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Choi SJ, Kang DWD, Ham CH, Kim JH, Kwon WK. Full endoscopic surgery for calcium pyrophosphate deposition disease (CPPD) in the cervical ligamentum flavum: report of two cervical myelopathy cases. Acta Neurochir (Wien) 2024; 166:185. [PMID: 38639798 DOI: 10.1007/s00701-024-06080-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2024] [Accepted: 04/11/2024] [Indexed: 04/20/2024]
Abstract
Calcium pyrophosphate deposition disease (CPPD), known as pseudogout, is characterized by the accumulation of calcium pyrophosphate crystals in musculoskeletal structures, primarily joints. While CPPD commonly affects various joints, involvement in the cervical spine leading to myelopathy is rare. Surgical intervention becomes necessary when conservative measures fail, but reports on full endoscopic surgeries are extremely rare. We present two successful cases where full endoscopic systems were used for CPPD removal in the cervical spine. The surgical technique involved a full endoscopic approach, adapting the previously reported technique for unilateral laminotomy bilateral decompression. Full-endoscopic removal of cervical CPPD inducing myelopathy were successfully removed with good clinical and radiologic outcomes. The scarcity of endoscopic cases for cervical ligamentum flavum CPPD is attributed to the condition's rarity. However, our successful cases advocate for endoscopic surgery as a potential primary treatment option for CPPD-induced cervical myelopathy, especially in elderly patients or those with previous cervical operation histories. This experience encourages the consideration of endoscopic surgery for managing cervical ligamentum flavum CPPD as a viable alternative.
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Affiliation(s)
- Seung Jin Choi
- Department of Neurosurgery, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Republic of Korea
| | | | - Chang Hwa Ham
- Department of Neurosurgery, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Republic of Korea
| | - Joo Han Kim
- Department of Neurosurgery, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Republic of Korea
| | - Woo-Keun Kwon
- Department of Neurosurgery, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Republic of Korea.
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An S, Kwon WK, Choi I, Lee JB, Kim J, Hur JW. Evaluating the Efficacy and Safety of Hemofence (Thorombin Cross-linked Sodium Hyaluronate Gel Matrix) in Hemostasis for Intractable Exudative Bleeding in Spinal Surgery: A Multicenter, Randomized, Phase III Clinical Trial. Neurospine 2024:ns.2448024.012. [PMID: 38575113 DOI: 10.14245/ns.2448024.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2024] [Accepted: 02/22/2024] [Indexed: 04/06/2024] Open
Abstract
Objective To demonstrate the non-inferiority of the novel hemostatic agent, Hemofence® (BMI Korea Co. Ltd., Jeju Korea, thrombin cross-linked sodium hyaluronate gel matrix) compared to the established agent, Floseal Hemostatic Matrix (Baxter, thrombin-gelatin matrix) in achieving hemostasis for spinal surgeries, with secondary objectives to assess additional efficacy and safety. Methods This clinical trial was a multicenter, randomized, subject-blinded, active-controlled, parallel-group, phase 3 study. Investigational drugs were administered to the first and second bleeding sites of each participant (or only to the first site if a second site was absent), evaluating hemostasis success rate within 10 minutes and the time to achieve hemostasis. Subsequent visits were conducted for safety assessments. For non-inferiority test, a 97.5% one-sided confidence interval was used; the test group was deemed non-inferior if the lower limit exceeded -10%. Results This trial showed a 97.10% success rate in the test group and 96.05% in the control group for primary efficacy. The 95% confidence interval (-4.90%, 7.44%) confirmed the test drug's non-inferiority. Time to hemostasis showed no significant difference between groups. All adverse events, adverse drug reactions, and serious adverse events were statistically similar between groups (p=1.0000, p=0.2427, and p=0.9663, respectively). Conclusion A novel hemostatic agent, Hemofence®, demonstrated an efficacy and safety profile comparable to that of Floseal.
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Affiliation(s)
- Sungjae An
- Department of Neurosurgery, Korea University Anam Hospital, Korea University College of Medicine, Seoul, Korea
| | - Woo-Keun Kwon
- Department of Neurosurgery, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Korea
| | - Il Choi
- Department of Neurosurgery, Dongtan Sacred Heart Hospital, Hallym University College of Medicine, Hwaseong, Korea
| | - Jang-Bo Lee
- Department of Neurosurgery, Korea University Anam Hospital, Korea University College of Medicine, Seoul, Korea
- Department of Neurosurgery, University of Iowa Hospitals & Clinics, Iowa City, IA, USA
| | - Joohyun Kim
- Department of Neurosurgery, Korea University Anam Hospital, Korea University College of Medicine, Seoul, Korea
| | - Junseok W Hur
- Department of Neurosurgery, Korea University Anam Hospital, Korea University College of Medicine, Seoul, Korea
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Kwon WK, Theologis AA, Kim JH, Moon HJ. Lumbar fusion surgery in the era of an aging society: analysis of a nationwide population cohort with minimum 8-year follow-up. Spine J 2024:S1529-9430(24)00109-8. [PMID: 38499063 DOI: 10.1016/j.spinee.2024.03.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2023] [Revised: 02/04/2024] [Accepted: 03/12/2024] [Indexed: 03/20/2024]
Abstract
BACKGROUND CONTEXT Fusions for lumbar spine diseases are widely performed and have a growing incidence, especially in elderly population. PURPOSE The goal of this study was to assess national trends of lumbar spinal fusions and examine the risk for re-operations after a lumbar fusion with a focus on 'epidemiologic transition' relating to age. STUDY DESIGN/SETTING The prospectively collected Korean Health Insurance Review and Assessment Service (HIRA) nationwide cohort database was retrospectively reviewed. PATIENT SAMPLE The total 278,815 patients who underwent lumbar spinal fusions for degenerative spine diseases between 2010 and 2018 were reviewed and used to assess trends in operative incidence. The 37,050 patients who underwent lumbar fusions between 1/2010 and 12/2011 were enrolled to determine 8-year reoperation rates. OUTCOME MEASURES The overall number of lumbar spinal fusions were analyzed for the national annual trend. Demographic data, reoperation rates, and confounding clinical factors were evaluated. METHODS The overall number of lumbar spinal fusions was analyzed to determine the national annual trend of operative incidence. For the reoperation rate analysis, the primary outcome measured was the cumulative incidence of revision operations within a minimum 8-year follow-up period. Additional outcomes included comparative analyses of the reoperation rate with respect to age, sex, or other underlying comorbidities. RESULTS Over time, elderly patients comprised a larger portion of the cohort (2010:24.2%; 2018:37.6%), while operations in younger patients decreased over time (2010:40.3%; 2018:27.0%). In the cohort of patients with a minimum 8-year follow-up (n=37,050), rates of reoperation peaked in patients aged 60-69 years (17.6 per 1000 person-years [HR 2.20 compared to <40years]) and decreased for more elderly patients (14.3 per 1000 person-years [HR 1.80 compared to <40years]). Age was the most significant risk factor for reoperation. Osteoporosis was also a risk factor for reoperation in post-menopausal females. CONCLUSIONS Increasing incidence of lumbar fusions in elderly patients was seen however the risk of reoperation decreased in patients aged 70 or more. Lumbar fusion for elderly patients should not be hesitated in the decision-making process because of concerns about reoperation.
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Affiliation(s)
- Woo-Keun Kwon
- Department of Neurosurgery, Korea University Guro Hospital, Korea University College of Medicine, 148 Gurodongro, Gurogu, Seoul 08308, Republic of Korea
| | - Alekos A Theologis
- Department of Orthopedic Surgery, University of California - San Francisco (UCSF), 500 Parnassus Ave, MUW 3rd Floor, San Francisco, CA 94143, USA
| | - Joo Han Kim
- Department of Neurosurgery, Korea University Guro Hospital, Korea University College of Medicine, 148 Gurodongro, Gurogu, Seoul 08308, Republic of Korea
| | - Hong Joo Moon
- Department of Orthopaedic Surgery, Washington University in St. Louise, 660 S. Euclid, St. Louise, MO 63110, USA.
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Choi SJ, Seo D, Ham CH, Kim JH, Kwon WK. A quantitative analysis of surgical smoke-derived particulate matter and formaldehyde exposure during spine surgery: a possible occupational hazard. J Neurosurg Spine 2024; 40:395-402. [PMID: 38100756 DOI: 10.3171/2023.10.spine23806] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2023] [Accepted: 10/11/2023] [Indexed: 12/17/2023]
Abstract
OBJECTIVE Since its introduction, electrocautery has served as a valuable surgical tool, enabling precise tissue cutting and effective hemostasis in spine surgery. While there have been numerous efforts to elucidate the possible hazardous effects of surgical smoke in various surgical fields, there has been very little discussion in the context of spine surgery. The objective of this study was to measure and conduct a quantitative analysis of the particulate matter (PM) of different sizes and of formaldehyde (HCHO) generated by smoke during spine surgeries. METHODS This study included a consecutive series of patients who underwent 1- or 2-level lumbar spinal fusion surgery between June and November 2021. Particle counts were measured using a particle counter, specifically focusing on six different sizes of PM (0.3, 0.5, 1, 2.5, 5, and 10 µm). Additionally, measurements were taken for HCHO in parts per million (ppm). Monopolar cautery was used in the surgical setting. Systematic measurements were conducted at specific time points during the surgical procedures to assess the levels of PM and HCHO. Furthermore, the efficacy of surgical smoke suction was evaluated by comparing the PM levels with and without adjacent placement of suction. RESULTS This study involved 35 patients, with measurements of both PM and HCHO taken in 27 cases. The remaining 8 cases had measurements only for PM. In this study, statistically significant quantitative changes in various PM sizes were observed when electrocautery was used during spine surgery (12.3 ± 1.7 vs 1975.7 ± 422.8, 3.4 ± 0.5 vs 250.1 ± 45.7, and 1.9 ± 0.2 vs 78.1 ± 13.3, respectively, for 2.5-, 5-, and 10-µm PM; p < 0.05). The level of HCHO was also significantly higher (0.085 ± 0.006 vs 0.131 ± 0.014 ppm, p < 0.05) with electrocautery use. Utilization of adjacent suction of surgical smoke during electrocautery demonstrated a statistically significant reduction in PM levels. CONCLUSIONS The findings of this study highlight the potential surgical smoke-related hazards that spine surgeons may be exposed to in the operating room. Implementing simple interventions, such as utilizing nearby suction, can effectively minimize the amount of toxic surgical smoke and mitigate these risks.
