PMCC PMCC

Search tips
Search criteria

Advanced
Results 1-25 (230)
 

Clipboard (0)
None
Journals
Year of Publication
Document Types
1.  Effects of Methylprednisolone on Neuroprotective Effects of Delay Hypothermia on Spinal Cord Injury in Rat 
Asian Spine Journal  2015;9(1):1-6.
Study Design
A retrospective study.
Purpose
The aim of this study was to evaluate the effects of delayed hypothermia on spinal cord injuries in rats. In addition, the effect of methylprednisolone on therapeutic window of hypothermia was evaluated.
Overview of Literature
Several studies have demonstrated that early hypothermia is the most effective neuroprotective modality. However, delayed hypothermia seems to be more practical for patients with traumatic spinal cord injuries. A combination of hypothermia and other neuroprotective methods, such as using methylprednisolone, may help extend the therapeutic window of hypothermia.
Methods
One hundred and twenty male rats were categorized into six groups. The rats in five groups were subjected to spinal cord injury using the weight drop method, followed by treatment, consisting of early hypothermia, late hypothermia, late hypothermia plus methylprednisolone, or methylprednisolone only. Biochemical tests including catalase, malondialdehyde, and superoxide level were evaluated in the injured spinal cord. Behavioral functions of the hind limb were evaluated by Basso-Battle-Bresnaham locomotor rating scale and tail-flick tests.
Results
Functional and biochemical evaluation showed both early and late hypothermia had significant neuroprotective effects. The treated groups did not differ significantly from one another in the behavioral tests. Hypothermia had better biochemical results compared to methylprednisolone. Also, methylprednisolone was shown to extend the therapeutic window of delayed hypothermia.
Conclusions
Hypothermia showed a significant neuroprotective effect, which can be improved with further studies optimizing the duration of hypothermia and the rewarming period. Moreover, the therapeutic effect of the delayed hypothermia can be extended by methylprednisolone.
doi:10.4184/asj.2015.9.1.1
PMCID: PMC4330203
Hypothermia; Spinal cord injury; Methylprednisolone; Hypothermia
2.  Repair Using Conventional Implant for Ruptured Annulus Fibrosus after Lumbar Discectomy: Surgical Technique and Case Series 
Asian Spine Journal  2015;9(1):14-21.
Study Design
A retrospective review of annulus fibrosus repair (AR) using a novel technique with a conventional implant.
Purpose
The purpose of this study was to present the feasibility and clinico-radiological outcomes of a novel AR technique using a conventional implant to minimize recurrence following a lumbar discectomy (LD).
Overview of Literature
Conventional repair techniques to prevent recurrence following LD have several drawbacks. The AR surgical technique has received little attention as an adjunct to LD.
Methods
A total of 19 patients who underwent novel AR following LD, and who were available for follow-up for at least three years, were enrolled in this study. Several variables, including the type and size of disc herniation, and the degree of disc degeneration, were evaluated preoperatively. Postoperatively, the presence of clinical and radiological recurrence of disc herniation was evaluated from pain intensity and functional statuses, as well as an enhanced L-spine magnetic resonance imaging at the final follow-up. The presence of a peripheral hollow rim and inserted anchor mobilization were also evaluated during the follow-up.
Results
During follow-ups, there were no recurrences of disc herniation or complications, including neurovascular complications. Pain and functional disability improved significantly after surgery, and the improvement was maintained throughout the three-year follow-up period. No mobilization or implant peripheral hollow rim was observed during the follow-up.
Conclusions
This study examined the feasibility of a novel and easily available annulus implant technique following LD. These results suggest performing AR with this technique may be a valuable alternative for optimizing outcomes, if the procedure is performed in proper candidates.
doi:10.4184/asj.2015.9.1.14
PMCID: PMC4330210
Annulus fibrosus; Repair; Intervertebral disc displacement; Lumbar vertebrae
3.  A Comparison of Computed Tomography Measures for Diagnosing Cervical Spinal Stenosis Associated with Myelopathy: A Case-Control Study 
Asian Spine Journal  2015;9(1):22-29.
Study Design
Retrospective comparative study.
Purpose
To assess differences in computed tomography (CT) imaging parameters between patients with cervical myelopathy and controls.
Overview of Literature
There is a lack of information regarding the best predictor of symptomatic stenosis based on osseous canal dimensions. We postulate that smaller osseous canal dimensions increase the risk of symptomatic central stenosis.
Methods
CT images and medical records of patients with cervical myelopathy (19 patients, 8 males; average age, 64.4±13.4 years) and controls (18 patients, 14 males; average age, 60.4±11.0 years) were collected. A new measure called the laminar roof pitch angle (=angle between the lamina) was conducted along with linear measures, ratios and surrogates of canal perimeter and area at each level C2-C7 (222 levels). Receiver-operator curves were used to assess the diagnostic value of each. Rater reliability was assessed for the measures.
Results
The medial-lateral (ML) diameter (at mid-pedicle level) and calculated canal area (=anterior-posterior.×ML diameters) were the most accurate and highly reliable. ML diameter below 23.5 mm and calculated canal area below 300 mm2 generated 82% to 84% sensitivity and 67% to 68% sensitivity. No significant correlations were identified between age, height, weight, body mass in dex and gender for each of the CT measures.
Conclusions
CT measures including ML dimensions were most predictive. This study is the first to identify an important role for the ML dimension in cases of slowly progressive compressive myelopathy. A ML reserve may be protective when the canal is progressively compromised in the anterior-posterior dimension.
doi:10.4184/asj.2015.9.1.22
PMCID: PMC4330215
Cervical cord; Cervicle vertebrae; Spinal stenosis; Spinal cord compression; Spinal cord diseae
4.  A Prospective Randomized Clinical Trial Comparing Bone Union Rate Following Anterior Cervical Discectomy and Fusion Using a Polyetheretherketone Cage: Hydroxyapatite/B-Tricalcium Phosphate Mixture versus Hydroxyapatite/Demineralized Bone Matrix Mixture 
Asian Spine Journal  2015;9(1):30-38.
