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1.  Unipedicular Baloon Kyphoplasty 
Asian Spine Journal  2011;5(4):277.
PMCID: PMC3230658  PMID: 22164325
2.  A Levering Technique for Open Reduction of Traumatic Unilateral Locked Facets of Cervical Spine: Technical Note 
Asian Spine Journal  2011;5(3):176-179.
Reduction of traumatic unilateral locked facets of the cervical spine can be accomplished by closed or open means. If closed reduction is unsuccessful, then open reduction is indicated. The previously described techniques of open reduction of a unilateral locked facets of the cervical spine in the literature included drilling facet, forceful manipulation or using special equipment. We describe a reduction technique that uses a basic spinal curette, in a forceless manner, and it does not need facet drilling. We have successfully used this technique in 5 consecutive patients with unilateral locked facets. There have been no complications related to this technique.
PMCID: PMC3159066  PMID: 21892390
Cervical spine; Unilateral locked facets; Spinal reduction
3.  Lumbar Repositioning Accuracy as a Measure of Proprioception in Patients with Back Dysfunction and Healthy Controls 
Asian Spine Journal  2011;5(4):201-207.
Study Design
A control group cross-sectional design.
To compare the difference in repositioning accuracy, as a measure of lumbar proprioception, between patients with back dysfunction and healthy subjects.
Overview of Literature
Evidence suggests that spinal stability might be compromised in patients with back dysfunction. Lumbar proprioception in back dysfunction has not, however, been adequately investigated.
Forty-five participants, representing three groups, took part in the study. Subjects in group one (n = 15) were healthy subjects. Subjects in group two (n = 15) had a history of non-specific mechanical back dysfunction, while subjects in group three (n = 15) had discogenic back dysfunction. Subjects were required to reproduce a target position of 30° lumbar flexion and the absolute error (AE) was calculated.
The AEs between target and reproduced positions were calculated. The average repositioning AEs were 2.8, 7.5, and 7.1° for the control, mechanical, and discogenic back dysfunction groups respectively. Analysis of variance revealed significant difference between the three groups (p < 0.0002). The AEs were greater in the two back dysfunction groups compared to the control group. Post-hoc tests revealed significant difference in AEs between the control and mechanical group (p < 0.0003), and discogenic group (p < 0.0001), while there was no significant difference between the mechanical and discogenic back dysfunction groups (p = 0.73).
Differences in proprioception do exist between subjects with back dysfunction and normal subjects. The proprioceptive deficits do exist regardless of the cause of the back dysfunction, and may represent an important aspect of the patho-physiology of such a condition.
PMCID: PMC3230646  PMID: 22164313
Low back dysfunction; Position sense; Proprioception
4.  Variations in Practice Patterns among Neurosurgeons and Orthopaedic Surgeons in the Management of Spinal Disorders 
Asian Spine Journal  2011;5(4):208-212.
Study Design
This is a case series.
We wanted to identify variations in the practice patterns among neurosurgeons and orthopedic surgeons for the management of spinal disorders.
Overview of Literature
Spinal disorders are common in the clinical practice of both neurosurgeons and orthopedic surgeons. It has been observed that despite the availability of various guidelines, there is lack of consensus among surgeons about the management of various disorders.
A questionnaire was distributed, either directly or via e-mail, to the both the neurosurgeons and orthopedic surgeons who worked at 5 tertiary care centers within a single region of Korea. The surgeons were working either in private practice or in academic institutions. The details of the questionnaire included demographic details and the specialty (orthopedic/neurosurgeon). The surgeons were classified according to the level of experience as up to 5 years, 6-10 years and > 10 years. Questions were asked about the approach to lumbar discectomy (fragmentectomy or aggressive disc removal), using steroids for treating discitis, the fusion preference for spondylolisthesis, the role of an orthosis after fusion, the preferred surgical approach for spinal stenosis, the operative approach for spinal trauma (early within 72 hours or late > 72 hours) and the role of surgery in complete spinal cord injury. The data was analyzed using SPSS ver 16. p-values < 0.05 were considered to be significant.
Of the 30 surgeons who completed the questionnaire, 20 were neurosurgeons and 10 were orthopedic surgeons. Statistically significant differences were observed for the management of spinal stenosis, spondylolisthesis, using an orthosis after fusion, the type of lumbar discectomy and the value of surgical intervention after complete spinal cord injury.