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Affiliation(s)
- Seung Jin Choi
- Department of Neurosurgery, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Republic of Korea
| | - Dongmin Seo
- Department of Neurosurgery, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Republic of Korea
| | - Chang Hwa Ham
- Department of Neurosurgery, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Republic of Korea
| | - Joo Han Kim
- Department of Neurosurgery, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Republic of Korea
| | - Woo-Keun Kwon
- Department of Neurosurgery, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Republic of Korea
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Lee SH, Kwon WK, Ham CH, Na JH, Kim JH, Park YK, Park JY, Hur JW, Moon HJ. Postoperative survival after lumbar instrumented surgery for metastatic spinal tumors: a nationwide population-based cohort analysis. Ir J Med Sci 2024; 193:51-56. [PMID: 37450256 DOI: 10.1007/s11845-023-03459-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2022] [Accepted: 07/08/2023] [Indexed: 07/18/2023]
Abstract
BACKGROUND It is difficult to predict the expected survival after lumbar instrumented surgery for metastases owing to the difference among different cancer origins and the relatively short survival after surgery. AIMS The aim of this study is to analyze the postoperative survival period of lumbar spinal metastasis patients who underwent lumbar instrumented surgery. METHODS Data were collected from the Korean National Health Insurance Review and Assessment Service database. Patients who underwent lumbar spinal surgery with instrumentation between January 2011 and December 2015 for metastatic lumbar diseases were reviewed. The mean postoperative survival period of patients with metastatic lumbar cancer according to each primary cancer type was evaluated. RESULTS A total of 628 patients were enrolled and categorized according to primary cancer type. The overall median survival rate was 1.11±1.30 years. The three most prevalent primary cancer groups were lung, hepatobiliary, and colorectal cancers, presenting relatively short postoperative survival rates (0.93±1.25, 0.74±0.75 and 0.74±0.88 years, respectively). The best postoperative survival period was observed in breast cancer (2.23±1.83 years), while urinary tract cancer showed the shortest postoperative survival period (0.59±0.69 years). CONCLUSION The postoperative survival period of patients with lumbar metastatic spinal tumors according to different primary cancers after instrumented fusion was ˃1 year overall, with differences according to different primary origins. This result may provide information regarding the expected postoperative survival after instrumented surgery for lumbar spinal metastases.
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Affiliation(s)
- Seung Hoon Lee
- Department of Neurosurgery, Korea University Guro Hospital, Korea University College of Medicine, 148 Gurodong-ro, Guro-gu, Seoul, 08308, Republic of Korea
| | - Woo-Keun Kwon
- Department of Neurosurgery, Korea University Guro Hospital, Korea University College of Medicine, 148 Gurodong-ro, Guro-gu, Seoul, 08308, Republic of Korea.
| | - Chang Hwa Ham
- Department of Neurosurgery, Korea University Guro Hospital, Korea University College of Medicine, 148 Gurodong-ro, Guro-gu, Seoul, 08308, Republic of Korea
| | - Jung Hyun Na
- Department of Neurosurgery, Korea University Guro Hospital, Korea University College of Medicine, 148 Gurodong-ro, Guro-gu, Seoul, 08308, Republic of Korea
| | - Joo Han Kim
- Department of Neurosurgery, Korea University Guro Hospital, Korea University College of Medicine, 148 Gurodong-ro, Guro-gu, Seoul, 08308, Republic of Korea
| | - Youn-Kwan Park
- Department of Neurosurgery, Gachon University Gil Medical Center, Incheon, Republic of Korea
| | - Jung Yul Park
- Department of Neurosurgery, Korea University Anam Hospital, Korea University College of Medicine, Seoul, Republic of Korea
| | - Junseok W Hur
- Department of Neurosurgery, Korea University Anam Hospital, Korea University College of Medicine, Seoul, Republic of Korea
| | - Hong Joo Moon
- Department of Orthopaedic Surgery, Washington University in St. Louis, St. Louis, MO, USA
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Greil ME, Bergquist J, Kashlan ON, Kwon WK, Durfy S, Hofstetter CP. Incidence and management of dural tears in full-endoscopic unilateral laminotomies for bilateral lumbar decompression. Eur Spine J 2023; 32:2889-2895. [PMID: 37264093 DOI: 10.1007/s00586-023-07749-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/14/2022] [Revised: 04/20/2023] [Accepted: 04/25/2023] [Indexed: 06/03/2023]
Abstract
PURPOSE To report incidence of dural lacerations in lumbar endoscopic unilateral laminotomy for bilateral decompression (LE-ULBD) and to describe patient outcomes following a novel full-endoscopic bimanual durotomy repair. METHODS Retrospective review of prospectively collected database including 5.5 years of single surgeon experience with LE-ULBD. Patients with no durotomy were compared with patients who experienced intraoperative durotomy, including demographics, ASA score, prior surgery, number of levels treated, procedure time, hospital length of stay (LOS), visual analogue scale, perioperative complications, revision surgeries, use of analgesics, and Oswestry Disability Index (ODI). RESULTS In total, 13/174 patients (7.5%) undergoing LE-ULBD experienced intraoperative durotomy. No significant differences in demographic, clinical or operative variables were identified between the 2 groups. Sustaining a durotomy increased LOS (p = 0.0019); no differences in perioperative complications or rate of revision surgery were identified. There was no difference in minimally clinically important difference for ODI between groups (65.6% for no durotomy versus 55.6% for durotomy, p = 0.54). CONCLUSION In this cohort, sustaining a durotomy increased LOS but, with accompanying intraoperative repair, did not significantly affect rate of complications, revision surgery or functional outcomes. Our method of bimanual endoscopic dural repair provides an effective approach for repair of dural lacerations in interlaminar ULBD cases.
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Affiliation(s)
- Madeline E Greil
- Department of Neurological Surgery, University of Washington, 325 Ninth Ave, Box 359924, Seattle, WA, 98104, USA
| | - Julia Bergquist
- Stritch School of Medicine, Loyola University of Chicago, Maywood, IL, USA
| | - Osama N Kashlan
- Department of Neurosurgery, University of Michigan, Ann Arbor, MI, USA
| | - Woo-Keun Kwon
- Department of Neurosurgery, College of Medicine, Korea University Guro Hospital, Korea University, Seoul, Republic of Korea
| | - Sharon Durfy
- Department of Neurological Surgery, University of Washington, 325 Ninth Ave, Box 359924, Seattle, WA, 98104, USA
| | - Christoph P Hofstetter
- Department of Neurological Surgery, University of Washington, 325 Ninth Ave, Box 359924, Seattle, WA, 98104, USA.
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Affiliation(s)
- Woo-Keun Kwon
- Department of Neurosurgery, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Korea
| | - Se-Hoon Kim
- Department of Neurosurgery, Korea University Ansan Hospital, Korea University College of Medicine, Ansan, Korea
- Corresponding Author Se-Hoon Kim Department of Neurosurgery, Korea University Ansan Hospital, Korea University College of Medicine, 123 Jeokgeum-ro, Danwon-gu, Ansan 15355, Korea
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Kwon WK, Ham CH, Moon HJ, Kim JH, Park YK. Radiologic risk factors associated with development of myelopathy in patients with ossification of the posterior longitudinal ligament of the cervical spine. Clin Neurol Neurosurg 2023; 227:107668. [PMID: 36924696 DOI: 10.1016/j.clineuro.2023.107668] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2022] [Revised: 01/25/2023] [Accepted: 03/05/2023] [Indexed: 03/12/2023]
Abstract
STUDY DESIGN Retrospective Cohort Study OBJECTIVE: Myelopathy following ossification of the posterior longitudinal ligament (OPLL) is one of the devastating clinical features in these patients, while we still know little about which factors are associated with development of myelopathy. We evaluated the difference of radiologic measurements between OPLL patients with or without myelopathy and searched for the clinical significance with emphasis on the impact of dynamic motion. METHODS 305 patients diagnosed of OPLL were enrolled for retrospective review. They were divided into two groups according to the coexistence of radiographic evidence of myelopathy. Demographic data as well as radiologic measures including the presence of disc degeneration (DD), anterior-posterior diameter (APD) of central canal, canal compromise (CC) ratio, global and segmental range of motion (gROM and sROM), OPLL type (morphologic classification) and K-line were collected. RESULTS APD (odds ratio (OR); 0.411), CC ratio (OR; 1.100) and sROM (OR; 1.371) were significantly associated with the presence of myelopathy in the multivariate analysis. While the statistically significant factors were same in OPLLs with CC larger than 50%, presence of DD (OR; 4.509) and sROM (OR; 1.295) were significantly associated with myelopathy but not the CC itself in OPLLs with CC smaller than 50%. CONCLUSIONS We discovered that the APD, CC ratio and sROM had significant association with development of myelopathy in OPLLs. And the presence of dynamic factors had significant association with myelopathy in OPLLs with smaller CC ratios. This observation and its clinical significance on development of myelopathy might enhance our understanding of OPLL.
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Affiliation(s)
- Woo-Keun Kwon
- Department of Neurosurgery, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Republic of Korea; Focused Training Center for Trauma, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Republic of Korea
| | - Chang Hwa Ham
- Department of Neurosurgery, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Republic of Korea; Focused Training Center for Trauma, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Republic of Korea
| | - Hong Joo Moon
- Department of Neurosurgery, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Republic of Korea; Department of Orthopaedic Surgery, Washington University in St. Louis, St. Louis, MO, USA
| | - Joo Han Kim
- Department of Neurosurgery, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Republic of Korea
| | - Youn-Kwan Park
- Department of Neurosurgery, Gachon University Gil Medical Center, Incheon, Republic of Korea.
