The First Clinical Trial of Beta-Calcium Pyrophosphate as a Novel Bone Graft Extender in Instrumented Posterolateral Lumbar Fusion

BACKGROUND: Porous beta-calcium pyrophosphate (beta-CPP) was developed to improve the fusion success of posterolateral lumbar fusion (PLF). The possibility of accomplishing PLF using a mixture of porous beta-CPP and iliac bone was studied. This paper reports the radiologic results of PLF using the beta-CPP plus autograft for lumbar degenerative disease as a bone graft extender. METHODS: A prospective, case-matched, radiographic study evaluating the results of short segment lumbar fusion using a beta-CPP plus autograft was performed to compare the efficacy of beta-CPP plus autograft with that of an autograft alone for short segment lumbar fusion. Thirty one consecutive patients (46 levels) underwent posterolateral fusion with pedicle screw fixation and additional posterior lumbar interbody fusion. In all patients, 3 mL of beta-CPP plus 3 mL of autogenous bone graft was placed randomly in one side of a posterolateral gutter, and 6 mL of autogenous iliac bone graft was placed on the other. The fusion rates, volumes of fusion masses, and bone absorption percentage were evaluated postoperatively using simple radiographs and 3 dimensional computed tomography (3D-CT) scans. RESULTS: The control sides treated with an autograft showed significantly better Lenke scores than the study sides treated with beta-CPP at 3 and 6 months postoperatively, but there was no difference between the two sides at 12 months. The fusion rates (confirmed by 3D-CT) were 87.0% in the beta-CPP group and 89.1% in the autograft group, which were not significantly different. The fusion mass volumes and bone absorption percentage at 12 months postoperatively were 2.49 mL (58.4%) and 1.89 mL (69.5%) for the beta-CPP and autograft groups, respectively, and mean fusion mass volume was significantly higher in the beta-CPP group. CONCLUSIONS: beta-CPP combined with an autograft is as effective as autologous bone for grafting during instrumented posterolateral spinal fusion. These findings suggest that beta-CPP bone chips can be used as a novel bone graft extender for short-segment posterolateral spinal fusion.

Traumatic Retropharyngeal Hematoma of Delayed Onset in an Anticoagulated Patient / 대한정형외과학회잡지

The development of a retropharyngeal hematoma following a trivial blunt trauma is a rare occurrence. A lateral c-spine X-ray or a cervical CT image that shows marked widening of the prevertebral space is sufficient evidence for the clinical diagnosis of retropharyngeal hematoma. When this complication does occur, it can become life-threatening if the airway is compromised. But the diagnosis is obscure and initially veiled in complaints of sore throat or hoarseness, suggesting infection. Thorough investigation of such complaints is necessary especially in patients receiving anticoagulation therapy. We now report a case of retropharyngeal hematoma that occurred as a delayed-onset consequence of a trivial blunt trauma with no evidence of a bony cervical spine injury. It occurred in a 52-year-old man who had been taking warfarin. We also reviewed the literature.

A Case of Postoperative Tuberculous Spondylitis with a Bizarre Course

Postoperative infections following spine surgery are usually attributable to bacterial organisms. Staphylococcus aureus is known to be the most common single pathogen leading to this infection, and the number of infections caused by methicillin-resistant Staphylococcus aureus is increasing. However, there is a paucity of literature addressing postoperative infection with Mycobacterium tuberculosis. We encountered a case of tuberculous spondylitis after spine surgery. A man had fever with low back pain three weeks after posterior interbody fusion with instrumentation for a herniated intervertebral disc at the L4-L5 level. He had been treated with antibiotics for an extended period of time under the impression that he had a bacterial infection, but his symptoms and laboratory data had not improved. Polymerase chain reaction for Mycobacterium tuberculosis turned out to be positive. The patient's symptoms finally improved when he was treated with antituberculosis medication.

