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Hyo Jong Kim, Kyu Yeol Lee, Lih WangDepartment of Orthopaedic Surgery, College of Medicine, Dong-A University, Busan, KoreaBackground: The purpose of this study was to analyze the complications, clinical outcomes, and any correlative risk factors associated with degenerative lumbar deformity surgery in elderly patients.Methods: We reviewed 78 patients who underwent posterior decompression and posterolateral fusion requiring a minimum three-level fusion for degenerative lumbar deformity associated with spinal stenosis between May 2001 and May 2006, with at least a one-year follow-up period. We assessed and compared the postoperative complications and clinical outcomes for patients aged 65 years and over (group A) and patients aged 50–64 years (group B). Risk factors that could influence complications and clinical outcome were evaluated and statistically analyzed.Results: The postoperative complication rate was not significantly different between the two age groups (53% in group A and 40% in group B); however, group A had a significantly higher frequency of minor complications than group B, especially for urinary retention and postoperative delirium. A statistical relationship between diabetes mellitus and deep wound infection, one of the major complications of degenerative lumbar deformity surgery, was observed in both group A and group B. Male sex was a risk factor for urinary retention and long operative time, and abundant blood loss was a significant risk factor for postoperative delirium in group A.Conclusion: There were no significant differences in results for degenerative lumbar deformity surgery between patients older and younger than 65 years. However, diabetes mellitus showed a significant correlation with deep wound infection, which is one of the major complications of degenerative lumbar deformity surgery, and with urinary retention and postoperative delirium, which occurred frequently in patients aged older than 65 years.Keywords: spinal stenosis, lumbar deformity, elderly, risk factor, complication, clinical outcome

Purpose: The purpose of this study is to compare and analyze the radiological and clinical results after treatment of intertrochanteric fractures of the femur by three devices including DLT, PFNA and Gamma 3 nail. Materials and Methods: From January 2007 to January 2012, we reviewed 131 patients who suffered intertrochanteric fractures(33 cases of DLT, 59 cases of PFNA, 39 cases of Gamma 3 nail). The following were measured for all three groups; The tip apex distance (TAD), neck shaft angle and lag screw position at the head of femur, as well as the amount of blood loss and transfusion, operation time, duration of hospitalization and postoperative ICU admission, complications were also assessed. Results: In comparison of the radiological results, there were no statistical differences among the three groups in TAD, neck shaft angle and the lag screw position. There was no statistical difference in clinical results. In the last follow-up, there was one case of nonunion in the PFNA group. There also was, in the last follow up, a development of varus angulation & cut-out of lag screw that occurred in 2 cases (DLT), 4 cases (PFNA), 1 cases (Gamma 3). There was no statistical difference among the three groups in the sliding length of the lag screw. Conclusion: Any certain group was not better than the others with regard to the radiological and clinical results among DLT, PFNA and Gamma nail groups in treating intertrochanteric fracture. To achieve favorable results, precise reduction of fracture site and surgical techniques are important.

Study Design: A retrospective study. Objectives: The purpose of this study was to assess the clinical efficacy and long term results of patients undergoing percutaneous vertebroplasty, with bone cement, for osteoporotic compression fractures. Summary of Literature Review: Percutaneous vertebroplasty is an effective surgical method for the treatment of osteoporotic compression fracture. Materials and Methods: Among 82 patients who underwent percutaneous vertebroplasty, with bone cement, between February 2005 and February 2008, 54 patients who were followed-up for more than 4 years were selected. We compared the postoperative clinical and radiological findings immediately and at 1, 2, and 4 year follow-up. Clinical findings were evaluated using the Visual analogue scale (VAS) score. Radiologically, height of the vertebral body and adjacent vertebral body fracture were also assessed. Results: Clinical outcome by mean VAS score revealed a change from 5.9 to 3.8 points preoperatively. The mean VAS scores were 3.4, 3.5 and 3.7 at 1, 2, 4 year follow-up, retrospectively. The compression rate of the vertebral body on plain radiographs was 30.8% preoperatively, 22.4% immediately after the operation, 23.2% at 1 year follow-up, 26.9% at 2 year follow-up, and 29.7% at 4 year follow-up. A new adjacent vertebral body fracture was noted in 7 patients at 1 year follow-up and 3 patients at 2 and 4 year follow-up, respectively. Conclusions: Percutaneous vertebroplasty is a valuable method for the treatment of osteoporotic compression fractures, providing immediate pain relief as well as long term pain relief. However, percutaneous vertebroplasty gave unsatisfactory report about height of the vertebral body and adjacent vertebral body fracture.