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Ham CH, Kwon WK, Moon HJ, Kim JH, Park YK, Hofstetter CP. Use of prophylactic perioperative antibiotics for lumbar spinal fusions: A nationwide population-based cohort study. J Infect Public Health 2023; 16:354-360. [PMID: 36682101 DOI: 10.1016/j.jiph.2023.01.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2022] [Revised: 12/28/2022] [Accepted: 01/08/2023] [Indexed: 01/13/2023] Open
Abstract
BACKGROUND Perioperative prophylactic antibiotic (PPA) use in spine surgery is known to reduce the rate of surgical site infections. In the past decade, several evidence-based guidelines have been published and surveillance systems to monitor the proper use of antimicrobials had been adapted by many institutes. OBJECTIVE To report the trends of PPA prescription in lumbar fusion surgeries nationwide in the Republic of Korea. METHODS This is a nationwide registry study. Using the population-based data from the Republic of Korea provided by the Korean Health Insurance Review and Assessment Service, data of all lumbar spinal fusion surgeries performed between 2010 and 2018 in adult patients (age ≥19 years) were reviewed. RESULTS The most frequently used antibiotics were first-generation cephalosporins, which accounted for 38.2 % of total PPA prescriptions and were prescribed in 58.96 % of lumbar fusion surgeries. A gradual increase in prescription trends was observed. The second most frequently used PPAs were second-generation cephalosporins, which showed decrease in use from 2016. The frequency of vancomycin prescriptions gradually increased over the observation period and showed an almost four-fold increase in 2018 compared to 2010. First- and second-generation cephalosporins were prescribed less frequently to patients with renal disease. CONCLUSION The pattern of PPA use has changed remarkably over the observation period. Furthermore, specific differences in PPA prescriptions were observed among patients with certain co-morbidities.
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Affiliation(s)
- Chang Hwa Ham
- Department of Neurosurgery, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Republic of Korea
| | - Woo-Keun Kwon
- Department of Neurosurgery, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Republic of Korea.
| | - Hong Joo Moon
- Department of Neurosurgery, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Republic of Korea; Department of Orthopaedic Surgery, Washington University in St.Louise, MO, USA
| | - Joo Han Kim
- Department of Neurosurgery, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Republic of Korea
| | - Youn-Kwan Park
- Department of Neurosurgery, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Republic of Korea
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Ham CH, Kwon WK, Kim JH, Park YK, Kim JH. Management of a traumatic avulsion fracture of the occipital condyle in polytrauma patient: a case report. J Trauma Inj 2022. [DOI: 10.20408/jti.2022.0058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
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Kwon WK, Kelly KA, McAvoy M, Sivakanthan S, Ogunlade J, Yap NKY, Durfy S, Hofstetter CP. Full Endoscopic Ligamentum Flavum Sparing Unilateral Laminotomy for Bilateral Recess Decompression: Surgical Technique and Clinical Results. Neurospine 2022; 19:1028-1038. [PMID: 36597639 PMCID: PMC9816588 DOI: 10.14245/ns.2244344.172] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2022] [Accepted: 10/12/2022] [Indexed: 12/27/2022] Open
Abstract
OBJECTIVE Interlaminar endoscopic spine surgery has been introduced and utilized for lumbar lateral recess decompression. We modified this technique and utilized it for bilateral lateral recess stenoses without significant central stenosis. Here we present the surgical details and clinical outcome of ligamentum flavum sparing unilateral laminotomy for bilateral recess decompression (ULBRD). METHODS Prospectively collected registry for full-endoscopic surgeries was reviewed retrospectively. One hundred eighty-two consecutive cases from a single center between September 2015 and March 2021 were reviewed and 57 of them whom underwent ULBRD were enrolled for analysis. Basic patient demographic data, perioperative details, surgeryrelated complications, and clinical outcome were reviewed. The detailed surgical technique is presented as well. RESULTS Among the 57 patients enrolled, 37 were males while the other 20 were females. The mean age was 58.53 ± 14.51 years, and a bimodal age distribution at the age of mid-fifties and mid-sixties or older was noted. The later age-peak was related to coexistence of degenerative scoliosis. The average operative time per lamina was 70.34 ± 20.51 minutes and mean length of stay was 0.56 ± 0.85 days. Four perioperative complications were reported (7.0%) and the overall reoperation rate at the index level within 1 year was 8.8%. The preoperative back/leg visual analogue scale scores and functional outcome scales including EuroQol-5 dimension questionnaire, Oswestry Disability Index presented significant improvement immediately after surgery and were maintained until final follow-up. CONCLUSION ULBRD for bilateral lateral recess stenoses without significant central stenosis resulted in good clinical outcomes with acceptably low perioperative complications rates. Sufficient decompression was achieved with the central ligamentum flavum being preserved.
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Affiliation(s)
- Woo-Keun Kwon
- Department of Neurosurgery, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Korea
| | - Katherine A. Kelly
- Department of Neurological Surgery, University of Washington, Seattle, WA, USA
| | - Malia McAvoy
- Department of Neurological Surgery, University of Washington, Seattle, WA, USA
| | | | - John Ogunlade
- Department of Neurological Surgery, University of Washington, Seattle, WA, USA
| | - Natalie Kai Yi Yap
- Department of Neurological Surgery, University of Washington, Seattle, WA, USA
| | - Sharon Durfy
- Department of Neurological Surgery, University of Washington, Seattle, WA, USA
| | - Christoph P. Hofstetter
- Department of Neurological Surgery, University of Washington, Seattle, WA, USA,Corresponding Author Christoph Hofstetter Department of Neurological Surgery, University of Washington, 325 Ninth Ave, Box 359924, Seattle, WA 98104, USA ;
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Kwon WK, Ham CH, Choi H, Baek SM, Lee JW, Park YK, Moon HJ, Park WB, Kim JH. Elucidating the effect of mechanical stretch stress on the mechanism of ligamentum flavum hypertrophy: Development of a novel in vitro multi-torsional stretch loading device. PLoS One 2022; 17:e0275239. [PMID: 36269774 PMCID: PMC9586365 DOI: 10.1371/journal.pone.0275239] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2021] [Accepted: 09/01/2022] [Indexed: 11/05/2022] Open
Abstract
Objective We developed a novel multi-torsional mechanical stretch stress loading device for ligamentum flavum cells and evaluated its influence on the development of ligamentum flavum hypertrophy, a common cause of lumbar spinal canal stenosis. Materials and methods Stretch strength of the device was optimized by applying 5% and 15% MSS loads for 24, 48, and 72 h. A cytotoxicity assay of human ligamentum flavum cells was performed and the results were compared to control (0% stress). Inflammatory markers (interleukin [IL]-6, IL-8), vascular endothelial growth factor [VEGF], and extracellular matrix (ECM)-regulating cytokines (matrix metalloproteinase [MMP]-1, MMP-3 and MMP-9, and tissue inhibitor of metalloproteinase [TIMP]-1 and TIMP-2) were quantified via enzyme-linked immunosorbent assay. Results Using our multi-torsional mechanical stretch stress loading device, 5% stress for 24 hour was optimal for ligamentum flavum cells. Under this condition, the IL-6 and IL-8 levels, VEGF level, and MMP-1, MMP-3, and TIMP-2 were significantly increased, compared to the control. Conclusion Using the novel multi-torsional mechanical stretch stress loading device we confirmed that, mechanical stress enhances the production of inflammatory cytokines and angiogenic factors, and altered the expression of ECM-regulating enzymes, possibly triggering ligamentum flavum hypertrophy.
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Affiliation(s)
- Woo-Keun Kwon
- Department of Neurosurgery, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Korea,Focused Training Center for Trauma, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Republic of Korea
| | - Chang Hwa Ham
- Department of Neurosurgery, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Korea,Focused Training Center for Trauma, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Republic of Korea
| | - Hyuk Choi
- Department of Medical Sciences, Graduate School of Medicine, Korea University, Seoul, Korea
| | - Seung Min Baek
- Department of Medical Sciences, Graduate School of Medicine, Korea University, Seoul, Korea
| | - Jae Won Lee
- Department of Medical Sciences, Graduate School of Medicine, Korea University, Seoul, Korea
| | - Youn-Kwan Park
- Department of Neurosurgery, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Korea
| | - Hong Joo Moon
- Department of Neurosurgery, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Korea
| | - Woong Bae Park
- Department of Neurosurgery, Ewha Womans University Seoul Hospital, Seoul, Korea
| | - Joo Han Kim
- Department of Neurosurgery, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Korea,* E-mail:
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Kim J, Kwon WK, Cho H, Lee S, Lee JB, Park JY, Jin DU, Jung EY, Hur JW. Ligamentum flavum hypertrophy significantly contributes to the severity of neurogenic intermittent claudication in patients with lumbar spinal canal stenosis. Medicine (Baltimore) 2022; 101:e30171. [PMID: 36086706 PMCID: PMC10980470 DOI: 10.1097/md.0000000000030171] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2022] [Accepted: 07/07/2022] [Indexed: 11/25/2022] Open
Abstract
Ligamentum flavum hypertrophy (LFH) is a known contributor to lumbar spinal canal stenosis (LSCS). However, the clinical significance and quantitative role of LFH compared to other components, such as disc bulging and facet hypertrophy, have not yet been examined. We investigated the correlation between the quantitative radiological factors, clinical symptoms, and outcomes in patients with LSCS. In total, 163 patients diagnosed with single-level (L4-L5) stenosis were included. The patients were divided into 2 groups according to claudication severity: >100 m for mild (n = 92) and < 100 m for severe (n = 71). The visual analog scale (VAS) was used to quantify back and leg pain, and the Oswestry Disability Index (ODI) and Short form-36 (SF-36) physical component summary (PCS) scores, and Macnab criteria were evaluated as clinical factors 6 months after treatment. We measured the baseline canal cross-sectional area, ligamentum flavum (LF) area, disc herniation area, dural sac area, fat area, and LF thickness using MRI. A comparative analysis was performed to evaluate the association between radiologic and clinical factors. Additionally, further comparative analyses between the types of surgeries were performed. Among various radiologic factors, the baseline LF thickness (odds ratio [OR] 1.73; 95% confidence interval [CI] 1.25-2.41) was the only major contributing factor to the severity of claudication in the multivariate logistic regression analysis. The types of surgery (decompression alone vs fusion) did not significantly differ in terms of their clinical outcomes, including back and leg VAS, ODI, SF-36 PCS, and satisfaction with the MacNab classification. LF thickness is a major factor contributing to claudication severity.
