• Journal of Korean Neurosurgical Society
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• v.64 no.2
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• pp.247-254
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• 2021

Objective : The subaxial cervical pedicle screwing technique shows powerful biomechanical properties for posterior cervical fusion. When applying a pedicle screw using the freehand technique, it is essential to analyse cervical computed tomography and plan the surgery accordingly. Normal cervical computed tomography is usually performed in the supine position, whereas during surgery, the patient lies in a prone position. This fact leads us to suppose that radiological evaluations may yield misleading results. Our study aimed to investigate whether there is any superiority between preoperative preparation on computed tomography performed in the prone position and that performed in the supine position. Methods : This study included 17 patients (132 pedicle screws) who were recently operated on with cervical vertebral computed tomography in the prone position and 17 patients (136 pedicle screws) who were operated on by conventional cervical vertebral computed tomography as the control group. The patients in both groups were compared in terms of age, gender, pathological diagnosis, screw malposition and complications. A screw malposition evaluation was made according to the Gertzbein-Robbins scale. Results : No statistically significant difference was observed between the two groups regarding age, gender and pathological diagnosis. The screw malposition rate (from 11.1% to 6.9%, p<0.05), mean malposition distance (from 2.18 mm to 1.86 mm, p <0.05), and complications statistically significantly decreased in the prone position computed tomography group. Conclusion : Preoperative surgical planning by performing cervical vertebral computed tomography in the prone position reduces screw malposition and complications. Our surgical success increased with a simple modification that can be applied by all clinicians without creating additional radiation exposure or additional costs.

• Journal of Oral Medicine and Pain
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• v.20 no.2
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• pp.361-376
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• 1995

The purpose of this study was to investigate the relationship between the head and neck postre and the cervical curvature, especially in forward head postrue(FHP). Sixty patients with craniomandibular disorders and thirty dental students without any signs and symptoms of craniomandibular disordres participated in this study as patient groups and sa control group, respectively. The author evaluated the head and neck posture of all subjects by plumb line and CROM( Cervical Ragne of Motion), and had taken cephaograph in natural head position. On the cephalograph the angle of cervical inclination formed by true horizntal plane and 4th cervical vertebra(C4) and the radius of cervical curvature from C1 to C5 were measured. A specially designed ruler was used for measuring cervical curvature. Occlusal contac number and force with T-scan system, electromygraphic activity of cervical muscles with Bio-EMG, and distance of freeway space with Bio-ECN were recorded, respectively. The collected data were processed by SAS/STAT progrm. The obtained results were as follows : 1. In subjects with longer radius which was less cervical curvature, head positioned more anteriorly than subjects with smaller radius, and they showed slightly straight cervical vertebra. 2. Between the patients and the control group, there were no differences in cervical curvature, in forward head position by plumb line and in CROM. But the patient group had a greater cervical inclination than the control group had. 3. There were positive correlation between cervical curvature and forward head position by plumbline,between forward head position y plumb line and that by CROM in patient group. The cervical inclination, however, had negative correlation with cervical curvature, and with forward head postion by plumb line, respectively. 4. In case of showing more cervical curvature and more forward head position by plumb line the head position was defined as forward head posture. In patient group, subjects without forward head posture showed greater posterior teeth contact force than subjects with forward head posture, but in control group, there were no difference between the two subjects. 5. There were higher electromyographic activity in almost all muscles and smaller freeway space in induced forward head posture than those in natural head position in subjects without forward head posture. In conclusion, head position of patients with craniomandibular disorders were not more anterior than that of normal control person, but they had tendency to head extension. From the result of this study, forward head posture could be defined as posterior rotation of upper cervical segment with a straight lower cercial segment due to loss of normal lordosis.

• Journal of International Academy of Physical Therapy Research
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• v.9 no.1
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• pp.1381-1386
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• 2018

The purpose of this study is to investigate the effect of pelvic, Lumbar spine and Cervical spine manipulation on the joint position sense in normal adults. Thirty normal adults were divided into an experimental group of 15 subjects and a control group of 15 subjects. The experimental group was treated with pelvic, Lumbar spine and Cervical spine manipulation with massage, whereas the control group received only massage. Both groups were evaluated in terms of joint position errors (JPEs) using a digital dual clinometer before and after the experiment. The comparison of the JPEs of the experimental group and the control group before and after the experiment showed that the experimental group's cervical spine results were significantly different in the flexion, left lateral flexion, and right rotation (p < .05) and lumbar spine results were significantly different in the flexion and extension (p < .05), but the control group's results were not statistically significant in all items (p > .05). The pelvic, lumbar spine and cervical spine manipulation makes an effect on the joint position sense in normal adults. The findings of this study suggest that the pelvis, lumbar spine and cervical spine manipulation improve the motor ability in people with low joint position sense.

