• Journal of Korean Neurosurgical Society
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• v.39 no.5
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• pp.366-369
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• 2006

Objective : There are various surgical approaches to far-lateral lesions in the L5-S1 intervertebral space. Of these is the validity of a paramedian tangential approach is being investigated in this study. Methods : A retrospective study was conducted on 25 patients who had been diagnosed as having a far-lateral L5-S1 disc herniations, osteophyte, costal process hypertrophy, and had undergone a paramedian tangential approach from November 1999 through December 2003. The degree of symptoms and improvement were compared via the visual analog pain scale, before and after surgery. Results : This study included 4 males and 21 females with a mean age of $62{\pm}11.8$ years old. The average follow-up period after surgery was $8.2{\pm}2.7$ months. The visual analog pain scale taken before surgery was $6.7{\pm}1.1$ points, while the post-surgical scale was $2.4{\pm}0.9$ points showing a significant degrease [p < 005]. There were no complications that developed during surgery. Conclusion : A paramedian tangential approach is less invasive in the soft tissue than that of the median approach. This approach may effectively reduce nerve root compression and expand intervertebral foramens, and is devoid of the risk of spinal instability after surgery. The authors suppose that a paramedian tangential approach is quite an effective technique to relive compression in the far-lateral L5-S1 intervertebral space.

• Journal of Korean Neurosurgical Society
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• v.37 no.1
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• pp.39-43
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• 2005

Objective: For Posterior lumbar interbody fusion(PLIF) various cages or iliac bone dowels are used with or without pedicle screw fixation(PSF). To evaluate and compare the clinical and radiological results of different fusion methods, we intend to verify the effect of added PSF on PLIF, the effect of bone cages and several factors which are thought to be related with the postoperative prognosis. Methods: One hundred and ninety seven patients with lumbar spinal stenosis and instability or spondylolisthesis underwent various fusion operations from May 1993 to May 2003. The patients were divided into five groups, group A (PLIF with autologous bone dowels, N=24), group B (PLIF with bone cages, N=13), group C (PLIF with bone dowels and PSF, N=37), group D (PLIF with bone cages and PSF, N=30) and group E (PSF with intertransverse bone graft, N=93) for comparison and analyzed for the outcome and fusion rate. Results: Outcome was not significantly different among the five groups. In intervertebral height (IVH) changes between pre- and post-operation, Group B ($2.42{\pm}2.20mm$) was better than Group A ($-1.33{\pm}2.05mm$). But in the Group C, D and E, the IVH changes were not different statistically. Fusion rate of group C, D was higher than that of Group A and B. But the intervertebral height(IVH) increased significantly in group B($2.42{\pm}2.20mm$). Fusion rate of group C and D were higher than that of group A and D. Conclusion: Intervertebral cages are superior to autologous iliac bone dowels for maintaining intervertebral height in PLIF. The additional pedicle screw fixation seems to stabilize the graft and improve fusion rates.

• The Journal of Korean Physical Therapy
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• v.25 no.3
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• pp.149-154
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• 2013

Purpose: Spinal instability due to weakness of abdominal muscles is one of the major causes that induces low back pain (LBP). The purpose of this study was to investigate any differences in abdominal muscle activity during curl up, roll out, and jack knife exercises using a swiss-ball or sling. Methods: Twenty healthy subjects were randomly assigned into either a swiss-ball exercise group (SBEG) or a sling exercise group (SEG). Subjects performed curl up, roll out and jack knife exercises using the swiss ball or sling. Activity of abdominal muscles (rectus abdominis and external oblique muscle) was assessed using surface EMG and normalized maximal voluntary isometric contraction (MVIC). The significance of differences between the sling exercise group and the swiss-ball exercise group was evaluated by the independent t-test. Results: These Results indicated that activities of rectus abdominis on right and left of the SEG during the curl up exercise were significantly greater than the SBEG. During the roll out exercise, activity of the abdominal muscle was not significantly different between the SEG and SBEG. In addition, during the jack knife exercise, activities of the right rectus abdominis and left external oblique muscle in the SEG were significantly greater than the SBEG. Conclusion: In conclusion, activity of the abdominal muscles was maximized when curl up and jack knife exercise were performed using the sling rather than the swiss-ball. Therefore, if increased activation of the abdominal muscle is the goal of an exercise program, curl up and jack knife exercises may be useful.

