Nah, Ki Ho
(Department of Orthopedic Surgery, St. Paul's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea.)
,
Shin, Jae Hyuk
(Department of Orthopedic Surgery, Kang-Nam St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea.)
,
Choi, Nam Yong
(Department of Orthopedic Surgery, St. Paul's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea.)
,
Lee, Yong Sun
(Department of Orthopedic Surgery, St. Paul's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea.)
,
Ha, Kee Yong
(Department of Orthopedic Surgery, Kang-Nam St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea.)
목적: 퇴행성 척추전방전위증에서 후외방유합술 후 추가적인 후방요추체간유합술의 필요성에 대하여 알아보았다.
대상 및 방법: 제 4-5요추간 퇴행성 척추전방전위증에 대하여 단분절 후방감압술과 기기사용 유합술을 시행하고 최소 2년 이상 추시된 40예를 대상으로 후향적으로 연구하였다. 21예에서는 후외방유합술만을, 19예에서는 후외방유합술에 추가적으로 후방요추체간유합술을 시행하였다. 수술 전 분절간 가동성에 따라 안정군과 불안정군으로 나누었고, 유합 방법과 함께 안정-후외방유합군(n=13), 안정-원주상유합군(n-11), 불안정-후외방유합군(n=8)과 불안정-원주상유합군(n=8)으로 분류하여, 임상 및 방사선학적으로 후외방유합군과 원주상유합군간을 비교분석하였다.
결론: 퇴행성 척추전방전위증의 유합술시 수술 전 유합분절에 가동성이 적은 경우에는 후외방유합술만으로도 임상적으로 만족스러운 결과를 얻었으나, 수술 전 가동성이 큰 경우에는 추가적으로 후방요추체간유합술을 시행하여 임상 결과가 유의하게 우수하였다. 따라서 퇴행성 척추전방전위증의 유합술시 수술 전 분절간 가동성은 추가적인 후방요추체간유합술의 시행여부을 결정하는 요인이 된다고 생각한다.
목적: 퇴행성 척추전방전위증에서 후외방유합술 후 추가적인 후방요추체간유합술의 필요성에 대하여 알아보았다.
대상 및 방법: 제 4-5요추간 퇴행성 척추전방전위증에 대하여 단분절 후방감압술과 기기사용 유합술을 시행하고 최소 2년 이상 추시된 40예를 대상으로 후향적으로 연구하였다. 21예에서는 후외방유합술만을, 19예에서는 후외방유합술에 추가적으로 후방요추체간유합술을 시행하였다. 수술 전 분절간 가동성에 따라 안정군과 불안정군으로 나누었고, 유합 방법과 함께 안정-후외방유합군(n=13), 안정-원주상유합군(n-11), 불안정-후외방유합군(n=8)과 불안정-원주상유합군(n=8)으로 분류하여, 임상 및 방사선학적으로 후외방유합군과 원주상유합군간을 비교분석하였다.
결론: 퇴행성 척추전방전위증의 유합술시 수술 전 유합분절에 가동성이 적은 경우에는 후외방유합술만으로도 임상적으로 만족스러운 결과를 얻었으나, 수술 전 가동성이 큰 경우에는 추가적으로 후방요추체간유합술을 시행하여 임상 결과가 유의하게 우수하였다. 따라서 퇴행성 척추전방전위증의 유합술시 수술 전 분절간 가동성은 추가적인 후방요추체간유합술의 시행여부을 결정하는 요인이 된다고 생각한다.
Purpose: To determine the necessity of an additional posterior lumbar interbody fusion (PLlF) after a posterolateral fusion (PLF) for the treatment of degenerative spondylolisthesis (DS). Materials and Methods: A retrospective study, after a minimum follow-up of 2 years was conducted on forty patien...