Our results suggest that there continues to exist a statistically significant lack of consensus among neurosurgeons and orthopedic spine surgeons when considering using an orthosis after fusion, the type of discectomy and the value of intervention after complete spinal injury.
PMCID: PMC3230647  PMID: 22164314
Orthopedic surgeons; Neurosurgeons; Spinal trauma; Spinal stenosis; Complete cord injury
5.  The Incidence of Potential Candidates for Total Disc Replacement among Lumbar and Cervical Fusion Patient Populations 
Asian Spine Journal  2011;5(4):213-219.
Study Design
Retrospective chart review.
To evaluate the incidence of potential total disc replacement (TDR) candidates among cervical and lumbar fusion patient populations using strict Food and Drug Administration (FDA) criteria and with relative exclusion criteria removed.
Overview of Literature
Recent studies suggest that the potential percentage of patients that are candidates for TDR ranges from 0-5% in lumbar fusions and 43% in cervical fusions.
We performed a retrospective chart review of 280 consecutive patients who had lumbar (n = 174) and cervical (n = 106) fusion or TDR performed by one of four independent adult orthopaedic spine surgeons. Charts were screened for investigational device exemption (IDE) inclusion/exclusion criteria and later reanalyzed excluding relative exclusion criteria, such as history of chronic medical illness, twolevel disease (cervical cases), and history of prior fusion surgery in the anatomic region.
Of the 174 lumbar surgeries, 10 were TDR with Prodisc-L and 164 were lumbar fusions. The most common TDR exclusion criteria were lytic spondylolisthesis or spinal stenosis (47.7% of patients) and more than 2 level degenerative disc disease (37.9%). 14.9% had no IDE exclusion criteria and would be considered candidates for TDR. After excluding the relative lumbar exclusion criteria, this percentage increased to 25.8%. Of the 106 cervical cases, 3 had a TDR with Prodisc-C and 103 had a cervical fusion. Twenty eight percent had no IDE exclusion criteria and would be considered candidates for cervical TDR.
A larger percentage of cervical fusion candidates are potential candidates for TDR (28%) than lumbar fusion candidates (14.9%) based on the strict IDE criteria.
PMCID: PMC3230648  PMID: 22164315
Total disc replacement; Incidence; Inclusion/exclusion criteria; Contraindications; Cervical and lumbar fusions
6.  Posterior Epidural Migration of Sequestrated Cervical Disc Fragment: Case Series 
Asian Spine Journal  2011;5(4):220-227.
Study Design
A retrospective study was undertaken to delineate the characteristics of non-traumatic sequestrated epidurally migrated cervical disc prolapse.
To present first case series of eight such cases diagnosed preoperatively and to discuss their magnetic resonance imaging (MRI) characteristics and their management.
Overview of Literature
Non-traumatic spontaneous migration of the sequestrated disc fragment epidurally behind cervical vertebral body is rare. Only ten cases have been reported in literature.
Detailed clinico-radiological profiles of these 8 cases are presented. In six cases their clinical picture was suggestive of cervical myelopathy. MRI scan showed single level epidural migrated disc behind body of C4, C6, and C7 in six patients and two cases with multiple levels (C5-C6). In six cases, anterior corpectomy with excision of the disc was performed and the seventh patient underwent dorsal laminectomy. The eighth patient chose not to undergo surgery.
T1 images of the MRI scan showed an isointense signal in all the 8 cases. T2 images revealed a varying intensity. In six cases who underwent anterior corpectomy, there was a rent in the posterior longitudinal ligament. Among those in two cases multiple disc fragments were seen. In the rest four cases, a single large fragment was observed. These patients improved after anterior corpectomy and disc excision. There was no improvement in the patient who had undergone dorsal laminectomy. The eighth patient who refused surgery progressively deteriorated.
We opine that MRI scan especially T1 images are useful in these cases. We prefer to treat these cases through anterior corpectomy with excision of the sequestrated disc which proved to result in excellent outcome.
PMCID: PMC3230649  PMID: 22164316
Sequestrated cervical disc prolapse; Epidural cervical disc; Magnetic resonance imaging; Epidural cervical disc; Anterior cervical corpectomy
7.  Surgical Outcomes of Minimally Invasive Transforaminal Lumbar Interbody Fusion for the Treatment of Spondylolisthesis and Degenerative Segmental Instability 
Asian Spine Journal  2011;5(4):228-236.