Study Design: To analyze the relationship between the adjacent superior segment disease and facet joint violations after lumbar fusion. Objectives: We retrospectively analyzed the relationship between the adjacent superior segment disease and facet joint violations after lumbar fusion. Summary of Literature Review: Among numerous literatures regarding adjacent superior segment disease, there is no analysis concerning the relationship between adjacent superior segment disease and facet joint violations after lumbar fusion. Materials and Methods: We reviewed 2056 patients who underwent lumbar fusion, between March 2004 and April 2009. Analysis was performed for 79 (3.8%) of the 2056 patients with adjacent superior segment disease and needed a second operation. A facet joint was considered as 3 types of violations with computed tomography scans if any of the following situations were encountered: pedicle screw clearly within the facet joint; pedicle screw head clearly within the facet joint; and pedicle screw and/or screw head within 1mm from or abutting the facet joint, without clear joint involvement. Results: The incidence of the violations was 45% (36/79) of all patients and 28% (44/158) of all screws. The incidence of L4-5 facet joint violations was 35% (28/79) of patients with adjacent superior segment disease, statistically. Conclusions: Facet joint violations were observed in patients with the adjacent superior segment disease after posterolateral lumbar fusion. Because L3-4 facet joint violations increased when L4-5 fusion was done, more care should be taken to avoid facet joint violations when the surgeon is considered for insertion of the pedicle screws at L4-5.

목적: 65세 이상의 대퇴 전자간부 골절 환자에서 환자 위험 인자와 임상적 치료 결과와의 관계에 대하여 결과를 분석하였다. 대상 및 방법: 2000년 1월부터 2012년 3월까지 대퇴 전자간부 골절로 내원하여 본원에서 수술을 시행하였던 65세 이상 환자, 321명을 대상으로 하였다. 연령, 성별, 음주 및 흡연 유무, 심혈관계 질환, 뇌혈관계 질환, 술전 혈액 검사 수치 등의 환자 위험 요인을 분석하였으며, 입원 후 수술까지 지연된 기간, 주말 입원 여부, 마취 방법, 수술 시간 등의 수술 전 후 처치에 따른 수술 후 합병증 발생률 및 사망률과의 관계에 대하여 비교 분석하였다. 결과: 환자 위험 요인의 분석에서는 여성의 경우 사망률이 13.0%로 더 높은 것으로 나타났다(P=0.043). 수술 시간이 3시간 이상이었을 경우 사망률 및 합병증 발생률이 각각 29.1%, 20.8%로 더 높은 것으로 나타났으며(P

compared with the treatment recommended by TLICS classification to calculate the validity of the indexes. Results: Intraobserver and interobserver reliability in TLICS were higher than those in the McAfee classification. Agreement of the TLICS classification for treatment recommendation was 81.7%, comparing with the actual management of previous McAfee classification. Validity indexes were satisfactory in therapeutic decision making, especially specificity. Conclusions: TLICS classification has a relative high K-value, when compared with that of the McAfee classification for intraobserver and interobserver reliability. Through clinical studies, including prospective observational analysis, TLICS classification can be applied and adjusted more adequately.