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Affiliation(s)
- Joohyun Kim
- Department of Neurosurgery, College of Medicine, Korea University, Seoul, Republic of Korea
| | - Woo-Keun Kwon
- Department of Neurosurgery, College of Medicine, Korea University, Seoul, Republic of Korea
| | - Hyunwook Cho
- Department of Neurosurgery, College of Medicine, Korea University, Seoul, Republic of Korea
| | - Subum Lee
- Department of Neurosurgery, College of Medicine, Korea University, Seoul, Republic of Korea
| | - Jang-Bo Lee
- Department of Neurosurgery, College of Medicine, Korea University, Seoul, Republic of Korea
| | - Jung-Yul Park
- Department of Neurosurgery, College of Medicine, Korea University, Seoul, Republic of Korea
| | - Dong Uk Jin
- Department of Orthopedic Surgery, National Medical Center, Seoul, Republic of Korea
| | - Eui Yub Jung
- Department of Orthopedic Surgery, National Medical Center, Seoul, Republic of Korea
| | - Junseok W. Hur
- Department of Neurosurgery, College of Medicine, Korea University, Seoul, Republic of Korea
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Ham CH, Park YK, Kim JH, Kwon WK, Kim DW, Moon HJ. Characteristics of Sagittal Spinopelvic Alignment Changes After Symptom Relief After Simple Lumbar Decompression. Neurosurgery 2022; 91:331-338. [PMID: 35506942 DOI: 10.1227/neu.0000000000002013] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2021] [Accepted: 03/03/2022] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Sagittal spinopelvic alignment (SSPA) parameters are essential for the diagnosis of adult spinal deformities (ASDs) and their progression. Certain clinical symptoms that occur in patients with lumbar spinal stenosis (LSS) and herniated nucleus pulposus (HNP) may distort the SSPA and mimic ASD. OBJECTIVE To differentiate SSPA in symptomatic patients from asymptomatic patients within 10 minutes in the standing position. METHODS This retrospective cohort study evaluated changes in SSPA after simple lumbar decompression surgery in patients with LSS and HNP. Relative sagittal alignment (RSA), relative pelvic version, relative lumbar lordosis (RLL), Lordosis Distribution Index (LDI), and global alignment and proportion (GAP) values were calculated using the conventional Schwab classification method. First, the preoperative and postoperative SSPA parameters were compared. Second, patients were subgrouped into symptomatic within 10 minutes of standing (SP group) and other symptoms of LSS and HNP as controls. Changes in SSPA parameters after symptom relief after simple lumbar decompression surgery were compared between the two groups. RESULTS Overall, all SSPA parameters improved after surgery. However, after subgrouping, patients in the control group did not show significant SSPA alterations, except for LDI, whereas patients in the SP group significantly improved in terms of their RSA, RLL, LDI, and GAP values after symptom relief after surgery. CONCLUSION Patients with pain on standing within 10 minutes showed significant correction in RSA, RLL, and GAP values after simple lumbar decompression. Therefore, it is important to observe such clinical symptoms to avoid misdiagnosis of ASD.
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Affiliation(s)
- Chang Hwa Ham
- Department of Neurosurgery, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Republic of Korea
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15
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Kim JH, Ham CH, Kwon WK. Current Knowledge and Future Therapeutic Prospects in Symptomatic Intervertebral Disc Degeneration. Yonsei Med J 2022; 63:199-210. [PMID: 35184422 PMCID: PMC8860939 DOI: 10.3349/ymj.2022.63.3.199] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2021] [Revised: 11/29/2021] [Accepted: 12/01/2021] [Indexed: 11/27/2022] Open
Abstract
Intervertebral disc (IVD) degeneration is the main source of intractable lower back pain, and symptomatic IVD degeneration could be due to different degeneration mechanisms. In this article, we describe the molecular basis of symptomatic IVD degenerative disc diseases (DDDs), emphasizing the role of degeneration, inflammation, angiogenesis, and extracellular matrix (ECM) regulation during this process. In symptomatic DDD, pro-inflammatory mediators modulate catabolic reactions, resulting in changes in ECM homeostasis and, finally, neural/vascular ingrowth-related chronic intractable discogenic pain. In ECM homeostasis, anabolic protein-regulating genes show reduced expression and changes in ECM production, while matrix metalloproteinase gene expression increases and results in aggressive ECM degradation. The resultant loss of normal IVD viscoelasticity and a concomitant change in ECM composition are key mechanisms in DDDs. During inflammation, a macrophage-related cascade is represented by the secretion of high levels of pro-inflammatory cytokines, which induce inflammation. Aberrant angiogenesis is considered a key initiative pathologic step in symptomatic DDD. In reflection of angiogenesis, vascular endothelial growth factor expression is regulated by hypoxia-inducible factor-1 in the hypoxic conditions of IVDs. Furthermore, IVD cells undergoing degeneration potentially enhance neovascularization by secreting large amounts of angiogenic cytokines, which penetrate the IVD from the outer annulus fibrosus, extending deep into the outer part of the nucleus pulposus. Based on current knowledge, a multi-disciplinary approach is needed in all aspects of spinal research, starting from basic research to clinical applications, as this will provide information regarding treatments for DDDs and discogenic pain.
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Affiliation(s)
- Joo Han Kim
- Department of Neurosurgery, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Korea
| | - Chang Hwa Ham
- Department of Neurosurgery, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Korea
| | - Woo-Keun Kwon
- Department of Neurosurgery, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Korea.
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16
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Kim AG, Kim TW, Kwon WK, Lee KH, Jeong S, Hwang MH, Choi H. Microfluidic Chip with Low Constant-Current Stimulation (LCCS) Platform: Human Nucleus Pulposus Degeneration In Vitro Model for Symptomatic Intervertebral Disc. Micromachines (Basel) 2021; 12:1291. [PMID: 34832700 PMCID: PMC8621874 DOI: 10.3390/mi12111291] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/11/2021] [Revised: 10/15/2021] [Accepted: 10/18/2021] [Indexed: 01/07/2023]
Abstract
Intervertebral disc (IVD) degeneration is a major cause of low back pain (LBP) in the lumbar spine. This phenomenon is caused by several processes, including matrix degradation in IVD tissues, which is mediated by matrix metalloproteinases (MMPs) and inflammatory responses, which can be mediated by interactions among immune cells, such as macrophages and IVD cells. In particular, interleukin (IL)-1 beta (β), which is a master regulator secreted by macrophages, mediates the inflammatory response in nucleus pulposus cells (NP) and plays a significant role in the development or progression of diseases. In this study, we developed a custom electrical stimulation (ES) platform that can apply low-constant-current stimulation (LCCS) signals to microfluidic chips. Using this platform, we examined the effects of LCCS on IL-1β-mediated inflammatory NP cells, administered at various currents (5, 10, 20, 50, and 100 μA at 200 Hz). Our results showed that the inflammatory response, induced by IL-1β in human NP cells, was successfully established. Furthermore, 5, 10, 20, and 100 μA LCCS positively modulated inflamed human NP cells' morphological phenotype and kinetic properties. LCCS could affect the treatment of degenerative diseases, revealing the applicability of the LCCS platform for basic research of electroceuticals.
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Affiliation(s)
- An-Gi Kim
- Department of Medical Sciences, Graduate School of Medicine, Korea University, Seoul 08308, Korea; (A.-G.K.); (T.-W.K.)
| | - Tae-Won Kim
- Department of Medical Sciences, Graduate School of Medicine, Korea University, Seoul 08308, Korea; (A.-G.K.); (T.-W.K.)
| | - Woo-Keun Kwon
- Department of Neurosurgery, College of Medicine, Korea University Guro Hospital, Seoul 08308, Korea;
| | - Kwang-Ho Lee
- Division of Mechanical and Biomedical, Mechatronics, and Materials Science and Engineering, College of Engineering, Kangwon National University, Chuncheon 24341, Korea;
| | - Sehoon Jeong
- Department of Healthcare Information Technology, Inje University, Gimhae 50834, Korea;
| | - Min-Ho Hwang
- Department of Medical Sciences, Graduate School of Medicine, Korea University, Seoul 08308, Korea; (A.-G.K.); (T.-W.K.)
| | - Hyuk Choi
- Department of Medical Sciences, Graduate School of Medicine, Korea University, Seoul 08308, Korea; (A.-G.K.); (T.-W.K.)
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17
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Jang JY, Kwon WK, Roh H, Moon JH, Hwang JS, Kim YJ, Kim JH. Time-saving effects using helicopter transportation: comparison to a ground transportation time predicted using a social navigation software. Medicine (Baltimore) 2021; 100:e26569. [PMID: 34232201 PMCID: PMC8270619 DOI: 10.1097/md.0000000000026569] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2021] [Accepted: 06/07/2021] [Indexed: 01/04/2023] Open
Abstract
Previous comparison studies regarding 2 types of transportation, helicopter (HEMS) versus ground emergency medical services (GEMS), have shown underlying heterogeneity as these options have completely different routes and consequent times with reference to one patient. To compare the 2 types of transportation on a case-by-case basis, we analyzed the retrospectively reviewed HEMS and predicted GEMS data using an open-source navigation software.Patients transferred by military HEMS from 2016 to 2019 were retrospectively enrolled. The HEMS records on the time of notification, injury point and destination address, and time required were reviewed. The GEMS data on distance and the predicted time required were acquired using open-source social navigation systems. Comparison analyses between the two types of transportation were conducted. Furthermore, linear logistic regression analyses were performed on the distance and time of the two options.A total of 183 patients were enrolled. There was no statistical difference (P = .3021) in the distance between the 2 types of transportation, and the HEMS time was significantly shorter than that of GEMS (61.31 vs 116.92 minutes, P < .001). The simple linear curves for HEMS and GEMS were separately secured, and two graphs presented the statistical significance (P) as well as reasonable goodness-of-fit (R2). In general, the HEMS graph demonstrates a more gradual slope and narrow distribution compared to that of GEMS.Ideally, HEMS is identified as a better transportation modality because it has a shorter transportation time (56 minutes saved) and a low possibility of potential time delays (larger R2). With a strict patient selection, HEMS can rescue injured or emergent patients who are "out of the golden hour."