Study Design
This is a retrospective case study.
This study was designed to analyze the surgical outcomes of patients who underwent minimally invasive transforaminal lumbar interbody fusion (TLIF) for the treatment of spondylolisthesis and degenerative segmental instability.
Overview of Literature
If the surgical outcomes of a procedure are evaluated together with multiple indications, it is not clear how the procedure helped each subgroup of patients. For the reason that some indications achieve better outcomes than the others, we performed a subgroup analysis using validated outcome measures to demonstrate the optimal indications and the treatment results of TLIF.
We conducted subgroup analyses by comparing the prospectively collecting data from the consecutive patients who underwent single-level minimally invasive TLIF for the treatment of the following 3 subgroups of indications: 23 cases of low-grade spondylolytic spondylolisthesis, 24 cases of degenerative spondylolisthesis, and 19 cases of degenerative segmental instability.
The average duration of follow up was 36.1 ± 9.9 months (range, 24 to 63 months). The preoperative pain and disability scores were significantly improved at final postoperative follow-up in all the subgroups (all measurements: p < 0.0001). The 3 subgroups exhibited an equivalent improvement of the pain and disability scores at the final follow-up. The rates of radiographic solid fusion and complications were also similar among the 3 groups.
Our data suggests that minimally invasive TLIF optimally and equivalently alleviates all of the associated symptoms and disabilities from low-grade spondylolisthesis and degenerative segmental instability. Furthermore, these patients seem to have optimal surgical indications for minimally invasive TLIF, while maintaining favorable surgical outcomes.
PMCID: PMC3230650  PMID: 22164317
Spondylolisthesis; Transforaminal lumbar interbody fusion; Minimally invasive; Surgical outcome; Optimal indication
8.  Treatment of Acute Tuberculous Spondylitis by the Spinal Shortening Osteotomy: A Technical Notes and Case Illustrations 
Asian Spine Journal  2011;5(4):237-244.
Surgical treatment for spinal tuberculosis is necessary in particular cases that a large amount of necrotic tissue is encountered and there is spinal cord compression. A spinal shortening osteotomy procedure has previously been described for the correction of the sagittal balance in a late kyphotic deformity, but there have been no reports on this as a surgical treatment in the acute stage. Thus, the aim of this report is to present the surgical techniques and clinical results of 3 patients who were treated with this procedure. Three patients with tuberculous spondylitis at the thoracic spine were surgically treated with this procedure. All the patients presented with severe progressive back pain, kyphotic deformity and neurological deficit. The patients recovered uneventfully from surgery without further neurological deterioration. Their pain was improved and the patients remained free of pain during the follow-up period. In conclusion, posterior spinal shortening osteotomy is an alternative method for the management of tuberculous spondylitis.
PMCID: PMC3230651  PMID: 22164318
Tuberculosis; TB spine; Shortening osteotomy; Surgical treatment
9.  Pyogenic Arthritis of the Facet Joint with Concurrent Epidural and Paraspinal Abscess: A Case Report 
Asian Spine Journal  2011;5(4):245-249.
Pyogenic arthritis of lumber spinal facet joints is an extremely rare condition. There are only 40 reported cases worldwide. Most cases were associated with history of paravertebral injection, which was not found in our patient. At the time of hospital admission, he had no abnormal magnetic resonance image findings. Two weeks later, he developed pyogenic facet joint arthritis associated with paravertebral and epidural abscess. This report is the first to describe delayed presentation of pyogenic arthritis associated with paravertebral abscess and epidural infection.
PMCID: PMC3230652  PMID: 22164319
Zygapophyseal joint; Pyogenic arthritis; Lumbar spine
10.  Transient Allodynia Following Caudal Lipoma Excision: A Case Report 
Asian Spine Journal  2011;5(4):250-252.
Allodynia is the sensation of pain due to non-painful stimuli. It usually occurs due to destructive lesions of the spinal cord or peripheral nerves. Allodynia following intradural lipoma surgery has been reported previously. We herein report a case of allodynia developed after microsurgical caudal lipoma excision without associated spinal cord injury.
