Il Sup Kim

Objective : In this study, we aimed to compare the clinical outcomes of unilateral biportal endoscopic (UBE) lumbar discectomy and open lumbar microdiscectomy (MD) for recurrent disc herniation.Methods : Ninety patients who underwent discectomy, including 44 and 46 who underwent UBE and MD, respectively, were enrolled. All surgeries were performed between March 2020 and April 2023. Only patients with single-level recurrence were included; patients with multilevel recurrence or unstable disease, as well as those who had undergone surgery less than 6 months prior, were excluded. Visual analog scale (VAS) scores, recurrence rates, and complications were compared between the groups.Results : The average follow-up periods were 19.09 and 20.45 months in the UBE revision and MD revision discectomy groups, respectively. The mean bleeding loss and hospital stay were shorter in the UBE group than in the MD group. Postoperative short-term back pain was lower in the UBE group (VAS score, 3.32) than in the MD group (VAS score, 7.89) (p<0.001). Radiating pain showed similar patterns in both groups at all time points. Recurrence was more frequent in the MD group; however, this difference did not reach statistical significance, likely owing to the small sample size (p=0.677). Similarly, incidental durotomy occurred less frequently in the UBE group (6.8% vs. 8.7%), but this difference was not statistically significant.Conclusion : Both UBE and MD could achieve good long-term outcomes; however, UBE revision was superior in terms of short-term back pain, bleeding loss, and length of hospital stay after surgery.

Objective: Delirium is a frequent and serious postoperative complication in older adults after spinal surgery, linked to prolonged hospitalization, cognitive decline, and increased mortality. Despite its clinical significance, multicenter data in Korea remain limited.Methods: This retrospective multicenter study analyzed 1,284 patients aged ≥75 years who underwent spinal fusion for degenerative lumbar disease across seven institutions between January 2022 and September 2023. Delirium was diagnosed using Diagnostic and Statistical Manual of Mental Disorders-5 criteria documented in electronic medical records. Demographic, clinical, and perioperative variables were compared between patients with and without delirium. Logistic regression was used to identify independent predictors.Results: Delirium occurred in 154 patients (12.0%), with marked inter-center variability in incidence (3.8%–33.3%). Among delirium cases, antipsychotics were prescribed in 165 instances (107.1%; range, 96.2%–283.3%), while psychiatric consultations were obtained in 112 cases (72.7%; range, 1.9%–316.7%), reflecting inconsistent management practices. In univariate analysis, older age, male sex, taller height, smoking, and opioid use history were associated with delirium. Multivariate analysis identified older age (adjusted odds ratio [OR], 1.08; 95% confidence interval [CI], 1.01–1.16), male sex (adjusted OR, 1.42; 95% CI, 1.03–1.96), and opioid history (adjusted OR, 2.18; 95% CI, 1.45–3.25) as independent predictors.Conclusion: Postoperative delirium in geriatric spinal surgery patients demonstrates substantial inter-institutional variability in diagnosis and management across Korea. Independent predictors included older age, male sex, and opioid history. These findings highlight the importance of standardized diagnostic criteria, consistent psychiatric involvement, and opioid-sparing strategies to optimize delirium prevention and management in this vulnerable population.

Objective: Retro-odontoid pseudotumor (ROP) is a nonneoplastic mass associated with atlantoaxial instability (AAI). This study compared ROP-positive and ROP-negative AAI patients and evaluated cystic versus granulation-type ROP regarding regression patterns and surgical outcomes.Methods: We retrospectively analyzed 112 AAI patients who underwent pre- and postoperative imaging and clinical evaluations. Patients were classified as ROP-positive or ROP-negative, with ROP-positive cases further categorized as cystic or granulation-type. Imaging parameters—including atlantodental interval (ADI), ΔADI, and cervical range of motion (ROM) were compared along with regression time and postoperative outcomes.Results: Among 112 patients, 57 (50.9%) had ROP. The ROP-positive group was older (67.37±13.13 years vs. 56.90±15.15 years, p<0.001) and had lower ADI (5.63±2.77 mm vs. 6.99±2.33 mm, p=0.034), ΔADI (3.01±2.27 mm vs. 3.89±2.07 mm, p=0.006), and C2–7 ROM (30.78°±15.45° vs. 41.73°±16.58°, p<0.001). In ROP subgroups, the cystic group had greater C1–2 ROM (15.69°±6.34° vs. 10.00°±7.72°, p=0.013) and ADI (6.98±2.68 mm vs. 5.14±2.66 mm, p=0.042). Immediate postoperative ROP thickness remained greater in the cystic group (6.85±2.49 vs. 5.21±1.82 mm, p=0.042), while ROP thickness at 3 months and 1 year showed no significant differences. JOA recovery rates were similar.Conclusion: This study demonstrates that ROP-positive AAI patients exhibit distinct radiological characteristics, with reduced cervical mobility. Furthermore, cystic ROP shows delayed regression following posterior fusion. These findings underscore the importance of ROP subtypes in surgical planning, requiring closer monitoring and possibly earlier intervention.