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Affiliation(s)
- Ji Young Jang
- Department of Neurosurgery, Armed Forces Capital Hospital, Gyeonggi-do
| | - Woo-Keun Kwon
- Department of Neurosurgery, Guro Hospital, Korea University College of Medicine, Seoul
| | - Haewon Roh
- Department of Neurosurgery, Armed Forces Capital Hospital, Gyeonggi-do
| | - Jong Ha Moon
- Medical Emergency Operation Center, Armed Forces Medical Command
| | - Jun Seong Hwang
- Medical Emergency Operation Center, Armed Forces Medical Command
| | - Yoon Jic Kim
- Medical Emergency Operation Center, Armed Forces Medical Command
| | - Jang Hun Kim
- Department of Neurosurgery, Armed Forces Capital Hospital, Gyeonggi-do
- Department of Neurosurgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Gyeonggi-do, Republic of Korea
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18
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Kim CH, Choi Y, Chung CK, Kim KJ, Shin DA, Park YK, Kwon WK, Yang SH, Lee CH, Park SB, Kim ES, Hong H, Cho Y. Nonsurgical treatment outcomes for surgical candidates with lumbar disc herniation: a comprehensive cohort study. Sci Rep 2021; 11:3931. [PMID: 33594185 PMCID: PMC7887235 DOI: 10.1038/s41598-021-83471-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2020] [Accepted: 02/01/2021] [Indexed: 11/30/2022] Open
Abstract
Physicians often encounter surgical candidates with lumbar disc herniation (LDH) who request non-surgical management even though surgery is recommended. However, second opinions may differ among doctors. Therefore, a prospective comprehensive cohort study (CCS) was designed to assess outcomes of nonsurgical treatment for surgical candidates who were recommended to undergo surgery for LDH but requested a second opinion. The CCS includes both randomized and observational cohorts, comprising a nonsurgery cohort and surgery cohort, in a parallel fashion. Crossover between the nonsurgery and surgery cohorts was allowed at any time. The present study was an as-treated interim analysis of 128 cases (nonsurgery cohort, n = 71; surgery cohort, n = 57). Patient-reported outcomes included visual analogue scores for the back (VAS-B) and leg (VAS-L), the Oswestry Disability Index, the EuroQol 5-Dimension instrument, and the 36-Item Short-Form Health Survey (SF-36), which were evaluated at baseline and at 1, 3, 6, 12, and 24 months. At baseline, age and SF-36 physical function were significantly lower in the surgery cohort than in the nonsurgery cohort (p < 0.05). All adjusted outcomes significantly improved after both nonsurgical and surgical treatment (p < 0.05). The nonsurgery cohort showed less improvement of VAS-B and VAS-L scores at 1 month (p < 0.01), but no difference between cohorts was observed thereafter for 24 months (p > 0.01). Nonsurgical management may be a negotiable option even for surgical candidates in the shared decision-making process.
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Affiliation(s)
- Chi Heon Kim
- Department of Neurosurgery, Seoul National University College of Medicine, 103 Daehak-ro, Jongno-gu, Seoul, 03080, South Korea.,Department of Neurosurgery, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul, 03080, South Korea
| | - Yunhee Choi
- Division of Medical Statistics, Medical Research Collaborating Center, Seoul National University Hospital, 101, Daehak-ro, Jongno-gu, Seoul, 03080, South Korea
| | - Chun Kee Chung
- Department of Neurosurgery, Seoul National University College of Medicine, 103 Daehak-ro, Jongno-gu, Seoul, 03080, South Korea. .,Department of Neurosurgery, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul, 03080, South Korea. .,Department of Brain and Cognitive Sciences, Seoul National University, 1 Gwanak-ro, Gwanak-gu, Seoul, 08826, South Korea.
| | - Ki-Jeong Kim
- Department of Neurosurgery, Seoul National University College of Medicine, 103 Daehak-ro, Jongno-gu, Seoul, 03080, South Korea.,Department of Neurosurgery, Seoul National University Bundang Hospital, 82 Gumi-ro 173 Beon-gil, Bundang-gu, Seongnam-si, Gyeonggi-do, 13620, South Korea
| | - Dong Ah Shin
- Department of Neurosurgery, Yonsei University Health System, 50-1 Yeonsei-ro, Seodaemun-gu, Seoul, 03722, South Korea.,Department of Neurosurgery, Yonsei University College of Medicine, 50-1 Yeonsei-ro, Seodaemun-gu, Seoul, 03722, South Korea
| | - Youn-Kwan Park
- Department of Neurosurgery, Korea University Guro Hospital, 148 Gurodong-ro, Guro-gu, Seoul, 08308, South Korea.,Department of Neurosurgery, Korea University College of Medicine, Korea-daero 73, Seongbuk-gu, Seoul, 02841, South Korea
| | - Woo-Keun Kwon
- Department of Neurosurgery, Korea University Guro Hospital, 148 Gurodong-ro, Guro-gu, Seoul, 08308, South Korea.,Department of Neurosurgery, Korea University College of Medicine, Korea-daero 73, Seongbuk-gu, Seoul, 02841, South Korea
| | - Seung Heon Yang
- Department of Neurosurgery, Seoul National University College of Medicine, 103 Daehak-ro, Jongno-gu, Seoul, 03080, South Korea.,Department of Neurosurgery, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul, 03080, South Korea
| | - Chang Hyun Lee
- Department of Neurosurgery, Seoul National University College of Medicine, 103 Daehak-ro, Jongno-gu, Seoul, 03080, South Korea.,Department of Neurosurgery, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul, 03080, South Korea.,Department of Neurosurgery, Seoul National University Bundang Hospital, 82 Gumi-ro 173 Beon-gil, Bundang-gu, Seongnam-si, Gyeonggi-do, 13620, South Korea
| | - Sung Bae Park
- Department of Neurosurgery, Seoul National University College of Medicine, 103 Daehak-ro, Jongno-gu, Seoul, 03080, South Korea.,Department of Neurosurgery, Seoul National University Boramae Hospital, Borame Medical Center 20, Boramae-ro 5-gil, Dongjak-gu, Seoul, 07061, South Korea
| | - Eun Sang Kim
- Department of Neurosurgery, Spine Center, School of Medicine, Samsung Medical Center Sungkyunkwan University, Seoul, Korea
| | - Hyunsook Hong
- Division of Medical Statistics, Medical Research Collaborating Center, Seoul National University Hospital, 101, Daehak-ro, Jongno-gu, Seoul, 03080, South Korea
| | - Yongeun Cho
- Department of Neurosurgery, Yonsei University College of Medicine, 50-1 Yeonsei-ro, Seodaemun-gu, Seoul, 03722, South Korea.,Department of Neurosurgery, Gangnam Severance Hospital, 211 Eonju-ro, Gangnam-gu, Seoul, 06273, South Korea
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Lee JK, Ham CH, Kwon WK, Moon HJ, Kim JH, Park YK. A New Classification for Cervical Ossification of the Posterior Longitudinal Ligament Based on the Coexistence of Segmental Disc Degeneration. J Korean Neurosurg Soc 2020; 64:69-77. [PMID: 33105534 PMCID: PMC7819796 DOI: 10.3340/jkns.2020.0080] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2020] [Accepted: 04/09/2020] [Indexed: 11/27/2022] Open
Abstract
Objective Classification systems for cervical ossification of the posterior longitudinal ligament (OPLL) have traditionally focused on the morphological characteristics of ossification. Although the classification describes many clinical features associated with the shape of the ossification, including the concept of spondylosis seems necessary because of the similarity in age distribution.
Methods Patients diagnosed with OPLL who presented with increase signal intensity (ISI) on magnetic resonance imaging were surgically treated in our department. The patients were divided into two groups (pure versus degenerative) according to the presence of disc degeneration.
Results Of 141 patients enrolled in this study, more than half (61%) were classified into the degenerative group. The pure group showed a profound male predominance, early presentation of myelopathy, and a different predilection for ISI compared to the degenerative group. The mean canal compromise ratio (CC) of the ISI was 47% in the degenerative group versus 61% in the pure group (p<0.0000). On the contrary, the global and segment motions were significantly larger in the degenerative group (p<0.0000 and p=0.003, respectively). The canal diameters and global angles did not differ between groups.
Conclusion Classifying cervical OPLL based on the presence of combined disc degeneration is beneficial for understanding the disorder’s behavior. CC appears to be the main factor in the development of myelopathy in the pure group, whereas additional dynamic factors appear to affect its development in the degenerative group.
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Affiliation(s)
- Jun Ki Lee
- Department of Neurosurgery, Korea University Guro Hospital, Seoul, Korea
| | - Chang Hwa Ham
- Department of Neurosurgery, Korea University Guro Hospital, Seoul, Korea
| | - Woo-Keun Kwon
- Department of Neurosurgery, Korea University Guro Hospital, Seoul, Korea
| | - Hong Joo Moon
- Department of Neurosurgery, Korea University Guro Hospital, Seoul, Korea
| | - Joo Han Kim
- Department of Neurosurgery, Korea University Guro Hospital, Seoul, Korea
| | - Youn-Kwan Park
- Department of Neurosurgery, Korea University Guro Hospital, Seoul, Korea
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Ham CH, Moon HJ, Kim JH, Park YK, Lee TH, Kwon WK. Coronavirus Disease (COVID-19) Outbreak and Its Impact on Spinal Daily Practice : Preliminary Report from a Single (Regional) University Hospital in Republic of Korea. J Korean Neurosurg Soc 2020; 63:407-414. [PMID: 32455517 PMCID: PMC7365272 DOI: 10.3340/jkns.2020.0114] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2020] [Accepted: 05/04/2020] [Indexed: 11/27/2022] Open
Abstract
Objective Since the first discovery of the 2019 novel coronavirus (COVID-19), rapid and wide spread of the disease has been reported and the World Health Organization announced that a ‘pandemic’ has started. Up to date there is little known regarding the impact of this outbreak on spinal specialists’ daily clinical practice. We intended to evaluate how COVID-19 has affected the number of spinal disease patients we meet and operate in daily practice.
