• Journal of Korean Neurosurgical Society
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• v.52 no.3
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• pp.210-214
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• 2012

Objective : This retrospective study aimed to compare clinical outcomes in terms of pain relief and recurrence rate between fragmentectomies and conventional microdiscectomies in patients with lumbar disc herniation (LDH). Methods : Between January 2008 and May 2011, a total of 175 patients met the inclusion criteria of this study. The visual analogue scale (VAS) scores of back and radicular pains were recorded before surgery, 2 and 6 weeks after surgery. Recurrence was defined when a patient had the same pattern of preoperative symptoms and was confirmed with magnetic resonance imaging. Results : Seventy-four patients (42.3%) were suitable for fragmentectomy, and 101 patients underwent conventional microdiscectomy. There were no significant differences in VAS scores between the fragmentectomy and conventional microdiscectomy groups 2 and 6 weeks after surgery. During the follow-up period, 3 patients (4.05%) in the fragmentectomy group and 7 patients (6.93%) in the conventional microdiscectomy group relapsed. Conclusion : If patients are selected according to well-defined criteria, fragmentectomy can be a good surgical option for LDH, in the physiological aspect of preserving healthy intervertebral disc materials.

• Journal of Korean Neurosurgical Society
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• v.38 no.5
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• pp.399-402
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• 2005

Direct anterior approach for lesions located anterior to the thecal sac is definitely superior to lateral or posterior approach in many respects. However, various anatomical obstacles and technical difficulties often hinder direct anterior approach. Thanks to ripe experience of retroperitoneal approach to the lumbar spine for anterior lumbar interbody fusion and total disc replacement, the authors could perform lumbar corpectomy and reconstruction by using midline retroperitoneal approach recently. During this approach, we repaired anterior longitudinal ligament also to reduce the risk of graft extrusion and to prevent erosion of vascular wall due to direct contact between metallic hardware, which was used for reconstruction of vertebral body, and major vessels.

• Journal of Korean Physical Therapy Science
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• v.11 no.1
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• pp.14-19
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• 2004

Objective : This study obtained normative values for variable parameters of lumbar function with the isoinertial triaxial dynamometer in patients with chronic low back pain. Subjects and Methods : 30 patients(male 15, female 15) with chronic low back pain in this study. Variable parameters that were measured with the Isostation B-200 were lumbar range of motion, isometric maximum torques, and maximum velocities in three axis. Results : In patient male group mean R.O.M. was $82.9{\pm}12.5$ degrees in lumbar rotation, $76.5{\pm}17.1$ degrees in lumbar flexion/extension, and $64.3{\pm}14.5$ degrees in lumbar lateral flexion. In patient female group mean R.O.M. was $78.4{\pm}18.5$ degrees in lumbar rotation, $71.7{\pm}20.4$ degrees in lumbar flexion/extension, and $63.2{\pm}14.4$ degrees in lumbar lateral flexion. In patient male group mean isometric maximum torques was $64.7{\pm}23.8ft-lbs$ in lumbar rotation, $81.1{\pm}42.0ft-lbs$ in lumbar flexion, $122.2{\pm}43.6ft-lbs$ in lumbar extension, and $101.0{\pm}37.0ft-lbs$ in lumbar lateral flexion. In patient female group mean isometric maximum torques was $41.9{\pm}9.2ft-lbs$ in lumbar rotation, $49.9{\pm}23.9ft-lbs$ in lumbar flexion, $90.1{\pm}26.8ft-lbs$ in lumbar extension, and $62.0{\pm}16.7ft-lbs$ in lumbar lateral flexion. In patient male group mean maximum velocity of isoinertial exercise with low (25%) resistance was $102.4{\pm}28.8deg/sec$ in lumbar rotation, $108.9{\pm}32.2deg/sec$ in lumbar flexion/extension, and $103.5{\pm}30.4deg/sec$ in lumbar lateral flexion. In patient female group mean maximum velocity of isoinertial exercise with low (25%) resistance was $84.1{\pm}24.4deg/sec$ in lumbar rotation, $93.2{\pm}32.9deg/sec$ in lumbar flexion/extension, and $98.5{\pm}33.7deg/sec$ in lumbar lateral flexion. In patient male group mean maximum velocity of isoinertial exercise with high (50%) resistance was $74.0{\pm}20.9deg/sec$ in lumbar rotation, $98.7{\pm}32.8deg/sec$ in lumbar flexion/extension, and $85.0{\pm}25.8deg/sec$ in lumbar lateral flexion. In patient female group mean maximum velocity of isoinertial exercise with high (50%) resistance was $67.3{\pm}26.4deg/sec$ in lumbar rotation, $82.5{\pm}31.0deg/sec$ in lumbar flexion/extension, and $79.7{\pm}23.9deg/sec$ in lumbar lateral flexion. Conclusion : Maximum isoinertial velocities were more reliable and more significant than isometric maximum torque for the objective assessment of chronic low hack pain.

