• 대한의용생체공학회:의공학회지
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• 제25권3호
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• pp.171-182
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• 2004

본 연구에서는 의료 영상과 유한요소 해석을 이용하여 골절된 척추체의 치료를 위해 골 시멘트를 주입하는 추체 성형술(vertebroplasty)에 영향을 미치는 여러 인자들에 대해 생체 역학적으로 분석하여 평가하고자 하였다. 의료 영상을 통해 구현된 모델들은 분석하고자 하는 인자에 대하여 크게 단분절과 다분절 유한요소 모델의 2 가지 형태로 구분하였다. 단분절 유한요소 모델을 통해 골다공증의 정도, 주입된 골 시멘트의 양, 골 시멘트의 주입량 및 환자에게 주입된 골 시멘트 양의 적절성을 평가하였으며, 골 시멘트의 주입이 척추체의 구조적 안정성에 미치는 효과를 분석하기 위하여 척추체 상종판에 수직 압축하중을 가하여 이때의 최대 수진 변위량을 분석하였다. 또한 단분절 척추체의 강성도(stiffness) 값을 산출한 뒤, 정상 상태의 척추체의 강성도 값으로 정규화 하였다. 다분절 유한요소 모델의 경우, 압박 골절 상태를 적용하여 척추 만곡의 변화가 인체에 미치는 영향을 분석하기 위하여 골절의 정도를 3 가지로 구현하였으며, 모델의 최상부에 압축 하중을 가한 후의 척추 만곡의 변화 정도를 분석하였다. 추체 성형술에 대한 다양한 인자들에 대한 분석 결과, 추체 성형술을 통해 환자의 골밀도가 상대적으로 높은 경우(BMD 50mg/$m\ell$이상)와 환자의 척추체 망상골 부피의 약 15%에 해당하는 골 시멘트 주입 시 가장 큰 척추체의 구조적 안정성의 증가 효과를 가져올 것으로 예측되었다. 또한 척추 골절이 미치는 영향에 대한 분석 결과, -2.8$^{\circ}$의 정상적인 후만곡을 가지는 T12∼L2 운동 분절이 골절의 모델링 후 약 9∼17$^{\circ}$의 큰 전만곡을 가지게 되었으며 이러한 척추 만곡의 변화는 동일한 하중 하에서 급격한 척추 만곡의 변화를 야기하는 것으로 나타났다. 또한 골절의 정도가 심할수록 척추 변형은 더욱 크게 증가하는 것으로 나타났다. 이러한 연구 결과들로부터, 전반적으로 추체 성형술은 골 시멘트의 주입량 또는 골밀도에 상관없이 약화된 척추체의 자체의 구조적 안정성의 증가 효과를 가져왔으며 골절로 인해 추체의 높이가 손상되었을 경우 이를 회복하는 것이 중요한 인자의 하나임을 나타내는 결과로 사료되어진다.

• 한국어병학회지
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• 제21권2호
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• pp.139-148
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• 2008

Vertebral deformity in hatchery-reared black sea bream (Acanthoparus schlegelii) fingerlings occurred. Deformed fish had a good appetite but no clinical signs were found except the vertebral abnormality and darkness around the dorsal skin of the deformed vertebra. As more than 90% of the hatchery-reared fish exhibited vertebral abnormality, the fingerlings could not be used for commercial seeds any more. No morphological change in the swim bladder was observed. Histopathological changes on the deformed vertebra, gill, liver, and spleen were observed to clarify the cause of the deformity. The vertebra were irregularly deformed upward with the shape of "V" in an alphabetic character causing the spinal cord and dorsal aorta suppressed. The diameters of the muscle fibers around the deformed vertebra, especially, in the dorsal part, were much smaller and more irregular than those in normal fish, and the gabs between the fiber bundles were enlarged. No evidence of inflammatory responses in the lateral musculature were found. On the basis of normal inflation of the swim bladder, cultural environments for growth of the fingerlings, and histopathological alterations in the muscle, vertebra and gills, it is suggested that high speed of water current in the culturing aquaria between 23 to 30 days after hatching was responsible for the development of vertebral abnormality.

