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Journals
Year of Publication
1.  Diagnosing Cervical Fusion: A Comprehensive Literature Review 
Asian Spine Journal  2008;2(2):127-143.
Study Design
Comprehensive literature review.
Purpose
To document the criteria for fusion utilized in these studies to determine if a consensus on the definition of a solid fusion exists.
Overview of Literature
Numerous studies have reported on fusion rates following anterior cervical arthrodesis. There is a wide discrepancy in the fusion rates in these studies. While factors such as graft type, Instrumentation, and technique play a factor in fusion rate, another reason for the difference may be a result of differences in the definition of fusion following anterior cervical spine surgery.
Methods
A comprehensive English Medline literature review from 1966 to 2004 using the key words "anterior," "cervical," and "fusion" was performed. We divided these into two groups: newer studies done between 2000 and 2004, and earlier studies done between 1966 and 2000. These articles were then analyzed for the number of patients, follow-up period, graft type, and levels fused. Moreover, all of the articles were examined for their definition of fusion along with their fusion rate.
Results
In the earlier studies from 1966 to 2000, there was no consensus for what constituted a solid fusion. Only fifteen percent of these studies employed the most stringent definition of a solid fusion which was the presence of bridging bone and the absence of motion on flexion and extension radiographs. On the other hand, the later studies (2000 to 2004) used such a definition a majority (63%) of the time, suggesting that a consensus opinion for the definition of fusion is beginning to form.
Conclusions
Our study suggests that over the past several years, a consensus definition of fusion is beginning to form. However, a large percentage of studies are still being published without using stringent fusion criteria. To that end, we recommend that all studies reporting on fusion rates use the most stringent criteria for solid fusion following anterior cervical spine surgery: the absence of motion on flexion/extension views and presence of bridging trabeculae on lateral x-rays. We believe that a universal adoption of such uniform criteria will help to standardize such studies and make it more possible to compare one study with another.
doi:10.4184/asj.2008.2.2.127
PMCID: PMC2852084  PMID: 20404968
Cervical; Fusion; Arthrodesis; Pseudoarthrosis
2.  Simultaneous Anterior and Posterior Surgery in the Management of Tuberculous Spondylitis with Psoas Abscess in Patients with Neurological Deficits 
Asian Spine Journal  2008;2(2):94-101.
Study Design
This is a retrospective study.
Purpose
We wanted to evaluate the treatment outcomes of performing simultaneous anterior and posterior surgery for patients with tuberculous spondylitis and psoas abscess.
Overview of Literature
Although various treatment options have been used for spinal tuberculosis, there are only a few reports on the treatment of tuberculous spondylitis with psoas abscess.
Methods
Between March 1997 and February 2006, we performed operations on 14 cases of tuberculous spondylitis with psoas abscess. All the cases underwent anterior debridement with an interbody bone graft and posterior fusion with using pedicle screws.
Results
Under the Frankel classification, 1 case improved by two grades, 10 cases improved by 1 grade and 3 cases demonstrated no change. The Kirkaldy-Willis functional outcomes were classified as excellent in 10 cases and good in 4. One year after surgery, bony union was confirmed in all 14 cases. The mean kyphotic angle of the spinal lesion was 12.4° and the mean lordotic angle at the final follow-up was 6.4°. Postoperative complications (superficial wound infections) were encountered in 2 cases.
Conclusions
Our results demonstrate that anterior debridement with interbody bone grafting and posterior instrumented fusion can provide satisfactory results for treating tuberculous spondylitis with psoas abscess in patients with neurological deficits.
doi:10.4184/asj.2008.2.2.94
PMCID: PMC2852085  PMID: 20404963
Tuberculous spondylitis; Psoas abscess; Neurological deficit; Anterior and posterior surgery
3.  The Effectiveness of Gefitinib on Spinal Metastases of Lung Cancer - Report of Two Cases - 
Asian Spine Journal  2008;2(2):109-113.