Study Design
Prospective randomized noninferiority trial.
Purpose
To evaluate whether the union rate of anterior cervical discectomy and fusion (ACDF) using a polyetheretherketone (PEEK) cage filled with a mixture of hydroxyapatite (HA) and demineralized bone matrix (DBM) is inferior to that of a mixture of β-tricalcium phosphate (β-TCP) and HA.
Overview of Literature
There have been no clinical trials investigating the outcomes of a mixture of HA and DBM in a PEEK cage in ACDF.
Methods
Eighty-five eligible patients were randomly assigned to group B (n=43), in which a PEEK cage with a mixture of HA and DBM was used, or group C (n=42), in which a PEEK cage with a mixture of HA and β-TCP was used. The primary study endpoint was the fusion rate, which was assessed with dynamic radiographs and computed tomography (CT) scans. Secondary endpoints included pain intensity using a visual analogue scale, functional outcome using a neck disability index score, laboratory tests of inflammatory profiles, and the infection rate.
Results
Seventy-seven patients (38 in group B and 39 in group C) were included in the final analysis. One year postoperatively, bone fusion was achieved in 87% of group B patients and 87% of group C patients on dynamic radiographs, and 87% of group B patients and 72% of group C patients on CT scans (p=1.00 and 0.16, respectively). There were also no between-groups differences with respect to the secondary endpoints.
Conclusions
A HA/DBM mixture inside a PEEK cage can provide noninferior outcomes compared to a HA/TCP mixture in ACDF.
doi:10.4184/asj.2015.9.1.30
PMCID: PMC4330216
Anterior cervical discectomy and fusion; Polyetheretherketone cage; Hydroxyapatites; Demineralized bone matrix; Beta-tricalcium phosphate
5.  Analysis of Postoperative Pain at the Anterior Iliac Crest Harvest Site: A Prospective Study of the Intraoperative Local Administration of Ropivacaine 
Asian Spine Journal  2015;9(1):39-46.
Study Design
This was a prospective randomized comparative study.
Purpose
The aim of this study was to objectify donor site-related pain following anterior iliac crest graft harvesting, in patients who have undergone multilevel anterior cervical discectomy and fusion with plating (ACDFP); and to assess the effect of an intraoperative local single injection of ropivacaine on postoperative pain.
Overview of Literature
Multilevel ACDFP can be associated with a high non-union rate. Autogenous iliac bone has been used to increase union rates, although a high incidence of donor site-related pain has been reported.
Methods
Forty consecutive patients who required 3-level or 4-level ACDFP were prospectively assessed for donor site-related pain. Pain levels were assessed daily for five days postoperative using the visual analog scale (VAS). Patients were randomly assigned to group A or B. In group A patients, 7-10 mL of ropivacaine (0.2%) was injected into the iliac crest after iliac crest graft harvesting. Morphine usage via patient controlled analgesia was calculated. At six months postoperative, patient complaints at the harvest site were documented.
Results
Patients were randomly assigned to group A or B. In group A, ropivacaine was locally administered at the site of the iliac crest graft harvest after fascia closure. In group B, no additional treatments were administered. The average patient age in group A was 56±7.6 years, whereas the average age of patients in group B was 52.6±10.4 years. Group A had an average of 0.6±0.7 previous surgeries per patient, whereas group B had an average of 0.8±1.0 previous surgeries per patient. The average number of levels fused in group A was 3.6±0.7, whereas the average number of levels fused in group B was 3.7±0.9 (all p>0.05). In group A, the mean ropivacaine volume administered was 8.4±1.5 mL. No patient complaints regarding chronic pain, were reported six months postoperatively. No complications were encountered from the harvest site, and all patients underwent successful 3-level and 4-level ACDFP. Statistical analysis showed significant differences for VAS on postoperative day 1 (p=0.004) and day 2 (p=0.005).
Conclusions
VAS assessment showed overall moderate perioperative morbidity in terms of donor site-related pain, which was reduced by administering ropivacaine.
doi:10.4184/asj.2015.9.1.39
PMCID: PMC4330217
Spine; Bone grafting; Complications; Local anesthetics; Pain assessment
6.  Comparison of the Japanese Orthopaedic Association Score and the Japanese Orthopaedic Association Cervical Myelopathy Evaluation Questionnaire Scores: Time-Dependent Changes in Patients with Cervical Spondylotic Myelopathy and Posterior Longitudinal Ligament 
Asian Spine Journal  2015;9(1):47-53.
Study Design
Prospective cohort study.
Purpose
To identify differences in time-dependent perioperative changes between the Japanese Orthopaedic Association (JOA) score and the JOA Cervical Myelopathy Evaluation Questionnaire (JOACMEQ) score in patients with cervical spondylotic myelopathy (CSM) and posterior longitudinal ligament (OPLL) who underwent cervical laminoplasty.
Overview of Literature
The JOA score does not take into consideration patient satisfaction or quality of life. Accordingly, the JOACMEQ was designed in 2007 as a patient-centered assessment tool.
Methods
We studied 21 patients who underwent cervical laminoplasty. We objectively evaluated the time-dependent changes in JOACMEQ scores and JOA scores for all patients before surgery and at 2 weeks, 3 months, 6 months, and 1 year after surgery.