• Journal of Korean Neurosurgical Society
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• 제55권5호
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• pp.284-288
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• 2014

A rare case of atlantoaxial rotatory subluxation occurred after pediatric cervical spine surgery performed to remove a dumbbell-shaped meningioma at the level of the C1/C2 vertebrae. This case is classified as a post-surgical atlantoaxial rotatory subluxation, but has a very rare morphology that has not previously been reported. Although there are several reports about post-surgical atlantoaxial rotatory subluxation, an important point of this case is that it might be directly related to the spinal cord surgery in C1/C2 level. On day 6 after surgery, the patient presented with the Cock Robin position, and a computed tomography scan revealed a normal type of atlantoaxial rotatory subluxation. Manual reduction was performed followed by external fixation with a neck collar. About 7 months after the first surgery, the subluxation became severe, irreducible, and assumed an atypical form where the anterior tubercle of C1 migrated to a cranial position, and the posterior tubercle of C1 and the occipital bone leaned in a caudal direction. The pathogenic process suggested deformity of the occipital condyle and bilateral C2 superior facets with atlantooccipital subluxation. A second operation for reduction and fixation was performed, and the subluxation was stabilized by posterior fixation. We encountered an unusual case of a refractory subluxation that was associated with an atypical deformity of the upper spine. The case was successfully managed by posterior fixation.

• Journal of Korean Neurosurgical Society
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• 제30권4호
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• pp.451-455
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• 2001

Objectives : There have been several studies documenting the changing level of the conus throughout infancy and childhood, but there is only a little detailed study that documents the range of conus positions in a living adult population, especially in Korean, without spinal deformity. Methods : we made a sequential study of magnetic resonance images of the lumbar spine to determine the variation in position of the conus medullaris in 650 living korean adults population without spinal deformity who checked MRI to identify the cause of low back pain. The study population consisted of patients over the age of 16 years. A T1-weighted, midline, sagittal image was reviewed for identifying the postion of conus. This location was recorded in relation to the upper, middle, or lower third of the adjacent vertebral body or the adjacent intervertebral disc. Results : The study group consisted of 305 men(47%) and 345 women(53%) with a mean age 45.9 years(range, 16-79 years). The conus existed commonly at the middle third of L1(131cases, 20.2%), at the L1-2 intervertebral space(129cases, 19.8%), and the lower third of L1(123cases, 18.9%). The mean position of conus was the lower third of L1(range, middle third of T12 to middle third of L3). Conclusions : The mean position of conus was at the lower third of L1(range, middle third of T12 to middle third of L3). This results was same as that of foreign study. Our results of living korean adult population could allow for safe clinical procedures such as lumbar puncture, spinal anesthesia, and help to explain the differences among observed neurologic injuries from fracture-dislocation at the thoracolumbar junction.

• Journal of Genetic Medicine
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• 제7권2호
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• pp.145-150
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• 2010

