Korea University Guro Hospital

Department of Neurosurgery, Korea University Guro Hospital South Korea.

Kwon et al., from the Department of Neurosurgery, Korea University Guro Hospital South Korea introduced a technique and results of retro-pleural/ peritoneal “lateral pediculectomy” for the decompression of thoracolumbar fractures and reconstruction using expandable titanium cage, and circumferential fixation at a single stage.

18 patients who had single unstable, burst thoracolumbar fracture were treated by this technique between January 2014 and December 2016 (T12: 9 cases, L1: 7 cases, L2: 2 cases). They were reviewed retrospectively in terms of radiologic (CT scan and X-ray), clinical outcomes and complications. The results were compared with another cohort of thoracolumbar fractures treated by posterior only surgery.

There was no radiologic complications implying pseudoarthrosis or instrument failure on the postoperative 6 months CT scan. There was also no neurologic deterioration or infections during the same period. 2 patients (11.%) of iatrogenic and 1 patient of trauma related injury of the dura were secured without any delayed complications. 3 patients (16.7%) of transient weakness in left hip flexion immediately after operation were observed and recovered within 2 weeks in all cases. 6 patients (33.3%) complained of dysesthesia and/or hypoesthesia on incision site.

The present technique suggests “lateral pediclectomy” as a distinct anatomic landmark and surgical tactics to access and remove bony fragment effectively and safely. This provides a more straightforward assess to the burst fragment and helps the surgeon to make better intra-operative decompression strategies. Moreover, this circumferential instrumentation with anterior support and fusion revealed better restoration of the thoracolumbar spine alignment compared to posterior only surgery, with acceptable complications rates ¹⁾.

Kim JH, Kim JH, Kwon TH, Chong K, Hwang SY, Yoon WK. Aseptic Bone Flap Resorption after Cranioplasty with Autologous Bone: Incidence, Risk Factors, and Clinical Implications. World Neurosurg. 2018 Jul;115:e111-e118. doi: 10.1016/j.wneu.2018.03.197. Epub 2018 Apr 4. PubMed PMID: 29626687.

2: Chang Y, Kim BM, Bang OY, Baek JH, Heo JH, Nam HS, Kim YD, Yoo J, Kim DJ, Jeon P, Baik SK, Suh SH, Lee KY, Kwak HS, Roh HG, Lee YJ, Kim SH, Ryu CW, Ihn YK, Kim B, Jeon HJ, Kim JW, Byun JS, Suh S, Park JJ, Lee WJ, Roh J, Shin BS, Kim JM. Rescue Stenting for Failed Mechanical Thrombectomy in Acute Ischemic Stroke: A Multicenter Experience. Stroke. 2018 Apr;49(4):958-964. doi: 10.1161/STROKEAHA.117.020072. Epub 2018 Mar 16. PubMed PMID: 29581342.

3: Kim BM, Baek JH, Heo JH, Nam HS, Kim YD, Yoo J, Kim DJ, Jeon P, Baik SK, Suh SH, Lee KY, Kwak HS, Roh HG, Lee YJ, Kim SH, Ryu CW, Ihn YK, Kim B, Jeon HJ, Kim JW, Byun JS, Suh S, Park JJ, Lee WJ, Roh J, Shin BS, Bang OY. Collateral status affects the onset-to-reperfusion time window for good outcome. J Neurol Neurosurg Psychiatry. 2018 Mar 8. pii: jnnp-2017-317627. doi: 10.1136/jnnp-2017-317627. [Epub ahead of print] PubMed PMID: 29519900.

4: Hwang MH, Son HG, Lee JW, Yoo CM, Shin JH, Nam HG, Lim HJ, Baek SM, Park JH, Kim JH, Choi H. Phototherapy suppresses inflammation in human nucleus pulposus cells for intervertebral disc degeneration. Lasers Med Sci. 2018 Jul;33(5):1055-1064. doi: 10.1007/s10103-018-2470-4. Epub 2018 Mar 3. PubMed PMID: 29502159.