• The Journal of Korean Academy of Orthopedic Manual Physical Therapy
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• v.16 no.2
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• pp.18-27
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• 2010

Purpose: This study is to identify the muscle fatigue and pain by various cervical positions in the VDT work. Methods: Twenty two volunteers (11 males and 11 females) participated in this study. Each subject gazes monitor in front of them for thirty minutes in the three cervical positions (neutral, 30 degree flexed, and 30 degree extended positions). Visual analogue scale (VAS) for the pain and pressure pain threshold(PPT) of the trapezius and levator scapula for the muscle fatigue were measured every fifteen minutes. Results: VASs after 15 minutes were $1.23{\pm}0.43$ in neutral, $3.0{\pm}0.93$ in flexed, and $5.27{\pm}1.03$ in extended position respectively and increased to $1.5{\pm}0.67$, $4.59{\pm}1.26$, and $7.73{\pm}0.98$ after 30 minutes. The order of magnitude of VAS was extended, flexed, and neutral position(p<0.01). PPTs in both sides of upper trapezius and levator scapula muscles were decreased at the three positions after 15 and 30 minutes respectively(p<0.01). There were no statistical differences of PPTs in neutral and flexed positions after 15 and 30 minutes(p<0.01). Extended position showed lowest PPTs in both side of upper trapezius and levator scapula muscles after 15 and 30 minutes(p<0.01). There were statistical differences of PPTs in extended position and the other two positions after 15 and 30 minutes(p<0.01). Conclusion: The cervical position that has the most influence on the cervical muscle fatigue and pain in the VDT work is extended position.

• The Journal of Korean Medicine
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• v.28 no.3 s.71
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• pp.45-56
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• 2007

Objectives : We investigated the possibility of cervical spine misalignment caused by scalenus anticus syndrome to find out how it affects cervical spine misalignments. Methods : 28 patients with scalenus anticus syndrome (sample group), along with 21 participants without neck pain (control group), who attended the Dept. of Oriental Rehabilitation Medicine, College of Oriental Medicine, Dong-guk University from the 20th of June to the 30th of November, 2006 were investigated. After researching misalignments through neutrality, flexion and extension lateral x-ray examination views, we measured the difference of each length of cervical spine misalignment. We analyzed the relationships among the neutrality lateral, flexion lateral and extension lateral positions. Results : We found with statistical significance that there were differences in length of cervical spine misalignments between the sample and control groups. Furthermore, we found that C3 and C4 vertebra bodies were shown in lateral neutrality position, only C3 vertebra body in flexion lateral position, and C2, C3, and C4 vertebra bodies in extension lateral position. Conclusions : It is considered that scalenus anticus syndrome could increase cervical spine misalignment which could be a factor in causing cervical spine disease.

• Physical Therapy Korea
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• v.18 no.4
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• pp.1-10
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• 2011

This study compared the stability of the cervical spine according to the presence of neck pain and deep neck flexor performance. Thirty subjects with neck pain, and thirty subjects without neck pain were recruited for this study. The Cranio-cervical flexion (CCF) test was applied using a pressure biofeedback unit to classify the subjects into four subgroups; no cervical pain and good deep neck flexor performance (NG group), no cervical pain and poor deep neck flexor performance (NP group), cervical pain and good deep neck flexor performance (PG group), and cervical pain and poor deep neck flexor performance (PP group). The head sway angle was measured using a three-dimensional motion analysis system. A 3-kg weight was used for external perturbation with the subject sitting in a chair in the resting and erect head positions with voluntary contraction of the deep neck flexors. A one-way analysis of variance (ANOVA) was performed with a Bonferroni post hoc test. The deep neck flexor performance differed significantly among the four groups (p<.05). The NG group had significantly greater deep neck flexor performance than NP and PP groups. The stability of the cervical spine also differed significantly among the four groups in the resting head position (p<.05). The head sway angle was significantly smaller in NG group as compared with the other groups. The PP group had the greatest head sway angle in the resting head position. However, there was no significant difference in the stability of the cervical spine among the groups in the erect head position with voluntary contraction of deep neck flexors (p=.57). The results of this study suggest that the deep neck flexor performance is important for maintaining the stability of cervical spine from external perturbation.

• Journal of Korean Neurosurgical Society
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• v.52 no.5
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• pp.459-465
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• 2012

Objective : To present the accuracy and safety of cervical pedicle screw insertion using the technique with direct exposure of the pedicle by laminoforaminotomy. Methods : We retrospectively reviewed 12 consecutive patients. A total of 104 subaxial cervical pedicle screws in 12 patients had been inserted. We also assessed the clinical and radiological outcomes and analyzed the direction and grade of pedicle perforation (grade 0: no perforation, 1: <25%, 2: 20% to 50%, 3: >50% of screw diameter) on the postoperative vascular-enhanced computed tomography scans. Grade 2 and 3 were considered as incorrect position. Results : The correct position was found in 95 screws (91.3%); grade 0-75 screws, grade 1-20 screws and the incorrect position in 9 screws (8.7%); grade 2-6 screws, grade 3-3 screws. There was no neurovascular complication related with cervical pedicle screw insertion. Conclusion : This technique (technique with direct exposure of the pedicle by laminoforaminotomy) could be considered relatively safe and easy method to insert cervical pedicle screw.