Objective: To elucidate the clinical outcomes of craniocervical realignment surgery in patients with craniovertebral junction (CVJ) kyphosis accompanied by negative sagittal imbalance, and to identify radiological predictors associated with favorable outcomes.Methods: A retrospective analysis was performed on 28 patients who underwent craniocervical realignment between 2014 and 2022 for CVJ kyphosis with accompanying negative sagittal imbalance. Clinical outcomes were evaluated using the Neck Disability Index (NDI), visual analogue scale for neck pain, and the Japanese Orthopaedic Association (JOA) score. Radiographic parameters included the C0–2 angle and the C2–7 sagittal vertical axis (SVA). Favorable outcomes were defined as an improvement of more than 20 points in the NDI and a JOA recovery rate exceeding 50%. Multiple linear regression and receiver operating characteristic (ROC) curve analyses were conducted to identify independent predictors and to determine optimal threshold values.Results: Significant improvements in both clinical outcomes and radiographic alignment were observed in association with craniocervical realignment surgery. Patients who achieved favorable outcomes exhibited greater postoperative changes in the C0–2 angle and the C2–7 SVA. Multivariate analysis identified changesm in the C0–2 angle (p=0.019) and C2–7 SVA (p=0.010) as independent predictors of NDI improvement, while age (p=0.033) and C2–7 SVA change (p=0.037) were independently associated with the JOA recovery rate. ROC curve analysis determined optimal cutoff values of ≥10.65° for C0–2 angle change and ≥19.2 mm for C2–7 SVA change, with corresponding area under the curve values of 0.872 and 0.802, respectively.Conclusion: Craniocervical realignment appears to be a viable surgical option for patients with CVJ kyphosis and negative sagittal imbalance. Postoperative changes in C0–2 angle and C2–7 SVA were found to be associated with favorable clinical and functional outcomes, suggesting their potential role as prognostic factors.

Objective: To evaluate C2 muscle preservation effect and the radiological and clinical outcomes after C2 recapping laminoplasty.Methods: Fourteen consecutive patients who underwent C2 recapping laminoplasty around C1–2 level were enrolled. To evaluate muscle preservation effect, the authors conducted a morphological measurement of extensor muscles between the operated and nonoperated side. Two surgeons measured the cross-sectional area (CSA) of obliquus capitis inferior (OCI) and semispinalis cervicis (SSC) muscle before and after surgery to determine atrophy rates (ARs). Additionally, we examined range of motion (ROM), sagittal vertical axis (SVA), neck visual analogue scale (VAS), Neck Disability Index (NDI), and Japanese Orthopaedic Association (JOA) score to assess potential changes in alignment and consequent clinical outcomes following posterior cervical surgery.Results: We measured the CSA of OCI and SSC before surgery, and at 6 and 12 months postoperatively. Based on these measurements, the AR of the nonoperated SSC was 0.1% ± 8.5%, the AR of the operated OCI was 2.0% ± 7.2%, and the AR of the nonoperated OCI was -0.7% ± 5.1% at the 12 months after surgery. However, the AR of the operated side’s SSC was 11.2% ± 12.5%, which is a relatively higher value than other measurements. Despite the atrophic change of SSC on the operated side, there were no prominent changes observed in SVA, C0–2 ROM, and C2–7 ROM between preoperative and 12 months postoperative measurements, which were 11.8 ± 10.9 mm, 16.3° ± 5.9°, and 48.7° ± 7.7° preoperatively, and 14.1 ± 11.6 mm, 16.1° ± 7.2°, and 44.0° ± 10.3° at 12 months postoperative, respectively. Improvement was also noted in VAS, NDI, and JOA scores after surgery with JOA recovery rate of 77.3% ± 29.6%.Conclusion: C2 recapping laminoplasty could be a useful tool for addressing pathologies around the upper cervical spine, potentially mitigating muscle atrophy and reducing postoperative neck pain, while maintaining sagittal alignment and ROM.

