PubMed Health⌕ Search

Biomedical subjects

Lih-Huei Chen

Publications and source records attributed to Lih-Huei Chen.

At least 19 recordsLinked to original sources
PubMed2006

Percutaneous endoscopic discectomy and drainage for infectious spondylitis.

Fifteen patients with infectious spondylitis were treated by percutaneous endoscopic discectomy and drainage (PEDD) and associated appropriate parenteral antibiotics. Infectious spondylitis was diagnosed clinically, on the basis of elevated erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) values, and on roentgenographic and magnetic resonance imaging (MRI) findings. Causative bacteria were identified in 13 (86.7%) of 15 biopsy specimens. Systemic antibiotics were administered according to sensitivity analyses of pathogens. All patients reported immediate back pain relief except for two, who required anterior debridement and fusion one week and two weeks later, respectively. Two other patients with recurrent infection and intractable pain underwent surgical intervention at one month and eight months after PEDD, respectively. The remaining 11 patients recovered uneventfully after full-course, specific, antimicrobial therapy. No surgery related complications or side effects were observed during at least 12 months of follow-up. In conclusion, PEDD can provide retrieval of sufficient specimens and has high diagnostic efficacy, thereby enabling prompt and appropriate antibiotic therapy to the offending pathogens. It can be considered an effective alternative for treating uncomplicated spondylitis.

Adult↗
PubMed2006

Prognosis of operative treatment for metastatic hepatocellular carcinoma of the spine.

UNLABELLED: Developing and developed countries have been reported increasing numbers of hepatocellular carcinoma and increased rates of distant metastasis from hepatocellular carcinoma. Data regarding operative treatments and prognoses of hepatocellular carcinoma metastasis to the spine are lacking in the literature. We retrospectively reviewed 12 patients with hepatocellular carcinoma and metastasis to the spine who had spinal surgery between 1986 and 1996. All 12 patients had severe back pain preoperatively. Posterior surgery alone was performed on two patients, anterior surgery alone in six patients, and combined anterior and posterior surgery in four. Ten of the 12 patients experienced pain relief and their neurologic status was preserved or improved. We designed a new outcome assessment, a modified Prolo scale, to evaluate surgical outcome. Seven of the 12 patients had good or excellent results. Our sample size was limited and we could draw no definite conclusions regarding the prognoses of these patients or the value of surgical intervention; however, we think that operative treatment for spinal metastatic hepatocellular carcinoma lesions may improve quality of life, regardless whether the survival time is prolonged. LEVEL OF EVIDENCE: Therapeutic study, Level IV (case series--no, or historical, control group). See the Guidelines for Authors for a complete description of levels of evidence.

Adult↗
PubMed2006

The effect of interspinous ligament integrity on adjacent segment instability after lumbar instrumentation and laminectomy--an experimental study in porcine model.

Eight fresh porcine lumbar spines received a posterior instrumentation at L4-L5 using pedicle screw-rod system. Each specimen was tested utilizing laminectomies of varying extent. Group A (Integrity) preserved the spinous process and interspinous ligament; Group B (Partial laminectomy) removed the inferior portion of L4 spinous process and preserved the interspinous ligament of L3-L4; Group C (Complete laminectomy) removed the entire L4 spinous process. Hydraulic testing machine was used to generate an increasing moment up to 8400 N mm in flexion and extension. The intervertebral displacement on the superior adjacent disc between L3-L4 was measured using an extensometer. Under extension, no significant difference in the intervertebral displacement was observed among three different models of laminectomy. However, under flexion, the intervertebral displacement on adjacent disc with complete laminectomy was statistically larger than those of integrity and partial laminectomies (P=0.000976 and P=0.0363, respectively). No difference was found between integrity and partial laminectomy groups (P>0.05). This study implies that an instrumented spine with integrity of posterior complex is less likely to develop adjacent instability than a spine with destruction of the anchoring point for supraspinous ligament.

