• Journal of Korean Neurosurgical Society
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• 제63권1호
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• pp.89-98
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• 2020

Objective : Ossification of posterior longitudinal ligament (OPLL) in the thoracic spine may cause chronic compressive myelopathy that is usually progressive, and unfavorable by conservative treatment. Although surgical intervention is often needed, the standard surgical method has not been established. Recently, it has been reported that posterior decompression with dekyphosis is effective surgical technique for favorable clinical outcome. The purpose of this study was to evaluate the surgical outcomes in patients with thoracic OPLL according to dekyphosis procedure and to identify predictive factors for the surgical results. Methods : A total of 25 patients with thoracic OPLL who underwent surgery for myelopathy from May 2004 to March 2017, were retrospectively reviewed. Patients with cervical myelopathy were excluded. We assessed the clinical outcomes according to various surgical approaches. The modified Japanese orthopedic association (JOA) scores for the thoracic spine (total, 11 points) and JOA recovery rates were used for investigating surgical outcomes. Results : Of the 25 patients, 10 patients were male and the others were female. The mean JOA score was 6.7±2.3 points preoperatively and 8.8±1.8 points postoperatively, yielding a mean recovery rate of 53.8±31.0%. The mean patients' age at surgery was 52.4 years and mean follow-up period was 40.2 months. According to surgical approaches, seven patients underwent anterior approaches, 13 patients underwent posterior approaches, five patients underwent combined approaches. There was no significant difference of the surgical outcomes related with different surgical approaches. Age (≥55 years) and high signal intensity on preoperative magnetic resonance (MR) image in the thoracic spine were significant predictors of the lower recovery rate after surgery (p<0.05). Posterior decompression with dekyphosis procedure was related to the excellent surgical outcomes (p=0.047). Dekyphosis did not affect the complication rates. Conclusion : In this study, our result elucidated that old age (≥55 years) and presence of intramedullary high signal intensity on preoperative MR images were risk factors related to poor surgical outcomes. In the meanwhile, posterior decompression with dekyphosis affected favorable clinical outcome. Posterior approach with dekyphosis procedure can be a recommendable surgical option for favorable results.

• Journal of Acupuncture Research
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• 제31권3호
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• pp.75-82
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• 2014

Objectives : The purpose of this study is to investigate the effects of warm needling therapy in a patient with cervical myelopathy caused by ossification of posterior longitudinal ligament. Methods : A 53-year-old Korean male patient diagnosed with cervical myelopathy due to ossification of posterior longitudinal ligament was treated with warm needling therapy on posterior neck aside from the routine inpatient treatment from June 26th to July 16th. Clinical improvement was evaluated with visual analogue scale(VAS), Japanese orthopedic score(JOA), grip and release test, finger escape sign and patient satisfaction was measured using a five-point Likert scale. Results : After 21 days of treatment, the patient showed improvement in VAS, JOA, grip and release test and finger escape sign. The patient also expressed satisfaction with the treatment. Conclusions : The results suggest that warm needling therapy may be an effective additional treatment for cervical myelopathy and other symptoms related to ossification of posterior longitudinal ligament(OPLL). Further studies should be carried out regarding possible long-lasting effects.

• Journal of Korean Neurosurgical Society
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• 제62권6호
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• pp.671-680
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• 2019

Objective : We introduce innovative method of cervical column reconstruction and performed the reconstruction with a flanged titanium mesh cage (TMC) instead of a plate after anterior corpectomy for cervical spondylotic myelopathy (CSM) and an ossified posterior longitudinal ligament (OPLL). Methods : Fifty patients with CSM or OPLL who underwent anterior cervical reconstruction with a flanged TMC were investigated retrospectively. Odom's criteria were used to assess the clinical outcomes. The radiographic evaluation included TMC subsidence, fusion status, and interbody height. Thirty-eight patients underwent single-level and 12 patients underwent two-level corpectomy with a mean follow-up period of 16.8 months. Results : In all, 19 patients (38%) had excellent outcomes and 25 patients (50%) had good outcomes. Two patients (4%) in whom C5 palsy occurred were categorized as poor. The fusion rate at the last follow-up was 98%, and the severe subsidence rate was 34%. No differences in subsidence were observed among Odom's criteria or between the single-level and two-level corpectomy groups. Conclusion : The satisfactory outcomes in this study indicate that the flanged TMC is an effective graft for cervical reconstruction.