5: Kim JE, Lee MK, Lee DK, Choi SS, Park JS. Continuous cervical epidural block: Treatment for intractable hiccups. Medicine (Baltimore). 2018 Feb;97(6):e9444. doi: 10.1097/MD.0000000000009444. PubMed PMID: 29419660; PubMed Central PMCID: PMC5944690.

6: Yoon W, Kim H, Kim YW, Kim SR, Park IS. Usefulness and Stability of Intraoperative Digital Subtraction Angiography Using the Transradial Route in Arteriovenous Malformation Surgery. World Neurosurg. 2018 Mar;111:e799-e805. doi: 10.1016/j.wneu.2017.12.164. Epub 2018 Jan 5. PubMed PMID: 29309977.

7: Hwang MH, Cho DH, Baek SM, Lee JW, Park JH, Yoo CM, Shin JH, Nam HG, Son HG, Lim HJ, Cho HS, Moon HJ, Kim JH, Lee JK, Choi H. Spine-on-a-chip: Human annulus fibrosus degeneration model for simulating the severity of intervertebral disc degeneration. Biomicrofluidics. 2017 Dec 6;11(6):064107. doi: 10.1063/1.5005010. eCollection 2017 Nov. PubMed PMID: 29250209; PubMed Central PMCID: PMC5718916.

8: Kwon WK, Yoon W, Kwon TH, Kim JH, Jung HS, Ahn J, Huh H, Ji C. Transradial access for cerebrovascular angiography: Evaluation of palmar collateral circulation with hand angiography and its correlation with Allen test. Clin Neurol Neurosurg. 2018 Jan;164:14-18. doi: 10.1016/j.clineuro.2017.10.035. Epub 2017 Oct 31. PubMed PMID: 29145041.

9: Kim TJ, Ko SB, Jeong HG, Kim CK, Kim Y, Nam K, Mo H, An SJ, Choi HA, Yoon BW. Nocturnal Desaturation is Associated With Neurological Deterioration Following Ischemic Stroke: A Retrospective Observational Study. J Clin Sleep Med. 2017 Nov 15;13(11):1273-1279. doi: 10.5664/jcsm.6796. PubMed PMID: 29065961; PubMed Central PMCID: PMC5656476.

10: 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 Jul-Sep;12(3):519-524. doi: 10.4103/1793-5482.153497. PubMed PMID: 28761534; PubMed Central PMCID: PMC5532941.

11: Kwon WK, Moon HJ, Kwon TH, Park YK, Kim JH. Influence of rabbit notochordal cells on symptomatic intervertebral disc degeneration: anti-angiogenic capacity on human endothelial cell proliferation under hypoxia. Osteoarthritis Cartilage. 2017 Oct;25(10):1738-1746. doi: 10.1016/j.joca.2017.06.003. Epub 2017 Jun 21. PubMed PMID: 28647468.

12: Choi JC, Park YH, Park SK, Lee JS, Kim J, Choi JI, Yoon KB, Lee S, Lim DE, Choi JY, Kim MH, Park G, Choi SS, Lee JM. Testosterone effects on pain and brain activation patterns. Acta Anaesthesiol Scand. 2017 Jul;61(6):668-675. doi: 10.1111/aas.12908. PubMed PMID: 28573655.

13: Lee T, Lim TH, Lee SH, Kim JH, Hong J. Biomechanical function of a balloon nucleus pulposus replacement system: A human cadaveric spine study. J Orthop Res. 2018 Jan;36(1):167-173. doi: 10.1002/jor.23607. Epub 2017 Jun 15. PubMed PMID: 28513885.

14: Han JS, Seo HS, Lee YH, Lee H, Suh SI, Jeong EK, Sapkota N, Kim KJ. Fractional anisotropy and diffusivity changes in thyroid-associated orbitopathy. Neuroradiology. 2016 Dec;58(12):1189-1196. Epub 2016 Nov 14. PubMed PMID: 27844093.

15: Kim TJ, Ko SB, Jeong HG, Lee JS, Kim CK, Kim Y, Nam K, Mo H, Joon An S, Choi HA, Yoon BW. Nocturnal Desaturation in the Stroke Unit Is Associated With Wake-Up Ischemic Stroke. Stroke. 2016 Jul;47(7):1748-53. doi: 10.1161/STROKEAHA.116.013266. Epub 2016 May 24. PubMed PMID: 27222527.

