• The Journal of Korean Physical Therapy
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• 제2권1호
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• pp.103-112
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• 1990

The intervertebral disc in the anterior portion of the function unit gives the spine its flexibility. The disc is attached closely to the vertebral endplates. Between these endplates and the annulus fibrosus, the nucleus pulposus of the lumbar disc is enclosed in a circle of unyielding tissues. Compressive pressure placed on the disc is dissipated circumferentially in a passive manner In response to the greater axial forced exerted on the lumbar spine in comparison to the cervical and thoracic spines, the nucleus pulposus has its greatest surface area in the lumbar spine. The intervertebral disc is not only structure that helps diss pate stresses placed on the spine. With flexion, extension, rotation, or shear stress, the load distribution on the function unit is shared by the intervertebral disc, anterior and posterior longitudinal ligaments, the facet joints and capsules, and other ligamentous structures like the ligamentum flavum, interspinous and supraspinous ligaments, which attach to the posterior elements of the functional unit.

• 대한영상의학회지
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• 제81권3호
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• pp.654-664
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• 2020

목적 경추 전산화단층촬영(cervical spine CT; 이하 C-spine CT)과 일반촬영을 이용하여 환추횡인대골화증(ossification of the transverse ligament of the atlas; 이하 OTLA)과 연관된 영상 소견에 대하여 알아보았다. 대상과 방법 11년간 3975명의 환자에게서 촬영한 5201개의 C-spine CT를 분석하여 OTLA의 유무를 확인하였고, 이를 대조군과 비교하여 그 빈도와 연관된 영상 소견의 통계학적 유의성을 확인하였다. 결과 3975명 중 45명에서 OTLA가 확인되었다(1.1%). 그 빈도는 나이에 따라 증가하는 소견을 보였으며(p < 0.005), 80세 이상인 환자의 12%에서 관찰되었다. 척수 공간(space available for spinal cord; 이하 SAC)은 OTLA 환자군에서 유의하게 작은 것으로 확인되었으며(p < 0.005), 전방환추후두막(anterior atlantooccipital membrane)-Barkow 인대 복합체의 광물질침착(mineralization), 황색인대골화증(ossification of ligamentum flavum), 경추후만증 또한 유의미한 양의 상관관계를 보였다(p < 0.005). 결론 OTLA는 환자의 나이, SAC 협소, 경추후만증, 다른 경추인대의 골화증과 연관되어 퇴행성 척추병증, 전신적인 골 과잉 상태, 혹은 기계적 스트레스나 불안정성에 관련이 있을 것으로 생각된다.

• 한국정밀공학회:학술대회논문집
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• 한국정밀공학회 2005년도 춘계학술대회 논문집
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• pp.907-910
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• 2005

Although several artificial disc designs have been developed for the treatment of discogenic low back pain, biomechanical change with its implantation was rarely studied. To evaluate the effect of artificial disc implantation on the biomechanics of functional spinal unit, nonlinear three-dimensional finite element model of L4-L5 was developed with 1-mm CT scan data. Two models implanted with artificial discs, SB $Charit\acute{e}$ or Prodisc, via anterior approach were also developed. The implanted model predictions were compared with that of intact model. Angular motion of vertebral body, force on spinal ligaments and facet joint, and the stress distribution of vertebral endplate for flexion-extension, lateral bending, and axial rotation with a compressive preload of 400 N were compared. The implanted model showed increased flexion-extension range of motion and increased force in the vertically oriented ligaments, such as ligamentum flavum, supraspinous ligament and interspinous ligament. The increase of facet contact force on extension were greater in implanted models. The incresed stress distribution on vertebral endplate for implanted cases indicated that additinal bone growth around vertebral body and this is matched well with clinical observation. With axial rotation moment, relatively less axial rotation were observed in SB $Charit\acute{e}$ model than in ProDisc model.

