• Journal of Korean Neurosurgical Society
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• v.60 no.5
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• pp.567-576
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• 2017

Objective : Preoperative parameters including the T1 slope (T1S) and C2-C7 sagittal vertical axis (SVA) have been recognized as predictors of kyphosis after laminoplasty, which is accompanied by posterior neck muscle damage. The importance of preoperative parameters has been under-estimated in anterior cervical discectomy and fusion (ACDF) because there is no posterior neck muscle damage. We aimed to determine whether postoperative subsidence and pseudarthrosis could be predicted according to specific parameters on preoperative plain radiographs. Methods : We retrospectively analyzed 41 consecutive patients (male : female, 22 : 19; mean age, $51.15{\pm}9.25years$) who underwent ACDF with a stand-alone polyether-ether-ketone (PEEK) cage (>1 year follow-up). Parameters including SVA, T1S, segmental angle and range of motion (ROM), C2-C7 cervical angle and ROM, and segmental inter-spinous distance were measured on preoperative plain radiographs. Risk factors of subsidence and pseudarthrosis were determined using multivariate logistic regression. Results : Fifty-five segments (27 single-segment and 14 two-segment fusions) were included. The subsidence and pseudarthrosis rates based on the number of segments were 36.4% and 29.1%, respectively. Demographic data and fusion level were unrelated to subsidence. A greater T1S was associated with a lower risk of subsidence (p=0.017, odds ratio=0.206). A cutoff value of T1S<$28^{\circ}$ significantly predicted subsidence (sensitivity : 70%, specificity : 68.6%). There were no preoperative predictors of pseudarthrosis except old age. Conclusion : A lower T1S (T1S<$28^{\circ}$) could be a risk factor of subsidence following ACDF. Surgeons need to be aware of this risk factor and should consider various supportive procedures to reduce the subsidence rates for such cases.

• Journal of The Korean Society of Integrative Medicine
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• v.8 no.4
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• pp.191-202
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• 2020

Purpose : The purpose of this study is to examine the effect of the segmental mobilization technique of the lower back on the characteristics of the muscles and limited of stability of chronic backache patients. Methods : The subjects of the study were 30 chronic back pain patients who were divided into groups of 15, a manual therapy group (Group I) and a spinal decompression therapy group (Group II), via random assignation. The subjects had 15 minutes of superficial heat therapy, 15 minutes of interference wave therapy, and 5 minutes of ultrasound therapy for conservative physical therapy. Additionally, manual therapy and spinal decompression therapy were administered to each group for 30 minutes, 5 times a week for 8 weeks. Before intervention, the characteristics of the muscles and limited of stability of the muscles were analyzed. After 8 weeks of intervention, the above items were re-measured in the same manner and analyzed between groups. Results : The results of comparative analysis of the characteristics of the muscles and limited of stability between groups showed that there were statistically significant differences. The manual therapy group (Group I) showed significant differences in characteristics of the muscles compared to the spinal decompression therapy group (Group II). The manual therapy group (Group I) showed significant differences in limited of stability compared to the spinal decompression therapy group (Group II). Conclusion : The result confirmed that manual therapy was more effective in the characteristics of the muscles and limited of stability. Based on this study, additional studies are necessary on the effect of various techniques of manual therapy on muscle activity and muscle thickness in chronic back pain patients. In order to develop an effective manual therapy program, studies using a variety of evaluations are needed.

• Phonetics and Speech Sciences
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• v.3 no.3
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• pp.19-26
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• 2011