선단이골증(acrodysostosis)은 매우 드문 골격계 이형성 질환의 하나로, 말단골 이형성을 보이는 짧은 손가락과 발가락, 코뼈의 저형성 및 정신지체를 그 특징으로 한다. 본 증례에서 저자들은 전형적인 임상 양상을 보이면서 신경 증상 및 징후와 경추관 협착을 동반한 선단이골증 16세 남아를 경험하여 보고 하고자 한다. 환아는 양쪽 상지의 간헐적인 통증과 위약감을 호소하였으며 양팔을 높이 들어올리는 것이 불가능함을 주소로 내원하였다. 신체 검진상 저신장을 보였으며 넓으면서도 낮은 콧등, 작고 위로 들려 올라간 코끝, 양쪽 눈의 안쪽 눈구석 주름 및 경한 양안격리증 등 특징적 안면 소견을 보였다. 신경심리검사상 중등도의 정신지체가 확인되었으며 청력검사상 양측의 신경성 난청 소견이 동반되어 있었다. 방사선학적 검사에서는, 원뿔 모양의 골단을 보이는 넓으면서도 짧은 중수골 및 지골, 양측 전와부의 마델룽 변형(Madelung deformity), 과형성된 첫 번째 중족골과 두꺼워진 두개골이 확인되었다. 뇌 및 척추 자기공명영상검사에서는 경추관 협착, 경추-연수 접합부의 압박을 동반한 편평두개저 및 소뇌 편도의 하방 이동 소견을 보였다. 선단이골증에서 동반되는 경추관 협착증은 시간이 지남에 따라 진행하는 경향을 보이므로, 6개월 후 추적 영상검사에서 진행되는 소견을 보이거나 증상이나 징후가 악화될 경우에는 수술적 갑압술을 실시할 계획이다. 본 증례는 선단이골증의 국내 보고로는 두 번째이나, 경추관 협착증의 증상 및 징후를 동반한 선단이골증의 첫 번째 보고이다. 선단이골증에서의 척추관 협착증은 시간이 지남에 따라 진행하는 증상이며 심각한 합병증이 초래될 수 있기 때문에, 특징적 임상 양상을 보이는 환자를 조기에 진단할 수 있다면 이러한 합병증에 대한 적절한 치료로서 치명적인 신경학적 후유증의 발생을 피할 수 있다. 따라서, 말단골의 이형성을 보이는 환자의 중요한 감별 질환 중 하나로 선단이골증은 반드시 고려되어야 할 것이다.

• Journal of Yeungnam Medical Science
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• 제13권2호
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• pp.234-242
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• 1996

영남대학교 의과대학 부속병원 신경외과에서 1994년 l월부터 1994년 12월까지 1년간 흉요추접합부 파열골절로 입원한 환자중 전측방경유법으로 10례를 수술로 치료경험 하였던 바, 척추골절이 척수원추 상부이면서 전방의 골편에 의해 척수신경이 압박되고 있는 불안정 파열골절시는 전방도달술에 의한 늑골 골융합 및 Kaneda기기내고정술로 좋은 결과를 기대할 수 있겠고, 척수 후주의 심한 손상이나 또는 3 column을 전체가 손상된 불안정 파열골절의 경우에는 후방접근법이나 후측방접근법으로 신경감압 및 내고정술 시행하는 것이 좋은 치료법이라 할 수 있겠다.

• Journal of Korean Neurosurgical Society
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• 제51권1호
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• pp.66-70
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• 2012

Thoracic pedicle screw fixation techniques are still controversial for thoracic deformities because of possible complications including neurologic deficit. Methods to aid the surgeon in appropriate screw placement have included the use of intraoperative fluoroscopy and/or radiography as well as image-guided techniques. We describe our technique for free hand pedicle screw placement in the thoracic spine without any radiographic guidance and present the results of pedicle screw placement analyzed by computed tomographic scan in two human cadavers. This free hand technique of thoracic pedicle screw placement performed in a step-wise, consistent, and compulsive manner is an accurate, reliable, and safe method of insertion to treat a variety of spinal disorders, including spinal deformity.

• The Journal of Korean Physical Therapy
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• 제16권1호
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• pp.60-69
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• 2004

