Eung-Ha Kim

Radiographic Progression of Degenerative Lumbar Scoliosis after Short Segment Decompression and Fusion

Study Design A retrospective study. Purpose To assess the radiographic progression of degenerative lumbar scoliosis after short segment decompression and fusion without deformity correction. Overview of Literature The aims of surgery in degenerative lumbar scoliosis are the relief of low back and leg pain along with a correction of the deformity. Short segment decompression and fusion can be performed to decrease the level of low back and leg pain provided the patient is not indicated for a deformity correction due to medical problems. In such circumstance, the patients and surgeon should be concerned with whether the scoliotic angle increases postoperatively. Methods Forty-seven patients who had undergone short segment decompression and fusion were evaluated. The average follow-up period was more than 3 years. The preoperative scoliotic angle and number of fusion segments was 13.6±3.9° and 2.3±0.5, respectively. The preoperative, postoperative and last follow-up scoliotic angles were compared and the time of progression of scoliotic angle was determined. Results The postoperative and last follow-up scoliotic angle was 10.4±2.3° and 12.1±3.6°, respectively. In eight patients, conversion to long segment fusion was required due to the rapid progression of the scoliotic angle that accelerated from 6 to 9 months after the primary surgery. The postoperative scoliosis aggravated rapidly when the preoperative scoliotic angle was larger and the fusion was extended to the apical vertebra. Conclusions The scoliotic angle after short segment decompression and fusion was not deteriorated seriously in degenerative lumbar scoliosis. A larger scoliotic angle and fusion to the apical vertebra are significant risk factors for the acceleration of degenerative lumbar scoliosis.

En Bloc Partial Laminectomy and Posterior Lumbar Interbody Fusion in Foraminal Spinal Stenosis

Study Design A retrospective study. Purpose An en bloc partial laminectomy and posterior lumbar interbody fusion (PLIF) in spinal stenosis patients with severe foraminal narrowing has a shorter operation time, less neural manipulation and allows indirect decompression by restoring the interforaminal height compared to other procedures. This study investigated the efficacy of the procedure. Overview of Literature PLIF is one of the most popular surgery for degenerative spine such as foraminal spinal stenosis, instability spondylolisthesis and discogenic pain. Various techniques for PLIF have their own advantages and disadvantages. But in some severe cases, we need an efficient method of PLIF for decompression and fusion. Methods This study examined 61 patients, who had 85 levels treated with PLIF using an en bloc partial laminectomy and facetectomy, and could be followed up for more than 2 years. The mean age of the patients and mean follow up period was 66 years and 39 months, respectively. The clinical results were evaluated using the MacNabs criteria, Visual Analogue Scale (VAS) score, and Korea Version Oswestry Disability Index (KODI). The union of the intervertebral space was evaluated using Lenkes criteria. The intervertebral angle and height of the posterior intervertebral disc were also measured. Results Excellent and good results were obtained in 54 cases (89%) according to MacNabs criteria. The VAS and KODI scores were 8.1 and 34.6, preoperatively, and 3.4, and 14.1, postoperatively. Bone union was A and B grades according to Lenkes criteria in 57 cases. The mean segmental angle and mean height of the posterior disc were respectively, 7.4° and 6.5 mm preoperatively, 9.1° and 10.6 mm postoperatively, and 8.0° and 9.7 mm in the last follow-up. There were 5 cases of postoperative infection, 4 cases of junctional problems and 1 case of screw malposition. Conclusions En bloc partial laminectomy and PLIF is an effective method for treating severe spinal stenosis with foraminal narrowing.