Surgical Treatment for Degenerative Lumbar Disease With Neurologic Deficits: Comparison Between Oblique Lumbar Interbody Fusion and Posterior Lumbar Interbody Fusion / 대한신경손상학회지

Objective@#This study aimed to compare the radiological and clinical outcomes of oblique lumbar interbody fusion (OLIF) and posterior lumbar interbody fusion (PLIF) surgeries and to confirm the effects of additional partial laminectomy on the surgical outcomes of OLIF. @*Methods@#This retrospective study included 130 patients who underwent OLIF or PLIF for single-level fusion. Among them, 42 patients underwent PLIF and open pedicle screw fixation and 88 underwent OLIF and percutaneous pedicle screw fixation. In the OLIF group, 42 patients received additional neural decompression through partial laminectomy and discectomy (direct OLIF), whereas the remaining 46 patients did not (indirect OLIF). To measure the neurological deficits, the clinical outcomes were evaluated using a visual analog scale for back and leg pain and the Oswestry Disability Index. Radiologic outcomes were evaluated based on the disc and foraminal heights as well as the segmental lordotic and lumbar lordotic angles. @*Results@#The improvement in the clinical outcomes did not differ significantly among the 3 groups. Radiologically, the 2 OLIF groups showed statistically significant improvements in the disc and foraminal heights when compared with the PLIF group. The PLIF group showed a significant decrease in the disc height and segmental lordotic angle when compared with the OLIF group in the postoperative 1-year period. @*Conclusion@#Both OLIF and PLIF showed similar clinical outcomes in the single-level lumbar fusion. However, OLIF grafts showed an advantage over PLIF with respect to the radiographic outcomes and complication rates. Additionally, partial laminectomy did not significantly affect the radiological results.

Can Supine Magnetic Resonance Imaging Be an Alternative to Standing Lateral Radiographs for Evaluating Cervical Sagittal Alignment? / 대한신경손상학회지

Objective@#Recently, many studies have reported that cervical alignment is related to clinical outcomes. However, poor visibility of anatomical structures during X-ray (XR) imaging limits accurate measurements. In supine magnetic resonance (MR) imaging, the boundary of the anatomical structure is clear, but the correlation to XR images taken in a standing position is problematic. In this study, we evaluated the agreement of sagittal alignment parameters between MR and XR measurements. @*Methods@#We retrospectively reviewed 268 patients. Cervical sagittal parameters were measured using XR and MR images, and their relationships were evaluated using Pearson's correlation, paired t-tests, and 2-way random, single score intraclass correlation coefficient (ICCs) (2,1). Using simple linear regression analysis, MR results were converted to the expected value (MR-E). The subsequent comparison of MR-Es with XRs was used to examine whether MR-Es could replace XRs when the measurement difference was less than 2 mm or 2°. @*Results@#The correlation between the MR and XR measurements was high, but ICCs showed low reliability. All parameters were significantly different between XR and MR measurements in paired t-tests. Converting the MR values eliminated the t-test differences between MR-Es and XRs, but did not affect correlations and ICCs. The replacement ratio included the Cobb angle: 20.3%, T1: 27.1%, the sagittal vertical axis: 17.6%, C1–2: 29.7%, and C2: 16.0%. @*Conclusion@#These results indicate that supine MR measurements could not replace upright XR measurements.

Thickening Ligamentum Flavum Mimicking Tumor in the Epidural Space of the Cervical Spine / 대한신경손상학회지

In patients with tumors and spinal cord lesions, inflammation and tissue infection can result in mass effect detection on imaging. As a result, surgical biopsy procedures are often performed on the lesions. We report a rare case in which the thickening ligamentum flavum (LF) appeared to be a tumor in the epidural space of the cervical spine based on imaging findings. A 52-year-old man visited our outpatient clinic with severe shoulder pain and radicular pain in his right arm that had developed gradually after a traffic accident two months earlier. Magnetic resonance imaging of the cervical spine revealed an extradural mass at the cervicothoracic junction level. Suspecting a tumor, spinal decompression surgery was performed and a biopsy of the mass was obtained. At the time of surgery, the LF was thick and compressed the spinal cord. After successful removal of the LF, the spinal cord appeared normal. Histopathological examination confirmed the mass as the LF. The patient was discharged without pain or weakness two weeks postoperatively. This case demonstrated that when the LF of the cervicothoracic junction is thickened, it may be misdiagnosed as a cervical spine tumor compressing the spinal cord.

Endonasal Removal of Dentigerous Cyst in the Maxillary Sinus / 대한이비인후과학회지

Dentigerous cyst is the second most common odontogenic cyst and is associated with the crown of an unerupted tooth. Removal of the entire cyst with the impacted tooth is a treatment of choice to prevent recurrence. Although Caldwell-Luc approach has been used frequently for the treatment of a dentigerous cyst in the maxillary sinus, it has more morbidity than transnasal endoscopic approach. Moreover, endoscopic approach has several other advantages, such as good illumination, clear and magnified visualization, resulting in more conservative surgery with pre-cise dissection. A 37-year-old man was referred to the outpatient clinic due to an incidental large expansile cystic lesion containing ectopic tooth in the right maxillary sinus. Endoscopic examination identified a prominent bulging lesion in the inferior meatus. The cyst with the tooth was removed completely through a large inferior meatal antrostomy with endoscopic guidance. Postoperative course was uneventful and there was no recurrence for 4 years postoperatively.

Correlation between Improvement of Subjective Nasal Patency and Changes of Parameters Measured by Acoustic Rhinometry after Septoplasty and Outfracturing of Both Turbinates / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: There have been some studies performed to evaluate subjective and objective changes after septoplasty and of their correlation, but have reported contradicting results. In this light, this study attempted to evaluate subjective and objective postoperative changes and investigate whether there is any correlation between them. SUBJECTS AND METHOD: This study was performed prospectively in 48 patients who underwent septoplasty and outfracturing of both turbinates. The parameters of subjective nasal patency and acoustic rhinometry (AR) were measured before and after surgery. We evaluated these changes and determined if there exists a correlation between the changes of AR parameters and improvement of subjective nasal patency. RESULTS: Minimal cross-sectional area (MCA) and nasal volume in the convex side of nasal cavity were significantly improved after the surgery (p<0.05). Subjective nasal patency and septal symmetry were also improved (p<0.05). There was a correlation between the changes of MCA and nasal volume in the convex side of nasal cavity with respect to the improvement of subjective nasal patency (p<0.05). However, the improvement of symmetry was not correlated with that of subjective nasal patency. CONCLUSION: Both subjective nasal patency and AR parameters were improved after septoturbinoplasty. Changes of MCA and nasal volume in the convex side of nasal cavity well reflected the improvement of subjective nasal patency postoperatively, whereas the improvement of symmetry did not correlate with the improvement of subjective nasal patency.