[Show abstract][Hide abstract] ABSTRACT: To report the radiological and clinical results after corrective osteotomy in ankylosing spondylitis patients. Furthermore, this study intended to classify the types of deformity and to suggest appropriate surgical treatment options.
We retrospectively analyzed ankylosing spondylitis patients who underwent corrective osteotomy between 1996 and 2009. The radiographic assessments included the sagittal vertical axis (SVA), spinopelvic alignment parameters, correction angle, correction loss, type of deformity related to the location of the apex, and the craniocervical range of motion (CCROM). The clinical outcomes were assessed by the Oswestry Disability Index (ODI) scores.
A total of 292 corrective osteotomies were performed in 248 patients with a mean follow-up of 40.1 months (range, 24 to 78 months). There were 183 cases of single pedicle subtraction osteotomy (PSO), 19 cases of multiple Smith-Petersen osteotomy (SPO), 17 cases of PSO + SPO, 14 cases of single SPO, six cases of posterior vertebral column resection (PVCR), five cases of PSO + partial pedicle subtraction osteotomy (PPSO), and four cases of PPSO. The mean correction angles were 31.9° ± 11.7° with PSO, 14.3° ± 8.4° with SPO, 38.3° ± 12.7° with PVCR, and 19.3° ± 7.1° with PPSO. The thoracolumbar type was the most common. The outcome analysis showed a significant improvement in the ODI score (p < 0.05). Statistical analysis revealed that the ODI score improvements correlated significantly with the postoperative SVA and CCROM (p < 0.05). There was no correlation between the clinical outcomes and spinopelvic parameters. There were 38 surgery-related complications in 25 patients (10.1%).
Corrective osteotomy is an effective method for treating a fixed kyphotic deformity occurring in ankylosing spondylitis, resulting in satisfactory outcomes with acceptable complications. The CCROM and postoperative SVA were important factors in determining the outcome.
Clinics in orthopedic surgery 09/2015; 7(3):330-6. DOI:10.4055/cios.2015.7.3.330
[Show abstract][Hide abstract] ABSTRACT: OBJECT Most thoracolumbar fractures have a good healing outcome with adequate treatment. However, posttraumatic thoracolumbar kyphosis can occur in a proportion of thoracolumbar fractures after inappropriate treatment, osteoporosis, or osteonecrosis of the vertebral body. There are several surgical options to correct posttraumatic thoracolumbar kyphosis, including anterior, posterior, and combined approaches, which are associated with varying degrees of success. The aim of this study was to assess the use of a modified closing wedge osteotomy for the treatment of posttraumatic thoracolumbar kyphosis and to evaluate the radiographic findings and clinical outcomes of patients treated using this technique. METHODS Thirteen consecutive patients with symptomatic posttraumatic thoracolumbar kyphosis were treated using a modified closing wedge osteotomy. The mean patient age was 62 years. The kyphosis apex ranged from T-10 to L-2. The sagittal alignment, kyphotic angle, neurological function, visual analog scale for back pain, and Oswestry Disability Index were evaluated before surgery and at follow-up. RESULTS The mean preoperative regional angle was 27. 4°, and the mean correction angle was 29. 6°. Sagittal alignment improved with a mean correction rate of 58. 3%. The mean surgical time was 275 minutes, and the mean intraoperative blood loss was 1585 ml. The intraoperative complications included 2 dural tears, 1 nerve root injury, and 1 superficial wound infection. The mean visual analog scale score for back pain improved from 6. 6 to 2, and the Oswestry Disability Index score decreased from 55. 4 to 22. 6 at the last follow-up. All patients achieved bony anterior fusion based on the presence of trabecular bone bridging at the osteotomy site. CONCLUTIONS The modified posterior closing wedge osteotomy technique achieves satisfactory kyphosis correction with direct visualization of the circumferentially decompressed spinal cord, as well as good fusion with less blood loss and fewer complications. It is an alternative method for treating patients with posttraumatic thoracolumbar kyphosis.
Journal of neurosurgery. Spine 07/2015; DOI:10.3171/2015.1.SPINE131011 · 2.38 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: To present the incidence and management of dural tears and cerebrospinal fluid leakage during corrective osteotomy [Pedicle Subtraction Osteotomy (PSO) or Smith-Petersen Osteotomy (SPO)] for ankylosing spondylitis with kyphotic deformity.
