• Journal of Korean Neurosurgical Society
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• v.64 no.4
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• pp.575-584
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• 2021

Objective : Cervical expansive laminoplasty is an effective surgical method to address multilevel cervical spinal stenosis. During surgery, the spinous processes of C2 and C7 are usually preserved to keep the insertion points of the cervical musculature and nuchal ligament intact. In this regard, dome-like laminectomy (undercutting of C7 lamina) instead of laminoplasty is performed on C7 in selected cases. However, resection of the lamina can weaken the C7 lamina, and stress fractures may occur, but this complication has not been characterized in the literature. The objective of the present study was to investigate the incidence and risk factors for C7 laminar fracture after C7 dome-like laminectomy and its impact on clinical and radiological outcomes. Methods : Patients who underwent cervical open-door laminoplasty combined with C7 dome-like laminectomy (n=123) were classified according to the presence of C7 laminar fracture. Clinical parameters (neck/arm pain score and neck disability index) and radiologic parameters (C2-7 angle, C2-7 sagittal vertical axis, and C7-T1 angle) were compared between the groups preoperatively and at postoperatively at 3, 6, 12, and 24 months. Risk factors for complications were evaluated, and a formula estimating C7 fracture risk was suggested. Results : C7 lamina fracture occurred in 32/123 (26%) patients and occurred at the bilateral isthmus in 29 patients and at the spinolaminar junction in three patients. All fractures appeared on X-ray within 3 months postoperatively, but patients did not present any neurological deterioration. The fracture spontaneously healed in 27/32 (84%) patients at 1 year and in 29/32 (91%) at 2 years. During follow-up, clinical outcomes were not significantly different between the groups. However, patients with C7 fractures showed a more lordotic C2-7 angle and kyphotic C7-T1 angle than patients without C7 fractures. C7 fracture was significantly associated with the extent of bone removal. By incorporating significant factors, the probability of C7 laminar fracture could be assessed with the formula 'Risk score = 1.08 × depth (%) + 1.03 × length (%, of the posterior height of C7 vertebral body)', and a cut-off value of 167.9% demonstrated a sensitivity of 90.3% and a specificity of 65.1% (area under the curve, 0.81). Conclusion : C7 laminar fracture can occur after C7 dome-like laminectomy when a substantial amount of lamina is resected. Although C7 fractures may not cause deleterious clinical outcomes, they can lead to an unharmonized cervical curvature. The chance of C7 fracture should be discussed in the shared decision-making process.

• Journal of the Korean Society of Radiology
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• v.8 no.2
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• pp.89-96
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• 2014

This paper tries to examine whether the application of joint mobilization to subjects who have the forward head posture due to malalignment in the cervical joint has influence on posture changes and functions in the cervical joint. The subjects were 39 students from G University in Gyeongsangbuk-do. The cervical joint mobilization was applied to 20 subjects and not to 19. The students with a cervical lordosis angle of $21^{\circ}C$ or less, an anterior weight bearing (AWB) of 15mm or greater, and a cervical extension ROM of $70^{\circ}C$ or less in terms of radiography were selected as subjects under their voluntary agreement. The patients actively performed the joint mobilization slowly 8 times per session while therapists continuously applied sustained accessory glide to their painful joints 3 times per week for 4 weeks along with the cervical expansion and flexion in SNAGS among other Mulligan's (1995) techniques. The measurement was carried out in terms of radiographic inspection and neck disability indexes. As a result of the experiment, it turned out that the subjects with the forward head posture had changes in the cervical AWB and ARA, the ranges of expansion and flexion, and the NDI(Neck Disability Index) after the intervention for the experimental group by applying cervical joint mobilization. There were no changes observed in the control group. In conclusion, the application of joint mobilization turned out to have influence on the improvement of cervical joint postures, and craniocervical region functions.

• The Journal of Korean Physical Therapy
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• v.29 no.4
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• pp.158-163
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• 2017

Purpose: The purpose of this study was to investigate the relationship among pain, range of motion of the neck, neck disability index and grip strength after thoracic manipulation and cervical stabilization training in patients with chronic neck pain. Methods: In this study, twelve subjects with chronic neck pain were included. All participants had thoracic manipulation and cervical stabilization training. Intervention was conducted three times per a week, for 4 weeks. The visual analogue scale (VAS), range of motion of neck, neck disability index (NDI), as well as the grip strength before and after intervention were measured in all participants. Paired t-test was used to compare variables before and after intervention. Pearson correlation analysis was used to identify the correlations between the variables. Results: All variables after the intervention were significantly improved. There was a significant negative correlation between VAS and flexion angle of the neck (r=-0.669, p<0.05). Moreover, there was a significant positive correlation between NDI and VAS (r=0.636, p<0.05), and a significant negative correlation between NDI and flexion angle of the neck (r=-0.692, p<0.05). Conclusion: Patients with reduced pain following therapeutic intervention illustrated that there would be an improvement in the flexion angle rather than the extension angle of the neck, and that those with increased flexion angle would have less restriction of activities in daily living.

