• The Korean Journal of Pain
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• 제20권2호
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• pp.116-122
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• 2007

Background: Lumbar zygapophysial joints are a common source of chronic lower back pain and radiofrequency thermocoagulation (RF) of the medial branches (MB) has been shown to be effective at providing substantial pain relief for chronic low back pain. Therefore, we carried out this study to determine the short term outcomes and prognostic factors of RF on the MB of patients with lumbar facet syndrome. Methods: We performed RF in fourteen patients who showed greater than 80% pain relief up to three times after a diagnostic MB block was conducted using 0.3 ml of 0.5% bupivacaine. Using 10 cm curved electrodes with 10-mm active tip, a 60 second, $80^{\circ}C$ lesion was made after electrical stimulation at 50 Hz for sensory and 2 Hz for motor nerve testing. The degree of pain relief was then assessed after 2 weeks, and again after 3 months using a visual analog scale (VAS) and a four point Likert scale. The outcome was regarded as 'success' if at least a 50% reduction in the VAS was observed. Possible prognostic factors between the two groups were also evaluated Results: The success rate was 71.4% (10/14) after three months of follow-up. However, there were transient complications, such as neuritis like syndrome, in 4 patients. In addition, short symptom duration and low minimal voltage (< 0.4 V) for sensory stimulation were shown to be the relevant prognostic factors for a successful outcome. Conclusions: RF may be an alternative to repeated MB block or intraarticular injection for palliation of lumbar facet syndrome. For better outcomes, early diagnosis and strict patient selection should be coupled with efforts to avoid anatomically incorrect RF.

• 대한기계학회논문집A
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• 제29권6호
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• pp.913-920
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• 2005

Compared to previous in-vitro test, FE model showed reliable motion patterns. A finite element model of a 50th percentile male neck was developed to study the mechanics of whiplash injury while the rear impacts. The model was consisted of the whole cervical vertebrae including part of occipital, intervertebral discs. which were modeled using linear viscoelastic materials and posterior elements. The sliding interfaces were defined to simulate contact phenomena in facet joints and in odontoid process. All ligaments and atlanto-occipital membrane were modeled as nonlinear bar elements. Only muscle elements were not considered. Motion of each cervical vertebra was obtained from the dynamic simulation with a MADYMO model for 15 km/h $40\%$ rear end offset impacts. Soft tissue neck injury(STNI) was investigated with a developed FE model. In FE model analysis, the high stress was appeared at C3/C4 disc in offset impact. Further research is still needed in order to improve the developed neck FE model for many different crash patterns.

• Journal of Korean Neurosurgical Society
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• 제56권1호
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• pp.55-57
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• 2014

Synovial cysts of the cervical spine, although they occur infrequently, may cause acute radiculopathy or myelopathy. Here, we report a case of a cervical synovial cyst presenting as acute myelopathy after manual stretching. A 68-year-old man presented with gait disturbance, decreased touch senses, and increased sensitivity to pain below T12 level. These symptoms developed after manual stretching 3 days prior. Computed tomography scanning and magnetic resonance imaging revealed a 1-cm, small multilocular cystic lesion in the spinal canal with cord compression at the C7-T1 level. We performed a left partial laminectomy of C7 and T1 using a posterior approach and completely removed the cystic mass. Histological examination of the resected mass revealed fibrous tissue fragments with amorphous materials and granulation tissue compatible with a synovial cyst. The patient's symptoms resolved after surgery. We describe a case of acute myelopathy caused by a cervical synovial cyst that was treated by surgical excision. Although cervical synovial cysts are often associated with degenerative facet joints, clinicians should be aware of the possibility that these cysts can cause acute neurologic symptoms.

