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2013년 9월 29일 일요일

[담양여행] 죽녹원, 소쇄원

전남 담양의 죽녹원 입니다.

7월경에 갔는데 땀이 줄줄 흘렀어요.
























































죽녹원에 들어서면 이렇게 키 큰 대나무 수 십만그루가 자리잡고 있어요.
전체가16만 제곱미터 면적이라고 해요.
































온통 초록빛 대나무 밭이라 눈이 맑아지는 기분!
하늘을 올려다보면 대나무 수 만 그루 사이로 해가 반짝반짝해요.

죽녹원을 구경하고 가까운 곳에 있는 소쇄원에 들렀어요.


 너무 예쁜 백일홍



 소쇄원은  1530년에 소쇄 양산보가 건립한 곳으로 스승인 조광조가 유배 당해 죽게되자 출세에 뜻을 버리고 이곳에서 자연과 더불어 살았다고 해요.







































옛 선비들은 이렇게 아름다운 곳에서 학문을 익혔다니 멋지네요.





서울에서 멀다는 단점이 있지만 멋진 곳이예요.
단풍이 물드는 가을에 가면 정말 좋을 것 같아요.
역시 전라도는 매력 터지네요.

2013년 9월 28일 토요일

Assessment of Magnetic Resonance Imaging in the diagnosis of lumbar spine foraminal stenosis -A surgeon's perspective

Detailed review


*Title: Assessment of Magnetic Resonance Imaging in the diagnosis of lumbar spine foraminal stenosis -A surgeon's perspective

요추 추간공 협착증 진단에서의 MRI의 측정 -외과의의 관점

*Author: Naftaly Attias, MD, Anne Hayman, MD, John A. Hipp, PhDz Philip Noble, PhD,
and Stephen I. Esses, MD




Study Design: A 2-part cadaveric study


Introduction:
1. Lumbar spine foraminal stenosis (LSFS) incidence >> 8% ~ 11%

2. Limitations of MRI itself for the diagnosis of LSFS

3. Not well understood about the effect of the variability on assessing LSFS
   1) Various Techniques
   2) Various Observers

4. No control over the final quality, or quantity of images provided to the surgeons

5. Glenn's words for size of a lesion in spine
   >> 1) normal, 2) slight, 3) mild, 4)moderate, 5) sever

6. Wildermuth et al's semi-quantitative classification system for grading LSFS
   1) On the basis of 'Open' MRI findings
   2) Grade 0 >> foramina without pathology
   3) Grade 1 >> slight foraminal stenosis
   4) Grade 2 >> marked foraminal stenosis
   5) Grade 3 >> advanced stenosis

7. About this study
   1) 2-part study to investigate the use of MRI in diagnosing LSFS
     Take MRIs of 3 cadavers in 3 centers, 8 spine surgeons to assess
       >> Reliability of Wildermuth semiquantitative classification system
       >> Variability in MRI examinations carried out in different institutions
     Compare MRI measurements vs. cadaveric slices to assess
       >> Differences between measurements from MRI vs. cadaveric specimens


Methods:
1. Fresh, frozen human lumbar spines (3 cadavers)
2. Examined with 3 different clinical MRI systems
3. Graded foramina by 8 surgeons on the basis of Wildermuth semiquantitative way
4. MRI measurements
   1) Foraminal height
   2) Superior foraminal width
   3) Middle foraminal width
   4) Posterior disc height















5. Specimen measurements
   1) Foraminal height
   2) Superior foraminal width
   3) Middle foraminal width


Results, Part 1:
1. 9set MRI scan review/total 72 foramina per one observer

2. Grading
   0) Grade 0 >> 222 foramina (39%)
   1) Grade 1 >> 201 foramina (35%)
   2) Grade 2 >> 127 foramina (22%)
   3) Grade 3 >>  26 foramina (04%)
   4) P = 0.15, nearly significant on the basis of paired t-tests

