• Journal of Korean Neurosurgical Society
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• v.63 no.3
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• pp.346-357
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• 2020

During the follow-up period after surgery for spinal dysraphism, a certain portion of patients show neurological deterioration and its secondary phenomena, such as motor, sensory or sphincter changes, foot and spinal deformities, pain, and spasticity. These clinical manifestations are caused by tethering effects on the neural structures at the site of previous operation. The widespread recognition of retethering drew the attention of medical professionals of various specialties because of its incidence, which is not low when surveillance is adequate, and its progressive nature. This article reviews the literature on the incidence and timing of deterioration, predisposing factors for retethering, clinical manifestations, diagnosis, surgical treatment and its complications, clinical outcomes, prognostic factors after retethering surgery and preventive measures of retethering. Current practice and opinions of Seoul National University Children's Hospital team were added in some parts. The literature shows a wide range of data regarding the incidence, rate and degree of surgical complications and long-term outcomes. The method of prevention is still one of the main topics of this entity. Although alternatives such as spinal column shortening were introduced, re-untethering by conventional surgical methods remains the current main management tool. Re-untethering surgery is a much more difficult task than primary untethering surgery. Updated publications include strong skepticism on re-untethering surgery in a certain group of patients, though it is from a minority of research groups. For all of the abovementioned reasons, new information and ideas on the early diagnosis, treatment and prevention of retethering are critically necessary in this era.

• Korean Journal of Applied Biomechanics
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• v.24 no.4
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• pp.375-383
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• 2014

The purpose of this study was to assess the inter-segmental trunk motion during which multi-segmental movements of the spinal column was designed to interpret the effect of segmentation on the total measured spine motion. Also it analyzed the relative motion at three types of the spine models in drop landing. A secondary goal was to determine the intrinsic algorithmic errors of spine motion and the usefulness of such an approach as a tool to assess spinal motions. College students in the soccer team were selected the ten males with no history of spine symptoms or injuries. Each subject was given a fifteen minute adaptation period of drop landing on the 30cm height box. Inter-segmental spine motion were collected Vicon Motion Capture System (250 Hz) and synchronized with GRF data (1000 Hz). The result shows that Model III has a more increased range of motion (ROM) than Model I and Model II. And the Lagrange energy has significant difference of at E3 and E4 (p<.05). This study can be concluded that there are differences in the three models of algorithm during the phase of load absorption. Especially, Model III shows proper spine motion for the inter-segmental joint motion with the interaction effects using the seven segments. Model III shows more proper observed values about dynamic equilibrium than Model I & Model II. The findings have shown that the dynamic stability strategy of Model III toward multi-directional spinal motion supports for better function of the inter-segmental motor-control than the Model I and Model II.

• Journal of Korean Neurosurgical Society
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• v.55 no.3
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• pp.142-147
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• 2014

Objective : A thoracolumbar burst fracture is usually unstable and can cause neurological deficits and angular deformity. Patients with unstable thoracolumbar burst fracture usually need surgery for decompression of the spinal canal, correction of the angular deformity, and stabilization of the spinal column. We compared two struts, titanium mesh cages (TMCs) and expandable cages. Methods : 33 patients, who underwent anterior thoracolumbar reconstruction using either TMCs (n=16) or expandable cages (n=17) between June 2000 and September 2011 were included in this study. Clinical outcome was measured by visual analogue scale (VAS), American Spinal Injury Association (ASIA) scale and Low Back Outcome Score (LBOS) for functional neurological evaluation. The Cobb angle, body height of the fractured vertebra, the operation time and amount of intra-operative bleeding were measured in both groups. Results : In the expandable cage group, operation time and amount of intraoperative blood loss were lower than that in the TMC group. The mean VAS scores and LBOS in both groups were improved, but no significant difference. Cobb angle was corrected higher than that in expandable cage group from postoperative to the last follow-up. The change in Cobb angles between preoperative, postoperative, and the last follow-up did not show any significant difference. There was no difference in the subsidence of anterior body height between both groups. Conclusion : There was no significant difference in the change in Cobb angles with an inter-group comparison, the expandable cage group showed better results in loss of kyphosis correction, operation time, and amount of intraoperative blood loss.

• Journal of the Korean Orthopaedic Association
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• v.54 no.6
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• pp.562-566
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• 2019

Osteochondroma is a common benign bone tumor, but relatively rare in the spine. Spinal osteochondroma originates mainly from the posterior column and sometimes invades the spinal canal causing cord compression and myelopathy. A 36-year-old man was admitted to the authors' institution with a two-year history of neck pain. A radiology examination revealed osteochondroma, arising from the left superior articular process of the T1 vertebra with significant central canal narrowing. Most cases of the spinal osteochondroma originate in the cervical vertebra, but there are few reports of an origin of the cervicothoracic junction. This paper reports a case of osteochondroma at the cervicothoracic junction with a review of the relevant literature.

