Search Results

You are looking at 1 - 8 of 8 items for :

  • Author or Editor: Min Park x
  • Journal of Neurosurgery: Spine x
Clear All Modify Search
Restricted access

Sung Hun Park, Woo Min Park, Cheul Woong Park, Kwan Soo Kang, Young Keun Lee and Sang Rak Lim

Object

The purpose of this study was to determine whether anterior lumbar interbody fusion (ALIF) followed by percutaneous translaminar facet screw fixation is effective in elderly patients with degenerative spinal disease.

Methods

Twenty-nine patients > 60 years old who underwent ALIF with percutaneous translaminar facet screw fixation from January to June 2004 were studied. The radiological and clinical data of these patients were collected and analyzed. The mean follow-up period was 14.6 months (range 12–17 months).

Results

The mean preoperative, immediate postoperative, and 6- and 12-month postoperative posterior disc heights were 7.1, 11.6, 9.8, and 9.8 mm, respectively. Subsidences of posterior disc height > 20% developed in 9 patients (30%). The significant risk factor for subsidence was found to be 2-level operations (p = 0.023). The mean preoperative Oswestry Disability Index score and visual analog scale scores for the back and leg were 24.4, 6.6, and 7.5, respectively, and improved postoperatively to 14.2, 1.5, and 1.8, respectively.

Conclusions

Minimally invasive ALIF followed by percutaneous translaminar facet screw fixation was performed as a minimally invasive surgical technique in elderly patients. However, in certain circumstances such as multilevel operations or in patients with severe osteoporosis, significant cage subsidence can develop.

Restricted access

Sung-Min Kim, T. Jesse Lim, Josemaria Paterno, Jon Park and Daniel H. Kim

Object. The stability of lateral lumbar interbody graft—augmented fusion and supplementary lateral plate fixation in human cadavers has not been determined. The purpose of this study was to investigate the immediate biomechanical stabilities of the following: 1) femoral ring allograft (FRA)—augmented anterior lumbar interbody fusion (ALIF) after left lateral discectomy combined with additional lateral MACS HMA plate and screw fixation; and 2) ALIF combined with posterior transpedicular fixation after anterior discectomy.

Methods. Sixteen human lumbosacral spines were loaded with six modes of motion. The intervertebral motion was measured using a video-based motion-capturing system. The range of motion (ROM) and the neutral zone (NZ) in each loading mode were compared with a maximum of 7.5 Nm.

The ROM values for both stand-alone ALIF approaches were similar to those of the intact spine, whereas NZ measurements were higher in most loading modes. No significant intergroup differences were found. The ROM and NZ values for lateral fixation in all modes were significantly lower than those of intact spine, except when NZ was measured in lateral bending. All ROM and NZ values for transpedicular fixation were significantly lower than those for stand-alone anterior ALIF. Transpedicular fixation conferred better stabilization than lateral fixation in flexion, extension, and lateral bending modes.

Conclusions. Neither approach to stand-alone FRA-augmented ALIF provided sufficient stabilization, but supplementary instrumentation conferred significant stabilization. The MACS HMA plate and screw fixation system, although inferior to posterior transpedicular fixation, provided adequate stability compared with the intact spine and can serve as a sound alternative to supplementary spinal stabilization.

Restricted access

Yong Ahn, Sang-Ho Lee, Woo-Min Park and Ho-Yeon Lee

✓ The purpose of this study was to determine the efficacy and feasibility of posterolateral percutaneous endoscopic lumbar foraminotomy (PELF) for foraminal or lateral exit zone stenosis of the L5—S1 level in the awake patient.

Twelve consecutive patients with L5—S1 foraminal stenosis and associated leg pain underwent PELF between May 2001 and July 2002. Under fluoroscopic guidance, posterolateral endoscopic foraminal decompression was performed using a bone reamer, endoscopic forceps, and a laser. Using this new technique, the authors removed part of the hypertrophied superior facet, thickened ligamentum flavum, and protruded disc compressing the exiting (L-5) nerve root. Clinical outcome was measured using the Macnab criteria. The mean follow-up period was 12.9 months. All the patients were discharged within 24 hours. Satisfactory (excellent or good) results were demonstrated in 10 patients. There was no complication.

The PELF procedure provides a simple alternative for treating lumbar foraminal or lateral exit zone stenosis in selected cases. The authors found that the posterolateral endoscopic approach to the L5—S1 foramen was usually possible and that using a bone reamer to undercut the superior facet was effective.

