Publications (10)13.85 Total impact
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Article: Surgical site infection in spinal surgery: detection and management based on serial C-reactive protein measurements.
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ABSTRACT: C-reactive protein (CRP) is a well-known sensitive laboratory parameter that shows an increase within 6 hours after the onset of bacterial infection. In relation to surgery, a normal CRP response is a rapid increase followed by a gradual reduction, eventually returning to the normal range. The goal of this study was to determine the diagnostic significance of CRP as a detector for early onset surgical site infection in spinal surgery and to discuss effective medical treatment through clinical interpretation and application of the measured CRP values. A prospective study was performed in 348 consecutive cases involving patients who underwent spinal surgery under general anesthesia between February and September 2008. Blood samples were obtained preoperatively and on postoperative Days 1, 3, and 5 in patients undergoing single-level decompression surgery. An additional blood specimen was obtained at postoperative Day 7 in patients requiring more extensive surgeries. Recorded laboratory results were compared with the patients' clinical course to determine the diagnostic significance of CRP. All of the patients received intravenous prophylactic antibiotic therapy. Once an abnormal response of CRP, indicated by a tendency toward continuous elevation, was noted on Day 5 or Day 7, the prophylactic antibiotics were replaced with another regimen and administration was resumed along with careful observation for signs of surgical site infection. Monitoring of CRP revealed a characteristic increase and decrease pattern in 332 of 348 patients (95.4%) showing a normal clinical course with regard to early infectious complications. The mean measured CRP (reference range < 4 mg/L) averaged 14.9 +/- 20.3 mg/L on Day 1, 15.4 +/- 25.1 mg/L on Day 3, and 7.9 +/- 13.3 mg/L on Day 5. In contrast, there were 16 cases (4.6%) of abnormal CRP responses resulting in the resumption of intravenous antibiotic treatment, which included a second rise (in 12 cases) and a steady rise (in 4) in the CRP value. Five (1.4%) of 16 patients experienced infectious complications related to spinal surgery. Three patients (0.9%) received long-term antibiotic therapy for 4-6 weeks; however, all patients recovered with medical treatment alone and did not experience gross wound disruption or subsequent discitis. As a predictor for early wound infection, the sensitivity, specificity, positive predictive value, and negative predictive value for abnormal CRP responses were calculated as 100%, 96.8%, 31.3%, and 100%, respectively. The above results demonstrate that CRP screening is a simple and reliable test for the detection of early infectious complications after spinal surgery. Close observation and appropriate medical management should be performed in a timely fashion when abnormal CRP responses are observed at 5 or 7 days after surgery.Journal of neurosurgery. Spine 08/2010; 13(2):158-64. · 1.61 Impact Factor -
Article: Comparison study of the instrumented circumferential fusion with instrumented anterior lumbar interbody fusion as a surgical procedure for adult low-grade isthmic spondylolisthesis.
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ABSTRACT: Instrumented circumferential fusion has been used as a primary and salvage procedure in lumbar spine fusion, especially for adult low-grade isthmic spondylolisthesis. Recently, instrumented anterior lumbar interbody fusion (ALIF) has been shown to provide good clinical and radiologic results that are comparable with those attained with traditional lumbar fusion. However, there have been no reports available that compare instrumented circumferential fusion with instrumented ALIF. Between January 2003 and November 2004, a total of 43 consecutive patients underwent instrumented ALIF (group I) at one hospital of the authors. Between February 2003 and October 2006, a total of 32 consecutive patients underwent instrumented circumferential fusion (group II) at the other hospital of the authors. The authors retrospectively reviewed clinical and radiologic data from patients. The time spent on the operation, blood loss, blood transfusions, the length of hospital stay, complications, clinical results, and radiologic results, including disc height (DH), degree of listhesis, segmental lordosis (SL), and whole lumbar lordosis (WL), were analyzed and compared. Clinical outcomes were graded using visual analog scale (VAS) scores. Functional outcomes were measured using Oswestry Disability Index (ODI) scores and return-to-work status. The mean follow-up period was 41.1 and 32.9 months in group I and group II, respectively. Radiologic evidence of fusion was noted in 42 of 43 patients in group I and in 32 of 32 patients in group II. In both groups, all of the radiologic data, including the DH, degree of listhesis, SL, and WL significantly changed from the preoperative to postoperative period except for WL in group II. In both groups, VAS scores for back and leg pain and ODI scores significantly changed from the preoperative to postoperative period. There was no significant difference for VAS scores for back ODI scores in the two treatment groups after surgery. The mean time until return to work was 3.7 months in group I and 3.6 months in group II (p < .05). The mean hospital stay for group I (7.4 days) was shorter than that for group II (15.2 days) (p < .05). The mean operation time in group I (190 minutes) was shorter than that in group II (260.8 minutes) (p < .05). The mean blood loss in group I (300 mL) was less than that in group II (379 mL) (p < .05). According to the present clinical outcome, instrumented ALIF is at least as effective as instrumented circumferential fusion for the treatment of back pain in adult patients with low-grade isthmic spondylolisthesis. Moreover, in terms of operative data including the duration of operation and hospital stay, as well as blood loss, instrumented ALIF demonstrates better results.World Neurosurgery 05/2010; 73(5):565-71. · 0.68 Impact Factor -
Article: Comparison of percutaneous endoscopic lumbar discectomy and open lumbar microdiscectomy for recurrent disc herniation.