A retrospective study was performed for ankylosing spondylitis patients with fixed sagittal imbalance, who had undergone corrective osteotomy (PSO or SPO) at lumbar level. 87 patients were included in this study. 55 patients underwent PSO, 32 patients underwent SPO. The mean age of the patients at the time of surgery was 41.7 years (21-70 years). Of the 87 patients, 15 patients had intraoperative dural tears.
The overall incidence of dural tears was 17.2%. The incidence of dural tears during PSO was 20.0%, SPO was 12.5%. There was significant difference in the incidence of dural tears based on surgical procedures (PSO vs. SPO) (p<0.05). The dural tears ranged in size from 12 to 221 mm(2). A nine of 15 patients had the relatively small dural tears, underwent direct repair via watertight closure. The remaining 6 patients had the large dural tears, consequently direct repair was impossible. The large dural tears were repaired with an on-lay graft of muscle, fascia or fat harvested from the adjacent operation site. All patients had a successful repair with no patient requiring reoperation for the cerebrospinal fluid leak.
The overall incidence of dural tears during PSO or SPO for ankylosing spondylitis with kyphotic deformity was 17.2%. The risk factor of dural tears was complexity of surgery. All dural tears were repaired primarily using direct suture, muscle, fascia or fat graft.
Journal of Korean Neurosurgical Society 07/2015; 58(1):60-4. DOI:10.3340/jkns.2015.58.1.60 · 0.64 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: A retrospective comparative study.
To provide an ideal correction angle of lumbar lordosis (LL) in degenerative flat back deformity.
The degree of correction in degenerative flat back in relation to pelvic incidence (PI) remains controversial.
Forty-nine patients with flat back deformity who underwent corrective surgery were enrolled. Posterior-anterior-posterior sequential operation was performed. Mean age and mean follow-up period was 65.6 years and 24.2 months, respectively. We divided the patients into two groups based on immediate postoperative radiographs-optimal correction (OC) group (PI-9°≤LL<PI+9°) and under-correction (UC) group (LL<PI-9°). We also classified the patients according to the PI of each patient-low PI group (PI<55°) and high PI group (PI≥55°). Radiological and clinical results were analyzed.
Patients in OC group had significantly less correction loss and maintained normal sagittal alignment (sagittal vertical axis<5 cm), as compared to patients in UC group (p<0.05). LL of low PI group significantly maintained within 9° better than high PI group (p<0.05). Oswestry disability index (ODI) significantly decreased at last follow-up, as compared to preoperative state. However, there was no significant difference in last follow-up ODI between the groups.
In flat back deformity, correction of LL to within 9° of PI will result in better sagittal balance. Thus, we recommend sufficient LL to prevent correction loss, especially in patients with high PI.
Asian spine journal 06/2015; 9(3):352-360. DOI:10.4184/asj.2015.9.3.352
[Show abstract][Hide abstract] ABSTRACT: Retrospective study.
To evaluate the radiological and clinical results of three different methods in the deformity correction of a degenerative flat back.
There are no comparative studies about different procedures in the treatment of degenerative flat back.
Sixty-four patients who consecutively underwent corrective surgery for degenerative flat back were reviewed. The operations were performed by three different methods: posterior-only (group P, n=20), one-stage anterior-posterior (group AP, n=12), and two-stage anterior-posterior with iliac screw fixation (group AP-I, n=32). Medical and surgical complications were examined and radiological and clinical results were compared.
The majority of medical and surgical complications were found in group AP (5/12) and group P (7/20). The sagittal vertical axes were within normal range immediately postoperatively in all groups, but only group AP-I showed normal sagittal alignment at the final follow-up. Postoperative lumbar lordosis was also significantly higher in group AP-I than in group P or group AP and the finding did not change through the last follow-up. The Oswestry disability index was significantly lower in groups AP and AP-I than in group P at the final follow-up. Meanwhile, the operating time was the longest in group AP-I, and total amount of blood loss was larger in group AP-I and group AP than in group P.
Anterior-posterior correction showed better clinical results than posterior-only correction. Two-staged anterior-posterior correction with iliac screw fixation showed better radiological results than posterior-only or one-staged anterior-posterior correction. Two-staged anterior-posterior correction with iliac screw fixation also showed a lower complication rate than one-staged anterior-posterior correction.
