| Hyang Kwon Park | 7 Articles |
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[English]
Recently, postoperative results of cervical spondylosis, disc herniation, tumor, and ossiication of posterior longitudinal ligament(OPLL) after anterior cervical surgeries have been improving due to new kinds of medical imaging, electrophysiological examinations, improved operative equipment, and improved surgical technique. However, occasional unsatisfactory cases needing a secondary operation remain. The author analyzed and developed strategies for multioperated cervical cases : all patients had two or more operations. From Sep. 93 to Aug. 98, 167 anterior cervical surgeries with fusions were performed in Dept. of Neurosurgery, Tong Dae Moon hospital. The author experienced 11 cases(6.6%) of failed anterior cervical surgeries and fusions : 8 men and 3 women. Initial diagnosis was 1 spondylosis, 2 cervical traumas, 3 disc herniations, and 5 cases of ossification of posterior longitudinal ligament. These multioperated cases were classified by the following cases : hardware-related complications, graft-related complications, and others. These groups were analyzed, and the resulting surgical strategies, including indications and techniques of anterior surgery, are described. The results of this study indicates that in order to reduce the need for multioperated cases, initial skillful surgical techniques and proper understanding of cervical spinal anatomy are necessary.
[English]
During the period from Sep.,1993 to Dec.,1997, in a series of 148 patients with anterior cervical fusions on using a modified Smith-Robinson technique, long-term follow-up results complete with historical evaluation or laryngeal examination were obtained in all patients. The visualization of the underlying pathology was adequate through magnification of the operating microscope in the anterior approach. The complications were analyzed on the basis of 157 operative cases in 148 patients treated surgically right sided approach with variable underlying pathologies. The most common complication was a postoperative hoarseness in 8(5%), but risks and complications of the procedure were few in spite of right sided approach. Measures to minimize the incidence of vocal cord paralysis include careful surgical techique and knowledge of the surgical anatomy of the laryngeal nerves. Suggestions are given for the assessment of postoperative hoarseness, and for the management of vocal cord paralysis.
[English]
59 Consequtive patients with cervical disc disease were treated with single or multilevel anterior discectomy and fusion using a modified Smith-Robinson procedure from Sep. 1993 to Dec. 1996. There were 36 single-level fusions, 19 two-level fusions and 4 three-level fusions. The most common presenting complaint was radiating pain to upper extremity and the most frequent site was the C5-6 in single level, C5-6-7 in two level, and C3-4-5-6 in three level. Immediate postoperative complications were encountered in 11 cases : graft extrusion in three, hardware failure and loosening in two, donor site pain and hematoma in four, and transient hoarseness in two cases. With an average follow-up of 1 year, the fusion rate was 96.5%(83 of 86 levels). The single-level fusion rate was 100%, the two-or three-level was 94%. Results by clinical examination revealed 32(54%) excellent, 23(39%) good, 1 fair and 3 poor. There were no significant graft collapse or exrusion and wound infection or neurologic complications. The modified Smith-Robinson procedure for anterior cervical discectomy and fusion has led to the successful treatment of cervical disc disease with improved results and few complications in long-term follow up.
[English]
Animal models of peripheral nerve ischemia have yielded variable results. The question of whether postischemia re-estableshment of blood flow to the nerves auguments injury has not been examined. To study this question, the ipsilateral common iliac and femoral arteries were occluded with arterial snares for 3 hours in rats. C14-butanol tissue distribution was then used to measure blood flow in both sciatic and posterior tivial nerve trunks during occlusion and reperfusion. Clinical limb function was graded serially, with the undisturbed contralateral limb serving as the study control. Nerve blood flow was reduced throughout the ischemic period and was only 20% of the control value in the posterior tibial nerve. All rats had functional impairment with an average limb function score of 7.5(normal score<2). During reperfusion period, blood flow in the distal sciatic and posterior tibial nerves was approximately double that of control nerbes at 2 hours. At 21 hours, tibial nerve blood flow was still twice that of the control nerve, but flows in the distal sciatic nerve were unchanged from control levels. Clinically, limb function improved progressively after reperfusion. It was concluded that nerve ischemia is attended by a relatively prolonged hyperemic flow response during reperfusion.
