• Journal of Korean Neurosurgical Society
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• 제39권3호
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• pp.188-191
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• 2006

Objective : The purpose of this study is to evaluate the efficacy and necessity of combined anterior approach [discectomy and fusion] and posterior approach[open-door laminoplasty] in the treatment of cervical spondylotic myelopathy. Methods : The authors reviewed 14 cases in whom combined anterior and posterior approach performed for cervical myelopathy due to simultaneous anterior and posterior pathology such as huge central disc herniation with narrow spinal canal between January 2000 and December 2002. Clinical symptoms were evaluated by Japanese Orthopaedic Association [JOA] score and then the cervical curvature, change of spinal canal to vertebral body[SC/VB] ratio and canal widening were measured and compared to the clinical symptoms. Results : The mean JOA score increased from $10.4{\pm}3.1$ preoperatively to $14.8{\pm}1.2$ at the final follow up with a mean recovery rate 66.4%. In all cases, there were not neurologic deterioration. Mild postoperative complications developed in two cases. One patient had a limitation of range of neck motion and the other one showed kyphotic change. Postoperative radiography showed an improvement of body to canal ratios [average $0.70{\pm}0.08$ before surgery to $1.05{\pm}0.12$ after surgery and mainte nance or recovery of cervical lordosis. Canal widening of antero-posterior diameter and dimension after operation is 6.8mm. $116.61mm^2$. Conclusion : Combined anterior and posterior procedure could be helpful in decompression of the spinal cord and good functional recovery in spondylotic myelopathy patients with combined anterior and posterior pathology such as huge disc herniation accompanying narrow spinal canal.

• 대한약침학회지
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• 제25권2호
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• pp.138-144
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• 2022

Cervical spondylotic myelopathy (CSM) is common in elderly people and severe CSM patients are recommended to receive surgery. However, in some cases, surgery may fail to improve the patients' symptoms. An 80-year-old man diagnosed with CSM complained of right hemiplegia and right arm and leg pain with the presence of a Foley catheter, despite treatment with laminectomy and laminoplasty. Acupuncture, bee venom pharmacopuncture, and herbal medicine were administered for 129 days. As a result, manual muscle testing (MMT) and the Modified Barthel Index (MBI) improved, the pain in his right arm and leg decreased, and he was able to urinate by himself. This case report implies that integrative Korean medicine (IKM) can be an option for patients suffering from muscular weakness resulting from myelopathy.

• Journal of Acupuncture Research
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• 제29권1호
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• pp.159-167
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• 2012

Objectives : The purpose of this study is to investigate the effecacy of Korean medical treatments on cervical myelopathy patient diagnosed by magnetic resonance imaging(MRI). Methods : The patient was treated by Korean medical treatments including acupunture, pharmacopuncture, herbal medicine, cervical traction technique of Chuna treatment. To evaluate the change of MRI view, slipped disc ratio and A-P compression ratio were used. The improvement of the clinical symptoms was observed by Score of pain part and Nurick grade. Results : After treatment, patient's score of pain part, Nurick grade were decreased and slipped disc ratio, A-P compression ratio were also improved. Conclusions : The Korean medical treatments might be an effective method to improve the clinical symptoms and radiological view of cervical myelopathy.

• PNF and Movement
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• 제16권3호
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• pp.333-343
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• 2018

Purpose: The purpose of this study was to investigate the effects of a neck exercise using a proprioceptive neuromuscular facilitation (PNF) neck flexion and extension pattern on body balance in a progressive range of positions (supine, prone on elbow, and sitting), on numbness in the upper extremities, and on neck flexion motions in cervical myelopathy patients. Methods: One participant who was diagnosed with cervical myelopathy participated in this study. A reversal design (A-B-A') was used. The A and A' were the baseline period (no intervention), and B was the intervention period. The intervention used a neck extension pattern with a hold-relax technique and a neck flexion pattern with a combination of isotonic techniques in the supine position. Then, neck flexion and extension patterns were applied together with a reversal technique for stabilization, followed by a neck extension pattern with a combination of isotonic techniques in the prone position on the elbows. Finally, a neck flexion and extension pattern was used with a stabilizing reversal technique, and a neck extension pattern was applied with a combination of isotonic techniques in the sitting position for 60 minutes per day, 3 times per week for 8 weeks. To measure balance, numbness, and neck motion during neck flexion, the one-leg stand test and the visual analogue scale were used. Results: The right and left one-leg stand tests showed increased balance ability in the intervention phase. Upper extremity numbness was decreased in the intervention phase, and neck flexion motion was increased in the intervention phase. These increases were maintained after the intervention (Baseline II). Conclusion: These results suggest that a neck exercise using a PNF neck pattern with additional techniques in a progressive range of positions has a positive effect on cervical myelopathy patients for balance, numbness, and neck motion.