• 한국정밀공학회지
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• 제27권2호
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• pp.137-144
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• 2010

In general, spinal fusion surgery takes pressure off the pain induced nerves, by restoring the alignment of the spine. Therefore spinal fixation system is used to maintain the alignment of spine. In this study, a biomechanical study was performed comparing the SROM(Spinal Range Of Motion) of three types of system such as Rigid, Dynesys, and Fused system to analyze the behavior of spinal fixation system inserted in vertebra. Dynesys system, a flexible posterior stabilization system that provides an alternative to fusion, is designed to preserve inter-segmental kinematics and alleviate loading at the facet joints. In this study, SROM of inter-vertebra with spinal fixation system installed in the virtual vertebra from L4 to S1 is estimated. To compare with spinal fixation system, a simulation was performed by BRG. LifeMOD 2005.5.0 was used to create the human virtual model of spinal fixation system. Through this, each SROM of flexion, extension, lateral bending, and axial rotation of human virtual model was measured. The result demonstrates that the movement of Dynesys system was similar to normal condition through allowing the movement of lumbar.

• Journal of Korean Neurosurgical Society
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• 제29권11호
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• pp.1456-1460
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• 2000

Objectives : Transpedicular screw fixation has become an important method for internal fixation in variety of disorders. However, acceleration of degeneration at the adjacent segment in any follow. The goal of this study is to review the change of motion ranges of vertebral joints adjacent to fused level in lumbar spine. Methods : This study consists of 22 patients with degenerative spinal instability. Treatment of spinal instability includes posterior fusion with transpedicular screw fixation or transpedicular screw fixation with posterior lumbar interbody fusion. The flexion-extension angle(FEA) was measured from dynamic views of lumbar spine taken both at preoperative and post operative period. Results : The FEA of upper vertebral joint adjacent(FEA-u) to a fused L4-5 level was increased(p＝0.010). The FEA-u was increased in case of L5-S1 fusion(p＝0.025). The change of FEA-u in case of L5-S1 fusion was greater than that in L4-5 fusion(p＝0.013). Conclusion : After L4-5 fusion, there seems to be more meaningful increase in FEA of L3-4 than that of L5-S1. The reason may be due to the damage of L3-4 facet joints during the operation, the other possible explanation may be the anatomical stability of L5-S1 vertebral joint. The change of FEA-u of L5-S1 fusion is increased more than that of L4-5 fusion. Because there are compensations in the adjacent vertebrae both above and below the fused L4-5, the compensatory motion in FEA-u of L5-S1 fusion was greater than that of the L4-5 fusion.

• 대한핵의학회지
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• 제36권4호
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• pp.255-260
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• 2002

목적: SAPHO 증후군은 전흉벽의 골관절에 주로 위치하는 혈청학적 검사상 음성을 보이면서 다양한 피부증상을 동반하는 골관절 질환으로 질병의 특성에 대한 폭넓은 이해를 통하여 조기진단을 함으로써 불필요한 수술이나 장기간의 비효율적인 항생제 치료를 피하는 것이 임상적으로 중요점이라 할 수가 있겠다. 이에 저자들은 SAPHO 증후군으로 진단받은 환자에서 골신티그라피의 소견의 특징을 알아보고 유용성을 알아보고자 하였다. 대상 및 방법: 다발성 관절통과 반복적으로 재발되는 피부증상이 있어 임상적으로 SAPHO 증후군으로 진단 받은 5명의 환자(모두 남자, $22.8{\pm}4.75$세)를 대상으로 하였다. 모든 환자에서 저에너지 고해상도 조준기가 장착된 이중헤드 감마카메라(ECAM, Siemens, Germany)를 이용하여 전신영상을 얻었고, 2명의 환자에서는 척추 관절의 이상 유무를 확인하기 위하여 SPECT 영상을 얻었다. 골신티그라피상 섭취증가를 보이는 관절을 알아보고 호발빈도와 단순 X선과 관절 침범 유무를 진단하는 성능을 비교하였다. 결과: 골신티그라피상 모든 환자에서 이상소견을 보인 관절은 흉쇄골 관절, 천장골 관절, 수부의 소관절이었다. 흉쇄골 관절이상은 양측성이 3/5 (60%)이고 일측성이 2/5 (40%)로 관찰되었다. 천장골 관절에서는 양측성이 4/5 (80%) 이고 일측성이 1/5 (20%)로 관찰되었다. 척추 관절의 이상은 4/5 (80%)에서 관찰되었는데 이 가운데 요추 이상은 4명 모두에서 볼수가 있었고 흉추의 이상은 3명, 경추의 이상은 1명에서 보여 척추에서는 요추의 침범이 가장 많았다. 척추골 SPECT는 2명에서 시행되었는데 추체나 척추경 보다는 후관절에 이상을 초래함을 평면영상에 비하여 보다 상세히 알 수가 있었다. 결론: SAPHO 증후군은 피부증상과 함께 다양한 골관절을 침범하는 질환으로 골신티그라피를 시행함으로써 관절의 이상을 조기에 진단하여 불필요한 수술이나 장기간의 비효율적인 항생제 치료를 피하는데 도움이 될 것으로 사료된다.

