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1.  Causes of Late Revision Surgery after Bone Cement Augmentation in Osteoporotic Vertebral Compression Fractures 
Asian Spine Journal  2013;7(4):294-300.
Study Design
A retrospective study.
Purpose
To elucidate the causes of late revision following bone cement augmentation for osteoporotic vertebral compression fractures (OVCFs).
Overview of Literature
Percutaneous vertebroplasty (PVP) or kyphoplasty (KP) is thought to be effective for the treatment of OVCFs. Many complications related to PVP or KP have been reported. However, there is a paucity of reports regarding the causes of late revision surgery after failed PVP or KP.
Methods
Twenty six patients who developed unremitted back pain and/or progressive neurological deficit after a symptom-free period since treatment with PVP or KP were enrolled. All patients underwent cement removal and anterior reconstruction. Among the 26 patients, 22 patients underwent anterior interbody fusion combined with posterior instrumentation; 4 patients underwent anterior reconstruction only. The causes of revision surgery were assessed. Clinical results were assessed using a visual analogue scale (VAS) and Oswestry Disability Index (ODI). The complications were analyzed.
Results
The average time to revision surgery was 18.9±14.6 months (range, 3-78 months). The causes of late revision surgery included 6 late infections, 8 progressive kyphoses, 10 proximal fractures after instrumented lumbar fusions, and 2 late neurological involvement. During the mean follow-up period of 13.5±7.8 months, pre-revision mean VAS (8.5±0.9) and ODI (81.2±12.5) were improved to 4.2±1.4 and 54.8±17.6, respectively. Five patients (19%) had serious complications after revision surgery.
Conclusions
This study presents complications of PVP or KP in the treatment of OVCFs although PVP or KP can be an effective treatment strategy for OVCF when applied in highly selected patients.
doi:10.4184/asj.2013.7.4.294
PMCID: PMC3863655  PMID: 24353846
Osteoporosis; Spinal fractures; Vertebroplasty; Surgical revision
2.  The Efficacy of Proximal Lumbar Curve Flexibility in Patients with Main Thoracic Adolescent Idiopathic Scoliosis Treated by Selective Thoracic Fusion Surgery 
Asian Spine Journal  2010;4(1):32-38.
Study Design
Retrospective radiographic study.
Purpose
To evaluate the efficacy of the proximal lumbar curve flexibility compared with the traditional whole lumbar curve flexibility in patients with main thoracic adolescent idiopathic scoliosis (MT-AIS).
Overview of Literature
Traditionally the flexibility of the whole lumbar curve was measured, and the flexibility of the proximal lumbar curve was not analyzed in any study.
Methods
Twenty-eight MT-AIS patients treated by anterior selective thoracic fusion (STF) were evaluated after mean follow-up of 50.1 months (range, 25 to 116 months). The male : female ratio was in 5 : 23. The man age at surgery was 14 years and 8 months (range, 11.4 to 18.4 years). The lumbar curve was divided into the proximal and distal curves by the lumbar apex.
Results
The mean final correction rates (CR)/(flexibilities) of the MT, lumbar, proximal lumbar, and distal lumbar curves were 65.2%/(50.5%), 61.9%/(92.8%), 65.3%/(90.9%), and 36.4%/(134%), respectively. With the final lumbar CR, the lumbar flexibility (r = 0.267, p > 0.05) and the proximal lumbar flexibility (r = 0.327, p > 0.05) was similarly correlated. The mean lumbar CR was similar to the proximal lumbar CR (61.9% vs. 65.3%, p = 0.305). And the correlation between the flexibility and the CR was significant only in the proximal lumbar curve (r = 0.457, p < 0.05), but not in the lumbar curve (r = 0.267, p > 0.05) or the distal lumbar curve (r = 0.175, p > 0.05).