3. Level of interobserver agreement
   0) k grade 0 >> 0.13
   1) k grade 1 >> -0.01
   2) k grade 2 >> 0.06
   3) k grade 3 >> 0.11
   4) combined >> 0.07
   5) Most observers underestimated LSFS grade as compared with grading specimens.
   6) Preferred Method to assess the foramen >> T1 sagittal sequence


Results, Part 2:
1. MRI measurements
   1) Foraminal height >> 14.78mm (SD 4.53)
   2) Superior foraminal width >> 7.73mm (SD 1.77)
   3) Middle foraminal width >> 3.79mm (SD 1.68)
   4) Posterior disc height >> 5.55mm (SD 1.63)
   5) Correlation between MRI measurements and Actual dimensions in specimens >> Poor

2. Specimen measurements
   1) Measured 24 foramina and Graded according to Wildermuth classification
     Grade 0 >> 8 (33%)
     Grade 1 >> 3 (12%)
     Grade 2 >> 10 (42%)
     Grade 3 >> 3 (12%)

   2) Measurments of foraminal size
     Foraminal height >> 16.12mm (SD -3.11)
     Proximal foraminal width >> 8.99mm (SD -2.43)
     Middle foraminal width >> 4.76mm (SD -2.80)


Conclusion:
The parameters associated with the grade of stenosis assigned to the foramen were as follows: 
(1) the observer doing the grading
(2) the place it was imaged
(3) the location of the foramen.
There was poor correlation between measurements of the foramina carried out on MRI and the specimens.

2013년 9월 27일 금요일

A prospective assessment of SRS-24 scores after endoscopic anterior instrumentation for scoliosis

Brief review


*Title: A prospective assessment of SRS-24 scores after endoscopic anterior instrumentation for scoliosis.

척추측만증 치료를 위한 내시경 전방 유합술 후의 SRS-24점수의 전향적 측정.

*Author: John R. Crawford, FRCS, Maree T. Izatt, BPhty, Clayton J. Adam, PhD, Robert D. Labrom, FRACS, and Geoffrey N. Askin, FRACS




STUDY DESIGN: Prospective clinical case series.


OBJECTIVE:

-To evaluate the clinical outcome of anterior endoscopic instrumention for scoliosis using the Scoliosis Research Society(SRS) -24 questionnaire.

-To examine how these scores change over a 2-year follow-up period.


SUMMARY OF BACKGROUND DATA:  
The clinical results of Anterior endoscopic instrumentation correction using a validated 

outcome measure have rarely been reported in the literature.


METHODS:
Subject number: 83 consecutive patients (74 females + 9 males)

Inclusion criteria: 
underwent endoscopic anterior instrumented fusion for scoliosis using a single rod technique. (period: 2000.04~2005.01)

Surgical technique: 
To perform anterior scoliosis instrumentation and fusion via an endoscopic approach.

Clinical outcomes evaluation: To assessed before surgery and at 3, 6, 12, 24 months after surgery using the SRS-24 questionnaire.

Radiographic evaluation: 
The major Cobb angle was measured using the cobb method at all review appointments

Statistical analysis: using SPSS software, Mann-Whitney test.


RESULTS:
Clinical outcomes evaluation:
-Evaluated clinical outcomes(using SRS-24) are listed belows.















-Changes of SRS-24 scores VS time during (preop, 3,6,12,24 months) graph

-->The graph showed that the greatest improvement in function occurred between 6 and 12 months after surgery.




Radiographic evaluation:
-Mean coronal Cobb angle: 52.6° (preop) --> 21.7° (postop)


CONCLUSIONS:  
-Endoscopic anterior instrumentation for scoliosis significantly improved pain, self-image, and function.

-The SRS-24 scores at 1 year from surgery may provide a good indicator of patient outcome in the long-term.




Key points:
Endoscopic anterior instrumentation for scoliosis significantly improved pain, self-image, and
function when assessed using the SRS-24 Outcome Instrument.

