• Journal of Korean Neurosurgical Society
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• 제61권2호
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• pp.167-179
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• 2018

The prevalence of patients with adult spinal deformity (ASD) has been reported as high as 68%. ASD often leads to significant pain and disability. Recent emphasis has been placed on sagittal plane balance and restoring normal sagittal alignment with regards to the three dimensional deformity of ASD. Optimal sagittal alignment has been known to increase spinal biomechanical efficiency, reduce energy expenditure by maintaining a stable posture with improved load absorption, influence better bony union, and help to decelerate adjacent segment deterioration. Increasingly positive sagittal imbalance has been shown to correlate with poor functional outcome and poor self-image along with poor psychological function. Compensatory mechanisms attempt to maintain sagittal balance through pelvic rotation, alterations in lumbar lordosis as well as knee and ankle flexion at the cost of increased energy expenditure. Restoring normal spinopelvic alignment is paramount to the treatment of complex spinal deformity with sagittal imbalance. Posterior osteotomies including posterior column osteotomies, pedicle subtraction osteotomies, and posterior vertebral column resection, as well anterior column support are well known to improve sagittal alignment. Understanding of whole spinal alignment and dynamics of spinopelvic alignment is essential to restore sagittal balance while minimizing the risk of developing sagittal decompensation after surgical intervention.

• 국제물리치료학회지
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• 제10권2호
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• pp.1797-1802
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• 2019

Background: Breathing is the essential step of Pilates exercise and can be used to activate core muscles. Although the effects of breathing exercise on pain, breathing muscles, and cervical posture have been extensively studied, little is known about the impact of Pilates breathing on spinal posture and alignment. Purpose: To determine the effect of 3D-Pilates breathing exercise on spinal curvature and alignment of healthy adults during corrected to normal alignment. Design: One group pre-post test design Methods: Eighteen participants were given a 3D-pilates breathing exercise twice a week (20 minutes per session) for three weeks and warmed up for 10 minutes before each exercise session. To examine spinal curvature and alignment of each subject, this study used radiation free rasterstereography (Formetric III, Germany). Paired t-test and Wilcoxon signed rank test were performed to determine the difference between pre and post exercise. Results: There were statistically significant differences in height (p<.001), kyphosis angle (p<.05), trunk imbalance (p<.05), kyphotic apex (p<.01), cervical fleche (p<.05), pelvic tilt (p<.01), and lateral deviation (p<.05) between before and after 3D Pilates breathing exercise. However, there was no significant difference in lordosis angle. Conclusions: The study results indicated that three week 3D-pilates breathing exercise program could be presented as an effective rehabilitation method for improving spinal curvature and alignment.

• 국제물리치료학회지
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• 제11권4호
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• pp.2197-2202
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• 2020

Background: If there is a difference in leg length, the center of gravity shifts unilaterally toward the short leg, causing loss of balance and secondary postural imbalance, trunk muscle tone changes, gait abnormalities and pelvic imbalance. Objectives: To investigate effects of self exercise program on leg length, balance in adults with leg-length discrepancy. Design: Single blind randomized controlled trial. Methods: Twenty-eight participants were selected and divided into resistance exercise, flexibility exercise, and core exercise. Each exercise was performed for 40 minutes, 3 times a week for 6 weeks. Leg length and balance before and after exercise were measured and analyzed. Results: Following the interventions, resistance exercise group showed significant improvement in balance, but leg length difference did not show significant results. Flexibility exercise group showed significant improvement in leg length difference, but balance did not show significant results. Core exercise group showed significant improvement in leg length difference and balance. There was no significant difference in the comparison between the three groups. Conclusion: This study suggests that customized exercise according to the patient's level is beneficial to the patients.

• The Journal of Korean Physical Therapy
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• 제29권4호
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• pp.223-226
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• 2017

Purpose: This study examined two trunk strategies - medio-lateral ramp and anterior-posterior ram - and their effects on pelvis and trunk movements, providing basic material for safe ramp utilization. Methods: The present study included 20 asymptomatic males recruited from a local university. Participants were asked to stand with their feet shoulder-width apart. Their dorsal side faced the camera, and measurements were performed while standing in a neutral double stance, one leg stance, $15^{\circ}$ of medial and lateral ramp, and $15^{\circ}$ of anterior and posterior ramp. Participants were allowed to practice for 3 minutes, and each participant had a 30 seconds rest between the two ramp conditions. One-way repeated measures analysis of variance was used to determine the effects the ramp conditions on spinal alignment. In all analyses, p<0.05 was used to indicate statistical significance. Results: The trunk-inclination angle on the posterior ramp was significantly lower than that of the double stance position (p<0.05). The trunk imbalance angle was significantly higher on the medial ramp, than that on the double stance position (p<0.05). The pelvic position and pelvic torsion angles were significantly higher in the medial, lateral, and anterior ramp positions than that of the double stance position (p<0.05). The pelvic rotation angles on the medial, lateral, and anterior ramps were significantly lower than that of the double stance position (p<0.05). Conclusion: These findings suggest that when people are exposed to the same form of ramp for an extended period, posture modifications may be triggered.