• Journal of Korean Neurosurgical Society
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• 제56권5호
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• pp.436-440
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• 2014

Sarcoidosis is a systemic disease of unknown etiology that may affect any organ in the body. The nervous system is involved in 5-16% of cases of sarcoidosis. Here, we report a case of intramedullary sarcoidosis presenting with delayed spinal cord swelling after laminoplasty for the treatment of compressive cervical myelopathy. A 56-year-old woman was admitted to our hospital complaining of upper extremity pain and gait disturbance. The patient had undergone laminoplasty for compressive cervical myelopathy 3 months previously. Follow-up magnetic resonance imaging revealed a large solitary intramedullary lesion with associated extensive cord swelling, signal changes, and heterogeneous enhancement of spinal cord from C2 to C7. Spinal cord biopsy revealed non-necrotizing granulomas with signs of chronic inflammation. The final diagnosis of sarcoidosis was based upon laboratory data, imaging findings, histological findings, and the exclusion of other diagnoses. Awareness of such presentations and a high degree of suspicion of sarcoidosis may help arrive at the correct diagnosis.

• 척추신경추나의학회지
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• 제5권1호
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• pp.145-156
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• 2010

Objects: This study was to report a clinical effect of Chuna Treatment for a patient diagnosed by Magnetic Resonance Imaging(MRI) as Cervical Myelopathy. Methods: In order to alleviate shoulder pain and neck stiffness, the patient was treated by acupuncture therapy, herbal medicine, pharmacopucture, cervical traction technique of Chuna treatment and conservative managements. To evaluate the effect of the treatment, Recovery rate of Hirabayashi, VAS(Visual Analogue Scale), NDI and ROM(Range of Motion) were used. Lhermitte's sign, Valsalva test, Distraction test, Compression test and Spurling test were carried out. Results: VAS, NDI and ROM were improved and Recovery rate was 100%. Conclusions: Korean Treatment can be effectively used for a patient with Cervical Myelopathy. Further clinical studies are needed to verify the findings.

• Journal of Korean Neurosurgical Society
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• 제41권6호
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• pp.382-386
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• 2007

Objective : Various techniques of cervical laminoplasty have been developed to decompress the spinal canal in patients with multilevel cervical spondylotic myelopathy. This study compared the early surgical outcomes between unilateral open-door laminoplasty and midline splitting cervical laminoplasty. Materials and Methods : From March 2004 to August 2005, we performed cervical laminoplasty in 34 patients with cervical myelopathy. Of these patients, 24 were treated by unilateral open-door laminoplasty [open-door group] and 10 by midline splitting cervical laminoplasty [splitting group]. The mean duration of follow up was 9.2 months in the open-door group and 15.8 months in the splitting group. We retrospectively analyzed neurological outcomes using the Japanese Orthopedic Association [JOA] score, and compared the radiological changes between the two groups. Results : Postoperative JOA score and recovery rate were $13.29{\pm}4.01$ and $56.28{\pm}44.91%$ in the open-door group and $15.75{\pm}0.88$ and $72.69{\pm}19.99%$ in the splitting group. There was no statistical difference between the two groups [p>0.05]. Regarding the radiological assessment, the increase of postoperative axial canal area was $63.23{\pm}23.24%$ in the open-door group and $42.30{\pm}14.96%$ in the splitting group [p<0,05]. Conclusion : There was no statistical difference in the neurological outcome when the early surgical outcomes of the open-door group and the splitting group were compared. However, the open-door group showed wider cervical spinal canal areas than the splitting group.