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ABSTRACT: The purpose of this study was to compare clinical and radiological outcomes of percutaneous endoscopic lumbar discectomy (PELD) and open lumbar microdiscectomy (OLM) for recurrent disc herniation. Fifty-four patients, who underwent surgery, either PELD (25 patients) or repeated OLM (29 patients), due to recurrent disc herniation at L4-5 level, were divided into two groups according to the surgical methods. Excluded were patients with sequestrated disc, calcified disc, severe neurological deficit, or instability. Clinical outcomes were assessed using Visual Analogue Scale (VAS) score and Oswestry Disability Index (ODI). Radiological variables were assessed using plain radiography and/or magnetic resonance imaging. Mean operating time and hospital stay were significantly shorter in PELD group (45.8 minutes and 0.9 day, respectively) than OLM group (73.8 minutes and 3.8 days, respectively) (p < 0.001). Complications occurred in 4% in PELD group and 10.3% in OLM group in the perioperative period. At a mean follow-up duration of 34.2 months, the mean improvements of back pain, leg pain, and functional improvement were 4.0, 5.5, and 40.9% for PELD group and 2.3, 5.1, and 45.0% for OLM group, respectively. Second recurrence occurred in 4% after PELD and 10.3% after OLM. Disc height did not change after PELD, but significantly decreased after OLM (p = 0.0001). Neither sagittal rotation angle nor volume of multifidus muscle changed significantly in both groups. Both PELD and repeated OLM showed favorable outcomes for recurrent disc herniation, but PELD had advantages in terms of shorter operating time, hospital stay, and disc height preservation.Journal of Korean Neurosurgical Society 12/2009; 46(6):515-21. · 0.60 Impact Factor -
Article: Mini-transforaminal lumbar interbody fusion versus anterior lumbar interbody fusion augmented by percutaneous pedicle screw fixation: a comparison of surgical outcomes in adult low-grade isthmic spondylolisthesis.
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ABSTRACT: Retrospective clinical data analysis. To compare clinical results with radiologic results of 2 fusion techniques for adult low-grade isthmic spondylolisthesis. There is clear evidence that lumbar interbody fusion using anterior and posterior approaches provides a high fusion rate, good sagittal alignment, and good clinical outcomes. However, there are no recent studies that compare these 2 fusion techniques. Between March 2004 and December 2004, 48 patients underwent instrumented mini-anterior lumbar interbody fusion (ALIF) and 46 underwent instrumented mini-transforaminal lumbar interbody fusion (TLIF). The mean follow-up periods were 32.6 and 29.7 months, respectively. The mean visual analog scale (VAS) scores for back and leg pain decreased, respectively, from 7.7 and 7.5 to 2.9 and 2.7 in the ALIF group and from 7.0 and 6.3 to 2.3 and 2.2 in the TLIF group. The mean Oswestry disability index (ODI) scores improved from 51.4% to 23.2% in the ALIF group and from 52% to 14.4% in the TLIF group. In both groups, the VAS and ODI scores significantly changed preoperatively to postoperatively (P<0.001). However, statistical analysis showed no significant difference in postoperative VAS/ODI scores between groups. Radiologic evidence of fusion was noted in 95.8% and 92.3% of the patients in the ALIF group and the TLIF group, respectively. In both the groups, changes in the disc height, segmental lordosis, degree of listhesis, and whole lumbar lordosis (WL) between the preoperative and postoperative periods were significant except for WL in the TLIF group. The amount of change between preoperative and postoperative disc height, segmental lordosis, and WL demonstrated significant intergroup differences (P<0.05). The mini-ALIF group demonstrated key radiographic advantages compared with the mini-TLIF group for adult low-grade isthmic spondylolisthesis. However, clinical and functional outcomes did not demonstrate significant differences between groups.Journal of spinal disorders & techniques 04/2009; 22(2):114-21. · 1.21 Impact Factor -
Article: An analysis of general surgery-related complications in a series of 412 minilaparotomic anterior lumbosacral procedures.