• Journal of Korean Neurosurgical Society
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• 제46권2호
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• pp.168-171
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• 2009

Intradural lumbar disc herniation (ILDH) is rare. In this report, authors present 2 cases of ILDHs associated with severe adhesion between the dural sac and posterior longitudinal ligament. In a 40-year-old man, ILDH occurred in association with epidural adhesion due to ossification of the posterior longitudinal ligament (OPLL). In other 31-year-old man, ILDH occurred in presence of epidural adhesion due to previous spine surgery.

• 한방재활의학과학회지
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• 제26권3호
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• pp.59-65
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• 2016

Objectives The purpose of this review is to analyze domestic research trend of the ossification of posterior longitudinal ligament in Korean medicine. Methods We searched articles in Korean databases such as OASIS, RISS, NDSL and sorted the articles by journals, published year, institutions and research type. Results 9 suitable theses were reviewed. They were published between 2002 till 2011. Most of the theses were published in The Acupuncture, the journal of Korean Acupuncture & Moxibustion Medicine Society. There were 6 case reports, 2 case series and single disease review. Conclusions There were only 9 studies about the ossification of posterior longitudinal ligament in Korean medicine and most of them were case reports. To reinforce the evidence of effectiveness of Korean medicine, additional studies are required and well designed studies such as randomized controlled trials need to be carried out.

• Journal of Korean Neurosurgical Society
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• 제60권5호
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• pp.577-583
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• 2017

Objective : Laminoplasty is an effective surgical method for treating cervical degenerative disease. However, postoperative complications such as kyphosis, restriction of neck motion, and instability are often reported. Despite sufficient preoperative lordosis, this procedure often aggravates the lordotic curve of the cervical spine and straightens cervical alignment. Hence, it is important to examine preoperative risk factors associated with postoperative kyphotic alignment changes. Our study aimed to investigate preoperative radiologic parameters associated with kyphotic deformity post laminoplasty. Methods : We retrospectively reviewed the medical records of 49 patients who underwent open door laminoplasty for cervical spondylotic myelopathy (CSM) or ossification of the posterior longitudinal ligament (OPLL) at Pusan National University Yangsan Hospital between January 2011 and December 2015. Inclusion criteria were as follows : 1) preoperative diagnosis of OPLL or CSM, 2) no previous history of cervical spinal surgery, cervical trauma, tumor, or infection, 3) minimum of one-year follow-up post laminoplasty with proper radiologic examinations performed in outpatient clinics, and 4) cases showing C7 and T1 vertebral body in the preoperative cervical sagittal plane. The radiologic parameters examined included C2-C7 Cobb angles, T1 slope, C2-C7 sagittal vertical axis (SVA), range of motion (ROM) from C2-C7, segmental instability, and T2 signal change observed on magnetic resonance imaging (MRI). Clinical factors examined included preoperative modified Japanese Orthopedic Association scores, disease classification, duration of symptoms, and the range of operation levels. Results : Mean preoperative sagittal alignment was $13.01^{\circ}$ lordotic; $6.94^{\circ}$ lordotic postoperatively. Percentage of postoperative kyphosis was 80%. Patients were subdivided into two groups according to postoperative Cobb angle change; a control group (n=22) and kyphotic group (n=27). The kyphotic group consisted of patients with more than $5^{\circ}$ kyphotic angle change postoperatively. There were no differences in age, sex, C2-C7 Cobb angle, T1 slope, C2-C7 SVA, ROM from C2-C7, segmental instability, or T2 signal change. Multiple regression analysis revealed T1 slope had a strong relationship with postoperative cervical kyphosis. Likewise, correlation analysis revealed there was a statistical significance between T1 slope and postoperative Cobb angle change (p=0.035), and that there was a statistically significant relationship between T1 slope and C2-C7 SVA (p=0.001). Patients with higher preoperative T1 slope demonstrated loss of lordotic curvature postoperatively. Conclusion : Laminoplasty has a high probability of aggravating sagittal balance of the cervical spine. T1 slope is a good predictor of postoperative kyphotic changes of the cervical spine. Similarly, T1 slope is strongly correlated with C2-C7 SVA.