• The Korean Journal of Pain
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• v.20 no.2
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• pp.190-194
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• 2007

Complex regional pain syndrome (CRPS), which is a syndrome that is defined by pain and sudomotor and/or vasomotor instability, is usually resistant to conventional treatment. Here, a case involving a 30-year-old male patient with CRPS type I who showed severe intractable right shoulder pain with allodynia and hyperalgesia despite being treated with oral medications, nerve blocks including thoracic sympathetic neurolysis, and spinal cord stimulation is described. The patient frequently visited the emergency room due to severe uncontrollable breakthrough pain. Although a favorable effect was observed in response to intermittent ketamine infusion therapies that were performed on an outpatient basis, acute exacerbation of pain occurred frequently during the night and could not be controlled. Therefore, subcutaneous ketamine infusion therapy using a patient-controlled analgesic system was attempted and found to effectively control acute exacerbation of pain during 6 weeks of infusion without serious complications.

• Journal of Korean Neurosurgical Society
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• v.37 no.5
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• pp.340-344
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• 2005

Objective: Posterior lumbar interbody fusion(PLIF), the current leading method of pedicle screw fixation combined with interbody fusion via posterior route, sometimes requires too much destruction of the facet joint than expected especially for the patient with a narrow spine. On the other hand, tranforaminal lumbar interbody fusion(TLIF) technique provides potential advantages over PLIF and can be chosen as a better surgical alternative to more traditional fusion methods in certain surgical conditions. Methods: From October 1999, 99 PLIF and 29 TLIF procedures were done for the patients with spinal stenosis and instability. Radiological data including the interpedicular distance and the size of the pedicles as well as the clinical parameters were collected retrospectively. The degree of resection of the inferior articular process was compared with the interpedicular distance in each patient who received PLIF. Results: No significant differences were found between PLIF and TLIF regarding the operation time, blood loss, duration of hospital stay, or short term postoperative clinical result. There were no complication with TLIF, but PLIF resulted in 9(9.1%) complications. During PLIF procedure, all patients(n=24) except one with the interpedicular distance shorter than 27mm required near complete or complete resection of the inferior articular processes, whereas only 6(31.5%) of 19 patients with the interpedicular distances longer than 30mm required the similar extent of resection. Conclusion: TLIF is better than PLIF in terms of the complication rate. The patient who had narrow interpedicular distance(<27mm) might be better candidate for TLIF.

• Physical Therapy Korea
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• v.26 no.4
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• pp.1-9
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• 2019

Background: Cervical dysfunction is a common pathomechanical marker in individuals with forward head posture (FHP). To overcome the limitations of the isometric chin-tuck (ICT) exercise, dynamic neuromuscular stabilization (DNS), which emphasizes an entire spinal chain exercise, has recently shown promising clinical results. Objects: Purpose of this study was to compare the immediate effects between ICT and DNS techniques. Methods: 43 young subjects (mean age, $24.0{\pm}5.0$ years) were recruited. Group of subjects with FHP were measured under baseline, ICT, and DNS conditions. Outcome measures included sitting height, longus colli (LC) and sternocleidomastoid (SCM) muscle thickness and LC/SCM thickness ratio. One-way repeated measures ANOVA was used to compare the continuous dependent variables among FHP, ICT, and DNS conditions at p<.016. Results: Both ICT and DNS exercise conditions yielded significantly increased LC muscle thickness, LC/SCM thickness ratio and sitting height than did FHP condition (p<.0001, respectively). Sitting height was significantly greater in DNS exercise than in the ICT exercise (p<.0001). Conclusion: The present results demonstrated that sitting height was greater in the DNS exercise than in the ICT exercise, as well as both corrective postural training exercises were effective on LC/SCM muscle balance ratio when compared with the baseline FHP condition. Therefore, it is considered that DNS exercise can be the recommended exercise for people with FHP.

