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Do Heum Yoon, Kook Hee Yang, Keung Nyun Kim and Sung Han Oh

✓ Posterior dislocation of the atlas onto the axis without related fracture of the odontoid process is a very rare traumatic condition of which five cases have been previously reported.

The authors present a sixth case in which management was different from the others. The patient was successfully treated by open reduction of the dislocation and C1–2 transarticular screw fixation. The rarity of the lesion, the differences in diagnostic studies, and the successful treatment by safe intraoperative reduction and fixation are factors of interest in this case.

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Dong Ah Shin, Keung Nyun Kim, Hyun Cheol Shin and Do Heum Yoon

Object

The objective of this study was to evaluate the invasiveness of microendoscopic discectomy (MED) in comparison with microscopic discectomy (MD) by measuring serum levels of creatine phosphokinase (CPK)-MM and lactate dehydrogenase (LDH)-5, and by comparing visual analog scale (VAS) scores of postoperative pain.

Methods

This study included a group of 15 patients who underwent surgery using MED and 15 patients who underwent surgery using MD, both for single-level unilateral herniated nucleus pulposus. The CPK-MM and LDH-5 levels were measured at admission and after 1, 3, and 5 days postoperatively. Pain assessment was recorded using scores raging from 0 to 10 on a subjective VAS at admission and at 1, 3, and 5 days postoperatively.

Results

The mean CPK-MM levels were lower for the MED group than for the MD group at both 3 (576.1 ± 286.3 IU/L compared with 968.1 ± 377.8 IU/L) and 5 days (348.1 ± 231.0 IU/L compared with 721.7 ± 463.2) postoperatively (p < 0.05). The mean VAS scores for postoperative back pain were lower in the MED group than in the MD group, both at 1 (3.3 ± 2.3 compared with 5.8 ± 1.5) and 5 days (1.9 ± 1.1 compared with 3.6 ± 1.1) postoperatively (p < 0.01).

Conclusions

The MED procedure is less invasive than MD, and causes less muscle damage and less back pain.

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Poong-Gi Ahn, Keung Nyun Kim, Sung Whan Moon and Keun Su Kim

Object

This was a retrospective clinical study in which the follow-up period exceeded 2 years. The authors investigated the time course of radiographic changes in the cervical range of motion (ROM) and sagittal alignment after cervical total disc replacement involving the ProDisc-C artificial disc.

Methods

Eighteen patients who underwent C5–6 total disc replacement were followed for an average of 27 months. Cervical neutral and flexion-extension lateral radiographs were obtained before and at 1 and 3 months after surgery for early-phase observations and at the last follow-up for late-phase observation. Segmental ROM values in the treated, superior, and inferior adjacent segments were measured. For whole-neck motion, C2–7 ROM was also measured. The percentage contributions of ROM at functional and adjacent segments to whole-neck motion were calculated. For evaluating sagittal alignment, C2–7 and C5–6 Cobb angles were measured. All data from ProDisc-C arthroplasty were compared with the results obtained in 22 patients who underwent C5–6 interbody fusion in which a Solis cage was used and who were followed for an average of 25 months

Results

In the ProDisc-C group, C2–7 and C5–6 ROM significantly decreased in the early phase after surgery and returned to preoperative levels in the late phase. Both superior and inferior adjacent segments showed significantly decreased ROM in the acute phase after surgery and returned to the preoperative values in the late phase. In terms of contributions to whole-neck motion, the ROM of the functional and adjacent segments did not change significantly compared with the preoperative ROM. In the cage group, C2–7 ROM was also significantly decreased in the early phase after surgery and returned to preoperative levels at the late phase. Both superior and inferior adjacent segments exhibited significantly increased ROM and percentage contributions to whole-neck motion in the early and late phases. Sagittal alignment of the whole cervical spine became significantly more lordotic in the late phase in the ProDisc-C group. The C5–6 Cobb angle became significantly lordotic in the ProDisc-C group, whereas there was no significant change in C5–6 Cobb angle in the cage group.

Conclusions

In the early phase after ProDisc-C replacement, the ROM of the entire neck as well as functional and adjacent segments decreased but, at the late phase, they returned to the preoperative state. Contributions of functional and adjacent segments to whole-neck motion were not changed after ProDisc-C replacement. Adjacent-segmental motion could be saved by ProDisc-C replacement instead of interbody cage fusion. Segmental degenerative kyphosis was significantly corrected in patients who underwent ProDisc-C replacement.

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Chang Kyu Lee, Dong Ah Shin, Seong Yi, Keung Nyun Kim, Hyun Chul Shin, Do Heum Yoon and Yoon Ha

OBJECT

The goal of this study was to determine the relationship between cervical spine sagittal alignment and clinical outcomes after cervical laminoplasty in patients with ossification of the posterior longitudinal ligament (OPLL).