• Journal of Korean Neurosurgical Society
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• 제30권4호
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• pp.493-500
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• 2001

Objective : Anterior cervical locking plates are the devices for achieving anterior cervical spinal fusion. This study was conducted to evaluate the locking plate system regarding its long-term advantages and disadvantages in the view of interbody fusion rate, hardware-related failures, vertebral change close to the fusion segment and postoperative complications. Method : Eight-six patients, operated from Jan., 1996 to Jun. 1998, were followed-up for more than two years. All of the cases were fused with iliac bone graft and ORION locking plate(Sofamor Danek USA, Inc., Memphis, TN) fixation. The patients were discharged or transferred to rehabilitation department 2-7 days after operation. A comprehensive evaluation of the interbody fusion state, instrument failure, vertebral change and postoperative complications were made by direct interview and cervical flexion-extension lateral plain films. Results : There were 55 male and 31 female with a mean age of 45 years(18-75 years). The mean follow-up period was 29 months(24-43 months). Various disorders that were operated were 40 cervical discs, 6 cervical stenosis including OPLL, 2 infections, and 38 traumas. Fusion level was single in 59 cases, two levels of each disc space in 15 cases, and two levels after one corpectomy in 12 cases. There was no instrument failure. Pseudoarthrosis was observed in two cases(2%) without radiological instability. The other patients(98%) showed complete cervical fusion with stable instrument. Mild settling of interbody graft with upward migration of screws was found in 12 cases(14%). Anterior bony growth at the upper segment was found in 5 cases(6%). Postoperative foreign body sensation or dysphagia was observed in 12 cases(4%), and disappeared within one month in 7 cases and within six months in 4 cases. One patient complained for more than six months and required reoperation to remove paraesophageal granulation tissue. Conclusion : The results show that Orion cervical locking plate has some disadvantages of upward migration of screws, anterior bony growth at the upper segment, or possibility of esophageal compression even though it has advantages of high interbody fusion rate or low instrument failure. Author believe that anterior cervical locking plate in the future should be thinner, and should have short end from the screw hole, and movable screw with adequate stability.

• 척추신경추나의학회지
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• 제15권1호
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• pp.135-145
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• 2020

Objectives : This study reports the clinical case of a patient diagnosed with ossification of the posterior longitudinal ligament treated with Korean Medicine focusing on Chuna therapy. Methods : The patient was treated by a doctor from July 18th, 2019 to November 28th, 2019. The patient was diagnosed with ossification of the posterior longitudinal ligament based on magnetic resonance imaging results and was recommended to undergo surgery at another hospital. The primary complaint of the patient was left neck pain, left arm sensation, right leg sensation, and right leg loss of strength. The doctor treated the patient with Chuna therapy, acupuncture, cupping, herbal medicine, and pharmacopuncture. The effect of treatment was evaluated using visual analogue scale, neck disability index, pain rating score and Japanese Orthopedic Association score. Spurling, compression, and distraction tests were utilized. Results : Visual analogue scale decreased from 10 at the arm and 10 at the leg to 1 and 2, respectively. Neck disability index decreased from 25 to 11, pain rating score decreased from 66 to 1, and Japanese Orthopedic Association score recovered from 12 to 17 points. In addition, positive spurling test, compression test, and distraction test all improved to negative. Conclusions : Korean medicine treatment can be effective for ossification of the posterior longitudinal ligament patients, even when surgery is recommended. Further clinical studies, such as case series and case-control studies, are required to verify these findings.

• 한국광학회지
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• 제16권1호
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• pp.21-26
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• 2005

40 Gbit/s 광 시분할 신호(OTDM:optical time-division-multiplexed)로부터 클럭 재생된 10 GHz 신호를 얻기 위해 고조모드잠금된 광섬유 레이저와 TOAD(Terahertz Optical Asymmetric Demultiplexer)를 이용하여 광 위상 동기 회로를 구성하였다. 입력된 40Gbit/s 광 신호 펄스로부터 TOAD를 통과한 펄스의 위상 정보를 이용하여 10 GHz로 위상 동기된 신호를 추출하였다. 추출된 10GHz RF 신호와 주변의 잡음 신호의 비는 40 dB 이상으로 측정되었다. 또한 TOAD에서 위상 정보 추출 과정에 대한 시뮬레이션을 수행하였다. 위상 동기 주파수의 작동범위는 입력 광 펄스의 기본 주파수를 중심으로 10 kHz 이내에서 측정되었다.

• 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.