• Journal of Trauma and Injury
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• v.32 no.2
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• pp.80-85
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• 2019

Purpose: To compare the time intervals to magnetic resonance imaging (MRI) and surgical treatment in patients having traumatic cervical spinal cord injury (SCI) with and without bony lesions. Methods: Retrospectively analyzed adult patients visited Kyungpook National University Hospital and underwent surgical treatment for cervical SCI within 24 hours. The patients who were suspected of having cervical SCI underwent plain radiography and computed tomography (CT) upon arrival. After the initial evaluation, we evaluated the MRI findings to determine surgical treatment. Waiting times for MRI and surgery were evaluated. Results: Thirty-four patients were included. Patients' mean age was 57 (range, 23-80) years. Patients with definite bony lesions were classified into group A, and 10 cases were identified (fracture-dislocation, seven; fracture alone, three). Patients without bony lesions were classified into group B, and 24 cases were identified (ossification of the posterior longitudinal ligament, 16; cervical spondylotic myelopathy, eight). Mean intervals between emergency room arrival and start of MRI were 93.60 (${\pm}60.08$) minutes in group A and 313.75 (${\pm}264.89$) minutes in group B, and the interval was significantly shorter in group A than in group B (p=0.01). The mean times to surgery were 248.4 (${\pm}76.03$) minutes in group A and 560.5 (${\pm}372.56$) minutes in group B, and the difference was statistically significant (p=0.001). The American Spinal Injury Association scale at the time of arrival showed that group A had a relatively severe neurologic deficit compared with group B (p=0.046). There was no statistical significance, but it seems to be good neurological recovery, if we start treatment sooner among patients treated within 24 hours (p=0.198). Conclusions: If fracture or dislocation is detected by CT, cervical SCI can be easily predicted resulting in MRI and surgical treatment being performed more rapidly. Additionally, fracture or dislocation tends to cause more severe neurological damage, so it is assumed that rapid diagnosis and treatment are possible.

• Archives of Plastic Surgery
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• v.49 no.6
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• pp.769-772
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• 2022

Femoral nerve injuries are devastating injuries that lead to paralysis of the quadriceps muscles, weakening knee extension to prohibit ambulation. We report a devastating case of electrical injury-induced femoral neuropathy, where no apparent site of nerve disruption can be identified, thus inhibiting the traditional choices of nerve reconstruction such as nerve repair, grafting, or transfer. Concomitant spinal cord injury resulted in spastic myopathy of the antagonist muscles that further restricted knee extension. Our strategy was to perform (1) supercharge end-to-side technique (SETS) to augment the function of target muscles and (2) fractional tendon lengthening to release the spastic muscles. Dramatic postoperative improvement in passive and active range of motion highlights the effectiveness of this strategy to manage partial femoral nerve injuries.

• Journal of Korean Neurosurgical Society
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• v.60 no.5
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• pp.534-539
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• 2017

Objective : Patients with hematological malignancies frequently encounter spine-related symptoms, which are caused by disease itself or process of treatment. However, there is still lack of knowledge on their epidemiology and clinical courses. The purpose of this article is to review clinical presentations and surgical results for spinal involvement of hematologic malignancies. Methods : From January 2011 to September 2014, 195 patients (98 males and 97 females) suffering from hematological malignancies combined with spinal problems were retrospectively analyzed for clinical and radiological characteristics and their clinical results. Results : The most common diagnosis of hematological malignancy was multiple myeloma (96 patients, 49.7%), followed by chronic myeloid leukemia (30, 15.2%), acute myeloid leukemia (22, 11.2%), and lymphoma (15, 7.56%). The major presenting symptoms were mechanical axial pain (132, 67.7%) resulting from pathologic fractures, and followed by radiating pain (49, 25.1%). Progressive neurologic deficits were noted in 15 patients (7.7%), which revealed as cord compression by epidural mass or compressive myelopathy combined with pathologic fractures. Reconstructive surgery for neurologic compromise was done in 16 patients. Even though surgical intervention was useful for early paralysis (Frankel grade D or E), neurologic recovery was not satisfactory for the progressed paralysis (Frankel grade A or B). Conclusion : Hematological malignancies may cause various spinal problems related to disease progression or consequences of treatments. Conservative and palliative treatments are mainstay for these lesions. However, timely surgical interventions should be considered for the cases of pathologic fractures with progressive neurologic compromise.