Study Design: This is a retrospective study for radiographically and clinically assessing nonunion after lumbar spine fusion. Objectives: We wanted to analyze the risk factors for nonunion that requires surgical treatment after lumbar spine fusion Summary of the Literature Review: A diagnosis of the nonunion after lumbar spine fusion was made by using only the only radiologic images. The incidence of nonunion has been underreported because there are many asymptomatic patients. Materials and Methods: The plain X-ray films were evaluated for 1317 patients who could be followed up more than 1 year after lumbar fusion. Nonunion was diagnosed at 1 year after fusion by instability seen on the flexion-extension radiograph and the clinical findings like as sustained pain and local tenderness at the surgical site. The risk factors we reviewed included age, the number of levels fused, associated diseases, smoking, alcohol drinking, the initial diagnosis, a previous history of spinal operation, infection, a clear zone and malposition of pedicle screws and metal failure. The relations between nonunion and the factors mentioned above were analyzed. Results: Thirty-nine patients were diagnosed as having nonunion underwent reoperation and all had surgically confirmed nonunion. Smoking, infection and a previous history of spine operation had a significant influence on nonunion (p < 0.05). Clear zones persisting more than 1 year and metal failure also had a significant influence on nonunion (p < 0.05). Age, the number of fused levels, the initial diagnosis and alcohol drinking were not shown to influence the rate of nonunion (p < 0.05). Conclusion: A through clinical and radiologic evaluation is essential to diagnose nonunion, and this should not be done according to the radiologic images only. Risk factors such as a previous history of spine operation, infection, smoking, the development of a clear zone and metal failure all showed a statistically significant influence on nonunion. Additionally, preoperative and postoperative evaluation of these parameters is needed to achieve bone union.

303 통신저자:김 현 준 부산시 서구 동대신동 3가 1 동아대학교 의과대학 정형외과학교실 Tel:051-240-5167ᆞFax:051-254-6757 E-mail:campbellkim@naver.com 이 논문의 요지는 2009년도 제35차 대한골절학회 추계학술대회에서 구 연되었음. 이 논문은 동아대학교 학술연구비지원에 의하여 연구되었음. 접수: 2009. 11. 19 심사 (수정): 1차 2010. 1. 30, 2차 2010. 3. 4 게재확정: 2010. 4. 7 Address reprint requests to:Hyeon Jun Kim, M.D. Department of Orthopedic Surgery, College of Medicine, Dong-A University, 1, Dongdaesin-dong 3-ga, Seo-gu, Busan 602-715, Korea Tel:82-51-240-5167ᆞFax:82-51-254-6757 E-mail:campbellkim@naver.com 전위된 관절 내 종골 골절에서 관혈적 정복 및 AO 종골 금속판을 이용한 내고정술

Study design : Retrospective analysis of surgical treatment in patients with osteoporotic vertebral fracture associated myelopathy. Objectives : To evaulate the clinical outcome of anterior decompression and fusion for osteoporotic vertebral fracture associated with myelopathy. Summary of Literature Review : Major treatment of osteoporotic vertebral fracture were conservative methods. In patients with myelopathy, surgical treatment is recommanded. Materials and Methods : From January 1995 to December 1998, twelve patients who had osteoporotic vertebral fracture associated with myelopathy and treated by operation were evaluated retrospectively. With simple roentgenography and dual energy absorptiometry, osteoporosis was evaluated. And with MRI and nerve conduction velocity test, we could diagnosed myelopathy. In ten patients, anterior approach was used, and in two patients, posterior approach was used. Results : In all patients after operation, the neurologic symptoms according to the Frankel grading scale were improved over one grade and follow-up X-ray showed bone union finding unrelated to the site, shape, and severity of fracture. No significant complications such as increasing of kyphotic angle and metal loosening were existed in all cases. Conclusions : For the osteoporotic vertebral fracture associated with myelopathy, we can treat properly with spinal decompression and interbody fusion with internal fixation.