Restricted access

Sung-Min Kim, T. Jesse Lim, Josemaria Paterno, Jon Park and Daniel H. Kim

Object. In bilateral cervical facet dislocation, biomechanical stabilities between anterior locking screw/plate fixation after anterior cervical discectomy and fusion (ACDFP) and posterior transpedicular screw/rod fixation after anterior cervical discectomy and fusion (ACDFTP) have not been compared using the human cadaver, although ACDFP has been performed frequently. In this study the stability of ACDFP, a posterior wiring procedure after ACDFP (ACDFPW), and ACDFTP for treatment of bilateral cervical facet dislocation were compared.

Methods. Spines (C3—T1) from 10 human cadavers were tested in the intact state, and then after ACDFP, ACDFPW, and ACDFTP were performed. Intervertebral motion was measured using a video-based motion capture system. The range of motion (ROM) and neutral zone (NZ) were compared for each loading mode to a maximum of 2 Nm.

The ROM for spines treated with ACDFP was below that of the intact spine in all loading modes, with statistical significance in flexion and extension, but NZs were decreased in flexion and extension and slightly increased in bending and axial rotation; none of these showed statistical significance. The ACDFPW produced statistically significant additional stability in axial rotation ROM and in flexion NZ than ACDFP. The ACDFTP provided better stability than ACDFP in bending and axial rotation, and better stability than ACDFPW in bending for both ROM and NZ. There was no significant difference in extension with either ROM or NZ for the three fixation methods.

Conclusions. The spines treated with ACDFTP demonstrated the most effective stabilization, followed by those treated with ACDFPW, and then ACDFP. The spines receiving ACDFP also revealed a higher stability than the intact spine in most loading modes; thus ACDFP can also provide a relatively effective stabilization in bilateral cervical facet dislocation, but with the aid of a brace.

Restricted access

Chi Heon Kim, Chun Kee Chung, Hee Suk Hong, Eun Hyun Kim, Min Jung Kim and Byung Joo Park

Object

Recent studies have emphasized measuring the sagittal vertical axis (SVA) and pelvic parameters (pelvic incidence, sacral slope, and pelvic tilt) when evaluating spinal disorders. An accurate and reproducible measurement is important for a reliable result. Although computerized measurement is more consistent than manual measurement, computerized measurement requires an expensive software program, the need to transfer images to a workstation, and additional education for users. An inexpensive and convenient computerized measurement program is desirable and necessary. The object of this study was to propose a computerized tool for measuring spinal and pelvic parameters and to evaluate the efficacy of this new tool compared with manual measurement.

Methods

The authors devised a tool that provides computerized measurements of the SVA and pelvic parameters in a picture archiving and communication system (PACS) without transferring images to another program. This tool was created by merging functions in the PACS. The resulting tool is easy to implement by merging functions (indicate the center of 2 points, plot a vertical and a horizontal line from a point, and measure the angles between lines) in any image viewer. The tool was made into icons on a toolbar in the PACS. Measurements of distance and angle were computerized by identifying crucial points after selecting the icon. For SVA, 4 points were identified around each corner of the C-7 body and a fifth point at the superior/posterior corner of the S-1 body. For pelvic parameters, 4 points were identified at the centers of each femoral head and at the anterior/superior and posterior/superior corners of S-1. Thirty-three whole-spine lateral radiographs were randomly selected from the radiographic database. To evaluate inter- and intraobserver variability between observers and method, skilled (2 years of experience) and unskilled (1 week of experience) observers measured SVA and pelvic parameters 3 times with a 7-day interval between each time using both computerized and manual measurement methods. The reliability was measured using the intraclass correlation coefficient.

Results

The computerized method showed better congruity than the manual method in both skilled and unskilled observers (p < 0.05), and the intraclass correlation coefficients were > 0.9. The skilled observer showed better agreement than the unskilled observer with both computerized and manual methods, and this difference was prominent in measuring pelvic parameters (p < 0.05). The computerized method required less time than the manual method, especially for the unskilled observer (p < 0.05).

Conclusions

A computerized measurement of pelvic parameters may be a more reliable and efficacious approach than manual measurements. This benefit is more prominent in the unskilled observer, and adding this simple function to an image viewer may be recommended in future studies.

Restricted access

Suk-Joo Hong, Youn-Kwan Park, Jung Hyuk Kim, Soon Hyuck Lee, Kyung Nam Ryu, Cheol Min Park and Yeon Soo Kim

Object

The authors evaluate the biomechanical properties of vertebral bodies (VBs) stabilized with calcium phosphate (CaP) cements for use in vertebroplasty in comparison with polymethylmethacrylate (PMMA).