• Journal of Korean Neurosurgical Society
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• 제53권2호
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• pp.96-101
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• 2013

Objective : The purpose of this study was to analyze the differences of spinopelvic parameters between degenerative spondylolisthesis (DSPL) and isthmic spondylolisthesis (ISPL) patients. Methods : Thirty-four patients with DSPL and 19 patients with ISPL were included in this study. Spinopelvic parameters were evaluated on whole spine X-rays in a standing position. The following spinopelvic parameters were measured : pelvic incidence (PI), sacral slope, pelvic tilt (PT), lumbar lordosis (LL), and sagittal vertical axis from C7 plumb line (SVA). The population of patients was compared with a control population of 30 normal and asymptomatic adults. Results : There were statistically significant differences in LL (p=0.004) and SVA (p=0.005) between the DSPL and ISPL group. The LL of DSPL ($42{\pm}13^{\circ}$) was significantly lower than that of the control group ($48{\pm}11^{\circ}$; p=0.029), but that of ISPL ($55{\pm}6^{\circ}$) was significantly greater than a control group (p=0.004). The SVA of DSPL ($55{\pm}49$ mm) was greater than that of a control group (<40 mm), but that of ISPL ($21{\pm}22$ mm) was within 40 mm as that of a control group. The PT of DSPL ($24{\pm}7^{\circ}$) and ISPL ($21{\pm}7^{\circ}$) was significantly greater than that of a control group ($11{\pm}6^{\circ}$; p=0.000). Conclusion : Both symptomatic DSPL and ISPL patients had a greater PI than that of the asymptomatic control group. In conclusion, DSPL populations are likely to have global sagittal imbalance (high SVA) compared with ISPL populations because of the difference of lumbar lordosis between two groups.

• Journal of Korean Neurosurgical Society
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• 제59권6호
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• pp.615-621
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• 2016

Objectives : To review surgical results of post-fusion lumbar flatback treated with pedicle subtraction osteotomy (PSO) or Smith-Petersen osteotomies (SPOs). Methods : Twenty-eight patients underwent osteotomies. Radiological outcomes by sagittal vertical axis (SVA), and pelvic tilt (PT), T1 pelvic angle (T1PA), and pelvic incidence (PI)-lumbar lordosis (LL) at preoperative, postoperative 1 month, and final were evaluated. Oswestry Disability Index (ODI), visual analog scale (VAS) score of back pain/leg pain, and Scoliosis Research Society-22 score (SRS-22r) were analyzed and compared. Patients were divided into 2 groups (SVA ${\leq}5cm$ : normal, SVA >5 cm : positive) at final and compared outcomes. Results : Nineteen patients (68%) had PSO and the other 9 patients had SPOs with anterior lumbar interbody fusions (ALIFs) (Mean age : 65 years, follow-up : 31 months). The PT, PI-LL, SVA, T1PA were significantly improved at 1 month and at final (p<0.01). VAS score, ODI, and SRS-22r were also significantly improved at the final (p<0.01). 23 patients were restored with normal SVA and the rest 5 patients demonstrated to positive SVA. SVA and T1PA at 1 month and SVA, PI-LL, and T1PA at final were significantly different (p<0.05) while the ODI, VAS, and SRS-22r did not differ significantly between the groups (p>0.05). Common reoperations were early 4 proximal junctional failures (14%) and late four rod fractures. Conclusion : Our results demonstrate that PSO and SPOs with ALIFs at the lower lumbar are significantly improves sagittal balance. For maintenance of normal SVA, PI-LL might be made negative value and T1PA might be less than $11^{\circ}$ even though positive SVA group was also significantly improved clinical outcomes.

• 한국산학기술학회논문지
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• 제18권1호
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• pp.431-440
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• 2017

본 연구는 아헹가 요가 프로그램이 중년여성의 하체불균형에 미치는 영향을 분석하는데 그 목적이 있다. 연구의 대상자는 35-60세 사이의 중년여성으로서 요가 수련의 경험이 없으며 다른 운동 훈련에 참가 하지 않고, X-RAY검사와 간스테드 테크닉(Gonsted Technique) 분석을 통하여 골반불균형이면서 하지 길이의 차이가 있는 중년여성 24명을 선정하여 12주 동안, 주3회, 1일 90분 동안 수련하였다. 통계방법은 대응 t-검정을 실시하여 수련 전과 후를 비교하였고, 유의 수준은 0.05로 설정하였다. 이 연구의 결과는 첫째, 아헹가 요가는 골반 불균형을 교정하는데 통계적으로 유의한 결과를 나타냈다. 즉 골반 불균형 개선에서 좌 우 엉덩뼈 높이(p < 0.001), 좌 우 엉덩뼈 넓이 (p < 0.001), 좌 우 엉덩뼈 길이 ((p < 0.001), 좌 우 엉치뼈넓이 (p < 0.001)에서 수련 전보다 수련 후 그 차이가 감소하는 유의한 변화를 보여주었다. 둘째, 하지 길이의 변화에서는 아헹가 요가 수련 전 보다 수련 후에 좌 우 하지 길이 차이 (p < 0.001)가 현저하게 감소하였으며 통계적으로 유의한 효과를 나타내었다. 이상의 연구 결과에서 아헹가 요가 수련이 중년여성의 신체불균형을 교정하는데 매우 효과가 크다는 것을 알 수 있었다.