• 대한족부족관절학회지
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• 제16권2호
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• pp.116-122
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• 2012

Purpose: Subtalar arthrodesis has been the gold standard for the painful subtalar joint disorders. Successful subtalar arthrodesis requires fusion of the 3 facet joints. The purpose of the study is to compare the clinical outcome of the posterior fixation (P2) and anterior-posterior (A1P1) fixation technique for subtalar arthrodesis which enhance anterior and middle facet fixation. Materials and Methods: The study is based on the 20 feet (19 patients) of the subtalar arthrodesis utilizing cannulated screws from September 2006 to September 2009 with at least 1-year follow-up. Two fixation techniques were utilized for the subtalar arthrodesis: 1) posterior fixation only (P2, 7 feet, 35%) and 2) anterior-posterior (A1P1) fixation method (13 feet, 65%). Visual Analog Scale Pain (VAS) score, American Orthopaedic Foot and Ankle Society (AOFAS) ankle-hindfoot score (maximum: 94 points), the time for returning to daily living and the patient satisfaction were also evaluated. Results: Average follow-up period were 13.2 months (12-3 mo). The AOFAS score improved from preoperative average 45 (0-68) to 81.6 (62-94), while VAS score was decreased from average 8.0 (3-10) to 1.8 (0-5) at final follow-up. Ninety-five percent of the patients were satisfied with surgery. All the patients returned to daily living at average 7.2 months (2-15 mo) post-surgery. Radiographically, 2 techniques both showed 100% fusion of the posterior compartment of the subtalar joint. Postoperative complications were 1 case of low grade infection and 1 case of sural nerve neuralgia. Conclusion: The subtalar arthrodesis using A1P1 fixation technique showed better fusion rate of the anterior compartment of the subtalar joint compared to P2 fixation technique although the 2 techniques both showed similar favorable clinical outcome. Therefore the A1P1 fixation technique is found to be a viable option to address chronic painful subtalar joint disorders to enhance the anterior compartment fixation.

• 대한의용생체공학회:의공학회지
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• 제28권3호
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• pp.397-409
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• 2007

Owing to needs of biomechanical comprehension and analysis to obtain various medical treatment designs which are related with the spine in order to cure and diagnose LBP patients, the FE modeling and nonlinear analysis of lumbosacrum including a partial ilium and iliolumbar ligaments, were carried out. First, we investigated whether the geometrical configuration of vertebrae displayed by DICOM slice files is regular and normal condition. After constructing spinal vertebrae including a partial ilium, a sacrum and five lumbars (from L1 to L5)with anatomical shape reconstructed using softwares such as image modeler and CAD modeler, we added iliolumbar ligaments, lumbar ligaments, discs and facet joints, etc.. And also, we assigned material property and discretized the model using proper finite element types, thus it was completely modeled through the above procedure. For the verification of each segment, average sagittal ROM, average coronal ROM and average transversal ROM under various loading conditions(${\pm}10Nm$), average vertical displacement under compression(400N), ALL(Anterior Longitudinal Ligament) and PLL(Posterior Longitudinal Ligament) force at L12 level, strains of seven ligaments on sagittal plane at L45 level and maximal strain of disc fibers according to various loading conditions at L45 level, etc., they were compared with experimental results. For the verification of multilevel-lumbosacrum spine including partial ilium and iliolumbar ligaments, the cases with and without iliolumbar ligaments were compared with ROM of experiment. The results were obtained from analysis of the verified FE model as follows: I) Iliolumbar ligaments played a stabilizing role as mainly posterior iliolumbar ligaments under flexion and as both posterior and anterior iliolumbar ligaments of one side under lateral bending. 2) The iliolumbar ligaments decreased total ROM of 1-8% in total model according to various motion conditions, which changed facet contact forces of L5S level by approximately 0.8-1.4 times and disc forces of L5S level by approximately 0.8-1.5 times more than casewithout ilioligaments, under various loading conditions. 3) The force of lower discs such as L45 and L5S was bigger than upper discs under flexion, left and right bending and left and right twisting, except extension. 4) It was predicted that strains of posterior ligaments among iliolumbar ligaments would produce the maximum 16% under flexion and the maximum 10% under twisting. 5) It's expected that this present model applies to the development and design of artificial disc, since it was comparatively in agreement with the experimental datum.