Asian spine journal 06/2015; 9(3):361-369. DOI:10.4184/asj.2015.9.3.361
[Show abstract][Hide abstract] ABSTRACT: Study Design: A prospective study. Objective: To provide methods for predicting ideal trajectory and position of C1 lateral mass screw (C1LMS) from plain radiographs. Summary of Background Data: There has been no study on prediction of C1LMS position using plain radiographs. Methods: A total of 40 consecutive subjects (with 79 screws) who had undergone C1LMS placement were enrolled. To evaluate the C1LMS position, the positions of screw head and tips on anteroposterior (AP) radiographs, screw length and height on lateral radiograph were graded; 0, I and II respectively. On the postoperative computed tomography (CT) images, we analyzed lateral mass (LM) perforation, screw thread engagement percent (%), bicortical fixation, extruded screw length and violation of adjacent joints. Results: Screws with tip located medial to LM (tip 0) showed LM perforation in all cases. Polyaxial head located within LM (head 0) or cross the lateral margin of LM (head I) showed no LM perforation. Screw thread engagement percent was highest with head I-tip I (medial half of LM) position (97.6%) and followed by head 0-tip I (90.5%), head I-tip II (lateral half of LM) (86.4%). Screws longer than posterior half of C1 anterior arch (AA) showed bicortical fixation in all cases with mean extruded screw length of 1.9[medium shade]mm. Adjacent joint was not violated in 98% with the screw height below half of C1AA. Conclusions: On an AP radiograph, a C1LMS with the screw head located on the lateral margin of the LM and with the screw tip in the medial half of the LM resulted in the safest and longest trajectory. On lateral radiograph, a screw tip that is placed within the anterior-inferior quadrant of the C1AA result in safe bicortical fixation without injury to the adjacent structures. These plain radiographic findings may be helpful both postperatively and intra-operatively for assessing the trajectory and length of the screw.
[Show abstract][Hide abstract] ABSTRACT: Study Design. A retrospective radiological studyObjective. To analyze the course of intra-axial vertebral artery (IAVA) and evaluate the relationship between the three-dimensional (3D) courses for IAVA with respect to safe trajectory for C2 pedicle screw (C2PS).Summary of Background Data. The vertebral artery at the level of C2 has a distinct 3D course. The traditional concept of 'high-riding' VA was based on sagittal plane but does not provide all the 3D course of IAVA for safe C2PS placement. However, 3D course of IAVA has not been previously analyzed.Methods. Three-dimensional, vascular enhanced CT images on the cervical spine of 100 patients, 200 IAVA (M:F = 50:50, mean age 58.4 years) were analyzed. 1) The arterial parameters including ①'Medial-shifting (MS)' (A: lateral. B: neutral, C: medial to C3 TF) and ②'High-riding (HR)' (0: below C2 TF, 1 within C2TF, 2: above C2TF) of IAVA was measured. 2) The bony parameters including pedicle diameter (PD), medial convergence angle (MCA), and sagittal angle (SA) of C2PS were measured. Correlation between the arterial and bony parameters, differences between gender, laterality, dominance of VA, and age were analyzed.Results. MS (grade A 37.5%, B 37%, and C 25.5%) and HR (grade 0 in 34%, 1 in 42%, and 2 in 24%) showed significant correlation with each other (p<0.001). The main patterns of IAVA were A-0 (26%), B-1(26.5%), and C-2(18.5%). Higher grade of MS and HR showed significantly smaller PD, larger MCA and smaller SA (p<0.001). Female sex and older age are factors that showed significantly higher grade of MS and HR (p<0.001).Conclusion. Tortuosity of IAVA was greater in the female gender and it also increased with aging. The different IAVA courses significantly influenced the pedicle diameter and the safe trajectory for C2PS; therefore, these factors should be considered before planning C2 pedicle screw placement.
[Show abstract][Hide abstract] ABSTRACT: To determine whether ACE insertion/deletion (I/D) polymorphism is associated with the ossification of the posterior longitudinal ligament (OPLL) of the spine in the Korean population.
A case-control study was conducted to investigate the association between I/D polymorphism of the angiotensin I converting enzyme (peptidyl-dipeptidase A) 1 (ACE) gene and OPLL. The 95 OPLL patients and 274 control subjects were recruited. Polymerase chain reaction for the genotyping of ACE I/D polymorphism was performed. The difference between the OPLL patients and the control subjects was compared using the contingency χ(2) test and the logistic regression analysis. For statistical analysis, SPSS, SNPStats, SNPAnalyzer, and Helixtree programs were used.