• Journal of Korean Physical Therapy Science
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• v.6 no.2
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• pp.1063-1073
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• 1999

Objective: Poor head and neck support during sleep can exacerbate the neck pain. Based on the ideal sleep posture and pillow suggested by Cyriax, we designed a new cervical pillow and compared the degree of pain reduction, quality of sleep and pillow satisfaction with a low hospital pillow and a high pillow. Method: The newly designed pillow has a built-in pressure-adjustable air bag in the cervical area and provides normal cervical lordotic curve in supine position and maintains cervical and thoracic vertebrae to form a horizontal line in side-lying position. Thiry-four patients with cervical pain used low hospital pillows for the first week of 3-week randomized crossover design study. They were subsequently randomly assigned to use each of the other two pillows for 1-week period. Outcomes were measured using Visual analog scale, Sleep questionaire, a pillow satisfaction scale. Result: Compared with other 2 types of pillow, Subjects using the newly desinged pillow showed much reduced pain intensity, increased duration of sleep and better satisfaction. Conclustion: We desinged a cervical pillow with built-in pressure adjustable air bag and it can significantly reduce pain intensity and improve quality of sleep in patients with cervical pain.

• Journal of Oral Medicine and Pain
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• v.21 no.2
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• pp.393-405
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• 1996

This study was performed to investigate the effects of changes of head posture and cervical spine shape on the mandibular resting or clenching electromyographic(EMG) activity in anterior temporalis(TA), masseter(MM), sternocleidomastoid muscle(SCM) and trapezius insertion(TI). 30 patients with Temporomandibular Disorders(TMDs) participated in this study. EMG activity($\mu$V) at rest and clenching was observed in four head postures, namely natural head posture(NHP), forward head posture(FHP), upward head posture(UHP), and downward head posture(DHP). For taking in upward or downward head posture head was inclined 10$^{\circ}$ upward or downward and CROM$^\textregistered$(cervical-range-of motion, Performance attainment Inc., USA) was used to maintain same posture during the procedure, and BioEMG$^\textregistered$ (Bioelectromyograph, Bioresearch Inc., USA) was used to record EMG activity in the above four muscles at eight locations on both sides. The recorded EMG activity($\mu\textrm{V}$) were compared and analyzed by cervical spine shape such as the head position from plum line, cervical curvature, and cervical inclination. Head position from plum line was measured in vertical plate calibrated with cm scale, comical curvature by radius was measured with adjustable curved ruler, and cervical inclination by cervical vertebrae tangent(CVT)was measured in lateral cephalograph. The results obtained were as follows : 1. Mean value of head position from plum line, cervical curvature, and cervical inclination were 4.8cm, 26.7cm, and 86.6$^{\circ}$, respectively, And There were no correlationship among these items. 2. For resting EMG activity by head posture, the value in anterior temporalis was higher at FHP than at DHP, the value in masseter was higher at FHP than at NHP, and DHP, the value in sternocleidomastoid muscle was higher at UHP than at NHP, and the value in trapezius insertion was higher at FHP and DHP than, NHP and UHP. The clenching EMG activity, however, did not show any difference by head posture. 3. Comparison of resting and clenching EMG activity between higher and lower groups by head position from plum line, cervical curvature, and cervical inclination did not show any significant difference. From this result, the author concluded that the cervical spine shape had not significantly affected to EMG activity in usual patients with TMDs.

• Journal of the Korean Society of Radiology
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• v.9 no.2
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• pp.101-107
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• 2015

In anteroposterior radiation test for cervical vertebra, it is general that the incidence angle of X-ray is $15^{\circ}$ to $20^{\circ}$ degrees to head regardless of position. So this study suggests appropriate incidence angle of cervical vertebra depended on the position. From 1 January 2013 to 31 December 2013, cervical spine radiographys and magnetic resonance imaging was performed in 107 people who visited P Hospital located in Pusan. Among them, 39 people(men 24, women 15) were below 80 above 20 years old(average age 54 years) with normal cervical lordosis(normal $40^{\circ}{\pm}5^{\circ}$). In erect position, the incidence angle of cervical vertebra is measured from lateral radiographic images. And in supine position, it measured from MRI sagittal images. Results based on gender, the incidence angle of cervical vertebra in erect position was $25.9^{\circ}$ for men, women was $23.1^{\circ}$, showed statistically significant (p<0.05). And the angle in supine was $11.6^{\circ}$ for men, women was $12.6^{\circ}$, showed not statistically significant (p>0.05) An analysis of age group shows, the incidence angle of cervical vertebra in erect position was $24.6^{\circ}$ under 50, and $25.0^{\circ}$ over 50. The angle in supine was $12.0^{\circ}$ under 50, and $11.9^{\circ}$ over 50. And all of them showed not statistically significant (p>0.05). At all ages, the average of incidence angles in erect position were $24.8^{\circ}$, and the angle in supine was $12.0^{\circ}$, showed statistically significant (p<0.05). The cervical vertebra incidence angle for X-ray was $15^{\circ}$ to $20^{\circ}$ degrees to head in general. But, through the results, it is recommended that the angle is $24.8^{\circ}$ in erect and $12.0^{\circ}$ in supine position. It could be shown true anteroposterior(AP) view of cervical vertebra and accurate intervertebral fusion fixing devices.