Animals↗
PubMed2005

The fusion rate of calcium sulfate with local autograft bone compared with autologous iliac bone graft for instrumented short-segment spinal fusion.

STUDY DESIGN: A prospective study. OBJECTIVES: To compare the efficacy of calcium sulfate pellets plus laminectomy bone chips with a fresh autologous iliac bone graft for short-segment lumbar fusion. SUMMARY OF BACKGROUND DATA: Bone graft substitute material can be used to expand an existing quantity of available laminectomy bone chips. METHODS: Seventy-four patients underwent surgery for instrumented one- or two-segment fusion with decompression. Autologous iliac crest bone graft was placed in one posterolateral gutter, while on the other side, an equal quantity of autogenous laminectomy bone supplemented with calcium sulfate was placed. Radiographic assessment included radiographs alone; this was performed every 3 months (3 months to 12 months), then annually. The status of fusion and the relative size of the fusion bone mass on either side of the vertebra were compared. RESULTS: Using iliac crest bone graft (control side) versus autograft laminectomy bone with calcium sulfate (test side), there was no significant difference between the fusion rate and sizes of the fusion bone mass (P > 0.05). Follow-up periods ranged from 30 months to 34 months, averaging 32.5 months. For the 39 patients who received single-segment fusion, 34 patients (87.2%) exhibited bone fusion on the test side, and 35 patients (89.7%) had evidence of fusion on the control side. For the 35 patients who received two-segment fusion, 29 patients (82.9%) exhibited bone fusion on the test side and 30 patients (85.7%) demonstrated complete fusion on the control side. CONCLUSIONS: The fusion rate and fusion size between the two groups are similar. Calcium sulfate pellets may play a role as a bone graft extender in short-segment spinal fusion.

Adult↗
PubMed2005

Maintenance of interbody space in one- and two-level anterior cervical interbody fusion: comparison of the effectiveness of autograft, allograft, and cage.

UNLABELLED: The use of allografts, autologous iliac crest grafts, and cages for anterior cervical fusion is well documented, however there is no comparison regarding the effectiveness of maintaining the interbody space with the three approaches. We retrospectively measured the rate and amount of interspace collapse, segmental sagittal angulations, clinical results, and radiographic fusion success rates to determine which is the best fusion material. We assessed 73 patients who had one- and two-level cervical discectomies and interbody fusions without instrumentation. The three groups had similar clinical results and fusion rates. However, in the autograft group union occurred in 4 months. In the allograft group, union did not occur until 5.54 months. Moreover, the loss of cervical lordosis (2.75 degrees) was less in the cage group than in the allograft group (9.23 degrees). Additionally, the anterior interspace collapse (1.73 mm) in the cage group was less than the collapse recorded in the autograft group (2.82 mm) and in the allograft group (4 mm). An interspace collapse of 3 mm or greater was observed in 56.1% of the patients in the allograft group, compared with only 19% of the patients in the cage group. We showed that the cage is superior to the allograft and autograft in maintaining cervical interspace height and cervical lordosis after one-level and two-level anterior cervical decompression procedures. LEVEL OF EVIDENCE: Therapeutic study, Level III-2 (retrospective cohort study).

Cervical Vertebrae↗
PubMed2005

Unipedicle percutaneous vertebroplasty for spinal intraosseous vacuum cleft.

UNLABELLED: Osteoporotic compression fractures have been widely treated by vertebroplasty through a bipedicle approach. We suspected that a compression fracture with vacuum cleft can be treated successfully with a unipedicle approach. We retrospectively reviewed 27 patients with an osteoporotic compression fracture with intraosseous vacuum cleft. The patients received percutaneous vertebroplasty with bone cement (polymethylmethacrylate) augmentation. Bone cement was injected into the fractured vertebral body through only one cannula in the selected pedicle. Cement filling, vertebral height restoration, and relief of pain were evaluated. The minimum followup was 12 months (range, 12-30 months). Twenty six of 27 patients had adequate filling. Average vertebral height restoration was 27%. The patients' visual analog scale improved an average of 40 points. Percutaneous transpedicle vertebroplasty is effective for treating osteoporotic compression fractures with intraosseous vacuum clefts. Because of the preexistent cleft, the procedure can be done successfully via a unipedicle approach. LEVEL OF EVIDENCE: Therapeutic study, Level IV (case series--no, or historical, control group). See the Guidelines for Authors for a complete description of levels of evidence.

