• The Journal of Korean Physical Therapy
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• v.34 no.5
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• pp.272-277
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• 2022

Purpose: This study compared the subjective and objective sleep quality between subjects with and without thoracic hyper-kyphosis. Methods: Forty participants were divided into a hyper-kyphosis (n=17) and normal group (n=17) by thoracic spinal angle measurement. The subjective sleep quality was measured using PSQI, a self-report, and objective sleep quality was measured using an actigraphy that measures time according to sleep patterns. Results: The PSQI scores of subjects with thoracic hyper-kyphosis were significantly higher than those with normal thoracic curvature (p=0.013). The total sleep time and real sleep time were less in subjects with hyper-kyphosis than in normal subjects (p=0.006; p=0.029). The light sleep time was less in subjects with excessive spondylolisthesis than in normal subjects (p=0.010). Light sleep time was less in those with hyper-kyphosis, but deep sleep time was similar to the subjects with a normal thoracic curvature (p=0.003; p=0.140). Conclusion: Subjects with thoracic hyper-kyphosis had a decrease in subjective sleep quality, such as sleep discomfort, and objective sleep quality, such as a decrease in sleep time compared to normal subjects.

• Journal of Biomedical Engineering Research
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• v.44 no.5
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• pp.354-361
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• 2023

Most of spinal diseases are diagnosed based on the subjective judgment of a specialist, so numerous studies have been conducted to find objectivity by automating the diagnosis process using deep learning. In this paper, we propose a method that combines segmentation and feature extraction, which are frequently used techniques for diagnosing spinal diseases. Four models, U-Net, U-Net++, DeepLabv3+, and M-Net were trained and compared using 1000 X-ray images, and key-points were derived using Douglas-Peucker algorithms. For evaluation, Dice Similarity Coefficient(DSC), Intersection over Union(IoU), precision, recall, and area under precision-recall curve evaluation metrics were used and U-Net++ showed the best performance in all metrics with an average DSC of 0.9724. For the average Euclidean distance between estimated key-points and ground truth, U-Net was the best, followed by U-Net++. However the difference in average distance was about 0.1 pixels, which is not significant. The results suggest that it is possible to extract key-points based on segmentation and that it can be used to accurately diagnose various spinal diseases, including spondylolisthesis, with consistent criteria.

• The Journal of the Korean bone and joint tumor society
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• v.17 no.2
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• pp.106-110
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• 2011

In the patient who has intradural mass associated with spinal stenosis, if the operation for spinal stenosis is performed alone, the symptom may remain. We report with literature review that we achieved the successful outcome after simultaneous decompression of spinal stenosis and space occupying mass removal in the case of intradural and extradural compression. A 71-year-old female patient suffering from low back pain and radiating pain of both lower extremities admitted. In magnetic resonance imaging, spinal stenosis on L4-5 and spondylolisthesis on L5-S1 compressed dural sac and intradural space occupying mass on L4 level compressed. By posterior approach, decompression and interbody fusion were carried out. Then mass was removed with median durotomy. Pathologic diagnosis was schwannoma and the symptom was improved remarkably.

• Journal of Korean Neurosurgical Society
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• v.29 no.11
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• pp.1505-1513
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• 2000

Objectives : Many surgical procedures have been introduced to a symptomatic lumbar stenosis. Most of these procedures still have been regarded as an extensive surgical intervention with respect to normal aging process of the lumbar spine. We adopted a microsurgical decompression procedure via unilateral exposure as a minimally invasive intervention for symptomatic lumbar stenosis without instability. Materials and Methods : Fifty-seven patients with symptomatic lumbar stenosis underwent microsurgical decompression via unilateral laminotomy between March 1998 and December 1999. The conceptual modification and technical refinements were added to the previously reported microsurgical decompression procedure. Bilateral decompression through a unilateral laminotomy hole was performed in 11 patients. These patients profile also included 9 cases of degenerative spondylolisthesis(Grade I) without instability. Results : Preoperative neurogenic intermittent claudication(NIC) was more notably improved than low back pain, 60% to 82% during the follow-up period. Overall clinical results were excellent in 20(35%), good in 29(51%), fair in 6(11%) and poor in 2(3%). Conclusions : Microsurgical decompression for lumbar stenosis with stable spine provided a satisfactory symptomatic improvement without extensive destruction of the weight-bearing structures and functional mobile segments, even bilateral symptoms existed.