Conclusions
The proximal lumbar curve flexibility may be an alternative method of measuring the lumbar flexibility in MT-AIS patients treated by STF.
doi:10.4184/asj.2010.4.1.32
PMCID: PMC2900166  PMID: 20622952
Adolescent idiopathic scoliosis; Selective thoracic fusion; Lumbar flexibility; Proximal lumbar flexibility
3.  Thoracic Disc Herniation of the Adjacent Segment With Acutely Progressing Myelopathy 
Asian Spine Journal  2010;4(1):52-56.
We report a case of a 66-year-old woman with progressing myelopathy. Her history revealed instrumented fusion from T10 to S1 for degenerative lumbar kyphosis and spinal stenosis. The plain radiographs showed narrowing of the intervertebral disc space with a gas shadow and sclerotic end-plate changes at T9-T10. Magnetic resonance imaging revealed a posterolateral mass compressing the spinal cord at the T9-T10 level. The patient was treated with a discectomy through the posterior approach combined with posterior instrumentation. The patient's symptoms and myelopathy resolved completely after the discectomy and instrumented fusion. The thoracic disc herniation might have been caused by the increased motion and stress concentration at the adjacent segment.
doi:10.4184/asj.2010.4.1.52
PMCID: PMC2900170  PMID: 20622956
Adjacent; Thoracic; Disc herniation; Paraplegia
4.  Treatment for Multiple Aspergillus Spondylitis Including a Hip Joint 
Asian Spine Journal  2009;3(2):106-112.
Multiple aspergillus spondylitis (AS) is a life threatening infection that occurs more commonly in immunocompromised patients, and is commonly treated with antifungal agents. However, there is relatively little information available on the treatment of multiple AS. The authors encountered a 46-year-old man suffering from low back and neck pain with radiculomyelopathy after a liver transplant. The patient had concomitant multiple AS in the cervico-thoraco-lumbar spine and right hip joint, as confirmed by radiologic imaging studies. The pathological examination of a biopsy specimen revealed fungal hyphae at the cervical and lumbar spine. Anterior decompression and interbody fusion were performed for the cervical and lumbar lesions, which showed instability and related neurological symptoms. Additional antifungal therapy was also performed. The patient was treated successfully with remission of his symptoms.
doi:10.4184/asj.2009.3.2.106
PMCID: PMC2852076  PMID: 20404956
Multiple spondylitis; Aspergillus; Immunocompromised
5.  Kyphotic Angle Progression of Thoracic and Thoracolumbar Tuberculous Spondylitis after Surgical Treatment: Comparison with Predicted Kyphosis Outcome after Conservative Treatment 
Asian Spine Journal  2009;3(2):80-88.
Study Design
Retrospective comparative study.
Purpose
To compare the progression of the kyphotic angle (KA) in a surgically treated group with the predicted outcome of a conservatively treated group.
Overview of Literature
Late onset kyphosis is a complication of tuberculous spondylitis making its prevention a major goal of surgery.
Methods
Twenty six consecutive patients underwent an anterior reconstruction and posterior instrumented fusion in conjunction with antituberculous chemotherapy. The mean follow up was 56 months (range, 28 to 112 months). The patients were divided into subgroups based on the involved region of the thoracic and the thoracolumbar spine, initial KA, and the initial vertebral body loss (VBL(x)). The predicted KA (KAPd) was calculated using the formula, KAPd=5.5+30.5 VBL(x), to predict the final gibbus deformity. Kyphotic angle progression (ΔKA) based on the radiographic measurements after surgery (ΔKAR), and the predicted outcome of conservative treatment (ΔKAP) with chemotherapy were compared.
Results
Among the subgroups of the regions involved and initial KA, the ΔKA was radiographically superior with a reduced amount of kyphogenesis in the surgery group than the predicted outcome of the conservatively treated patients (p<0.05). The radiographic ΔKA was similar (p>0.05) with VBL(x)≤0.5 in the VBL(x) subgroup.
Conclusions
These results showed that in the VBL(x) subgroup, an initial VBL(x)≤0.5 is an indication of conservative antituberculous chemotherapy without surgery.
doi:10.4184/asj.2009.3.2.80
PMCID: PMC2852082  PMID: 20404952
Tuberculous spondylitis; Kyphosis; Initial vertebral body loss
6.  Axial Plane Lumbar Responses after Anterior Selective Thoracic Fusion for Main Thoracic Adolescent Idiopathic Scoliosis 
Asian Spine Journal  2008;2(2):81-89.
