• Journal of Korean Neurosurgical Society
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• v.64 no.4
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• pp.575-584
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• 2021

Objective : Cervical expansive laminoplasty is an effective surgical method to address multilevel cervical spinal stenosis. During surgery, the spinous processes of C2 and C7 are usually preserved to keep the insertion points of the cervical musculature and nuchal ligament intact. In this regard, dome-like laminectomy (undercutting of C7 lamina) instead of laminoplasty is performed on C7 in selected cases. However, resection of the lamina can weaken the C7 lamina, and stress fractures may occur, but this complication has not been characterized in the literature. The objective of the present study was to investigate the incidence and risk factors for C7 laminar fracture after C7 dome-like laminectomy and its impact on clinical and radiological outcomes. Methods : Patients who underwent cervical open-door laminoplasty combined with C7 dome-like laminectomy (n=123) were classified according to the presence of C7 laminar fracture. Clinical parameters (neck/arm pain score and neck disability index) and radiologic parameters (C2-7 angle, C2-7 sagittal vertical axis, and C7-T1 angle) were compared between the groups preoperatively and at postoperatively at 3, 6, 12, and 24 months. Risk factors for complications were evaluated, and a formula estimating C7 fracture risk was suggested. Results : C7 lamina fracture occurred in 32/123 (26%) patients and occurred at the bilateral isthmus in 29 patients and at the spinolaminar junction in three patients. All fractures appeared on X-ray within 3 months postoperatively, but patients did not present any neurological deterioration. The fracture spontaneously healed in 27/32 (84%) patients at 1 year and in 29/32 (91%) at 2 years. During follow-up, clinical outcomes were not significantly different between the groups. However, patients with C7 fractures showed a more lordotic C2-7 angle and kyphotic C7-T1 angle than patients without C7 fractures. C7 fracture was significantly associated with the extent of bone removal. By incorporating significant factors, the probability of C7 laminar fracture could be assessed with the formula 'Risk score = 1.08 × depth (%) + 1.03 × length (%, of the posterior height of C7 vertebral body)', and a cut-off value of 167.9% demonstrated a sensitivity of 90.3% and a specificity of 65.1% (area under the curve, 0.81). Conclusion : C7 laminar fracture can occur after C7 dome-like laminectomy when a substantial amount of lamina is resected. Although C7 fractures may not cause deleterious clinical outcomes, they can lead to an unharmonized cervical curvature. The chance of C7 fracture should be discussed in the shared decision-making process.

• Journal of the Korean Society for Heat Treatment
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• v.19 no.1
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• pp.30-36
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• 2006

Fretting fatigue behavior of SCM420 steel commonly used in the automotive industry for structural applications was investigated in this study. In addition, the effect of bridge pad on the fretting fatigue test was evaluated from different pad materials and following conclusions were drawn. Simple fatigue limit of SCM 420 steel was determined to be 350 MPa while this value was 225 MPa and 285.5 MPa with SCM420H and with SM45C pad, respectively. Reduction in fatigue limit was, thus found to be 35.7% and 17.9% with SCM 420H pad and SM45C pad, respectively. Results of fracture surface observation revealed that typical striation pattern of fatigue failure existed as well as dimpled and cleavage frature appearance was found in final fractured region. From the EDS compositional analysis, test sample and pad part all had high signals for oxygen and iron, suggesting that worn particles might be iron oxide, although exact chemical composition has to be confirmed. Considerable reduction in fatigue life was apparent in SCM 420 steel under fretting fatigue against simple fatigue. Such reduced fatigue life by fretting damage should be considered as an important factor not only in the viewpoint of repairing but also inevitably in the design stage of structural components.