• 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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• 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.

• The Journal of Korean Physical Therapy
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• 제17권3호
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• pp.311-327
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• 2005

The purpose of this study was to investigate the effects of diaphragmatic breathing on activation of trunk muscles of patients with low back pain. Diaphragmatic breathing may affect activation of trunk muscles. The assumptions are as follows: the crural diaphragm attatches to the lumbar vertebrae from L1 to L3, the voluntary downward pressurization of the diaphragm increases intra-abdominal pressure, and this increases the stiffness of the spine. Diaphragmatic breathing increases intra-abdominal pressure and the increased intra-abdominal pressure may contribute to the lumbar stability. Sixty patients with low back pain were randomly divided into two groups. Experimental group performed diaphragmatic breathing exercise with six breathing positions and control group performed only the breathing positions for five times per week during six weeks. % maximal voluntary contraction(% MVC) of trunk muscles on six breathing positions of experimental and control group was measured according to testing period of pre test, three weeks, and six weeks. The repeated measures of one-way ANOVA were used to analyze % MVC on trunk muscles of experimental and control group according to testing period. The results of this study were as follows: First, % MVC of right and left erector spinae in the right leg extension position indicated the statistically significant difference in experimental group which performed diaphragmatic breathing exercise rather than control group (p<0.05). Second, % MVC of right and left erector spinae in all-four positions indicated the statistically significant difference in experimental group which performed diaphragmatic breathing exercise rather than control group (p<0.05). Third, % MVC of right and left erector spinae, external oblique in the sitting position indicated the statistically significant difference in experimental group which performed diaphragmatic breathing exercise rather than control group (p<0.05). Fourth, % MVC of right and left erector spinae, external oblique in the standing position indicated the statistically significant difference in experimental group which performed diaphragmatic breathing exercise rather than control group (p<0.05). Fifth, % MVC of right and left erector spinae, external oblique in the supine position indicated the statistically significant difference in experimental group which performed diaphragmatic breathing exercise rather than control group (p<0.05). Sixth, % MVC of right and left erector spinae, external oblique in the lying on prone position indicated the statistically significant difference in experimental group which performed diaphragmatic breathing exercise rather than control group (p<0.05). In conclusion, as experimental group performed diaphragmatic breathing exercise according to the period of pre-test, post three weeks, and post six weeks, experimental group showed the greater significant effect on the activation of right, left erector spinae, and external oblique muscle. Diaphragmatic breathing exercise which resulted in activation of trunk muscles can be effective for managing the patients with back pain and should be utilized as the new therapeutic intervention.

• Journal of Korean Neurosurgical Society
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• 제62권4호
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• pp.432-441
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• 2019

Objective : Few studies have reported direct comparative data of lumbar spine angles between direct lateral interbody fusion (DLIF) and oblique lateral interbody fusion (OLIF). The purpose of this study was to investigate the clinical and radiological outcomes of DLIF and OLIF, and determine influential factors. Methods : The same surgeon performed DLIF from May 2011 to August 2014 (n=201) and OLIF from September 2014 to September 2016 (n=142). Radiological parameters, cage height, cage angle (CA), cage width (CW), and cage location were assessed. We checked the cage location as the distance (mm) from the anterior margin of the disc space to the anterior metallic indicator of the cage in lateral images. Results : There were significant differences in intervertebral foramen height (FH; $22.0{\pm}2.4$ vs. $21.0{\pm}2.1mm$, p<0.001) and sagittal disc angle (SDA; $8.7{\pm}3.3$ vs. $11.3{\pm}3.2^{\circ}$, p<0.001) between the DLIF and OLIF groups at 7 days postoperatively. CA ($9.6{\pm}3.0$ vs. $8.1{\pm}2.9^{\circ}$, p<0.001) and CW ($21.2{\pm}1.6$ vs. $19.2{\pm}1.9mm$, p<0.001) were significantly larger in the OLIF group compared to the DLIF group. The cage location of the OLIF group was significantly more anterior than the DLIF group ($6.7{\pm}3.0$ vs. $9.1{\pm}3.6mm$, p<0.001). Cage subsidence at 1 year postoperatively was significantly worse in the DLIF group compared to the OLIF group ($1.0{\pm}1.5$ vs. $0.4{\pm}1.1mm$, p=0.001). Cage location was significantly correlated with postoperative FH (${\beta}=0.273$, p<0.001) and postoperative SDA (${\beta}=-0.358$, p<0.001). CA was significantly correlated with postoperative FH (${\beta}=-0.139$, p=0.044) and postoperative SDA (${\beta}=0.236$, p=0.001). Cage location (${\beta}=0.293$, p<0.001) and CW (${\beta}=-0.225$, p<0.001) were significantly correlated with cage subsidence. Conclusion : The cage location, CA, and CW seem to be important factors which result in the different-radiological outcomes between DLIF and OLIF.

