• Journal of Korean Neurosurgical Society
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• v.30 no.12
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• pp.1388-1393
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• 2001

Objective : In the retrospective analyzing 19 consecutive patients with subaxial cervical spine(C3~T1) injury treated by posterior cervical fixation and fusion, clinical manifestation, radiologic finding, operative technique, and postoperative results following 6 months were analyzed. Materials and Methods : Most common fracture level was C4-5, mean age 41, and male to female ratio 13 : 6. The most common cause of injury was motor vehicle accident(17 cases). In 19 cervical procedures, interspinous triple wiring was done in 14 cases, lateral mass plating in 5 cases, and additional anterior fusion in 2 cases. Results : Twelve weeks after operation, all cases were reviewed by plain cervical radiogram. In 17 cases that treated by posterior fusion only, 14 cases(81%) had kyphotic angle change less than $5^{\circ}$, 2 cases(12%) $5-20^{\circ}$, and 1 case(6%) more than $20^{\circ}$. Overall fusion rate was 88%, and there was no significant difference of bone fusion rate between autogenous bone graft and allogenous bone graft. Conclusion : In the case of severe posterior column injury or displacement, posterior approach seems superior to anterior approach, but in the case of combined anterior column injury, anterior approach is considered necessary. In this study, posterior fixation and fusion might be acceptable procedure for subaxial cervical fracture and dislocation, owing to its high fusion rate, low kyphotic angulation and low operation related complication rate.

• Journal of Korean Neurosurgical Society
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• v.52 no.2
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• pp.107-113
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• 2012

Objective : Various procedures have been introduced for anterior interbody fusion in degenerative cervical disc disease including plate systems with autologous iliac bone, carbon cages, and cylindrical cages. However, except for plate systems, the long-term results of other methods have not been established. In the present study, we evaluated radiologic findings for cylindrical cervical cages over long-term follow up periods. Methods : During 4 year period, radiologic findings of 138 patients who underwent anterior cervical fusion with cylindrical cage were evaluated at 6, 12, 24, and 36 postoperative months using plain radiographs. We investigated subsidence, osteophyte formation (anterior and posterior margin), cage direction change, kyphotic angle, and bone fusion on each radiograph. Results : Among the 138 patients, a minimum of 36 month follow-up was achieved in 99 patients (mean follow-up : 38.61 months) with 115 levels. Mean disc height was 7.32 mm for preoperative evaluations, 9.00 for immediate postoperative evaluations, and 4.87 more than 36 months after surgery. Osteophytes were observed in 107 levels (93%) of the anterior portion and 48 levels (41%) of the posterior margin. The mean kyphotic angle was $9.87^{\circ}$ in 35 levels showing cage directional change. There were several significant findings : 1) related subsidence [T-score (p=0.039) and anterior osteophyte (p=0.009)], 2) accompanying posterior osteophyte and outcome (p=0.05). Conclusion : Cage subsidence and osteophyte formation were radiologically observed in most cases. Low T-scores may have led to subsidence and kyphosis during bone fusion although severe neurologic aggravation was not found, and therefore cylindrical cages should be used in selected cases.

• Journal of Korean Neurosurgical Society
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• v.46 no.6
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• pp.532-537
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• 2009

Objective : Recently, motion preservation has come to the forefront of emerging technologies in spine surgery. This is the important background information of the emergence of cervical arthroplasty as an alternative to arthrodesis that offers the promise of restoring normal spinal movement and reduces a kinematic strain on adjacent segments. The study was designed to evaluate early surgical outcome and radiological effects of $Bryan^{(R)}$ cervical disc prosthesis. Methods : The authors retrospectively reviewed radiographic and clinical outcomes in 52 patients who received the $Bryan^{(R)}$ Cervical Disc prosthesis, for whom follow-up data were available. Static and dynamic radiographs were measured by computer to determine the angles formed by the endplates of the natural disc preoperatively, those formed by the shells of the implanted prosthesis, the angle of functional spine unit (FSU), and the C2-7 Cobb angle. The range of motion (ROM) was also determined radiographically, whereas clinical outcomes were assessed using Odom's criteria, visual analogue pain scale (VAS) and neck disability index (NDI). Results : A total of 71 $Bryan^{(R)}$ disc were placed in 52 patients. A single-level procedure was performed in 36 patients, a two-level procedure in 13 patients, and a three-level procedure in 3. Radiographic and clinical assessments were made preoperatively. Mean follow-up duration was 29.2 months, ranging from 6 to 36 months. All of the patients were satisfied with the surgical results by Odom's criteria, and showed significant improvement by VAS and NDI score (p < 0.05). The postoperative ROM of the implanted level was preserved without significant difference from preoperative ROM of the operated level (p < 0.05). 97% of patients with a preoperative lordotic sagittal orientation of the FSU were able to maintain lordosis. The overall sagittal alignment of the cervical spine was preserved in 88.5% of cases at the final follow up. Interestingly, preoperatively kyphotic FSU resulted in lordotic FSU in 70% of patients during the late follow up, and preoperatively kyphotic overall cervical alignment resulted in lordosis in 66.6% of the patients postoperatively. Conclusion : Arthroplasty using the $Bryan^{(R)}$ disc seemed to be safe and provided encouraging clinical and radiologic outcome in our study. Although the early results are promising, this is a relatively new approach, therefore long-term follow up studies are required to prove its efficacy and its ability to prevent adjacent segment disease.

