Sang-Ki Chung

Validation of the Korean version of the oswestry disability index.

Study Design. Validation of a translated, culturally adapted questionnaire. Objectives. To translate and culturally adapt a Korean version of the Oswestry Disability Index (ODI) and to validate its use in Korean patients. Summary of Background Data. The ODI is one of the most widely used and validated instruments for measuring disability in spinal disorders. However, no validated Korean version of the index was available at the time our study was initiated. Methods. The study was carried out in three phases: the first was translation into Korean and cultural adaptation of the questionnaire; the second was a pilot study to assess the comprehensibility of the prefinal version and modification; the third was a reliability and validity study of the final version. The Korean version was tested on 206 patients with lumbar spinal disorders who had undergone operations at the authors’ institute. Test-retest reliability, internal consistency, concurrent validity, and construct validity were investigated. Follow-up questionnaires were obtained from 39 patients at the 3-month postoperative follow-up meeting. Differences in the ODI, visual analog scale (VAS), and World Health Organization (WHO) quality of life assessment (WHOQOL-BREF) between preoperative and follow-up questionnaires were evaluated. The correlation of the postoperative ODI with the pain rating on a visual analog scale and WHOQOL-BREF was also analyzed. Results. Test-retest reliability was assessed with 88 patients in a time interval of 48 hours. The intraclass correlation coefficient of test-retest reliability was 0.9167. Reliability estimated by the internal consistency reached a Cronbach’s alpha of 0.84. The correlation of the preoperative ODI with the pain rating on a visual analog scale (100 mm) was r = 0.425 (P = 0.0001). The correlation between three of the WHOQOL-BREF domains (physical health, psychological health, and environment) and the ODI was statistically significant. The correlation coefficient between the ODI and physical health domain of the WHOQOL-BREF was r = −0.48 (P < 0.05). The correlations with psychological health and environment domains were low with r = −0.192 and −0.160, respectively, even though statistically significant (P < 0.05). The correlation of the postoperative ODI with the pain rating on a visual analog scale (100 mm) was r = 0.626 (P = 0.0001). The correlation between all four domains of the WHOQOL-BREF and the postoperative ODI was statistically significant. Conclusions. The results of this study indicate that the Korean version of the ODI is a reliable and valid instrument for the measurement of disability in Korean patients with lower back problems. The authors recommend this Korean version of the ODI for use in future clinical studies in Korea.

Cervical transforaminal epidural steroid injection for the management of cervical radiculopathy: a comparative study of particulate versus non-particulate steroids

ObjectiveTo determine if a particulate steroid which has a risk for embolic infarct would be more effective than a non-particulate steroid for transforaminal epidural steroid injection (TFESI). The purpose of this study was (1) to compare the effect of cervical TFESI using particulate (e.g., triamcinolone) and non-particulate (e.g., dexamethasone) steroids and (2) to evaluate the effectiveness of cervical TFESI in general.Materials and methodsFrom January 2006 to August 2008, 159 consecutive patients [male:female (M:F) 89:70; mean age 53xa0years, range 33–75xa0years] who underwent cervical TFESI were included in this non-randomized study. For cervical TFESI, triamcinolone was injected into 97 patients and dexamethasone into 62 patients. Short-term follow-up was conducted within 1xa0month. The outcome was classified as effective or ineffective. Fisher’s exact test was used to analyze the difference of outcome according to the injected steroid (triamcinolone vs dexamethasone). Other possible outcome predictors, such as age, gender, duration of radiculopathy, predominant symptom, attack of radiculopathy, cause of radiculopathy, number of nerve root compression levels, previous operation, and failure of previous interlaminar epidural injection, were also analyzed.ResultsCervical TFESI using triamcinolone (78/97, 80.4%) was slightly more effective than that using dexamethasone (43/62, 69.4%), which was not significant (Pu2009=u20090.129). In general, cervical TFESIs were effective in 121 of 159 patients (76.1%) at short-term follow-up. The only significant outcome predictor was whether the patient had had a previous operation (6/13, 46/2%) or not (115/146, 78.8%) (Pu2009=u20090.015).ConclusionThere was no significant difference between particulate or non-particulate steroid for the effect of cervical TFESI. Cervical TFESI was effective in managing cervical radiculopathy in general.

Minimum 2-year follow-up result of degenerative spinal stenosis treated with interspinous u (coflex).