• Journal of Korean Physical Therapy Science
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• v.24 no.3
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• pp.56-63
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• 2017

Purpose: This study aimed to investigate the effects of sitting posture on cervical flexion angle and pain during smart phone use. Method: This research was performed on 10 adult female students who use smart phones regularly, Each of the two groups of participants used the provided smart phone for 20 minutes while maintaining the given default posture. The evaluation order was randomly selected and the two groups were photographed twice before and after the experiment and were asked to answer if they felt pain during or after the experiment. Result: First, both upright sitting position and vertebra bent position pre and post experiment readings showed significant statistical difference (p<.05). And it is shown to be a factor that induces pain around the neck via increase in neck flexion angle. Second, although there were no significant statistical difference between the pre and post experiment readings of the upright sitting position results and the vertebra bent position results, the vertebra bent position readings showed bigger changes to the neck flexion angle then the upright sitting position readings. Third, all participants from both groups claimed pain in all the tested postures of smart phone usage. Conclusion: Smart phone usage for an extended amount of time in all body postures may prove to have a negative effect making the "optimal" smart phone usage position as a controlled time with neck stretches included in between short sessions.

• Journal of the Korea Society of Computer and Information
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• v.26 no.6
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• pp.129-135
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• 2021

The purpose of this study was to investigate the relationship of the head posture with the tone and stiffness of the cervical extensor muscles. Eighty adults in their twenties were chosen as subjects, and the tone and stiffness of the cervical extensor muscles were measured, with their usual head posture in the sagittal plane. For the measured head posture, the craniovertebral angle (CVA), craniorotation angle (CRA), and forward shoulder angle (FSA) were analyzed using Image J. It was observed that the tone and stiffness of the upper trapezius muscle increased significantly with a decrease in the CVA as well as with an increase in the CRA (p < 0.05). As a result of further classification into the normal and forward head postures based on the CVA of the subjects, the forward head posture was characterized by a significant increase in the tone and stiffness of the upper trapezius muscle (p<.05). The results of this study are expected to be used as basic data for the evaluation of the forward head posture and posture education in clinical practice.

• The Journal of Korea CHUNA Manual Medicine
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• v.2 no.1
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• pp.85-92
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• 2001

Objectives : To study the cervical lordosis and disc degeneration in neck pain patients with or without low back pain. Subjects. The study was composed of 57 neck pain patients with low back pain(LBP group) and 40 neck pain patients without low back pain(Non-LBP group). Methods : Radiographic measures of spinal lordosis(cervical and lumbar) and disc degeneration were collected, and statistically analyzed. Results: LBP group showed a significant increase in cervical lordotic angle as compared with Non-LBP group, whereas no significant change in cervical disc degeneration. A relationship was found between cervical and lumbar disc degeneration in LBP $group({\gamma}-0.3064)$. Conclusions : The findings from this study suggest that the curvature of the cervical spine is related to the subject's low back pain.

• Journal of Korean Neurosurgical Society
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• v.30 no.12
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• pp.1369-1374
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• 2001

Objectives : The rates of pseudarthrosis for two- and three level fusion have been reported to be 17-63 and 50% without anterior cervical plating. The purpose of this study is to assess the effects of anterior cervical plating in the treatment of multilevel degenerative cervical disease such mostly the additional risks associated with hardware implants and its benefits, fusion rate and radiographic results, and clinical outcomes. Methods : Forty-seven patients who underwent operations between 1993 and 1997 were retrospectively reviewed. The technique for operation was same for both groups(Smith Robinson with autologous iliac bone graft). Group I consisted of 35 consecutive patients treated with anterior cervical decompression and fusion with anterior cervical plate fixation. Group II consisted of 12 consecutive patients treated without plate fixation. We compared clinical outcomes by Prolo score, radiographic results in the rate of fusion, cervical lordosis by Gore angle, disc height by Farfan method, and surgical complications between two groups. Results : The favorable clinical outcomes(excellent and good) by Prolo score were observed with the use of anterior cervical plate fixation(89% vs 75%). The successful fusion rate of multilevel cervical fusion was as seen with anterior cervical plate fixation(97% vs 75%). The overall graft complication rate in multilevel fusions was decreased, with anterior cervical plate fixation, and the hardware related complications were relatively minimal without serious consequences. Conclusion : Anterior cervical plate fixation in the treatment of multilevel cervical disorders is an effective stabilizing method which provides increased bony fusion rate, decreased graft complications, maintained cervical lordosis, early mobilization of the these patients without serious hardware related complications.