Study Design
A retrospective radiographic study.
Purpose
To evaluate the axial plane lumbar responses after anterior selective thoracic fusion (STF) in patients with main thoracic adolescent idiopathic scoliosis (MT-AIS).
Overview of Literature
Anterior scoliosis surgery induces more MT derotation through disc preparation than posterior surgery.
Methods
Twenty-eight MT-AIS patients treated with STF were evaluated after a minimum follow-up (FU) of 2 years. The MT and lumbar coronal angles, as well as the MT and lumbar rotational angles at the most rotated vertebrae were measured.
Results
At the last FU, the MT coronal correction and derotation rates were 65% and 41%, respectively. The lumbar coronal correction rate was 61% but there was minimal lumbar derotation (2%). Nine cases were decompensated (coronal balance >10 mm). After surgery, the compensated and decompensated groups showed similar MT coronal and axial correction rates. During the FU, the MT and lumbar apecies rotated in the same direction (r=0.443). In addition, significant MT derotation occurred in the decompensated group with increasing lumbar rotational correction loss. At the last FU, while the MT coronal correction was similar between the two groups, there was more MT derotation in the decompensated group. Furthermore, the MT rotational change was strongly associated with the coronal C7 plumb line position (r=0.728).
Conclusions
After anterior STF in patients with MT-AIS, the final MT derotation is strongly associated with the coronal C7 plumb line position. During the FU, the excessive MT derotation in the decompensated group was attributed to excessive lumbar rotational correction loss.
doi:10.4184/asj.2008.2.2.81
PMCID: PMC2852094  PMID: 20404961
Adolescent idiopathic scoliosis; Selective thoracic fusion; Anterior spinal fusion; Derotation; Decompensation
7.  Senescence of Nucleus Pulposus Chondrocytes in Human Intervertebral Discs 
Asian Spine Journal  2008;2(1):1-8.
Study Design
Senescence-related markers were assessed in surgically obtained human nucleus pulposus (NP) specimens.
Purpose
To demonstrate the mechanism and signaling pathway involved in the senescence of NP chondrocytes.
Overview of Literature
The population of senescent disc cells has been shown to be increased in degenerated or herniated discs. However, the mechanism and signaling pathway involved in the senescence of NP chondrocytes are unknown.
Methods
We examined cell senescence markers [senescence-associated β-galactosidase (SA-β-gal), telomere length, telomerase activity, p53, p21, pRB and p16] and the hydrogen peroxide (H2O2) content in human NP specimens.
Results
The percentage of SA-β-gal-positive NP chondrocytes increased with age, while the telomere length and telomerase activity declined. However, there was no significant correlation between age and H2O2 content. The NP specimens with grade III or IV degeneration showed significantly higher percentages of SA-β-gal-positive NP chondrocytes than those with grade II degeneration. Immunohistochemistry showed that senescent NP chondrocytes in all specimens expressed p53, p21, and pRB, while a few NP chondrocytes in only two specimens expressed p16.
Conclusions
The present study demonstrates that, with increasing age and advancing disc degeneration, senescent NP chondrocytes increase or accumulate in the NP. Furthermore, the telomere-based p53, p21, pRB pathway, rather than the stress-based p16, pRB pathway, plays a more important role in the senescence of NP chondrocytes in in vivo conditions. Our results suggest that prevention or reversal of senescence of NP chondrocytes can be a novel mechanism by which to prevent human disc degeneration.
doi:10.4184/asj.2008.2.1.1
PMCID: PMC2857488  PMID: 20411135
Senescence; Nucleus pulposus; Chondrocytes; Intervertebral disc; Disc degeneration
8.  The Effect of Radiofrequency Neurotomy on Chronic Low Back Pain 
Asian Spine Journal  2007;1(2):88-90.