The genotype and allele frequencies of ACE I/D polymorphism showed significant differences between the OPLL patients and the control subjects (genotype, p<0.001; allele, p=0.009). The frequencies of D/D genotype and D allele in the OPLL group were higher than those in the control group. In logistic regression analysis, ACE I/D polymorphism was associated with OPLL (dominant model; p=0.002; odd ratio, 2.20; 95% confidence interval, 1.33-3.65).
These results suggest that the deletion polymorphism of the ACE gene may be a risk factor for the development of OPLL in the Korean population.
Annals of Rehabilitation Medicine 02/2014; 38(1):1-5. DOI:10.5535/arm.2014.38.1.1
[Show abstract][Hide abstract] ABSTRACT: To investigate the feasibility and sample size required for a full-scale randomised controlled trial of the effectiveness of acupuncture with non-steroidal anti-inflammatory drugs (NSAIDs) for chronic neck pain compared with acupuncture or NSAID treatment alone.
A total of 45 patients with chronic neck pain participated in the study. For 3 weeks the acupuncture with NSAIDs treatment group took NSAIDs (zaltoprofen, 80 mg) daily while receiving acupuncture treatment three times a week. The acupuncture treatment group received treatment three times a week and the NSAID treatment group took NSAIDs daily. The primary outcomes were to determine the feasibility and to calculate the sample size. As secondary outcomes, pain intensity and pain-related symptoms for chronic neck pain were measured.
With regard to enrolment and dropout rates, 88.2% of patients consented to be recruited to the trial and 15.6% of participants were lost to follow-up. The sample size for a full-scale trial was estimated to be 120 patients. Although preliminary, there was a significant change in the visual analogue scale (VAS) for neck pain intensity between the baseline measurement and each point of assessment in all groups. However, there was no difference in VAS scores between the three groups.
This pilot study has provided the feasibility and sample size for a full-scale trial of acupuncture with NSAIDs for chronic neck pain compared with acupuncture or NSAID treatment alone. Further research is needed to validate the effects of acupuncture with NSAIDs.
NIH ClinicalTrials.gov NCT01205958.
Acupuncture in Medicine 10/2013; 32(1). DOI:10.1136/acupmed-2013-010410 · 1.50 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Based on the previous studies, cervical lordosis (CL) is a parameter influenced by thoracic kyphosis (TK); however, the correlations still remain unclear. Few studies have analyzed the correlations between the cervical spine lordosis and global spinopelvic balance. To date, there has been no study focused on the factors determining cervical spine sagittal balance.
Seventy-seven asymptomatic volunteers without the history of symptoms related to whole spine.
Statistical significance of correlations of radiographic parameters on cervical spine and whole-spine standing lateral radiograph.
To analyze the factors determining cervical spine sagittal balance, including global spinopelvic balance and thoracic inlet (TI) alignment in asymptomatic adults.
A prospective radiographic study.
Cervical and whole-spine standing lateral radiographs were taken to analyze the following parameters: spinopelvic parameters pelvic incidence (PI), sacral slope (SS), lumbar lordosis (LL), and TK; TI parameters thoracic inlet angle (TIA) and T1 slope; and cervical spine parameters C0-C2, C2-C7, and C0-C7 angles and cervical tilting. Statistical analysis was performed using the Pearson correlation coefficients and multiple regression analysis.
All the parameters showed a normal distribution. There was a significant sequential linkage between PI and SS (r=0.653), SS and LL (r=0.807), LL and TK (r=-0.516), and TK and C0-C7 angle (r=-0.322). There was a significant relationship between TK and T1 slope (r=0.351) but no significant relationship between TK and TIA. There were significant sequential relationships between TIA and T1 slope (r=0.694), T1 slope and C2-C7 angle (r=-0.624), and C2-C7 and C0-C2 angles (r=-0.547). T1 slope was the only parameter that demonstrated a significant correlation with both SP and TI parameters. A linear regression model showed that T1 slope had a stronger relationship with TIA (r=0.694) than TK (r=0.351).
T1 slope was a key factor determining cervical spine sagittal balance. Both spinopelvic balance and TI alignment have a significant influence on cervical spine sagittal balance via T1 slope, but TIA had a stronger effect than TK. An individual with large T1 slope required large CL to preserve physiologic sagittal balance of the cervical spine. The results of the present study could serve as baseline data for further studies on the cervical spine sagittal balance in various clinical conditions including the surgical reconstruction of lordosis.
