• 대한정형도수물리치료학회지
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• 제19권1호
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• pp.69-77
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• 2013

The pelvic girdle function as an integrated unit with all three bones moving at all three joints, are influenced by the lower extremities below and vertebral column and trunk above sacroiliac movements are caused by spinal motion, whereas iliosacral movements are caused by movements of the lower limbs. Concept of normal functional integration among the lumbar spine, pelvic and hip joint is basic to the understanding of dysfunction in this region and also functional movement of the lumbo-pelvic-hip region are part of the clinical examination, consequently the integrated biomechanics of these region need to be understood. The purpose of this review is to ascertain the integrated biomechanics among the lumbo-pelvic-hip complex by consideration of literature and to give sufficient information to be able to render accurate assessment and treatment for the syndromes described.

• 한국산학기술학회논문지
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• 제21권12호
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• pp.43-51
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• 2020

이 연구는 8주간의 척추 안정화 운동프로그램이 경부 장애 지수, 균형 능력 및 자세 변화에 어떠한 영향을 주는지를 알아보는 것이다. 운동 프로그램은 8주간 주 3회 척추 안정화 운동을 시행하였으며, 총 60분으로 구성하였다. 연구의 대상자는 6개월간 경부통을 호소하는 만성 경부통 환자 16명을 대상으로 운동 집단(n=8명)과 통제 집단(n=8명)으로 분류하여 운동 프로그램 사전, 사후의 결과를 관찰하여 다음과 같은 결과를 도출하였다. 경부 장애 지수는 시기, 집단, 상호작용에서 유의차가 나타났다(p<.05). 균형 능력은 집단 및 시기 간에서 유의한 상호작용 효과가 나타났다(p<.05). 자세 변화는 골반 경사각에서 시기, 상호작용에서 유의차가 나타났고(p<.05), 경부 및 어깨 위치각은 집단, 시기, 집단, 상호작용 모두 유의차가 나타났다(p<.05). 이상의 결과 척추 안정화 운동이 만성 경부통 환자에게 경부 장애 지수, 균형 능력 변화, 자세 변화에서 유의하게 개선된 결과를 나타내었다. 추후 연구에서는 방사선 영상을 통한 척추 구조 변화에 대한 구체적인 변화를 분석하여 척추 안정화 운동의 타당성을 높이는 연구가 필요할 것으로 사료된다.

• Annals of Clinical Neurophysiology
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• 제12권1호
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• pp.3-6
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• 2010

The British guideline for early management of persistent low back pain, published in 2009, indicated that physicians should offer exercise or medication, rather than radiological interventions or injections, as first choice of treatment in the patients with chronic low back pain (CLBP). However, there had been great controversies regarding the effectiveness of interventional treatment of patients with CLBP. Both somatic (discogenic, instability, etc) and psychosocial factors contribute to the pathophysiology of chronic low back pain (CLBP). Although it can be difficult in many occasions, thorough interview with the patients and specific diagnostic approaches can help us to identify which is the main etiology in individual patient. With the recent progress in medical radiology and development of new therapeutic modalities, some subgroups of patients of CLBP caused by somatic factors appear to be good candidates of interventional therapy. Interventional therapy can be considered in patients with CLBP caused by annulus rupture, facet joint degeneration, disc degeneration, and vertebral column instability. Among other subgroups of CLBP, carefully selected patients with disc degeneration show the most favorable result by interventional therapy. In this regard, discogenic pain, either as a form of CLBP or acute discogenic radiculopathy, seems to be a good indication of interventional therapy. Because many spine specialists generally consider those with radiculopathy are easier to be treated, patients with CLBP tend to be subjects of conventional conservative therapy. For these reasons, clinicians should make their best effort to identify every possible somatic cause in patients with CLBP before regarding them as hypochondriacs. In this review, some of the recent evidence on the role of interventional treatment in patients with CLBP will be discussed, and some of our cases who showed favorable results by interventional therapy will be presented.

• Journal of Korean Neurosurgical Society
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• 제29권11호
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• pp.1484-1490
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• 2000