Methods The de-identified data regarding number of patients visiting the spine clinic at a tertiary referral hospital and a secondary level hospital from January, February and March of 2017 to 2020 were retrospectively reviewed. The number of out-patient department (OPD) visits, number of emergency room (ER) visits as well as number of surgeries performed during the reviewed period were collected and analyzed, comparing 2020 to the previous 3 years.
Results The number of daily OPD visits showed a steady decrease starting from January, and presented a statistically significant decrease by early March 2020, compared to the previous 3 years. During the same period, decrease in number of daily ER visits was statistically significant as well. The number of elective surgeries or number of surgeries for patients admitted via ER during COVID-19 outbreak remained similar to that of 2017–2019 suggesting, despite the decrease of patients visiting the hospital for spinal diseases, those whom required surgery still visited the hospital. The results were consistant among other hospital level.
Conclusion The outbreak of COVID-19 affected our daily practice as OPD and ER visits reduced but did not affect the number of surgeries. We believe that this report will be informative to spinal specialists worldwide fighting the COVID-19 pandemic.
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Affiliation(s)
- Chang Hwa Ham
- Department of Neurosurgery, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Korea
| | - Hong Joo Moon
- Department of Neurosurgery, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Korea
| | - Joo Han Kim
- Department of Neurosurgery, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Korea
| | - Youn-Kwan Park
- Department of Neurosurgery, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Korea
| | - Tae Hoon Lee
- Spine and Joint Center, 9988 Hospital, Seoul, Korea
| | - Woo-Keun Kwon
- Department of Neurosurgery, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Korea.,Focused Training Center for Trauma, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Korea
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Kim JH, Lee J, Lee WJ, Shin DW, Lee SJ, Roh H, Jeong HJ, Lee TH, Kwon WK. Efficacy of automated percutaneous lumbar discectomy for lumbar disc herniation in young male soldiers. Medicine (Baltimore) 2019; 98:e18044. [PMID: 31725682 PMCID: PMC6867797 DOI: 10.1097/md.0000000000018044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Lumbar disc herniation (LDH) often results in back pain and radicular pain and is frequently treated with minimally invasive non-surgical methods in Korean Armed Forces Hospitals. Automated percutaneous lumbar discectomy (APLD) has been reported to have good clinical outcomes with low complication rates; however, the clinical efficacy of APLD performed in young male soldiers is uncertain. In order to clarify the efficacy of APLD for the treatment of LDH in young male soldiers, we designed a retrospective case-control study to compare patients who received APLD with patients treated with epidural steroid injection (ESI) alone.A total of 181 patients were enrolled and divided into the APLD (n = 92) and ESI (n = 89) groups according to the treatment modality. A simple logistic regression analysis was conducted to clarify the difference between the two. To optimize patient selection, APLD group was additionally divided for subgroup analysis into favorable (n = 59) and unfavorable (n = 33) groups based on satisfaction scales. A simple logistic analysis was also performed.The differences between pre- and postoperative numerical rating scale of pain (P = .0027) and hospital-own satisfaction scale (P = .0045) of the APLD group were significantly better compared to those of the ESI group. In terms of subgroup analysis, single-level pathology (P = 0.244) and protruded disc (P = .0443) were associated with favorable outcomes, whereas dual pathology and extruded disc were related with unfavorable outcomes.APLD using Dekompressor, performed in young male soldiers with back and radicular pain owing to LDH, showed better clinical outcomes compared to the ESI only therapy. Additionally, a single-level pathology with protruded disc was associated with favorable outcomes and may be indicated for treatment.
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Affiliation(s)
- Jang Hun Kim
- Department of Neurosurgery, Armed Forces Yang Ju Hospital, Gyeonggi-do
- Department of Neurosurgery, Guro Hospital, Korea University College of Medicine, Seoul
- Focused Training Center for Trauma, Guro Hospital, Korea University College of Medicine, Seoul
| | - Junki Lee
- Department of Neurosurgery, Armed Forces Yang Ju Hospital, Gyeonggi-do
- Department of Neurosurgery, Guro Hospital, Korea University College of Medicine, Seoul
| | - Won Jae Lee
- Department of Neurosurgery, Armed Forces Yang Ju Hospital, Gyeonggi-do
| | - Dong-Won Shin
- Department of Neurosurgery, Armed Forces Yang Ju Hospital, Gyeonggi-do
| | - Seong-Jong Lee
- Department of Neurosurgery, Armed Forces Yang Ju Hospital, Gyeonggi-do
| | - Haewon Roh
- Department of Neurosurgery, Guro Hospital, Korea University College of Medicine, Seoul
- Focused Training Center for Trauma, Guro Hospital, Korea University College of Medicine, Seoul
| | - Hyung Jun Jeong
- Spine and Joint Center, 9988 Hospital, Seoul, Republic of Korea
| | - Tae Hoon Lee
- Spine and Joint Center, 9988 Hospital, Seoul, Republic of Korea
| | - Woo-Keun Kwon
- Department of Neurosurgery, Guro Hospital, Korea University College of Medicine, Seoul
- Focused Training Center for Trauma, Guro Hospital, Korea University College of Medicine, Seoul
- Spine and Joint Center, 9988 Hospital, Seoul, Republic of Korea
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Chong K, Kwon WK, Kim JH, Park YK, Yoon W, Kim JH, Kwon TH, Moon HJ. Inflammation by activated macrophage-like THP-1 cells increases human dura mater cell adhesion with alteration of integrin α 2 β 1 and matrix metalloproteinase. J Orthop Res 2019; 37:706-716. [PMID: 30561137 DOI: 10.1002/jor.24207] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2018] [Accepted: 12/06/2018] [Indexed: 02/04/2023]
Abstract
This study was designed to investigate (i) extracellular matrix to specify adhesive substrates to human dura mater cell (hDMC); (ii) the alteration on adhesion-related molecules in hDMC; and (iii) secreted matrix metalloproteinases (MMPs) linked with extracellular matrix remodeling after exposure to inflammation. The hDMC was cultured from human dura mater tissue, and the studies were performed with hDMC after co-culturing with macrophage like THP-1 cells (Mϕ). The adhesion of co-cultured hDMC through collagen I increased 6.4-fold and through collagen IV increased 5.0-fold compared with the adhesion of naïve cells (p < 0.001). Integrin subtype α2 β1 expression was increased 6.3-fold (p < 0.001) and α1 expression was decreased 2.0-fold (p < 0.001) in the co-cultured cells compared with the naïve cells. Co-culturing induced significant increases in MMP-1 (13.9-fold, p < 0.01), MMP-3 (7.6-fold, p < 0.01), and VEGF (VEGF: 3.8-fold, p < 0.05) expression and decreases in MMP-9 (0.1-fold, p < 0.01) compared with the sum of naïve hDMC and Mϕ values. Increased hDMC adhesion under inflammatory conditions is caused by an increased cellular affinity for collagen I and IV mediated by increased hDMC levels of integrin subtype α2 β1 and environmental MMP-1, -3 and decreased MMP-9. Selective integrin subtype α2 β1 inhibition assay showed 37.8% and 35.7% reduction in adhesion of co-cultured hDMC to collagen I (p < 0.001) and IV (p = 0.057), respectively. The present study provides insight into the pathological conditions related to dura mater adhesion in inflammation. © 2018 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 9999:1-11, 2019.