Aged↗
PubMed2005

Single cylindrical threaded cage used in recurrent lumbar disc herniation.

OBJECTIVES: Where fusion is being considered after repeated discectomy for recurrent lumbar disc herniation (RLDH), interbody fusion is reasonable. But interbody fusion by dual cages inserted posteriorly is difficult because of the scarring from the previous surgery. Under this consideration, a prospective clinical study of RLDH operated on by posterolateral placement of a single cylindrical threaded cage through the virgin side after decompression was conducted. The study is not intended to indicate when to fuse the recurrent herniation but to evaluate the efficacy of this fusion method for these patients whenever fusion is necessary. METHODS: From November 1998 to April 2000, 14 RLDH patients were enrolled after failure of conservative treatment. Eleven patients had a lesion at L4-L5 and three at L5-S1. Two patients experienced disc reherniation on the side opposite the original injury, whereas the subsequent reherniation was ipsilateral for the other 12. CONCLUSIONS: In this series, there was no evidence of dural tears or neurologic deficits, but three temporary superficial wound infections, one urinary tract infection, and one asymptomatic disc wedging were experienced. As for the result of interbody fusion by cage, 12 patients (85.8%) achieved successful fusions; the other two had radiolucency along the cage-endplate interfaces and were therefore defined as failure of interbody fusion. Satisfactory clinical results were achieved for 13 patients (92.9%; excellent [n = 6], good [n = 7]) using this procedure.

Adult↗
PubMed2005

Trapezoidal titanium cage in anterior cervical interbody fusion: a clinical experience.

BACKGROUND: Use of autogenous bone grafting taken from anterior iliac crest for anterior cervical interbody fusion has been the "gold-standard" for decades. Substitutes for autogenous bone graft continue to be sought to avoid potential donor site morbidity. A titanium-alloy square-shaped hollow cage was applied to facilitate the process of fusion as a bone graft substitute, then assessed in this retrospective clinical study. METHODS: From July 2000 to July 2001, sixty-three discs from fifty-four patients were selected to receive this cage for one or two segments of the cervical spine for anterior cervical interbody fusion. The Japanese Orthopedic Association (JOA) score and Odom's criteria were used to measure the clinical outcome. Postoperative radiographs were analyzed for graft dislodgement, loss of anterior and posterior disc heights, maintenance of lordosis correction, and status of fusion between the cage and endplates to assess their suitability as a grafting substitute. RESULTS: Eighty-seven percent of patients exhibited satisfactory clinical outcome. Successful fusion was obtained in ninety point five percent of operated discs. Partial cage dislodgement was observed in four point eight percent of discs and caused no adverse symptoms. The mean collapse of the anterior and posterior disc heights were 1.73 mm and 0.91 mm, respectively. Moreover, the mean loss of lordosis correction was 2.75 degrees. CONCLUSIONS: Based on this primary clinical experience, the trapezoid-design, titanium-alloy cage provided adequate mechanical support and stability in the disc space and an excellent fusion result without significant subsidence of disc height or any other complications.

Bone Transplantation↗
PubMed2005

Surgical treatment of spinal pseudoarthrosis in ankylosing spondylitis.