• Journal of Korean Neurosurgical Society
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• v.39 no.5
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• pp.340-346
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• 2006

Objective : The lack of anatomical knowledge for the anterior cervical microforaminotomy is liable to injure the neurovascular structures. The surgical anatomy is examined with special attention to the ventral aspect exposed in anterior cervical microforaminotomy. Methods : In 16adult formalin fixed cadaveric cervical spine, the author measured the distances from the medical margin of the longus colli to the medical wall of the ipsilateral vertebral artery and the angle for the ipsilateral vertebral artery. The distances from the lateral margin of the posterior longitudinal ligament to the medial margin of the ipsilateral medial wall of the vertebral artery, to the ipsilateral dorsal root ganglion was measured too. Results : The distance from the medial margin of the longus colli to the ipsilateral vertebral artery was $13.3{\sim}14.7mm$ and the angle for the ipsilateral vertebral artery was $41{\sim}42.5\;degrees$. The range of distance from the lateral margin of the posterior longitudinal ligament to the ipsilateral vertebral artery was $11.9{\sim}16.1mm$, to the ipsilateral dorsal root ganglion was $11.6{\sim}12.9mm$. Conclusion : These data will aid in reducing neurovascular injury during anterior cervical approaches.

• Journal of Korean Neurosurgical Society
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• v.58 no.2
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• pp.119-124
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• 2015

Objective : We compared the clinical and radiographic outcomes of stand-alone polyetheretherketone (PEEK) cage and Zero-Profile anchored spacer (Zero-P) for single level anterior cervical discectomy and fusion (ACDF). Methods : We retrospectively reviewed 121 patients who underwent single level ACDF within 2 years (Jan 2011-Jan 2013) in a single institute. Total 50 patients were included for the analysis who were evaluated more than 2-year follow-up. Twenty-nine patients were allocated to the cage group (m : f=19 : 10) and 21 for Zero-P group (m : f=12 : 9). Clinical (neck disability index, visual analogue scale arm and neck) and radiographic (Cobb angle-segmental and global cervical, disc height, vertebral height) assessments were followed at pre-operative, immediate post-operative, post-3, 6, 12, and 24 month periods. Results : Demographic features and the clinical outcome showed no difference between two groups. The change between final follow-up (24 months) and immediate post-op of Cobb-segmental angle (p=0.027), disc height (p=0.002), vertebral body height (p=0.033) showed statistically better outcome for the Zero-P group than the cage group, respectively. Conclusion : The Zero-Profile anchored spacer has some advantage after cage for maintaining segmental lordosis and lowering subsidence rate after single level anterior cervical discectomy and fusion.

• Journal of the Korean Society of Physical Medicine
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• v.16 no.3
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• pp.81-87
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• 2021

PURPOSE: This study compared the cross-sectional areas (CSA) of the cervical muscles of straight neck patients and normal participants during a craniocervical flexion exercise (CCFE) using computerized tomography (CT) to investigate the effects of CCFE on the cervical curve. METHODS: Eighteen subjects were recruited for this study. Nine subjects were allocated to the straight neck group (subjects with pain and a cervical lordosis angle of less than 20°); the remainder formed the control group (subjects with a cervical lordosis angle greater than 20°). The CSA of the subjects' neck flexors (longus colli, longus capitis, and sternocleidomastoid) were measured by CT during rest and CCFE in the supine position, and the range of motion (ROM) of neck flexion was measured using a C-ROM instrument in a sitting. RESULTS: The straight neck group had a significantly smaller CSA of the longus colli, longus capitis, and sternocleidomastoid than the control group (p < .05). Both the straight neck and control groups showed statistically significant increases in the CSA of the neck flexors during CCFE compared to that at rest (p < .05). In addition, the straight neck group showed a significantly smaller ROM of neck flexion than the control group (p < .05). CONCLUSION: The results of this study provide more concrete evidence for therapists by demonstrating that CCFE improves the neck function by strengthening the neck flexors and increasing the neck stability for straight neck patients. Therefore, it is necessary to perform CCFE and neck extension exercises to rehabilitate straight neck patients.