Activity level improved between 3 and 6months, whereas function from back condition and postoperative function domains improved between 6 and 12 months after surgery.


No further improvement occurred in any of the SRS-24 domains after 1 year, and these scores may provide a good indicator of patient outcome in the long-term.



+ SRS-24: Scoliosis Research Society questionnarie
(Dominique A. Rothenfluh et al. Eur Spine J (2012) 21:1590–1595)
       
(Haher TR, et al. Spine 1999;24:1435–40.)

2013년 9월 25일 수요일

ASIA SPINE 2013

source: ASIA SPINE website





<Program at a glance >



Relation Inquiry: spine@ibmed.co.kr, Tel: +82-2-2273-8556, Fax: +82-2-2273-7651
(ASIA SPINE 2013)

2013년 9월 24일 화요일

2013년 9월 23일 월요일

Perioperative complications in transforaminal lumbar interbody fusion versus anterior-posterior reconstruction for lumbar disc degeneration and instability.

Brief review 2

*Title: Perioperative complications in transforaminal lumbar interbody fusion versus anterior-posterior reconstruction for lumbar disc degeneration and instability.

*Authors: Alan T. Villavicencio, MD,  Sigita Burneikiene, MD,  Ketan R. Bulsara, MD,  Jeffrey J. Thramann, MD




OBJECTIVES: 
To assess clinical parameters for TLIF and AP reconstructive surgery for lumbar fusion.

(clinical parameters: 1)surgical blood loss, 2)duration of the procedure, 3)length of 
hospitalization, 4)complications)



METHODS: retrospective analysis -chart review (2002.01~2004.03)

Subject number: Total 167 cases
-TLIF: 124 patients (73 minimally invasive + 51 open cases) & AP surgery: 43 patients

Indications: 
-painful degenerative disc disease
-facet arthropathy
-degenerative instability
-spinal stenosis
-degenerative spondylolisthesis.



RESULTS:
1)blood loss, 2)operative times, 3)hospitalization times are listed belows.



 >OR Time: OpeRation Time
   EBL: Estimated Blood Loss
   LOS: Length Of Stay











4)complication rate are as follows.

-Major Complications
















-Minor Complications
















CONCLUSIONS:

1)blood loss : AP lumbar interbody fusion (significantly increased) > TLIF 

2)operative times: AP lumbar interbody fusion (more longer) > TLIF

3)hospitalization times: AP lumbar interbody fusion (more longer) > TLIF

4)complication rate: AP lumbar interbody fusion (more than 2 times higher) > TLIF

2013년 9월 21일 토요일

Does the presence of the nerve root sedimentation sign on MRI correlate with the operative level in patients undergoing posterior lumbar decompression for lumbar stenosis?

Brief review 1

*Title: Does the presence of the nerve root sedimentation sign on MRI correlate with the operative level in patients undergoing posterior lumbar decompression for lumbar stenosis?

*Authors: Akil Fazal, MD,  Andrew Yoo, BA,  John A. Bendo, MD




BACKGROUND CONTEXT:
-Recent research describes the use of a nerve root sedimentation sign to diagnose lumbar spinal stenosis (LSS).
-The lack of sedimentation of the nerve roots (positive sedimentation sign) to the dorsal part of the dural sac is the characteristic feature of this new radiological parameter.


PURPOSE: To demonstrate how the nerve root sedimentation sign compares with other more traditional radiological parameters in patients who have been operated for LSS.


STUDY DESIGN/SETTING: A retrospective chart and image review.


PATIENT SAMPLE: Preoperative MRI were reviewed from 71 consecutive operative patients who presented with LSS and received spinal decompression surgery (2006-2010).


OUTCOME MEASURES: Preoperative T2-weighted MRIs were reviewed for each patient.


METHODS:
Measurements
134 vertebral levels (L1-5) were measured for
1)     sedimentation sign
2)     cross-sectional area (CSA)
3)     anterior/posterior (A/P) diameter of the dural sac
4)     thickness of the ligamentum flavum
5)     Fujiwara grade of facet hypertrophy.

