• Journal of Korean Neurosurgical Society
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• v.42 no.3
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• pp.168-172
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• 2007

Objective : Hirabayashi's open-door laminoplasty is a good procedure to use to treat patients with myelopathy of the cervical spine; however, the authors have experienced problems in maintaining an open-window in cervical spines after the surgery. The authors developed a modified method of the expanded open-door laminoplasty and compared the radiological and clinical results with those of the classical method. Methods : In the modified method, wiring fixation with lateral mass screws on the contra lateral-side instead of fixing the paraspinal muscle or facet joint, as in the classical methods, was used in the open window of the cervical spine. Fifteen patients with cervical myelopathy were treated using the classical method and 12 patients were treated using the modified method. Preoperative and postoperative clinical conditions were assessed according to the Japanese Orthopedic Association (JOA) score. The radiological results were compared with the preoperative and postoperative computed tomography (CT) findings. Results : In both methods, the clinical results revealed a significant improvement in neurological function (p<0.001). Image analysis revealed that the cervical canals were continuously expanded in patients treated using the modified methods. However, authors have observed restenosis during the follow-up periods in 4 patients treated using the original method. Progression to deformity and spinal instability were not observed in any of the patients in the radiological results. Conclusion : Although analysis with a larger population and a longer follow-up period needs to be undertaken, our modified open-door laminoplasty has shown an advantage in better maintaining an open window in comparison with the Hirabayashi's open-door laminoplasty.

• Journal of Korean Neurosurgical Society
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• v.55 no.5
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• pp.284-288
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• 2014

A rare case of atlantoaxial rotatory subluxation occurred after pediatric cervical spine surgery performed to remove a dumbbell-shaped meningioma at the level of the C1/C2 vertebrae. This case is classified as a post-surgical atlantoaxial rotatory subluxation, but has a very rare morphology that has not previously been reported. Although there are several reports about post-surgical atlantoaxial rotatory subluxation, an important point of this case is that it might be directly related to the spinal cord surgery in C1/C2 level. On day 6 after surgery, the patient presented with the Cock Robin position, and a computed tomography scan revealed a normal type of atlantoaxial rotatory subluxation. Manual reduction was performed followed by external fixation with a neck collar. About 7 months after the first surgery, the subluxation became severe, irreducible, and assumed an atypical form where the anterior tubercle of C1 migrated to a cranial position, and the posterior tubercle of C1 and the occipital bone leaned in a caudal direction. The pathogenic process suggested deformity of the occipital condyle and bilateral C2 superior facets with atlantooccipital subluxation. A second operation for reduction and fixation was performed, and the subluxation was stabilized by posterior fixation. We encountered an unusual case of a refractory subluxation that was associated with an atypical deformity of the upper spine. The case was successfully managed by posterior fixation.

• Journal of Korean Neurosurgical Society
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• v.56 no.2
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• pp.108-113
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• 2014

Objective : Ankylosing spondylitis is an inflammatory rheumatic disease mainly affecting the axial skeleton. The rigid spine may secondarily develop osteoporosis, further increasing the risk of spinal fracture. In this study, we reviewed fractures in patients with ankylosing spondylitis that had been clinically diagnosed to better define the mechanism of injury, associated neurological deficit, predisposing factors, and management strategies. Methods : Between January 2003 and December 2013, 12 patients with 13 fractures with neurological complications were treated. Neuroimaging evaluation was obtained in all patients by using plain radiography, CT scan, and MR imaging. The ASIA Impairment Scale was used in order to evaluate the neurologic status of the patients. Management was based on the presence or absence of spinal instability. Results : A total of 9 cervical and 4 thoracolumbar fractures were identified in a review of patients in whom ankylosing spondylitis had been diagnosed. Of these, 7 fractures were associated with a hyperextension mechanism. 10 cases resulted in a fracture by minor trauma. Posttraumatic neurological deficits were demonstrated in 11 cases and neurological improvement after surgery was observed in 5 of these cases. Conclusions : Patients with ankylosing spondylitis are highly susceptible to spinal fracture and spinal cord injury even after only mild trauma. Initial CT or MR imaging of the whole spine is recommended even if the patient's symptoms are mild. The patient should also have early surgical stabilization to correct spinal deformity and avoid worsening of the patient's neurological status.