Lung cancer has a high mortality rate and is often diagnosed at the metastatic stage. Recently, gefitinib, a molecule target therapeutic drug, has offered a new approach for patients with non-small-cell lung cancer (NSCLC). This report describes the effects of gefitinib on bone metastases in two patients with NSCLC. The pain induced by a bone metastasis was relieved after the administration of gefitinib. Furthermore, the radiographs and CT findings showed sclerotic changes that matched those of the metastatic bone tumor after gefitinib administration in both patients. It is believed that gefitinib inhibited tumor cell proliferation and induced normal bone formation. In patients with NSCLC, gefitinib may be effective in the treatment of bone metastases.
doi:10.4184/asj.2008.2.2.109
PMCID: PMC2852086  PMID: 20404966
Gefitinib; Bone metastases; Lung cancer
4.  Cobb Angle Measurement of Scoliosis Using Computer Measurement of Digitally Acquired Radiographs-Intraobserver and Interobserver Variability 
Asian Spine Journal  2008;2(2):90-93.
Study Design
We evaluated computer assisted digital measurement of radiographic parameters in patients with idiopathic scoliosis.
Purpose
To assess the reliability of digital measurements.
Overview of Literature
Various authors analyzed scoliotic deformities by conventional radiographs, but very few studies have addressed the reliability of digital radiographic measurement using computer software.
Methods
Three independent, blinded observers measured 318 whole spine pre-operative antero-posterior radiograms of children with varying degrees of idiopathic scoliosis. Only one curve per radiograph was measured. Each observer measured the Cobb angle three times with a 1-week gap between each measurement. The computer system, picture archiving and communication system (PACS, PiViewSTAR version 5) was used in all cases. The end vertebrae were pre-selected to avoid this as a potential source of error. The results were statistically analyzed for intraobserver and interobserver reliability and variability.
Results
The 95% confidence intervals for intraobserver and interobserver variability were ±1.30 and ±1.260, respectively. There was better reliability in larger curves.
Conclusions
Measurement using a digitized system may help to minimize measurement discrepancies by eliminating an intrinsic cause of error.
doi:10.4184/asj.2008.2.2.90
PMCID: PMC2852087  PMID: 20404962
Scoliosis; Digital imaging; Cobb angle; Intraobserver and interobserver variability
6.  Effect of Bone Marrow Cell Collection Techniques and Donor Site Locations on In-Vitro Growth of Bone Forming Cells 
Asian Spine Journal  2008;2(2):59-63.
Purpose
This study evaluated the influence of bone marrow cell collection techniques and donor site locations on the in-vitro growth of bone-forming cells.
Methods
Sixty six samples of bone marrow cell collections (BMCC) or bone marrow aspirates (BMA) from 15 patients were obtained. Thirty eight samples for culture were composed of 23 BMA from 7 tibial condyles and 16 ilia, with the other 15 BMCC from the contralateral ilia. The other 28 samples were used for the analysis of alkaline phosphatase activities. After counting total cell number, mesenchymal stem cells (MSC) obtained from samples were incubated for 14 days. Alkaline phosphatase staining was used to count the number of stained colonies to show osteogenic differentiation.
Results
The average MSC counts of BMA from tibial condyles and ilia were 1.42×106 and 7.35×106 respectively, with 4.80×106 from ilial BMCC (p=0.010). MSC cultures could not be produced from tibial condyles in all 7 samples. However, 9 of 15 BMCC samples and 9 of 16 ilial BMA samples were successfully cultured (p=0.018). The average of cell counts in the successful cultures was 7.92×106, whereas that in the failed cultures was 2.85×106 (p=0.000). Multiple regression analysis showed that colony count was associated with the patient's age and total cell numbers, but not with collection methods such as BMCC or BMA (p=0.000, R=0.648, beta; age=-0.405, cell number=0.356). The discriminating formula indicated that more than 5.25×106 cells were needed for successful culture.
Conclusions
For successful cultures in vitro and for grafts, the total number of collected bone forming cells is more important than donor sites or collection methods. For young patients, grafting of bone-marrow-derived osteoprogenitor cells is promising.
doi:10.4184/asj.2008.2.2.59
PMCID: PMC2852089  PMID: 20404958
Bone marrow cells; Bone marrow collection; Bone marrow aspiration
7.  Multiple Pyogenic Spondylodiscitis with Bilateral Psoas Abscesses Accompanying Osteomyelitis of Lateral Malleolus - A Case Report - 
Asian Spine Journal  2008;2(2):102-105.