• Journal of Korean Neurosurgical Society
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• v.54 no.2
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• pp.128-131
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• 2013

Transforaminal lumbar interbody fusion (TLIF) is commonly used procedure for spinal fusion. However, there are no reports describing anterior cage dislodgement after surgery. This report is a rare case of anterior dislodgement of fusion cage after TLIF for the treatment of isthmic spondylolisthesis with lumbosacral transitional vertebra (LSTV). A 51-year-old man underwent TLIF at L4-5 with posterior instrumentation for the treatment of grade 1 isthmic spondylolisthesis with LSTV. At 7 weeks postoperatively, imaging studies demonstrated that banana-shaped cage migrated anteriorly and anterolisthesis recurred at the index level with pseudoarthrosis. The cage was removed and exchanged by new cage through anterior approach, and screws were replaced with larger size ones and cement augmentation was added. At postoperative 2 days of revision surgery, computed tomography (CT) showed fracture on lateral pedicle and body wall of L5 vertebra. He underwent surgery again for paraspinal decompression at L4-5 and extension of instrumentation to S1 vertebra. His back and leg pains improved significantly after final revision surgery and symptom relief was maintained during follow-up period. At 6 months follow-up, CT images showed solid fusion at L4-5 level. Careful cage selection for TLIF must be done for treatment of spondylolisthesis accompanied with deformed LSTV, especially when reduction will be attempted. Banana-shaped cage should be positioned anteriorly, but anterior dislodgement of cage and reduction failure may occur in case of a highly unstable spine. Revision surgery for the treatment of an anteriorly dislodged cage may be effectively performed using an anterior approach.

• Proceedings of the Korean Society of Precision Engineering Conference
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• 2005.06a
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• pp.892-895
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• 2005

This study investigated changes of mechanical characteristics in the trabecular and cortical bone of the lumbar vertebrae of the ovariectomised(OVX) rat. In previous researches, there were many studies for morphology of osteoporotic bones based on Micro-CT (Micro - Computed Tomography). However, there were few studies for detecting and tracking changes of mechanical characteristics in the trabecular bone and cortical bone of the lumbar vertebrae for the OVX rat. For this study, one female Sprague-Dawley rat was used: an OVX rat. The 4th lumbar of the OVX rat was utilized as a specimen. Detecting and tracking changes of mechanical characteristics could be investigated in the trabecular and cortical bone of the lumbar vertebrae for an OVX rat using In-vivo Micro-CT. An OVX rat was scanned at week 0 (just before surgery), at week 4, and week 8 after surgery. Micro finite element(${\mu}\;FE$) analysis was used to investigate mechanical characteristics in the trabecular and cortical bone of the lumbar vertebrae for an OVX rat.