This study aimed to retrospectively assess results of intracranial meningioma surgery with or without intraoperative neuromonitoring (IONM) in a single institution. Two cohorts (a historical cohort and a monitoring cohort) were collected for the analysis. Before IONM was introduced, a total of 107 patients underwent intracranial meningioma operation without IONM from January 2000 to December 2008 by one neurosurgeon (historical cohort). After IONM was introduced, a total of 99 patients with intracranial meningioma were operated under IONM between November 2018 and February 2023 by two neurosurgeons (monitoring cohort). A retrospective comparison was made on the complications from meningioma surgery between the two groups. In the monitoring cohort, warning signals of motor evoked potential (MEPs) or somatosensory evoked potential (SSEPs) were alarmed in 10 patients. Two of these 10 patients aborted the operation and eight of these 10 patients with warning signals underwent tumor resection. Of these eight patients, five showed postoperative morbidity. Five of 89 patients without warning signals developed neurological deficits. In the historical cohort, 14 of 107 patients showed postoperative morbidity or mortality. Even after successful resection of intracranial meningiomas prior to the advent of IONM, integration of MEPs and SSEPs monitoring yielded valuable insights for surgical teams during operative procedures.

Objective: Achieving successful fusion during spine surgery is dependent on rigid pedicle screw fixation. To assess fixation strength, the insertional torque can be measured during intraoperative screw fixation. This study aimed to explore the technical feasibility of measuring the insertional torque of a pedicle screw, while investigating its relationship with bone density.Methods: Thoraco-lumbar screw fixation fusion surgery was performed on 53 patients (mean age, 65.5 ± 9.8 years). The insertional torque of 284 screws was measured at the point passing through the pedicle using a calibrated torque wrench, with a specially designed connector to the spine screw system. The Hounsfield units (HU) value was determined by assessing the trabecular portion of the index vertebral body on sagittal computed tomography images. We analyzed the relationship between the measured insertional torque and the following bone strength parameters: bone mineral density (BMD) and HU of the vertebral body.Results: The mean insertion torque was 105.55 ± 58.08 N∙cm and T-score value (BMD) was -1.14 ± 1.49. Mean HU value was 136.37 ± 57.59. Screw insertion torque was positively correlated with BMD and HU in whole patients. However, in cases of osteopenia, all variables showed very weak correlations with insertional torque. In patients with osteoporosis, there was no statistically significant correlation between BMD and torque strength; HU showed a significant correlation.Conclusion: The insertional torque of screw fixation significantly correlated with bone density (BMD and HU). HU measurements showed greater clinical significance than did BMD values in patients with osteoporosis.

Cross-sectional comparative study. This study aimed to analyze the role of cervical parameters, in terms of the perception process, when evaluating cervical sagittal balance on an X-ray image. Reports on the role of cervical parameters in the perception of cervical sagittal balance have not been made. The study included 4 board-certified neurosurgeons and 6 residents of a neurosurgical department. They were instructed to answer a total of 40 questions. The parameter that was the most helpful in deriving the answer was checked. The correct answer rate, dependency on the parameter, and correct answer contribution of the parameter were analyzed. Among the various parameters, 5 parameters [C2-7 angle (C2-7A), T1 slope minus cervical lordosis (T1s-CL), C2 slope (C2s), C7 slope (C7s), and C2-7 sagittal vertical axis) were selected. The simple parameter (C2s, C7s) has a higher dependency and correct answer contribution than the complex parameter (C2-7A, T1s-CL). The angular (C2-7A, T1s-CL, C2s, C7s) parameters have a higher dependency; however, both the length and angular parameters correct answer contribution were similar. The cervical parameters that have simpler properties were highly preferred and had a lower perception error.