Previous laboratory studies have shown that prosodic structures are encoded in the modulations of phonetic patterns of speech including suprasegmental as well as segmental features. Drawing on a prosodically annotated large-scale speech data from the Buckeye corpus of conversational speech of American English, the current study first evaluated the reliability of prosody annotation by a large number of ordinary listeners and later examined whether and how prosodic prominence influences the phonetic realization of multiple acoustic parameters in everyday conversational speech. The results showed that all the measures of acoustic parameters including pitch, loudness, duration, and spectral balance are increased when heard as prominent. These findings suggest that prosodic prominence enhances the phonetic characteristics of the acoustic parameters. The results also showed that the degree of phonetic enhancement vary depending on the types of the acoustic parameters. With respect to the formant structure, the findings from the present study more consistently support Sonority Expansion Hypothesis than Hyperarticulation Hypothesis, showing that the lexically stressed vowels are hyperarticulated only when hyperarticulation does not interfere with sonority expansion. Taken all into account, the present study showed that prosodic prominence modulates the phonetic realization of the acoustic parameters to the direction of the phonetic strengthening in everyday conversational speech and ordinary listeners are attentive to such phonetic variation associated with prosody in speech perception. However, the present study also showed that in everyday conversational speech there is no single dominant acoustic measure signaling prosodic prominence and listeners must attend to such small acoustic variation or integrate acoustic information from multiple acoustic parameters in prosody perception.

• Journal of Korean Neurosurgical Society
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• v.64 no.6
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• pp.913-921
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• 2021

Objective : Accurate measurement of T1 slope (a component of T1s minus cervical lordosis [CL]) is often constrained by anatomical limitations. In this situation, efforts should be made to find the exact meaning of T1s-CL and whether there are any alternatives to it. Methods : We enrolled 117 patients who received two-level anterior cervical discectomy and fusion (ACDF). Occipital slope, C2 slope (C2s), C7 slope (C7s), T1, O-C2 angle (O-C2A), C2-7 angle (C2-7A), O-C7 angle (O-C7A), T1s-CL, C7-T1 angle (C7-T1A), and C2-7 sagittal vertical axis were measured. We determined 16° (T1s-CL) as the reference point for dividing subjects into the mismatch group and the balance group, and a comparative analysis was performed. Results : The mean value of C7-T1A was constantly maintained within 2.6° peri-operatively. In addition, C2s and T1s-CL showed the same absolute change (Δ|0.8|°). The mean values of T1s-CL of the mismatch and balance groups were 23.0° and 7.6°, respectively. The five factors with the largest differences between the two groups were as follows : C2s (Δ13.3°), T1s-CL (Δ15.4°), O-C2A (Δ8.7°), C2-7A (Δ14.7°), and segmental angle (Δ7.9°) before surgery. Only four factors showed statistically significant change between the two groups after ACDF : T1s-CL (Δ4.0° vs. Δ0.2°), C2s (Δ3.2° vs. Δ0.7°), O-C2A (Δ2.6° vs. Δ1.3°), C2-7A (Δ6.3° vs. Δ1.3°). A very strong correlation between T1s-CL and C2s was also found (r=|0.88-0.96|). Conclusion : C2s itself may be the essential key to represent T1s-CL. The amounts and directions of change of these two factors (T1s-CL and C2s) were also almost identical. The above phenomenon was re-confirmed once again through the correlation analysis.

• Journal of Korean Neurosurgical Society
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• v.60 no.5
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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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• v.47 no.5
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• pp.338-344
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• 2010

Objective : This study assessed the safety and efficacy of one level unilateral laminotomy bilateral decompression (ULBD) with the placement of a device for intervertebral assisted motion (DIAM) compared with one level ULBD only in elderly patients with degenerative lumbar spinal stenosis (DLSS). Methods : A non randomized prospective analysis was performed on 16 patients who underwent one level ULBD with DIAM (Group A) and 20 patients with one level ULBD only (Group B) between February 2007 and March 2008. Radiographic imaging, visual analog scale (VAS) and MacNab outcome scale were obtained before and after surgery at a mean interval of 21 months (range 17-27 months). Results : The disc height, interpedicular distance, slip distance and segmental lordotic angle were similar between two groups. In the group A, there was no significant difference between the pre- and post-operative imaging in terms of the sagittal balance and disc height. Both groups showed significant improvement in the clinical outcomes. In addition, there was significantly less low-back pain in the group A than in the group B at the last follow up, while the clinical improvement of the leg pain and MacNab outcome scale showed no significant difference in the two groups. There were no major complications or DIAM associated complications. Conclusion : ULBD with DIAM is a safe and efficacious treatment for selective elderly patients with DLSS, particularly for relieving low back pain comparing to ULBD. ULBD with DIAM did not alter the disc height or sagittal alignment at the mean 21 months follow-up interval.