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Affiliation(s)
- Kyuha Chong
- Department of Neurosurgery, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Korea
| | - Woo-Keun Kwon
- Department of Neurosurgery, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Korea.,Spine Center, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Korea
| | - Joo Han Kim
- Department of Neurosurgery, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Korea.,Spine Center, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Korea
| | - Youn-Kwan Park
- Department of Neurosurgery, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Korea.,Spine Center, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Korea
| | - Wonki Yoon
- Department of Neurosurgery, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Korea
| | - Jong Hyun Kim
- Department of Neurosurgery, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Korea
| | - Taek-Hyun Kwon
- Department of Neurosurgery, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Korea
| | - Hong Joo Moon
- Department of Neurosurgery, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Korea.,Spine Center, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Korea
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Kwon WK, Park WB, Lee GY, Kim JH, Park YK, Moon HJ. Decompression with Lateral Pediculectomy and Circumferential Reconstruction for Unstable Thoracolumbar Burst Fractures: Surgical Techniques and Results in 18 Patients. World Neurosurg 2018; 120:e53-e62. [DOI: 10.1016/j.wneu.2018.07.137] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2018] [Revised: 07/13/2018] [Accepted: 07/14/2018] [Indexed: 10/28/2022]
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Kwon WK, Oh JK, Cho JM, Kwon TH, Park YK, Moon HJ, Kim JH. Non-Operatively Treated Thoracolumbar Burst Fracture with Posterior Ligamentous Complex Injury: Case Report and Consideration on the Limitation of Thoracolumbar Injury Classification and Severity (TLICS) Score. J Trauma Inj 2018. [DOI: 10.20408/jti.2018.31.2.76] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Affiliation(s)
- Woo-Keun Kwon
- Department of Neurosurgery, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Korea
- Department of Focused Training Center for Trauma, Departments of Korea University Guro Hospital, Korea University College of Medicine, Seoul, Korea
| | - Jong-Keon Oh
- Department of Focused Training Center for Trauma, Departments of Korea University Guro Hospital, Korea University College of Medicine, Seoul, Korea
- Department of Orthopedic Surgery, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Korea
| | - Jun-Min Cho
- Department of Focused Training Center for Trauma, Departments of Korea University Guro Hospital, Korea University College of Medicine, Seoul, Korea
- Department of General Surgery, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Korea
| | - Taek-Hyun Kwon
- Department of Neurosurgery, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Korea
| | - Youn-Kwan Park
- Department of Neurosurgery, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Korea
| | - Hong Joo Moon
- Department of Neurosurgery, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Korea
| | - Joo Han Kim
- Department of Neurosurgery, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Korea
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Kwon WK, Moon HJ, Kwon TH, Park YK, Kim JH. The Role of Hypoxia in Angiogenesis and Extracellular Matrix Regulation of Intervertebral Disc Cells During Inflammatory Reactions. Neurosurgery 2018; 81:867-875. [PMID: 28475716 DOI: 10.1093/neuros/nyx149] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2016] [Accepted: 03/02/2017] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND The intervertebral disc (IVD) is an avascular structure, and is therefore stable under hypoxic conditions. Previous studies have demonstrated that hypoxia might be related to symptomatic degenerative disc diseases (DDDs); however, the pathomechanism is still poorly understood. OBJECTIVE To identify the effect of hypoxia on the production of inflammatory mediators, angiogenic factors, and extracellular matrix-regulating enzymes of IVD cells during inflammatory reactions. METHODS Human nucleus pulposus (NP) and annulus fibrosus (AF) cells harvested during surgery for DDDs were cultured in macrophage conditioned media or interleukin (IL)-1β-stimulated media under hypoxic (2%) and normoxic (21%) conditions. Hypoxia-inducible factor-1α transcription factor activation was analyzed by western blotting. IL-6, IL-8, vascular endothelial growth factor (VEGF), vascular cell adhesion molecule (VCAM), matrix metalloproteinase (MMP)-1, MMP-3, tissue inhibitor of metalloprotease (TIMP)-1, and TIMP-2 in conditioned media were measured by an enzyme-linked immunosorbent assay. RESULTS NP cells expressed higher hypoxia-inducible factor-1α in the IL-1β-stimulated group under hypoxic condition. MMP-1 was significantly increased in the AF cells under hypoxic condition; TIMP-1 and TIMP-2 were significantly decreased in both naïve NP and AF cells during hypoxia. Both cells in macrophage conditioned media significantly diminished the production of IL-6 and VCAM, while VEGF significantly increased during hypoxia. After 1 ng/mL IL-1β stimulation, IL-8, VEGF, MMP-1, and MMP-3 were significantly increased in both cell types during hypoxia, while VCAM, TIMP-1, and TIMP-2 were decreased. CONCLUSION We found that hypoxia can enhance the angiogenic ability of IVD during inflammatory reactions, and cause progress in development of DDD via extracellular matrix regulation in this in vitro study.
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Affiliation(s)
- Woo-Keun Kwon
- Department of Neurosurgery, Guro Hospital, College of Medicine, Korea University, Seoul, Korea
| | - Hong Joo Moon
- Department of Neurosurgery, Guro Hospital, College of Medicine, Korea University, Seoul, Korea
| | - Taek-Hyun Kwon
- Department of Neurosurgery, Guro Hospital, College of Medicine, Korea University, Seoul, Korea
| | - Youn-Kwan Park
- Department of Neurosurgery, Guro Hospital, College of Medicine, Korea University, Seoul, Korea
| | - Joo Han Kim
- Department of Neurosurgery, Guro Hospital, College of Medicine, Korea University, Seoul, Korea
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Kwon WK, Oh JK, Kwon TH, Park YK, Moon HJ, Kim JH. A Rare Case of Lumbar Traumatic Intradiscal Hematoma Followed by Repeatative Occupation Related Minor Trauma. Journal of Trauma and Injury 2018. [DOI: 10.20408/jti.2018.31.1.38] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Affiliation(s)
- Woo-Keun Kwon
- Department of Neurosurgery, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Korea
- Focused Training Center for Trauma, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Korea
| | - Jong-Keon Oh
- Focused Training Center for Trauma, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Korea
- Department of Orthopedic Surgery, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Korea
| | - Taek-Hyun Kwon
- Department of Neurosurgery, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Korea
| | - Youn-Kwan Park
- Department of Neurosurgery, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Korea
| | - Hong Joo Moon
- Department of Neurosurgery, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Korea
| | - Joo-Han Kim
- Department of Neurosurgery, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Korea
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Yoon W, Kwon WK, Choudhri O, Ahn J, Huh H, Ji C, Do HM, Mantha A, Jeun SS. Complications Following Transradial Cerebral Angiography : An Ultrasound Follow-Up Study. J Korean Neurosurg Soc 2017; 61:jkns.2017.0209. [PMID: 29207853 PMCID: PMC5769853 DOI: 10.3340/jkns.2017.0209] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2017] [Revised: 08/30/2017] [Accepted: 10/11/2017] [Indexed: 12/29/2022] Open
Abstract
OBJECTIVE The feasibility and usefulness of transradial catheterization for coronary and neuro-intervention are well known. However, the anatomical change in the catheterized radial artery (RA) is not well understood. Herein, we present the results of ultrasonographic observation of the RA after routine transradial cerebral angiography (TRCA). METHODS Patients who underwent routine TRCA with pre- and post-procedure Doppler ultrasonography (DUS) of the catheterized RA were enrolled. We then recorded and retrospectively reviewed the diameter and any complicated features of the RA observed on DUS, and the factors associated with the diameter and complications were analyzed. RESULTS A total of 223 TRCAs across 181 patients were enrolled in the current study. The mean RA diameter was 2.48 mm and was positively correlated with male gender (p<0.001) and hypertension (p<0.002). The median change in diameter after TRCA was less than 0.1 mm (range, -1.3 to 1.2 mm) and 90% of changes were between -0.8 and +0.7 mm. Across 228 procedures, there were 12 cases (5.3%) of intimal hyperplasia and 22 cases (9.6%) of asymptomatic local vascular complications found on DUS. Patients with abnormal findings on the first procedure had a smaller pre-procedural RA diameter than that of patients without findings (2.26 vs. 2.53 mm, p=0.0028). There was no significant difference in the incidence of abnormal findings for the first versus subsequent procedures (p=0.68). CONCLUSION DUS identified the pre- and post-procedural diameter and local complications of RA. Routine TRCA seems to be acceptable with regard to identifying local complications and changes in RA diameter.
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Affiliation(s)
- Wonki Yoon
- Department of Neurosurgery, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Korea
| | - Woo-Keun Kwon
- Department of Neurosurgery, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Korea
- Focused Training Center for Trauma, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Korea
| | - Omar Choudhri
- Department of Cerebrovascular Skull Base Surgery, Mischer Neuroscience Institute, University of Texas Medical School at Houston, Houston, TX, USA
| | - Jaegeun Ahn
- Department of Neurosurgery, St. Paul’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Hanyong Huh
- Department of Neurosurgery, St. Paul’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Choel Ji
- Department of Neurosurgery, St. Paul’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Huy M. Do
- Department of Radiology, Stanford University Medical Center, Stanford, CA, USA
| | - Aditya Mantha
- Stanford University Medical Center, Stanford, CA, USA
| | - Sin-Soo Jeun
- Department of Neurosurgery, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
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Kwon WK, Kim JH, Moon HJ, Park YK. The Korean Spinal Neurosurgery Society ; Are We Reimbursed Properly for Spinal Neurosurgical Practices under the Korean Resource Based Relative Value Scale Service? J Korean Neurosurg Soc 2017; 60:47-53. [PMID: 28061492 PMCID: PMC5223755 DOI: 10.3340/jkns.2016.0405.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2016] [Accepted: 08/29/2016] [Indexed: 11/27/2022] Open
Abstract
OBJECTIVES The Korean Resource Based Relative Value Scale (K-RBRVS) was introduced in 2001 as an alternative of the previous medical fee schedule. Unfortunately, most neurosurgeons are unfamiliar with the details of the K-RBRVS and how it affects the reimbursement rates for the surgical procedures we perform. We summarize the K-RBRVS in brief, and discuss on how the relative value (RV) of the spinal neurosurgical procedures have changed since the introduction in 2001. METHODS We analyzed the change of spinal procedure RVs since 2001, and compared it with the change of values in the brain neurosurgical procedures. RVs of 88 neurospinal procedures on the list of K-RBRVS were analyzed, while 24 procedures added during annual revisions were excluded. RESULTS During the past 15 years, RVs for spinal procedures have increased 62.8%, which is not so different with the cumulative increase of consumer prices during this time period or the increase rate of 92.3% for brain surgeries. When comparing the change of RVs in more complex procedures between spinal and brain neurosurgery, the increase rate was 125.3% and 133%, respectively. CONCLUSION More effort of the society of spinal surgeons seems to be needed to get adequate reimbursement, as there have been some discrimination compared to brain surgeons in the increase of RVs. And considering the relative underestimation of spinal neurosurgeons' labor, more objective measures of neurospinal surgeons' work and productivity should be developed for impartial reimbursement.