Study Design: A retrospective clinical and radiological analysis Objectives: To determine the relationship between the classifications of unstable burst fractures on the thoracolumbar region, radiologic studies, signal change area on MRA and analysis of the prognostic factors. Summary of Literature Review: MRI is the first imaging modality that visualizes the extent of spinal cord derangement directly and it has the potential to provide an accurate diagnosis and prognosis. Materials and Methods: From March 1998 to September 2006, 39 patients who were eligible for a follow up of more than 1 year with an unstable burst fracture on the thoracolumbar region were studied. With these cases, The size of the bone fragment at the initial injury, signal change area on MRI, time to surgery, reduction rate of the bone fragments, recovery of the posterior curvature of the vertebrae and height of the vertebral body were analyzed. Results: The mean fracture size rate, average time to surgery, reduction rate of bone fragment and the recovery rate of the height of the vertebral body was 46.1±12.8%, 17±4.5 hours, 35.2±10.1%, and 57.9±17.4%, respectively. The data shows that the time elapsed until surgery had no relationship with the prognosis (P=0.317). Injuries with broad signal changes on MRI were not associated with the reduction rate of bone fragments, recovery of posterior curvature of the vertebrae and the height of the vertebral body. Conclusions: In unstable burst fractures of the thoracolumbar region, although a comparison of the prognostic factors on simple X-ray film had no significance, it still has significant meaning when correlated with the signals on MRI.

Address reprint requests to Kyu-Yeol Lee, M.D. Department of Orthopedic Surgery, College of Medicine, Dong-A University, 1, Dongdaesin-dong 3-ga, Seo-gu, Busan 602-715, Korea Tel: 82-51-240-2867, Fax: 82-51-243-9764 E-mail: gylee@dau.ac.kr Received: 2008. 12. 8. Accepted: 2009. 9. 8. *이 논문은 2008년도 제 25차 대한척추외과학회 추계학술대회에서 구연되었음. *이 논문은 동아대학교 학술연구비지원에 의하여 연구되었음. 퇴행성 요추 질환에서 척추경나사 주위 방사선 투과 영역의 임상적 의미

Survival after traumatic atlanto-occipital dislocation is rare. Severe persistent neurological deficits are common in the survivors, but early resuscitation and the use of the newer diagnostic techniques have contributed to improved outcomes. We present here the case of a 42 year old man with traumatic atlanto-occipital dislocation combined with a dens fracture, and the patient obtained good clinical results after we applied a Halo-vest and performed posterior fusion.

Background: Patients may be unwilling to accept blood products for religious reasons – Jehovah’s Witnesses (JW). Because of its minority, as well as JW patients, physicians have a lot of difficulty and anxiety to treatment. Furthermore, sometimes cancer patients are needed transfusion during operation or chemotherapy. So, we analyze the clinical outcomes of JW cancer patients who had treated for identifying the risk of treatment and transfusion need. Methods: We analyzed 77 cases of histological confirmed cancer patients (JW) from Jan. 2001 to Apr. 2008. Results: Male to female ratio was 1:1.48. Median age of patients was 59 years (range, 8 –83 years). The most common primary site was stomach (20.8%) followed by breast (14.3%), colorectal (11.7%), liver (7.8%), lung (6.5%), and hematologic malignancy (5.2%). At diagnosis, 53 patients (68.8%) were operable early cancer patients. Operation was done in 47 patients (89%). three patients refused operation itself. Change of CBC profile after operation was observed in hemoglobin (Mean ± SD; 12.7 ± 2.1 g/dL to 10.6 ± 2.3 g/dL, P Conclusion: Bloodless cancer treatment was not accompanied with serious complication. A few cases of palliative chemotherapy were needed transfusion, but adequate physician’s assist - dose modification and use of G-CSF and erythropoietin - could make keep the patient’s hope and quality of life.

목 적: 대퇴골 전자간부 골절 치료에서 골절의 양상 및 안정성을 예측하기 위해 술 전 3차원 컴퓨터 단층촬영을 시행하여 불안정 골절에 대해 추가 분류하였고 후방 골편 고정의 중요성 및 중간 치료결과에 대해 보고하고자 한다. 대상 및 방법: 2006년 10월부터 2007년 8월까지 후방 골편이 있는 불안정 골절로 진단 받고 ...

연구계획: 인접분절 질환의 위험인자에 대한 후향적 연구. 연구목적: 요추부 유합술 후 발생하는 인접분절 질환에 대해 수술적 치료를 요하는 위험인자들을 분석하였고, 이에 따른 치료 결과를 보고 하고자 한다. 대상 및 방법: 1993년 3월부터 2006년 8월까지 본원에서 요추부 유합술 시행 받고 최소 5년 이상 추시가 가능...

