• Neurospine
• /
• 제15권4호
• /
• pp.348-352
• /
• 2018

Objective: Postoperative dynamic cryo-compression (DC) therapy has been proposed as a method of reducing pain and the inflammatory response in the early postoperative period after orthopedic joint reconstruction surgery. Our aim was to analyze the analgesic efficacy of DC therapy after adult lumbar spinal surgery. Methods: DC was applied for 30 minutes every 6 hours after surgery. Pain was measured by a visual analogue scale (VAS) in the preoperative period, immediately after surgery, and every 6 hours postoperatively for the first 72 hours of the hospital stay. Patients' pain medication requirements were monitored using the patient-controlled analgesia system and patient charts. Twenty patients who received DC therapy were compared to 20 historical controls who were matched for demographic and surgical variables. Results: In the postanesthesia care unit, the mean VAS back pain score was $5.87{\pm}0.9$ in the DC group and $6.95{\pm}1.0$ (p=0.001) in the control group. The corresponding mean VAS scores for the DC vs. control groups were $3.8{\pm}1.1$ vs. $5.4{\pm}0.7$ (p < 0.001) at 6 hours postoperatively, and $2.7{\pm}0.7$ vs. $6.25{\pm}0.9$ (p<0.001) at discharge, respectively. The cumulative mean analgesic consumption of paracetamol, tenoxicam, and tramadol in the DC group vs. control group was $3,733.3{\pm}562.7mg$ vs. $4,633.3{\pm}693.5mg$ (p<0.005), $53.3{\pm}19.5mg$ vs. $85.3{\pm}33.4mg$ (p<0.005), and $63.3{\pm}83.4mg$ vs. $393.3{\pm}79.9mg$ (p<0.0001), respectively. Conclusion: The results of this study demonstrated a positive association between the use of DC therapy and accelerated improvement in patients during early rehabilitation after adult spine surgery compared to patients who were treated with painkillers only.

• Neurospine
• /
• 제15권4호
• /
• pp.383-387
• /
• 2018

Objective: Lower back pain (LBP) is a worldwide health problem, and magnetic resonance imaging (MRI) is a common modality used to aid in its diagnosis. Although specific guidelines for assessing the necessity of MRI usage exist, the use of MRI as the initial imaging method for LBP seems to be more common than necessary in general practice. Methods: We conducted a retrospective chart review of 313 patients who had undergone MRI of the lumbosacral spine during 2014-2015. We recorded and compared various factors, including age, sex, body mass index, current smoking status, race, symptoms, MRI findings, and progression to surgery within the next year. All rates were compared according to whether the MRI results showed radiographically significant findings (MRI-positive) or not (MRI-negative) using the chi-square or Fisher exact tests (if the expected cell count was <5). All analyses were performed using SAS version 9.4. Results: There were no statistically significant differences in the rates of each symptom between the MRI-positive and MRI-negative groups, which accounted for 58.5% (183 of 313) and 41.5% (130 of 313) of the MRIs, respectively. The difference in the rate of surgery in the next year (18% among MRI-positive patients and 8.5% among MRI-negative patients) was found to be statistically significant (p<0.05). Conclusion: Based on our findings, 41.5% of patients underwent lumbar MRI unnecessarily and 81% of patients with positive MRIs did not have surgery within the next year. Further physician training is needed to avoid unnecessary investigations and expenditures.

• Neurospine
• /
• 제15권4호
• /
• pp.388-393
• /
• 2018

Objective: Computed tomography following myelography (CTM) revealed an unusual flow of contrast dye into the anterior median fissure (AMF) in a patient with cervical spondylotic myelopathy. Since then, several AMF configurations have been observed on CTM. Therefore, we evaluated morphological patterns of the AMF on CTM and investigated the significance and mechanisms of contrast dye flow into the AMF. Methods: Morphological patterns of the AMF on CTM were examined in 79 patients. Group A (24 patients) underwent surgery because of symptomatic cervical myelopathy. Group B (43 patients) had no clinical symptoms but showed spinal cord compression on CTM. Group C (12 patients), who showed neither clinical symptoms nor cord changes, underwent CTM for lumbar lesion evaluation. AMF patterns were classified into 4 types according to their configurations on CTM (reversed T, Y, V, and O types). Results: In group B, the reversed T type and Y type appeared significantly more often near the compressed portion (p<0.001). A similar tendency was seen in group A. The V and O types were most frequently observed in group C (p<0.001). Conclusion: On CTM, contrast dye tends to flow into the AMF of the cervical cord when the spinal cord is compressed. We speculate that there may be 3 possible mechanisms for this phenomenon: deformation of the epipial layer of the AMF due to cervical cord compression, AMF dilatation due to atrophy of the anterior funiculus or anterior horn, and temporary AMF dilatation when it becomes an alternative route for cerebrospinal fluid circulation.