• Journal of Korean Neurosurgical Society
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• v.53 no.6
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• pp.356-369
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• 2013

Objective : We performed a retrospective analysis of medical records and radiographic images of patients who never underwent spinal treatment including diagnosis. The objective of this study is to explain the biomechanical and physiologic characteristics of cervical alignment related to thoracic inlet angle including T1 slope changes in each individual. Methods : We reviewed the cervical CT radiographs of 80 patients who visited ENT outpatient clinic without any symptom, diagnosis and treatment of cervical spine from January 2011 to September 2012. All targeted people were randomized without any prejudice. We assessed the data-T1 slope, Cobb's angle C2-7, neck tilt, sagittal vertical axis (SVA) C2-7 and thoracic inlet angle by the CT radiographs. Results : The relationships between each value were analyzed and we concluded that Cobb's angle C2-7 gets higher as the T1 slope gets higher, while the SVA C2-7 value decreases. Conclusion : We propose that the T1 slope is background information in deciding how much angle can be made in the cervical spinal angle of surgical lordotic curvature, especially severe cervical deformity.

• Journal of Korean Neurosurgical Society
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• v.29 no.1
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• pp.58-65
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• 2000

Objective : Thoracolumbar junction is second most common level of injury next to cervical spine. The object of this study is to study the usefulness of surgical titanium mesh instead of bone graft, as well as to evaluate the correction of spinal deformity and safety of early ambulation in patients with injury at thoracolumbar junction. Patients and Methods : This review included 51 patients who were operated from July 1994 to December 1997. The injured spine is considered to be unstable, if it shows involvement of two or more columns, translatory displacement more than 3.5mm, decrease more than 35% in height of vertebral body and progression of malalignment in serial X-ray. The decision to operate was determined by (1) compression of spinal cord or cauda eguina, (2) unstable fracture, (3) malalignment and (4) fracture dislocation. The procedure consisted of anterior decompression through corpectomy and internal fixation with anterior instrument and surgical titanium mesh which was impacted with gathered bone chip from corpectomy. Results : Fifty-one patients were followed up for at least 12 months. The main causes of injury were fall and vehicle accident. The twelfth thoracic and the first and the second lumbar vertebrae were frequently involved. Complete neural decompression was possible under direct vision in all cases. Kyphotic angulation occurred in a patient. Radiologic evaluation showed correction of deformity and no distortion or loosening of surgical titanium mesh with satisfactory fixation postoperatively. Conclusions : We could obtain neurological improvement, relief of pain, immediate stabilization and early return to normal activities postoperatively. Based on these results, authors recommend anterior decompression and internal fixation with surgical titanium mesh in thoracolumbar unstable spine injuries.

• Journal of Korean Neurosurgical Society
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• v.38 no.6
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• pp.435-441
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• 2005

Objective : Expandable cage used for spinal reconstruction after corpectomy has several advantages over nonexpendable cages. Here we present our clinical experience with the use of this cage after anterior column corpectomy with an average of one year follow up. Methods : Ten patients underwent expandable cage reconstruction of the anterior column after single-level or multilevel corpectomy for various cervical spinal disorders. Anterior plating with or without additional posterior instrumentation were performed in all patients. Functional outcomes, complications, and radiographic outcomes were determined. Results : There was no cage-related complication. Functionally, neurological examination revealed improvement in 7 of 10 patients and no patient had neurological deterioration after the surgery. Immediate stability was achieved and maintained throughout the period of follow-up. There was minimal subsidence [<2mm] noticeable in three of the cases that underwent a two-level corpectomy. Subsidence was noted in osteoporotic patients and patients undergoing multi-level corpectomies. Average pre-operative kyphotic angle was 9 degrees. This was corrected to an average of 5.4 degrees in lordosis postoperatively. Conclusion : In conclusion, expandable cages are safe and effective devices for vertebral body replacement after cervical corpectomy when used in combination with anterior plating with or without additional posterior stabilization. The advantages of using expandable cages include its ability to easily accommodate itself into the corpectomy defect, its ability to tightly purchase into the end plates after expansion and thus minimizing the potential for migration, and finally, its ability to correct kyphosis deformity via its in vivo expansion properties.

• Journal of Korean Neurosurgical Society
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• v.51 no.3
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• pp.177-181
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• 2012

We present a case of an athetoid cerebral palsy with quadriparesis caused by kyphotic deformity of the cervical spine, severe spinal stenosis at the cervicomedullary junction, and atlantoaxial instability. The patient improved after the first surgery, which included a C1 total laminectomy and C-arm guided righ side unilateral C1-2 transarticular screw fixation. C1-2 fixation was not performed on the other side because of an aberrant and dominant vertebral artery (VA). Eight months after the first operation, the patient required revision surgery for persistent neck pain and screw malposition. We used intraoperative VA angiography with simultaneous fluoroscopy for precise image guidance during bilateral C1-2 transarticular screw fixation. Intraoperative VA angiography allowed the accurate insertion of screws, and can therefore be used to avoid VA injury during C1-2 transarticular screw fixation in comorbid patients with atlantoaxial deformities.