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ABSTRACT: Anterior lumbar surgery is associated with certain perioperative visceral and vascular complications. The aim of this study was to document all general surgery-related adverse events and complications following minilaparotomic retroperitoneal lumbar procedures and to discuss strategies for their management or prevention. The authors analyzed data obtained in 412 patients who underwent anterior lumbosacral surgery between 2003 and 2005. The series comprised 114 men and 298 women whose mean age was 56 years (range 34-79 years). Preoperative diagnoses were as follows: isthmic spondylolisthesis (32%), degenerative spondylolisthesis (24%), instability/stenosis (15%), degenerative disc disease (15%), failed-back surgery syndrome (7%), and lumbar degenerative kyphosis or scoliosis (7%). A single level was exposed in 264 patients (64%), 2 in 118 (29%), and 3 or 4 in 30 (7%). The average follow-up period was 16 months. Overall, 52 instances of complications and adverse events occurred in 50 patients (12.1%), including sympathetic dysfunction in 25 (6.06%), vascular injury repaired with/without direct suture in 12 (2.9%), ileus lasting > 3 days in 5 (1.2%), pleural effusion in 4 (0.97%), wound dehiscence in 2 (0.49%), symptomatic retroperitoneal hematoma in 2 (0.49%), angina in 1 (0.24%), and bowel laceration in 1 patient (0.24%). There was no instance of retrograde ejaculation in male patients, and most complications had no long-term sequelae. This report presents a detailed analysis of complications related to anterior lumbar surgery. Although the incidence of complications appears low considering the magnitude of the procedure, surgeons should be aware of these potential complications and their management.Journal of Neurosurgery Spine 02/2009; 10(1):60-5. · 1.53 Impact Factor -
Article: Anterior debridement and fusion followed by posterior pedicle screw fixation in pyogenic spondylodiscitis: autologous iliac bone strut versus cage.
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ABSTRACT: An anterior approach for debridement and fusion with autologous bone graft has been recommended as the gold standard for surgical treatment of pyogenic spondylodiscitis. The use of anterior foreign body implants at the site of active infection is still a challenging procedure for spine surgeons. Several authors have recently introduced anterior grafting with titanium mesh cages instead of autologous bone strut in the treatment of spondylodiscitis. The authors present their experience of anterior fusion with 3 types of cages followed by posterior pedicle screw fixation. They also compare their results with the use of autologous iliac bone strut. The authors retrospectively reviewed the cases of 60 patients with pyogenic spondylodiscitis treated by anterior debridement between January 2003 and April 2005. Fusion using either cages or iliac bone struts was performed during the same course of anesthesia followed by posterior fixation. Twenty-three patients underwent fusion with autologous iliac bone strut, and 37 patients underwent fusion with 1 of the 3 types of cages. The infections resolved in all patients, as noted by normalization of their erythrocyte sedimentation rates and C-reactive protein levels. Patients in both groups were evaluated in terms of their preoperative and postoperative clinical and imaging findings. Single-stage anterior debridement and cage fusion followed by posterior pedicle screw fixation can be effective in the treatment of pyogenic spondylodiscitis. There was no difference in clinical and imaging outcomes between the strut group and cage group except for the subsidence rate. The subsidence rate was higher in the strut group than in the cage group. The duration until subsidence was also shorter in the strut group than in the cage group.Journal of Neurosurgery Spine 06/2008; 8(5):405-12. · 1.53 Impact Factor -
Article: Lymphocele formation after anterior lumbar interbody fusion at L4-5. Case report.
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ABSTRACT: In this report, the authors present the case of patient with a lymphocele in the retroperitoneal area following anterior lumbar interbody fusion at L4-5. A lymphocele is a rare complication of spinal operations, especially lower lumbar spinal surgeries. The authors discuss this complicating factor and describe its features and treatments.Journal of Neurosurgery Spine 12/2007; 7(5):566-70. · 1.53 Impact Factor -
Article: An evaluation of vascular anatomy for minilaparotomic anterior L4-5 procedures.