• Journal of Korean Neurosurgical Society
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• v.46 no.5
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• pp.431-436
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• 2009

Objective : This study examines whether functional motion is present at one or more years after Bioflex System placement. BioFlex System is a flexible rod system which has been used to preserve motion at the area of implantation. There has not been a scientific study showing how much motion is preserved after implantation. Methods : A total of 12 consecutive patients underwent posterior dynamic stabilization using the BioFlex System. Six patients were treated using a L3-4-5 construct and other six patients using a L4-5-S1 construct. Follow-up ranged from 12 to 33 months and standing neutral lateral, extension, flexion and posteroanterior (PA) radiographs were obtained at 3, 6, 9, and 12 months and at more than 12 months postoperatively. Range of motion (ROM), whole lumbar lordosis, and ROMs of motion segments from L2 to S1 were determined. Results : Patients with a L3-4-5 construct demonstrated a decrease in mean ROM for whole lumbar decreased from 40.08 to 30.77. Mean ROM for L3-4 (6.12 to 2.20) and L4-5 (6.55 to 1.67) also decreased after one year. Patients with a L4-5-S1 construct demonstrated L4-5 (8.75 to 2.70) and L5-S1 (9.97 to 3.25) decrease of mean ROM at one year postoperatively. Lumbar lordosis was preservep at both L3-4-5 and L4-5-S1 constructs. Clinical results showed significant improvements in both study groups. Conclusion : The present study provides preliminary information regarding the BioFlex motion preservation system. We conclude that the BioFlex System preserves functional motion to some degree at instrumented levels. However, although total lumbar lordosis was preserved, ROMs at implantation segments were lower than preoperative values.

• Journal of Korean Neurosurgical Society
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• v.54 no.3
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• pp.207-210
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• 2013

Objective : To compare spinopelvic parameters in young adult patients with spondylolysis to those in age-matched patients without spondylolysis and investigate the clinical impact of sagittal spinopelvic parameters in patients with L5 spondylolysis. Methods : From 2009 to 2012, a total of 198 young adult male patients with spondylolysis were identified. Eighty age-matched patients without spondylolysis were also selected. Standing lateral films that included both hip joints were obtained for each subject. Pelvic incidence (PI), sacral slope (SS), pelvic tilt, lumbar lordosis angle, sacral inclination, lumbosacral angle, and sacral table angle were measured in both groups. A comparative study of the spinopelvic parameters of these two groups was performed using SPSS 15.0 (SPSS Inc., Chicago, IL, USA). Results : Among the aforementioned spinopelvic parameters, PI, SS and STA were significantly different between patients with spondylolysis and those without spondylolysis. PI and SS were higher in the spondylolysis group than in the control group, but STA was lower in the spondylolysis group than in the control group. Conclusion : PI and SS were higher in the spondylolysis group than in the control group, but STA was lower in the spondylolysis group than in the control group. Patients with spondylolysis have low STA at birth, which remains constant during growth; a low STA translates into high SS. As a result, PI is also increased in accordance with SS. Therefore, we suggest that STA is an important etiologic factor in young adult patients with L5 spondylolysis.

• Journal of Korean Neurosurgical Society
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• v.54 no.3
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• pp.194-200
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• 2013

Objective : Lumbar spine stenosis (LSS) can result in symptomatic compression of the neural elements, requiring surgical treatment if conservative management fails. Minimally invasive surgery has come to be more commonly used for the treatment of LSS. The current study describes outcomes of bilateral microdecompression by unilateral or bilateral laminotomy (BML) for degenerative LSS after a minimum follow-up period of 3 years and investigates factors that result in a poor outcome. Methods : Twenty-one patients who were followed-up for at least 3 years were included in this study. For clinical evaluation, the Japanese Orthopedic Association (JOA) scoring system for low back pain was used. The modified grading system of Finneson and Cooper was used for outcome assessment. Radiographic evaluation was also performed for spondylolisthesis, sagittal rotation angle, and disc height. Results : Twenty-one patients (10 men, 11 women) aged 53-82 years ($64.1{\pm}8.9$ years) were followed-up for a minimum of 3 years (36-69 months). During follow-up, two patients underwent reoperation. Average preoperative JOA score and clinical symptoms, except persistent low back pain, improved significantly at the latest follow-up. There were no significant differences in radiological findings preoperatively and postoperatively. Thirteen patients (61.9%) had excellent to fair outcomes. Conclusion : BML resulted in a favorable and persistent outcome for patients with degenerative LSS without radiological instability over a mid-term follow-up period. Persistent low back pain unrelated to postoperative instability adversely affects mid-term outcomes.