Objectives : In spinal metastasis and myeloma, percutaneous vertebroplasty could be an effective treatment method to provide spinal stabilization and to relief pain for early rehabilitation. The authors report twenty-five cases the clinical results of percutaneous vertebroplasty for twenty-five cases of spinal metastasis and myeloma. Materials and Methods : From September 1998 to December 1999, seventy percutaneous vertebroplasties(PVP) were performed for spinal metastases and myeloma in 25 patients, sixteen women and nine men ranging in age from 34 to 74. The primary malignancies were 6 multiple myelomas, and in metastatic tumore from various origin. All patients complained of severe pain and had osteolytic vertebral body destructions without spinal cord compression. To evaluate clinical improvement, suObjective verbal analogue pain score(VAS) and Karnofsky performance scale(KPS) were used. Thin sliced(2mm-thickness) sectional computed tomography(CT) was performed before and after PVP. Plain X-ray film was followed up every 1 month to assess the vertebral column stability. Results : In 25 patients, a total of seventy PVPS were performed successfully : 6 cervical, 33 thoracic and 31 lumbar vertebrae. Most patients had clear improvement of pain after PVP ; mean as score was 8.1 and 2.9 before and after PVP, respectively. Improvement was maintained in most patients. No further collapse of treated vertebrae was observed(mean follow-up, 7 months). Leakage of PMMA was notod in the spinal canal(13 levels), neural foramen (2 levels), adjacent disk(15 levels), paravertebral soft tissue(14 levels) and vein(8 levels). Pulmonary embolism was detected in three patients after the procedure, but was not associated with clinical symptoms. Conclusion : These results indicate that percutaneous vertebroplasty can be valuable treatment method in osteolytic spinal metastasis and myeloma, providing immediate pain relief and spinal stabilization and contributing to early rehabilitation.

• Journal of Korean Neurosurgical Society
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• 제58권5호
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• pp.412-418
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• 2015

Objective : To investigate the effects of posterior implant rigidity on spinal kinematics at adjacent levels by utilizing a cadaveric spine model with simulated physiological loading. Methods : Five human lumbar spinal specimens (L3 to S1) were obtained and checked for abnormalities. The fresh specimens were stripped of muscle tissue, with care taken to preserve the spinal ligaments and facet joints. Pedicle screws were implanted in the L4 and L5 vertebrae of each specimen. Specimens were tested under 0 N and 400 N axial loading. Five different posterior rods of various elastic moduli (intact, rubber, low-density polyethylene, aluminum, and titanium) were tested. Segmental range of motion (ROM), center of rotation (COR) and intervertebral disc pressure were investigated. Results : As the rigidity of the posterior rods increased, both the segmental ROM and disc pressure at L4-5 decreased, while those values increased at adjacent levels. Implant stiffness saturation was evident, as the ROM and disc pressure were only marginally increased beyond an implant stiffness of aluminum. Since the disc pressures of adjacent levels were increased by the axial loading, it was shown that the rigidity of the implants influenced the load sharing between the implant and the spinal column. The segmental CORs at the adjacent disc levels translated anteriorly and inferiorly as rigidity of the device increased. Conclusion : These biomechanical findings indicate that the rigidity of the dynamic stabilization implant and physiological loading play significant roles on spinal kinematics at adjacent disc levels, and will aid in further device development.

• 한국산학기술학회논문지
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• 제14권12호
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• pp.6527-6533
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• 2013

연안역 조립식 경골잔교는 단일거더 시스템이므로 비틀림에 큰 영향을 받는 구조물이다. 본 연구에서는 이 잔교를 합리적으로 해석하고 설계하기 위한 해석모델을 개발하고자 하였다. ��강성을 포함한 7자유도 보요소를 사용한 해석모델의 구속조건을 조절하여 해석모델을 선정하였으며, 선정된 해석모델은 실물크기의 실험체를 이용한 정적하중재하 실험을 통하여 검증하였다. 실험결과와의 비교분석을 통하여 개발한 해석모델을 입증하였으며, 이 해석 모델을 이용하여 연결부의 단면력을 산정함으로써 합리적인 연결부 설계를 가능하게 하였다.

• Journal of Korean Neurosurgical Society
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• 제42권4호
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• pp.293-299
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• 2007

Objective : Thoracoscopic spinal surgery provides minimally invasive approaches for effective vertebral decompression and reconstruction of the thoracic and thoracolumbar spine, while surgery related morbidity can be significantly lowered. This study analyzes clinical results of thoracoscopic spinal surgery performed at our institute. Methods : Twenty consecutive patients underwent video-assisted thoracosopic surgery (VATS) to treat various thoracic and thoracolumbar pathologies from April 2000 to July 2006. The lesions consisted of spinal trauma (13 cases), thoracic disc herniation (4 cases), tuberculous spondylitis (1 case), post-operative thoracolumbar kyphosis (1 case) and thoracic tumor (1 case). The level of operation included upper thoracic lesions (3 cases), midthoracic lesions (6 cases) and thoracolumbar lesions (11 cases). We classified the procedure into three groups: stand-alone thoracoscopic discectomy (3 cases), thoracoscopic fusion (11 cases) and video assisted mini-thoracotomy (6 cases). Results : Analysis on the Frankel performance scale in spinal trauma patients (13 cases), showed a total of 7 patients who had neurological impairment preoperatively : Grade D (2 cases), Grade C (2 cases), Grade B (1 case), and Grade A (2 cases). Four patients were neurologically improved postoperatively, two patients were improved from C to E, one improved from grade D to E and one improved from grade B to grade D. The preoperative Cobb's and kyphotic angle were measured in spinal trauma patients and were $18.9{\pm}4.4^{\circ}$ and $18.8{\pm}4.6^{\circ}$, respectively. Postoperatively, the angles showed statistically significant improvement, $15.1{\pm}3.7^{\circ}$ and $11.3{\pm}2.4^{\circ}$, respectively(P<0.001). Conclusion : Although VATS requires a steep learning curve, it is an effective and minimally invasive procedure which provides biomechanical stability in terms of anterior column decompression and reconstruction for anterior load bearing, and preservation of intercostal muscles and diaphragm.