• Journal of International Academy of Physical Therapy Research
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• v.10 no.2
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• pp.1797-1802
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• 2019

Background: Breathing is the essential step of Pilates exercise and can be used to activate core muscles. Although the effects of breathing exercise on pain, breathing muscles, and cervical posture have been extensively studied, little is known about the impact of Pilates breathing on spinal posture and alignment. Purpose: To determine the effect of 3D-Pilates breathing exercise on spinal curvature and alignment of healthy adults during corrected to normal alignment. Design: One group pre-post test design Methods: Eighteen participants were given a 3D-pilates breathing exercise twice a week (20 minutes per session) for three weeks and warmed up for 10 minutes before each exercise session. To examine spinal curvature and alignment of each subject, this study used radiation free rasterstereography (Formetric III, Germany). Paired t-test and Wilcoxon signed rank test were performed to determine the difference between pre and post exercise. Results: There were statistically significant differences in height (p<.001), kyphosis angle (p<.05), trunk imbalance (p<.05), kyphotic apex (p<.01), cervical fleche (p<.05), pelvic tilt (p<.01), and lateral deviation (p<.05) between before and after 3D Pilates breathing exercise. However, there was no significant difference in lordosis angle. Conclusions: The study results indicated that three week 3D-pilates breathing exercise program could be presented as an effective rehabilitation method for improving spinal curvature and alignment.

• The Journal of Churna Manual Medicine for Spine and Nerves
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• v.2 no.2
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• pp.1-16
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• 2007

Objectives : The purpose of this study was to identify spinal curvatures, plantar pressure and foot angles in a walking. Methods : 19 outpatients under 19 years old were included. Plantar pressure and foot angle in a walking were measured by using Gaitview AFA-50. Spinal curvatures were measured by using radiograph. Results : The cervical lordotic angle is significantly difference with left and right plantar pressure(p=0.027). The thoracic kyphotic angle is significantly difference with left and right plantar pressure(p=0.026). Cobb's angle is significantly difference with left and right plantar pressure(p=0.027). The other plantar pressure were no difference from spinal curvatures and foot angle in a walking. Conclusion : There were no correlation between plantar pressure, spinal curvatures and foot angle. We consider that needed more additional study.

• Journal of Trauma and Injury
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• v.25 no.1
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• pp.7-16
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• 2012

Purpose: Cervical dislocations with locked facets account for more than 50% of all cervical injuries. Thus, investigating a suitable management of cervical locked facets is important. This study examined factors of close reduction failure in traumatically locked facets of the subaxial cervical spine patients to determine suitable surgical management. Methods: We retrospectively analyzed of the case histories of 28 patients with unilateral/bilateral cervical locked facets from Nov. 2004 to Dec. 2010. Based on MRI evaluation of disc status at the injury level, we found unilateral dislocations in 9 cases, and bilateral dislocations in 19 cases, The patients were investigated for neurologic recovery, closed reduction rate, factors of the close reduction barrier, fusion rate and period, spinal alignment, and complications. Results: The closed reduction failed in 23(82%) patients. Disc herniation was an obstacle to closed reduction (p=0.015) and was more frequent in cases involving a unilateral dislocation (p=0.041). The pedicle or facet fracture was another factor, although some patients showed aggravation of neurologic symptoms, most patients had improved by the last follow up. The kyphotic angle were statistically significant (p=0.043). Sixs patient underwent anterior decompression/fusion, and 15 patients underwent circumferential fusion, and 7 patients underwent posterior fusion. All patients were fused at 3 months after surgery. The complications were 1 case of CSF leakage and 1 case of esphageal fistula, 1 case of infection. Conclusion: We recommend closed reduction be performed as soon as possible after injury to maximize the potential for neurological recovery. Patients fot whom closed reduction of the cervical locked facets have a higher incidence of anatomic obstacles to reduction, including facet fractures and disc herniation. Immediate direct open anterior reduction or circumferential fixation/fusion of locked cervical facets is recommended as a treatment of choice for traumatic locked cervical facet patients after closed reduction failure.

