• 한방재활의학과학회지
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• 제28권4호
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• pp.59-69
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• 2018

Objectives This is one of the manuals of East-west integrative medicine which was created by the Committee on integrative medicine of Chung-Yeon Korean Medicine Hospital. The purpose of this manual is to support clinical decision making and communication during the rehabilitation of patients after lumbar spine surgery. Methods The drafting was done by two rehabilitation specialists in Korean Medicine. After a rehabilitation specialist in western medicine reviewed the draft and exchanged their ideas, a revised version that reflects the goal of consultation was made. Then the Committee agreed to adopt the manuals through the process of review and feedback in addition to face-to-face discussions. Results This manual describes clinical decision making for rehabilitation after lumbar microdiskectomy, interbody fusion, and kyphoplasty. Therefore it contains the schedule of rehabilitation treatment through the surgical technique, general goal of the rehabilitation by phase, scales for outcome measure and postoperative infection management. Conclusions The proposal of this manual has a significance for it provides information about decision making process and contents of treatment in one medical institution for East-west integrative rehabilitation treatment after lumbar spine surgery.

• 대한정형외과 초음파학회지
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• 제6권2호
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• pp.81-93
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• 2013

본 종설에서는 요추부 중재술에 있어서 초음파라는 장비가 영상 장치로서 얼마나 유용한가에 대해 기술하였다. 우선 요천추부의 표면 해부학과 초음파 해부학에 대하여 기술하였는데, 이는 초음파 유도하 중재술에서 영상의 판독과 술기의 수행에 있어 해부학의 자세한 이해가 반드시 필요하기 때문이다. 방사선 투시하에 척추 중재술을 하는 것이 보편화 되어 있지만 방사선을 피폭해야 하는 문제가 늘 존재한다. 초음파는 방사선이 없고 간편하며 높은 정확도로 실시간 영상을 제공하는 장점들이 있으며 어떠한 임상 환경적 조건에서도 시행할 수 있다. 초음파 유도하 요추부 중재술은 방사선 투시기나 컴퓨터 단층촬영 유도로 시행하였던 기존의 방식을 대신할 수 있으며 방사선 피폭 없이 안전하게 시행할 수 있는 방법이다.

• Journal of Korean Neurosurgical Society
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• 제41권2호
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• pp.118-119
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• 2007

We report a rare case of Wallenberg's lateral medullary syndrome caused by prone position for spine surgery. A 48-year old man developed Wallenberg's syndrome characterized by involuntary myoclonic movements, ataxia on his left side, hyperalgia and cold sensation on his right side after prone position for general anesthesia for the spinal stenosis L3-L4, L4-L5. Brain computed tomography scan was immediately performed and showed negative findings, but magnetic resonance image [MRI] demonstrated brain infarction on the left medulla. Emergent heparinization was performed and his motor power and sensation returned to normal and discharged with stable and satisfactory recovery after 16 days.

• 대한족부족관절학회지
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• 제1권2호
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• pp.119-125
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• 1997

The fracture and fracture-dislocation of the neck of the talus (Hawkins' type I-IV) are uncommon injuries and represent only 0.12 to 0.32% of all fracures. Authors clinically evaluated in 12 cases Whom treated fracures of the neck of the talus, at department of orthopaedic surgery, Sun General Hospital, from 1990 to 1996, and the following results are obtained. 1. Of 12 cases, there were 11 males and 1 female, average age was 30 years. 2. Causes of fracture was fall down injury in 7 cases(58%), traffic accident in 4 cases(33%), direct trauma in 1 case(8%). 3. According to the classification by Hawkins' type I in 2 cases(17%), type II in 7cases (58%), type III in 3cases(25%). 4. Associated injuries were calcaneal fracture in 3 cases, fracture-dislocation of talus in 3 cases, subtalar dislocation in 3 cases, medial malleolar fracture in 5 cases, soft tissue injury in 3 cases, femur and tibia fracture in 1 case, and lumbar Spine compression fracture in 1 case. 5. Average time to operation after injury was 2.5 days. 6. In 2 cases were treated conservatively and 10 cases were treated open reduction and internal fixation with screw or K-wire. 7. Complications were avascular necrosis in 4 cases, post traumatic arthritis in 2 cases, skin necrosis in 4 cases, and then ankle fusion was done in 2 cases. 8. High rate of complication was seen in the talar neck fracture associated with calcaneal fracture. In the analysis of above results, evaluated by Hawkins' scoring system were excellent to fair in 75%.

• Archives of Plastic Surgery
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• 제35권3호
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• pp.279-282
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• 2008

Purpose: It is known that the chronic absence of unilateral breast can cause spine curvature. The artificial breast manufactures take up the position of that possibility. This study was designed to evaluate the influence of the mastectomy on the spine and appearance of scoliosis among women who wanted delayed breast reconstruction. ted delayed breast reconstruction. Methods: The study population consisted of 47 women who underwent delayed breast reconstruction at our Department of Plastic Surgery from April 2001 to May 2007. The whole spine anteroposterior and lateral X-ray was taken to evaluate the Cobb's angle. As a general rule a Cobb angle of 10 is regarded as a minimum angulation to define scoliosis. We evaluated Cobb's angle and drew a correlation between the duration of the mastectomy state and the weight of the mastectomy specimen. Results: There were no family history of scoliosis, and no numbness or weakness in the upper or lower extremities. They had normal reflex and experienced no tenderness of the perispinal area. The Spearman Correlation Coefficient between Cobb's angle and the period that took time from the mastectomy to the X-rays and analysis between Cobb's angle and specimen weight was 0.032 and-0.115. there were no correlation between Cobb's angle and time, or between Cobb's angle and specimen weight. Conclusion: lthough the patients attribute their back pain and distorted posture to having received an one-sided mastectomy, it is unlikely that one-sided mastectomy causes spinal deformity and scoliosis.