The spine journal: official journal of the North American Spine Society 09/2013; 15(4). DOI:10.1016/j.spinee.2013.06.059 · 2.43 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Degenerative lumbar scoliosis (DLS) is a spinal deformity that develops after skeletal maturity and progresses with age. In contrast to adolescent idiopathic scoliosis, the genetic association of DLS has not yet been elucidated. The purpose of this study was to investigate the association between regulating synaptic membrane exocytosis 2 (RIMS2, OBOE) gene polymorphisms and DLS. Two coding single-nucleotide polymorphisms [rs2028945 (Gln1200Gln) and rs10461 (Ala1327Ala)] of RIMS2 were selected and genotyped by direct sequencing. As a result, the rs10461 was associated with DLS in allele frequencies (P=0.008) and genotype distributions (P=0.006 in the codominant model, 0.018 in the dominant model and 0.029 in the recessive model). In the analysis of haplotypes, two haplotypes exhibited significant differences between the control and DLS groups (CC haplotype, P=0.009 in the codominant model, 0.038 in the dominant model and 0.030 in the recessive model; CT haplotype, P=0.041 in the codominant model and 0.021 in the dominant model). These findings suggest that RIMS2 may be associated with the development of DLS.
[Show abstract][Hide abstract] ABSTRACT: Intraspinal cystic lesions with different pathogeneses have been reported to cause neurological deficits; however, no one has focused on the intraspinal extradural cysts that develop after osteoporotic compression fracture. The reported case features a 66-year-old woman presenting with progressive neurological deficit, back pain, and no history of additional trauma after undergoing conservative treatment for an osteoporotic fracture of L-1. The authors present serial radiographs and MR images demonstrating an epidural cyst successfully treated via a single posterior approach. This appears to be the first such case reported in the literature.
[Show abstract][Hide abstract] ABSTRACT: Degenerative lumbar scoliosis (DLS) progresses with aging after 50-60 years. The genetic association of DLS remains largely unclear. In this study, the genetic association between glutamate receptor, ionotropic, N-methyl D-aspartate (NMDA, GRIN) receptor genes and DLS was investigated. A total of 9 coding single nucleotide polymorphisms (cSNPs) in NMDA receptor genes [GRIN2A (rs8049651, Leu425Leu; rs9806806, Tyr730Tyr); GRIN2B (rs7301328, Pro122Pro; rs35025065, Asp447Asp; rs1805522, Ile602Ile; rs1806201, Thr888Thr; rs1805247, His1399His); and GRIN2C (rs689730, Ala33Ala; rs3744215, Arg1209Ser)] were selected and genotyped using direct sequencing in 70 patients with DLS and 141 healthy controls. Multiple logistic models (codominant, dominant and recessive) were calculated for the odds ratio (OR), 95% confidence interval (CI) and corresponding P-values. The SNPStats, SNPAnalyzer and HelixTree programs were used for the evaluation of the genetic data. Among the SNPs examined, no significant associations were observed between the NMDA receptor genes and DLS. When the patients were divided into two groups according to clinical characteristics based on Cobb's angle (<20° or ≥20°) and lateral listhesis (<6 mm or ≥6 mm), associations were observed between rs689730 of GRIN2C and Cobb's angle (codominant, P=0.038; dominant, P=0.022) and between rs7301328 of GRIN2B and lateral listhesis (codominant, P=0.003; dominant, P=0.015; recessive, P=0.015). These results indicate that the GRIN2A, GRIN2B and GRIN2C genes do not affect the development of DLS. However, the GRIN2C gene may be associated with Cobb's angle, while the GRIN2B gene may be associated with lateral listhesis.
