• Journal of International Society for Simulation Surgery
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• v.3 no.1
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• pp.28-32
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• 2016

Background Congenital muscular torticollis (CMT) is a benign condition. With early diagnosis and appropriate management, it can be cured completely, leaving no residual deformity. However, long-standing, untreated CMT can lead to permanent craniofacial deformities and asymmetry.Methods Nineteen patients presented to the author with congenital muscular torticollis. Three dimensional computed tomography (3-D CT) scans was obtained upon patient’s admission. Adjustment of skull’s position to Frankfort horizontal plan was done. Cervical vertebral segmentation was done which allowed a 3D module to be separately created for each vertebra to detect any anatomical or positional changes.Results The segmented vertebrae showed an apparent anatomical changes, which were most noticeable at the level of the atlas and axis vertebrae. These changes decreased gradually till reaching the seventh cervical vertebra, which appeared to be normal in all patients. The changes in the atlas vertebra were mostly due to its intimate relation with the skull base, while the changes of the axis were the most significantConclusion Cervical vertebral segmentation is a reliable tool for isolation and studying cervical vertebral pathological changes of each vertebra separately. The accuracy of the procedures in addition to the availability of many software that can be used for segmentation will allow many surgeons to use segmentation of the vertebrae for diagnosis and even for preoperative simulation planning.

• Journal of radiological science and technology
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• v.35 no.2
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• pp.83-92
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• 2012

In anteroposterior projection for cervical vertebra, it is general that the incidence angle of X-ray is $15^{\circ}$ to $20^{\circ}$ degrees to head in order to prevent overlap of mandible and occipital bone and to observe array of cervical interbody and shapes of joints. However, the angle is appropriate for foreigners that was determined by foreign literature review long ago, and there have been few researches of incidence angle for Koreans' body type. The purpose of in this study are to identify the incidence angle appropriate for Koreans and to present methodology. In order to measure the incidence angle, 1,044 patients who visited S Hospital located in Seosan were selected and measured of average length of cervical vertebra, OID, axis angle, and FID. The incidence angle was calculated from the applied formula by measuring average values per age groups and sex (see Formula 1 and 2). The average length of cervical vertebra was 6cm: the length was increased from teenagers to twenties but was decreased since thirties. The difference between males and females was around 1cm (p<.01). The OID was almost the same regardless of age groups and sex. As for axis angle, the slope was increased in teenagers and twenties, but was decreased since thirties. The difference between males and females was around 2 degrees (p<.01). The FID measurements were almost the same regardless of age groups and sex, and when the incidence angle was measured from these values, the teenagers were $15.9^{\circ}$, the twenties were $16.9^{\circ}$, the thirties were $16.6^{\circ}$, the forties were $16.2^{\circ}$, the fifties were $15.9^{\circ}$, and the sixties were $14.5^{\circ}$, indicating that the angle was increased from teenagers to the twenties but decreased since the thirties. While the angles of males and females were measured to be the same in the teenagers, the angle was different between males and females by $2^{\circ}$. When the incidence angle statistically analyzed with measurement of average length of cervical vertebra, OID, axis angle, and FID, all of them were shown to have correlations with the incidence angle (p<.01). Conclusively, it was shown that the incidence angle was measured differently from average length of cervical vertebra, OID, FID, and axis slope, as well as from age and sex. Therefore, it can be suggested that the anteroposterior radiation test for cervical vertebra should be conducted by different incidence angles based on age and sex. The data of this study may be used as reference in determining the incidence angle of cervical vertebra tests for the future.

• The Journal of Korean Academy of Orthopedic Manual Physical Therapy
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• v.22 no.2
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• pp.51-56
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• 2016

Background: The purpose of this study is to compare axis change during cervical flexion and extension according to lordosis angle to patients with scoliosis. Methods: Movement axis change was estimated during cervical flexion and extension in twenty-four scoliosis patients with hypolordosis using radiography. Subjects were divided into mild lordotic curve group (MLCG, n=12, $34{\sim}25^{\circ}$) and severe lordotic curve group (SLCG, n=12, less $25^{\circ}$) according to cervical lordosis angle. Results: During cervical flexion, both group showed movement axis change to upper part of cervical vertebra and SLCG showed greater than MLCG but there is no significant difference. During cervical extension, SLCG showed greater than MLCG and there is significant difference. Conclusion: It is considered that cervical hypolordosis acts as important factor to scoliosis and degenerative joint disease because it leads to change of movement axis and central route of joint.