Purpose: To determine the necessity of an additional posterior lumbar interbody fusion (PLlF) after a posterolateral fusion (PLF) for the treatment of degenerative spondylolisthesis (DS). Materials and Methods: A retrospective study, after a minimum follow-up of 2 years was conducted on forty patients who underwent a single level decompression and instrumented fusion for DS with spinal stenosis at the L4-5 level. A PLF was performed in 21 patients, and a circumferential fusion (CF) with an additional PLIF in 19 patients. According to the fusion methods and preoperative segmental mobility, the patients were divided into four groups; s-PLF group (PLF in the stable group, n=13), s-PLIF group (CF in the stable group, n=11), u-PLF group (PLF in the unstable group, n=8), and u-PLIF group (CF in the unstable group, n=8). Clinical and radiographic comparisions between the PLF and PLIF groups were performed. Results: The mean decrements of Oswestry Disability Index (Visual Analog Scale) scores were 29% (5.5), 29% (5.9), 22% (2.6) and 42% (5.9) respectively for the s-PLIF, s-PLIF, u-PLIF and u-PLIF groups, and a statistical difference was found only between the u-PLIF and u-PLIF groups (ODI: p=0.032, VAS: p=0.004). Fusion rates were 92%, 100%, 88% and 100% respectively. The mean slip angle increments were serially 2.5°, -3.1°, -1.5° and -0.3°, and the mean percent slip decrements were 6.7%, 8.7%, 5.1% and 3.7%, and the mean disc height increments were -0.4 mm, 1.8 mm, 0.5 mm and 3.0 mm, and the mean lumbar lordosis increments were 8.6° 4.7°, -1.9° and 1.9° and the mean sacral tilt increments were 3.8°, 3.4°, -1.3° and 0.9°. Statistical differences were found only between the s-PLF and s-PLIF groups in slip angle increments (p=0.029) and between the s-PLIF and s-PLIF groups (p=0.043) and between the u-PLF and u-PLIF groups (p=0.042) in disc height increments. Conclusion: PLF alone provided successful clinical outcome in stable group, but CF provided better clinical outcomes in the unstable groups. This study suggests that preoperative segmental mobility may be a criterion to determine whether or not an additional PLIF is necessary in the treatment of lumbar DS.
Purpose: To determine the necessity of an additional posterior lumbar interbody fusion (PLlF) after a posterolateral fusion (PLF) for the treatment of degenerative spondylolisthesis (DS). Materials and Methods: A retrospective study, after a minimum follow-up of 2 years was conducted on forty patients who underwent a single level decompression and instrumented fusion for DS with spinal stenosis at the L4-5 level. A PLF was performed in 21 patients, and a circumferential fusion (CF) with an additional PLIF in 19 patients. According to the fusion methods and preoperative segmental mobility, the patients were divided into four groups; s-PLF group (PLF in the stable group, n=13), s-PLIF group (CF in the stable group, n=11), u-PLF group (PLF in the unstable group, n=8), and u-PLIF group (CF in the unstable group, n=8). Clinical and radiographic comparisions between the PLF and PLIF groups were performed. Results: The mean decrements of Oswestry Disability Index (Visual Analog Scale) scores were 29% (5.5), 29% (5.9), 22% (2.6) and 42% (5.9) respectively for the s-PLIF, s-PLIF, u-PLIF and u-PLIF groups, and a statistical difference was found only between the u-PLIF and u-PLIF groups (ODI: p=0.032, VAS: p=0.004). Fusion rates were 92%, 100%, 88% and 100% respectively. The mean slip angle increments were serially 2.5°, -3.1°, -1.5° and -0.3°, and the mean percent slip decrements were 6.7%, 8.7%, 5.1% and 3.7%, and the mean disc height increments were -0.4 mm, 1.8 mm, 0.5 mm and 3.0 mm, and the mean lumbar lordosis increments were 8.6° 4.7°, -1.9° and 1.9° and the mean sacral tilt increments were 3.8°, 3.4°, -1.3° and 0.9°. Statistical differences were found only between the s-PLF and s-PLIF groups in slip angle increments (p=0.029) and between the s-PLIF and s-PLIF groups (p=0.043) and between the u-PLF and u-PLIF groups (p=0.042) in disc height increments. Conclusion: PLF alone provided successful clinical outcome in stable group, but CF provided better clinical outcomes in the unstable groups. This study suggests that preoperative segmental mobility may be a criterion to determine whether or not an additional PLIF is necessary in the treatment of lumbar DS.
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