• Clinics in Orthopedic Surgery
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• 제10권4호
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• pp.508-512
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• 2018

Foraminal decompression using a minimally invasive technique to preserve facet joint stability and function without fusion reportedly improves the radicular symptoms in approximately 80% of patients and is considered one of the good surgical treatment choices for lumbar foraminal or extraforaminal stenosis. However, proper decompression was not possible because of the inability to access the foramen at the L5-S1 level due to prominence of the iliac crest. To overcome this challenge, endoscopy-based minimally invasive spine surgery has recently gained attention. Here, we report the technical skills required in unilateral extraforaminal biportal endoscopic spinal surgery using a $30^{\circ}$ arthroscope to enable foraminal decompression at the L5-S1 level. Two 0.8-cm portals were created 2 cm lateral from the lateral border of the pedicles at the L5-S1 level. After sufficient working space was made, half of the superior articular process (SAP) in the hypertrophied facet joint was removed using a high-speed burr and a 5-mm wide osteotome, whereas the remaining inside part of the SAP was removed using a Kerrison punch and pituitary punch. The foraminal ligamentum flavum should be removed to inspect the conditions of the L5 exiting root and disc. Removing of the extruded disc could decompress the L5 root. The extraforaminal approach using a $30^{\circ}$ arthroscope is considered a minimally invasive alternative technique for decompressing foraminal stenosis at the L5-S1 level that preserves facet stability and provides symptomatic relief.

• Journal of Korean Neurosurgical Society
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• 제30권6호
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• pp.761-768
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• 2001

Objective : To describe the underlying causes, surgical results, and prognostic factors in thoracic stenosis causing myelopathy, retrospective analysis for 28 cases of thoracic stenosis with surgery was performed Materials & Method : Twenty-eight patients(male, 15 ; female, 13) who underwent decompressive surgery for thoracic stenosis between 1987 and 1997 were analyzed. The mean age was 49 and the mean follow-up was 30.6 months. Statistical analysis with $SPSS^{(R)}$ was performed. Chi-square test was used for the analysis of relationship between subjects and multivariate analysis with general linear model was used to find prognostic factors. Result : Degenerative spondylosis was the most common cause, and three cases were associated with systemic diseases. Decompressive laminectomy was done in 23 cases, anterior decompression in four cases, and combined decompression in one case. Ossification of ligamentum flavum was found in 18 cases, facet hypertrophy in 13, ossification of posterior longitudinal ligament in six, and ventral spur in four. Postoperatively, 16 patients improved functionally and 4 patients worsened. The group of which initial symptom duration was less than two years showed better result(p=0.003). The group with sufficient decompression and no additional proximal stenosis had better outcome(p=0.002, p=0.001). Conclusion : Chronic myelopathy caused by thoracic stenosis can be reversible with appropriate decompression.

• 대한약침학회지
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• 제6권3호
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• pp.75-80
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• 2003

Lumbar spinal stenosis results from the progressive combined narrowing of the central spinal canal, the neurorecesses, and the neuroforaminal canals. In the absence of prior surgery, tumor, or infection, the spinal canal may become narrowed by bulging or protrusion of the intervertebral disc annulus, herniation of the nucleus pulposis posteriorly, thickening of the posterior longitudinal ligament, hypertrophy of the ligamentum flavum, epidural fat deposition, spondylosis of the intervertebral disc margins, or a combination of two or more of the above factors. Patients with spinal stenosis become symptomatic when pain, motor weakness, paresthesia, or other neurologic compromise causes distress. In one case, we administrated oriental medical treatment with acupuncture treatment and herb-medicine. Oriental medical treatment showed desirable effect on lumbar spinal stenosis.

• Journal of Acupuncture Research
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• 제21권6호
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• pp.127-149
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• 2004

Objective : Ossification of ligaments within spinal canal, i.e., OPLL and OLF, is uncommon clinical entity as a cause of the progressive compression myelopathy or radiculopathy. More and more cases being reported in the field of occidental medicine, but very few cases have been reported in the field of oriental medicine. The purpose of this study is to report on oriental medical approaches to OPLL and OLF. Methods : Subjects of this study are 3 cases of OPLL and 3 cases of OLF who visited Won-kwang oriental medical hospital(Dept. of acupuncture and Moxibustion) from May, 2002 to October, 2003. These patients undergo oriental medical treatment such as acupuncture, cupping, Bee-Venom therapy and herbal medication and so on. We made a comparison JOA scores between before treatment and after treatment and we evaluated results of treatment. Results : The results of treatment in these six cases are as follows ; One case was evaluated 'Excellent', one case was evaluated 'Good', two cases were evaluated 'Fair' and two cases were evaluated 'Failure'. One of these cases had a surgical operation after discharge from this hospital. Conclusions : After oriental medical care for these cases, there are some improvements such as decrease of pains, relief of myelopathy etc. But, it had little effect on some cases, therefore we considered that more special study to find various and effective methods of oriental medical treatment for these diseases should be made.