• Journal of Yeungnam Medical Science
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• v.14 no.1
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• pp.209-219
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• 1997

Objectives: Anterior approach to achieve arthrodesis of the cervical spine has become a widely accepted and often-used approach since its earliest reports by Bailey and Badgley, Smith and Robinson and Cloward. However, anterior interbody fusion in the presence of the posterior instability may be complicated by the bone graft dislodgement, kyphotic defomity or nonunion. As an attemp to prevent this undesirable complication, additional methods such as skeletal traction, halo appratus or even posterior fusion has been utilized. Therefore, The cervical spine locking plate(CSLP) with the anterior intervertebral body bone grafting provide immediate cervical stabilization and widely successful in achieving fusion. Material and methods: This study analysed 14 patients who underwent a single anterior procedure and application of CSLP for the treatment of the cervical spinal disorder. Eleven patients were disc herniations and three patients were traumatic lesion. The average age of the patient was 47 years and the mean follow up periods was 20 months ranging from 13 to 27 months. Results: Ambulation was started 2nd day after the operation with the aid of the Philadelpia orthoses. Bone union was observed 13 cases on average 12 weeks after operation. The one case was nonunion with plate breakage without clinical symptom. Conclusion: Anterior fusion with CSLP are thought to be a safe and valuable method for treating cervical spine disorder.

• Composites Research
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• v.25 no.4
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• pp.98-104
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• 2012

In recent years, degenerative spinal instability has been effectively treated with a cage. However, little attention is focused on the stiffness of the cage. Recent advances in the medical implant industry have resulted in the use of medical carbon fiber reinforced polymer (CFRP) cages. The biomechanical advantages of using different cage material in terms of stability and stresses in bone graft are not fully understood. A previously validated three-dimensional, nonlinear finite element model of an intact L2-L5 segment was modified to simulate posterior interbody fusion cages made of CFRP and titanium at the L4-L5 disc with pedicle screw, to investigate the effect of cage stiffness on the biomechanics of the fused segment in the lumbar region. From the results, it could be found that the use of a CFRP cage would not only reduce stress shielding, but it might also have led to increased bony fusion.

• Korean Journal of Head & Neck Oncology
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• v.34 no.1
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• pp.21-27
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• 2018

Background/Objectives: This study aimed to evaluate the changes of uptake around the sternoclavicular joint (SCJ) according to 18F-FDG PET images in patients with head and neck cancer who underwent neck dissection. Materials & Methods: Retrospectively, the medical records of patients who received selective or comprehensive neck dissection were reviewed. Preoperative and 1-year postoperative 18F-FDG PET images, if available, were analyzed by nuclear medicine physicians in both qualitative and quantitative manners. Correlation between the changes of uptake around SCJ and perioperative data were statistically analyzed. Results: Thirty-seven patients satisfying the inclusion criteria were enrolled. Seven patients with increased uptake around SCJ on 1-year postoperative 18F-FDG PET showed a correlation with radical or comprehensive neck dissection, accessory nerve sacrifice, and high postoperative SUVmax. When 20 patients with increased uptake around SCJ according to quantitative measurement were compared with other patients without increased uptake, no parameter was significantly different, except postoperative SUVmax. Bivariate logistic regression analysis revealed that the clinical symptom (shoulder or sternal pain) was significantly correlated with the extent of neck dissection (OR 0.227, CI 0.053-0.966, p=0.045) and spinal accessory nerve sacrifice (OR 13.500, CI 1.189-153.331, p=0.036). Conclusions: Increased uptake around SCJ on 1-year postoperative 18 F-FDG PET was correlated with either the radical or comprehensive procedure, as well as with accessory nerve sacrifice. This suggests that subjective analysis of 18F-FDG PET can be used to detect subclinical shoulder instability.

• Journal of Veterinary Clinics
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• v.26 no.3
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• pp.273-275
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• 2009

A 6-year-old castrated male Shih-tzu was presented because of a 1-month history of progressive tetraplegia. On the basis of the findings of neurological examination, radiographs and magnetic resonance imaging, herniated intervertebral disc of C4-C5, C5-C6 and C6-C7 compressed spinal cord. The oxygen-ozone was intra-operatively injected into the C4-C5 and C6-C7 intervertebral disc and a ventral decompression performed at C5-C6 intervertebral space. Immediately after the surgery, neck pain was disappeared and three weeks after surgery, there was complete resolution of the neurological deficits with normal gaits. On magnetic resonance images at 2-month after surgery, herniated disc materials of C5-C6 and C6-C7 were completely removed and that of C4-C5 remarkably reduced. Consequently decompression which was performed at all of the three lesions resulted in good clinical outcome without additional internal fixation for minimizing postoperative instability.