[English]
The multifactorial character of cervical spondylotic myelopathy indicates a probable onset and progression of this disease as well as a diversity of clinical manifestations. Patients admitted with the clinical symptomatology of a progressive myelopathy associated with radiologic findings compatible with spondylotic degeneration of the cervical spine and who manifest appropriate neurophysiological abnormalities should be considered as candidates for surgical treatment. For several decades, both anterior and posterior spinal decompressive procedures have been performed who are generally being informed before the operation that the aim of surgery is to stabilize their neurologic condition and that actual improvement often cannot be expected. A retrospective analysis of 42 patients admitted to the Dongdaemoon hospital utilizing MRI, CT in small amount to make diagnosis and surgical indication of degenerative cervical spine lesions was undertaken. Almost all patents were taken T1 Weighted Image(T1W1),T2 Weighted Image(T2W1) and gradient echo image on 1.5 Tesla unit. All patients could be evaluated the extent and degrees of disc hemiation, osteophytes and cord compression. A focal area of High-Signal-Intensity(HSI) was observed on T2W1 in 15 patients with myelopathy predominantly. HSI was diminished postoperatively in the patients who improved clinically , remained and unchanged who didn't improve. In this study, MRI with high resolution images I the initial procedure of choice of degenerative cervical spine lesion was important on the decision making of the patients, Furthermore hight signal of the spinal cord by the compressive lesions appear to be an important indicator for predicting prognosis of patients with myelopathy.
[English]
Although various kinds of spine stabilizing instruments have been developed over the past years for the treatment of unstable lumbar spinal disorders, the subject is still controversial and contradictory reports are seen in the literature. Among such instruments, Graf instrument has attracted much interest because of the originality of the idea as s soft stabilizer. All patients suffered from intractable symptomatic degenerative disc disease which could be localized to one or more levels. The results of the 30 consecutive patients using the Graf stabilization system are presented from Jan. 94 to Dec. 95. I have performed Graf soft fixation system on 30 cases of degenerative lumbar spine diseases for 2 years and more than 3 months of postoperative follow-up. 1) There were 10 males and 20 females. 2) The main preoperative diagnosis and evaluation was a severe back pain caused by degenerative disc disease with instability. 3) The most common operation level was a single level, L4/5 in 8 cases(27%), followed by two levels, L4/5+L5/S1 in 6 case(20%). 4) Out of the 30 operated cases, the follow-up results for low back pain were excellent in 14 cases(47%),good in 10 cases(33%). Although the follow-up in relatively short, the results from this study are sufficiently encouraging to prompt this report. Compared with conventional instrumented spinal fusion, the advantages of Graf system are less surgical trauma with shorted hospital stay and faster rehabilitation with early normal life, The Graf system instead of rigid implant is highly recommendable in managing unstable lumbar disorders.
[English]
While odontoid fractures are common injuries, disagreement exists regarding treatment. Because of the high risk of nonunion in type II odontoid fractures, surgical fusion should be considered in the initial treatment of odontoid fractures, surgical fusion should be considered in the initial treatment of odontoid fractures. Surgical fusion of odontoid fractures has usually been carried out by posterior C1-2 arthrodesis rather than fracture fixation. The former approach has been associated with significant mortality and morbidity. In addition, it results in a decreased range of motion, particularly lateral rotation and requires postoperative external immobilization. Recently several authors aors have advocated anterior scrow fixation of the fracture as an alternative to posterior cervical fusion. This paper presents a descuddion of different fusion methods and a limmited experience of screw fixation method. Direct anterior odentoid screw fixation can be used for the successful treatment of selected odontoid fractures and nonunions.
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