• Journal of International Society for Simulation Surgery
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• v.2 no.2
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• pp.67-70
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• 2015

We propose an automatic vessel segmentation method of vertebral arteries in CT angiography using combined circular and cylindrical model fitting. First, to generate multi-segmented volumes, whole volume is automatically divided into four segments by anatomical properties of bone structures along z-axis of head and neck. To define an optimal volume circumscribing vertebral arteries, anterior-posterior bounding and side boundaries are defined as initial extracted vessel region. Second, the initial vessel candidates are tracked using circular model fitting. Since boundaries of the vertebral arteries are ambiguous in case the arteries pass through the transverse foramen in the cervical vertebra, the circle model is extended along z-axis to cylinder model for considering additional vessel information of neighboring slices. Finally, the boundaries of the vertebral arteries are detected using graph-cut optimization. From the experiments, the proposed method provides accurate results without bone artifacts and eroded vessels in the cervical vertebra.

• Journal of Oral Medicine and Pain
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• v.21 no.1
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• pp.197-206
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• 1996

This study ws performed to investigate the relationship between cervical curvature and the spatial position of the posterior part of the atlas imaged in the lateral cephalograph. Sixty six patients with temporomandibular disorders(TMD) and twenty dental students were selected for patients group and control group, respectively. The average age of patients group was 26.3 years, and 24.9 years in control group. Measured variables were cervical depth, upper space between the atlas and the base of the occiput, lower space between the atlas and the spinous process of the axis, rea of the posterior part of the atlas imaged in the lateral cephalograph, and the cervical curvature passing through the uppermost point in dorsal side of Dens of the Axis to the lowermost and rearmost point of the 5th cervical vertebra. The reliability of the method used for measuring cervical curvature with curved ruler was also tested. The results obtained were as follows : 1. Cervical depth of patients group was 122.9mm and significantly shorter than that of control group, in which cervical depth was 131.9mm, and cervical depth was significantly correlated with other variables in all subjects. 2. Upper space was greater in patients group, but total space including upper and lower space showed no difference between the two groups. The average value of total space was 26.5mm. 3. Area of the posterior part of the atlas was 168.2$\textrm{mm}^2$ in patients group, and 186.5$\textrm{mm}^2$ in control group with significant difference between the two groups. 4. Average range of radius of cervical curvature were 33-40cm and there was no difference between the two groups. 5. There was no significant correlation between the cervical curvature and the area of the posterior arch of the atlas. 6. The method using curved ruler for measuring cervical curvature could be accepted as a reliable method.

• Journal of Oral Medicine and Pain
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• v.23 no.4
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• pp.457-473
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• 1998

This study was performed to investigate the morophological and positional correlation between the upper cervical vertebra, the oral structures and the pharyngeal tissues, and the correlation of these anatomical structures with dental features, such as teeth wear area nad tooth contact status, etc. Seventy patients with temporamandibular disorders and sixty three dental students without any signs and symptoms in head and neck region were selected for this study. All they had natural dentition without any fixed and removable protheses. Teeth wear area and arch width wre measured from the upper dental cast, tooth contact status were observed by T-Scan system$^\textregistered$ and four cephaloradiograpohs were taken from four head postures, namely, natural(NHP), forward(FHP), upward(UHP), and downward head postiure(DHP). 22 cephalometric items were measured on the films and the data were processed with SAS statistical program. The result of this study were as follows : 1. In normal group, angle of cervical vertebra tangent and of between hard and soft palate were broader in female subjects than those in male subjacets, but distance from subocciput to axis, size of soft palate, and pharyngeal space width were larger in male subjects. 2. In normal group with natural head posture, the items correlated each others from the three anatomical regions were distance between first nad second vertebra in posterior part, distance from the lingual surface of lower anterior teeth to anterior surface of soft palate, and distance from the hyoid bone to third vertebra. 3. Three set of items showed significant correlation each other in the four head postures in normal group. First set was the angle between hard and soft palate and the idstance from subocciput to posterior arch of first vertebra, second set was the distance between first and second vertebra in posterior part and the teeth wear area, third set was number and force of tooth contact and length of soft palate and distance from anterior tip of hyoid bone to mandibular plane.

• Korean Journal of Veterinary Service
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• v.46 no.1
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• pp.87-92
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• 2023

A 7-year-old dog weighing 3.9 kg visited the hospital with symptoms of inability to stand and quadriparesis. There were seizure symptoms 2 months before admission to the hospital, and the symptoms of stiffness and rigidity appeared. Radiographs showed normal vertebrae in cervical vertebral column. Magnetic resonance imaging (MRI) and computed tomography (CT) were performed immediately to diagnose vertebral lameness. As a result of the CT, it was possible to observe the fracture of the odontoid process of the axis, and the exact location of the damage was identified. The odontoid process was fractured and separated from the body of the 2^nd cervical vertebra (axis), and fragment of the process was observed inside the vertebral arch of the first cervical vertebra (atlas), and the body of the axis was lifted to the dorsal side. The MRI examination reflected the CT findings and confirmed severe spinal cord compression due to the fracture of the odontoid process. The patient was applied by neck brace and medical management including Mycophenolate mofetil administration was performed. The patient was able to move legs and tail after 2 weeks, and was able to voluntarily defecate, urinate and stand up after 4 weeks of administration.