• 한국산학기술학회논문지
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• 제20권10호
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• pp.303-308
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• 2019

65세 남자환자에서 전신마취하 관절경 어깨 수술후 갑자기 발생한 사지 마비 증례를 보고하고자 한다. 환자는 술 후 급격한 사지 마비 증상을 보였으며 마취 관리상 특별한 문제는 없었다. 환자의 수술시 자세와 관련하여 마취 유도시에 기관삽관을 위한 과도한 경추 신전은 시행되지 않았으며 수술중 자세에서도 경추부의 과도한 회전이나 신전 또한 진행되지 않았다. 그러나 수술이 종료된 후 근이완의 완전한 회복과 의식 및 자발호흡은 확인되었으나 사지 마비 증상 및 배뇨장애 증상을 보였다. 신속히 시행한 경추부 자기공명 영상에서 경추간판에 의한 척수 신경 압박 소견 보이는 척추성 경추증 증상을 보였다. 환자는 21일간의 고농도 스테로이드 정주 요법을 포함한 보존적 치료 후에 감각 및 운동신경의 완전한 회복을 보이고 다른 신경학적 이상 소견은 보이지 않은 채로 퇴원하였다. 외상과 관련 없이 사지 마비로 나타나는 수술후 척추성 경추증의 발생은 흔하지 않다. 본 증례를 통해 수술후 발생한 비외상성 척추성 경추증 발생에 대해 타 증례 보고와 비교 분석하여 고찰해 보고자 한다. 임상 의사는 60세 이상의 노년층에서의 수술후 사지 마비에 대해 척추성 경추증의 원인 기여에 대해서도 고려하기를 권고한다.

• Journal of Korean Neurosurgical Society
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• 제29권12호
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• pp.1634-1641
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• 2000

Objective : The cerebrospinal fluid(CSF) pulsates within the craniospinal axis in response to rhythmic cerebral blood volume variation during the cardiac cycle. The aim of this study is to characterize the normal and abnormal CSF flow and its waveforms in the cervical spinal subarachnoid space. Methods : The magnetic resonance(MR) images were obtained with 1.5 T(GE Signa, GE Medical Systems, Milwaukee, USA) unit using the 2 dimensional cine PC(phase contrast) sequence with cardiac gating and gradient recalled echo imaging. This pulse sequence yielded 16 quantitative flow-encoded images per cardiac cycle. Sagittal and axial images of the cervical spinal CSF space were obtained, and target sites were analyzed for characteristic CSF flow (TR=50ms, TE=12.5-15ms). The region of interest(ROI) was 1mm 3 in volume. Twenty six persons were included in this study : 10 healthy volunteers and 16 patients with cervical myelopathy. The post-operative cine MR study were also done in five patients. Results : The normal CSF pulsation dynamics in the cervical spine showed discrete systolic and diastolic components. The CSF flow revealed a sine wave pattern, in which the systolic phase was shorter than the diastolic phase(ratio=2 : 3). The patient group revealed decreased amplitudes of the CSF flow and irregularly distored flow waves. The systolic phase was elongated in the ROI above the stenotic level, whereas the diastolic phase was lengthened below the level. In the postoperative images, the abnormal pattern and amplitude were found to be corrected. Conclusion : From these results, the authors believe that the CSF flow study provides valuable informations regarding the extent of cervical stenosis and may be useful for the surgical planning and post-operative evaluation.

• 한국임상수의학회지
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• 제36권6호
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• pp.340-344
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• 2019

A 14-month-old Thoroughbred colt with hind limbs lameness was referred to Equine Hospital of Jeju National University. During physical examination, the patient could not walk in a straight line but wobbled especially with hind limbs. He hesitated when backing and crossed hind limbs while circling tightly by protracting the outer hind limb keeping the inner hind limb stationed. Stenosis was observed between the 2nd (C2) and 3rd (C3), and the C3 and 4th (C4) cervical vertebrae on radiographs. The colt diagnosed as cervical stenotic myelopathy (CSM) based on the clinical signs and radiological findings. To confirm the diagnosis, postmortem computed tomography (CT) and histopathologic examination were performed after the euthanasia. The CT images revealed severe compression of the spinal cavity and cord between C3 and C4 cervical vertebrae. Grossly, there was compression of the spinal cord between the C3 and C4 cervical vertebrae. Histopathologically, severe axonal swelling and demyelination characterized by vacuolation and cavity formation were observed in the white matter of the spinal cord, especially in C3 and C4. CSM is problematic in the horse racing industry because of abnormal walking. This case report of CSM may offer information for diagnosis of the disease in the equine veterinary fields in the Republic of Korea.