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Purpose: To determine the necessity of an additional posterior lumbar interbody fusion (PLIF) 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-PLF, s-PLIF, u-PLF and u-PLIF groups, and a statistical difference was found only between the u-PLF 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-PLF 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: This experimental study hypothesize that 'rapid degeneration of the intervertebral disc over the ability of auto-stabilization by osteophytes bridging to adjacent segments might be the pathomechanism of degenerative lumbar scoliosis (DLS).' An effort to prove this hypothesis was attempted by confirming the differences in the expression of matrix metalloproteinase-3 (MMP-3) in DLS and pure spinal stenosis. Materials and Methods: The intervertebral disc materials obtained during a discectomy through a posterior approach, were included in this experimental study. Two protruded herniated nucleus pulposus were included for the control group. Eight spinal stenosis and seven DLS were included as experimental groups 1 and 2, respectively. The expression of MMP-3 was evaluated by immunohistochemical staining and western blotting using anti human MMP-3 antibody. Results: In the immunohistochemical stains, sparse staining was noted in the control group. More staining, however, mainly extracelluar, was noted in the discs of DLS compared with those of the spinal stenosis group. In western blotting, greater MMP-3 expression was noted in the discs of DLS (mean optical density: 20.68) than in those of the spinal stenosis group (mean optical density: 6.24) which was statistically significant (p

With increasing number of the elderly persons, the incidence of aortic aneurysm is increasing too. Infected aneurysm is considered as a lesion of the arterial wall due to bacterial contamination, and most infected aneurysms are the complication of preexisting aneurysms. Uncommonly an infected aortic aneurysm may rupture into adjacent internal organs or the retroperitoneum, and rarely this may result in pyogenic spondylitis. Salmonella is a relatively uncommon organism in infectious spondylitis, and accounts for less than 1% of infectious spondylitis. Salmonella spondylitis is frequently encountered in patients having an immnosuppression state, sickle cell anemia, lymphoma or chronic liver disease. Recently, the authors experienced a case of Salmonella spondylitis concomitant with a ruptured infected aortic aneurysm and reported this case with a literature reviews.

Recently, the use of acupuncture has been increasing for the management of low back pain and herniated nucleus pulposus. There are many debates on its usefulness and associated complications. Complications such as hemorrhage, infection, direct internal organ or nerve injury and disease transmission have been reported. We report a case of dural sac and nerve root compression caused by chronic inflammatory granuloma. This chronic inflammatory granuloma, which might have been formed by local hemorrhage or lowgrade infection after acupuncture is highly suspected to produce the symptoms of spinal stenosis; moreover, after surgical excision of the granuloma the patient's symptoms were eliminated. Hence, we report this case and discuss the possibility of the acupuncture as a cause.

Purpose : The purpose of this experiment was to investigate the relationship between sex hormones and degenerative spinal disorder. Materials and Methods : 22 ligamentum flavum were obtained from 22 patients who had undergone spinal surgery. Patients’specimens were divided into three groups. The experimental group contatining 16 postmenopausal female patients, diagnosed as having degenerative spinal stenosis. As a control group, two groups were formed. The first control group was composed of 4 male patients diagnosed as having same disease and the second group was two premenopausal females, who were diagnosed as having disc herniation and fracture. The relative amount of estrogen receptor expression at gene level was measured by reverse transcription-polymerase chain reaction (RT-PCR). The amounts of expressed gene in each group were compared: receptor subtypes (ER-, ER-), sex and age (pre, postmenopausal). The calculated amount of ER- and ER- gene expression was standardizised with respect to the mRNA of GAPDH. Results : The mean density of the estrogen receptor signals were 55.012.3, 143.032.1 in the experimental group, 39.68.0, 89.720.1 in the first control group and 34.12.0, 102.52.7 in the second control group. The mean density of the estrogen receptor signals were higher in the experimenal group than in the control group. A statistically significant difference was found between the experimental group and the control group (p gene in the human ligamentum flavum was confirmed. It was inferred from this study that a high expression of estrogen receptor might affect ligamentum flavum hypertropy in postmenopausal women and that this is likely to be a predisposing factor for degenerative spinal disorder.

Purpose : To clarify b-FGF expression in different types of herniated nucleus pulposus (HNP) as angiogenesis marker, and to identify the novel vasculature in avascular nucleus pulposus. Materials and Methods : Twenty-seven disc specimens removed surgically from patients who underwent discectomy for L4-5 HNP. The control disc specimens were obtained from five patients who underwent surgery for spine fracture or idiopathic scoliosis. According to MRI and operative findings, HNP was classified into 3 groups; protruded, extruded and sequestrated. The study involved; 7 protruded cases, 10 extruded cases and 10 sequestrated cases. Specimens were analyzed by western quantitative comparisons were performed upon the different bands. H-E stain and immunohistochemistry of CD 34 were performed to identify vessels in the avascular nucleus pulposus. Results : The expression of b-FGF was not significantly increased in the protruded disc (p>0.05), but was significantly increased in the extruded disc as compared with the protruded disc (p