PMCID: PMC3230653  PMID: 22164320
Hyperalgesia; Caudal lipoma surgery
11.  Paraplegia due to Missed Thoracic Meningioma after Laminotomy for Lumbar Spinal Stenosis: Report of Two Cases 
Asian Spine Journal  2011;5(4):253-257.
To describe two cases of thoracic paraplegia due to a thoracic spinal cord tumor (meningioma) that was not detected during lumbar spinal decompressive surgery for lumbar canal stenosis and a complaint of claudication. The follow-up period ranged from 1 year and 6 months to 1 year and 8 months. The neurological deficit due to thoracic meningioma after surgery for lumbar canal stensois was decreased after mass excision. So, careful physical examination and magnetic resonance imaging can reveal another thoracic spine compressive lesion such as meningioma. Additional thoracic decompressive surgery can provide partial amelioration of each patient's neurological condition. Surgeons should know that a silent meningioma can aggrevate neurological symptoms after lower lumbar spine surgery and should inform their patient before surgery.
PMCID: PMC3230654  PMID: 22164321
Thoracic paraplegia; Meningioma; Lumbar surgery
12.  Guidewire Breakage: An Unusual Complication of Anterior Odontoid Cannulated Screw Fixation 
Asian Spine Journal  2011;5(4):258-261.
The preferred treatment of a type II odontoid fracture is anterior odontoid screw fixation to preserve the cervical spine range of movement. This case report describes an unusual complication of guidewire breakage during anterior odontoid cannulated screw fixation for a 52-year-old patient who presented with a type II odontoid fracture after a motor vehicle accident. The distal segment of the guidewire was bent over the tip of the cannulated odontoid screw and broke off during guidewire withdrawal. The three months follow-up computed tomography examination of the cervical spine showed acceptable screw placement, good odontoid process alignment with incomplete fusion, and no migration of the fractured segment of the guidewire. It is recommended that the guidewire be withdrawn once the cannulated screw is passed through the fractured site into the odontoid process and a new guidewire be used in each surgical procedure instead of been reused to avoid metal stress fatigue that can result in easy breakage.
PMCID: PMC3230655  PMID: 22164322
Odontoid; Fracture; Complication; Guidewire; Breakage
13.  MRI Changes of the Spinal Subdural Space after Lumbar Spine Surgeries: Report of Two Cases 
Asian Spine Journal  2011;5(4):262-266.
Although magnetic resonance imaging (MRI) is frequently used to assess the lumbar spine, there are few reports in the medical literature that have evaluated using MRI immediately following spinal surgery. Furthermore, descriptions of the subdural changes after lumbar spine surgery are also infrequent. In this paper, we present two cases with subdural change seen on MRI immediately after lumbar surgery. Both the patients had mild symptoms that resolved spontaneously, and the follow-up MRI scans showed resolution of the subdural changes. Subdural changes should be considered as one of the possible causes of unexpected symptoms in patients following lumbar spinal surgery.
PMCID: PMC3230656  PMID: 22164323
Lumbar spine; Subdural change; Magentic resonance imaging; Post-operative period
14.  Ossification of the Posterior Longitudinal Ligament: A Review of Literature 
Asian Spine Journal  2011;5(4):267-276.
Ossification of the posterior longitudinal ligament (OPLL) is most commonly found in men, in the elderly, and in Asian patients. The disease can start with mild or no symptoms, but some patients progress slowly to develop symptoms of myelopathy. An accurate diagnosis through the use plain radiograph, computed tomography, and magnetic resonance imaging findings is very important to monitor the development of symptoms and to make decisions regarding a treatment plan. When symptoms are mild and non-progressive, conservative treatments and periodic observations are good enough, but once symptoms of myelopathy are present and neurologic symptoms are progressive, the treatment of choice is surgery to relieve spinal cord compression. Surgical management of OPLL continues to be controversial. Each surgical technique has some advantages and disadvantages, and the choice of operation should be decided carefully with various considerations. The patient's neurological condition, location and extent of pathology, cervical kyphosis, presence or absence of accompanied instability, and the individual surgeon's experience must be an important factors that should be considered before surgery.
PMCID: PMC3230657  PMID: 22164324
Cervical spine; Ossification; Posterior longitudinal ligament
15.  The Prevalence of Undetected Vertebral Fracture in Patients with Back Pain by Dual-Energy X-ray Absorptiometry (DXA) of the Lateral Thoracic and Lumbar Spine 
Asian Spine Journal  2011;5(3):139-145.