A psoas abscess is a potentially life-threatening infection. Multiple pyogenic spondylodiscitis with bilateral psoas abscesses accompanying an osteomyelitis of the lateral malleolus is an extremely rare event. We present our experience with needle aspiration for the treatment of osteomyelitis of the lateral malleolus and CT-guided percutaneous catheter drainage for a psoas abscess in an elderly patient. Both infections were completely resolved without recurrence. A psoas abscess should be included in the differential diagnosis of a patient with low back pain during musculoskeletal infection. Percutaneous needle aspiration or CT-guided percutaneous catheter drainage is an effective method for treating certain musculoskeletal infections.
doi:10.4184/asj.2008.2.2.102
PMCID: PMC2852090  PMID: 20404964
Spondylodiscitis with psoas abscess; Osteomyelitis of lateral malleolus; CT-guided percutaneous drainage
8.  Congenital Absence of Unilateral Lumbar Articular Process - A Case Report - 
Asian Spine Journal  2008;2(2):106-108.
A congenital absence of a lumbar articular process is a rare condition with an uncertain etiology. However, an intervertebral instability caused by this anomaly can cause occasional lower back pain. A 20 years old man presented with lower back pain. The physical examination revealed no neurological deficits. Plain radiographs of the lumbar spine revealed an absence of the left inferior articular process at the fourth lumbar vertebra associated with hypoplasia of the left lamina. The patient's symptoms were resolved after conservative treatment. We report a case of a congenital absence of articular process at the fourth lumbar vertebra.
doi:10.4184/asj.2008.2.2.106
PMCID: PMC2852091  PMID: 20404965
Lumbar anomaly; Inferior articular process
9.  Safety and Efficacy of Pedicle Screws and Titanium Mesh Cage in the Treatments of Tuberculous Spondylitis of the Thoracolumbar Spine 
Asian Spine Journal  2008;2(2):64-73.
Study Design
This is a retrospective series.
Purpose
We wanted to analyze the safety and effectiveness of using the newer generation metallic implants (pedicle screws and/or titanium mesh) for the treatment of tuberculous spondylitis.
Overview of the Literature
There have been various efforts to prevent the development of a kyphotic deformity after the treatment of tuberculous spondylitis, including instrumentation of the spine. Pedicle screws and titanium mesh cages have become more and more popular for treating various spinal problems.
Methods
Twenty two patients who had tuberculous spondylitis were treated with anterior radical debridement and their anterior column of spine was supported with a tricortical iliac bone graft (12 patients) or by mesh (10 patients). Supplementary posterior pedicle screw instrumentation was performed in 17 of 22 patients. The combination of surgeries were anterior strut bone grafting and posterior pedicle screws in 12 patients, anterior titanium mesh and posterior pedicle screws in 5 patients and anterior mesh only without pedicle screws in 5 patients. The patients were followed up with assessing the laboratory inflammatory parameters, the serial plain radiographs and the neurological recovery.
Results
The erythrocyte sedimentation rate and C-reactive protein levels were eventually normalized and there was no case of persistent infection or failure to control infection in spite of a mettalic implant in situ. The overall correction of kyphotic deformity was initially 8.9 degrees, and the loss of correction was 6.2 degrees. In spite of some loss of correction, this technique effectively prevented clinically significant kyphotic deformity. The preoperative Frankel grades were B for 1 patient, C for 4, D for 4 and E for 13. At the final follow-up, 7 of 9 patients recovered completely to Frankel grade E and only two patients showed a Frankel grade of D.
Conclusions
Stabilizing the spine with pedicle screws and/or titanium mesh in patients with tubercuous spondylitis effectively prevents the development of kyphotic deformity and this did not prevent controlling infection when this technique was combined with radical debridement and anti-tuberculous chemotherapy.
doi:10.4184/asj.2008.2.2.64
PMCID: PMC2852092  PMID: 20404959
Tuberculous spondylitis; Pedicle screw; Titanium mesh
10.  Comparison of Apical Axial Derotation between Adolescent Idiopathic and Neuromuscular Scoliosis with Pedicle Screw Instrumentation 
Asian Spine Journal  2008;2(2):74-80.