• Journal of Korean Neurosurgical Society
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• 제58권5호
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• pp.412-418
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• 2015

Objective : To investigate the effects of posterior implant rigidity on spinal kinematics at adjacent levels by utilizing a cadaveric spine model with simulated physiological loading. Methods : Five human lumbar spinal specimens (L3 to S1) were obtained and checked for abnormalities. The fresh specimens were stripped of muscle tissue, with care taken to preserve the spinal ligaments and facet joints. Pedicle screws were implanted in the L4 and L5 vertebrae of each specimen. Specimens were tested under 0 N and 400 N axial loading. Five different posterior rods of various elastic moduli (intact, rubber, low-density polyethylene, aluminum, and titanium) were tested. Segmental range of motion (ROM), center of rotation (COR) and intervertebral disc pressure were investigated. Results : As the rigidity of the posterior rods increased, both the segmental ROM and disc pressure at L4-5 decreased, while those values increased at adjacent levels. Implant stiffness saturation was evident, as the ROM and disc pressure were only marginally increased beyond an implant stiffness of aluminum. Since the disc pressures of adjacent levels were increased by the axial loading, it was shown that the rigidity of the implants influenced the load sharing between the implant and the spinal column. The segmental CORs at the adjacent disc levels translated anteriorly and inferiorly as rigidity of the device increased. Conclusion : These biomechanical findings indicate that the rigidity of the dynamic stabilization implant and physiological loading play significant roles on spinal kinematics at adjacent disc levels, and will aid in further device development.

• 척추신경추나의학회지
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• 제2권1호
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• pp.99-114
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• 2007

Objectives : The purpose of this study was to introduce the Chuna Manual Therapy (CMT) using Bong (a type of stick which is called 'bong') as a part of Oriental Medicine. Methods : We searched several traditional methods of CMT using Bong, either individual contact to specialist of CMT using Bong or referred to publications, and summarized briefly for introduction. Authors also made a comparative study between existing CMT and CMT using the bong. Results & Conclusions : The indications of Bong CMT are regarded as acute or chronic pain syndrome, whiplash associated disorders, facet syndrome, vertebral misalignment, chronic fatigue syndrome, obesity and also lower extremity length difference caused by malalignment of vertebrae and pelvic bone. The Meridian Muscle Therapy by pressing down using the Bong can be carried out on the imbalances of the muscle by shortening and lengthening contraction. CMT with Bong is considered more effective than other existing CMT in terms of effectiveness. In the case of pelvic correction which needs a tremendous amount of force, it can reduce the force required effectively. This fact can be inferred by the theory of composition and decomposition of force during the transmission of power. We can perform Bong CMT feeling less fatigued subsequently than general CMT. Pressing down with flexed fingers to grip bong acts on the contraction of flexor digiti and extensor digiti muscle, this protects the $doctor^{\circ}{\emptyset}s$ wrist joints from injury. The bong which acts as a tool between the doctor and the patient, while being given treatment, absorbs and spreads out the direct impact from the patient to the doctor. CMT with Bong is able to apply to both existing massage therapies with the hand. The bong appliance can be used in all applications, particularly, but not limited to; Orthopedic and Manual Correction Therapy, Meridian Muscle Pressing, Exercise Therapy, and Meridian Point Manual Pressing Therapy. CMT with Bong belongs to the category of oriental rehabilitation and Chuna manual medicine.