Ki Tack Kim

Osteotomy of the Spine to Correct the Spinal Deformity

There are a number of reports on Smith-Petersen osteotomy (SPO), pedicle subtraction osteotomy (PSO) and vertebral column resection (VCR). However, there are few systematic reviews of all three kinds of osteotomies. Literature review and authors experience of SPO, PSO and VCR osteotomy will be described. Various surgical techniques can be applied according to the disease entity and magnitude of the deformity. The most appropriate methods for deformity correction should be chosen and the potential complications should be considered. Before attempting an osteotomy of the spine for a spinal deformity, sufficient surgical experience and a thorough understanding of the anatomy of the spine and adjacent structures are needed. In addition, a well-organized team with the other departments is essential.

Association of COL2A1 Gene Polymorphism with Degenerative Lumbar Scoliosis

Background Degenerative lumbar scoliosis (DLS) progresses with aging after 50-60 years, and the genetic association of DLS remains largely unclear. In this study, the genetic association between collagen type II alpha 1 (COL2A1) gene and DLS was investigated. Methods COL2A1 gene polymorphism was investigated in DLS subjects compared to healthy controls to investigate the possibility of its association with COL2A1 gene. Based on a single nucleotide polymorphism (SNP) database, SNP (rs2276454) in COL2A1 were selected and genotyped using direct sequencing in 51 patients with DLS and 235 healthy controls. The SNP effects were analyzed using three models of codominant, dominant, and recessive. Logistic regression models were calculated for odds ratios (ORs) with 95% confidence intervals (CIs) and corresponding p-values, controlling age and gender as co-variables. Results SNP (rs2276454) in COL2A1 was significantly associated with the degenerative lumbar scoliosis in the codominant (OR, 1.90; 95% CI, 1.17 to 3.10; p = 0.008) and dominant models (OR, 3.58; 95% CI, 1.59 to 9.29; p = 0.001). Conclusions The results suggest that COL2A1 is associated with the risk of DLS in Korean population.

Surgical Experience of Neglected Lower Cervical Spine Fracture in Patient with Ankylosing Spondylitis

The management of lower cervical fractures in patients with ankylosing spondylitis (AS) differs from normal cervical fractures. Patients with AS are highly susceptible to extensive neurologic injuries and spinal deformities after cervical fractures from even minor traumatic forces. These injuries are uniquely complex, require careful imaging assessment, and aggressive surgical management to optimize spinal stability and functional outcomes.

Association of Interferon Gamma Polymorphism with Ossification of the Posterior Longitudinal Ligament in the Korean Population

In this study, we investigated whether genetic polymorphisms of the interferon gamma (IFNG) gene were associated with the susceptibility of ossification of the posterior longitudinal ligament (OPLL) in the Korean population. To observe the association between the IFNG gene and the susceptibility of OPLL, we genotyped 135 OPLL patients and 222 control subjects for a single nucleotide polymorphism (SNP, rs2430561) and a microsatellite (CAn repeats, rs3138557) located in the first intron of the IFNG gene, using the direct sequencing and gene scan method. The numbers of microsatellites (CA13 and CA15) were significantly changed in the OPLL patients. A combined analysis of the genotype of rs2430561 and the number of microsatellites revealed that the OPLL was associated with frequencies of CA13-AA, CA15-AA and CA15-AT. Our results suggest that the IFNG gene may be one of the factors determining the OPLL in the Korean population. However, larger collaborative and biological studies are needed to confirm these results.

Surgical correction in patients with lumbar degenerative kyphosis who had low bone mineral density: an analysis of 40 patients with a minimum follow-up of two years.

Study Design Retrospective study. Purpose To investigate influence of bone mineral density (BMD) on the surgical correction of lumbar degenerative kyphosis (LDK). Overview of Literature No studies so far have reported the influence of BMD on the surgical correction of LDK. Methods Forty LDK patients with more than 2 years follow-up were studied. Pelvic incidence (PI), pelvic tilt, sacral slope, sagittal vertical axis (SVA), lumbar lordosis (LL), and thoracic kyphosis were measured preoperatively, immediate postoperatively and at final follow-up. Adverse outcomes: proximal adjacent fractures, sagittal decompensation, pseudoarthrosis, and cage subsidence were documented. Results There were 37 females and 3 males. Average age was 65.1±4.5 years and mean follow-up was 34.2±16.7 months. 42.5% were Takemitsu type 3 curves, 27.5% type 2, 20.0% type 4 and 10.0% type 1. 37.5% had osteopenia, 40.0% osteoporosis and 22.5% had severe osteoporosis. SVA improved from 237.0±96.7 mm preoperatively to 45.3±41.8 mm postoperatively (p=0.000). LL improved from 10.5°±14.7° to -40.6°±10.9° postoperatively (p=0.000). At final follow-up SVA deteriorated to 89.8±72.2 mm and LL to 34.7°±15.8° (p=0.000). The association between late sagittal decompensation, pseudoarthrosis, or proximal adjacent fractures and osteoporosis was insignificant. The difference between immediate postoperative LL and PI (PIDiff) had a significant association with sagittal decompensation and pseudoarthrosis. Conclusions Osteoporosis did not influence the degree of correction, late sagittal decompensation, proximal adjacent fractures, and pseudoarthrosis in LDK. PIDiff had a significant association with sagittal decompensation and pseudoarthrosis.

