• Journal of Korean Neurosurgical Society
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• 제62권4호
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• pp.376-381
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• 2019

Objective : To define optimal method that calculate the safe direction of cervical pedicle screw placement using computed tomography (CT) image based three dimensional (3D) cortical shell model of human cervical spine. Methods : Cortical shell model of cervical spine from C3 to C6 was made after segmentation of in vivo CT image data of 44 volunteers. Three dimensional Cartesian coordinate of all points constituting surface of whole vertebra, bilateral pedicle and posterior wall were acquired. The ideal trajectory of pedicle screw insertion was defined as viewing direction at which the inner area of pedicle become largest when we see through the biconcave tubular pedicle. The ideal trajectory of 352 pedicles (eight pedicles for each of 44 subjects) were calculated using custom made program and were changed from global coordinate to local coordinate according to the three dimensional position of posterior wall of each vertebral body. The transverse and sagittal angle of trajectory were defined as the angle between ideal trajectory line and perpendicular line of posterior wall in the horizontal and sagittal plane. The averages and standard deviations of all measurements were calculated. Results : The average transverse angles were $50.60^{\circ}{\pm}6.22^{\circ}$ at C3, $51.42^{\circ}{\pm}7.44^{\circ}$ at C4, $47.79^{\circ}{\pm}7.61^{\circ}$ at C5, and $41.24^{\circ}{\pm}7.76^{\circ}$ at C6. The transverse angle becomes more steep from C3 to C6. The mean sagittal angles were $9.72^{\circ}{\pm}6.73^{\circ}$ downward at C3, $5.09^{\circ}{\pm}6.39^{\circ}$ downward at C4, $0.08^{\circ}{\pm}6.06^{\circ}$ downward at C5, and $1.67^{\circ}{\pm}6.06^{\circ}$ upward at C6. The sagittal angle changes from caudad to cephalad from C3 to C6. Conclusion : The absolute values of transverse and sagittal angle in our study were not same but the trend of changes were similar to previous studies. Because we know 3D address of all points constituting cortical shell of cervical vertebrae. we can easily reconstruct 3D model and manage it freely using computer program. More creative measurement of morphological characteristics could be carried out than direct inspection of raw bone. Furthermore this concept of measurement could be used for the computing program of automated robotic screw insertion.

• 대한물리의학회지
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• 제17권1호
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• pp.41-48
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• 2022

PURPOSE: This study examined the relationship between the cervical lordosis angle (CLA) and the craniovertebral angle (CVA) and between CVA and a cross-sectional area (CSA) of the cervical muscles. METHODS: In 17 healthy college students, the CLA was measured using a posterior tangent technique. The CVA was analyzed using photographic images, and the CSA of the cervical muscles, including longus colli, longus capitis, and sternocleidomastoid, was evaluated using computerized tomography. The Pearson's correlation coefficient was used to determine the relationship between these variables and a neck disability index. RESULTS: The CVA correlated with the CLA and with a CSA of longus colli (r = .487, p = .047 and r = .592, p = .012, respectively). The CLA correlated with a CSA of longus colli (r = .578, p = .015). CONCLUSION: This study clarified the relationship between the postural, structural, and muscular changes in the cervical regions. A significant correlation was observed between the CVA and a CSA of the longus colli with the CLA and between the CVA and the CSA of the longus colli. Prescription strengthening exercises for the deep neck flexors for individuals with a forward head posture and reduced cervical lordosis are useful.

• Journal of Oral Medicine and Pain
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• 제23권4호
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• pp.457-473
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• 1998

This study was performed to investigate the morophological and positional correlation between the upper cervical vertebra, the oral structures and the pharyngeal tissues, and the correlation of these anatomical structures with dental features, such as teeth wear area nad tooth contact status, etc. Seventy patients with temporamandibular disorders and sixty three dental students without any signs and symptoms in head and neck region were selected for this study. All they had natural dentition without any fixed and removable protheses. Teeth wear area and arch width wre measured from the upper dental cast, tooth contact status were observed by T-Scan system$^\textregistered$ and four cephaloradiograpohs were taken from four head postures, namely, natural(NHP), forward(FHP), upward(UHP), and downward head postiure(DHP). 22 cephalometric items were measured on the films and the data were processed with SAS statistical program. The result of this study were as follows : 1. In normal group, angle of cervical vertebra tangent and of between hard and soft palate were broader in female subjects than those in male subjacets, but distance from subocciput to axis, size of soft palate, and pharyngeal space width were larger in male subjects. 2. In normal group with natural head posture, the items correlated each others from the three anatomical regions were distance between first nad second vertebra in posterior part, distance from the lingual surface of lower anterior teeth to anterior surface of soft palate, and distance from the hyoid bone to third vertebra. 3. Three set of items showed significant correlation each other in the four head postures in normal group. First set was the angle between hard and soft palate and the idstance from subocciput to posterior arch of first vertebra, second set was the distance between first and second vertebra in posterior part and the teeth wear area, third set was number and force of tooth contact and length of soft palate and distance from anterior tip of hyoid bone to mandibular plane.