• Journal of Fashion Business
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• v.27 no.4
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• pp.125-140
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• 2023

This study aimed to develop a smart wearable device for assessing the risk angle associated with turtle neck syndrome in patients with Video Display Terminal (VDT) syndrome. Turtle neck syndrome, characterized by forward head posture resulting from upper cross syndrome, leads to thoracic kyphosis. In this research, a stretch sensor was used to monitor the progression of turtle neck syndrome, and the sensor data was analyzed using a Universal Testing Machine (UTM) and the Gauge Factor (GF) calculation method. The scapula and cervical spine angles were measured at five stages, with 15-degree increments from 0° to 60°. During the experimental process, the stretch sensor was attached to the thoracic spine in three different lengths: 30mm, 50mm, and 100mm. Among these, the attachment method yielding the most reliable data was determined by measuring with three techniques (General Trim Adhesive, PU film, and Heat Transfer Machine), and clothing using the heat transfer machine was selected. The experimental results confirmed that the most significant change in thoracic kyphosis occurred at approximately 30° of forward head posture. Prolonged deformity can lead to various issues, highlighting the need for textile sensor solutions. The developed wearable device aims to provide users with real-time feedback on their turtle neck posture and incorporate features that can help prevent or improve the condition.

• Journal of the Korean Orthopaedic Association
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• v.52 no.1
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• pp.73-82
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• 2017

Purpose: To assess the chronological changes of disease-related kyphosis after chemotherapy alone. Materials and Methods: A total of 101 children aged 2 to 15 years with spinal tuberculosis, accompanied by various stages of disease processes were enrolled for analysis. By utilizing the images in them, the growth plate condition and chronological changes of kyphosis after chemotherapy were analyzed at two points in time; the first assessment was at post-chemotherapy one-year and second at the final discharge. Results: Complete disc destruction in the cervical, dorsal and lumbosacral spines was observed in 2 out of 40 children (5.0%), 8 out of 30 children (26.7%), and 6 out of 31 children (19.4%), respectively. In those cases, the residual kyphosis inevitably developed. In the remaining children, the discs were intact or partially damaged. Among the 101 children kyphotic deformity was maintained without change in 20 children (19.8%). Kyphosis decreased in 14 children (13.9%), while it increased in 67 children (66.3%) with non-recoverably damaged growth plate. Conclusion: Although it is tentatively possible to predict the deformity progress or non-progress and spontaneous correction at the time of the initial treatment, its predictive accuracy is low. Therefore, assessment of the chronological changes should be performed at the end of chemotherapy. In children with progressive curve change, assessment of deformity should be continued until maturity.

• Journal of Interdisciplinary Genomics
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• v.1 no.2
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• pp.19-22
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• 2019

CATCH 22 syndrome is rare genetic disease that has various manifestations. Cervical vertebral anomaly, such as Klippel-Feil anomaly, is frequently observed in the patients with CATCH22 syndrome. We present the case of an 11-year-old female patient with CATCH22 syndrome and Klippel-Feil anomaly who had been treated torticollis using the customized soft neck collar. During the patient's first visit to our clinic, she presented with low ear set, skull deformity, intellectual disability, and tilting of the head to the left by approximately 25 degrees. Imaging studies revealed multisegmental fusion and C3 hemivertebrae of the cervical spine and left thoracic scoliosis at T4 with 50 degrees of Cobb's angle. We instructed passive stretching and applied the customized soft neck collar we invented. The ipsilateral aspect of the neck collar is designed to provide vertical support between the clavicle and mandibular angle and is adjustable in height. The Velcro was attached to the neck collar at the point of contact with the ipsilesional mandibular angle, which provides negative sensory feedback, inducing her to tilt neck to the contralesional side. We applied the neck collar for 2 hours a day. After 1 year of treatment, her neck inclination angle improved from 25 to 10 degrees. Providing negative sensory feedback using the customized soft neck collar can be one of the treatment options of postural management in patients with torticollis in cases of CATCH 22 syndrome combined with Klippel-Feil anomaly.