• Neurospine
• /
• 제15권4호
• /
• pp.362-367
• /
• 2018

Objective: To assess the efficacy of cervical open-door laminoplasty by hydroxyapatite implant insertion between the lamina and the lateral mass without suturing. Methods: All patients who underwent cervical open-door laminoplasty with C2/C7 undermining and insertion of hydroxyapatite implants from C3 to C6 were retrospectively evaluated for surgical time and neurological outcomes according to the Japanese Orthopaedic Association (JOA) score. To assess the alignment of the cervical spine and postoperative cervical pain, the C2-7 angle and a visual analogue scale score were used, respectively. Results: The population consisted of 102 women and 222 men ranging in age from 32 to 90 years. The average surgical time was 86 minutes. Fourteen of 1,296 hydroxyapatite implants were kept in place with sutures due to a weak restoration force of the hinge during surgery. No hydroxyapatite implant dislocation was detected on cervical computed tomography at 1 year after surgery. The average JOA score was $10.2{\pm}2.5$ before surgery and $14.6{\pm}2.8$ at 1 year after surgery. The average recovery rate was 61.8%. The average C2-7 angle at the neutral position was $7.1^{\circ}{\pm}6.2^{\circ}$ before surgery and $6.5^{\circ}{\pm}6.3^{\circ}$ at 1 year after surgery. Conclusion: This method enabled us to achieve minimal exposure of the lateral mass, prevention of lateral mass injury and dural injury, and a shorter surgical time while maintaining acceptable surgical outcomes. The idea that firm suture fixation is needed to prevent spacer deviation during cervical open-door laminoplasty may need to be revisited.

• Neurospine
• /
• 제15권4호
• /
• pp.329-337
• /
• 2018

Objective: Machine learning algorithms excel at leveraging big data to identify complex patterns that can be used to aid in clinical decision-making. The objective of this study is to demonstrate the performance of machine learning models in predicting postoperative complications following anterior cervical discectomy and fusion (ACDF). Methods: Artificial neural network (ANN), logistic regression (LR), support vector machine (SVM), and random forest decision tree (RF) models were trained on a multicenter data set of patients undergoing ACDF to predict surgical complications based on readily available patient data. Following training, these models were compared to the predictive capability of American Society of Anesthesiologists (ASA) physical status classification. Results: A total of 20,879 patients were identified as having undergone ACDF. Following exclusion criteria, patients were divided into 14,615 patients for training and 6,264 for testing data sets. ANN and LR consistently outperformed ASA physical status classification in predicting every complication (p < 0.05). The ANN outperformed LR in predicting venous thromboembolism, wound complication, and mortality (p < 0.05). The SVM and RF models were no better than random chance at predicting any of the postoperative complications (p < 0.05). Conclusion: ANN and LR algorithms outperform ASA physical status classification for predicting individual postoperative complications. Additionally, neural networks have greater sensitivity than LR when predicting mortality and wound complications. With the growing size of medical data, the training of machine learning on these large datasets promises to improve risk prognostication, with the ability of continuously learning making them excellent tools in complex clinical scenarios.

• Neurospine
• /
• 제15권4호
• /
• pp.368-375
• /
• 2018

Objective: To evaluate the results of operative management of subaxial spine injuries managed with 2-level anterior cervical corpectomy and fusion with a cervical locking plate and autologous bone-filled titanium mesh cage. Methods: This study included 23 patients with a subaxial spine injury who matched the inclusion criteria, underwent 2-level anterior cervical corpectomy and fusion at our institution between 2013 and 2016, and were followed up for neurological recovery, axial pain, fusion, pseudarthrosis, and implant failure. Results: According to Allen and Ferguson classification, there were 9 cases of distractive extension; 4 of compressive extension; 3 each of compressive flexion, vertical compression, and distractive flexion; and 1 of lateral flexion. Sixteen patients had a score of 6 on the Subaxial Injury Classification system, and the rest had a score of more than 6. The mean follow-up period was 19 months (range, 12-48 months). Neurological recovery was observed in most of the patients (78.21%). All patients experienced relief of axial pain. None of the patients received a blood transfusion. Twenty-one patients (91.3%) showed solid fusion and 2 (8.69%) showed possible pseudarthrosis, with no complications related to the cage or plate. Conclusion: Two-level anterior cervical corpectomy and fusion, along with stabilization with a cervical locking plate and autologous bone graft-filled titanium mesh cage, can be considered a feasible and safe method for treating specific subaxial spine injuries, with the benefits of high primary stability, anatomical reduction, and direct decompression of the spinal cord.