• Journal of Korean Neurosurgical Society
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• v.64 no.6
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• pp.944-949
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• 2021

Objective : The stability is an important factor to decide the treatment plan in thoracolumbar burst fracture patients. Patients with an unstable burst fracture generally need operative management. Decrease in vertebral body height, local kyphosis, involvement of posterior column, and/or canal compromise are considered important factors to determine the treatment plan. On the other hand, in thoracolumbar injury classification system (TLICS), surgery is recommended in patients with TLICS of more than 5 points. The purpose of this study was to apply the TLICS score in patients with thoracolumbar burst fractures and to distinguish the differences of treatment plan on burst fracture. Methods : All patients, diagnosed as a thoracolumbar burst fracture between January 2006 and February 2019 were included in this study. Unstable thoracolumbar burst fracture was defined as burst fracture with neurologic deficit, three-column injury, kyphosis over 30 degrees, decrease of anterior body height over 40 percent and canal comprise more than 50%. TLICS score was measured with morphology, neurological involvement and posterior ligamentous complex integrity. The existence of instability was compared with TLICS score. Results : Total 233 patients (131 men, 102 women) were included in this study. In Denis classification, 51 patients (21.9%) diagnosed as stable burst fracture while 182 patients (78.1%) had unstable burst fracture. According to TLICS, 72 patients (30.9%) scored less than 4, while 161 patients (69.1%) scored 4 or more. All the patients with stable burst fracture scored 2 in TLICS. Twenty-one patients (9.0) scored 2 in TLICS but diagnosed as unstable burst fracture. Thirteen patients had over 40% of vertebra body compression, four patients had more than 50% of canal compromise, three patients had both body compression over 40% and kyphosis over 30 degrees, one patients had both body compression and canal compromise. Fifteen patients presented kyphosis over 30 degrees, and three (20%) of them scored 2 in TLICS. Seventy-three patients presented vertebral body compression over 40% and 17 (23.3%) of them scored 2 in TLICS. Fifty-three patients presented spinal canal compromise more than 50%, and five (9.4%) of them scored 2 in TLICS. Conclusion : Although the instability of thoracolumbar burst fracture was regarded as a critical factor for operability, therapeutic strategies by TLICS do not exactly match with the concept of instability. According to the concept of TLICS, it should be reconsidered whether the unstable burst fracture truly unstable to do operation.

• Journal of Korean Neurosurgical Society
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• v.52 no.6
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• pp.509-512
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• 2012

Objective : The purpose of this study is to evaluate neuroprotective effect of sacral neuromodulation in rat spinal cord injury (SCI) model in the histological and functional aspects. Methods : Twenty-one female Sprague Dawley rats were randomly divided into 3 groups : the normal control group (CTL, n=7), the SCI with sham stimulation group (SCI, n=7), and the SCI with electrical stimulation (SCI+ES, n=7). Spinal cord was injured by dropping an impactor from 25 mm height. Sacral nerve electrical stimulation was performed by the following protocol : pulse duration, 0.1 ms; frequency, 20 Hz; stimulation time, 30 minutes; and stimulation duration, 4 weeks. Both locomotor function and histological examination were evaluated as scheduled. Results : The number of anterior horn cell was $12.3{\pm}5.7$ cells/high power field (HPF) in the CTL group, $7.8{\pm}4.9$ cells/HPF in the SCI group, and $6.9{\pm}5.5$ cells/HPF in the SCI+ES group, respectively. Both the SCI and the SCI+ES groups showed severe loss of anterior horn cells and myelin fibers compared with the CTL group. Cavitation and demyelinization of the nerve fibers has no significant difference between the SCI group and the SCI+ES group. Cavitation of dorsal column was more evident in only two rats of SCI group than the SCI+ES group. The locomotor function of all rats improved over time but there was no significant difference at any point in time between the SCI and the SCI+ES group. Conclusion : In a rat thoracic spinal cord contusion model, we observed that sacral neuromodulation did not prevent SCI-induced myelin loss and apoptosis.