Results
The average total JOA score and the recovery rate improved significantly after surgery in both groups, with a slightly better recovery rate in the OPLL group. Cervical spine function improved significantly in the CSM group but not in the OPLL group. Upper- and lower-extremity functions were more stable in the CSM group than in the OPLL group. The effectiveness rate of the JOACMEQ for measuring quality of life was quite low in both groups. In both groups, the Spearman contingency coefficients were dispersed widely except for upper- and lower-extremity function.
Conclusions
Scores for upper- and lower-extremity function on the JOACMEQ correlated well with JOA scores. Because the JOACMEQ can also assess cervical spine function and quality of life, factors that cannot be assessed by the JOA score alone, the JOACMEQ is a more comprehensive evaluation tool.
doi:10.4184/asj.2015.9.1.47
PMCID: PMC4330218
Questionnaires; Spinal cord diseases; Spondylosis; Ossification of posterior longitudinal ligament; Quality of life
7.  Foramen Magnum Meningioma: Some Anatomical and Surgical Remarks through Five Cases 
Asian Spine Journal  2015;9(1):54-58.
Study Design
Foramen magnum meningioma foramen magnum meningioma (FMM) represents 2% all of meningiomas. The clinical symptomatology is usually insidious and consists of headache, neck pain and hypoesthesia in C2 dermatome. Because of their location, the management is challenging.
Purpose
The purpose of this paper is to present our experience in the surgery of FMM.
Overview of Literature
Since 1938, numerous series have been published but they are very heterogeneous with high variability of location and surgical approaches.
Methods
During two years, we operated 5 patients with FMM. All the patients had magnetic resonance imaging (MRI) with angio-MRI to study the relationship between tumour and vertebral artery (VA). In all the cases, we used prone position.
Results
In one case, considering the tumour localization (posterior and pure intradural) the tumour was removed via a midline suboccipital approach with craniotomy and C1-C2 laminectomy. In all other cases, meningiomas were posterolateral (classification of George) with extradural extension in one case. In all cases, VA was surrounded by tumor. So, we opted for a modified postero-lateral approach with inverted L incision, craniotomy and C1-C2 laminectomy without resect occipital condyle. Epidural part of VA was identified and mobilized laterally. Once VA was identified we opened dura mater and began to remove the tumour.
Conclusions
In this paper, we present five cases of operated FMM, describe our approaches, the reason of each approach and propose some surgical remarks.
doi:10.4184/asj.2015.9.1.54
PMCID: PMC4330219
Craniocervical; Foramen magnum; Meningioma; Surgical approach; Neurosurgery; Posterior cranial fossa
8.  Total Disc Arthroplasty for Treating Lumbar Degenerative Disc Disease 
Asian Spine Journal  2015;9(1):59-64.
Study Design
Lumber disc arthroplasty is a technological advancement that has occurred in the last decade to treat lumbar degenerative disk diseases.
Purpose
The aim of this retrospective study was to establish the impact and outcomes of managing patients with lumbar degenerative disk disease who have been treated with lumbar total disc arthroplasty (TDA).
Overview of Literature
Several studies have shown promising results following this surgery.
Methods
We reviewed the files of 104 patients at the Department of Neurosurgery in Colmar (France) who had been operated on by lumbar spine arthroplasty (Prodisc) between April 2002 and October 2008.
Results
Among the 104 patients, 67 were female and 37 were male with an average age of 33.1 years. We followed the cases for a mean of 20 months. The most frequent level of discopathy was L4-L5 with 62 patients (59.6%) followed by L5-S1 level with 52 patients (50%). Eighty-three patients suffered from low back pain, 21 of which were associated with radiculopathy. The status of 82 patients improved after surgery according to the Oswestry Disability Index score, and 92 patients returned to work.
Conclusions
The results indicate that TDA is a good alternative treatment for lumbar spine disk disease, particularly for patients with disabling and chronic low back pain. This technique contributes to improve living conditions with correct patient selection for surgery.
doi:10.4184/asj.2015.9.1.59
PMCID: PMC4330220
Low back pain; Lumbar vertebrae; Intervertebral disk degeneration
9.  Surgical Correction in Patients with Lumbar Degenerative Kyphosis Who Had Low Bone Mineral Density: An Analysis of 40 Patients with a Minimum Follow-Up of Two Years 
Asian Spine Journal  2015;9(1):65-74.
Study Design
Retrospective study.
Purpose
To investigate influence of bone mineral density (BMD) on the surgical correction of lumbar degenerative kyphosis (LDK).
Overview of Literature
No studies so far have reported the influence of BMD on the surgical correction of LDK.
Methods
Forty LDK patients with more than 2 years follow-up were studied. Pelvic incidence (PI), pelvic tilt, sacral slope, sagittal vertical axis (SVA), lumbar lordosis (LL), and thoracic kyphosis were measured preoperatively, immediate postoperatively and at final follow-up. Adverse outcomes: proximal adjacent fractures, sagittal decompensation, pseudoarthrosis, and cage subsidence were documented.
Results
There were 37 females and 3 males. Average age was 65.1±4.5 years and mean follow-up was 34.2±16.7 months. 42.5% were Takemitsu type 3 curves, 27.5% type 2, 20.0% type 4 and 10.0% type 1. 37.5% had osteopenia, 40.0% osteoporosis and 22.5% had severe osteoporosis. SVA improved from 237.0±96.7 mm preoperatively to 45.3±41.8 mm postoperatively (p=0.000). LL improved from 10.5°±14.7° to -40.6°±10.9° postoperatively (p=0.000). At final follow-up SVA deteriorated to 89.8±72.2 mm and LL to 34.7°±15.8° (p=0.000). The association between late sagittal decompensation, pseudoarthrosis, or proximal adjacent fractures and osteoporosis was insignificant. The difference between immediate postoperative LL and PI (PIDiff) had a significant association with sagittal decompensation and pseudoarthrosis.
