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2014년 7월 27일 일요일

우리들병원 이정환 원장 The Spine Journal논문 등재- Comparison of cervical kinematics between patients with cervical artificial disc replacement and anterior cervical discectomy and fusion for cervical disc herniation

Brief review
우리들병원 이정환 원장님이 The Spine Journal 최신호에 출판한 논문 입니다.

경추 디스크 탈출증이 있어 cervical artificial disc replacement혹은 anterior cervical discectomy and fusion을 받은 환자들을 대상으로 경추의 운동학적인 결과를 비교한 연구입니다.
임상적 결과로서 통증지수(VAS), 일상생활 장애지수(K-NDI)를 측정하였고, 운동학적인 결과분석을 위해 3차원 동작분석을 시행했습니다.

측정결과, VAS, NDI등의 임상결과는 두 군간에 유의한 차이가 없었습니다.
3D 동작분석 결과, cervical artificial disc replacement를 받은 환자군이 anterior cervical discectomy and fusion를 받은 환자군에 비해 굽힘, 편 상태에서 움직임의 범위가 통계적으로 유의하게 유지되었습니다.
아래 링크 들어가서 읽어보세요^^



*Title: Comparison of cervical kinematics between patients with cervical artificial disc replacement and anterior cervical discectomy and fusion for cervical disc herniation.


*Authors: Lee JH, Kim JS, Lee JH, Chung ER, Shim CS, Lee SH




BACKGROUND CONTEXT
Although anterior cervical discectomy and fusion (ACDF) is an effective treatment option for patients with cervical disc herniation, it limits cervical range of motion, which sometimes causes discomfort and leads to biomechanical stress at neighboring segments.

In contrast, cervical artificial disc replacement (ADR) is supposed to preserve normal cervical range of motion than ACDF. A biomechanical measurement is necessary to identify the advantages and clinical implications of ADR.

However, literature is scarce about this topic and in those available studies, authors used the static radiological method, which cannot identify three-dimensional(3-D) motion and coupled movement during motion of one axis.


PURPOSE
-To compare the clinical parameters and cervical motion between ACDF and ADR (by 3-D motion analysis)
-To investigate the ability of ADR to maintain cervical kinematics.


STUDY DESIGN
Prospective case control study.


PATIENT SAMPLE
Patients who underwent ADR or ACDF for the treatment of single-level cervical disc herniation.


OUTCOME MEASURES
Visual analog scale (VAS)
Korean version of Neck Disability Index (NDI, %)
3-D motion analysis


METHODS
-Clinical outcomes: evaluated by VAS and the Korean version of the NDI (%) to assess pain degree and functional status.

-Cervical motions: assessed by 3-D motion analysis in terms of sagittal, coronal, and horizontal planes.
(Markers of 2.5 cm in diameter were attached at frontal polar (Fpz), center (Cz), and occipital (Oz) of 10-20 system of electroencephalography, C7 spinous process, and both acromions)

-These evaluations were performed preoperatively and 1 month and 6 months after surgery.





RESULTS
»Pre op: no significant difference in VAS, NDI (%), and cervical range of motion (between two groups)

»After surgery:
-no significant difference in VAS and NDI (%)

-In motion analysis, significantly more range of motion was retained in flexion and extension in the ADR group than the ACDF group at 1 month and 6 months.

There was no significant difference in lateral tilt and rotation angle. In terms of coupled motion, ADR group exhibited significantly more preserved sagittal plane motion during right and left rotation and also showed significantly more preserved right lateral bending angle during right rotation than ACDF group at 1 month and 6 months. There was no significant difference in other coupled motions.
 



CONCLUSION
-3-D motion analysis could provide useful information in an objective and quantitative way about cervical motion after surgery. In addition, it allowed us to measure not only main motion but also coupled motion in three planes.

-ADR demonstrated better retained cervical motion mainly in sagittal plane (flexion and extension) and better preserved coupled sagittal and coronal motion during transverse plane motion than ACDF.

-ADR had the advantage in that it had the ability to preserve more cervical motions after surgery than ACDF.

2014년 7월 17일 목요일

The Spine Journal 7월호 논문 목록

The Spine Journal에서 나온 7월호 논문 목록 입니다.
일부만 가져왔으니 나머지는 저널 홈페이지에서 보시면 됩니다^^ (이레 링크 참조)







2014년 7월 16일 수요일

Stand-Alone Anterior Lumbar Interbody Fusion for Degenerative Disc Disease of the Lumbar Spine: Results With a Two Year Follow Up

Brief review

SPINE지의 최신호에 나온 논문 입니다.
퇴행성 디스크 질환이 있는 환자들에게 stand alone 전방경유요추체간 유합술을 시행한 후 2년이 지난 후의 임상적, 방사선학적 결과를 관찰한 연구 입니다.
허리,다리의 통증지수(VAS) 및 일상생활장애지수(ODI) 가 수술전에 비해 유의하게 감소하였고, 인접분절의 disc height도 감소되지 않는 좋은 결과가 나왔네요.
아래의 링크로 들어가서 한번 읽어보세요^^ 시간 없으시면 아래의 key points만 읽어봐도 도움이 될 듯 합니다.

*Title: Stand-Alone Anterior Lumbar Interbody Fusion for Degenerative Disc Disease of the Lumbar Spine: Results With a Two Year Follow Up.
*Authors: Lammli J, Whitaker C, Moskowitz A, Duong J, Dong F, Felts L, Konye G, Ablah E, Wooley P.
*Bibliography: Spine (Phila Pa 1976). 2014 May 12. [Epub ahead of print]

Study Design
Retrospective chart review

Objective
To report outcomes of a consecutive series of patients diagnosed with degenerative disc disease (DDD) between L4 and S1, treated with stand alone Anterior Lumbar Interbody Fusion (ALIF, either one or two-level) and use of rhBMP-2 for bony fusion with instrumented fixation.

Summary of Background Data
Degeneration of the lumbar spine is described as lumbar spondylosis, or DDD. To treat DDD, surgical interventions include: ALIF, circumferential fusion (360° fusion), posterior spinal fusion (PSF), and total disc replacement (TDR). Currently, there has been paucity in the literature on the evaluation of ALIFs.

Methods
Researchers reviewed a consecutive series of patients with DDD that had undergone a 1-level or 2-level ALIF between 2005 and 2010, with the use of rhBMP-2. Patients' clinical and functional outcomes were documented. Radiographs were analyzed for disc height, mean optical density, and integrated optical density. Operative time, length of hospital stay, and estimated blood loss were also reported.



























Results
Patients' two year Oswestry Disability Index (ODI) and Visual Analog Scale (VAS) scores significantly improved from pre-surgery (p ≤ 0.0001). Patients' two year post-operative disc height was significantly greater than the pre-operative disc height at the fused level (p ≤ 0.0001); there was no significant difference at the level adjacent to fusion. Majority of patients (107 of 115, 93.0%) satisfied fusion criteria based on mean optical density. Intra-operative time, estimated blood loss, and hospital stay was significantly fewer with 1-level and 2-level ALIFs than 360 fusions and TDR.




















Conclusion

Stand alone ALIF used to treat DDD can produce comparative clinical and functional outcomes. ALIFs showed significant decreases in blood loss, operative time, and hospital stay. Furthermore, at two years' time, mean optical density suggests high rate of bony fusion, and no significant loss of disc height was noted at the adjacent level.


2014년 7월 6일 일요일