Study Design
This is a prospective study.
This study is conducted to determine the prevalence of unrecognized vertebral fracture (VF) in patients who present with back pain.
Overview of Literature
VF is often unrecognized, and significantly increases the risk of further fractures. Unfortunately, the patients at a high risk for VF usually do not receive adequate therapy to reduce the fracture risk.
This is a prospective study of 344 patients who presented with back pain from April 2008 to May 2009. The patients underwent dual-energy X-ray absorptiometry (DXA) evaluation and vertebral fracture assessment from T4 to L4 using a hologic densitometer.
Three hundred forty four of 386 patients who presented with back pain were included. Forty two patients were excluded because of a prior history of VF or the lack of written consent. Most of the patients were female (95.3%). The mean age of the patients was 58.21 ± 11.74 years. According to the World Health Organization definition (based on the T-score), 13.4% of the patients had normal lumbar spine bone mineral density (BMD). 27.9% of them were osteopenic and 58.7% were osteoporotic. The overall prevalence of VF, as established by lateral vertebral assessment, was 39% (n = 134). Moreover, 62.6% (n = 84) of the patients with VF had more than one fracture and 64.1% (n = 86) of them had Grade 2 or 3 fracture.
We recommend performing not only DXA scanning for BMD evaluation, but also VFA by DXA in old patients with back pain.
PMCID: PMC3159061  PMID: 21892385
Osteoporosis; Vertebral fracture; Absorptiometry; Photon
16.  Posterior Direct Decompression and Fusion of the Lower Thoracic and Lumbar Fractures with Neurological Deficit 
Asian Spine Journal  2011;5(3):146-154.
Study Design
A retrospective study.
To analyze the treatment outcome of patients with lower thoracic and lumbar fractures combined with neurological deficits.
Overview of Literature
Although various methods of the surgical treatment for lower thoracic and lumbar fractures are used, there has been no surgical treatment established as a superior option than others.
Between March 2001 and August 2009, this study enrolled 13 patients with lower thoracic and lumbar fractures who underwent spinal canal decompression by removing posteriorly displaced bony fragments via the posterior approach and who followed up for more than a year. We analyzed the difference between the preoperative and postoperative extents of canal encroachment, degrees of neurologic deficits and changes in the local kyphotic angle.
The average age of the patients was 37 years. There were 10 patients with unstable burst factures and 3 patients with translational injuries. Canal encroachment improved from preoperative average of 84% to 9% postoperatively. Local kyphosis also improved from 20.5° to 1.5°. In 92% (12/13) of the patients, neurologic deficit improved more than Frankel grade 1 and an average improvement of 1.7 grade was observed. Deterioration of neurologic symptoms was not observed. Although some loss of reduction of kyphotic deformity was observed at the final follow-up, serious complications were not observed.
When posteriorly displaced bony fragments were removed by the posterior approach, neurological recovery could be facilitated by adequate decompression without serious complications. The posterior direct decompression could be used as one of treatments for lower thoracic and lumbar fractures combined with neurologic injuries.
PMCID: PMC3159062  PMID: 21892386
Lower thoracic and lumbar; Unstable burst fracture; Posterior direct decompression; Neurologic manifestations
17.  The Use of Titanium Mesh Cages in the Reconstruction of Anterior Column Defects in Active Spinal Infections: Can We Rest the Crest? 
Asian Spine Journal  2011;5(3):155-161.
Study Design
Retrospective clinical series.
To assess whether titanium cages are an effective alternative to tricortical iliac crest bone graft for anterior column reconstruction in patients with active pyogenic and tuberculous spondylodiscitis.
Overview of Literature
The use of metal cages for anterior column reconstruction in patients with active spinal infections, though described, is not without controversy.
Seventy patients with either tuberculous or pyogenic vertebral osteomyelitis underwent a single staged anterior debridement, reconstruction of the anterior column with titanium mesh cage and adjuvant posterior instrumentation. The lumbar spine was the predominant level of involvement. Medical co-morbidities were seen in 18 (25.7%) patients. A significant neurological deficit was seen in 32 (45.7%) patients. At follow up patients were assessed for healing of disease, bony fuson, and clinical outcome was assessed using Macnab's criteria.