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ABSTRACT: The complexity of the vascular anatomy pertinent to the L4-5 intervertebral disc space has led to difficulties when performing the anterior approach to the lumbar spine. The purpose of the present study was to evaluate the variations of the great vessels to match the imaging-documented axial anatomy with the surgical exposure. The authors analyzed data obtained in 223 patients who had undergone mini-open anterior lumbar surgery involving the L4-5 disc. The preoperative magnetic resonance images or computed tomography scans were evaluated by examiners blinded to the surgical approach to determine the vascular configuration. All complications of the procedures were described. Two major variations of the vascular configuration were delineated according to the location of the bifurcation of the inferior vena cava. On images showing the lower margin of the L-4 vertebra, the anatomy in 182 patients (81%) was classified as Type A because the inferior vena cava (IVC) was not bifurcated; in 38 patients (17%) it was classified as Type B because the IVC was bifurcated. Type A could be subdivided into Types A1 and A2 according to whether the aorta was bifurcated (A2) or not (A1) on the same image. The surgical exposure used was above the bifurcations (in Type A) and below the bifurcations (in Type B). The major complications were three venous injuries, and the leading complication was sympathetic dysfunction in 14 patients, which in most cases resolved spontaneously. Careful preoperative evaluation of the vascular anatomy is essential to conducting successful anterior lumbar surgery. The determination of an appropriate approach can contribute to a reduction of unnecessary vascular retraction and a consequent decrease in vascular complications.Journal of Neurosurgery Spine 01/2007; 5(6):508-13. · 1.53 Impact Factor -
Article: Revision surgery of the lumbar spine: anterior lumbar interbody fusion followed by percutaneous pedicle screw fixation.
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ABSTRACT: The aim of this study was to evaluate the efficacy of anterior lumbar interbody fusion (ALIF) augmented by percutaneous pedicle screw fixation (PSF) for revision surgery in the lumbar spine and to determine the prognostic factors affecting surgical outcomes. The population included 54 consecutively treated patients in whom revision surgery involving ALIF with PSF was performed between 2001 and 2004. There were 22 men and 32 women, whose mean age was 59.5 years (range 25-78 years). The diagnoses prior to revision ALIF were as follows: degenerative disc disease in 25 patients, instability/spondylolisthesis in 15, recurrent disc herniation in seven, and pseudarthrosis in seven. The mean follow-up period was 24 months (range 12-52 months). The mean visual analog scale score for back and leg pain decreased, respectively, from 7.8 to 2.3 and 8.0 to 2.3 (p < 0.001). The mean Oswestry Disability Index score improved from 70 to 25% (p < 0.001). Radiological evidence of fusion was noted in 52 of 54 patients. The mean preoperative segmental lordosis, whole lumbar lordosis, and sacral tilt were 15.2, 35.5, and 28.3 degrees, respectively; these values were significantly increased to 20.4, 40.7, and 31.4degrees, respectively, after revision surgery (p < 0.001). The increase in sacral tilt was positively correlated with improvement in back pain (p = 0.028) and functional status (p = 0.025). The results demonstrate that ALIF followed by PSF can be an effective alternative in revision surgery of the lumbosacral spine in selected cases. Not only can solid fusion be achieved, sagittal alignment can also be restored in the majority of patients.Journal of Neurosurgery Spine 09/2006; 5(3):228-33. · 1.53 Impact Factor -
Article: Operative failure of percutaneous endoscopic lumbar discectomy: a radiologic analysis of 55 cases.
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ABSTRACT: A retrospective study. To determine the range of lumbar disc herniation that can be addressed effectively using current endoscopic techniques. The current technical limitation of the procedure in terms of the location and size of the herniation has not been fully documented in previous studies. The inclusion was an intracanal lower lumbar disc herniation in which subsequent surgery was performed because of the presence of remnant fragments. All 1586 cases, including 55 failed cases, were classified according to the size, location, and extent of migration. In the nonmigrated herniations, the central located high-canal compromised (>50%) herniations showed the highest rate of failure (15%), and the rate was significantly different from the low and high-canal compromise group (1.9% and 11.1%, respectively, P < 0.001). There was no significant difference in the failure rate between the nonmigrated herniations and low-grade migration group (2.7% and 3.7%, respectively). However, the high-grade migration group (beyond the measured height of the posterior marginal disc space) showed a significantly high-incidence of failure (15.7%, P < 0.001). Based on these results, open surgery may be considered for herniations with high-canal compromise and high-grade migration. On the other hand, percutaneous endoscopic lumbar discectomy can be considered to be a surgical option in the remaining intracanal disc herniations.Spine 06/2006; 31(10):E285-90. · 2.08 Impact Factor
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2008–2009
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Wooridul Spine Hospital Group
Seoul, Seoul, South Korea
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