• Journal of Korean Neurosurgical Society
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• v.60 no.2
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• pp.211-219
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• 2017

Objective : This study aimed to compare the clinical and radiologic outcomes of patients with subaxial cervical injury who underwent anterior cervical discectomy and fusion (ACDF) with autologous iliac bone graft or polyetheretherketone (PEEK) cages using demineralized bone matrix (DBM). Methods : From January 2005 to December 2010, 70 patients who underwent one-level ACDF with plate fixation for post-traumatic subaxial cervical spinal injury in a single institution were retrospectively investigated. Autologous iliac crest grafts were used in 33 patients (Group I), whereas 37 patients underwent ACDF using a PEEK cage filled with DBM (Group II). Plain radiographs were used to assess bone fusion, interbody height (IBH), segmental angle (SA), overall cervical sagittal alignment (CSA, C2-7 angle), and development of adjacent segmental degeneration (ASD). Clinical outcome was assessed using a visual analog scale (VAS) for pain and Frankel grade. Results : The mean follow-up duration for patients in Group I and Group II was 28.9 and 25.4 months, respectively. All patients from both groups achieved solid fusion during the follow-up period. The IBH and SA of the fused segment and CSA in Group II were better maintained during the follow-up period. Nine patients in Group I and two patients in Group II developed radiologic ASD. There were no statistically significant differences in the VAS score and Frankel grade between the groups. Conclusion : This study showed that PEEK cage filled with DBM, and plate fixation is at least as safe and effective as ACDF using autograft, with good maintenance of cervical alignment. With advantages such as no donor site morbidity and no graft-related complications, PEEK cage filled with DBM, and plate fixation provide a promising surgical option for treating traumatic subaxial cervical spine injuries.

• Journal of Korean Neurosurgical Society
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• v.59 no.4
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• pp.374-378
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• 2016

Objective : A modified surgical technique of posterior cervical foramintomy called posterior cervical inclinatory foraminotomy (PCIF) was introduced in previous preliminary article. PCIF allows better preservation of facet joint and capsule than conventional techniques. The authors conducted a study to investigate long-term outcomes of PCIF. Methods : We retrospectively reviewed demographic, radiologic, and clinical data from the patients who underwent PCIFs at our institution. Criteria included a minimum of 48 month follow-up and PCIFs for patients with radiculopathy from foraminal stenosis (C2-T1; single or multilevel) with persistent or recurrent root symptoms despite conservative treatment for more than 3 months. Patients who had undergone previous cervical operation were excluded. The visual analogue scale (VAS) score was used for clinical follow-up, and radiologic follow-up was performed to compare the changes of cervical sagittal alignment, focal angle and disc-space height of treated segment. Results : The PCIFs were performed between April 2007 and March 2011 on 46 patients (32 males and 14 females) with a total of 73 levels affected. The average duration of follow-up was 74.4 months. Improvements in radiculopathic pain were seen in 39 patients (84.7%), and VAS score decreased from $6.82{\pm}1.9$ to $2.19{\pm}1.9$. Posterior neck pain also improved in 25 patients (71.4%) among 35 patients, and VAS score decreased from $4.97{\pm}2.0$ to $2.71{\pm}1.9$. The mean disc-space heights of treated segment were $5.41{\pm}1.03mm$ preoperatively and decreased to $5.17{\pm}1.12mm$ postoperatively. No statistically significant changes in cervical sagittal alignment, focal angle were seen during the follow-up period (Cox proportional hazards analysis and Student t-test, p>0.05). Conclusion : The PCIF is highly effective in treating patients with cervical spondylotic radiculopathy, leading to long-lasting relief in pain. Long-term radiologic follow-up showed no significant spinal angular imbalance.

• Journal of Korean Neurosurgical Society
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• v.39 no.4
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• pp.260-264
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• 2006

Objective : The retrospective study is undertaken to report clinical results of anterior cervical interbody fusion with an intradiscal cage with an integrated plate [PCB cervical plating system]. Methods : 38 patients underwent anterior cervical interbody fusion with PCB cervical plating system and followed $6{\sim}24\;months$. The authors investigated overall surgical results; clinical outcome, fusion rate, change of interspace height & lordotic angle, and complications. Results : No complication was observed during the operation. Clinical improvement was identified in 34 cases [89.5%]. Bone fusion observed in 44 out of 49 sites [90.7%]. After operation, the interspace height increased from $5.4{\pm}1.3mm$ to $7.8{\pm}1.5mm$ and maintained $7.4{\pm}1.1mm$ and, interspace angle went up from $4.2{\pm}0.7^{\circ}$ to $4.8{\pm}1.1^{\circ}$ and maintained $4.6{\pm}$0.9^{\circ}. The loosening of screw was observed in 6 cases, one of which had reoperation because of the expulsion of the device accompanied. Conclusion : PCB cervical plating system could restore interbody height and lordosis in anterior cervical interbody fusion. But, if the insertion of the spacer is not precise, the frequencies of hardware failure are relatively high. It is considered necessary for the operator to be careful in the procedure.