Final follow up was done on 64 (91.4%) patients at a mean average of 25 months (range, 12 to 110 months). Pathologic organisms could be identified in 42 (60%) patients. Forty two (60%) patients had histopathological findings consistent with tuberculosis. Thirty of 32 (93.7%) patients showed neurological recovery. The surgical wound healed uneventfully in 67 (95.7%) patients. Bony fusion was seen in 60 (93.7%) patients. At final follow up healing of infection was seen in all patients. As per Macnab's criteria 61 (95.3%) patients reported a good to excellent outcome.
Inspite of the theoretical risks, titanium cages are a suitable alternative to autologous tricortical iliac crest bone graft in patients with active spinal infections.
PMCID: PMC3159063  PMID: 21892387
Thoracolumbar spine; Discitis; Anterior column reconstruction; Titanium cage
18.  Efficacy of Unipedicular Baloon Kyphoplasty for Treatment of Multiple Myeloma Vertebral Lesions 
Asian Spine Journal  2011;5(3):162-168.
Study Design
A retrospective cohort study.
To analyze differences in between the unipedicular vs. bipedicular balloon kyphoplasty for the treatment of multiple myeloma lesions.
Overview of Literature
Both vertebroplasty and kyphoplasty are reported to be effective for the treatment of vertebral compression fractures in multiple myeloma patients. Kyphoplasty is often performed with a bipedicular approach while vertebroplasty with a monopedicular approach. Monopedicular kyphoplasty is investigated as a viable surgical technique alternatively in comparison with the bipedicular method.
We performed 37 vertebral body augmentation procedures, 18 vertebroplasty (group A) and 19 kyphoplasty, 9 unipedicular approaches (group B1) and 10 bipedicular approaches (group B2), on 14 patients affected by multiple myeloma with a mean clinical and radiographic follow up of more than 12 months.
Both kyphoplasty techniques lead to a better postoperative improvement of the vertebral height and kyphotic deformity if compared with the vertebroplasty, with a statistical significance for the body height restoration only (p = 0.0066). The unipedicular and the bipedicular kyphoplasty have similar results in term of kyphotic deformity correction and height restoration. The 85.7% (12/14) of the patients had an immediate improvement of the pain and no difference between the vertebroplasty and kyphoplasty groups were observed regarding the pain. We observed a 24.3% of cement leakage in all groups with no clinical symptoms and noticed that the risk of extravasations was higher in multilevel treatment, in bipedicular kyphoplasty procedures and in patients not treated previously with a bone marrow transplant.
Both vertebroplasty and kyphoplasty are effective in treating vertebral compression fracture due to multiple myeloma. Unipedicular kyphoplasty could give equivalent results as with bipedicular kyphoplasty in multilevel disease, aiming only to restore the sagittal alignment of the spine and the height of the vertebral body especially at the thoracolumbar spinal segment.
PMCID: PMC3159064  PMID: 21892388
Unipedicular; Kyphoplasty; Vertebroplasty; Multiple myeloma
19.  Comparative Study of Clinical Outcomes of Anterior Cervical Discectomy and Fusion Using Autobone Graft or Cage with Bone Substitute 
Asian Spine Journal  2011;5(3):169-175.
Study Design
A retrospective study.
To compare the clinical and radiological outcomes of autogenous bone graft and cage with bone substitute for anterior cervical discectomy and fusion.
Overview of Literature
The clinical outcomes of cage with bone substitute for anterior cervical discectomy and fusion is satisfactory.
Eighty four patients who underwent cervical spine surgery between February 2004 and April 2009 were included. Fifty-nine patients were approached anteriorly and underwent anterior cervical discectomy and fusion by the Smith-Robinson method (Group A), and 25 patients underwent fusion by decompression of the cervical spine and cage with bone substitute (Group B). We measured and evaluated the postoperative period until patients were able to ambulate, for pre- and postoperative symptomatic improvement, postoperative complications, pre- and postoperative change of lordosis, degree of endplate collapse or subsidence, and fusion rate and period of union.
By Robinson's criteria, respectively 45, 10 and 4 patients in Group A experienced excellent, good and fair symptomatic improvement, and respectively 19, 5 and 1 patients in Group B experienced excellent, good and fair symptomatic improvement. The postoperative period in which patients became ambulant and the period of hospital stay was significantly shorter in Group B. Increase of lordosis at final follow up after surgery was significantly larger in Group A, as was the fusion period. Significantly more endplate collapse occurred in Group B.