• Korean Journal of Ichthyology
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• v.9 no.1
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• pp.114-120
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• 1997

Frequencies and the types of abnormal vertebrae in the juvenile of five cyprinid fishes collected from the Kumho River during 1995 and 1996 were examined. Types of vertebral anomalies in investigated species were spinal curvature, fused vertebrae, helical sutures of cetera and abnormal vertebrae with one or two additional spines. The frequencies and the types of vertebral anomalies were different among the species. Of all the examined species, the type with one or two additional spines showed the highest frequencies, 11.72~12.11%. The frequencies of fused vertebrae was 4.45~7.68%. Thes two types of vertebral anomalies were observed in all species. Among the several types of fused vertebrae, the frequencies of double fused vertebrae were higher than those of other types. Also, the incidence of fused vertebrae located in the caudal region of vertebral column was much higher than that in other regions. The percentages of spinal curvature and helical sutures of vertebrae in the investigated species were 0.02~0.15% and 0.02%, respectively. Among the examined specimens, vertebral anomalies include fused vertebrae and one or two additional spines were shown in the three species, Korean slender gudgeon (Squalidus gracilis majimae), False dace (Pseudorasbora parva) and Crucian carp (Carassius auratus). In addition to the two vertebral anomalies, spinal curvature was shown in the Korean gudgeon (Squalidus chankaensis tsuchigae). Dark chub (Zacco temmincki) had fused vertebrae, one or two additional spines, spinal curvature, and helical sutures of vertebrae. This species has the most variable vertebral anomalies. Frequencies of fused vertebrae and one or two additional spines in the all tested fishes were not related with their standard lengths measured. However, spinal curvature and helical sutures of vertebrae were shown only in the specimens smaller than 20mm in standard length.

• The Korean Journal of Physiology and Pharmacology
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• v.19 no.5
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• pp.427-434
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• 2015

Significant evidence supports the role of the vestibular system in the regulation of blood pressure during postural movements. In the present study, the role of the vestibulo-spino-adrenal (VSA) axis in the modulation of blood pressure via the vestibulosympathetic reflex was clarified by immunohistochemical and enzyme immunoassay methods in conscious rats with sinoaortic denervation. Expression of c-Fos protein in the intermediolateral cell column of the middle thoracic spinal regions and blood epinephrine levels were investigated, following microinjection of glutamate receptor agonists or antagonists into the medial vestibular nucleus (MVN) and/or sodium nitroprusside (SNP)-induced hypotension. Both microinjection of glutamate receptor agonists (NMDA and AMPA) into the MVN or rostral ventrolateral medullary nucleus (RVLM) and SNP-induced hypotension led to increased number of c-Fos positive neurons in the intermediolateral cell column of the middle thoracic spinal regions and increased blood epinephrine levels. Pretreatment with microinjection of glutamate receptor antagonists (MK-801 and CNQX) into the MVN or RVLM prevented the increased number of c-Fos positive neurons resulting from SNP-induced hypotension, and reversed the increased blood epinephrine levels. These results indicate that the VSA axis may be a key component of the pathway used by the vestibulosympathetic reflex to maintain blood pressure during postural movements.

• Journal of Chest Surgery
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• v.28 no.11
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• pp.1071-1074
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• 1995

Approximately 9.8% of neurogenic tumors of the mediastinum extend into the spinal column so that the composite neoplastic mass was dumbbell shaped. We experienced three patients confirmed by Dumbbell shaped mediastinal tumor radiologically and tried surgical resection by posterolateral thoracotomy only corpectomy and costotransversectomy was performed simultaneously in three patients and interbody fusion in two. In one patient the diagnosis was liposarcoma and in 1 neuroblastoma and in 1 neurilemmoma. then followed by radiation theraphy in case I and radiation and chemotheraphy in case II. All three cases showed satisfactory results clinically and radiographically.

• Journal of Chest Surgery
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• v.23 no.5
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• pp.916-921
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• 1990

Clinical observations were performed on 17 cases of the traumatic sternal fracture, those were admitted and treated at the department of thoracic and cardiovascular surgery in Chosun University Hospital during the past 6 years 5months period from January 1983 to May 1989. Obtained results were as follows: 1. The frequency was about 4.8% of the nonpenetrating chest trauma. 2. The ratio of male to female was 16: 1 in male predominance and age distribution was from 24 to 62 years old. 3. The common cause were high decelerating injury [impact of the steering column] and falling down[more than 3 m in high]. 4. The most common fracture site was sternal body and next was sternomanubrial junction. 5. Associated intrathoracic organ injuries were cardiac contusion [6 cases], hemopneumothorax[1 Case], mediastinal bleeding[1 case], and thoracic cage and extrathoracic organ injuries were rib fracture, head injuries, thoracic spinal fracture, and long bone fracture. 6. Abnormal EGG findings were sinus bradycardia[1 case], bundle branch block [2 cases], and sinus tachycardia[3 cases]. 7. The operative reduction and fixation was necessary in only one case and the others were treated with conservative treatment.