Purpose: To report the results of spine surgery for patients refusing allotransfusion. Materials and Methods: The operations were performed for 24 patients who were scheduled to undergo posterolateral fusion with internal fixation between January 2004 and March 2006. There were 7 male and 17 female patients, and the average age of the patients was 54 (range: 12~71) years. All fo these patients were indicated for posterolateral fusion with internal fixation requiring intraoperative and postoperative blood transfusion. In the whole study group, all of the patients refused to receive conventional transfusion therapy because of religious convictions. To categorize the patients by disease, there were 17 cases of spinal stenosis, two cases of spondylolytic spondylolisthesis, four cases of spinal stenosis with degenerative spondylolisthesis, and one case of neurofibromatosis scoliosis. In order to increase hemoglobin level, recombinant human erythropoietin was administered before the operation, and controlled hypotensive anesthesia, acute normovolemic hemodilution, a cell saving system, and reducing operating time methods were intraoperatively used to spare blood in spine surgery. Postoperatively, recuperative techniques were used to decrease blood loss and maximize blood production. Results: In the entire study group, there were no side effects or associated symptoms following bloodless surgery. In the followup period, there were no side effects or a lack of blood. Conclusion: Our results suggest that bloodless spinal surgery is an important method that can be used for decreasing the side effects of blood transfusion, and can be considered one of the good modalities with which to satisfy medical demands in spinal surgery.

‐ Abstract ‐ Study Design: A retrospective study. Objectives: To analyze the causes and treatment outcomes of reoperation after a lumbar discectomy. Summary of Literature Review: The major causes of reoperation after a lumbar disc surgery is recurrent disc herniation. Satisfactory outcomes can be obtained with reoperation for patients still requiring treatment. Materials and Methods: Fifty two patients, who had undergone reoperations after lumbar discectomies with a minimum followup period of one year, were reviewed. The causes of the reoperation were analyzed according to the physical examination and conventional radiographic evaluation. The surgical outcome was assessed using the JOA score and Kirkaldy-Willis criteria, and the recovery rate was calculated according to the JOA score. Statistical analysis was carried out to evaluate the factors that might influence the outcome of reoperation. Results: The causes of reoperation after lumbar disc surgery included 46 cases of recurrent disc herniation, each two cases of the wrong level, spinal canal stenosis and lumbar instability. The average JOA score increased from 11 to 24, and the average recovery rate was approximately 72%. According to the Kirkaldy-Willis criteria, the results were excellent and good in approximately 85% of cases. Statistical analysis revealed that the factors associated with a successful outcome were a single previous surgical procedure (p�0.02), a preoperative JOA score over 10 points (p�0.01), and a pain-free interval of more than 12 months after the previous operation(p�0.01). Conclusion: The treatment outcomes of reoperative lumbar disc herniation were satisfactory. Factors, such as the low number of prior procedures, high preoperative JOA score, and long pain-free interval after a previous operation, can lead to a successful treatment outcome of reoperation.

Study design: To determine the capability to predict the clinical manifestations and treatment outcomes of traumatic cervicothoracic cord injury patients based on MR images. Objective: To determine the relationship between the differences in MR patterns and signal areas according to Maravilla and Cohen’s classification and the PACS system compared with the Frankel classification, in patients that demonstrated neurologic improvement within 1 year. Summary of Literature Review: MR is the first imaging modality that directly visualizes the extent of spinal cord derangement, and thus, it has the potential to provide an accurate diagnosis of an injury and to determine the prognosis. Materials and Methods: MR images were evaluated within 3 days of trauma in 36 spinal cord injury patients. The clinical follow-up period was more than 1 year. Quantitative analysis of spinal cord lesions was performed according to the PACS system. Results: According to Maravilla and Cohen’s classification, 36 cases were classified as follows: 8 cases of type I, 10 cases of type II, 9 cases of type III and 9 cases of type IV. There was 1 case of type I, 8 cases of type II, 5 cases of type III, and no cases of type IV, who demonstrated neurologic improvements of more than 1 grade in the Frankel classification. An analysis of the signal areas according to the PACS system demonstrated no cases of areas greater than 100 mm, 5 cases of areas between 50 to 100 mm, and 9 cases of areas less than 50 mm who demonstrated neurologic improvement. Conclusion: Classification according to the differences between MR imaging and MRI signal areas in patients with spinal cord injuries demonstrated the indicators of neurologic improvement; therefore, we MR imaging can be utilized as a prognostic factor in cases of spinal cord injuries.