16: Kim JS, Choi Y, Jin SH, Kim CH, Park CK, Kim SM, Lee KW, Chung CK, Paek SH. Effect of peripheral nerve tetanic stimulation on the inter-trial variability and accuracy of transcranial motor-evoked potential in brain surgery. Clin Neurophysiol. 2016 May;127(5):2208-13. doi: 10.1016/j.clinph.2016.01.018. Epub 2016 Mar 12. PubMed PMID: 27072091.

17: Hwang MH, Kim KS, Yoo CM, Shin JH, Nam HG, Jeong JS, Kim JH, Lee KH, Choi H. Photobiomodulation on human annulus fibrosus cells during the intervertebral disk degeneration: extracellular matrix-modifying enzymes. Lasers Med Sci. 2016 May;31(4):767-77. doi: 10.1007/s10103-016-1923-x. Epub 2016 Mar 17. PubMed PMID: 26987527.

18: 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 Apr;143:27-33. doi: 10.1016/j.clineuro.2016.02.005. Epub 2016 Feb 6. PubMed PMID: 26895206.

19: Oh CH, Ji GY, Yoon SH, Hyun D, Park HC, Kim YJ. Paralytic Ileus and Prophylactic Gastrointestinal Motility Medication after Spinal Operation. Yonsei Med J. 2015 Nov;56(6):1627-31. doi: 10.3349/ymj.2015.56.6.1627. PubMed PMID: 26446646; PubMed Central PMCID: PMC4630052.

20: Park JJ, Moon HJ, Park JH, Kwon TH, Park YK, Kim JH. Induction of proinflammatory cytokine production in intervertebral disc cells by macrophage-like THP-1 cells requires mitogen-activated protein kinase activity. J Neurosurg Spine. 2016 Jan;24(1):167-75. doi: 10.3171/2015.3.SPINE14729. Epub 2015 Oct 2. PubMed PMID: 26431069.

21: Liu CC, Chien JH, Chang YW, Kim JH, Anderson WS, Lenz FA. Functional role of induced gamma oscillatory responses in processing noxious and innocuous sensory events in humans. Neuroscience. 2015 Dec 3;310:389-400. doi: 10.1016/j.neuroscience.2015.09.047. Epub 2015 Sep 25. PubMed PMID: 26408986; PubMed Central PMCID: PMC5675836.

22: Liu CC, Chien JH, Kim JH, Chuang YF, Cheng DT, Anderson WS, Lenz FA. Cross-frequency coupling in deep brain structures upon processing the painful sensory inputs. Neuroscience. 2015 Sep 10;303:412-21. doi: 10.1016/j.neuroscience.2015.07.010. Epub 2015 Jul 10. PubMed PMID: 26168707; PubMed Central PMCID: PMC5675837.

23: Hur JW, Kim BJ, Park JH, Kim JH, Park YK, Kwon TH, Moon HJ. The Mechanism of Ligamentum Flavum Hypertrophy: Introducing Angiogenesis as a Critical Link That Couples Mechanical Stress and Hypertrophy. Neurosurgery. 2015 Aug;77(2):274-81; discussion 281-2. doi: 10.1227/NEU.0000000000000755. PubMed PMID: 25850600.

24: Hong D, Seo HS, Lee YH, Kim KJ, Suh SI, Jung JM. Leptomeningeal enhancement on magnetic resonance imaging as a predictor of hemodynamic insufficiency. J Comput Assist Tomogr. 2015 May-Jun;39(3):307-12. doi: 10.1097/RCT.0000000000000213. PubMed PMID: 25695866.

25: Ji GY, Oh CH, Park SH, Kurniawan F, Lee J, Jeon JK, Shin DA, Kim KN. Feasibility of translaminar screw placement in Korean population: morphometric analysis of cervical spine. Yonsei Med J. 2015 Jan;56(1):159-66. doi: 10.3349/ymj.2015.56.1.159. PubMed PMID: 25510760; PubMed Central PMCID: PMC4276750.