Analysis of Homepages Relating to Lumbar Disc Surgery in Orthopaedic and Neurosurgical Hospitals / 대한정형외과학회잡지

PURPOSE: This study evaluated the operability for disease of lumbar intervertebral disc (LID) of practitioners and pay doctors of orthopedic surgeons and neurosurgeons by examining their websites. MATERIALS AND METHODS: From March 2006 to April 2006, we searched the internet using the key words orthopedic surgery and neurosurgery, with NAVER as the portal site. There were 68 homepages of orthopedic hospitals and physician's offices (OHP) and 27 homepages of neurosurgical hospitals and physician's offices (NHP). Each homepage was visited in order to survey the operability for disease of an intervertebral disc and the number of board of orthopedists and neurosurgeons. Statistical analysis was carried out using a chi-square test. RESULTS: In 45.6% (31/68) of OHP and 85.2% (23/27) of NHP, the operation for LID was performed and there was significant difference (p<0.001). In 16.2% (11/68) of OHP, neurosurgeons employed by OHP performed the operation for spinal disorders. In 29.4% of OHP, the orthopedic surgeon performed the operation for LID. Orthopedists were employed in 51.9% of NHP. NHP were significantly higher than OHP in the cases in whom the orthopedists and neurosurgeons worked together in a single hospital (p<0.001). CONCLUSION: In 70% of OHP, surgery for LID was not performed. A survey about reasons for not performing operation for LID and improvement of that reasons should be carried out by the medical association.

Evaluation of Quality of Website Information about Lumbar Herniated Intervertebral Disc / 대한정형외과학회잡지

PURPOSE: This study evaluated the information quality of websites that provide information about herniated intervertebral discs (HIVD) and examined the correlation between the information quality score (IQS) and the rank of popularity. MATERIALS AND METHODS: From April 1 to May 31, 2005, of 308 homepages that had been searched on three search engines using the key words (vertebra, disc, lumbago, HIVD), 150 homepages with information about HIVD were surveyed. The informational quality score of each homepage was examined according to the existence or nonexistence of 25 criteria and compared the IQS according to the discipline and operating scale. The homepages were rated according to the rank of popularity and the correlations between their point of popularity and informational quality were assessed. RESULTS: The mean IQS of the 150 homepages were 8.5 (+/-6.4) points, IQS of 94 (62.6%) homepages were <10 points. There were no significant differences between the IQS of orthopedic surgery and neurosurgery (p=0.985). However, the IQS of oriental medicine were significantly lower than orthopaedic surgery (p<0.001) and neurosurgery (p<0.001). There was no significant correlation between the popularity and IQS (p=0.256). CONCLUSION: Proper guidelines and certification of the homepage that provide information about HIVD by the medical association are needed.

Comparison of Posterior Cruciate Ligament Retentionversus Substitution in PFCSigma Rotating-Platform Total Knee Arthroplasty / 대한정형외과학회잡지

PURPOSE: The purpose of this study was to assess the results of posterior cruciate ligament-retaining and posterior cruciate ligament-sacrificing total knee arthroplasty using PFC Sigma rotating-platform (RP). MATERIALS AND METHODS: The subjects for this study were 43 patients who had undergone total knee arthroplasties by means of PFC Sigma RPs from February 2002 to July 2002 and, thereafter, had been observed for a period of at least 36 months. Twenty-two of the patients were categorized to group I, which retained the posterior cruciate ligament and 21 to group II, which substituted for the ligament. All the patients were evaluated for pre- and post-operative ranges of motion, the Hospital for Special Surgery (HSS) knee rating system, and radiographic analysis. RESULTS: The average flexion contracture was 6.5degrees (+/-1.0o) in group I and 6.7degrees (+/-0.8degrees) in group II pre-operatively, and 1.1degrees (+/-0.3degrees) in group I and 0.9degrees (+/-0.2degrees) in group II at the last follow-up. The average active range of knee motion improved from 87.6degrees (+/-6.5degrees) in group I and 86.6degrees (+/-6.1degrees) in group II pre-operatively, to 123.0degrees (+/-7.8degrees) and 125.1degrees (+/-7.3degrees), respectively, at the last follow-up. The average HSS score improved from 41.1degrees (+/-7.1degrees) in group I and 40.3degrees (+/-5.3degrees) in group II pre- operatively, to 87.3degrees (+/-6.0degrees) and 88.9degrees (+/-4.9degrees), respectively, at the last follow-up. There was also improvement in the average tibio-femoral angle from 8.0degrees in varus to 5.7degrees in valgus in group I and from 10.9 in varus to 5.4degrees in valgus in group II. Radiolucent lines were observed in 4 cases from group I and in 1 case from the group II. No significant progressive periprosthetic osteolysis was observed in the follow-up radiographs of both groups. CONCLUSION: There were no clinical and radiographic differences between the posterior cruciate ligament-retention and ligament-substitution groups, which indicates the necessity for long-term observation.