• Journal of Korean Clinical Nursing Research
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• v.20 no.3
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• pp.290-302
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• 2014

Purpose: The purpose of this study was to identify sexual activities of males with spinal cord injury (SCI) and influential factors of sexual adjustment. Methods: A correlational survey was conducted among a total of 135 males with SCI. Results: After SCI, patients maintained low levels of sexual adjustment, and a main obstacle of sexual rehabilitation was decreased erectile function (65.2%). Sexual desires recovered in 84.4%, with 62.4% patients reporting more than once intercourse experiences. The erectile function of participants with normal, decreased or no erectile function were 13.0%, 62.6% and 24.4%, respectively. 8.1% of the participants reported no problem with ejaculation. Patients with incomplete SCI had better preserved erectile function than those with complete SCI (t=-4.627, p<.001). Patients with upper motor neuron injury had better preserved erectile function than those with lower motor neuron injury (t=2.446, p =.016). Sexual adjustment was relevant to age, job, degree of injury, post-injury period, sexual desire, intercourse experience, erection therapy, erectile function, and sexual health. Sexual adjustment was a factor of sexual health with a power of 24.2%. Conclusion: The main obstacle of sexual rehabilitation for males with SCI decreased erectile function. Erection and ejaculation are dependent on the severity and level of SCI. The major influence on sexual adjustment is sexual health.

• The Journal of Korean Medicine
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• v.39 no.3
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• pp.89-100
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• 2018

Objectives: Korean Standard Classification of Functioning, Disability and Health (KCF), a useful tool for a comprehensive consideration of the health-related overall implications, might be also promising way to validate the effectiveness of Korean medicine. This study reports the change of pre- and post-hospitalization using the KCF in a patient with spinal cord infarction who underwent rehabilitation plus Korean medicine treatment. This study aims to apply the KCF to this case, evaluate its applicability, and review its expected benefits and obstacles in the clinical practice of Korean medicine. Methods: The changes in the overall health status of the patient were assessed by the KCF as well as the chief complaints, diagnosis, neurological deficits, and activities of daily living (ADL), impairment scale etc. before and after admission to a Korean medicine hospital were investigated. Results: Most of the chief complaints of the patient were improved enough to perform her daily routine activities independently. These improvements were reflected in the neurological function and ADL scores, but could not change the diagnosis according to the Korean Standard Classification of Diseases nor the impairment scale. The KCF, on the other hand, was able to grasp the changes of the patient in various aspects in terms of body function, body structure, activity and participation, and environmental factors. Conclusions: Through this case, we found the applicability of the KCF in clinical practice of Korean medicine and the possibility that the KCF can be a promising tool to show the effectiveness and benefits of Korean medicine.

• Journal of Korean Neurosurgical Society
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• v.61 no.5
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• pp.539-547
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• 2018

Traumatic spinal cord injury (SCI) research has recently focused on the use of rat and mouse models for in vivo SCI experiments. Such small rodent SCI models are invaluable for the field, and much has been discovered about the biologic and physiologic aspects of SCI from these models. It has been difficult, however, to reproduce the efficacy of treatments found to produce neurologic benefits in rodent SCI models when these treatments are tested in human clinical trials. A large animal model may have advantages for translational research where anatomical, physiological, or genetic similarities to humans may be more relevant for pre-clinically evaluating novel therapies. Here, we review the work carried out at the University of British Columbia (UBC) on a large animal model of SCI that utilizes Yucatan miniature pigs. The UBC porcine model of SCI may be a useful intermediary in the pre-clinical testing of novel pharmacological treatments, cell-based therapies, and the "bedside back to bench" translation of human clinical observations, which require preclinical testing in an applicable animal model.

• Journal of the Ergonomics Society of Korea
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• v.33 no.1
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• pp.15-25
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• 2014

Objective: This study aims to analyze the factors that affect the ability to maintain dynamic sitting balance (DSB), biomechanical characteristics, and physical characteristics in spinal cord injuries (SCI) patients. Background: Virtual ski training systems, ski equipment, and training protocols for disabled skiers are being studied to spread awareness. However, few studies have been reported on the sitting balance ability associated with chair mono skiing. Method: A dynamic sitting balance border system was built to investigate the ability to maintain dynamic sitting balance in SCI patients. Trunk muscle activity was evaluated by electromyogram while conducting dynamic sitting balance tests. The trunk muscle strength was tested with a portable handheld dynamometer. Physical activity scores were measured with the physical activity recall assessment. Results: There were high levels of correlation between the ability to maintain DSB and trunk flexor strength, extensor strength, rotator strength, and physical activity score. However, height, weight, and injury level in SCI patients were not correlated with the ability to maintain DSB. Additionally, strong negative correlations were found between muscle activities of the external oblique and lumbar erector spinae muscles and the ability to perform the backward tilt test. Trunk extensor muscle activity during the ball lifting test was significantly higher than in other tests. Conclusion: The results indicate that improving trunk muscle strength and physical activity can increase the ability to maintain DSB. Application: The findings of a close relationship between trunk strength, physical activity, and the ability to maintain DSB need to be reflected in the chair mono ski training program.