BACKGROUND: In ankylosing spondylitis (AS), the spine with osteoporotic changes is fragile and vulnerable to trauma. Patients may develop spinal pseudoarthrosis (SP), whose clinical features are usually misdiagnosed as a tuberculous infection. This study reports our experience with surgical treatment for SP in AS. METHODS: Eight patients with AS and SP at the thoracolumbar area were treated surgically and followed-up for at least 3 years. All had persistent back pain and progressive kyphosis. One patient had neurologic deficits preoperatively. Anterior debridement and interbody fusion followed by posterior stabilization were performed in all patients. A posterior corrective osteotomy was additionally done in 3 patients whose kyphotic angle exceeded 45 degrees. RESULTS: All patients with persistent back pain obtained significant pain relief postoperatively. On a visual analogue scale, there was an average improvement of 43 points on the clinical scores. The patient with neurologic deficits showed improvement after the operation. Solid bony fusion was achieved in an average of 7.5 months, and correction of the kyphotic angle averaged 18.6 degrees. CONCLUSIONS: Spinal pseudoarthrosis should be considered in patients with AS, and must be differentiated from tuberculous and other infections. The results of this study show that pain relief and correction of the kyphotic deformity can be achieved by surgical treatment for ankylosing spondylitis complicated with pseudoarthrosis.

Adult↗
PubMed2005

Pyogenic spondylitis presenting with skip lesions.

We report on a 65-year-old man who presented with a 1-month history of aggravating backache and low-grade fever. He suddenly became paraplegic (Frankel B). Muscle power was grade 0 approximately 1 over the bilateral lower limbs. X-ray films showed disc space narrowing and end-plate blurring at the T9 approximately T11 and L4 approximately L5 levels. Magnetic resonance imaging showed an infectious lesion at T9 approximately T11 and another at L4 approximately L5. An emergent operation was performed under the impression of pyogenic spondylitis with spinal cord compression. The patient showed a significant recovery (Frankel D) after the thoracic and lumbar spinal surgeries. Pyogenic spondylitis usually presents as a vertebra-disc-vertebra lesion spreads to the contiguous vertebra-disc-vertebra unit. The current patient had pyogenic spondylitis with coexistent thoracic and lumbar lesions. This kind of skip lesion is common in spinal malignant metastasis, but rare in spinal infections. Awareness of the possibility of multiple lesions or skip lesions will facilitate the diagnosis and treatment of this condition.

Aged↗
PubMed2004

Relation between laminectomy and development of adjacent segment instability after lumbar fusion with pedicle fixation.

STUDY DESIGN: A retrospective study of 101 patients who had undergone posterolateral lumbar fusion, to analyze the association between adjacent instability and the extent of laminectomy. OBJECTIVES: To investigate the hypothesis that the integrity of the posterior complex (spinous process/supraspinous ligament/spinous process) between the fused segments and the neighboring motion segments significantly influences lumbar spine stability. SUMMARY OF BACKGROUND DATA: Spinal fusion with pedicle fixation accelerates the degeneration of adjacent motion segments. The lowest cranial motion segment is the most common level for the development of adjacent instability. Laminectomy, including removal of the spinous process, supraspinous ligament, interspinous ligament, lamina and ligamentum flavum, jeopardizes the integrity of the posterior complex of the spine. METHODS: This study enrolled 101 patients, followed up for at least 6 years, who had been treated with posterolateral lumbar fusion with pedicle fixation because of lumbar spondylolisthesis. The diagnosis of adjacent instability depended on the dynamic lateral views of the lumbosacral spine during each follow-up. The integrity of the posterior complex was based on the extent of laminectomy and the fusion level. RESULTS: At the cranial adjacent motion segment, 2 of 31 (6.5%) patients with preserved posterior complex integrity between the fused segment and motion segment developed adjacent instability, compared with 17 of 70 (24.3%) without preserved posterior complex integrity. At the caudal adjacent motion segment, none of 13 patients (0%) with preserved integrity developed adjacent instability, compared with 3 of 54 (5.6%) without preserved integrity. CONCLUSIONS: Damaging the integrity of the posterior complex between the fused segments and the neighboring motion segments may jeopardize lumbar spine stability. Sacrificing either the supraspinous ligament or the tendon insertion points on the spinous processes leads to an accelerated development of adjacent instability.