• Journal of Korean Neurosurgical Society
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• 제64권1호
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• pp.69-77
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• 2021

Objective : Classification systems for cervical ossification of the posterior longitudinal ligament (OPLL) have traditionally focused on the morphological characteristics of ossification. Although the classification describes many clinical features associated with the shape of the ossification, including the concept of spondylosis seems necessary because of the similarity in age distribution. Methods : Patients diagnosed with OPLL who presented with increase signal intensity (ISI) on magnetic resonance imaging were surgically treated in our department. The patients were divided into two groups (pure versus degenerative) according to the presence of disc degeneration. Results : Of 141 patients enrolled in this study, more than half (61%) were classified into the degenerative group. The pure group showed a profound male predominance, early presentation of myelopathy, and a different predilection for ISI compared to the degenerative group. The mean canal compromise ratio (CC) of the ISI was 47% in the degenerative group versus 61% in the pure group (p<0.0000). On the contrary, the global and segment motions were significantly larger in the degenerative group (p<0.0000 and p=0.003, respectively). The canal diameters and global angles did not differ between groups. Conclusion : Classifying cervical OPLL based on the presence of combined disc degeneration is beneficial for understanding the disorder's behavior. CC appears to be the main factor in the development of myelopathy in the pure group, whereas additional dynamic factors appear to affect its development in the degenerative group.

• Journal of Chest Surgery
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• 제27권12호
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• pp.1060-1065
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• 1994

For most surgeons, stomach and colon are the first choice for reconstruction of the esophagus, as well as for bypass. When the esophagogastric or esophagocolonic anastomosis is made in the neck, cervical anastomosis site leakage is the main complication. In our most recent four patients who underwent a transhiatal & posterior mediastinal esophagogastric or esophagocolonic anastomoses following esophageal resection, we performed the cervical anastomoses with a circular EEA stapler. No leaks have developed at the anastomosis site. In these four patients the cancer was tiny and was located on the upper or middle third of the thoracic esophagus. A total esophagectomy was performed by blunt resection without thoracotomy. Surgical staplers have been used previously for esophagogastric anastomosis through a right thoracotomy with a very low rate of leakage. When the esophagogastric or esophagocolonic anastomosis is performed in the neck, the prevalence of leakage does not increase the postoperative mortality, but it can increase significantly the duration of hospitalization and morbidity. The use of the circular stapler allowed us to perform four consecutive cervical esophagogastric & esophagocolonic anastomoses without any leakage and to shorten the operating time.

• 융합정보논문지
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• 제7권4호
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• pp.97-103
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• 2017

본 연구의 목적은 앉은 자세에서 골반의 앞방향경사와 뒷방향경사에 따른 스마트폰의 사용이 목세움근과 위등세모근의 근활성도를 알아보고 IoT 디바이스 개발에 필요한 기초자료를 얻고자 하였다. 건강한 20-30대 성인남녀 15명을 대상으로 앉은 자세에서 골반앞방향경사와 골반뒷방향경사를 중재한 뒤 5분간 스마트폰을 사용하여 근전도 신호를 측정하고 중앙 3분의 근전도 신호를 사용하였다. 연구결과 앉은 자세에서 골반앞방향경사의 스마트폰 사용이 골반뒤방향경사와 비교하여 양측 목세움근(p<.001), 왼쪽 위등세모근(p<.001), 오른쪽 위등세모근(p<.002)의 %RVC 값이 유의하게 낮았다. 이는 골반의 앞방향경사를 통한 앉은 자세가 척추의 정상적인 만곡을 유지하여 스마트폰 사용 시 발생하게 되는 전방머리자세를 방지하여 목과 어깨 주변의 부하를 감소시켜 %RVC 값이 유의하게 낮았다고 사료되며 향후 골반경사에 중점을 둔 새로운 자세교정 IoT 디바이스들이 개발되어야할 것이다.