-using Surgimap 1.1.2.169 software (Nemaris, Inc., New York, NY, USA)

-Exclusion criteria: 1) previous spine surgeries 2) absence of MRI on extended dynamic range 3) surgeries for primary diagnosis other than LSS

Statistical analyses
-using the SPSS 17.0 statistical software (SPSS Inc., Chicago, IL, USA).

-Significance was demonstrated using unpaired t tests and chi-squared tests.


RESULTS: The measurements are listed below.

















CONCLUSIONS:
-The sign is most often present in patients who have clinically significant lumbar stenosis and require surgery.

-The sedimentation sign is a new measurement tool that can enable physicians to objectively assess and quantify spinal stenosis.






*Fujiwara grading system: aim to assess the severity of the facet joint osteoarthritis.

2013년 9월 20일 금요일

Mini-Transforaminal Lumbar Interbody Fusion Versus Anterior Lumbar Interbody fusion Augmented by Percutaneous Pedicle Screw Fixation

3rd journal review

*Title: Mini-Transforaminal Lumbar Interbody Fusion Versus Anterior Lumbar Interbody fusion Augmented by Percutaneous Pedicle Screw Fixation.

*Author: Jin-Sung Kim, MD,  Byung-Uk Kang, MD,  Sang-Ho Lee, MD, PhD,  Byungjoo Jung, MD, PhD,  Young-Gun Choi, MD,  Sang Hyeop Jeon, MD  Ho Yeon Lee, MD, PhD 


*Bibliography: J Spinal Disord Tech. 2009 Apr;22(2):114-21.


Study Design: Retrospective clinical data analysis.

Objective: To compare clinical results with radiologic results of 2 fusion techniques for adult low-grade isthmic spondylolisthesis.


Summary of Background Data: There is clear evidence that comparing ALIF versus PLIF.


However, there are no recent studies that compare these 2 fusion techniques(ALIF and TLIF).

Methods: 
>Patient population
-patient characteristics (2004.03~2004.12)



-inclusion criteria
1) presence of single-level low-grade isthmic spondylolisthesis
2) chronic and persistent radiculopathy despite conservative treatment
3) progressive neurologic deficits
4) persistent and unremitting lower-back pain for more than 6months
5) loss of quality of life because of neurologic claudication
6) minimum follow-up period 2years
7) age range of 18 to 65 years

-exclusion criteria
1) previous spine surgery
2) concomitant scoliosis of more than 15 degrees
3) compression fracture or instability at the adjacent segment
4) underwent simultaneous decompression at adjacent segments

>Outcome assessment
-Radiologic outcome:
evaluated on anteroposterior, lateral, and flexion-extension radiographs.
 Radiologic data: 1)disc height 2) segmental lordosis 3) whole lumbar lordosis 4) degree of listhesis

<radiologic measurement method>


 Clinical outcome: 1) VAS(visual analog scale) 2) ODI(oswestry disability index)

>Surgical Techniques
-All ALIF procedures were performed using the mini-laparotomic retroperitoneal approach.

>Mini-TLIF with PPF


>Statistical Analysis
-An analysis of variance was conducted using the 2 proportions test, independent 2 sample t test, x^test, paired t test. (p<0.05)


Results
>Radiologic results
The postoperative radiologic data revealed below.





















-DH and SL -->  significant difference
-degree of listhesis and WL--> Not  significant difference


>Clinical outcomes
-VAS score
ALIF- back: 7.7 --> 2.9
        leg:    7.5--> 2.7
TLIF- back: 7.0 --> 2.3
        leg:    6.3--> 2.2

-ODI score
ALIF: 51.4%--> 23.2%
TLIF: 52%   --> 14.4%


Conclusions
-The mini-ALIF group demonstrated key radiographic advantages compared with the mini-TLIF group for adult low-grade isthmic spondylolisthesis. 

-However, clinical and functional outcomes did not demonstrate significant differences between groups.