• 척추신경추나의학회지
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• 제4권1호
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• pp.95-102
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• 2009

Objectives : We studied in order to compare the differences between the symptoms of patients and findings of MRI and X-Ray of patients with herniated disc which has been diagnosed often recently. Methods : We randomly selected among the 301 patients with X-Ray and L-spine MRI films who have visited Jaseng Hospital with low-back pain and lumbar and low extremity pain from Jan.1st of 2009 to Jan.28. We used SPSS 13.0 for Windows I in analyzing statistical data of study results and the level of significance were below 0.05. Results and Conclusions : 1. If there were radiating pain, based on MRI findings, the amount of herniation was more severe(P>0.05). 2. If the finding of a X-ray showed narrowing, based on MRI findings, the amount of herniation was more severe(P>0.05). 3. There were no significant differences between the presence of radiating pain and the findings of X-Ray(P>0.05). 4. Among the 301 cases, cases which showed findings beside HIVD were 79. 7 cases of hemanggioma(2.3%), 24 cases of spinal neoplasm(cord cyst, tumor etc)(8%), 7 cases of spondylitis(2.3%), 16 cases of spinal canal stenosis(5,3%) 9 cases of ligamentum flavum thickening(3%) and 16 cases of facet syndrome(5.3%).

• Journal of Korean Neurosurgical Society
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• 제29권4호
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• pp.528-535
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• 2000

Objective : To investigate objectively the postoperative improvement of gait disturbance in patients with cervical myelopathy through a gait analysis. Patients and Methods : Ten patients who underwent cervical decompression and fusion for cervical myelopathy caused by spondylosis, OPLL, or concomitant hypertrophy of ligamentum flavum were studied. Preoperatively, gait disturbance was present in all patients. The patients were evaluated by gait analysis using three dimensional motion analyzer to collect data of linear and kinematic parameters before surgery, 1 week and 3 months after surgery. Statistical analysis of the related pre-and post-operative data were performed. Results : In the linear parameters, average value of cadence, walking speed, stride length, step time, width and double support were increased postoperatively compare to preoperative value. In the kinematic parameters, average value of knee flexion during initial swing phase, plantar flexion of ankle and range of motion of hip joint were increased as well. These differences were statistically significant(p<0.05). Conclusion : This study suggests that gait analysis can be used as a method of quantitative analysis of postoperative gait improvement in patients with cervical myelopathy.

• 한방재활의학과학회지
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• 제20권4호
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• pp.139-146
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• 2010

Objectives : To compare the differences between the symptoms and the findings of MRI(magnetic resonance imaging) and x-ray, we studied the patients with neck pain or radiating pain, which has been diagnosed as cervical herniated disc recently. Methods : We randomly selected among the 143 patients with x-ray and cervical spine(C-spine) MRI films who have visited Ja-seng hospital with neck pain and neck and radiating pain from April 1 of 2010 to May 1. We used SPSS 13.0 for windows in analyzing statistical data of study results and the level of significance was below 0.05. Results : 1. There were no significant differences between the presence of radiating pain and the amount of cervical herniation(p>0.05). 2. If the finding of a x-ray showed narrowing, based on MRI findings, the amount of herniation was more severe(p>0.05). 3. There were no significant differences between the presence of radiating pain and the findings of x-ray(p>0.05). 4. Among the 143 cases, which showed findings beside HIVD(herniation of intervertebral disc) were 13 cases. 88 cases of straightening(61.5%). 78 cases of uncovertebral joint arthrosis(54.5%). 25 cases of stenosis(17.5%), 13 cases of retrolisthesis(9.1%), 8 cases of osteophyte(6.6%), 4 cases of spondylolisthesis(2.8%), 2 cases of hemangioma(1.4%), 3 cases of OPLL(ossification of posterior longitudinal ligament)(2.1%), 2 cases of block vertebrae(1.4%), 2 cases of spondylitis(1.4%), 1 case of kyphosis(0.1) and 1 case of ligamentum flavum hypertrophy(0.1%). Conclusions : The findings from this study suggest that there was no relation between radiating pain and radiological result. On the other hand, diagnosis of x-ray and MRI showed significant relevance. The narrower disc space there were, the severer the state of herniation there existed.