Study Design : The influence of lumbar disc degeneration, the space-occupying ratio on MRI and the amount of removed disc on the clinical outcomes of an open discectomy were analyzed retrospectively. Objectives: This study analyzed the pre and post-operative factors associated with the clinical outcome of an open discectomy. Summary of Literature Review : Much controversy still exists regarding the factors that influence the clinical outcome following an open discectomy. Materials and Methods: Out of 207 patients who had been treated with an open discectomy for a lumber disc herniation, between April 1997 and December 2003, 161 patients who underwent MRI with the same apparatus, with at least 6 months of follow-up, were analyzed. The study group was composed of 111 men and 50 women, with a mean age at the time of surgery of 33.1 years old. The mean follow-up period was 42 months. The degree of disc degeneration was classified according to the Thompson's classification, and the extent of the discectomy was measured by the volume. The postoperative outcomes were judged using Nayer's classification. Results: The highest frequency of disc herniation occurred at the L4-5 level, with being of the subligamentous extrusion type. The disc degeneration observed on MRI had a high statistical correlation with age (p 0.05). Clinically, 123 cases were more than fair, and 4 cases underwent reoperation due to recurrence. The clinical outcome, sex, age and space-occupying ratio were of little statistical value (p>0.05). Statistically, the greater the amount of disc removed, the better the clinical outcome (p

Study design: Patients who had had a revision operation were classified according to their outcome Objective: To review a consecutive series of patients who had had a revision operation on the lumbar spine and to determine which factors contributed to a successful outcome. Summary of Literature Review : The long-term failure rates after the primary surgery on the spine have been reported to be as high as 30 %. Materals and Methods: This study analyzed 57 patients who had had a revision operation on the lumbar spine between September 1995 and December 2001, and had been followed for a minimum of two years and were available for analysis. All the patients had had a decompression and instrumented fusion except for two patients who had just undergone a bone graft. These patients were followed for an average of 39 months. There were 37 men and 20 women. The patients had undergone one or more surgical procedures and an average of 54 months had elapsed since the most recent operation. The average age at the time of the revision was 52 years. The outcome was considered to be successful if the patient had met the all three criteria (Ed note: What were the 3 criteria?). Several factors were evaluated using multiple regression (level of significance, P

A 31-year-old female complained of neck pain and limitation in neck motion. She had a 3 month history of treatment with Halovest at another hospital for a fracture of the odontoid process due to a car accident. The patient complained of persistent pain and limitation in neck motion following the cessation of Halovest. A dynamic radiograph demonstrated instability on C1-2 and she underwent a posterior cervical fusion with wiring. A wound infection developed, and loosening of the wire and lysis of the posterior arch at C1-2 were seen on a follow up plain radiograph 2 months postoperatively. She was transferred to our hospital where she underwent occipitocervical fusion with a double plate after control of the infection. There were rigid fixations of the plate and bone union on a follow up radiograph 24 months postoperatively. 대한척추외과학회지 제 11 권 제 2 호 Journal of Korean Spine Surg. Vol. 11, No. 2, pp 121~124, 2004