• 고신대학교 의과대학 학술지
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• 제33권2호
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• pp.135-140
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• 2018

Endometriosis is an estrogen-dependent chronic inflammatory condition that affects women in their reproductive period and is associated with pelvic pain and infertility. Oxidative stress (OS) occurs when reactive oxygen stress (ROS) and anti-oxidants are in imbalance. OS is a potential factor involved in the pathophysiology of endometriosis. Iron-induced ROS may trigger a chain of events resulting in the development and progression of endometriosis. Endogenous ROS are correlated with increased cellular proliferation and ERK1/2 activation in human endometriotic cells. An oxidative environment leads to stimulation of the ERK and PI3K/AKT/mTOR signaling pathways that facilitate endometriotic lesion progression through adhesion, angiogenesis, and proliferation. OS is also known to be involved in epigenetic mechanisms in endometriosis. We summarize the recent knowledge in our understanding of the role of oxidative stress in the pathogenesis of endometriosis.

• PNF and Movement
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• 제12권4호
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• pp.243-248
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• 2014

Purpose: The transverse abdominis and themultifidus muscle are located in the core. They surround one's trunk and help in body stabilization. Specifically, they control spine articulation to maintain posture and balance. Therefore, weakened deep muscle in the trunk may cause spinal malalignment. This study aims to compare the correlation between the thickness of the transverse abdominis and the multifidus muscle and the spine alignment among college students in their 20s. Methods: This study measured the thickness of the transverse abdominis and the multifidus muscle of 42 healthy college students in their 20s using ultrasonic waves. The thickness of the muscle was measured for the length of the cross-section except for fascia. The thickness of the left and right muscles was measured, and the mean value was calculated. As the thickness of the transverse abdominis can increase because of pressure during exhalation, it was measured at the last moment of exhalation. Spinal alignment was measured by the kyphosis angle, lordosis angle, pelvic tilt, trunk inclination, lateral deviation, trunk imbalance, and surface rotation using Formetric III, which is a three-dimensional imaging equipment. They were measured for three times, and the mean values were calculated. The general characteristics of the subjects were analyzed using descriptive statistics. The correlations between each factor were analyzed using Pearson's correlation analysis. Results: The transverse abdominis showed asignificant correlation with trunk inclination (p<.05). The multifidus muscle showed a significant positive correlation with pelvic tilt and a negative correlation with surface rotation (p<.05). Conclusion: The thickness of transverse abdominis and the multifidus muscle appears to influence spinal alignment. Specifically, the multifidus muscle, which plays an important role on the sagittal plane, influences surface rotation, thus making it an important muscle for scoliosis patients. Therefore, a strengthening training program for the transverse abdominis and the multifidus muscle is necessary according to specific purposes among adults with spinal malalignment.

• Journal of Korean Neurosurgical Society
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• 제63권1호
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• pp.99-107
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• 2020

Objective : The purpose of this study was to report the results of pedicle subtraction osteotomy (PSO) for fixed sagittal imbalance with a minimum 2-year follow-up. Besides, authors evaluated the effect of adjunctive multi-level posterior column osteotomy (PCO) on achievement of additional lumbar lordosis (LL) during PSO. Methods : A total of 31 consecutive patients undergoing PSO for fixed sagittal imbalance were enrolled and analyzed. Correction angle of osteotomized vertebra (PSO angle) and other radiographic parameters including pelvic incidence (PI), thoracic kyphosis, LL, and sagittal vertical axis (SVA) were evaluated. Clinical outcomes and surgical complications were also assessed. Results : The mean age was 66.0±9.3 years with a mean follow-up period of 33.2±10.5 months. The mean number of fused segments was 9.6±3.5. The mean operative time and surgical bleeding were 475.9±160.5 minutes and 1406.1±932.1 mL, respectively. The preoperative SRS-22 score was 2.3±0.7 and improved to 3.2±0.8 at the final follow-up. The mean PI was 54.5±9.5°. LL was changed from 7.0±28.9° to -50.2±13.2°. The PSO angle was 33.7±13.5° (15.6±20.1° preoperatively, -16.1±19.4° postoperatively). The difference of correction angle of LL (57.3°) was greater about 23.6° than which of PSO angle (33.7°). SVA was improved from 189.5±93.0 mm, preoperatively to 12.4±40.8 mm, postoperatively. There occurred six, eight, and 14 cases of complications at intraoperative, early (<2 weeks) postoperative, and late (≥2 weeks) postoperative period, respectively. Additional operations were needed in nine patients due to the complications. Conclusion : PSO could provide satisfactory results for patients with fixed sagittal imbalance regarding clinical and radiographic outcomes. Additional correction of LL could be achieved with conduction of adjunctive multi-level PCOs during PSO.