OBJECTIVEnClinical and radiological results of posterior dynamic stabilization using interspinous U (ISU, Coflex, Paradigm Spine Inc.(R), NY, USA) were analyzed in comparison with posterior lumbar interbody fusion (PLIF) in degenerative lumbar spinal stenosis (LSS).nnnMETHODSnA retrospective study was conducted for a consecutive series of 61 patients with degenerative LSS between May 2003 and December 2005. We included only the patients completed minimum 24 months follow up evaluation. Among them, 30 patients were treated with implantation of ISU after decompressive laminectomy (Group ISU) and 31 patients were treated with wide decompressive laminectomy and posterior lumbar interbody fusion (PLIF; Group PLIF). We evaluated visual analogue scale (VAS) and Oswestry Disability Index (ODI) for clinical outcomes (VAS, ODI), disc height ratio disc height (DH), disc height/vertebral body length x100), static vertebral slip (VS) and depth of maximal radiolucent gap between ISU and spinous process) in preoperative, immediate postoperative and last follow up.nnnRESULTSnThe mean age of group ISU (66.2 +/- 6.7 years) was 6.2 years older than the mean age of group PLIF (60.4 +/- 8.1 years; p = 0.003 ). In both groups, clinical measures improved significantly than preoperative values (p < 0.001). Operation time and blood loss was significantly shorter and lower in group ISU than group PLIF (p < 0.001). In group ISU, the DH increased transiently in immediate postoperative period (15.7 +/- 4.5% --> 18.6 +/- 5.9%), however decreased significantly in last follow up (13.8 +/- 6.6%, p = 0.027). Vertebral slip (VS) of spondylolisthesis in group ISU increased during postoperative follow-up (2.3 +/- 3.3 --> 8.7 +/- 6.2, p = 0.040). Meanwhile, the postoperatively improved DH and VS was maintained in group PLIF in last follow up.nnnCONCLUSIONnAccording to our result, implantation of ISU after decompressive laminectomy in degenerative LSS is less invasive and provides similar clinical outcome in comparison with the instrumented fusion. However, the device has only transient effect on the postoperative restoration of disc height and reduction of slip in spondylolisthesis. Therefore, in the biomechanical standpoint, it is hard to expect that use of Interspinous U in decompressive laminectomy for degenerative LSS had long term beneficial effect.

Imaging features suggestive of a conjoined nerve root on routine axial MRI

ObjectiveThe purpose of our study is to evaluate imaging features suggestive of a conjoined nerve root on routine axial MRI.MethodsTwo radiologists and two surgeons retrospectively reviewed the MRI of three cases in which a conjoined nerve root was discovered during operation and found three suggestive signs on routine axial MR images: “corner” (asymmetric morphology of the anterolateral corner of the dural sac), “fat crescent” (intervening extradural fat between the asymmetric dura and the nerve root), and “parallel” signs (visualization of the entire parallel course of the nerve root at the disc level). Two radiologists prospectively found these signs during routine MRI interpretation sessions over a period of 6xa0months. If one or a combination of signs were noted on axial MR images, contiguous axial scans were additionally obtained. Three cases that were previously found during operations were also included. Prevalence and confidence scores for each sign were assessed on axial T1- and T2-weighted images.ResultsTwelve patients showed one or a combination of the three signs, 9 had contiguous axial MR scans. Five cases were confirmed by operation. The prevalence of the corner, fat crescent, and parallel signs were 12 out of 12 (100%), 6 out of 12 (50%), and 8 out of 12 (67.7%) on axial T1-weighted images. The overall diagnostic confidence was higher on T1- than on T2-weighted images (Pu2009<u20090.05).ConclusionOn routine axial L-spine MRI, corner, fat crescent, and parallel signs are suggestive of and assist in the recognition of a conjoined nerve root.