Study Design
A retrospective study.
Purpose
To compare outcomes of apical derotation with pedicle screws in idiopathic and neuromuscular scoliosis (NMS).
Overview of Literature
No information about apical derotation in NMS with pedicle screws is available.
Methods
We performed deformity correcting surgery using pedicle screw constructs on 12 adolescent idiopathic scoliosis (AIS) patients (mean age 14.1 years) and 16 NMS patients (mean age 16.5 years). Preoperative, postoperative, and final follow-up radiographs were analyzed for Cobb's angle and pelvic obliquity, while apical rotation was measured on CT scans using the Aaro-Dahlborn method.
Results
For AIS, the mean preoperative Cobb's angle, pelvic obliquity, and apical rotation values were 57.3°, 2.8°, and 20.4°, respectively, and postoperatively they were 16.8°, 1.1° and 14.7°, respectively, showing significant correction. For NMS, the mean preoperative Cobb's angle, pelvic obliquity, and apical rotation values were 75.6°, 13.7°, and 42.9°, respectively, and postoperatively they were 27.1°, 5.8°, and 34.1°, respectively, also showing significant correction. There were no significant differences between AIS and NMS patients Cobb's angle p=0.306, pelvic obliquity p=0.887 and apical derotation p=0.113°. There were no differences in curve severity in the three groups (AIS, NMS >80°and NMS <80°); or the correction of apical rotation (p=0.25), although less correction was achieved in the Cobb's angle in the >80 NMS group (p=0.04).
Conclusions
Apical axial derotation can be achieved with posterior only pedicle screw fixation in NMS without anterior release, with comparable results in idiopathic scoliosis.
doi:10.4184/asj.2008.2.2.74
PMCID: PMC2852093  PMID: 20404960
Idiopathic scoliosis and neuromuscular scoliosis; Posterior only pedicle screw fixation; Computed tomography scan; Apical derotation
11.  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
12.  The Effects of Intersegmental Compression on the 3-D Correction of Idiopathic Scoliosis Using Thoracoscopic Surgery 
Asian Spine Journal  2008;2(1):44-50.
Study Design
Retrospective study.
Purpose
To investigate whether intersegmental compression can affect the results of threedimensional correction for idiopathic scoliosis.
Overview of Literature
Intersegmental compression is usually performed to increase the correction rate and enhance kyphosis restoration. However, it is presumed that the risk of decompensation is increased.
Methods
Twenty-seven patients with idiopathic scoliosis who were corrected thoracoscopically were divided into two groups: a compression group and a non-compression group. Thoracic and lumbar scoliotic Cobb angles were measured pre-operatively, one week postoperatively, and at last follow-up. Changes in thoracic kyphosis and in sagittal and coronal balance were compared.
Results
The average correction rates for thoracic scoliotic curves were 70.3% and 58.8% in the compression and non-compression groups, respectively (p=0.023), at 1 week postoperatively. However, these changed to 62.6% and 58.1% at the final follow-up visit (p=0.381). Thoracic kyphosis increased by 37.4% in the compression group and 20.9% in the non-compression group at 1 week postoperatively (p=0.435). Finally, thoracic kyphosis increased by 59.9% and 42.6%(p=0.473), respectively, at final follow-up. Axial rotation was corrected by 45.3% and 24.7% in the compression and non-compression groups, respectively (p=0.214). There were no significant differences in postoperative changes in coronal and sagittal balance between the two groups.
Conclusions
Three-dimensional correction by intersegmental compression tended to produce better results, especially during the early postoperative period. However, at final follow-up, no significant differences were observed between the two groups in terms of three-dimensional correction. Thus, we conclude that intersegmental compression is not always necessary for thoracoscopic scoliosis correction.
doi:10.4184/asj.2008.2.1.44
PMCID: PMC2857482  PMID: 20411142
Idiopathic scoliosis; Thoracoscopy; Intersegmental compression; Three dimensional correction
13.  The Clinical and Radiological Availability of Percutaneous Balloon Kyphoplasty as a Treatment for Osteoporotic Burst Fractures 
Asian Spine Journal  2008;2(1):9-14.