Conclusions
Osteoporosis did not influence the degree of correction, late sagittal decompensation, proximal adjacent fractures, and pseudoarthrosis in LDK. PIDiff had a significant association with sagittal decompensation and pseudoarthrosis.
doi:10.4184/asj.2015.9.1.65
PMCID: PMC4330221
Lumbar degenerative kyphosis; Bone mineral density; Surgery; Outcome; Osteoporosis
10.  Expression of Hyaluronidase-4 in a Rat Spinal Cord Hemisection Model 
Asian Spine Journal  2015;9(1):7-13.
Study Design
Examination of hyaluronidase-4 (Hyal-4) expression in a rat spinal cord hemisection model.
Purpose
To determine the status of Hyal-4 expression after hemisection of the spinal cord, and the relationship between its expression and that of chondroitin sulfate proteoglycans (CSPGs).
Overview of Literature
CSPGs are expressed at the site of spinal cord injury and inhibit axon regeneration. Administration of exogenous chrondroitinase ABC (ChABC), derived from bacteria, digested CSPGs and promoted axonal regrowth. Using a rat hemisection model, we have demonstrated peak CSPGs levels at by 3 weeks after injury but then decreased spontaneously. Could there be an endogenous enzyme similar to ChABC in the spinal cord? It has been suggested that Hyal-4 is involved in CSPG degradation.
Methods
A rat hemisection model was prepared and spinal cord frozen sections were prepared at 4 days and 1, 2, 3, 4, 5, and 6 weeks post-cordotomy and stained for CSPGs and Hyal-4 and subjected to Western blotting.
Results
CSPGs appeared at the injury site at 4 days after hemisection, reached a peak after 3 weeks, and then decreased. Hyal-4 was observed around the injury site from 4 days after cordotomy and increased until after 5-6 weeks. Double staining showed Hyal-4 around CSPGs. Western blotting identified a band corresponding to Hyal-4 from 4 days after hemisection.
Conclusions
Hyal-4 was expressed in a rat hemisection model in areas surrounding CSPGs, and as its peak was delayed compared with that of CSPGs. These results suggest the involvement of Hyal-4 in the digestion of CSPGs.
doi:10.4184/asj.2015.9.1.7
PMCID: PMC4330222
Spinal cord injury; Chondroitin sulfate proteoglycans; Hyaluronidase
11.  The Efficacy of Intramuscular Calcitonin Injection in the Management of Lumbar Spinal Stenosis 
Asian Spine Journal  2015;9(1):75-82.
Study Design
A prospective, cross-sectional, non-randomized study.
Purpose
To assess the effectiveness of intramuscular calcitonin injection in the treatment of lumbar spinal stenosis (LSS).
Overview of Literature
LSS, manifesting as chronic low back pain and neurogenic claudication, is a chronic condition with an increasing incidence in the elderly population having inadequate effective conservative treatment options.
Methods
In this study, 36 patients with LSS who were diagnosed based on the clinical findings and magnetic resonance imaging were included. Patients received 100 IU of calcitonin per week for one month and were evaluated before and after treatment using the Oswestry disability index (ODI) questionnaire and visual analogue scale (VAS). Before treatment, the patients were divided into two subgroups based on their ODI results: patients with mild to moderate low back pain (disability, 0%-40%) and patients with severe or very severe low back pain (disability, 40%-100%).
Results
In patients with mild to moderate low back pain, there were no significant changes in the ODI and VAS after calcitonin injection. But in patients with severe or very severe low back pain, pain severity, personal functions, ability to lift and carry objects, time interval between standing and initiation of pain, social life, disability percentage, and VAS were significantly improved after treatment with calcitonin.
Conclusions
It seems that an intramuscular injection of low dose of calcitonin may have some beneficial effects on the pain due to LSS, especially in patients who suffer from severe or very severe low back pain.
doi:10.4184/asj.2015.9.1.75
PMCID: PMC4330223
Lumbar spinal stenosis; Calcitonin; Intramuscular injection
12.  An Evaluation of the Effectiveness of Hyaluronidase in the Selective Nerve Root Block of Radiculopathy: A Double Blind, Controlled Clinical Trial 
Asian Spine Journal  2015;9(1):83-89.
Study Design
Prospective, double-blind, randomized controlled trial.
Purpose
To determine the ability of hyaluronidase to provide longer lasting pain relief and functional improvement in patients with lumbar radiculopathy.
Overview of Literature
Selective nerve root block (SNRB) is a good treatment option in lumbar radiculopathy. We studied the effectiveness of hyaluronidase when added to the traditional SNRB regimen.
Methods
A sample size of 126 patients per group was necessary. A sample of 252 patients who underwent an injection procedure with or without hyaluronidase due to radiculopathy was included in this study. The patients were randomly divided into two groups: the control (C) group and the hyaluronidase (H) group. After SNRB due to radiculopathy, the visual analog scale (VAS) was compared at 2, 4, 6, 8, and 12 weeks between the two groups, and the Oswestry disability index (ODI) was compared at 12 weeks between the two groups.
Results
Both groups seemed to have general improvement in VAS, but in C group, the VAS was higher than the H group 2 and 4 weeks after the surgery, and the difference in time-group change between 2 groups was statistically significant (p <0.05). ODI improved in both groups, and the difference in time-group change between 2 groups was not statistically significant (p >0.05).
Conclusions
The rebound pain (the re-occurrence of pain within 2-4 weeks after injection) that occurs within 2-4 weeks after the injection of the routine regimen can be reduced when hyaluronidase is added to the routine SNRB regimen.
doi:10.4184/asj.2015.9.1.83
PMCID: PMC4330224
Nerve block; Hyaluronidase; Visual analog scale
13.  Clinical Outcomes of Surgical Treatments for Traumatic Spinal Injuries due to Snowboarding 
Asian Spine Journal  2015;9(1):90-98.