• Journal of the Korean Society for Precision Engineering
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• v.24 no.1 s.190
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• pp.110-117
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• 2007

This study investigated changes of mechanical characteristics of the trabecular and cortical bone in the lumbar vertebrae of the ovariectomised (OVX) rat. In previous researches, there were many studies for morphology of osteoporotic bones based on Micro-Computed Tomography (Micro-CT). However, there were few studies for detecting and tracking changes of mechanical characteristics of the trabecular and cortical bone in the lumbar vertebrae of the OVX rat. For this study, the 4th lumbar of the OVX rat (female Sprague-Dawley) was utilized as a specimen. An OVX rat was scanned at week 0 (just before surgery), at week 4, and week 8 after surgery. Micro-finite element (${\mu}-FE$) analysis was used to investigate mechanical characteristics of the trabecular and cortical bone in the lumbar vertebrae for an OVX rat. When the OVX rat (at week 8) was compared with the OVX rat (at week 0), the structural modulus of cortical and trabecualr bone was decreased by 52% and 99%, respectively. This study showed the change of mechanical characteristics of cortical bone as well as trabecular bone of an OVX rat. Detecting and tracking changes of mechanical characteristics could greatly contribute to an experiment test for the trabecular and cortical bone in the lumbar vertebrae of an OVX rat by using In-vivo Micro-CT.

• Journal of Korean Neurosurgical Society
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• v.53 no.3
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• pp.145-149
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• 2013

Objective : We analyzed the clinical and radiologic features of posterior apophyseal ring separation (PARS) with lumbar disc herniation and suggest the proper management options according to the PARS characteristics. Methods : We reviewed case series of patients with PARS who underwent surgery of lumbar disc herniation. Preoperative symptoms, neurologic status, Body Mass Index, preoperative and postoperative Visual Analogue Scale (VAS) and Korean-Oswestry Disability Index (K-ODI) scores, operation types were obtained. PARS size, locations, the degree of resection were assessed. Results : PARS was diagnosed in 109 (7.5%) patients among 1448 patients given surgical treatment for single level lumbar disc herniation. There were 55 (50.5%) small PARS and 54 (49.5%) large PARS. Among the large PARS group, 15 (27.8%) had lower endplate PARS of upper vertebra at the level of disc herniation. Thirty-nine (72.2%) were upper endplate PARS of lower vertebra. Among the group with upper endplate PARS of lower vertebra, unresected PARS was diagnosed in 12 (30.8%) cases and resected PARS was diagnosed in 27 (69.2%) cases. VAS and K-ODI scores changes were $3.6{\pm}2.9$ and $5.4{\pm}6.4$ in the unresected PARS group, $5.8{\pm}2.1$ and $11.3{\pm}7.1$ in the resected PARS group. The group with upper endplate PARS of lower vertebra showed significant difference of VAS (p=0.01) and K-ODI (p=0.013) score changes between unresected and resected PARS groups. Conclusion : The large PARS of upper endplate in lower vertebra should be removed during the surgery of lumbar disc herniation. High level or bilateral side of PARS should be widely decompressed and arthrodesis procedures are necessary if there is a possibility of secondary instability.

• Journal of Korean Neurosurgical Society
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• v.58 no.2
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• pp.112-118
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• 2015

Objective : Thoracic ossification of the ligamentum flavum (OLF) is a relatively rare disease. Because of ambiguous clinical symptom, it is difficult for early diagnosis of OLF and subsequent treatment can be delayed or missed. Therefore, the purpose of this study is to comprehensively assess the prevalence and distribution of thoracic OLF by magnetic resonance imaging (MRI) and coexisting spinal disease in Korean patients with back pain or leg pain. Methods : The sample included 2134 Korean patients who underwent MRI evaluation for back pain. The prevalence and distribution of thoracic OLF were assessed using lumbar MRI with whole spine sagittal images. Additionally, we examined the presence of coexisting lumbar and cervical diseases. The presence of thoracic OLF as well as clinical parameters such as age, sex, and surgery were retrospectively reviewed. Results : The prevalence of thoracic OLF in total patients was 16.9% (360/2134). The prevalence tended to increase with aging and was higher in women than in men. The lower thoracic segment of T10-11 was the most frequently affected segment. Of the 360 patients with OLF, 31.9% had coexisting herniated thoracic discs at the same level. Approximately 74% of the patients with OLF had coexisting lumbar and cervical disease. Nine (2.5%) of 360 OLF patients underwent surgery for thoracic lesion. Conclusion : The prevalenceof thoracic OLF was relatively higher than those of previous reports. And coexisting lumbar and cervical disease were very frequent. Therefore, we should check coexisting spinal diseases and the exact diagnostic localization of ossification besides lumbar disease.