‐ Abstract ‐ Study Design: A retrospective study O b j e c t i v e s: This study was designed to compare the clinical results, with the correction of the lumbar lordotic and scoliotic angles, in degenerative lumbar scoliosis patients, with spinal stenosis, who underwent an operation. Summary of Literature Review: Few studies have compared the postoperative lordotic angle with the clinical results in degenerative lumbar scoliosis, with spinal stenosis. Subjects and Methods: Out of 68 cases, where the patients underwent posterior decompression, pedicle screw fixation and fusion, due to the degenerative lumbar scoliosis with spinal stenosis, between February 1997 and February 2001, 59 cases, with the possible follow-ups for over 2 year, were studied and are herein reported. The decompression was carried out over a segment that showed the neurological symptom and occlusion of the spinal canal or the compression on the nerve root observed on CT or MRI scans. The pedicle screw fixation and fusion were carried out over the segment that received the decompression. The average age of the patients was 63.4, ranging from 51 to 76 years, and the average follow-up period was 38, ranging from 24 to 56 months. The measurements were performed in relation to the vertebral rotation, scoliotic and lumbar lordotic angles preoperatively, postoperatively and at the time of the final follow-ups, respectively. The clinical results were classified by the Kirkaldy-Willis questionnaire, and the statistical calculations performed through chi-squared and Pearson’ s correlation tests. Results: The average lumbar scoliotic angles preoperatively, postoperatively and at the time of the final follow-ups were 15.7± 4.9, 8.9±3.1 and 10.8±4.7 degrees, respectively. The average lumbar lordotic angles were 14.2±6.1, 20.1±7.3 and 19.4±7 . 2 degrees, respectively. The vertebral rotation degrees were 0.88, 0.62 and 0.64, respectively. The clinical results by the KirkaldyWillis questionnaire indicated over 73% satisfactory results, showing 9 excellent, 34 good, 13 fair and 3 poor cases. The lumbar lordotic angle was statistically correlated with the clinical results (p=0.04), while the scoliotic angle (p=0.41) and the vertebral rotation degree (p=0.29) were not. The scoliotic and lordotic angles had negative correlations, but these were not statistically

Gorham's disease is a rare vanishing bone disease characterized by massive osteolysis and replacement with numerous wide engorged capillaries. The exact nature and effective treatment modalities for this condition are as yet unclear. A fifty-years old female, who had unexplained destruction of the left shoulder joint, was diagnosed as having Gorham's disease according to histopathological (capillary tissue aggregation) and immunopathological (immunoreactions with IL-1and IL-6) studies. Although we treated her with antiresorptive medication and radiotherapy, which are current treatment modalities, the destructive process progressed. We report upon this case and provide a review of its literature.

Study design : Clinical significance of space-occupying ratio according to MRI finding in lumbar disc herniation. Objectives : To estimate relationship between patient’s symptoms and space-occupying ratio in herniated lumbar vertebral disc in MRI according to JOA scoring system. Summary of literature review : Using MRI, herniated intervertebral disc may be estimated with the extent of derangement of the constituents of the disc. Symptoms and signs did not correlate with the degree of reduction of the herniation in MRI. Material and Method : A retrospective analysis was performed upon 99 patients that underwent lumbar spine MRI. The degree of the occupied spinal canal was measured by ‘Space-occupying ratio’, which was the ratio of the longitudinal diameter at the spinal canal to the longitudinal diameter at the herniated nucleus purposus. Each ‘30% Space-occupying ratio’ to ‘50% Spaceoccupying ratio’ was classified to analysis I, analysis II. Under the percent was group A, above the percent was group B. We estimate the patient’s condition related with lower back pain according to JOA scoring system. Results : The herniation type of the nucleus purposus was classified to 5 protruded type, 62 subligamentous extruded type, 22 transligamentous extruded type, 10 sequestral type. The patients who have above 30% were 62 cases, under 30% were 26 cases in analysis I, have above 50% were 19 cases, under 50% were 69 cases in analysis II. So, there was not distinguished from analysis I to analysis II according to the degree of the herniation. Mean JOA score was 9.307 in group A, mean JOA score was 9.370 in group B in analysis I. Mean JOA score was 9.391 in group A, mean JOA score was 9.315 in group B in analysisII. There was not correlate statistically with analysisI(p value=0.5669) and analysis II(p value=0.5390) using the Wilcoxon score test. Conclusion : There was not correlate statistically with the degree of the herniation in lumbar spine MRI according to JOA scoring system.