Experimental and therapeutic medicine 03/2013; 5(3):977-981. DOI:10.3892/etm.2013.910 · 1.27 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Study Design. A retrospective study.Objective. To describe the technique of a partial pedicle subtraction osteotomy (PPSO) and to report on the clinical and radiologic outcomes.Summary of Background Data. Numerous corrective osteotomy techniques have been reported. Until now, there still has been no reported method that can achieve a correction angle between those of the Smith-Petersen osteotomy(SPO) and pedicle subtraction osteotomy(PSO) as a posterior closing osteotomy that can be safely performed on the thoracic spine.Methods. A total of 38 patients aged between 31 and 72 years old who underwent PPSO for spinal sagittal deformity correction were enrolled in this study. The mean postoperative follow-up period was 30.1 months (range 24-36 months). The assessments included the Oswestry Disability Index (ODI) scores, immediate postoperative and 2 year postoperative correction angles, correction loss, pseudoarthrosis and complications.Results. There were 6 patients who underwent PPSO alone and 32 patients who underwent PPSO combined with at least one other surgical procedure (PSO in 16 patients, ALIF in 12 patients, and SPO in 4 patients). The level of the osteotomy was T10 in 6 patients, T11 in 15 patients, T12 in 10 patients, 1 in 4 patients, L2 in 2 patients, and L3 in 1 patient. There were significant improvements in the overall ODI scores (p = 0.001). The mean post-operative correction angle immediately following the PPSO was 18.8° (range 12.4°-26.1°) and the mean postoperative correction angle at 2 years was 18.4° (range 11.9°-25.7°). There was no significant loss of correction found during the 2 year follow up. There was also no pseudoarthrosis or neurological complications.Conclusion. PPSO had resulted in intermediate correction rates between those of SPO and PSO. PPSO is considered to be a safe and reliable procedure for patients with spinal sagittal deformities even at the thoracic spine level.
[Show abstract][Hide abstract] ABSTRACT: To present the accuracy and safety of cervical pedicle screw insertion using the technique with direct exposure of the pedicle by laminoforaminotomy.
We retrospectively reviewed 12 consecutive patients. A total of 104 subaxial cervical pedicle screws in 12 patients had been inserted. We also assessed the clinical and radiological outcomes and analyzed the direction and grade of pedicle perforation (grade 0: no perforation, 1: <25%, 2: 20% to 50%, 3: >50% of screw diameter) on the postoperative vascular-enhanced computed tomography scans. Grade 2 and 3 were considered as incorrect position.
The correct position was found in 95 screws (91.3%); grade 0-75 screws, grade 1-20 screws and the incorrect position in 9 screws (8.7%); grade 2-6 screws, grade 3-3 screws. There was no neurovascular complication related with cervical pedicle screw insertion.
This technique (technique with direct exposure of the pedicle by laminoforaminotomy) could be considered relatively safe and easy method to insert cervical pedicle screw.
Journal of Korean Neurosurgical Society 11/2012; 52(5):459-65. DOI:10.3340/jkns.2012.52.5.459 · 0.64 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: The prevalence of intervertebral disc herniation (IDH) of the thoracic spine is rare compared to the cervical or lumbar spine. In particular, IDH of the upper thoracic spine is extremely rare. We report the case of T1-2 IDH and its treatment, with a literature review. A 37-year-old male patient visited our hospital due to radiating pain at the left upper extremity and weakness of grip power. In cervical spine magnetic resonance images, T1-2 disc space showed herniated disc material and compressed T1 root was identified. Laminoforaminotomy was performed with a posterior approach. The radiating pain and weakness of grip power improved immediately after the surgery. Of patients who show radiating pain or numbness at the medial aspect of forearm, or weakness of intrinsic muscle of hand, can be suspected to have T1 radiculopathy. A detailed physical examination and a radiologic evaluation including this area should be required for the T1 radiculopathy.
Asian spine journal 09/2012; 6(3):199-202. DOI:10.4184/asj.2012.6.3.199
[Show abstract][Hide abstract] ABSTRACT: Study design:
A technical note and a retrospective review of cervical osteotomy using an innovative reduction technique.
To present the clinical and radiological outcomes and effectiveness of the sterile-freehand reduction technique for cervical osteotomy. SUMMARY OF BACKGROUD DATA: For a successful osteotomy, controlled reduction of deformity after complete release of bony deformity is the most critical step. Conventional "unscrubbed-scrubbed" manual reduction techniques necessitate multiple releases and retightening of the clamp and are inconvenient for the surgeon to control the force and monitor the surgical field closely.
A total of 7 consecutive patients (5 male and 2 female; mean age, 52.6 yr) who underwent corrective osteotomy of the fixed cervical kyphosis by a single surgeon were enrolled. Radiographically, C2-C7 sagittal and coronal angle, and the chin-brow vertical angle were measured. In the prone position, the entire head and the Gardner-Wells tong were included in the surgical field, and a sterile rope was connected to a weight through a hole made in the surgical drape. After complete release of bony element and fixation of the caudal part of osteotomy with a prebent lordotic rod, the operator held the tong with right hand and gradually reduced the deformity to place the rod within the screw heads on the cranial part of osteotomy under close visual observation, with the support of the caudal part with left hand. RESULTS.: The type of osteotomy performed was pedicle-subtraction osteotomy in 5 cases and anterior-release-posterior osteotomy in 2 cases. The mean correction angle was 39.7° (28°-63°) on the sagittal plane and 9.3° (0°-16°) on the coronal plane. The mean correction of the chin-brow vertical angle was 37.1° (18°-61°). There was no neurovascular complication.