• Journal of Korean Neurosurgical Society
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• 제43권1호
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• pp.5-10
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• 2008

Objective : To evaluate the surgical outcomes of ventral interbody grafting and anterior or posterior spinal instrumentation for the treatment of advanced spondylodiscitis with patients who had failed medical management. Methods : A total of 28 patients were evaluated for associated medical illness, detected pathogen, level of involved spine, and perioperative complications. Radiological evaluation including the rate of bony union, segmental Cobb angle, graft- and instrumentation-related complications, and clinical outcomes by mean Frankel scale and VAS score were performed. Results : There are 14 pyogenic spondylodiscitis, 6 postoperative spondylodiscitis, and 8 tuberculous spondylodiscitis. There were 21 males and 7 females. Mean age was 51 years, with a range from 18 to 77. Mean follow-up period was 10.9 months. Associated medical illnesses were 6 diabetes, 3 pulmonary tuberculosis, and 4 chronic liver diseases. Staphylococcus was the most common pathogen isolated (25%), and Mycobacterium tuberculosis was found in 18% of the patients. Operative approaches, either anterior or posterior spinal instrumentation, were done simultaneously or delayed after anterior aggressive debridement, neural decompression, and structural interbody bone grafting. All patients with neurological deficits improved after operation, except only one who died from aggravation as military tuberculosis. Mean Frankel scale was changed from $3.78{\pm}0.78$ preoperatively to $4.78{\pm}0.35$ at final follow up and mean VAS score was improved from $7.43{\pm}0.54$ to $2.07{\pm}1.12$. Solid bone fusion was obtained in all patients except only one patient who died. There was no need for prolongation of duration of antibiotics and no evidence of secondary infection owing to spinal instrumentations. Conclusion : According to these results, debridement and anterior column reconstruction with ventral interbody grafting and instrumentation is effective and safe in patients who had failed medical management and neurological deficits in advanced spondylodiscitis.

• 한국방사선학회논문지
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• 제14권3호
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• pp.235-243
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• 2020

허허리뼈 전만각(LLA)은 허리뼈의 곡률을 평가하는 데 사용할 수 있는 지표이다. 허리뼈의 구조적 안정성과 추간판 각도(IDA)에서 척추의 각 부분의 안정성을 측정할 수 있다. 특히, 본 연구 자료에 따르면 허리뼈에 대한 비만과 전만각 사이에는 강한 양의 상관관계가 있는 것으로 나타났다. 또한, 비만의 경우 IDA가 큰 이유는 해부학적 구조의 약화와 중력 효과의 결과인 것으로 보인다. 비만은 정상적인 시상면 균형을 방해하고 최소한의 에너지로 똑바른 자세를 유지하지 못한다. 따라서 비만은 허리뼈 전만증을 변화시켜 요통을 유발하는 중요한 요소가 될 수 있다.

• The Korean Journal of Pain
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• 제12권1호
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• pp.114-118
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• 1999

Backgrouds: Cervical epidural blocks were used as part of a comprehensive multimodal treatment program for patients with chronic pain in the head, neck and upper extremities. The depth of the epidural space beneth the skin surface varies at different levels of the spinal column in the same patient. It also varies from patient to patient at the same vertebral level. We studied the distance the skin to the cervical epidural space in adults patients at different intervertebral spaces. Methods: Date were gathered from 628 patients having cervical epidural block for relief of cervical and upper extrimity pain. All blocks were performed using hanging drop method after loss of resistance with saline at C5-6, C6-7, C7-T1 intervertebral space. Results: Mean distances for skin to cervical epidural space (DSES) were 5.42 cm, 5.06 cm, 4.68 cm in male, 5.00 cm, 4.61 cm, 4.10 cm in female at C7-T1, C6-7, C5-6 intervertebral space. DSES correlated with body weight, neck circumference and body mass index significantly. Conclusion: In the cervical spine, DSES varies from space to space. The longest DSES were noted at C7-T1 level in male, and the shortest DSES were at C5-6 in female. DSES has significant relationships with weight, neck circumference and body mass index.