• Journal of Korean Neurosurgical Society
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• 제56권2호
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• pp.114-120
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• 2014

Objective : At present, gold-standard technique of cervical cord decompression is surgical decompression and fusion. But, many complications related cervical fusion have been reported. We adopted an extended anterior cervical foraminotomy (EACF) technique to decompress the anterolateral portion of cervical cord and report clinical results and effectiveness of this procedure. Methods : Fifty-three patients were operated consecutively using EACF from 2008 to 2013. All of them were operated by a single surgeon via the unilateral approach. Twenty-two patients who exhibited radicular and/or myelopathic symptoms were enrolled in this study. All of them showed cervical cord compression in their preoperative magnetic resonance scan images. Results : In surgical outcomes, 14 patients (64%) were classified as excellent and six (27%), as good. The mean difference of cervical cord anterior-posterior diameter after surgery was 0.92 mm (p<0.01) and transverse area was $9.77mm^2$ (p<0.01). The dynamic radiological study showed that the average post-operative translation (retrolisthesis) was 0.36 mm and the disc height loss at the operated level was 0.81 mm. The change in the Cobb angle decreased to 3.46, and showed slight kyphosis. The average vertebral body resection rate was 11.47%. No procedure-related complications occurred. Only one patient who had two-level decompression needed anterior fusion at one level as a secondary surgery due to postoperative instability. Conclusions : Cervical cord decompression was successfully performed using EACF technique. This procedure will be an alternative surgical option for treating cord compressing lesions. Long-term follow-up and a further study in larger series will be needed.

• Journal of Korean Neurosurgical Society
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• 제52권6호
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• pp.570-573
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• 2012

Avulsion of spinous process, also called Clay-shoveler's fracture, is most prevalent among those engaged in hard physical labor. To the best of the author's knowledge, only one case of multiple spinous process fractures of the upper thoracic spine in a novice golfer has been reported. A 45-year-old female presented with intractable posterior neck pain. The patient experienced a sharp, sudden pain on the neck while swinging a golf club, immediately after the club head struck the ground. Dynamic cervical radiographic findings were C6 and C7 spinous process fractures. Magnetic resonance imaging revealed C6 and C7 spinous process fractures without spinal cord pathology. The patient was treated with pain medications and cervical bracing. The patient's pain gradually improved. The injury mechanism was speculated to be similar to Clay-shoveler's fracture. Lower cervical spinous process fractures can be associated with a golf swing. If the patient complains of long lasting neck pain and has a history of golf activity, further study should be conducted to rule out lower cervical spinous fracture.

• Journal of Korean Neurosurgical Society
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• 제46권2호
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• pp.172-175
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• 2009

We describe a case of 36-year-old man who presented with a subacute headache preceded by a 1-month history of posterior neck pain without trauma history. Head and neck magnetic resonance imaging (MRI) studies disclosed bilateral supratentorial subdural and retroclival extradural hematomas associated with marked cervical epidural venous engorgement. Cerebral and spinal angiography disclosed no abnormalities except dilated cervical epidural veins. We performed serial follow-up MRI studied to monitor his condition. Patient's symptoms improved gradually. Serial radiologic studies revealed gradual resolution of pathologic findings. A 3-month follow-up MRI study of the brain and cervical spine revealed complete resolution of the retroclival extradural hematoma, disappearance of the cervical epidural venous engorgement, and partial resolution of the bilateral supratentorial subdural hematoma. Complete resolution of the bilateral supratentorial subdural hematoma was confirmed on a 5-month follow-up brain MRI. The diagnosis and possible mechanisms of this rare association are discussed.

• Journal of Korean Neurosurgical Society
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• 제56권1호
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• pp.55-57
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• 2014

Synovial cysts of the cervical spine, although they occur infrequently, may cause acute radiculopathy or myelopathy. Here, we report a case of a cervical synovial cyst presenting as acute myelopathy after manual stretching. A 68-year-old man presented with gait disturbance, decreased touch senses, and increased sensitivity to pain below T12 level. These symptoms developed after manual stretching 3 days prior. Computed tomography scanning and magnetic resonance imaging revealed a 1-cm, small multilocular cystic lesion in the spinal canal with cord compression at the C7-T1 level. We performed a left partial laminectomy of C7 and T1 using a posterior approach and completely removed the cystic mass. Histological examination of the resected mass revealed fibrous tissue fragments with amorphous materials and granulation tissue compatible with a synovial cyst. The patient's symptoms resolved after surgery. We describe a case of acute myelopathy caused by a cervical synovial cyst that was treated by surgical excision. Although cervical synovial cysts are often associated with degenerative facet joints, clinicians should be aware of the possibility that these cysts can cause acute neurologic symptoms.