• Physical Therapy Rehabilitation Science
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• 제12권3호
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• pp.240-250
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• 2023

Objective: The purpose of this study was to characterize the movement of adjacent segments that occurred when posteroanterior joint mobilization was applied to the 3rd lumbar and thereby to provide basic clinical data. Design: Randomized controlled trial design. Methods: While the subjects were receiving posteroanterior joint mobilization of the 3rd lumbar vertebra, LD (lumbar displacement), LID (lumbar intervertebral distance), LIA (lumbar intervertebral angle), and LLA (lumbar lordosis angle) were measured using X-ray, and the data were then analyzed. Changes before and after posteroanterior joint mobilization were analyzed using a paired-sample t-test, and a one-way ANOVA of variance was performed to determine the difference between segmental movements. In addition, Pearson's correlation analysis was performed to determine the correlation between segmental movements. Results: The results revealed that there was a significant change in LD before and after the application of joint mobilization of the 3rd lumbar in all lumbar vertebrae (p<0.000), among which the 2nd lumbar vertebra, an adjacent segment, showed the most significant change. A significant change in LIA angle was observed in all segments (p<0.000), with the most significant change observed between the 2nd and 3rd lumbar vertebrae. There was a significant change in LLA before and after the application of posteroanterior joint mobilization (p<0.000). The correlation analysis showed a high correlation between displacement of the 3rd lumbar vertebra and displacement of all the other lumbar vertebrae. Conclusions: The presence of kinematic movements of the lumbar vertebrae when segmental movements were generated through the application of posteroanterior joint mobilization of the 3rd lumbar vertebra.

• 척추신경추나의학회지
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• 제6권1호
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• pp.53-61
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• 2011

Objective: The purpose of this study is to evaluate the disc block subluxation for lumbar scoliosis and herniation of nucleus pulpous (HNP). Methods: We used AP & Lateral view X-ray for patients. And we measured of disc wedge angle, vertebral body rotation to evaluate the typical and atypical disc block subluxation. Results: On the analysis of the lateral view X-ray, 4th lumbar intervertebral disc angle (I.V.D angle) showed $4^{\circ}$, $5^{\circ}$, $3^{\circ}$, $0^{\circ}$ in the cases. On the 4th lumbar analysis of the AP view X-ray, lumbar scoliosis showed right disc wedge angle was $11^{\circ}$ (case 1), $17^{\circ}$ (case 2) and left vertebral body rotation was 13mm, 6mm. Lumbar HNP showed left disc wedge angle was $5^{\circ}$ (case 3), $4^{\circ}$ (case 4) and left vertebral body rotation was 2mm, 4mm. Conclusions: Disc block subluxation has been in lumbar scoliosis, but not been in lumbar HNP.

• Journal of Korean Neurosurgical Society
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• 제59권4호
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• pp.385-391
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• 2016

Objective : The purpose of this study was to evaluate long-term follow-up radiologic/clinical outcomes of patients who underwent anterior cervical discectomy and inter-body fusion (ACDF) with stand-alone cages (SAC) in a single academic institution. Methods : Total 99 patients who underwent ACDF with SAC between February 2004 and December 2012 were evaluated retrospectively. A total of 131 segments were enrolled in this study. Basic demographic information, radiographic [segmental subsidence rate, fusion rate, C2-7 global angle, and segmental angle changes)/clinical outcomes (by Odom's criteria and visual analog score (VAS)] and complications were evaluated to determine the long-term outcomes. Results : The majority were males (55 vs. 44) with average age of 53.2. Mean follow-up period was 62.9 months. The segmental subsidence rate was 53.4% and fusion rate was 73.3%. In the subsidence group, anterior intervertebral height (AIH) had more tendency of subsiding than middle or posterior intervertebral height (p=0.01). The segmental angle led kyphotic change related to the subsidence of the AIH. Adjacent segmental disease was occurred in 18 (18.2%) patients. Total 6 (6%) reoperations were performed at the index level. There was no statistical significance between clinical and radiological outcomes. But, overall long-term clinical outcome by Odom's criteria was unsatisfactory (64.64%). The neck and arm VAS score were increased by over time. Conclusion : Long-term outcomes of ACDF with SAC group were acceptable but not satisfactory. For optimal decision making, more additional comparative long-term outcome data is needed between ACDF with SAC and ACDF with plating.