• The Journal of Korean Physical Therapy
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• v.13 no.3
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• pp.495-507
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• 2001

The purpose of this study was to find the effects of the dynamic lumbar stabilization exercise on functional recovery of low back pain patients. The subjects were consisted of sixty patients who had nonspecific subacute low back pain. All subjects randomly assigned to dynamic lumbar stabilization exercise group. Williams exercise group and modalities treatment group. The dynamic lumbar stabilization exercise group received modalities treatment with dynamic lumbar stabilization exercise. Williams exercise group received modalities treatment with Williams flexion exercise and modalities treatment group received modalities treatment without exercise. The Oswestry low back pain disability questionnaire was used to measure disability of low back pain. Assessment was carried out before treatment fur obtain baseline measurement of low back pain and reassessment were carried out at after 20 and 40 treatment sessions. The results of this study were as following: 1. The Oswestry low back pain disability questionnaire scores were significantly decreased after 20th and 40th treatment in dynamic lumber stabilization exercise group(p<.05). 2. The Oswestry low back pain disability questionnaire scores were significantly decreased after 20th and 40th treatment in Williams exercise group(p<.05). 3. The Oswestry low back pain disability questionnaire scores were significantly decreased after 20th and 40th treatment in modalities treatment group(<.05). 4. There were no statistical difference between the 3 groups at pre-treatment with Oswestry low back pain disability questionnaire scores(p>.05). 5. There were no statistical difference between the 3 groups after 20th treatment with Oswestry low back pain disability questionnaire scores(p>.05). 6. There were statistical difference between the 3 groups after 40th treatment with Oswestry low back pain disability questionnaire scores(p<.05). 7. The Oswestry low back pain disability questionnaire scores were significantly decreased after 40th treatment in all 3 groups and the decrement were greater in order of dynamic lumbar stabilization exercise group. Williams exercise group and modalities treatment group.

• Journal of Korean Neurosurgical Society
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• v.56 no.4
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• pp.315-322
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• 2014

Objective : Posterior accessed lumbar interbody fusion (PALIF) has a clear objective to restore disc height and spinal alignment but surgeons may occasionally face the converse situation and lose lumbar lordosis. We analyzed retrospective data for factors contributing to a postoperative flat back. Methods : A total of 105 patients who underwent PALIF for spondylolisthesis and stenosis were enrolled. The patients were divided according to surgical type [posterior lumbar inter body fusion (PLIF) vs. unilateral transforaminal lumbar interbody fusion (TLIF)], number of levels (single vs. multiple), and diagnosis (spondylolisthesis vs. stenosis). We measured perioperative index level lordosis, lumbar lordosis, pelvic tilt, sacral slope, pelvic incidence, and disc height in standing lateral radiographs. The change and variance in each parameter and comparative group were analyzed with the paired and Student t-test (p<0.05), correlation coefficient, and regression analysis. Results : A significant perioperative reduction was observed in index-level lordosis following TLIF at the single level and in patients with spondylolisthesis (p=0.002, p=0.005). Pelvic tilt and sacral slope were significantly restored following PLIF multilevel surgery (p=0.009, p=0.003). Sacral slope variance was highly sensitive to perioperative variance of index level lordosis in high sacral sloped pelvis. Perioperative variance of index level lordosis was positively correlated with disc height variance ($R^2=0.286$, p=0.0005). Conclusion : Unilateral TLIF has the potential to cause postoperative flat back. PLIF is more reliable than unilateral TLIF to restore spinopelvic parameters following multilevel surgery and spondylolisthesis. A high sacral sloped pelvis is more vulnerable to PALIF in terms of a postoperative flat back.