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Affiliation(s)
- Woo-Keun Kwon
- Department of Neurosurgery, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Korea
| | - Joo Han Kim
- Department of Neurosurgery, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Korea
| | - Hong Joo Moon
- Department of Neurosurgery, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Korea
| | - Youn-Kwan Park
- Department of Neurosurgery, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Korea
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Kwon WK, Kwon TH, Park DH, Kim JH, Ha SK. Efficacy of superficial temporal artery-middle cerebral artery bypass in cerebrovascular steno-occlusive diseases: Hemodynamics assessed by perfusion computed tomography. Asian J Neurosurg 2017; 12:519-524. [PMID: 28761534 PMCID: PMC5532941 DOI: 10.4103/1793-5482.153497] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVES Our purpose of this study was to assess the cerebral hemodynamic improvement with perfusion computed tomography (CT), before and after superficial temporal artery (STA) to middle cerebral artery (MCA) bypass surgery in patients with cerebrovascular steno-occlusive diseases including both moyamoya disease and nonmoyamoya steno-occlusions. MATERIALS AND METHODS Twenty-four STA-MCA bypasses were performed to 22 patients with symptomatic cerebrovascular steno-occlusive diseases, including both moyamoya disease and nonmoyamoya steno-occlusive diseases. Brain perfusion CT images were obtained before and after the bypass surgery. The relative parameters such as cerebral blood volume (CBV), cerebral blood flow (CBF), and mean transit time (MTT) derived from the perfusion CT were collected and analyzed to assess the efficacy of STA-MCA bypass. RESULTS The CBF increased, and MTT decreased after the bypass surgery in both moyamoya group and nonmoyamoya group. The increase of CBF in nonmoyamoya group and the decrease of MTT delay in moyamoya group, overall group were statistically significant (P < 0.05). No significant postoperative change in CBV was noted. During the postoperative follow-up period, none of the 22 patients experienced any repeated ischemic/hemorrhagic attacks nor any newly developed neurologic deficits. CONCLUSION The STA-MCA bypass is an effective surgical management for patients with cerebrovascular steno-occlusive diseases, such as moyamoya disease and internal carotid artery/MCA steno-occlusion. And perfusion CT can be used as an effective quantitative modality to assess the cerebral perfusion before and after the STA-MCA bypass surgery.
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Affiliation(s)
- Woo-Keun Kwon
- Department of Neurosurgery, Korea University, Guro Hospital, Korea University College of Medicine, Seoul, Republic of Korea
| | - Taek-Hyun Kwon
- Department of Neurosurgery, Korea University, Guro Hospital, Korea University College of Medicine, Seoul, Republic of Korea
| | - Dong-Hyuk Park
- Department of Neurosurgery, Korea University, Anam Hospital, Korea University College of Medicine, Seoul, Republic of Korea
| | - Joo-Han Kim
- Department of Neurosurgery, Korea University, Guro Hospital, Korea University College of Medicine, Seoul, Republic of Korea
| | - Sung-Kon Ha
- Department of Neurosurgery, Korea University, Ansan Hospital, Korea University College of Medicine, Ansan, Republic of Korea
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Kwon WK, Kim JH, Lee JH, Lim BG, Lee IO, Koh SB, Kwon TH. Microelectrode recording (MER) findings during sleep–awake anesthesia using dexmedetomidine in deep brain stimulation surgery for Parkinson’s disease. Clin Neurol Neurosurg 2016; 143:27-33. [DOI: 10.1016/j.clineuro.2016.02.005] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2015] [Revised: 02/04/2016] [Accepted: 02/05/2016] [Indexed: 11/27/2022]
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Kwon WK, Park DH, Park KJ, Kang SH, Lee JH, Cho TH, Chung YG. Prognostic factors of clinical outcome after neuronavigation-assisted hematoma drainage in patients with spontaneous intracerebral hemorrhage. Clin Neurol Neurosurg 2014; 123:83-9. [PMID: 25012018 DOI: 10.1016/j.clineuro.2014.05.016] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2014] [Revised: 04/21/2014] [Accepted: 05/18/2014] [Indexed: 10/25/2022]
Abstract
OBJECTIVE The prognostic factors that contribute to outcome after navigation-assisted drainage in patients with spontaneous intracerebral hemorrhage (ICH) have not been defined. We compared the characteristics and clinical outcomes of patients with spontaneous ICHs who underwent neuronavigation-assisted hematoma drainage. METHODS Forty-seven patients were enrolled from January 2004 to August 2013. The patients were divided into two groups according to Glasgow Outcome Scale (GOS) scores: the good- (GOS 4-5) and poor-outcome (GOS 1-3) groups. A variety of factors, characteristics, and clinical outcomes were analyzed. RESULTS Among the 47 patients, 16 and 31 showed good and poor outcomes, respectively. The mortality rate was 4.3%. Patients' ages, horizontal and vertical diameters and volume of the hematoma on the initial brain computed tomography scan, and the initial Glasgow Coma Scale (GCS) scores were significantly different between the two groups (P<0.05). Ages less than 60 years, smaller horizontal and vertical diameters of the hematoma, less initial hematoma volume, higher initial GCS scores, and the absence of intraventricular hemorrhages were significantly associated with good outcome (P<0.05). Among these factors, initial hematoma volume was a borderline prognostic factor (odds ratio [OR], 0.951; 95% confidence interval [CI], 0.904-1.001; P=0.054), whereas initial GCS score was a significant prognostic factor (OR, 2.737; 95% CI, 1.371-5.465; P=0.004), in the multivariate analysis. CONCLUSION Initial GCS score and hematoma volume were important prognostic factors of clinical outcome in patients with spontaneous ICHs who underwent navigation-assisted drainage. Such factors should be carefully considered before patients are treated with navigation-assisted hematoma drainage.
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Affiliation(s)
- Woo-Keun Kwon
- Department of Neurosurgery, Korea University Medical Center, Korea University College of Medicine, Seoul, South Korea
| | - Dong-Hyuk Park
- Department of Neurosurgery, Korea University Medical Center, Korea University College of Medicine, Seoul, South Korea; Center of Innovative Cell Therapy and Research, Anam Hospital, Korea University College of Medicine, Seoul, South Korea.
| | - Kyung-Jae Park
- Department of Neurosurgery, Korea University Medical Center, Korea University College of Medicine, Seoul, South Korea
| | - Shin-Hyuk Kang
- Department of Neurosurgery, Korea University Medical Center, Korea University College of Medicine, Seoul, South Korea
| | - Jeong-Hyun Lee
- Center of Innovative Cell Therapy and Research, Anam Hospital, Korea University College of Medicine, Seoul, South Korea; Department of Anesthesiology and Pain Medicine, Samsung Medical Center, Sungkyunkwan University College of Medicine, Seoul, South Korea
| | - Tai-Hyoung Cho
- Department of Neurosurgery, Korea University Medical Center, Korea University College of Medicine, Seoul, South Korea; Center of Innovative Cell Therapy and Research, Anam Hospital, Korea University College of Medicine, Seoul, South Korea
| | - Yong-Gu Chung
- Department of Neurosurgery, Korea University Medical Center, Korea University College of Medicine, Seoul, South Korea
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Kwon WK, Park KJ, Park DH, Kang SH. Ruptured saccular aneurysm arising from fenestrated proximal anterior cerebral artery : case report and literature review. J Korean Neurosurg Soc 2013; 53:293-6. [PMID: 23908703 PMCID: PMC3730031 DOI: 10.3340/jkns.2013.53.5.293] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2012] [Revised: 02/03/2013] [Accepted: 05/13/2013] [Indexed: 11/27/2022] Open
Abstract
The aneurysm arising from fenestrated proximal anterior cerebral artery (ACA) is considered to be unique. The authors report a case of a 59-year-old woman who presented with a subarachnoid hemorrhage (SAH) secondary to a ruptured aneurysm originating from the fenestrated A1 segment of right ACA. The patient had another unruptured aneurysm which was located at the right middle cerebral artery bifurcation. She was successfully treated with surgical clipping for both aneurysms. From the previously existing literatures, we found 18 more cases (1983-2011) of aneurysms associated with fenestrated A1 segment. All cases represented saccular type of aneurysms, and 79% of the patients had SAH. There were three subtypes of the fenestrated A1 aneurysms depending on the anatomical location, relative to the fenestrated segment. The most common type was the aneurysms located on the proximal end of fenestrated artery (82%). Azygos ACA and hypoplastic A1 were frequently accompanied by the aneurysm (33% and 31%, respectively), and multiple aneurysms were shown in three cases (16%). Considering that fenestrated A1 segment is likely to develop an aneurysm, which has high risk of rupture, early management may benefit patients with aneurysms accompanied by fenestrated proximal ACA.
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Affiliation(s)
- Woo-Keun Kwon
- Department of Neurosurgery, Korea University College of Medicine, Seoul, Korea
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Lee MW, Kim YJ, Park SW, Hwang JH, Jung SI, Jeon HJ, Kwon WK. Percutaneous radiofrequency ablation of small hepatocellular carcinoma invisible on both ultrasonography and unenhanced CT: a preliminary study of combined treatment with transarterial chemoembolisation. Br J Radiol 2009; 82:908-15. [PMID: 19433482 DOI: 10.1259/bjr/55877882] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
The purpose of this study was to assess the feasibility and efficacy of percutaneous radiofrequency ablation combined with transarterial chemoembolisation (TACE) for the treatment of hepatocellular carcinoma that are invisible on both ultrasound and unenhanced CT. 73 patients with a total of 101 nodular hepatocellular carcinomas were referred for possible radiofrequency (RF) ablation. Of these, 14 lesions (14%) in 14 patients were invisible on both ultrasound and unenhanced CT. The invisible nodules averaged 1.2 cm in diameter (range, 0.8-2.0 cm; median, 1.1 cm). After segmental TACE, percutaneous RF ablation was performed if the index tumour was visible on fluoroscopy, ultrasound or CT. All cases of combined treatment were evaluated for size of ablative zone, complications, rate of technical effectiveness at 1-month follow-up CT and local tumour progression. After TACE, percutaneous RF ablation was technically feasible in 10 (71%) of the 14 nodules. RF ablation was performed with the guidance of fluoroscopy (n = 6, 42%), ultrasound (n = 2, 14%) or CT (n = 2, 14%). The mean diameter of the ablative zone by percutaneous RF ablation combined with TACE was 4.8+/-0.7 cm and 3.4+/-0.6 cm in the long and short axis, respectively. No major complications were documented. The primary technical effectiveness rate for nodules treated by combined treatment was 100% (10/10) at 1-month follow-up CT. No local tumour progression was found during the follow-up period (median 15 months; range 4-20 months). Percutaneous RF ablation combined with TACE is a feasible and effective technique for treating small hepatocellular carcinomas that are not visible on ultrasound or unenhanced CT.
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Affiliation(s)
- M W Lee
- Department of Radiology, Konkuk University School of Medicine, 4-12 Hwayang-dong, Gwangjin-gu, Seoul 143-729
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