Using the sterile-freehand reduction technique, the operator can obtain a safe, controlled reduction with close monitoring of the surgical field. The technique is potentially a simple and effective method to provide stable, 3-dimensional reduction for corrective osteotomies of the cervical spine.
[Show abstract][Hide abstract] ABSTRACT: A retrospective study.
To evaluate the efficacy and safety of the pedicle subtraction osteotomy (PSO) as a technique for correction of fixed sagittal imbalance with multiple etiologies.
This report represents the largest and longest series of patients with fixed sagittal imbalance other than ankylosing spondylitis who were managed with PSO.
A total of 140 consecutive patients who had undergone PSO for the management of sagittal imbalance with any etiology were reviewed. Etiologic diagnoses were ankylosing spondylitis in 86 patients, flatback syndrome in 20, post-traumatic kyphosis in 17, congenital kyphoscoliosis in 9, and post-tuberculotic kyphosis in 8 patients. The average duration of the follow-up period was 8 years (range, 5-12.5 yr). Radiological and clinical outcome analyses were performed.
All patients showed a solid union upon follow-up radiographs and no pseudarthrosis was noted. Correction with PSO averaged 36.2°. Blood loss averaged 1515.6 mL. The Oswestry Disability Index improved from 40.5 to 18.8 at the last follow-up, and 90.7% of the patients were very or somewhat satisfied. There were 15 cases (10.7%) of reversible complications including transient radiculopathy and 3 cases (2.1%) of irreversible complications.
Based on the results of this study, PSO is considered a reliable and relatively safe procedure for the correction of fixed sagittal imbalance with multiple etiologies.
[Show abstract][Hide abstract] ABSTRACT: We performed L1 posterior vertebral columnar resection and posterior correction for Andersson's lesion and thoracolumbar kyphosis in an ankylosing spondylitis patient during motor evoked potential (MEP) monitoring. We checked MEP intra-operatively, whenever a dangerous procedure for neural elements was performed, and no abnormal findings were seen during surgery. After the operation, we examined neurologic function in the recovery room; the patient showed a progressive neurologic deficit and no response to MEP. After emergency neural exploration and decompression surgery, the neurologic deficit was recovered. We questioned whether to acknowledge the results of this case as a false negative. We think the possible reason for this result may be delayed development of paralysis. So, we recommend that MEP monitoring should be performed not only after important operative steps but also after all steps, including skin suturing, for final confirmation.
Asian spine journal 03/2012; 6(1):50-4. DOI:10.4184/asj.2012.6.1.50
[Show abstract][Hide abstract] ABSTRACT: A case report.
To report the successful consecutive spinal osteotomies of multiple segments performed on a patient with extremely severe kyphotic deformity.
There have been no reports on the experience and surgical strategy of spinal osteotomy on multiple segments for severe global spine deformity.
A 48-year-old man, a patient with ankylosing spondylitis with "chin-on-pubis" deformity, underwent consecutive spinal osteotomies to correct the severe, fixed global kyphosis. The axial skeletons from the skull, all vertebrae, and both sacroiliac joints and hip joint were fused into a single bone. After both hip resectional arthroplasties for the first step, staged, sequential spinal osteotomies, including pedicle subtraction osteotomy (PSO) on C6, posterior vertebral column resection on T11-T12, and PSO on L3, were performed. Finally, both total hip arthoroplasties were performed.
The chin-brow vertical angle improved from 140° to 15°. Correction angles of 45°, 70°, and 30° in the cervical, thoracic, and lumbar spines, respectively, were achieved without complication. At the last follow-up, excellent improvement in activities of daily living and horizontal gaze were achieved.
This is the first report on C6 PSO and spinal osteotomies in whole spine segments. For patients with a severe global kyphotic deformity, it is important to place the patient in a stable prone position so that corrective surgery can be performed on the thoracolumbar spine. To accomplish this, initially correcting the deformities in the hip joints and the cervical spine can yield excellent clinical results.