‐ Abstract ‐ Design : A retrospective study was performed in isthmic and degenerative spondylolisthesis patients who had undergone posterolateral fusion (PLF) only (group Ⅰ) or posterolateral fusion (PLF) with posterior lumbar interbody fusion (PLIF) (group Ⅱ). Objectives : The objective of this study was to help in the selection of a surgical treatment option for spondylolisthesis. Summary of Literature Review : Irrespective of whether groupⅠ or groupⅡ, satisfactory results have been reported in the surgical treatment of spondylolisthesis. However, isthmic and degenerative types have not been investigated in terms of outcome. Material and Methods : We analyzed 112 patients (Isthmic: groupⅠ(32), groupⅡ(22), Degenerative : groupⅠ(37), groupⅡ(21)) who underwent surgical treatment for spondylolisthesis between April 1995 and December 2000. Kirkaldy-Willis criteria, radiologic union state, reduction ratio of slippage, change of disc space and change of segmental angle were analyzed as indicators of outcome. Results : We found the following by radiologic analysis: In isthmic spondylolisthesis, groupⅡ was better than groupⅠ in terms of reduction ratio of slippage (reduction loss:3.38% vs. 2.3%, P=0.15), change of segmental angle (reduction loss : 2.11 ° vs. 1.6° , P=0.15), bone union (83% vs. 92%, P=0.45) and change of disc space (reduction loss : 2.83 mm vs. 1.9 mm, P=0.02). In the degenerative spondylolisthesis, groupⅡ did not show significant difference from groupⅠ in terms of reduced slippage (reduction loss: 3.8% vs. 3.85%, P=0.47), change of segmental angle (reduction loss: 2.73。vs. 2.64。 , P=0.43), bone union (80% vs. 87%, P=0.72) or disc height (reduction loss: 3.2 mm vs. 3.14 mm, P=0.45). In terms of clinical outcome, groupⅡ was better than groupsⅠ in cases of isthmic spondylolisthesis (fair≤:85% vs. 93%, P=0.72), however, groupsⅡ was not better than groupsⅠ in cases of degenerative spondylolisthesis (fair≤:83% vs. 85%, P=0.23). Conclusions : In the degenerative spondylolisthesis patient, no significant difference was found between groupⅠ and groupⅡ, but in the isthmic spondylolisthesis patient, groupⅠ and groupⅡ were found to be significantly different in terms of the reduction ratio of the disc heights.

Study design : The metal failure of pedicle screw system followed by posterolateral or posterior fusion used in variable cases(spine fracture, degenerative disorder of spine, deformity of spine) was analyzed retrospectively. Purpose : The goal of this study was to analyze frequency and clinical consequence of pedicle screw fixation system failure in the treatment of different etiology(spine fracture, degenerative disorder, deformity of spine) and to evaluate affected factors in metal failure. Materials and Methods : We performed survivorship analysis on 442 patients treated with pedicle screw system from September 1990 to December 1999. The average follow-up period was 54 months(from 18 months to 129 months). As affected factors, some variables such as etiology, kinds of system and extent of fusion were subjected to analyzed their influence on metal failure. We also performed analysis about relationship between metal failure and clinical results. We defined the metal failure as 1) breakage of screw or rod 2) screw bending above 5 degrees 3) dissociation of rod-screw coupling system and 4) screw pull out from vertebral body or pedicle. Results : We found out 33 cases of metal failure: among 2786 screws, 41 screws had a problem. The metal failure rate was different between each etiology ; 12 cases in fracture(10%), 21 cases in degenerative disorder(6.9%). There was also difference between a kinds of implants; 13 cases in side assembling type(5.4%), 20 cases in back open type(10.5%). However, there were no difference according to extent of fusion; 6 cases in one segment(6.9%), 21 cases in two segments(8.1%), 6 cases in more than three segments(6.3%). Among the overall patients with metal failure (33 cases), only eight patients were complaint significant symptoms. And three of this eight patients were improved after reoperation The mean interval to metal failure was 14.4 months from operation. Conclusion : The metal failure was more common in spine fracture(p 0.05). And metal failure did not significantly affect the clinical results(p>0.05).