METHODS

Fifty consecutive patients who underwent a cervical laminoplasty for OPLL between January 2012 and January 2013 and who were followed up for at least 1 year were analyzed in this study. Standing plain radiographs of the cervical spine, CT (midsagittal view), and MRI (T2-weighted sagittal view) were obtained (anteroposterior, lateral, flexion, and extension) pre- and postoperatively. Cervical spine alignment was assessed with the following 3 parameters: the C2–7 Cobb angle, C2–7 sagittal vertical axis (SVA), and T-1 slope minus C2–7 Cobb angle. The change in cervical sagittal alignment was defined as the difference between the post- and preoperative C2–7 Cobb angles, C2–7 SVAs, and T-1 slope minus C2–7 Cobb angles. Outcome assessments (visual analog scale [VAS], Oswestry Neck Disability Index [NDI], 36-Item Short-Form Health Survey [SF-36], and Japanese Orthopaedic Association [JOA] scores) were obtained in all patients pre- and postoperatively.

RESULTS

The average patient age was 56.3 years (range 38–72 years). There were 34 male patients and 16 female patients. Cervical laminoplasty for OPLL helped alleviate radiculomyelopathy. Compared with the preoperative scores, improvement was seen in postoperative VAS and JOA scores. After laminoplasty, 35 patients had kyphotic changes, and 15 had lordotic changes. However, cervical sagittal alignment after laminoplasty was not significantly associated with clinical outcomes in terms of postoperative improvement of the JOA score (C2–7 Cobb angle: p = 0.633; C2–7 SVA: p = 0.817; T-1 slope minus C2–7 lordosis: p = 0.554), the SF-36 score (C2–7 Cobb angle: p = 0.554; C2–7 SVA: p = 0.793; T-1 slope minus C2–7 lordosis: p = 0.829), the VAS neck score (C2–7 Cobb angle: p = 0.263; C2–7 SVA: p = 0.716; T-1 slope minus C2–7 lordosis: p = 0.497), or the NDI score (C2–7 Cobb angle: p = 0.568; C2–7 SVA: p = 0.279; T-1 slope minus C2–7 lordosis: p = 0.966). Similarly, the change in cervical sagittal alignment was not related to the JOA (p = 0.604), SF-36 (p = 0.308), VAS neck (p = 0.832), or NDI (p = 0.608) scores.

CONCLUSIONS

Cervical laminoplasty for OPLL improved radiculomyelopathy. Cervical laminoplasty increased the probability of cervical kyphotic alignment. However, cervical sagittal alignment and clinical outcomes were not clearly related.

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Seong Yi, Do Heum Yoon, Hyun Chul Shin, Keung Nyun Kim and Sang Won Lee

✓ Spondylocostal dysostosis is a rare congenital segmental costovertebral malformation. Neural tube defects associated with it have been reported several times, and a genetic cause has been proposed. The authors report on the first patient with both spondylocostal dysostosis and an intrathoracic myelomeningocele in whom surgical treatment was successful.

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Sungkyu Lee, Chung Mo Nam, Do Heum Yoon, Keung Nyun Kim, Seong Yi, Dong Ah Shin and Yoon Ha

Object

The authors undertook this study to investigate the relationships between low-back pain (LBP) and spinal bone density. Low-back pain is a major health issue and contributes to increases in medical and economic costs. Epidemiological studies have identified individual, sociodemographic, psychosocial, and occupational risk factors for LBP. However, there have been limited studies addressing the relationships between LBP and spinal bone density.

Methods

Data were obtained from the population-based Fourth Korea National Health and Nutrition Examination Survey (K-NHANES IV, 2009). From 10,533 K-NHANES participants, the authors identified 7144 (3099 men and 4045 women) 21 years of age or older who underwent dual-energy x-ray absorptiometry and anthropometric measurements for inclusion in this study. Low-back pain patients were defined as those who had been diagnosed with LBP by a medical doctor. Chi-square tests, t-tests, and multivariable logistic regression analyses were used to examine the relationships between LBP and spinal bone density.

Results

The total prevalence of LBP in the patient sample was 17.1%. More females (21.0%) reported LBP than males (12.1%). A number of sociodemographic and medical factors—sex, age, place of residence, occupation, education, hypertension, diabetes mellitus, and depression—were all associated with LBP, while LBP was not associated with income or exercise levels. Regression analyses indicated that higher lumbar spine T-scores (OR 1.11, 95% CI 1.02–1.20) were associated with LBP.

Conclusions

Higher bone density in the lumbar spine is associated with LBP, independent of confounding factors such as sociodemographic status, education, and medical-psychiatric disorders. Cause and effect relationship between higher bone density and LBP, such as degenerative changes in spine, requires further investigation.