Restoration of Lumbar Lordosis in Flat Back Deformity: Optimal Degree of Correction

Study Design A retrospective comparative study. Purpose To provide an ideal correction angle of lumbar lordosis (LL) in degenerative flat back deformity. Overview of Literature The degree of correction in degenerative flat back in relation to pelvic incidence (PI) remains controversial. Methods Forty-nine patients with flat back deformity who underwent corrective surgery were enrolled. Posterior-anterior-posterior sequential operation was performed. Mean age and mean follow-up period was 65.6 years and 24.2 months, respectively. We divided the patients into two groups based on immediate postoperative radiographs-optimal correction (OC) group (PI-9°≤LL<PI+9°) and under-correction (UC) group (LL<PI-9°). We also classified the patients according to the PI of each patient-low PI group (PI<55°) and high PI group (PI≥55°). Radiological and clinical results were analyzed. Results Patients in OC group had significantly less correction loss and maintained normal sagittal alignment (sagittal vertical axis<5 cm), as compared to patients in UC group (p<0.05). LL of low PI group significantly maintained within 9° better than high PI group (p<0.05). Oswestry disability index (ODI) significantly decreased at last follow-up, as compared to preoperative state. However, there was no significant difference in last follow-up ODI between the groups. Conclusions In flat back deformity, correction of LL to within 9° of PI will result in better sagittal balance. Thus, we recommend sufficient LL to prevent correction loss, especially in patients with high PI.

Three Different Methods in Deformity Correction of Degenerative Flat Back: A Single Surgeon's Experience with 64 Consecutive Cases

Study Design Retrospective study. Purpose To evaluate the radiological and clinical results of three different methods in the deformity correction of a degenerative flat back. Overview of Literature There are no comparative studies about different procedures in the treatment of degenerative flat back. Methods Sixty-four patients who consecutively underwent corrective surgery for degenerative flat back were reviewed. The operations were performed by three different methods: posterior-only (group P, n=20), one-stage anterior-posterior (group AP, n=12), and two-stage anterior-posterior with iliac screw fixation (group AP-I, n=32). Medical and surgical complications were examined and radiological and clinical results were compared. Results The majority of medical and surgical complications were found in group AP (5/12) and group P (7/20). The sagittal vertical axes were within normal range immediately postoperatively in all groups, but only group AP-I showed normal sagittal alignment at the final follow-up. Postoperative lumbar lordosis was also significantly higher in group AP-I than in group P or group AP and the finding did not change through the last follow-up. The Oswestry disability index was significantly lower in groups AP and AP-I than in group P at the final follow-up. Meanwhile, the operating time was the longest in group AP-I, and total amount of blood loss was larger in group AP-I and group AP than in group P. Conclusions Anterior-posterior correction showed better clinical results than posterior-only correction. Two-staged anterior-posterior correction with iliac screw fixation showed better radiological results than posterior-only or one-staged anterior-posterior correction. Two-staged anterior-posterior correction with iliac screw fixation also showed a lower complication rate than one-staged anterior-posterior correction.

The State of the Art in Minimally Invasive Spine Surgery

1Department of Orthopedic Surgery, Taipei Medical University Hospital, Taipei, Taiwan 2Department of Orthopedics, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan 3Department of Orthopedic Surgery, Kyung Hee University Hospital at Gangdong, Seoul, Republic of Korea 4Department of Orthopedic Surgery, Osaka City University Graduate School of Medicine, Osaka, Japan 5University of New Mexico School of Medicine, Albuquerque, NM, USA 6Desert Institute for Spine Care, Phoenix, AZ, USA 7Department of Orthopedics, West China Hospital of Sichuan University, Chengdu, China