Of patients who had anterior cervical discectomy and fusion, results of both groups were both satisfactory.
PMCID: PMC3159065  PMID: 21892389
Cervical vertbrae; Anterior cervical discectomy and fusion; Autobone graft; Cage; Bone substitutes
20.  Risk Factors of New Compression Fractures in Adjacent Vertebrae after Percutaneous Vertebroplasty 
Asian Spine Journal  2011;5(3):180-187.
Study Design
Retrospective study.
To evaluate risk factors related to the development of new fractures in adjacent vertebrae after percutaneous vertebroplasty.
Overview of Literature
Recent reports indicate that undue numbers of new fractures in adjacent vertebral bodies occur after percutaneous vertebroplasty.
One hundred four of 369 patients who underwent percutaneous vertebroplasty were followed for over 1 year. Fifty-four patients (51.9%) subsequently suffered from adjacent vertebral fractures. Age, lumbar lordotic angle, sacral slope, pelvic tilt, pelvic incidence, bone mineral density, amounts of cement injected, the restoration of vertebral height, kyphotic angle differences preexisting fracture, and intradiscal cement leakage were noted.
Average bone mineral density was -3.52 in the fracture group and -2.91 in the fracture-free group; the risk of adjacent vertebral fracture increased as bone mineral density decreased (p < 0.05). Intradiscal cement leakage occurred in 18 patients (33.3%) in the fracture group, indicating that the risk of adjacent vertebral fracture increased with intradiscal cement leakage. In addition, 36 patients (66.7%) in the fracture group had a pre-existing fracture; thus, the presence of a preexisting fracture was found to be significantly associated with an increased risk of an adjacent vertebral fracture (p < 0.05). Higher restoration rates are associated with a greater likelihood of developing adjacent vertebral fractures (p < 0.05).
The factors found to contribute significantly to new fractures in adjacent vertebral bodies after percutaneous vertebroplasty were a lower bone mineral density, a greater restoration rate of vertebral height, a pre-existing fracture, and intradiscal cement leakage.
PMCID: PMC3159067  PMID: 21892391
Adjacent vertebral fractures; Percutaneous vertebroplasty; Risk factors
21.  Successful Bone Union Following Calcium Phosphate Cement-Assisted Percutaneous Transpedicular Balloon Kyphoplasty of a Large Interbody Cleft on Long-term Hemodialysis Patient 
Asian Spine Journal  2011;5(3):188-191.
A 68-year-old diabetic man, who had been on dialysis for 3 years, suffered a five week history of severe back pain that was unresponsive to bed rest, analgesics, and bracing. The vertebral cleft formed by an injury gradually increased in size on sequential plain films. Hence, he underwent calcium phosphate cement-assisted percutaneous transpedicular balloon kyphoplasty to treat a painful interbody vacuum cleft. Immediate pain relief and firm bone union were obtained.
PMCID: PMC3159068  PMID: 21892392
Hemodialysis; Adjacent vertebral fractures; Large vertebral cleft; Calcium phosphate cement
22.  Primary Lumbo-sacral Spinal Epidural Non-Hodgkin's Lymphoma: A Case Report and Review of Literature 
Asian Spine Journal  2011;5(3):192-195.
We present a case of 24-year-old male presented with low back pain radiating to the left lower limb, tingling numbness and weakness of 6 months duration. Magnetic resonance imaging scan with contrast reveals an extradural mass at lumbosacral region. Patient was operated with laminectomy and complete excision of the lesion was done. Patient's radicular pain relieved following the surgery and weakness also improved. Histopathology was suggestive of non-Hodgkin's lymphoma. Patient received chemotherapy which was followed by radiotherapy. Primary Non-Hodgkin's lymphoma of the lumbosacral spinal epidural tissue is an uncommon lesion. Lymphoma involves the central nervous system in 5-11% of cases either at presentation of the disease or during its course. The spinal epidural tissue is involved primarily in 0.1-3.3% of cases with spinal cord compression being the commonest presentation. Excision of the lesion followed by chemotherapy and radiotherapy is required to achieve cure.