• Neurospine
• /
• 제15권4호
• /
• pp.338-347
• /
• 2018

Objective: Patients with extradural spine tumors are at an increased risk for intraoperative cerebrospinal fluid (CSF) leaks and postoperative wound dehiscence due to radiotherapy and other comorbidities related to systemic cancer treatment. In this case series, we discuss our experience with the management of intraoperative durotomies and wound closure strategies for this complex surgical patient population. Methods: We reviewed our recent single-center experience with spine surgery for primarily extradural tumors, with attention to intraoperative durotomy occurrence and postoperative wound-related complications. Results: A total of 105 patients underwent tumor resection and spinal reconstruction with instrumented fusion for a multitude of pathologies. Twelve of the 105 patients (11.4%) reviewed had intraoperative durotomies. Of these, 3 underwent reoperation for a delayed complication, including 1 epidural hematoma, 1 retained drain, and 1 wound infection. Of the 93 uncomplicated index operations, there were a total of 9 reoperations: 2 for epidural hematoma, 3 for wound infection, 2 for wound dehiscence, and 2 for recurrent primary disease. One patient was readmitted for a delayed spinal fluid leak. The average length of stay for patients with and without intraoperative durotomy was 7.3 and 5.9 days, respectively, with a nonsignificant trend for an increased length of stay in the durotomy cases (p=0.098). Conclusion: Surgery for extradural tumor resections can be complicated by CSF leaks due to the proximity of the tumor to the dura. When encountered, a variety of strategies may be employed to minimize subsequent morbidity.

• 대한한방내과학회지
• /
• 제40권5호
• /
• pp.938-947
• /
• 2019

Objective: This study was performed to report the changes in symptoms and radiological consequences of a patient diagnosed with spinal neurofibroma and complaining of lower back pain. Methods: The patient was diagnosed with a spinal neurofibroma after MRI examination and was treated with traditional Korean medicine, including traditional Korean medication and acupuncture. We measured the change in symptom severity using a numerical rating scale (NRS) and the Oswestry Disability Index (ODI). We also used the EQ-5D (EuroQoL-5D) scale to assess the patient's quality of life. In addition, we examined the change in the size of the cyst by MRI twice after discharge: at about 3 months after discharge and at about 8 months after discharge. Results: After about 6 weeks of treatment, most pathological symptoms had decreased. The patient showed a decline in NRS and ODI scores and showed an increase in quality of life. The two MRI examinations after the discharge revealed a decrease in the size of the cyst. Conclusions: Traditional Korean medicine can be a solution for patients with spinal neurofibroma causing neurological pain.

• 정보처리학회논문지:소프트웨어 및 데이터공학
• /
• 제10권11호
• /
• pp.491-500
• /
• 2021

본 연구에서는 MS Kinect v2 RGBD 카메라 기반의 Human-Skeleton Keypoints와 2-Stacked Bi-LSTM 모델을 이용하여 낙상 행위를 탐지하는 방법을 제안한다. 기존의 연구는 RGB 영상에서 OpenPose 등의 딥러닝 모델을 이용하여 골격 정보를 추출한 후 LSTM, GRU 등의 순환신경망 모델을 이용해 인식을 수행하였다. 제안한 방법은 카메라로부터 골격정보를 바로 전달 받아 가속도 및 거리의 2개의 시계열 특징을 추출한 후 2-Stacked Bi-LSTM 모델을 이용하여 낙상 행위를 인식하였다. 어깨, 척추, 골반 등 주요 골격을 대상으로 중심관절을 구하고 이 중심관절의 움직임 가속도와 바닥과의 거리를 특징으로 제안하였다. 추출된 특징은 Stacked LSTM, Bi-LSTM 등의 모델과 성능비교를 수행하였고 GRU, LSTM 등의 기존연구에 비해 향상된 검출 성능을 실험을 통해 증명하였다.

• 대한한방내과학회지
• /
• 제43권5호
• /
• pp.827-837
• /
• 2022

Objectives: The purpose of this study is to investigate the effectiveness of using Korean medical treatment for peripheral facial nerve palsy. Methods: We primarily treated the patient's peripheral facial nerve palsy during hospitalization (06/28/21~07/13/21) without any other steroids or antiviral drug treatments and additionally treated their spinal stenosis, using Korean medical treatments in both cases (herbal medicine, acupuncture, and herbal acupuncture therapy). The House-Brackmann grading system and Yanagihara's unweighted grading system were used to assess facial symptom changes, and the Numerical Rating Scale was used to evaluate the back pain caused by the spinal stenosis. Results: Following treatment, the patient's House-Brackmann and Numerical Rating Scale scores decreased, while their Yanagihara unweighted score improved. Conclusions: This study suggests that Korean medicine may be effective in the treatment of facial nerve palsy.