26: Kim JH, Chien JH, Liu CC, Lenz FA. Painful cutaneous laser stimuli induce event-related gamma-band activity in the lateral thalamus of humans. J Neurophysiol. 2015 Mar 1;113(5):1564-73. doi: 10.1152/jn.00778.2014. Epub 2014 Dec 10. PubMed PMID: 25505116; PubMed Central PMCID: PMC4346717.

27: Ji GY, Oh CH, Choi WS, Lee JB. Three cases of hemiplegia after cervical paraspinal muscle needling. Spine J. 2015 Mar 1;15(3):e9-13. doi: 10.1016/j.spinee.2014.11.007. Epub 2014 Nov 14. PubMed PMID: 25459742.

28: Lee JH, Park YK, Kim JH. Chronic neck pain in young adults: perspectives on anatomic differences. Spine J. 2014 Nov 1;14(11):2628-38. doi: 10.1016/j.spinee.2014.02.039. Epub 2014 Mar 12. PubMed PMID: 24614257.

29: Park YK, Lee DY, Hur JW, Moon HJ. Delayed hinge fracture after plate-augmented, cervical open-door laminoplasty and its clinical significance. Spine J. 2014 Jul 1;14(7):1205-13. doi: 10.1016/j.spinee.2013.08.012. Epub 2013 Oct 29. PubMed PMID: 24176811.

30: Hong SJ, Lee S, Yoon JS, Kim JH, Park YK. Analysis of intradiscal cement leakage during percutaneous vertebroplasty: multivariate study of risk factors emphasizing preoperative MR findings. J Neuroradiol. 2014 Jul;41(3):195-201. doi: 10.1016/j.neurad.2013.07.004. Epub 2013 Sep 27. PubMed PMID: 24080117.

31: Chotai S, Kim JH, Kim JH, Kwon TH. Brain herniation induced by drainage of subdural hematoma in spontaneous intracranial hypotension. Asian J Neurosurg. 2013 Apr;8(2):112-5. doi: 10.4103/1793-5482.116390. PubMed PMID: 24049555; PubMed Central PMCID: PMC3775182.

32: Ji GY, Oh CH, Shin DA, Ha Y, Kim KN, Yoon DH, Yudoyono F. Stand-alone Cervical Cages Versus Anterior Cervical Plates in 2-Level Cervical Anterior Interbody Fusion Patients: Analysis of Adjacent Segment Degeneration. J Spinal Disord Tech. 2015 Aug;28(7):E433-8. doi: 10.1097/BSD.0b013e3182a355ad. PubMed PMID: 23897053.

33: Kim JH, Choi H, Suh MJ, Shin JH, Hwang MH, Lee HM. Effect of biphasic electrical current stimulation on IL-1β-stimulated annulus fibrosus cells using in vitro microcurrent generating chamber system. Spine (Phila Pa 1976). 2013 Oct 15;38(22):E1368-76. doi: 10.1097/BRS.0b013e3182a211e3. PubMed PMID: 23823576.

34: Chotai S, Ahn SY, Moon HJ, Kim JH, Chung HS, Chung YG, Kwon TH. Prediction of outcomes in young adults with aneurysmal subarachnoid hemorrhage. Neurol Med Chir (Tokyo). 2013;53(3):157-62. PubMed PMID: 23524499.

35: Park YK, Moon HJ, Kwon TH, Kim JH. Long-term outcomes following anterior foraminotomy for one- or two-level cervical radiculopathy. Eur Spine J. 2013 Jul;22(7):1489-96. doi: 10.1007/s00586-013-2712-x. Epub 2013 Feb 16. PubMed PMID: 23417750; PubMed Central PMCID: PMC3698334.

36: Chotai S, Moon HJ, Kim JH, Kim JH, Chung HS, Park YK, Kwon TH. Brain abscess caused by Gemella morbillorum: case report and review of the literature. Turk Neurosurg. 2012;22(3):374-7. doi: 10.5137/1019-5149.JTN.3634-10.0. Review. PubMed PMID: 22665012.

37: Kim JH, Moon HJ, Lee JH, Kim JH, Kwon TH, Park YK. Rabbit notochordal cells modulate the expression of inflammatory mediators by human annulus fibrosus cells cocultured with activated macrophage-like THP-1 cells. Spine (Phila Pa 1976). 2012 Oct 15;37(22):1856-64. doi: 10.1097/BRS.0b013e3182579434. PubMed PMID: 22472811.