Study Design
Retrospective study.
Purpose
To assess treatment outcomes of snowboarding-related spinal and spinal cord injuries.
Overview of Literature
Snowboarding-related spinal or spinal cord injury have a great impact on social and sporting activities.
Methods
A retrospective review of 19 cases of surgically treated snowboard-related injury was done. Analyzed parameters included site of injury, type of fracture, peri- and postoperative complications, pre- and postoperative neurological status, activities of daily living, and participation in sports activities at the final follow-up.
Results
The major site of injury was the thoracolumbar junction caused by fracture-dislocation (13/19 cases). The remaining 6 cases had cervical spine injuries. Over 60% of the patients had Frankel A and B paralysis. All patients were surgically treated by posterior fusion with instrumentation. Five underwent additional anterior fusion. Surgical outcome was restoration of ambulatory capacity in 12 patients (63.2%). Ultimately, 15 patients (78.9%) could return to work. Patients with complete paralysis upon admission showed reduced ambulatory capacity compared to those with incomplete paralysis. None of the patients again participated in any sports activities, including snowboarding.
Conclusions
Snowboarding-related spinal or spinal cord injury has a great impact on social as well as sports activities. It is necessary to enhance promotion of injury prevention emphasizing the snowboarders' responsibility code.
doi:10.4184/asj.2015.9.1.90
PMCID: PMC4330225
Snowboarding; Spinal injury; Surgical treatment; Clinical outcomes
14.  Coccygectomy as a Surgical Option in the Treatment of Chronic Traumatic Coccygodynia: A Single-Center Experience and Literature Review 
Asian Spine Journal  2014;8(6):705-710.
Study Design
Retrospective cohort study.
Purpose
Trauma is the most common cause for chronic coccygodynia. The present study aims at presenting our results after complete removal of the coccyx for refractory traumatic coccygodynia in terms of pain level, complication rates, and patients' overall satisfaction.
Overview of Literature
There is limited extant literature describing the success rate and complications in refractory isolated traumatic coccygodynia.
Methods
From January 2011 to January 2012, 10 consecutive patients with posttraumatic coccygodynia (six males and four females; mean age, 42 years) were enrolled in our study. Conservative treatment of the condition had failed in all patients. The same surgeon performed a complete coccygectomy on all patients. Postoperative outcomes included measurements of pain relief and degree of patient satisfaction with the procedure's results.
Results
In our selected cohort, all patients indicated complete pain relief or significant pain improvement in follow up-care and would recommend this procedure. One patient developed a subcutaneous hematoma that required surgical intervention.
Conclusions
Our results suggest that complete removal of the coccyx relieves pain in patients with refractory chronic traumatic coccygodyniaand is therefore a reasonable treatment option after conservative treatment failure.
doi:10.4184/asj.2014.8.6.705
PMCID: PMC4278974  PMID: 25558311
Coccygectomy; Coccyx
15.  The Extended Posterior Circumferential Decompression Technique in the Management of Tubercular Spondylitis with and without Paraplegia 
Asian Spine Journal  2014;8(6):711-719.
Study Design
Retrospective clinical series.
Purpose
To study the clinical, functional and radiological results of patients with tuberculous spondylitis with and without paraplegia, treated surgically using the "Extended Posterior Circumferential Decompression (EPCD)" technique.
Overview of Literature
With the increasing possibility of addressing all three columns by a single approach, posterior and posterolateral approaches are gaining acceptance. A single exposure for cases with neurological deficit and kyphotic deformity requiring circumferential decompression, anterior column reconstruction and posterior instrumentation is helpful.
Methods
Forty-one patients with dorsal/dorsolumbar/lumbar tubercular spondylitis who were operated using the EPCD approach between 2006 to 2009 were included. Postoperatively, patients were started on nine-month anti-tuberculous treatment. They were serially followed up to thirty-six months and both clinical measures (including pain, neurological status and ambulatory status) and radiological measures (including kyphotic angle correction, loss of correction and healing status) were used for assessment.
Results
Disease-healing with bony fusion (interbody fusion) was seen in 97.5% of cases. Average deformity (kyphosis) correction was 54.6% in dorsal spine and 207.3% in lumbar spine. Corresponding loss of correction was 3.6 degrees in dorsal spine and 1.9 degrees in the lumbar spine. Neurological recovery in Frankel B and C paraplegia was 85.7% and 62.5%, respectively.
Conclusions
The EPCD approach permits all the advantages of a single or dual session anterior and posterior surgery, with significant benefits in terms of decreased operative time, reduced hospital stay and better kyphotic angle correction.
doi:10.4184/asj.2014.8.6.711
PMCID: PMC4278975  PMID: 25558312
Extended posterior approach; Circumferential spinal canal decompression; Kyphosis correction; Interbody fusion; Neurological recovery
16.  Adjacent Segment Pathology Following Anterior Decompression and Fusion Using Cage and Plate for the Treatment of Degenerative Cervical Spinal Diseases 
Asian Spine Journal  2014;8(6):720-728.
Study Design
Retrospective study.
Purpose
To analyze the incidence and prevalence of clinical adjacent segment pathology (CASP) following anterior decompression and fusion with cage and plate augmentation for degenerative cervical diseases.
Overview of Literature
No long-term data on the use of cage and plate augmentation have been reported.