Study Design
We retrospectively assessed the results of percutaneous balloon kyphoplasty (KP) by clinical and radiological methods.
Purpose
To evaluate the outcome of KP as a treatment for osteoporotic burst fractures.
Overview of Literature
Many surgeons are concerned about the possibility of neurological complications after percutaneous kyphoplasty for osteoporotic burst fractures, secondary to intra-canal cement leakage.
Methods
We performed KP as a treatment for osteoporotic burst fractures. We studied 12 patients/13 vertebrae. The two control groups consisted of patients who only underwent conservative treatment and those who underwent posterior instrumentation and fusion. We measured each preoperative/postoperative vertebral kyphotic deformity angle (KDA) using simple lateral spine images and checked for leakage of cement, as well. The preoperative/postoperative visual analog scale (VAS) scores for back pain, degree of daily activity, and postoperative complications were evaluated.
Results
The mean improvement in KDA after KP was 9.7±2.2°. The mean preoperative and postoperative VAS scores for back pain were 8.3±0.4 and 3.1±0.17, respectively. Regarding the control group, the mean postoperative VAS score for the conservative group and the posterior surgery group decreased by 4.5±0.17 and 3.2±0.19, respectively. There was no statistically significant difference between the KP and posterior surgery groups (p=0.125). However, there was a statistically significant difference between the KP and conservative treatment groups (p=0.012).
Conclusions
KP is safe and useful for treating osteoporotic burst fractures.
doi:10.4184/asj.2008.2.1.9
PMCID: PMC2857483  PMID: 20411136
Thoracolumbar spine; Osteoporotic burst fracture; Percutaneous balloon kyphoplasty; Cement leakage
14.  Lumbar Pyogenic Spondylodiscitis and Bilateral Psoas Abscesses Extending to the Gluteal Muscles and Intrapelvic Area Treated with CT-guided Percutaneous Drainage - A Case Report - 
Asian Spine Journal  2008;2(1):51-54.
Bilateral psoas abscesses extending to the gluteal muscle and intrapelvic area are uncommon. We present our experience with computed tomography (CT)-guided percutaneous catheter drainage for the treatment of multiple aggressive abscesses in a diabetic patient. The abscesses completely resolved after the procedures. Psoas abscess should be considered in the differential diagnosis of older diabetic patients with fever, flank or back pain, and flexion contracture of the hip joint. CT scanning is a useful method in diagnosing abscesses, and CT-guided percutaneous catheter drainage is an effective treatment method in selected patients.
doi:10.4184/asj.2008.2.1.51
PMCID: PMC2857484  PMID: 20411143
Psoas abscess extending into the gluteal muscle and intrapelvic area; Diabetic patient; CT-guided percutaneous drainage
15.  Sacralization of L5 in Radiological Studies of Degenerative Spondylolisthesis at L4-L5 
Asian Spine Journal  2008;2(1):34-37.
Study Design
Radiological analysis.
Purpose
To investigate sacralization of L5 on radiological studies of degenerative spondylolisthesis at L4-L5.
Overview of Literature
Degenerative spondylolisthesis commonly develops at L4-L5. Sacralization of L5 is thought to cause stress concentration at this level, which accentuates degenerative changes and promotes development of degenerative spondylolisthesis. However, there has been no study dedicated to determining whether the presence of sacralization at L5 influences the radiological findings in degenerative spondylolisthesis at L4-L5.
Methods
Seventy-eight patients with degenerative spondylolisthesis at L4-L5 were classified into two groups according to the presence of L5 sacralization: with (n=54) and without (n=24). Four radiographic parameters were measured and compared between the two groups: anterior slippage of L4 on L5 (% slip), facet orientation of L4-L5 (degrees), facet osteoarthritis of L4-L5 by Fujiwara's criteria (1~4 grades), and disc degeneration of L4-L5 by Frymoyer's criteria (grades 1~5).
Results
There was no significant difference in the degree of anterior slippage of L4 on L5 (17.02±6.21 versus 16.65±4.87, p=0.809), facet orientation (54.99±12.18 versus 56.23±4.35, p=0.642), facet osteoarthritis (3.43±0.59 versus 3.53±0.37, p=0.527), or disc degeneration (4.50±0.51 versus 4.35±0.61, p=0.340) between the two groups.