• Journal of The Korean Society of Integrative Medicine
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• v.7 no.4
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• pp.301-309
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• 2019

Purpose : The purpose of this study was to provide an effective method of exercise therapy for patients with cervicogenic headache. Methods : The subjects were divided into the following two groups according to the intervention received: cervical stretch exercise (n=15, control group) cervix-stabilizing exercise (n=15, experimental group) tone (Hz) and stiffness (N/m) of the suboccipital and upper trapezius muscles were measured. T1 slope angle and neck tilt angle were measured. After the exercise program intervention, a greater amount of change in muscle tone and stiffness of suboccipital and upper trapezius muscles was found in the experimental group, as compared to the control group. Greater amount of change in posture was found in the experimental group, as compared to the control group (p<0.05). Results : After the exercise program intervention, a greater amount of change in muscle tone and stiffness of suboccipital and upper trapezius muscles was found in the experimental group, as compared to the control group. Greater amount of change in posture was found in the experimental group, as compared to the control group (p<0.05). Conclusion : The neck-stabilizing exercise were shown to be effective in decreasing the tone of the cervical muscles by stabilizing the cervical bone and improving muscle activity, and in improving the posture by decreasing muscle tone and stiffness.

• Physical Therapy Rehabilitation Science
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• v.6 no.2
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• pp.83-89
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• 2017

Objective: Computers and smartphones have become a necessity for modern people, and the use of these things in an inappropriate position has increased the number of people who complain about neck problems. The purpose of this study was to compare the changes of cervical angle, range of motion (ROM) and pain threshold according to the McKenzie stretching and dry cupping therapy. Design: Cross-over design. Methods: We included 12 male and 6 female college students in their twenties, and conducted a pre- and post-test to evaluate the changes of each variable after the application of the McKenzie stretching and dry cupping therapy. Results: Neither the cervical spine angle nor the turtle neck angle showed any change in both the McKenzie stretching and the dry cupping treatment. In the McKenzie stretching, the pain threshold decreased, and the ROM of the cervical spine increased in all directions but there was no significant difference. The pain threshold was increased in the dry cupping treatment, and the ROM of the cervical spine was significantly increased in all directions (p<0.05). Comparisons of the McKenzie stretching and cupping treatment showed that the cupping treatment produced significantly greater pain thresholds and improvements in ROM of the cervical spine than the McKenzie stretching technique (p<0.05). Conclusions: Cupping treatment is more effective in improving ROM of the cervical spine and pain thresholds than the McKenzie stretching technique. In the future, cupping treatment will be one of the treatment options for pain and ROM impairments of the cervical spine.

• The Journal of Korean Academy of Orthopedic Manual Physical Therapy
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• v.24 no.1
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• pp.15-21
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• 2018

Background: The purpose of this study was to determine the effects of cervical deep muscle flexion exercise (CCFE) on craniovertebral angle, pain, and neck disability for patients with chronic neck pain Methods: The subjects of this study were randomly divided into three groups of 30 patients with chronic neck pain: rectus abodominis functional massage (n=10), cervical deep muscle flexion exercises group (n=10), and the control group(n=10). To assess visual analog scale (VAS) was used to test the neck pain, To assess neck posture was used to craniovertebral angle, VAS was used to test the neck pain, neck disability index (NDI) was used to test the neck dysfunction. All measurements were performed before and after each intervention was applied 3 times a week for 4 weeks. Results: In the results of all measurements, 2 groups except for the control group showed a significant change in the recovery of posture, neck pain, neck disability index (p<.05). Conclusions: Our results of this study showed that applying cervical deep muscle flexion exercise and rectus abodominis functional massage to patients with chronic neck pain improved cervical posture, neck pain, neck disability.