Methods
The study population consisted of 231 patients who underwent anterior cervical discectomy and fusion (ACDF) with cage and plate for degenerative cervical spinal disease. The incidence and prevalence of CASP was determined by using the Kaplan-Meier survival analysis. To analyze the factors that influence CASP, data on preoperative and postoperative sagittal alignment, spinal canal diameter, the distance between the plate and adjacent disc, extent of fusion level, and the presence or absence of adjacent segment degenerative changes by imaging studies were evaluated.
Results
CASP occurred in 15 of the cases, of which 9 required additional surgery. At 8-year follow-up, the average yearly incidence was 1.1%. The rate of disease-free survival based on Kaplan-Meier survival analysis was 93.6% at 5 years and 90.2% at 8 years. No statistically significant differences in CASP incidence based on radiological analysis were observed. Significantly high incidence of CASP was observed in the presence of increased adjacent segment degenerative changes (p<0.001).
Conclusions
ACDF with cage and plate for the treatment of degenerative cervical disease is associated with a lower incidence in CSAP by 1.1% per year, and the extent of preoperative adjacent segment degenerative changes has been shown as a risk factor for CASP.
doi:10.4184/asj.2014.8.6.720
PMCID: PMC4278976  PMID: 25558313
Degenerative cervical spine disease; Anterior cervical discectomy and fusion; Adjacent segment pathology; Cage and plate
17.  How Many High Risk Korean Patients with Osteopenia Could Overlook Treatment Eligibility? 
Asian Spine Journal  2014;8(6):729-734.
Study Design
Retrospective study.
Purpose
To determine the prevalence of high risk patient with osteopenia requiring pharmacologic treatment and investigate the difference of 10-year fracture probability whether bone mineral density (BMD) include or not in Korean FRAX model.
Overview of Literature
Many people with the fracture have osteopenia rather than osteoporosis, and BMD alone could be considered as a chance to prevent fracture.
Methods
Three hundred sixty-nine patients who was diagnosed as osteopenia were divided into two groups according to age (group 1, under 65 years; group 2, over 65 years), and 10-year fracture probabilities were calculated by FRAX algorithm with and without femur neck T-score.
Results
The high risk patients of the fracture who had above 3% of 10-year hip fracture probability were 15 cases in group 1 and 121 cases in group 2. In 193 patients of group 1, the mean 10-year fracture probability with BMD was significantly higher than the results without BMD (hip fracture: p=0.04, major osteoporotic fracture: p=0.01). Unlike the results of the group 1, the mean 10-year fracture probability without BMD was significantly higher than the results with BMD in 176 patients of group 2 (hip fracture: p=0.01, major osteoporotic fracture: p=0.01).
Conclusions
Total of 136 cases (36.8%) as a high risk of the fracture with osteopenia could be overlooked treatment eligibility in Korean. The Korean FRAX model without BMD could be effective in predicting fracture risk especially in the individuals who were over 65 years.
doi:10.4184/asj.2014.8.6.729
PMCID: PMC4278977  PMID: 25558314
Osteopenia; Risk assessment; Bone mineral density; FRAX
18.  C1-C3 Lateral Mass Screw-Rod Fixation and Fusion for C2 Pathologies and Hangman's Fractures 
Asian Spine Journal  2014;8(6):735-746.
Study Design
Retrospective clinical study.
Purpose
We report our experience of eight patients treated with C1-C3 lateral mass rod-screw stabilization and fusion in the treatment of Hangman's fracture and other axis pathologies.
Overview of Literature
Different surgical approaches, both anterior and posterior, have been described for treating Hangman's fracture and other pathologies where surgery is indicated.
Methods
All patients who underwent surgical treatment for Hangman's fracture and axial pathology where C1-C3 lateral mass screw-rod stabilization and fusion done, following reduction of the fracture or removal of the pathology were included in this series. The recorded patient management data was retrospectively studied.
Results
There were 8 cases in total. All were male, with an average age of 40.75 years. Hangman's fracture occurred in 6 cases (75%), one with metastatic squamous cell carcinoma and the remaining with plasmocytoma. Among the Hangman's fractures 4 (66.66%) had no neuro-deficit. Reduction and bilateral C1-C3 lateral mass screw and rod fixation with posterior fusion by bone graft was performed in all cases. In 2 cases, a C2 body tumor was removed transorally. All patients with neuro-deficit fully recovered, except one who expired in the early post-operative period. Rest of all patients were leading a normal life till last follow up.
Conclusions
Although the number of cases was very small with a relatively short follow up period, C1 and C3 lateral mass screw-rod fixation followed by fusion showed promise as an effective and biomechanically sound way for the treatment of properly selected Hangman's fracture cases, and may also be suitable in other axial pathologies.
doi:10.4184/asj.2014.8.6.735
PMCID: PMC4278978  PMID: 25558315
C1-C3 lateral mass fixation; Hangman's fracture; C2 pathology
19.  Kinematic Analysis of the Cervical Cord and Cervical Canal by Dynamic Neck Motion 
Asian Spine Journal  2014;8(6):747-752.
Study Design
Normal cervical sagittal length patterns were measured by magnetic resonance imaging (MRI).
Purpose
The aim of this study was to evaluate the relationship of sagittal length patterns between the cervical cord and the cervical canal in flexion-extension kinematics.
Overview of Literature
Cervical dynamic factors sometimes cause a cervical spondylotic myelopathy in elderly subjects and an overstretching myelopathy in juvenile subjects. Previous studies showed the length changing of the cervical cord in flexion and extension. However, there is no detailed literature about the relationship between cervical vertebral motion and cord distortion yet.
Methods
Sixty-two normal subjects (28 male and 34 female, 42.1±8.5 years old) without neck motion disturbances and abnormalities on cervical X-ray and MRI were enrolled in this study.