• 한국전문물리치료학회지
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• 제29권1호
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• pp.37-47
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• 2022

Background: Lower back pain (LBP) is a major cause of disability and a common musculoskeletal disorder encountered at some point in life. Dysfunction of the lumbar vertebrae has been associated with decreased flexibility of the hamstrings, which exhibited a strong positive correlation with LBP. Hamstring tension affects lumbar pelvic rhythm. We aimed to activate pelvic stability with compression by Active Therapeutic Movement (ATM), muscle energy technique (MET) was applied to increase the flexibility of the hamstring. Objects: In this study, we aimed to investigate the effects of MET with ATM and general MET were applied to the hamstring of adults, who were in their twenties with nor without LBP, on their pelvic inclination and the length of their hamstring. Methods: A total of 32 subjects were briefed about the purpose of this study and agreed to participate voluntarily. Before the experiment, all subjects were pre-examined, and they were divided into an LBP group and a no lower back pain group accordingly. Thereafter, all subjects participated in both in a crossover manner. After at least one week, they switched to another group and participated in the same experiment. Results: The study results revealed that both groups demonstrated significant results in the modified active knee extension test (p < 0.01) and the sit and reach test (p < 0.01) performed to assess the hamstring flexibility; an interaction (p < 0.05) was noted. Moreover, a more significant difference was observed between the MET with ATM and the general MET. Although significant results were obtained for the pelvic inclination (p < 0.01), interaction was not noted. Conclusion: Conclusively, in this study, when the MET with ATM was applied to the two groups, there was a significant difference compared to the general MET for hamstring flexibility, but it was confirmed that there was no significant difference for the pelvic inclination.

• Imaging Science in Dentistry
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• 제35권1호
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• pp.41-46
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• 2005

Purpose : The purpose of this study was to investigate whether the fractal dimension and radiographic image brightness of periapical radiograph were useful in predicting osteoporosis. Materials and Methods : Ninety-two postmenopausal women were classified as normal, osteopenia and osteoporosis group according to the bone mineral density of lumbar vertebrae and periapical radiographs of both mandibular molar areas were taken. The ROIs of 358 areas were selected at periapical and interdental areas and fractal dimension and radiographic image brightness were measured. Results : The fractal dimension in normal group was significantly higher than that in osteoporosis group at periapical ROI (P < 0.05). The radiographic image brightness in normal group was higher than that in osteopenia and osteoporosis group. There was significant difference not only between normal and osteopenia group (P < 0.05) but also within osteopenia and osteoporosis group (P< 0.01) at periapical ROI. Significant difference was observed not only between normal and osteopenia group but also between normal and osteoporosis group at interdental ROI (P< 0.01). Positive linear relationship was weakly shown at Pearson correlation analysis between fractal dimension and radiographic image brightness. BMD significantly correlated with fractal dimension at periapical ROI (P< 0.01), and BMD and radiographic image brightness significantly correlated at both periapical and interdental ROIs (P< 0.01). Conclusion : This study suggests that the fractal dimension and radiographic image brightness of periapical ROI may predict BMD. (Korean J Oral Maxillofac Radiol 2005: 35 : 41-6)

• 한국임상수의학회지
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• 제30권1호
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• pp.80-85
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• 2013

Twenty one cows in Goyang and Paju cities were referred due to displacement of the abomasum and foreign body in the rumen. Omentopexy and rumenotomy through a right flank celiotomy were performed for treatment of abomasal displacement and the foreign body removal in the rumen. The right paralumbar fossa is clipped and prepared surgically. Local anesthesia is instituted by performing inverted L block. The abdomen was entered through 25 to 30 cm vertical incision in the right paralumbar fossa starting 4 to 5 cm ventral to the transverse processes of the lumbar vertebrae. A 14-gauge needle with rubber tubing attached is inserted to relieve the gaseous pressure and to facilitate further exploration and manipulation. The rumen was gently pulled out of the abdominal cavity and incision was made at the omentum. Rumenotomy was done and retrieved the foreign body. After the rumen was rinsed with sterile saline, the rumen wall was closed by a Lembert suture technique. The omentum was closed by a simple continuous suture. Right flank omentopexy was performed for the surgical correction of abomasal displacement. Recovery results among 21 cows included 9 excellent, 5 good, 2 fair and 5 bad. It was considered that operation of abomasal displacement and foreign body removal in the rumen through right flank celiotomy was a good surgical technique to reduce expenses, surgical pain, and surgery time.