• Journal of Korean Neurosurgical Society
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• v.67 no.1
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• pp.6-13
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• 2024

The integrity of the high cervical spine, the transition zone from the brainstem to the spinal cord, is crucial for survival and daily life. The region protects the enclosed neurovascular structure and allows a substantial portion of the head motion. Injuries of the high cervical spine are frequent, and the fractures of the C2 vertebra account for approximately 17-25% of acute cervical fractures. We review the two major types of C2 vertebral fractures, odontoid fracture and Hangman's fracture. For both types of fractures, favorable outcomes could be obtained if the delicately selected conservative treatment is performed. In odontoid fractures, as the most common fracture on the C2 vertebrae, anterior screw fixation is considered first for type II fractures, and C1-2 fusion is suggested when nonunion is a concern or occurs. Hangman's fractures are the second most common fracture. Many stable extension type I and II fractures can be treated with external immobilization, whereas the predominant flexion type IIA and III fractures require surgical stabilization. No result proves that either anterior or posterior surgery is superior, and the surgeon should decide on the surgical method after careful consideration according to each clinical situation. This review will briefly describe the basic principles and current treatment concepts of C2 fractures.

• Journal of Korean Neurosurgical Society
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• v.65 no.1
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• pp.96-106
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• 2022

Objective : The most common complication of anterior cervical discectomy and fusion (ACDF) is cage subsidence and maintenance of disc height affects postoperative clinical outcomes. We considered cage subsidence as an inappropriate indicator for evaluating preservation of disc height. Thus, this study aimed to consider patients with complications such as reduced total disc height compared to that before surgery and evaluate the relevance of several factors before ACDF. Methods : We retrospectively reviewed the medical records of 40 patients who underwent stand-alone single-level ACDF using a polyetheretherketone (PEEK) cage at our institution between January 2012 and December 2018. Our study population comprised 19 male and 21 female patients aged 24-70 years. The minimum follow-up period was 1 year. Twenty-seven patients had preoperative bone mineral density (BMD) data on dual-energy X-ray absorptiometry. Clinical parameters included sex, age, body mass index, smoking history, and prior medical history. Radiologic parameters included the C2-7 cobb angle, segmental angle, sagittal vertical axis, disc height, and total intervertebral height (TIH) at the preoperative and postoperative periods. Cage decrement was defined as the reduction in TIH at the 6-month follow-up compared to preoperative TIH. To evaluate the bone quality, Hounsfield unit (HU) value was calculated in the axial and sagittal images of conventional computed tomography. Results : Lumbar BMD values and cervical HU values were significantly correlated (r=0.733, p<0.001). We divided the patients into two groups based on cage decrement, and 47.5% of the total patients were regarded as cage decrement. There were statistically significant differences in the parameters of measuring the HU value of the vertebra and intraoperative distraction between the two groups. Using these identified factors, we performed a receiver operating characteristic (ROC) curve analysis. Based on the ROC curve, the cut-off point was 530 at the HU value of the upper cortical and cancellous vertebrae (p=0.014; area under the curve [AUC], 0.727; sensitivity, 94.7%; specificity, 42.9%) and 22.41 at intraoperative distraction (p=0.017; AUC, 0.722; sensitivity, 85.7%; specificity, 57.9%). Using this value, we converted these parameters into a bifurcated variable and assessed the multinomial regression analysis to evaluate the risk factors for cage decrement in ACDF. Intraoperative distraction and HU value of the upper vertebral body were independent factors of postoperative subsidence. Conclusion : Insufficient intraoperative distraction and low HU value showed a strong relationship with postoperative intervertebral height reduction following single stand-alone PEEK cage ACDF.

• Journal of Veterinary Clinics
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• v.30 no.6
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• pp.499-502
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• 2013

An eight-year-old, castrated male, Poodle dog was presented with a bite wound in the neck region. Clinical examination revealed non-ambulatory signs of tetraparesis with deep pain, and upper motor neuron changes in all limbs. Fractures of the transverse process of C1 and the dorsal spinous process of C2 were observed on the radiographs and the computed tomography (CT). Conservative therapy was performed for 1 week. However the neurological problems were not alleviated until 7 days after injury. The owners agreed to perform surgical stabilization. The surgical stabilization was performed 7 days after presentation. Ventral stabilization was performed with screws, K-wires and bone cement. The dog stood up independently after 4 weeks and was able to walk 6 weeks postoperatively. In this report we suggest that using combined stabilization techniques are effective for this type of cervical fracture in which the dorsal and ventral structures of the vertebra are severely disrupted.