Results
The cervical cord length was significantly longer in flexion and significantly shorter in extension in all cervical cord sagittal lines. The cervical canal length pattern was also the same as the cervical cord. The elongation of the cervical cord and canal was the largest at the site of the posterior cervical canal and the shortest at the anterior canal site. The positions of the cerebellar tonsils were verified at each neck position.
Conclusions
The posterior elements of the cervical canal were most affected by neck motion. Movement directions of the upper cervical cord were verified among the various neck positions.
doi:10.4184/asj.2014.8.6.747
PMCID: PMC4278979  PMID: 25558316
Cervical spine; Biomechanics; Magnetic resonance imaging
20.  Effect of Cryotherapy after Spine Surgery 
Asian Spine Journal  2014;8(6):753-758.
Study Design
Historical controlled trial.
Purpose
To clarify the usefulness of cryotherapy after spine surgery.
Overview of Literature
Cryotherapy has generally been performed subsequent to surgery on joints and in this application its clinical effects are well understood. However, cryotherapy has yet to be used following spine surgery. Its clinical efficacy in this context is unknown.
Methods
Thirty six patients had undergone one level microendoscopic surgery. Sixteen were enrolled into the cooling group, with the remaining 20 making up the no postoperative cryotherapy control group. Cryotherapy was performed at 5℃ using an icing system. A silicone balloon catheter with a thermo sensor on the tip was placed in the surgical wound. The temperature in the wound was recorded every 30 minutes until the next morning. The relationship between the depth of the sensor and the temperature in the wound were investigated using simple linear regression analysis. Laboratory data, visual analogue scale (VAS) for wound pain and postoperative bleeding were investigated.
Results
The mean temperature in the surgical wound was 37.0 in the control group and 35.0℃ in the cooling group (p<0.001). There was a positive correlation between the depth of the thermo sensor and the temperature in the wound in the cooling group (y=0.91x+30.2, r=0.67, p=0.004). There were no significant differences between the groups in terms of laboratory data, VAS or postoperative bleeding.
Conclusions
The temperature in the wound was decreased significantly by spinal surgery cryotherapy.
doi:10.4184/asj.2014.8.6.753
PMCID: PMC4278980  PMID: 25558317
Cryotherapy; Spine; Temperature
21.  Mid-Term Results of Computer-Assisted Cervical Pedicle Screw Fixation 
Asian Spine Journal  2014;8(6):759-767.
Study Design
A retrospective study.
Purpose
The present study aimed to evaluate mid-term results of cervical pedicle screw (CPS) fixation for cervical instability.
Overview of Literature
CPS fixation has widely used in the treatment of cervical spinal instability from various causes; however, there are few reports on mid-term surgical results of CPS fixation.
Methods
Record of 19 patients who underwent cervical and/or upper thoracic (C2-T1) pedicle screw fixation for cervical instability was reviewed. The mean observation period was 90.2 months. Evaluated items included Japanese Orthopaedic Association (JOA) score and C2-7 lordotic angle before surgery and at 5 years after surgery. Postoperative computerized tomography was used to determine the accuracy of screw placement. Visual analog scale (VAS) for neck pain and radiological evidence of adjacent segment degeneration (ASD) at the 5-year follow-up were also evaluated.
Results
Mean JOA score was significantly improved from 9.0 points before surgery to 12.8 at 5 years after surgery (p=0.001). The C2-7 lordotic angle of the neutral position improved from 6.4° to 7.8° at 5 years after surgery, but this was not significant. The major perforation rate was 5.0%. There were no clinically significant complications such as vertebral artery injury, spinal cord injury, or nerve root injury caused by any screw perforation. Mean VAS for neck pain was 49.4 at 5 years after surgery. The rate of ASD was 21.1%.
Conclusions
Our mid-term results showed that CPS fixation was useful for treating cervical instability. Severe complications were prevented with the assistance of a computed tomography-based navigation system.
doi:10.4184/asj.2014.8.6.759
PMCID: PMC4278981  PMID: 25558318
Cervical pedicle screw; Cervical instability; Mid-term results; Adjacent segment degeneration
22.  Comparison of Spinous Process-Splitting Laminectomy versus Conventional Laminectomy for Lumbar Spinal Stenosis 
Asian Spine Journal  2014;8(6):768-776.
Study Design
Seventy-five patients who had been treated for lumbar spinal stenosis (LSS) were reviewed retrospectively.
Purpose
Invasion into the paravertebral muscle can cause major problems after laminectomy for LSS. To address these problems, we performed spinous process-splitting laminectomy. We present a comparative study of decompression of LSS using 2 approaches.
Overview of Literature
There are no other study has investigated the lumbar spinal instability after spinous process-splitting laminectomy.
Methods
This study included 75 patients who underwent laminectomy for the treatment of LSS and who were observed through follow-ups for more than 2 years. Fifty-five patients underwent spinous process-splitting laminectomy (splitting group) and 20 patients underwent conventional laminectomy (conventional group). We evaluated the clinical and radiographic results of each surgical procedure.
Results
Japanese Orthopaedic Association score improved significantly in both groups two years postoperatively. The following values were all significantly lower, as shown with p-values, in the splitting group compared to the conventional group: average operating time (p=0.002), postoperative C-reactive protein level (p=0.006), the mean postoperative number of days until returning to normal body temperature (p=0.047), and the mean change in angulation 2 years postoperatively (p=0.007). The adjacent segment degeneration occurred in 6 patients (10.9%) in the splitting group and 11 patients (55.0%) in the conventional group.