Treatment of Upper Thoracic Disc Herniation Using Transthoracic Approach without Division of Latissimus Dorsi: Technical Note / 대한척추외과학회지

Thoracic disc herniation is a rare condition in which a posterior approach, extrapleural approach, posterolateral approach, or transthoracic approach is currently used. The posterior approach is not recommended in thoracic disc herniation surgery because of the risk of spinal cord injury. The transthoracic approach makes it possible to remove the intervertebral disc and is considered a standard method. However, due to an extensive transverse skin incision, division of the latissimus dorsi muscles, and rib resection, the conventional open approaches involve a risk of complications, such as infection and post-thoracotomy pain syndrome; and a long period of rehabilitation and recovery is required. Excision of the intervertebral disc under thoracoscopic guidance can reduce the damage to the skin and muscles, but the equipment and surgical materials are expensive and a long learning curve is required. Therefore, we report a case and a new muscle splitting transthoracic approach that can be performed by incising 10 cm of skin longitudinally and preserving the serratus anterior and latissimus dorsi muscles.

Surgical Treatment of Scapular Fracture using by Plate Fixation: 4 Cases Report

Fractures of the scapula are relatively uncommon injuries and most can be treated satisfactorily with non-operative methods. But scapular fractures are being seen with increasing frequency in our mechanized society, specially in patients who have multiple injuries. So most injuries were related high energy, that residual deformities were high and related to the residual symptoms. Authors had done open reduction and internal fixation with plate in the four cases of the scapular fracture and analyzed that results.

Conservative Treatment of Spontaneous Spinal Epidural Hematoma: A Case Report / 대한척추외과학회지

A spontaneous spinal epidural hematoma (SSEH) is a rare disease that accompanies severe axial pain in the spine with various levels of paralysis depending on the location of the hematoma. A SSEH is mainly caused by a coagulating disorder or anticoagulants medication, while certain cases relate this disease with spinal inflammatory conditions. The early diagnosis of a SSEH is important for its treatment. Most cases with neurologic symptoms can be treated with a immediate laminectomy and decompression. If the neurologic symptoms improves within 12 hours, a conservative treatment is effective, however few cases have been reported. We encountered a 59 years old male without a prior medical history suffering from severe back pain and paraplegia due to a SSEH at thoracic vertebrae. The patient was successfully treated conservatively. We report this case with a review of the relevant literature.

Long Term Results of the Selective Spinal Nerve Root Block for the Herniated Lumbar Intervertebral Disc / 대한척추외과학회지

STUDY DESIGN: A retrospective study. OBJECTIVES: To access the 5-year outcomes of patients with sciatica, not caused by spinal stenosis, spondylolysis, spondylolisthesis or congenital deformity, but by a lumbar herniated intervertebral disc (HIVD), treated by a selective nerve root block (SNRB). A review of the alternative treatments, during the follow up period, is also presented. SUMMARY OF LITERATURE REVIEW: Controversy exists about the therapeutic effects, particularly the long-term effects of a SNRB, in sciatica caused by a lumbar HIVD. MATERIALS AND METHODS: SNRB was performed on a total of 288 patients, diagnosed with a lumbar HIVD, through the clinical manifestations and physical and radiological findings, including MRI, between Jan. 1992 and Dec. 1997. Of the 288 patients, the 79 that underwent SNRB treatment only, and were minimally followed up for five years, were reviewed. The type of HIVD was based on the MRI findings, and the results of the SNRB were analyzed, with regard to the presence or absence of a relapse, the other treatments for recurrent or remnant symptoms following the SNRB, return to previous daily living and working activities and the degree of subjective symptomatic improvement, as assessed by a chart review, or an out patient department follow up or a telephone interview. RESULTS: With regard to the HIVD, there were 17 cases of bulging type (21.5%), 37 of protrusion (46.8%), 21 of extrusion (26.6%) and 4 of sequestration (5.1%) types. Medication and physical therapy was required in 13 cases (16.5%) and 35 cases (44.3%) used herbal medication and acupuncture. Thirteen of the 79 cases relapsed, and 10 were treated by microscopic discectomy. SNRBs were reperformed in 3 cases. Twenty-three cases (29.1%) required no treatment. Fifty-six cases (84.8%) returned to their previous daily living and working activities. SUMMARY: As this study did not accurately evaluate the change in the natural history of a HIVD following a SNRB, a further prospective study is still required. However, a SNRB is still a valuable non-operative treatment method for the acute radicular pain associated with a HIVD.