Many methods have been described for the early intervention of adolescent idiopathic scoliosis. Adolescent idiopathic scoliosis is lateral and rotational spinal curvature in absence of associated congenital or neurologic abnormalities, the most common type of scoliosis observed in child and young adults, and refers to curves that develop after the age of $10{\sim}18$. The curves of adolescent idiopathic scoliosis have the potential to progress rapidly during growth. Curves are currently universally measured by the Cobb's method and Ferguson method. Some curves do not remain small, these may be mildly or severely progressive and the ribs on the convex side of the curve separate, and those on the concave side ribs approximate so rib undergoes deformation with rib humping. The latter may make angles that can affect vestibular system, balance, sensory, especially cardipulmonary function. Intervention for adolescent idiopathic scoliosis is based on the patient's age, the angular value of the curve, the maturity of their skeleton, and the topography. The purpose of intervention for adolescent idiopathic scoliosis consists of knowing how to go to the best approach the correction of the lateral curve and rotational deformity holding the achieved for the remainder of spinal growth, preventing significant cosmetic abnormality, pain and cardiopulmonary complication, control the muscle imbalance and proprioceptive postural disturbances, be less need for radical surgery to avoid early surgery.

• Journal of Korean Neurosurgical Society
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• 제50권3호
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• pp.224-230
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• 2011

Objective : This study aimed to show the possibility of neural canal enlargement and restoration of bony fragments through laminectomy and minimal facetectomy without pediculectomy or an anterior approach, and also to prove the adequacy of posterior stabilization of vertebral deformities after thoracolumbar bursting fracture. Methods : From January 2003 to June 2009, we experienced 45 patients with thoracolumbar burst fractures. All patients enrolled were presented with either a neural canal compromise of more than 40% with a Benzel-Larson Grade of VI, or more than 30% compromise with less than a Benzel-Larson Grade of V. Most important characteristic of our surgical procedure was repositioning retropulsed bone fragments using custom-designed instruments via laminectomy and minimal facetectomy without removing the fractured bone fragments. Beneath the dural sac, these custom-designed instruments could push the retropulsed bone fragments within the neural canal after the decompression and bone fragment repositioning. Results : The mean kyphotic deformities measured preoperatively and at follow-up within 12 months were 17.7 degrees (${\pm}6.4$ degrees) and 9.6 degrees (${\pm}5.2$ degrees), respectively. The mean midsagittal diameter improved from 8.8 mm (${\pm}2.8$ mm) before surgery to 14.2 mm (${\pm}1.6$ mm) at follow-up. The mean traumatic vertebral body height before surgery was 41.3% (${\pm}12.6%$). At follow-up assessment within 12 months, this score showed a statistically significant increase to 68.3% (${\pm}12.8%$). Neurological improvement occurred in all patients. Conclusion : Though controversy exists in the treatment of severe thoracolumbar burst fracture, we achieved effective radiological and clinical results in the cases of burst fractures causing severe canal compromise and spinal deformity by using this novel custom-designed instruments, via posterior approach alone.

• Journal of Korean Neurosurgical Society
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• 제38권6호
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• pp.435-441
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• 2005

Objective : Expandable cage used for spinal reconstruction after corpectomy has several advantages over nonexpendable cages. Here we present our clinical experience with the use of this cage after anterior column corpectomy with an average of one year follow up. Methods : Ten patients underwent expandable cage reconstruction of the anterior column after single-level or multilevel corpectomy for various cervical spinal disorders. Anterior plating with or without additional posterior instrumentation were performed in all patients. Functional outcomes, complications, and radiographic outcomes were determined. Results : There was no cage-related complication. Functionally, neurological examination revealed improvement in 7 of 10 patients and no patient had neurological deterioration after the surgery. Immediate stability was achieved and maintained throughout the period of follow-up. There was minimal subsidence [<2mm] noticeable in three of the cases that underwent a two-level corpectomy. Subsidence was noted in osteoporotic patients and patients undergoing multi-level corpectomies. Average pre-operative kyphotic angle was 9 degrees. This was corrected to an average of 5.4 degrees in lordosis postoperatively. Conclusion : In conclusion, expandable cages are safe and effective devices for vertebral body replacement after cervical corpectomy when used in combination with anterior plating with or without additional posterior stabilization. The advantages of using expandable cages include its ability to easily accommodate itself into the corpectomy defect, its ability to tightly purchase into the end plates after expansion and thus minimizing the potential for migration, and finally, its ability to correct kyphosis deformity via its in vivo expansion properties.