• Journal of Trauma and Injury
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• 제26권1호
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• pp.30-33
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• 2013

A 55-year-old woman was seen in the emergency department with posterior neck pain and a headache after a traffic accident. Physical examination revealed tenderness on palpation over the posterior skull and a midline spinous process of the cervical spine without neurologic deficit. A plain radiograph of the cervical spine demonstrated the absence of the lateral portion of the posterior arch of the atlas and very lucent shadowing of the anterior midline of the atlas, suggesting a fracture of the anterior arch. On three-dimensional computed tomography (CT) of the cervical spine, anterior and posterior bony defects of the atlas were noted. Well-corticated defects were noted with sclerotic change and with no evidence of soft tissue swelling adjacent to the bony discontinuities, consistent with a congenital abnormality. With conservative therapy, the patient gradually showed a lessening of the midline tenderness. Careful investigation with radiography or CT is needed for these patients to avoid confusion with a fracture, because these patients seldom need surgical treatment.

• Journal of Trauma and Injury
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• 제31권1호
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• pp.16-18
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• 2018

Delayed esophageal rupture due to blunt injury is not new. However, rupture due to suspected barotrauma is very rare. We describe a case of esophageal rupture in a male 24-year-old patient after diving in shallow waters. The patient was quadriplegic and could not experience the typical chest pain related to rupture and resulting mediastinitis. The rupture was discovered 4 days after emergency decompressive laminectomy and fusion for his cervical spine. The rupture was evidently caused by barotrauma and was discovered four days after admission. He underwent primary closure and pericardial flap as a life-saving procedure.

• Journal of Korean Neurosurgical Society
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• 제41권5호
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• pp.295-300
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• 2007

Objective : Unilateral facet dislocation of the cervical spine occurs by flexion and rotation injuries and cannot be easily reduced by axial traction. We analyzed 14 consecutive patients with unilateral facet dislocation of the cervical spine to increase knowledge about anatomical reduction of locked facet and factors for successful reduction. Methods : Fourteen patients [10 men and 4 women] with unilateral facet dislocation of the cervical spine were retrospectively analyzed. Plain X-ray, computerized tomography scan, and magnetic resonance imaging were performed. All patients underwent manual reduction and surgery with anterior interbody fusion and plate fixation. The manual reduction was performed by neck flexion and rotation to the opposite side of dislocation, followed by rotation and flexion of the head toward the side of dislocation and extension with relaxation of traction. Mean follow-up period was 17 months. The level of spine, amount of subluxation, combined facet fracture, and time from injury to initial reduction were analyzed using the data obtained from medical records. Results : Thirteen [93%] patients were reduced successfully. Immediate reduction was achieved in 7 patients but failed in 7 patients. Seven patients underwent delayed closed reduction under general anesthesia, and successful reduction was achieved in 6 patients. Only one patient with bone chips between articular facets failed to achieve anatomical reduction. Conclusion : In order to reduce the locked facet more easily and safely, we recommend manipulative traction with anterior interbody fusion and plate fixation under general anesthesia after being aware of spinal cord injury with magnetic resonance imaging.

• The Korean Journal of Pain
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• 제27권4호
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• pp.313-320
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• 2014

Dexmedetomidine, an imidazoline compound, is a highly selective ${\alpha}_2$-adrenoceptor agonist with sympatholytic, sedative, amnestic, and analgesic properties. In order to minimize the patients' pain and anxiety during minimally invasive spine surgery (MISS) when compared to conventional surgery under general anesthesia, an adequate conscious sedation (CS) or monitored anesthetic care (MAC) should be provided. Commonly used intravenous sedatives and hypnotics, such as midazolam and propofol, are not suitable for operations in a prone position due to undesired respiratory depression. Dexmedetomidine converges on an endogenous non-rapid eye movement (NREM) sleep-promoting pathway to exert its sedative effects. The great merit of dexmedetomidine for CS or MAC is the ability of the operator to recognize nerve damage during percutaneous endoscopic lumbar discectomy, a representative MISS. However, there are 2 shortcomings for dexmedetomidine in MISS: hypotension/bradycardia and delayed emergence. Its hypotension/bradycardiac effects can be prevented by ketamine intraoperatively. Using atipamezole (an ${\alpha}_2$-adrenoceptor antagonist) might allow doctors to control the rate of recovery from procedural sedation in the future. MAC, with other analgesics such as ketorolac and opioids, creates ideal conditions for MISS. In conclusion, dexmedetomidine provides a favorable surgical condition in patients receiving MISS in a prone position due to its unique properties of conscious sedation followed by unconscious hypnosis with analgesia. However, no respiratory depression occurs based on the dexmedetomidine-related endogenous sleep pathways involves the inhibition of the locus coeruleus in the pons, which facilitates VLPO firing in the anterior hypothalamus.

• 대한정형외과학회지
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• 제52권1호
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• pp.92-96
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• 2017

슬관절 전치환술 후 감염은 큰 관심을 가지는 문제로 국소 부위 및 전신적 감염의 형태로 나타날 수 있으며, 때로는 패혈증으로 진행되는 사례가 보고되고 있다. 이러한 패혈증은 신체의 다양한 부위로 전파될 수 있으며 사망에까지 이르게 하는 중대한 합병증이다. 하지만 감염 후 척추로 전이된 경우는 임상 증상이 뚜렷하지 않아 진단이 어려우며, 이러한 증례에 대한 보고는 어떠한 문헌에도 없었다. 이에 양측 슬관절 전치환술 후 감염으로 인하여 패혈증으로 진행되어 척추로 전이된 증례를 보고하고자 한다.