Adult↗
PubMed2004

The effect of sagittal alignment on adjacent joint mobility after lumbar instrumentation--a biomechanical study of lumbar vertebrae in a porcine model.

BACKGROUND: The mechanisms and changes in range of motion of neighboring mobile segment (adjacent level) after the instrumented posterior stabilization are not completely understood. This study aims to investigate the effect of sagittal alignment on the adjacent joint mobility after lumbar instrumentation. METHODS: Eight fresh porcine lumbar spines were instrumented with pedicle screw implants from L2 to L4. Each specimen was tested in three different sagittal alignments. Group A were instrumented in lordotic alignment (lordosis 20 degrees ), Group B in straight alignment (lordosis 0 degrees ), and Group C in kyphotic alignment (kyphosis 20 degrees ). Hydraulic testing machine was used to generate an increasing moment in flexion and extension respectively for each specimen. The vertebral displacement of the disc between L1-L2 and L4-L5 were measured simultaneously with an extensometer. FINDINGS: There were no significant differences in vertebral displacement between the three different sagittal alignments in both the superior and inferior adjacent segments under extension motion. However, under flexion motion, the vertebral displacement on the superior adjacent segment (L1-L2) with kyphotic alignment was statistically larger than that of the straight and lordotic alignments (P = 0.0198 and P = 0.000473 respectively), and no differences were found between the three different sagittal alignments on the inferior adjacent segment (L4-L5). INTERPRETATION: The iatrogenically produced kyphotic lumbar spine by posterior instrumentation might cause larger adjacent joint mobility on the superior adjacent joint as compared to the instrumented lordotic lumbar spine. This study implies that an instrumented spine in lordosis is less likely to develop adjacent instability than a kyphotic spine.

Animals↗
PubMed2004

Effect of postoperative lumbar sagittal alignment on the development of adjacent instability.

OBJECTIVE: This study investigated the effect of postoperative lumbar sagittal alignment on the development of adjacent segment instability. METHODS: The patients were retrospectively divided into two groups (hypolordotic and hyperlordotic) using the lumbar lordosis on lateral lumbosacral view. Diagnosis of adjacent segment instability depended on the dynamic lateral views of the lumbosacral spine. RESULTS: Thirteen (21.7%) cases developed adjacent segment instability during the 6-year follow-up. The two groups had no significant difference in rates of developing adjacent segment instability. CONCLUSION: Restoring the lordosis of the lumbar curve during one motion segment fusion does not prevent the development of adjacent instability.

Aged↗
PubMed2004

Two-stage revision hip arthroplasty for infection with a custom-made, antibiotic-loaded, cement prosthesis as an interim spacer.

BACKGROUND: Two-stage reconstruction is a well-recognized treatment for deep infection of hip joint implants. The purpose of the study was to report the results of our treatment using a standardized protocol. METHODS: Forty-two consecutive patients with deep infection of the hip prosthesis were treated according to a prospective, two-stage resection/reimplantation protocol. Between stages, a custom-made, antibiotic-loaded, cement prosthesis was implanted as an interim spacer. RESULTS: Infection was eradicated in 41 patients after the first-stage operation. Thirty-six patients remained with the ability to walk with the interim cement pros-thesis. For 40 patients who underwent reimplantation, recurrence of infection was observed in only 1 patient at an average of 55.2 months' follow-up. CONCLUSION: We have found that our two-stage treatment protocol is a reliable approach for the management of infected hip prostheses. It is effective for eradicating infection and for providing a mobile and functional joint through the treatment course.

Adult↗
PubMed2004

Intervertebral disc herniation in adolescents.