Conclusions
Our study shows that the influence of sacralization of L5 on radiological findings in degenerative spondylolisthesis at L4-L5 may be less significant than previously expected. Further studies in large patient groups are needed to clarify the role of L5 sacralization on the development of degenerative spondylolisthesis at L4-L5.
doi:10.4184/asj.2008.2.1.34
PMCID: PMC2857485  PMID: 20411140
Degenerative spondylolisthesis; Sacralization; Radiological findings
16.  Characterization of Magnetic Resonance Images for Spinal Cord Tumors 
Asian Spine Journal  2008;2(1):15-21.
Study Design
Retrospective study MR images for spinal cord tumors.
Purpose
To analyze the characteristics of MR images for spinal cord tumors, which were then verified at surgery or biopsy.
Overview of Literature
MR images are often used as the primary diagnostic imaging tool and the preoperative study of choice. The need for biopsy may be obviated because of increasingly accurate preoperative histologic diagnosis by MR images.
Methods
The study group consisted of 39 patients who had undergone MR imaging for preoperative evaluation of spinal cord tumors between September 1989 and February 2008. All patients had operations for spinal cord tumors, which were confirmed at biopsy. Of the 39 patients, 18 were men, and 21 were women. The average follow-up period was 23.8 months. The mean patient age was 46.6 years.
Results
Diagnoses included neurilemmoma (19 cases), neurofibroma (4 cases), meningioma (5 cases), hemangioma (3 cases), giant cell tumor (1 case), ganglioneuroma (1 case), lymphoma (1 case), neuroblastoma (1 case), and metastatic tumor from the prostate (1 case). The remaining 3 cases were composed of arachnoid cysts (2 cases) and a vascular malformation (arteriovenous malformation, 1 case).
Conclusions
MR images are the preoperative modality of choice in the evaluation of spinal cord tumors. MR images can narrow the differential diagnosis and guide surgical resection.
doi:10.4184/asj.2008.2.1.15
PMCID: PMC2857486  PMID: 20411137
Magnetic resonance imaging; Spinal cord; Tumor
17.  Risk Factors Associated with the Halo Phenomenon after Lumbar Fusion Surgery and its Clinical Significance 
Asian Spine Journal  2008;2(1):22-26.
Study Design
Retrospective study.
Purpose
First, to examine the association between bone mineral density (BMD) and the halo phenomenon, and second, to investigate risk factors predisposing to the halo phenomenon and its correlation with clinical outcomes.
Overview of Literature
The few in vivo studies regarding the relationship between pedicle screw stability and BMD have shown conflicting results.
Methods
Forty-four female patients who underwent spine fusion surgery due to spinal stenosis were included in this study. The halo phenomenon and fusion state were evaluated through plain radiographs performed immediately after surgery and through the final outpatient follow-up examination. BMD, osteoarthritis grade in the hip and knee joints, and surgical outcome were also evaluated.
Results
BMD was not related to the halo phenomenon, but age, absence of osteoarthritis in the knee, and non-union state were found to be significant risk factors for the halo phenomenon. However, the radiological halo phenomenon did not correlate with clinical outcome (visual analogue scale for back pain and leg pain).
Conclusions
The halo phenomenon is a simple phenomenon that can develop during follow-up after pedicle screw fixation. It does not influence clinical outcomes, and thus it is thought that hydroxyapatite coating screws, expandable screws, cement augmentation, and additional surgeries are not required, if their purpose is to prevent the halo phenomenon.
doi:10.4184/asj.2008.2.1.22
PMCID: PMC2857487  PMID: 20411138
Halo phenomenon; Pedicle screw; Bone mineral density
18.  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
19.  Long Level (T4-L1) Spinal Epidural Abscess in a Diabetic Patient - A Case Report - 
Asian Spine Journal  2008;2(1):55-58.