• 한방재활의학과학회지
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• 제19권2호
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• pp.227-239
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• 2009

Objectives : The purpose of this study is to investigate the relation of Ferguson's angle, Lumbar lordotic angle, Lumbar IVD angle in traffic accident patients. Methods : Total patients were classified into TA(traffic accident) inpatients and non-TA(lumbago) inpatients. We analyzed the characteristics of each group Ferguson's angle, Lumbar lordotic angle, L4-5 IVD angle, L5-S1 IVD angle on X-ray film. Results : 1. Ferguson's angle and Lumbar lordotic angle were smaller than normal range. Non-TA group's angles were smaller than TA group's angles. 2. L4-5 IVD angle of female showed smaller than that of male in TA groups. The older age was, the smaller L4-5 IVD angle was at non-TA groups. 3. L5-S1 IVD angle of female showed smaller than that of male in total groups. The older age was, the smaller L5-S1 IVD angle was at non-TA groups. 4. Ferguson's angle, Lumbar lordotic angle, Lumbar IVD angle were related with direct proportion in total groups. 5. Non-TA groups showed more effective VAS variation than TA groups. Conclusions : Lumbar angles were intimately related with each others. And lumbar angles have an effect on curative value.

• 대한의용생체공학회:의공학회지
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• 제39권1호
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• pp.22-29
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• 2018

Intervertebral disc(IVD) mainly consists of Annulus fibrosus(AF) and Nucleus pulposus(NP), playing a role of distributing a mechanical load on vertebral body. IVD tissue engineering has been developed the methods to achieve anatomic morphology and restoration of biological function. The goal of present study is to identify the possibilities for creating a substitute of IVD the morphology and biological functions are the same as undamaged complete IVD. To fabricate the AF and NP combine biphasic IVD tissue, AF tissue scaffolds have been printed by 3D bio-printing system with natural biomaterials and NP tissues have been prepared by scaffold-free culture system. We evaluated whether the combined structure of 3D printed AF scaffold and scaffold-free NP tissue construct could support the architecture and cell functions as IVD tissue. 3D printed AF scaffolds were printed with 60 degree angle stripe patterned lamella structure(the inner-diameter is 5mm, outer-diameter is 10 mm and height is 3 mm). In the cytotoxicity test, the 3D printed AF scaffold showed good cell compatibility. The results of histological and immunohistochemical staining also showed the newly synthesized collagens and glycosaminoglycans, which are specific makers of AF tissue. And scaffold-free NP tissue actively synthesized glycosaminoglycans and type 2 collagen, which are the major components of NP tissue. When we combined two engineered tissues to realize the IVD, combined biphasic tissues showed a good integration between the two tissues. In conclusion, this study describes the fabrication of Engineered biphasic IVD tissue by using enable techniques of tissue engineering. This fabricated biphasic tissue would be used as a model system for the study of the native IVD tissue. In the future, it may have the potential to replace the damaged IVD in the future.

• 한국정보전자통신기술학회논문지
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• 제4권2호
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• pp.88-95
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• 2011

본 연구에서는 코브 각도 측정법을 이용하여 척추 X-ray 영상을 측정할 때에 적용이 용이하도록 추간원판을 뚜렷하게 만드는 영상처리 알고리즘과 코브 각도 측정법을 일일이 적용하지 않고도 척추 전장을 포함하는 X-ray 필름의 기립 후전방 척추 영상을 하나의 척추선 함수 그래프로 변환하여 척추측만 정도 측정에 적용 또는 응용이 용이하게 하는 영상처리 알고리즘을 제시하였다. 척추 X-ray영상의 코브 각도 $1^{\circ}$당 L값의 평균을 산출한 결과는 0.568로 나타났고, 이를 기준으로 척추측만 정도 검출이 가능하였다.

• Journal of Korean Neurosurgical Society
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• 제29권6호
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• pp.763-771
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• 2000

Objectives : Thoracolumbar burst fractures(TBLF) result in not only compressive deformity of vertebral body but also spinal cord compression by bony fragments. Many thoracolumbar burst fractures demand both anterior decompression and intervertebral fusion. Most of spinal surgeons use anterior instrumentation for anteior intervertebral bony fusion. The use of Z-plate has been increased recently, however there has been only a few reports regarding its clinical long-term strength. We studied nineteen patients with TBLF to find out the long-term stability of Z-plate. Methods : We have operated 19 patients from March 1996 to August 1998. They were treated with anterior decompression through either a transthoracic, retroperitoneal extrapleural or retroperitoneal approach. Retropulsed bony fragments were removed completely by corpectomy. Iliac bone graft was used for interbody fusion in all of the cases. They were evaluated by plain X-ray films including flexion and extention lateral films. Cobbs angle was used to evaluate kyphotic and lateral wedging deformity. Results : Burst fractured sites were T11 in two, three T12, nine L1, and five L2. Mean follow-up duration was fifteen months. Preoperative average kyphotic angle was 23.7 degree. Immediate postoperative kyphotic angle was 10.2 degree. Follow-up resluts of average kyphotic angles revealed 14 degrees. Four patients(21%), including two spinal 3-column injury, showed increasement of kyphotic angle more than 5 degree or breakage of intrumentation. Two patients showed the difference of kyphotic angle more than 3 degree. Five patients(26%) revealed lateral wedging deformity more than 3 degrees. Postoperative complications were two meralgia parestheticas, one pulmonary atelectasis and two donor site infections. Four of the eight patients, who initially showed incomplete spinal cord deficits, were nerologically improved by Frankel's grade. Conclusion : Z-plate fixation and iliac bone graft after anterior decompression in thoracolumbar burst fractures is a safe and easy method. Immediate postoperative results revealed excellent correction of posttraumatic kyphosis, but long-term follow-up evalution showed insufficient strength. Therefore we believe that use of Z-plate should be carefully decided, especially in the case of large lumbar fracture or 3-column injury.