• PNF and Movement
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• v.17 no.1
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• pp.41-46
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• 2019

Purpose: Continuous use of a smartphone increases the angle of forward bending of the user's cervical vertebrae, causing pain in the shoulders and back, including the thorax, lumbar region, and vertebrae. Although there are many studies on changes in the cervical spine due to smartphone usage, the changes in the shoulders, thoracolumbar spine, and pelvic have rarely been compared. The purpose of this study is to investigate the change in the spinal segments, shoulders, and pelvic when using a smartphone with both hands while in the standing position. Methods: This study was conducted on 35 adults in their twenties. The selection criteria for the subjects were limited to those in a similar age group, thus excluding posture differences according to age, and to those who did not have specific diseases or pain in the spinal and musculoskeletal system for 12 months prior to the study. In this study, we used a 3D spinal diagnostic imaging system (Back Mapper, Frickenhausen) to compare the changing conditions in each vertebral segment before and during smartphone usage with both hands while in the standing position. Posture differences according to smartphone usage were compared using the paired t-test for the motion of each spinal segment. Results: This study showed that the thoracic and lumbar angle increased posteriorly during smartphone usage (p<0.05). In addition, the anterior rotation angle of the shoulder bone significantly increased, but no significant difference occurred in the pelvic region. Conclusion: Based on the results of this study, smartphone usage with both hands while in the standing position showed that the spine, as a whole, forms a kyphotic curve. Therefore, we propose to present a postural guideline for correct smartphone usage, considering the change in each vertebral segment.

• 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 Korean Neurosurgical Society
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• v.53 no.2
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• pp.83-88
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• 2013

Objective : The authors reviewed their experiences of combined surgery (open door laminoplasty with unilateral screw fixation) for unstable multi-level cervical stenosis, to clarify the situation regarding the surgical approach most appropriate for the treatment of diffuse unstable multi-level cervical stenosis. Methods : From January 2011 to January 2012, combined surgery was performed for unstable multi-level cervical stenosis by one surgeon at our institution. The subjects of this study were 6 men of mean age 53.7 years (range, 48-71) with a mean follow-up of 9.3 (range, 3-14) months. All imaging studies showed severe multi-level cervical stenosis with spinal cord signal change, and instability or kyphotic deformity. A retrospective review of clinical, radiological, and surgical data was conducted. Results : Average laminoplasty level was 4.8 and the average screw fixation level was 5.0. Japanese Orthopedic Association score improved from an average of 5.2 to 11.2 points. According to Nurick's grades and Odom's criteria, symptom improvement was statistically significant. On the other hand, Cobb's angle changes were not significant. Average operation time was 5.86 hours with an average blood loss of 460 mL. No significant surgical complication was encountered. Conclusion : Despite the small cohort and the short follow-up duration, the present study demonstrates that laminoplasty with unilateral screw fixation is a safe and effective treatment for unstable multi-level cervical stenosis.

• The Journal of Korean Academy of Orthopedic Manual Physical Therapy
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• v.29 no.1
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• pp.81-93
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• 2023

Purpose: The current case study focuses on identifying the effects of manual therapy and home self-therapeutic exercise including on mouth opening and pain relief in patients with continuous neck pain with myofascial temporomandibular disorders (TMDs) accompanied by headache induced by masticatory myalgia Subjects: The study participant was a 27-year-old woman who was treated a year ago for pain related to TMDs accompanied by a headache. Methods: Manual therapy of the cervical spine with upper cervical spine posterior-to-anterior mobilization (C1~C2), upper cervical spine flexion mobilization (C0~C2), upper cervical spine lateral flexion mobilization (C0~C1), upper cervical spine thrust manual therapy (C1~C2) and manual therapy of the temporomandibular joint and muscles with transverse medial accessory temporomandibular joint mobilization, manual therapies for the temporal, the masseter, and medial pterygoid muscles were performed twice a week for about 30 minutes for 4 weeks. This protocol included 3 sessions in total. The home self-therapeutic exercise was to be performed two to three times a day. Results: The values more improved MMO increased to 41.4 mm, left masseter muscle PPT to 2.9 kgf/cm², right masseter muscle PPT to 3.1 kgf/cm², KHIT-6 to 46 points, neck pain intensity (by NRS) to 2 points, headache frequency to per weeks, cervical kyphotic angle to -8.06%, and GCPS to grade 1 (low-intensity pain without pain-related disorder). Conclusion: Manual therapy and home self-therapeutic exercise can be helpful for mouth opening and pain relief in patients with myofascial TMDs accompanied by secondary headaches induced by masticatory myalgia.