Conclusions
In this study, the spinous process-splitting laminectomy was shown to be less invasive and more stable for patients with LSS, compared to the conventional laminectomy.
doi:10.4184/asj.2014.8.6.768
PMCID: PMC4278982  PMID: 25558319
Lumbar spinal stenosis; Spinous process-splitting laminectomy; Postoperative low back pain; Paravertebral muscle, posterior approach
23.  Comparison between Bilateral C2 Pedicle Screwing and Unilateral C2 Pedicle Screwing, Combined with Contralateral C2 Laminar Screwing, for Atlantoaxial Posterior Fixation 
Asian Spine Journal  2014;8(6):777-785.
Study Design
A retrospective study.
Purpose
To compare clinical and radiological outcomes between bilateral C2 pedicle screwing (C2PS) and unilateral C2PS, combined with contralateral C2 laminar screwing (LS), for posterior atlantoaxial fixation.
Overview of Literature
Posterior fixation with C1 lateral mass screwing (C1LMS) and C2PS (C1LMS-C2PS method) is an accepted procedure for rigid atlantoaxial stabilization. However, conventional bilateral C2PS is not always allowed in this method due to anatomical variations of C2 pedicles and/or asymmetry of the vertebral artery. Although unilateral C2PS plus contralateral LS (C2PS+LS) is an alternative in such cases, the efficacy of this procedure has not been evaluated in controlled studies (i.e., with bilateral C2PS as a control).
Methods
Clinical and radiological records of patients who underwent the C1LMS-C2PS method, using unilateral C2PS+LS (n=9), and those treated using conventional bilateral C2PS (n=10) were compared, with a minimum two years follow-up.
Results
Postoperative complications related to the unilateral C2PS+LS technique included one case of spontaneous spinous process fracture of C2. A C1 anterior arch fracture occurred after a fall in one patient, who underwent bilateral C2PS and C1 laminectomy. No significant differences were seen between the groups in reduction of neck pain after surgery or improvement of neurological status, as evaluated using the Japanese Orthopaedic Association score. A delayed union occurred in one patient each of the groups, with the final fusion rate being 100% in both groups.
Conclusions
Clinical and radiological outcomes of unilateral C2PS+LS were comparable with those of the bilateral C2PS fixation technique for the C1LMS-C2PS method.
doi:10.4184/asj.2014.8.6.777
PMCID: PMC4278983  PMID: 25558320
Cervical spine; Atlantoaxial instability; Laminar screw; Pedicle screw
24.  Study of Vertebral Body Replacement with Reconstruction Spinal Cages in Dorsolumbar Traumatic and Koch's Spine 
Asian Spine Journal  2014;8(6):786-792.
Study Design
Retrospective and prospective case series.
Purpose
The aim of this study was to assess the results of reconstruction of anterior column, fusion and complications related to cages.
Overview of Literature
Literature shows that corpectomy has become a common surgical procedure for spinal infection, trauma, deformity, instability and metastasis. Also the use of reconstructive spinal cages is common after corpectomy.
Methods
Study was carried out in patients with dorsolumbar traumatic and Koch's spine. We assessed 25 patients (13 traumatic/12 tuberculous) who were treated with cages with/without any other instrumentation. Radiographs were obtained before and after the surgery. A preoperative magnetic resonance imaging was obtained in every patient.
Results
Fourteen patients underwent 1 level of corpectomy, 9 patients underwent 2 levels and 2 patients underwent 3 levels of corpectomy. Anterior reconstruction alone was performed in 8 patients; 360° reconstruction was performed in 17 patients and 2 of them underwent reconstruction through single posterior approach only. The mean kyphotic angulation improved from 21.2° preoperatively to 9.3° postoperatively and to 12° at final follow up. 8 patients with neurological deficits had improvement by at least one or more Frankel grade. No migration/displacement of cage was seen in any patients.
Conclusions
The present study demonstrates that the vertebral body replacement after corpectomy by reconstructive cages provides a reconstruction of the anterior column, good correction of the mean kyphotic angle, and a correction maintained with cage without any cage related complication at long term follow up. The fusion can be achieved with reconstructive cage plus bone graft with or without posterior instrumentation.
doi:10.4184/asj.2014.8.6.786
PMCID: PMC4278984  PMID: 25558321
Spinal fusion; Reconstructive surgical procedure; Autografts; Spinal Injuries; Tuberculosis, spinal; Tuberculosis, multi drug resistant
25.  PainVision Apparatus Is Effective for Assessing Low Back Pain 
Asian Spine Journal  2014;8(6):793-798.
Study Design
Case series.
Purpose
To determine the utility of "PainVision" apparatus for the assessment of low back pain.
Overview of Literature
A newly developed device, the PainVision PS-2100 (Nipro, Osaka, Japan), has been used to assess the perception of pain in a quantitative manner. In the current study, we aimed to evaluate the efficacy of PainVision for the assessment of low back pain.
Methods
We assessed 89 patients with low back pain. The numeric rating scale (NRS) score, McGill Pain Questionnaire (MPQ) score and the degree of pain calculated by PainVision were measured twice at 4-week intervals in each patient. An electrode was patched on the forearm surface of the patients and the degree of pain was automatically calculated (degree of pain=100×[current producing pain comparable with low back pain-current at perception threshold/current at perception threshold]). Correlations between NRS and MPQ scores and the degree of pain were determined using Spearman's rank correlation test.
Results
There was a strong correlation between the NRS and MPQ scores at each time point (rs=0.60, p<0.0001). The degree of pain also showed a moderate correlation with NRS and MPQ scores at each time point (rs=0.40, p<0.03). The change in the degree of pain over 4 weeks showed a moderate correlation with changes in the NRS and MPQ scores (rs=0.40, p<0.01).
Conclusions
PainVision as self-reported questionnaires is a useful tool to assess low back pain.
doi:10.4184/asj.2014.8.6.793
PMCID: PMC4278985  PMID: 25558322
PainVision; Low back pain; Tool; Assessment

Results 1-25 (230)