38: Moon HJ, Kim JH, Kim JH, Kwon TH, Chung HS, Park YK. The effects of anterior cervical discectomy and fusion with stand-alone cages at two contiguous levels on cervical alignment and outcomes. Acta Neurochir (Wien). 2011 Mar;153(3):559-65. doi: 10.1007/s00701-010-0879-z. Epub 2010 Dec 4. PubMed PMID: 21132445.

39: Modi HN, Suh SW, Hong JY, Park YH, Yang JH. Surgical correction of paralytic neuromuscular scoliosis with poor pulmonary functions. J Spinal Disord Tech. 2011 Jul;24(5):325-33. doi: 10.1097/BSD.0b013e3181f9f6fc. PubMed PMID: 20975591.

40: Modi HN, Suh SW, Hong JY, Yang JH. Posterior multilevel vertebral osteotomy for severe and rigid idiopathic and nonidiopathic kyphoscoliosis: a further experience with minimum two-year follow-up. Spine (Phila Pa 1976). 2011 Jun 15;36(14):1146-53. doi: 10.1097/BRS.0b013e3181f39d9b. PubMed PMID: 20948461.

41: Modi HN, Suh SW, Fernandez H, Yang JH, Song HR. Accuracy and safety of pedicle screw placement in neuromuscular scoliosis with free-hand technique. Eur Spine J. 2008 Dec;17(12):1686-96. doi: 10.1007/s00586-008-0795-6. Epub 2008 Oct 1. PubMed PMID: 18830636; PubMed Central PMCID: PMC2587671.

42: Modi H, Suh SW, Song HR, Yang JH. Accuracy of thoracic pedicle screw placement in scoliosis using the ideal pedicle entry point during the freehand technique. Int Orthop. 2009 Apr;33(2):469-75. doi: 10.1007/s00264-008-0535-x. Epub 2008 Mar 21. PubMed PMID: 18357448; PubMed Central PMCID: PMC2899059.

43: Kim JH, Kim JH, Kim JH, Kim KH, Kwon TH, Park YK. Depletion of ATP and release of presynaptic inhibition in the CA1 region of hippocampal slices during hypoglycemic hypoxia. Neurosci Lett. 2007 Jan 3;411(1):56-60. Epub 2006 Nov 13. PubMed PMID: 17095154.

44: Kim JH, Kim JH, Kwon TH, Park YK, Chung HS. DPCPX-resistant hypoxic synaptic depression in the CA1 region of hippocampal slices: possible role of intracellular accumulation of monocarboxylates. Neurosci Lett. 2006 Jul 31;403(1-2):141-6. Epub 2006 May 22. PubMed PMID: 16714083.

45: Choi SS, Lee PB, Kim YC, Kim HJ, Lee SC. C-arm-guided pudendal nerve block: a new technique. Int J Clin Pract. 2006 May;60(5):553-6. PubMed PMID: 16700853.

46: Park YK, Kim JH, Chung HS. Outcome analysis of patients after ligament-sparing microdiscectomy for lumbar disc herniation. Neurosurg Focus. 2002 Aug 15;13(2):E4. PubMed PMID: 15916401.

47: Park YK, Shim ES, Oh JI, Kim JH, Chung YG. Adenosine-mediated synaptic depression and EPSP/spike dissociation following high potassium-induced depolarization in rat hippocampal slices. Brain Res. 2003 Jun 13;975(1-2):237-43. PubMed PMID: 12763613.

48: Lee IO, Kim WK, Kong MH, Lee MK, Kim NS, Choi YS, Lim SH. No enhancement of sensory and motor blockade by ketamine added to ropivacaine interscalene brachial plexus blockade. Acta Anaesthesiol Scand. 2002 Aug;46(7):821-6. PubMed PMID: 12139537.

49: Park YK, Chung HS. Instrumented facet fusion for the degenerative lumbar disorders. Acta Neurochir (Wien). 1999;141(9):915-20. PubMed PMID: 10526072.