PMCID: PMC3159069  PMID: 21892393
Lumbosacral region; Spinal; Epidural; Non-Hodgkin's lymphoma
23.  Hemorrhagic Facet Cyst in the Lumbar Spine Causing Contralateral Leg Symptoms: A Case Report 
Asian Spine Journal  2011;5(3):196-200.
Here we present a case of hemorrhagic lumbar facet cyst presenting with progressive radiculopathy only on the contralateral side. If a patient has previous back pain or neuropathy for several months and then suddenly deteriorates, hemorrhagic facet cyst of the lumbar spine should be part of the differential diagnosis. However, as in the present case, we should be aware that there is a possibility of a contralateral lesion.
PMCID: PMC3159070  PMID: 21892394
Hematoma; Facet cyst; Lumbar spine; Zygapophyseal joint
24.  Posterior Decompression and Fusion in Patients with Multilevel Lumbar Foraminal Stenosis: A Comparison of Segmental Decompression and Wide Decompression 
Asian Spine Journal  2011;5(2):100-106.
Study Design
This is a prospective study.
We compared the outcomes of segmental decompression and wide decompression in patients who had multilevel lumbar foraminal stenosis with back pain.
Overview of Literature
Wide decompression and fusion in patients with multilevel lumbar foraminal stenosis may increase the risk of perioperative complications.
From March 2005 to December 2007, this study prospectively examined 87 patients with multilevel lumbar foraminal stenosis and who were treated by segmental or wide decompression along with posterior fusion using pedicle screw fixation, and these patients could be followed-up for a minimum of 2 years. Of the 87 patients, 45 and 42 patients were assigned to the segmental decompression group (group 1) and the wide decompression group (group 2), respectively. We compared the clinical and radiological outcomes of the patients in these two groups.
There were no significant differences between groups 1 and 2 in terms of the levels of postoperative pain based on the visual analogue scale, the Oswestry Disability Score, the clinical results based on the Kirkaldy-Willis Criteria, the complication rate or the posterior fusion rate. On the other hand, the mean operating times in groups 1 and 2 were 153 ± 32 minutes and 187 ± 36 minutes, respectively (p < 0.05). The amount of blood loss during surgery and on the first postoperative day was 840 ± 236 ml and 1,040 ± 301 ml in groups 1 and 2, respectively (p < 0.05).
These results suggest that segmental decompression offers promising and reproducible clinical and radiological results for patients suffering from multilevel lumbar foraminal stenosis.
PMCID: PMC3095798  PMID: 21629484
Multilevel lumbar foraminal stenosis; Segmental decompression; Wide decompression
25.  Are We Missing Osteoporosis-Related Vertebral Fractures in Men? 
Asian Spine Journal  2011;5(2):107-110.
Study Design
Retrospective study.
To assess the prevalence of osteoporosis related spinal fractures among Saudi Arabian males.
Overview of Literature
Vertebral fractures are the most common complication of osteoporosis and is the first sign in both sexes and only 25 to 30% of radiographically observed vertebral deformities are recognized.
We analyzed the chest radiographs of consecutive Saudi Arabian men ≥ 50 years and who visited the emergency room of King Fahd University Hospital, Al Khobar, Saudi Arabia for a period of 12 months between November 1, 2007 and October 31, 2008. The site and type of fractures were classified as per the semi-quantitative technique. The other data retrieved from the medical records of patients included medications and clinical investigations for osteoporosis.
Nine hundred seventy chest radiographs were performed during the study period and 876 radiographs could be analyzed. One hundred fifteen patients (13.1%) had 157 fractures. The mean age was 67.85 ± 10.1 years. There was more than one fracture in 21 patients (18.2%). The majority of fractures (n = 102, 64.9%) were observed in thoracic spine. Seventy-one (45.2%) fractures were classified as mild, 54 (34.4%) were moderate and 32 (20.4%) were severe. For 26 (22.6%) patients, the report of the radiologist highlighted the fracture.
Saudi Arabian males with osteoporosis continue to be missed despite the high prevalence osteoporosis leading to vertebral fractures. We believe it is important for physicians to identify vertebral fractures early and treat then appropriately before an extremity fracture occurs with high mortality.
PMCID: PMC3095799  PMID: 21629485
Male osteoporosis; Vertebral fractures; Saudi Arabians

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