posterior Column Injury and Dural Tear in Unstable Burst Fracture

PURPOSE: To analyze the pattern of posterior column injury in unstable burst fractures and to predict the possibility of dural injury. MATERIALS AND METHODS: Retrospective review was carried out on 22 patients of unstable burst fracture from Nov. 1996 to Sep. 2003. The pattern posterior column injury was analyzed by simple x-ray, CT and MRI findings. In simple x-ray, authors analyzed laminar fracture, posterior facet injury, inter-spinous widening and inter-spinous malalignment, posterior bony injury by CT, posterior inter-spinous ligament injury and dural tear by MRI. The statistical analysis was performed using Mann-Whitney test and Chi-square test. RESULTS: There were 13 men and 9 women, and mean age was 41 years-old (18~65). The level of injury showed 15 cases in T12-L2, 6 in L3, 3 L4. In simple x-ray, findings were showed 13 cases (59.1%) in laminar fracture, 7 (31.8%) in posterior facet injury, 16 (72.7%) in inter-spinous widening and 8 (36.4%) in inter-spinous malalignment. In CT, findings were showed 13 (59.1%) in laminar fracture, 10 (45.5%) in posterior facet injury, 9 (40.9%) in transverse process fracture. In MRI, findings were showed 18 (81.8%) in posterior inter-spinous ligament injury and were not showed dural tear. The combined cases of posterior bony and ligamentous injury was 6 (27%) and 5 of 6 showed dural tear and the analysis of dural tear and radiologic findings was showed positive correlation (p=0.004). CONCLUSION: Posterior ligament injury was more frequent than bony injury in unstable burst fracture. Among the posterior bony injuries, dural tear was more frequent in facet injury. Authors confirmed all dural tear with operation. In cases of posterior bony injury combined with ligamentous injuries, the possibility of dural tear was significantly higher than that of single structural injury (p=0.004).

Effect of Posterior Lumbar Interbody Fusion for Maintaining the Reduction in Isthmic Spondylolisthesis / 대한척추외과학회지

STUDY DESIGN: This is a retrospective study on the effect of posterior lumbar interbody fusion for maintaining the reduction in isthmic spondylolisthesis patients. OBJECTIVES: We evaluated the efficacy of performing posterior lumbar interbody fusion for maintaining the reduction in isthmic spondylolisthesis. SUMMARY OF THE LITERATURE REVIEW: There have been many reports regarding the surgical treatment of spondylolisthesis. Although there are many reports that the clinical results have nothing to do with the reduction, many surgeons have tried to maintain the reduction. However, the question about what kind of fusion modality is the most effective for maintaining the reduction is still controversial. MATERIAL AND METHOD: Between August 2002 and January 2004, 24 patients with isthmic spondylolisthesis were operated on. 14 underwent posterolateral fusion alone (group A) and 10 underwent additional posterior interbody fusion (group B). These two groups were compared in terms of the clinical results, the radiological changes and fusion rates. RESULTS: the reduction rate were 11.81% and 7.32% in the PLF and PLF+PLIF groups, respectively (p>0.05). The reduction losses were 0.19% and 0.35% in the PLF and PLF+PLIF groups, respectively (p>0.05). The changes after fusion were 0.11% and 0.10% in the PLF and PLF+PLIF groups, respectively (p>0.05). There was no case of nonunion. The satisfaction rates were 86% and 83% in the PLF and PLF+PLIF groups, respectively (p>0.05). CONCLUSIONS: In our study, the addition of posterior interbody fusion showed no benefit in maintaining correction. If solid fusion can be obtained, then posterolateral fusion seems to be sufficient enough to maintain correction in isthmic spondylolisthesis. The authors think that further studies are mandatory because of the small number subjects in our study.

Comparative Analysis of Unstable Burst Fracture According to the Methodology of Surgical Treatment / 대한척추외과학회지

STUDY DESIGN: A retrospective analysis of the results of various methodologies for the surgical treatment of an unstable burst fracture with posterior column injuries. OBJECTIVES: To compare the radiological and clinical results in unstable burst fractures, treated with various surgical methodologies (anterior, posterior and combined fusion), and to confirm their efficacy. LITERATURE REVIEW SUMMARY: Many authors recommended various surgical methods for the treatment of an unstable burst fracture, and of these, combined fusion is recommended for the preservation of stability. MATERIALS AND METHODS: A retrospective review of results was carried out on 22 patients, confirmed with an unstable burst fracture associated with a posterior column injury, between Nov. 1996 and Mar. 2003. The preoperative plane x-ray, CT and MRI, and the last postoperative follow up plane X-ray and CT, in 22 unstable burst fracture patients, were reviewed. The authors looked for laminar fracture, facet injury and inter-spinous widening in the plane x-ray, canal compromise on the CT, and a posterior ligament injury and dural tear on the MRI. The neurological injury was evaluated using the Bardford and McBride criteria and the clinical result with the Denis' pain and work scale. RESULTS: In the anterior fusion group, the radiological findings showed 3 laminar fractures, 2 facet injuries, 7 inter-spinous widening and 8 posterior ligament injuries. In the posterior fusion group, they showed 5 laminar fractures, 4 facet injuries, 5 inter-spinous widening and 5 posterior ligament injuries. In the combined fusion group, they showed 5 laminar fractures, 4 facet injuries, 4 inter-spinous widening and 5 posterior ligament injuries. The average canal compromise was 54.3% in cases of anterior fusion, 20.9% of posterior fusion and 74% of the combined fusion groups. A dural tear was found in 1 each of the anterior and posterior and 4 of the combined group. From the clinical results, improvements of the neurology in the anterior, posterior and combined groups were 2.0, 1.7 and 1.3 degrees, respectively. From the Denis' pain & work scale better than good degrees were shown in 3 of the anterior, 4 of the posterior and 2 of the combined groups. CONCLUSIONS: In conclusion, there were no differences in the improvements of the neurology and clinical results according to the surgical methodology employed. However, the use of combined fusion is recommended for the preservation of stability in an unstable burst fracture with combined posterior ligament and bony injuries as well as with severe canal compromise.