• Journal of Gastric Cancer
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• v.6 no.3
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• pp.198-201
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• 2006

Hyponatremia is a dangerous electrolyte disturbance in patients on chemotherapy and may cause sudden death if not detected early. SIADH (syndrome of inappropriate antidiuretic hormone) is one of the known causes of hyponatremia in patients undergoing chemotherapy. Few chemotherapeutic agents, however, are reported to cause SIADH. The current study reports that SIADH developed in a 55 year old woman on S-1 ($80\;mg/m^{2}$) and cisplatin ($60\;mg/m^{2}$) chemotherapy for the peritoneal metastasis of gastric cancer. The patient underwent a total gastrectomy, a splenectomy, and a segmental resection of the transverse colon for gastric cancer. She had used thiazide and ${\beta}-blocker$ to treat hyperiension for 12 years. She admitted to our hospital with complaining of general weakness, dysarthria, loss of appetite, and urinary discomfort. The serum level of sodium and potassium were 94 mEq/L and 2.2 mEq/L respectively. The hyponatremia completely resolved uneventfully after 3% saline infusion, which led to normalized electrolyte balance. The patient was discharged on the 13th hospital day.

• Journal of Korean Neurosurgical Society
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• v.60 no.1
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• pp.30-39
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• 2017

Objective : To compare the clinical outcomes and biomechanical effects of total disc replacement (TDR) and posterior cervical foraminotomy (PCF) and to propose relative inclusion criteria. Methods : Thirty-five patients who underwent surgery between 2006 and 2008 were included. All patients had single-level disease and only radiculopathy. The overall sagittal balance and angle and height of a functional segmental unit (FSU; upper and lower vertebral body of the operative lesion) were assessed by preoperative and follow-up radiographs. C2-7 range of motion (ROM), FSU, and the adjacent segment were also checked. Results : The clinical outcome of TDR (group A) was tended to be superior to that of PCF (group B) without statistical significance. In the group A, preoperative and postoperative upper adjacent segment level motion values were $8.6{\pm}2.3$ and $8.4{\pm}2.0$, and lower level motion values were $8.4{\pm}2.2$ and $8.3{\pm}1.9$. Preoperative and postoperative FSU heights were $37.0{\pm}2.1$ and $37.1{\pm}1.8$. In the group B, upper level adjacent segment motion values were $8.1{\pm}2.6$ and $8.2{\pm}2.8$, and lower level motion values were $6.5{\pm}3.3$ and $6.3{\pm}3.1$. FSU heights were $37.1{\pm}2.0$ and $36.2{\pm}1.8$. The postoperative FSU motion and height changes were significant (p<0.05). The patient's satisfaction rates for surgery were 88.2% in group A and 88.8% in group B. Conclusion : TDR and PCF have favorable outcomes in patients with unilateral soft disc herniation. However, patients have different biomechanical backgrounds, so the patient's biomechanical characteristics and economic status should be understood and treated using the optimal procedure.

• Journal of Digestive Cancer Reports
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• v.9 no.1
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• pp.1-7
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• 2021

The length, the frequency, and the methods of surveillance for intraductal papillary mucinous neoplasm (IPMN) of the pancreas are still debating. According to the recent guidelines, IPMN is stratified into "high-risk stigmata" or absolute indication and "worrisome features" or relative indication as a guide in managing these patients, either those with resection of the lesion or those under surveillance. The risk of malignant transformation was quite low for branch duct-IPMNs without worrisome features or high risk stigmata. However, because the incidence rate of pancreatic cancer in these patients increase linearly with time, continued long-term surveillance is therefore important for patients with low-risk, as well as higher-risk, IPMN. Considering the high prevalence of malignancy, main duct-IPMN should be treated by surgical resection. Among patients with these type IPMNs, segmental dilatation of the main pancreatic duct without any mural nodules and larger than 10 mm of main pancreatic duct might not be immediately resected and need very careful examination and observation. The risk related to a major pancreatic resection must balance the risk of surveillance in patients with IPMN of the pancreas who have co-morbidity and are elderly.