Percutaneous vertebroplasty for intravertebral cleft: analysis of therapeutic effects and outcome predictors

ObjectiveTo investigate the short-term therapeutic effect of percutaneous vertebroplasty (PVP) for intravertebral cleft (IVC) and to analyze possible outcome predictors.Materials and MethodsAfter retrospective review of spot radiographs during PVP, 23 patients were included in this study. Age, sex, symptom duration, functional status, injected cement volume, and type of approach were evaluated using patients’ medical and operative records. The following factors were analyzed on radiographs, MRI, dual bone densitometry, spot radiographs during PVP, and CT: anatomical location of the fracture, bone mineral density, morphology of the fracture, IVC morphology, presence of surrounding non-enhanced area and bone marrow edema, degeneration of adjacent discs, co-existing old compression fractures, patterns of cement opacification, pre-procedural kyphosis, and post-procedural kyphosis correction. Effectiveness was defined as a much-improved state or no pain after 1xa0week, 1xa0month, and 2xa0months. Statistical analyses were conducted to evaluate the relationship between those factors and therapeutic outcome using Fisher’s exact test, Chi-squared test, and the Mann–Whitney U test.ResultsPercutaneous vertebroplasty of IVC was effective in 16 out of 23 (69.6%) patients after 1xa0week and 1xa0month and 15 out of 23 (65.2%) patients after 2xa0months. Post-procedural kyphosis correction ≥5˚ and poor functional status (full dependency) were more common in the ineffective group after 1xa0week and 2xa0months respectively (Pu2009=u20090.047, Pu2009=u20090.02). Kyphotic correction ≥5˚ was related to pre-procedural kyphosis xa0≥15˚ (Pu2009=u20090.018). Functional status was related to subsequent fracture (Pu2009=u20090.005). Other factors were not statistically significant (Pu2009>u20090.05).ConclusionsPercutaneous vertebroplasty on osteoporotic vertebral compression fractures (VCF) with IVC was effective in only about 69.6% of patients after the first week and month and in 65.2% of patients after 2xa0months. Post-procedural kyphosis correction ≥5˚ was associated with poor outcomes after the first week. Twoxa0months after PVP, the functional status was more important because of the development of subsequent fractures.

Clinical analysis of thoracic ossified ligamentum flavum without ventral compressive lesion.

The aim of this study was to analyze the clinical characteristics of thoracic ossified ligamentum flavum (OLF) and to elucidate prognostic factors as well as effective surgical treatment modality. The authors analyzed 106 thoracic OLF cases retrospectively from January 1999 to December 2008. The operative (nxa0=xa040) and the non-operative group (nxa0=xa066) were diagnosed by magnetic resonance imaging (MRI) and/or computed tomography (CT) imaging. We excluded cases exhibiting ventral compressive lesions causing subarachnoid space effacement in thoracic vertebrae as well as those with a coexisting cervical compressive myelopathy. Those in the operative group were treated with decompressive laminectomy as well as resection of OLF. The preoperative neurologic status and postoperative outcomes of patients, as indicated by their modified Japanese Orthopedic Association (mJOA) scores and recovery rate (RR), Modic changes, the axial (fused or non-fused) and sagittal (omega or beak) configurations of OLF, and the ratios of the cross-sectional area (CSA) and anteroposterior diameter (APD) of the most compressed level were studied. The most commonly affected segment was the T10–11 vertebral body level (nxa0=xa049, 27.1%) and the least affected segment was the T7–8 level (nxa0=xa01, 0.6%). The ratios of the CSA in non-fused and fused types were 77.3 and 59.3% (pxa0<xa00.001). When Modic changes were present with OLF, initial mJOA score was found to be significantly lower than those without Modic change (7.62 vs. 9.09, pxa0=xa00.033). Neurological status improved after decompressive laminectomy without fusion (preoperative vs. last mJOA; 7.1xa0±xa02.01 vs. 8.57xa0±xa01.91, pxa0<xa00.001). However, one patient exhibited transient deterioration of her neurological status after surgery. In the axial configuration, fused-type OLF revealed a significant risk for a decreased postoperative mJOA score (0–7, severe and moderate) (Odds ratio: 5.54, χ2xa0=xa04.41, pxa0=xa00.036, 95% CI: 1.014–30.256). The results indicated that the new categorization of axial-type of OLF is a helpful predictor of postoperative patient outcome and fused type was related with poor prognosis. In OLF cases free from ventral lesions compressing the spinal cord, decompressive laminectomy is enough for successful surgical outcome. Therefore, early surgical treatment will be considered in cases with fused-type OLF compressing spinal cord even though they do not have myelopathic symptoms.

Spinal intraosseous schwannoma : a case report and review.

A case of spinal intraosseous schwannoma (SIS) in the lumbar vertebra is reported. Clinical and radiologic characteristics of 16 reported cases of SIS were reviewed. SIS can be a rare differential diagnosis for intraosseous tumors.