Study Design
A prospective study.
Purpose
To determine the success rate and duration of relief of radiofrequency neurotomy for lumbar facet joint pain.
Overview of Literature
There is a lack of effective treatment for chronic low back pain. Radiofrequency denervation appears to be an emerging technology, with substantial variations in use.
Methods
Fifty-eight patients underwent radiofrequent neurotomy on the posterior primary ramus for chronic low back pain. All patients with low back pain of more than 3 months duration, with or without non-radicular radiation to the buttock and hip, were included in the study. From October 2005 to December 2006, eligible patients underwent a standardized diagnostic work-up, which included the use of a visual analog scale (VAS), physical examination, review of imaging studies, and diagnostic blockades. Pain relief was assessed on the third day, and at 3 months and 6 months post-treatment, using the visual analog scale.
Results
There were 44 women and 14 men included in the study. The mean age was 57.7 years (range, 20~80 years). Radiofrequency neurotomy denervated three segments and a bilateral lesion in all patients. The visual analogue scale (VAS) scores on the third day (mean VAS score: 1.48) and 3 months (mean VAS score: 1.79) after treatment decreased significantly when compared with the pre-treatment scores (mean VAS score: 6.56). However, the final values of the VAS scores after 6 months were slightly increased as compared to the VAS scores measured at the beginning of the study (mean VAS score: 2.91). No cases of infection, new motor deficits, or new sensory deficits were identified.
Conclusions
We suggest that radiofrequency neurotomy offers an effective palliative management of lumbar facet pain. However, there is limited evidence that radiofrequency neurotomy offers short-term relief for chronic low back pain. Further high-quality randomized controlled trials are needed with larger patient numbers and more data on the long-term effects, for which current evidence is inconclusive.
doi:10.4184/asj.2007.1.2.88
PMCID: PMC2857474  PMID: 20411130
Lumbar facet joint; Chronic low back pain; Radiofrequency neurotomy
9.  Sagittal Plane Lumbar Responses after Anterior Selective Thoracic Fusion for Main Thoracic Adolescent Idiopathic Scoliosis 
Asian Spine Journal  2007;1(2):80-87.
Study Design
A retrospective radiographic study.
Purpose
To verify the correlation of sagittal and coronal plane changes after selective thoracic fusion in main thoracic (MT) adolescent idiopathic scoliosis (AIS).
Overview of Literature
Sagittal plane deformity is known to be essential in the evolution of scoliosis.
Methods
Twenty-eight MT AIS patients treated by anterior selective thoracic fusion were evaluated after minimal follow-up of two years. The unfused lumbar area was divided into proximal and distal parts by the lumbar apex in the coronal plane, and into proximal and distal lumbar lordosis by L2 in the sagittal plane. Surgical motion (the difference between preoperative and postoperative values) and follow-up motion (the difference between postoperative and the last follow-up values) were compared.
Results
Immediately after surgery, as thoracic kyphosis increased, lumbar lordosis decreased (r=0.734); proximal lumbar lordosis increased, and distal lumbar lordosis decreased. The proximal lumbar area was mobilized in the sagittal plane, and was straightened in the coronal plane. However, the distal lumbar area was stabilized in the sagittal plane, and showed resistant motion against MT translation in the coronal plane. The surgical motion was correlated to the follow-up motion, i. e., was regulated during follow-up, and the regulatory motion was more precise in the distal than proximal lumbar area in both sagittal and coronal planes.
Conclusions
Sagittal and coronal motions were co-related; optimal sagittal motions were necessary for optimal coronal motions after anterior selective thoracic fusion for MT AIS. Proximal and distal lumbar motions were different for different roles; the proximal lumbar area played a role as a bumper to absorb the MT translatory force, and the distal lumbar area played a role of resistance against MT translation.
doi:10.4184/asj.2007.1.2.80
PMCID: PMC2857478  PMID: 20411129
Sagittal plane; Selective thoracic fusion; Anterior spinal fusion; Adolescent idiopathic scoliosis

Results 1-9 (9)