• The korean journal of orthodontics
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• v.30 no.5 s.82
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• pp.535-542
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• 2000

The purpose of this study was to find the characteristics of the frontal natural head position(NHP) of patients with facial asymmetry, and to contribute to the diagnosis of facial asymmetry in the clinical examination of orthodontic patients. Twenty adult patients who had apparent facial asymmetry and no severe sagittal skeletal discrepancy were selected as the asymmetry group, and 21 young adults who had symmetric faces were selected as the symmetry group. Frontal cephalograms were obtained in the state of NHP using a pivot-mounted fluid level device. The degree of the menton deviation was defined as the angle between the line drawn through crista galli and anterior nasal spine and the line drawn through crista galli and menton. The following angles were measured and each of them was compared with the degree of the menton deviation one is the angle between the true vertical line and the supra-orbital line which is a tangent line to the extreme cranial point on the supra-orbital margin, and the other is the angle between the true vertical line and the cervical line drawn through the midpoint of atlas and the 4th cervical vertebra. Through the statistical analysis, following results were obtained. 1. The angle between the supra-orbital line and the true vertical line was much mote deviated from the right angle in the asymmetry group than in the symmetry group. 2. The angle between the cervical line and the true vertical line in the asymmetry group showed greater tendency than in the symmetry group, but the difference was not statistically significant. 3. In the asymmetry group, the degree of the menton deviation was positively correlated with the angle between the supraorbital line and the true vertical line. The above results suggest that racial asymmetry patients show the tendency to have the tilted NHP to compensate the deviation of menton position.

• Journal of Korean Medicine Rehabilitation
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• v.25 no.1
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• pp.77-85
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• 2015

This study analyzed the MMPI (Minnesota Multiphashic Personality Inventory), VAS (Visual Analogue Scale), cervical and lumbar curvature (Cervical angle, Ishihara Index, Lumbar angle, Ferguson angle) and satisfaction score of patient of traffic accident. About 59 cases of patients admitted to the Korean Medicine hospital, MMPI and pain levels (VAS) cervical and lumbar curvature (Cervical angle, Ishihara Index, lumbar angle, Ferguson angle) and satisfaction score were measured and statistically analyzed. Depending on the type of accident divided into two groups of In car TA and Out car TA. After hospitalization, patient's pain index was improved as a whole. Pain index and evaluation of the cervical and lumbar curvature, according to the accident types, the difference was not statistically significant. In the analysis of the MMPI validity scales, In car TA group was analyzed by 'V-shaped', Out car TA group was analyzed by umbrella- shaped, 'inverted V-shaped'. Clinical scales of out car TA group were analyzed by 3-1 profile compared to the In car TA group. Results of multiple regression analysis showed no association between factors and MMPI scales. In the case of a traffic accident patients, damage to the body, as well as emotional and psychological factors are thought to affect the condition or prognosis of patients. In the future, for the management and treatment of these parts will be needed to complement the academic or institutional.

• Journal of Korean Neurosurgical Society
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• v.61 no.2
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• pp.224-232
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• 2018

Objective : Cervical ossification of the posterior longitudinal ligament (OPLL) can be treated via anterior or posterior approach, or both. The optimal approach depends on the characteristics of OPLL and cervical curvature. Although most patients can be successfully treated by a single surgery with the proper approach, renewed or newly developed neurological deterioration often requires repeat surgery. Methods : Twenty-seven patients with renewed or newly developed neurological deterioration requiring salvage surgery for multi-segment cervical OPLL were enrolled. Ten patients (group AP) underwent anterior approach, and 17 patients (group PA) underwent posterior approach at the initial surgery. Clinical and radiological data from initial and repeat surgeries were obtained and analyzed retrospectively. Results : The intervals between the initial and repeat surgeries were $102.80{\pm}60.08months$ (group AP) and $61.00{\pm}8.16months$ (group PA) (p<0.05). In group AP, the main OPLL lesions were removed during the initial surgery. There was a tendency that the site of main OPLL lesions causing renewed or newly developed neurological deterioration were different from that of the initial surgery (8/10, p<0.05). Repeat surgery was performed for progressed OPLL lesions at another segment as the main pathology. In group PA, the main OPLL lesions at the initial surgery continued as the main pathology for repeat surgery. Progression of kyphosis in the cervical curvature (Cobb's angle on C2-7 and segmental angle on the main OPLL lesion) was noted between the initial and repeat surgeries. Group PA showed more kyphotic cervical curvature compared to group AP at the time of repeat surgery (p<0.05). Conclusion : The reasons for repeat surgery depend on the type of initial surgery. The main factors leading to repeat surgery are progression of remnant OPLL at a different segment in group AP and kyphotic change of the cervical curvature in group PA.

• Neurospine
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• v.15 no.4
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• pp.362-367
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• 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.