Spinal epidural abscesses are uncommon, but potentially devastating and often fatal. They can be found in normal patients, but they are more prevalent in immunocompromised patients, such as intravenous drug users, diabetics, chronic renal failure patients, pregnant women, and others. Timely diagnosis and treatment are the keys to optimizing outcome. Traditionally, treatment has comprised parenteral antibiotics and possible surgical intervention, such as decompression by pus drainage. We treated a long level (T4-L1) epidural abscess in a diabetic patient who had to undergo emergent long level decompression and drainage due to complete paralysis of the lower extremities and progression of neurologic deficit toward the upper thoracic level. Although lower extremity paralysis has not improved, the patient has completely recovered from lower extremity anesthesia. Further follow-up was not done because the patient expired due to sepsis eight month after surgery.
doi:10.4184/asj.2008.2.1.55
PMCID: PMC2857489  PMID: 20411144
Spinal epidural abscess; Diabetics; Multilevel laminectomy
20.  Muscle Imbalance in Volleyball Players Initiates Scoliosis in Immature Spines: A Screening Analysis 
Asian Spine Journal  2008;2(1):38-43.
Study Design
Retrospective comparative study using radiographs and clinical findings.
Purpose
To test the hypothesis that asymmetric loading of immature spines in young athletes initiates scoliosis.
Overview of Literature
Scoliosis in athletes has been reported in the literature, but its causative factors have not been investigated.
Methods
We compared the incidence, type and magnitude of scoliotic curves in volleyball players with those in the non-player population. One hundred sixteen adolescent volleyball players were grouped for selective screening. Data regarding their playing duration, handedness, age, height, and menarchal status (in girls) were recorded, along with clinical examination and radiological investigation when necessary. We analyzed data from 46,428 non-player school children, and their data were compared to athletes to determine differences.
Results
Volleyball players had a statistically significant increase in the incidence of scoliotic spinal curves. Playing hand dominance was related to the curve direction. Cobb angle had no significant correlation with the duration of playing.
Conclusions
There is a five-fold increase in the incidence of mild scoliosis in volleyball players. A high percentage (41%) of asymmetry was present on the Adams forward bending test, as compared to controls. The curves were either thoracic or thoracolumbar.
doi:10.4184/asj.2008.2.1.38
PMCID: PMC2857490  PMID: 20411141
Volleyball players; Asymmetric loading; Column buckling; Scoliosis; Etiology
21.  Incidence and Risk Factors Associated with Superior Mesenteric Artery Syndrome following Surgical Correction of Scoliosis 
Asian Spine Journal  2008;2(1):27-33.
Study Design
Retrospective study.
Purpose
To more accurately determine the incidence and clarify risk factors.
Overview of Literature
Superior mesenteric artery syndrome is one of the possible complications following correctional operation for scoliosis. However, when preliminary symptoms are vague, the diagnosis of superior mesenteric artery syndrome may be easily missed.
Methods
We conducted a retrospective study using clinical data from 118 patients (43 men and 75 women) who underwent correctional operations for scoliosis between September 2001 and August 2007. The mean patient age was 15.9 years (range 9~24 years). The risk factors under scrutiny were the patient body mass index (BMI), change in Cobb's angle, and trunk length.
Results
The incidence of subjects confirmed to have obstruction was 2.5%. However, the rate increased to 7.6% with the inclusion of the 6 subjects who only showed clinical symptoms of obstruction without confirmative study. The BMI for the asymptomatic and symptomatic groups were 18.4±3.4 and 14.6±3, respectively. The change in Cobb's angle for the asymptomatic and symptomatic groups were 24.8±13.6° and 23.4±9.1°, respectively. The change in trunk length for the asymptomatic and symptomatic groups were 2.3±2.1 cm and 4.5±4.8 cm, respectively. Differences in Cobb's angle and the change in trunk length between the two groups did not reach statistical significance, although there was a greater increase in trunk length for the symptomatic group than for the asymptomatic group.
Conclusions
Our study shows that the incidence of superior mesenteric artery syndrome may be greater than the previously accepted rate of 4.7%. Therefore, in the face of any early signs or symptoms of superior mesenteric artery syndrome, prompt recognition and treatment are necessary.
doi:10.4184/asj.2008.2.1.27
PMCID: PMC2857491  PMID: 20411139
Scoliosis; Superior mesenteric artery syndrome; Body mass index; Trunk length

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