Methods

In the first phase of the study, 73 VBs (T3–L2; thoracic region [T3–8] and thoracolumbar region [T9–L2]) were collected from seven fresh human cadavers. Compression tests were performed before and after vertebroplasty using PMMA (compression strength 80 MPa) and three kinds of CaP cements—CaP1 (5 MPa), CaP2 (20 MPa), and CaP3 (50 MPa). The authors compared the maximal compression loads (MCLs) and stiffness before and after vertebroplasty in each of the four cement groups. In the second phase of the study, 18 paired spinal units (PSUs) were collected from three fresh human cadavers, and the authors injected two types of cement selected from the first phase of the study into the lower level of six PSUs. They compared the MCLs of the untreated and two treated groups (there were six PSUs in each type of group) to analyze the tendency of inducing compression fractures in the upper level of the PSUs.

The MCLs of the PMMA-injected vertebrae were significantly increased after vertebroplasty. The MCL levels of the CaP3-injected vertebrae and the CaP2-injected thoracolumbar vertebrae were decreased from those of untreated vertebrae without being significant. The MCLs of CaP1-injected vertebrae and CaP2-injected thoracic vertebrae were significantly decreased after vertebroplasty. The stiffness of all cement groups was decreased after vertebroplasty compared with initial stiffness, significantly so in all three thoracic CaP groups. In the second compression test with PSUs, the MCLs of the CaP2- and CaP3-injected PSUs were not significantly different from those of the untreated control PSUs.

Conclusions

The CaP3-injected vertebrae restored the MCLs of human vertebrae closer to their initial levels than the PMMA-injected vertebrae did. The CaP2- and CaP3-injected PSUs showed no tendency to induce compression fractures in adjacent VBs.

Restricted access

Yong-Jun Cho, Chi Hern Lee, Dae Won Kim, Ki-Yeon Yoo, Won Sik Eum, Min Jea Shin, Hyo Sang Jo, Jinseu Park, Kyu Hyung Han, Keun Wook Lee and Soo Young Choi

The authors investigated the effects of a silk solution against laminectomy-induced dural adhesion formation and inflammation in a rat model. They found that it significantly reduced postlaminectomy dural adhesion formation and inflammation. Dural adhesion formation, thought to be an inevitable consequence of laminectomy, is one of the most common complications following spinal surgery, and the authors' results indicate that the silk solution might be a potential novel therapeutic agent for dural adhesion formation.

Full access

Jin-Young Hwang, Seong-Won Min, Young-Tae Jeon, Jung-Won Hwang, Sang-Heon Park, Jin-Hee Kim and Sung-Hee Han

OBJECT

Spinal cord ischemia remains a serious complication of thoracoabdominal aortic aneurysm surgery. Coenzyme Q10, a potent antioxidant, has been reported to exert a neuroprotective effect. In the present study, we evaluated the effect of coenzyme Q10 pretreatment on spinal cord ischemia-reperfusion injury.

METHODS

Male Sprague-Dawley rats were treated with either 300 mg/kg coenzyme Q10 (CoQ10 group, n = 12) or saline (control and sham groups, n = 12 for each group) for 5 days before ischemia. Spinal cord ischemia was induced in the control and CoQ10 groups. Neurological function was assessed using the Basso-Beattie-Bresnahan (BBB) motor rating scale until 7 days after reperfusion, and then the spinal cord was harvested for histopathological examinations and an evaluation of malondialdehyde level.

RESULTS

On post-reperfusion Day 1, the CoQ10 group showed higher BBB scores compared with those in the control group, although the difference was not significant. However, on Day 2, the CoQ10 group showed a significantly higher BBB score than the control group (14.0 [10.3–15.0] vs 8.0 [5.0–9.8], median [IQR], respectively; p = 0.021), and this trend was maintained until Day 7 (17.5 [16.0–18.0] vs 9.0 [6.5–12.8], respectively; p < 0.001). Compared with the control group, the CoQ10 group had more normal motor neurons (p = 0.003), fewer apoptotic changes (p = 0.003) and a lower level of tissue malondialdehyde (p = 0.024).

CONCLUSIONS

Pretreatment with 300 mg/kg coenzyme Q10 resulted in significantly improved neurological function and preservation of more normal motor neurons.