• The Korean Journal of Pain
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• v.33 no.1
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• pp.3-12
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• 2020

Neuropathic pain after spinal cord injury (SCI) has a significant negative impact on the patients' quality of life. The objective of this systematic review is to examine the safety and efficacy of pregabalin (PGB) and gabapentin (GBP) in the treatment of neuropathic pain due to SCI. PubMed, the Cochrane Library, Embase, Scopus, and the Web of Science were searched up to December 2018. The reference lists of key and review studies were reviewed for additional citations. The quality of the studies was evaluated using the Cochrane Collaboration's tools for assessing the risk of bias. A meta-analysis was performed for primary and secondary outcomes. Eight studies were eligible for inclusion. Meta-analysis of PGB vs. placebo showed that PGB was effective for neuropathic pain (standardized mean difference [SMD] = -0.40; 95% confidence interval [CI]: -0.78, -0.01), anxiety (MD = -0.68; 95% CI: -0.77, -0.59), depression (mean difference [MD] = -0.99; 95% CI: -1.08, -0.89), and sleep interference (MD = -1.08; 95% CI: -1.13, -1.02). Also, GBP was more effective than a placebo for reducing pain. No significant difference was observed between the efficacy of the two drugs (MD = -0.37; 95% CI: -1.67, 0.93). There was no significant difference between the two drugs for discontinuation due to adverse events (risk ratio = 3.00; 95% CI: 0.81, 11.15). PGB and GBP were effective vs. placebos in decreasing neuropathic pain after SCI. Also, there was no significant difference between the two drugs for decreasing pain and adverse events.

• Clinics in Orthopedic Surgery
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• v.10 no.4
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• pp.448-454
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• 2018

Background: Traumatic spinal cord injury (SCI) is a tragic event that has a major impact on individuals and society as well as the healthcare system. The purpose of this study was to investigate the strength of association between surgical treatment timing and neurological improvement. Methods: Fifty-six patients with neurological impairment due to traumatic SCI were included in this study. From January 2013 to June 2017, all their medical records were reviewed. Initially, to identify the factors affecting the recovery of neurological deficit after an acute SCI, we performed univariate logistic regression analyses for various variables. Then, we performed a multivariate logistic regression analysis for variables that showed a p-value of < 0.2 in the univariate analyses. The Hosmer-Lemeshow test was used to determine the goodness of fit for the multivariate logistic regression model. Results: In the univariate analysis on the strength of associations between various factors and neurological improvement, the following factors had a p-value of < 0.2: surgical timing (early, < 8 hours; late, 8-24 hours; p = 0.033), completeness of SCI (complete/incomplete; p = 0.033), and smoking (p = 0.095). In the multivariate analysis, only two variables were significant: surgical timing (odds ratio [OR], 0.128; p = 0.004) and completeness of SCI (OR, 9.611; p = 0.009). Conclusions: Early surgical decompression within 8 hours after traumatic SCI appeared to improve neurological recovery. Furthermore, incomplete SCI was more closely related to favorable neurological improvement than complete SCI. Therefore, we recommend early decompression as an effective treatment for traumatic SCI.

• Physical Therapy Rehabilitation Science
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• v.7 no.4
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• pp.147-153
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• 2018

Objective: This study investigated the effects of air stacking training (AST) on pulmonary function, respiratory strength, and peak cough flow (PCF) in persons with cervical spinal cord injury (CSCI). Design: Randomized controlled trial. Methods: A total of 24 persons with CSCI were randomly allocated to the AST group (n=12) or the incentive spirometry training (IST) group (n=12). Patients with CSCI received AST or IST for 15 minutes, with 3 sessions per week for 4 weeks, and all groups performed basic exercises for 15 minutes. In the AST group, after the subject inhaled the maximal amount of air as best as possible, the therapist insufflated additional air into the patient's lung using an oral nasal mask about 2-3 times. In the IST group, patients were allowed to hold for three seconds at the maximum inspiration and then to breathe. The pre and post-tests measured forced vital capacity (FVC), forced expiratory volume one at second (FEV1), maximal expiratory pressure (MEP), maximal inspiratory pressure (MIP) and PCF. Results: Both groups showed significant improvements in FVC, FEV1, MEP, MIP and PCF values after training (p<0.05). The FVC in the post-test and the mean change of FVC, FEV1, MIP were significantly higher in the AST group than the IST group (p<0.05). Conclusions: The findings of this study suggested that AST significantly improved pulmonary function, respiratory strength, and PCF in persons with CSCI. Therefore, AST should be included in respiratory rehabilitation programs to improve coughing ability, pulmonary function and respiratory muscle strength.