• Journal of Korean Neurosurgical Society
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• 제65권1호
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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.

• 한국정밀공학회지
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• 제26권10호
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• pp.116-121
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• 2009

It is important to consider lumbar lordotic angle for setup of training program in field of sports and rehabilitaton to prevent unexpected posture deviation and back pain. The purpose of this study was to analyze the biomechanical impact of the level of lumbar lordosis angle during isokinetic exercise through dynamic analysis using a 3-dimensional musculoskeletal model. We made each models for normal lordosis, excessive lordosis, lumbar kyphosis, and hypo-lordosis according to lordotic angle and inputted experimental data as initial values to perform inverse dynamic analysis. Comparing the joint torques, the largest torque of excessive lordosis was 16.6% larger and lumbar kyphosis was 11.7% less than normal lordosis. There existed no significant difference in the compressive intervertebral forces of each lumbar joint (p>0.05), but statistically significant difference in the anterioposterior shear force (p<0.05). For system energy lumbar kyphosis required the least and most energy during flexion and extension respectively. Therefore during the rehabilitation process, more efficient training will be possible by taking into consideration not simply weight and height but biomechanical effects on the skeletal muscle system according to lumbar lordosis angles.

• 한국방사선학회논문지
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• 제9권2호
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• pp.101-107
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• 2015

통상적으로 사용되는 목뼈 정면 입사각은 자세에 상관없이 머리 쪽으로 $15^{\circ}{\sim}20^{\circ}$의 입사각으로 촬영이 이루어지고 있으며 자세의 구분 없이 일률적으로 입사각을 사용하고 있으므로 자세에 따라 달라지는 목뼈의 추간판각을 측정하여 적정한 목뼈 정면 입사각을 제시하고자 하였다. 2013년 1월 1일부터 2013년 12월 31일까지 부산의 P대학병원을 내원한 목뼈 단순촬영 및 자기공명영상을 시행한 107명의 검사자 중 목뼈 전만각(정상 $40^{\circ}{\pm}5^{\circ}$)이 정상적인 20세 이상 80세 이하(평균연령 54세) 39명(남자 24명, 여자 15명)을 대상으로 선 자세는 목뼈 단순촬영 측면영상의 추간판각을 측정하였으며 누운 자세는 자기공명영상의 가운데 시상면영상의 추간판각을 측정하였고 성별로 분석한 결과를 보면 선 자세의 전체 목뼈 정면입사각은 남자는 $25.9^{\circ}$, 여자는 $23.1^{\circ}$로 나타났고 통계적으로 유의하였으며(p<0.05), 성별로 분석한 누운 자세의 전체 목뼈 정면입사각은 남자는 $11.6^{\circ}$, 여자가 $12.6^{\circ}$로 나타났으며 통계적으로 유의하지 않았고,(p>0.05) 연령별로 분석한 결과는 선자세의 전체 목뼈 정면입사각은 50세 미만이 $24.6^{\circ}$, 50세 이상에서 $25.0^{\circ}$로 나타났으며 누운 자세의 목뼈 정면 입사각은 50세 미만이 $12.0^{\circ}$, 50세 이상에서 $11.9^{\circ}$로 나타났으며 통계적으로 유의하지 않았고,(p>0.05) 선 자세와 누운 자세의 전체 목뼈 정면입사각의 결과는 선 자세에서는 $24.8^{\circ}$로 나타났으며 누운 자세에서는 $12.0^{\circ}$로 나타났고 통계적으로 유의하였다.(p<0.05) 연구의 결과를 볼 때 선 자세 및 누운 자세의 목뼈 정면 입사각은 종전의 머리 쪽으로 $15^{\circ}{\sim}20^{\circ}$가 아닌 각각 선 자세는 $24.8^{\circ}$, 누운 자세는 $12.0^{\circ}$가 추천되며 이로써 각각의 목뼈 추간판각에 따른 정확한 정면 목뼈와 추간원판의 구조 및 수술 후 각각의 목뼈 유합 수술환자 기구파악 및 정확한 위치를 나타내고 평가할 수 있다고 사료된다.