• Journal of Korean Neurosurgical Society
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• v.59 no.6
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• pp.610-614
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• 2016

Objective : The purpose of this study was to present the outcome of the microsurgical foraminotomy via Wiltse paraspinal approach for foraminal or extraforaminal (FEF) stenosis at L5-S1 level. We investigated risk factors associated with poor outcome of microsurgical foraminotomy at L5-S1 level. Methods : We analyzed 21 patients who underwent the microsurgical foraminotomy for FEF stenosis at L5-S1 level. To investigate risk factors associated with poor outcome, patients were classified into two groups (success and failure in foraminotomy). Clinical outcomes were assessed by the visual analogue scale (VAS) scores of back and leg pain and Oswestry disability index (ODI). Radiographic parameters including existence of spondylolisthesis, existence and degree of coronal wedging, disc height, foramen height, segmental lordotic angle (SLA) on neutral and dynamic view, segmental range of motion, and global lumbar lordotic angle were investigated. Results : Postoperative VAS score and ODI improved after foraminotomy. However, there were 7 patients (33%) who had persistent or recurrent leg pain. SLA on neutral and extension radiographic films were significantly associated with the failure in foraminotomy (p<0.05). Receiver-operating characteristics curve analysis revealed the optimal cut-off values of SLA on neutral and extension radiographic films for predicting failure in foraminotomy were $17.3^{\circ}$ and $24^{\circ}s$, respectively. Conclusion : Microsurgical foraminotomy for FEF stenosis at L5-S1 level can provide good clinical outcomes in selected patients. Poor outcomes were associated with large SLA on preoperative neutral (>$17.3^{\circ}$) and extension radiographic films (>$24^{\circ}$).

• Journal of Korean Neurosurgical Society
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• v.61 no.1
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• pp.114-119
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• 2018

Objective : The purpose of this study was to determine the feasibility of screw fixation in previously augmented vertebrae with bone cement. We also investigated the influence of cement distribution pattern on the surgical technique. Methods : Fourteen patients who required screw fixation at the level of the previous percutaneous vertebroplasty or balloon kyphoplasty were enrolled in this study. The indications for screw fixation in the previously augmented vertebrae with bone cement included delayed complications, such as cement dislodgement, cement leakage with neurologic deficits, and various degenerative spinal diseases, such as spondylolisthesis or foraminal stenosis. Clinical outcomes, including pain scale scores, cement distribution pattern, and procedure-related complications were assessed. Results : Three patients underwent posterior screw fixation in previously cemented vertebrae due to cement dislodgement or progressive kyphosis. Three patients required posterior screw fixation for cement leakage or displacement of fracture fragments with neurologic deficits. Eight patients underwent posterior screw fixation due to various degenerative spinal diseases. It was possible to insert screws in the previously augmented vertebrae regardless of the cement distribution pattern; however, screw insertion was more difficult and changed directions in the patients with cemented vertebrae exhibiting a solid pattern rather than a trabecular pattern. All patients showed significant improvements in pain compared with the preoperative levels, and no patient experienced neurologic deterioration as seen at the final follow-up. Conclusion : For patients with vertebrae previously augmented with bone cement, posterior screw fixation is not a contraindication, but is a feasible option.

• Journal of Korean Neurosurgical Society
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• v.51 no.6
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• pp.343-349
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• 2012

Objective : Pedicle-based dynamic stabilization systems, in which semi-rigid rods or cords are used to restrict or control spinal segmental motion, aim to reduce or eliminate the drawbacks associated with rigid fusion. In this study, we analyzed the two-year clinical outcomes of patients treated with the NFlex (Synthes Spine, Inc.), a pedicle-based dynamic stabilization system. Methods : Five sites participated in a retrospective study of 72 consecutive patients who underwent NFlex stabilization. Of these 72 patients, 65 were available for 2-year follow-up. Patients were included based on the presence of degenerative disc disease (29 patients), degenerative spondylolisthesis (16 patients), lumbar stenosis (9 patients), adjacent segment degeneration (6 patients), and degenerative lumbar scoliosis (5 patients). The clinical outcome measures at each assessment were Visual Analogue Scale (VAS) to measure back pain, and Oswestry Disability Index (ODI) to measure functional status. Radiographic assessments included evidence of instrumentation failure or screw loosening. Results : Sixty-five patients (26 men and 39 women) with a mean age of 54.5 years were included. Mean follow-up was 25.6 months. The mean VAS score improved from 8.1 preoperatively to 3.8 postoperatively, representing a 53% improvement, and the ODI score from 44.5 to 21.8, representing a 51% improvement. Improvements in pain and disability scores were statistically significant. Three implant-related complications were observed. Conclusion : Posterior pedicle-based dynamic stabilization using the NFlex system seems effective in improving pain and functional scores, with sustained clinical improvement after two years. With appropriate patient selection, it may be considered an effective alternative to rigid fusion.