• 대한골관절종양학회지
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• 제19권2호
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• pp.78-82
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• 2013

랑게르한스 세포 조직구증(Langerhans' cell histiocytosis)은 단핵구계에 속하는 정상 조직구들이 과도하게 증식하여 다양한 임상 경과와 치료결과를 보이는 질환 군으로 알려져 있다. 특히, 척추에 침범하는 경우에는 단발 혹은 다발성의 골 용해를 특징으로 한다. 병변의 침범 부위, 진행 정도 및 동반 증상에 따라 단순 경과 관찰에서부터 방사선 치료, 화학요법 및 수술적 치료에 이르기까지 다양한 치료법들이 적용되어 왔으나, 아직까지 확립된 치료법은 없는 것으로 알려져 있다. 저자들은 경추와 요추를 동시에 침범하면서 척추 내 골수 파괴 소견과 병적 골절을 동반한 단일조직 랑게르한스 세포 조직구증 환자에 대해 수술적 치료 및 전신화학요법을 시행한 1예를 경험하였기에 문헌 고찰과 함께 보고하는 바이다.

• The Korean Journal of Physiology and Pharmacology
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• 제14권6호
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• pp.359-364
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• 2010

Many therapeutic roles have been proposed for sigma-1 receptor (Sig-1R), but the involvement of Sig-1R in neuropathic pain has currently not been well explored. The present study aimed to evaluate the anti-nociceptive effect of Sig-1R antagonist (BD1047) in a rat model of chronic compression of the dorsal root ganglion (CCD), which is a model of human foraminal stenosis and radicular pain. When stainless steel rods were inserted into the intervertebral foramen of lumbar vertebrae 4 and 5, the CCD developed reliable mechanical (from 3 day) and cold allodynia (from 1 day) as compared with the sham operation group. The spinal expressions of Sig-1R and phosphorylation of extracellular signal-regulated kinase (pERK) were significantly increased from day 3 to day 14 after CCD surgery, as is consistent with the manifestation of allodynia. The BD 1047 (10, 30, 100 mg/kg) administered on postoperative days 0~5 dose-dependently suppressed both the induction of allodynia and the elevation of the spinal pERK expression in a manner comparable with that of gabapentin (100 mg/kg). At 7 days post-CCD surgery, BD1047 (10, 30, 100 mg/kg) administration also produced anti-nociceptive effects on the mechanical and cold allodynia similar with those of gabapentin (100 mg/kg). Therefore, this data suggested that Sig-1R may play an important role in both the development and maintenance of CCD-induced neuropathy.

• Journal of Korean Neurosurgical Society
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• 제42권5호
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• pp.363-366
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• 2007

Objective : Kyphoplasty performed in the middle thoracic spine presents technical challenges that differ from those in the lower thoracic or lumbar region due to small pedicle size and angular severity for thoracic kyphosis. The purpose of this study was to evaluate the efficacy of balloon kyphoplasty through extrapedicular approach for the treatment of intractable osteoporotic compression fractures in the middle thoracic spine. Methods : The patients who were performed with one level balloon kyphoplasty through extrapedicular approach due to painful osteoporotic compression fractures at T5-T8 from June 2003 to July 2005 were retrospectively analyzed. Imaging and clinical features were analyzed including involved vertebrae level, vertebral height, Injected cement volume, clinical outcome and complications. Results : Eighteen female patients (age ranged from 60 to 77 years old) were included in this study. The average amount of the implanted cement was $4.2{\pm}1.5\;cc$. The mean cobb angle and compression rate were improved from $12.1{\pm}6.5^{\circ}$ to $8.5{\pm}7.2^{\circ}$ and from 30% to 15%, respectively. The mean pain score (visual analogue scale) prior to kyphoplasty was 7.9 and it decreased to 3.0 after the procedure. Cement leakage to the adjacent disc (2 cases) and paravertebral soft tissues (1 case) were seen but there were no major complications such as pneumothorax, segmental arte 이 Injury, pulmonary embolism, or epidural leakage. Conclusion : Balloon kyphoplasty through extrapedicular approach is considered as a safe and effective in treating the middle thoracic regions with low complication rate.