BACKGROUND: The purpose of this study was to review surgery-proven lumbar disc herniation in adolescents with an emphasis on the distinguishing features. METHODS: Twenty-eight adolescents between 14 and 18 years old had lumbar discectomy after conservative treatment for 9 months. Indications for surgery were intractable pain and failure of conservative treatment for more than 6 weeks. Lumbar spine apophyseal ring fracture was found in 10 of the 24 patients (42%) who had computed tomography studies. Seven patients had piecemeal excision of the fractured apophysis together with the discectomy. RESULTS: All but three patients could raise their leg more than 70 degrees after the operation. The latest follow-up was conducted an average of 6.1 years after surgery. Good or excellent results were noted in 93% of the patients. Two patients had follow-up operations for recurrent disc herniation and wound infection. CONCLUSION: Apophyseal ring fracture was a feature in adolescent disc herniation that requires surgical intervention. Early computed tomography study is proposed to detect apophyseal ring lesion, which may lead to failure of conservative treatment. Excision of the fractured ring apophysis is suggested in addition to discectomy when the canal space is occupied.

Adolescent↗
PubMed2004

Minimally invasive treatment of osteoporotic vertebral compression fracture.

BACKGROUND: The use of percutaneous vertebroplasty (PV) to treat osteoporotic vertebral fractures is increasing. This investigation assesses the efficacy and safety of PV for refractory pain owing to osteoporotic vertebral compression fractures. METHODS: A retrospective investigation of PV was conducted with a minimal of 1 year follow up. PV with polymethylmethacrylate (PMMA) was performed on 75 patients with osteoporotic vertebral compression fractures that responded poorly to the conservative therapy. Patients were asked to quantify their degree of pain using Huskisson's visual analogue scale to assess the clinical results. RESULTS: Eighty-seven vertebrae treated using PV in 70 patients were evaluated with a minimal of 1 year follow up. Pain, as assessed on the VAS, decreased from 80+/-16 mm before PV to 36+/-28 mm at 1 month after PV and 30+/-19 mm at the most recent follow up. The reduction in pain from the baseline to 1 month (p=0.031) and to final follow up (p=0.023) were both statistically significant. Sixty-two patients (85.5%) quickly returned to their pre-injury activity level and achieved better quality of life. CONCLUSIONS: PV is effective in pain reduction for painful vertebral compression fractures. It provided significant pain relief. Skillful techniques and careful safeguards can minimize the risks of PMMA migration.

Aged↗
PubMed2004

Anterior cervical spinal surgery for multilevel cervical myelopathy.

BACKGROUND: In multilevel spinal cord compression caused by cervical spondylosis, surgeons face the choice of performing a posterior route as a laminectomy or laminoplasty, or an anterior route as multiple adjacent interbody decompressions or corpectomies. The anterior cervical operation is not considered by some clinicians because of concerns about complications and the complexity of multilevel anterior cervical surgery. METHODS: In this retrospective study, 14 patients with multilevel cervical spondylosis who were operated on via an anterior route were enrolled to evaluate the complexity, safety, and clinical results. The collected parameters were operation time, blood loss, hospital days, and early and late complications for evaluating the operative complexity, radiographic follow-up for evaluating fusion, graft problems, implants problems, and the recovery rate using the Japanese Orthopaedic Association score (JOA score) for evaluating the operative results. RESULTS: The mean operation time was 363.4 min, and blood loss was 431.4 ml. An early complication was noted in 1 patient with combined deep vein thrombosis and a pulmonary embolism. Late complications were screw breakage in 1 patient and screw loosening in 5 patients. The mean duration of follow-up was 21.9 months. The mean recovery rate of the JOA score was 38.8% postoperatively and 51.9% at the final follow-up. The fusion rate was 100% in this series. CONCLUSIONS: Anterior cervical decompression and fusion for multilevel stenosis requires a longer operation time than posterior procedures; however, the clinical results are satisfactory.

Adult↗