• Journal of Korean Neurosurgical Society
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• 제60권6호
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• pp.691-700
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• 2017

Objective : The authors prospectively analyzed the effect of one-level or two-level anterior cervical discectomy and fusion (ACDF), comparing stand-alone cages and cage-with-plate fixation constructs with respect to clinical outcomes and radiologic changes. Methods : A total of 84 patients who underwent one-level (n=52) or two-level ACDF (n=32) for cervical disc disease and who completed 2 years of follow-up were included in this study. The patients were divided by cervical level and grouped into ACDF-Cage-only and ACDF-Cage-with-plate groups. The following parameters were assessed using radiographs : subsidence, C2-C7 lordosis angle, fusion segment angle, adjacent disc space narrowing, and fusion status. Clinical outcomes were assessed using the neck disability index (NDI) and visual analog scale scores for arm pain. Results : In the comparison of one-level ACDF-cage-only and ACDF-cage-with-plate groups, the NDI score was better in the cage-only group at the 3-, 12-, and 24-month follow-ups : however, no significant difference in clinical outcomes was observed. In the comparison of two-level ACDF-cage-only and ACDF-cage-with-plate groups, no difference in any clinical outcome was observed between the two groups. At the 24-month follow-up, subsidence was observed in 45.8% of patients in the one-level cage-only group and 32.1% of patients in the one-level cage-with-plate fixation group. There was no statistically significant difference in the incidence rate between the two groups (p=0.312). Subsidence in the two-level cage-only group (66.6%) was significantly more frequent than in the two-level cage-with-plate fixation group (30%; p=0.049). The fusion rate for patients in the one-level cage-only group was not significantly different from that in the one-level cage-with-plate fixation group (cage-only, 87.5%; cage-with-plate fixation, 92.9%; p=0.425) ; fusion rate in the two-level patients were also similar between groups (cage-only, 83.3%; cage-with-plate fixation, 95%; p=0.31). Conclusion : Our clinical results showed that for single-level cases, plate fixation had no additional benefit versus cage-only; for two-level ACDF cases, the fusion rate and clinical outcomes were similar, although the cage-with-plate fixation group had a lower incidence of cage subsidence than did the cage-only group. We conclude that physicians should be aware of this possible disadvantage associated with using cervical plates in one-level ACDF. However, in two-level ACDF, subsidence is more likely to occur without plate fixation, and thus the addition of plate fixation should be considered.

• Journal of Korean Neurosurgical Society
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• 제48권4호
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• pp.342-346
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• 2010

Objective : This study assessed the efficacy of anterior cervical discectomy and fusion (ACDF) with cage alone compared with ACDF with plate instrumentation for radiologic and clinical outcomes in two-level cervical degenerative disease. Methods : Patients with cervical degenerative disc disease from September 2004 to December 2009 were assessed retrospectively. A total of 42 patients received all ACDF at two-level cervical lesion. Twenty-two patients who underwent ACDF with cage alone were compared with 20 patients who underwent ACDF with plate fixation in consideration of radiologic and clinical outcomes. Clinical outcomes were assessed using Robinson's criteria and posterior neck pain, arm pain described by a 10 point-visual analog scale. Fusion rate, subsidence, kyphotic angle, instrument failure and the degenerative changes in adjacent segments were examined during each follow-up examination. Results : VAS was checked during each follow-up and Robinson's criteria were compared in both groups. Both groups showed no significant difference. Fusion rates were 90.9% (20/22) in ACDF with the cage alone group, 95% (19/20) in ACDF with the plate fixation group (p = 0.966). Subsidence rates of ACDF with cage alone were 31.81% (7/22) and ACDF with plate fixation were 30% (6/20) (p = 0.928). Local and regional kyphotic angle difference showed no significant difference. At the final follow-up, adjacent level disease developed in 4.54% (1/22) of ACDF with cage alone and 10% (2/20) of ACDF with plate fixation (p= 0.654). Conclusion : In two-level ACDF, ACDF with cage alone would be comparable with ACDF with plate fixation with regard to clinical outcome and radiologic result with no significant difference. We suggest that the routine use of plate and screw in 2-level surgery may not be beneficial.

• Journal of Korean Neurosurgical Society
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• 제60권5호
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• pp.550-559
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• 2017

Objective : Subsidence is a frequent complication of anterior cervical discectomy and fusion. Postoperative segmental micromotion, thought to be a causative factor of subsidence, has been speculated to increase with uncinate process resection area (UPR). To evaluate the effect of UPR on micro-motion, we designed a method to measure UPR area based on pre- and postoperative computed tomography images and analyzed the relationship between UPR and subsidence as a proxy of micro-motion. Methods : We retrospectively collected clinical and radiological data from January 2011 to June 2016. A total of 38 patients (53 segments) were included. All procedures included bilateral UPR and anterior plate fixation. UPR area was evaluated with reformatted coronal computer tomography images. To reduce level-related bias, we converted UPR area to the proportion of UPR to the pre-operative UP area (pUPR). Results : Subsidence occurred in 18 segments (34%) and positively correlated with right-side pUPR, left-side pUPR, and the sum of bilateral pUPR (sum pUPR) (R=0.310, 301, 364; p=0.024, 0.029, 0.007, respectively). Multiple linear regression analysis revealed that subsidence could be estimated with the following formula : $subsidence=1.522+2.7{\times}sum\;pUPR$($R^2=0.133$, p=0.007). Receiver-operating characteristic analysis determined that sum $pUPR{\geq}0.38$ could serve as a threshold for significantly increased risk of subsidence (p=0.005, area under curve=0.737, sensitivity=94%, specificity=51%). This threshold was confirmed by logistic regression analysis for subsidence (p=0.009, odds ratio=8.471). Conclusion : The UPR measurement method confirmed that UPR was correlated with subsidence. Particularly when the sum of pUPR is ${\geq}38%$, the possibility of subsidence increased.

• Journal of Korean Neurosurgical Society
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• 제52권2호
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• pp.107-113
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• 2012

Objective : Various procedures have been introduced for anterior interbody fusion in degenerative cervical disc disease including plate systems with autologous iliac bone, carbon cages, and cylindrical cages. However, except for plate systems, the long-term results of other methods have not been established. In the present study, we evaluated radiologic findings for cylindrical cervical cages over long-term follow up periods. Methods : During 4 year period, radiologic findings of 138 patients who underwent anterior cervical fusion with cylindrical cage were evaluated at 6, 12, 24, and 36 postoperative months using plain radiographs. We investigated subsidence, osteophyte formation (anterior and posterior margin), cage direction change, kyphotic angle, and bone fusion on each radiograph. Results : Among the 138 patients, a minimum of 36 month follow-up was achieved in 99 patients (mean follow-up : 38.61 months) with 115 levels. Mean disc height was 7.32 mm for preoperative evaluations, 9.00 for immediate postoperative evaluations, and 4.87 more than 36 months after surgery. Osteophytes were observed in 107 levels (93%) of the anterior portion and 48 levels (41%) of the posterior margin. The mean kyphotic angle was $9.87^{\circ}$ in 35 levels showing cage directional change. There were several significant findings : 1) related subsidence [T-score (p=0.039) and anterior osteophyte (p=0.009)], 2) accompanying posterior osteophyte and outcome (p=0.05). Conclusion : Cage subsidence and osteophyte formation were radiologically observed in most cases. Low T-scores may have led to subsidence and kyphosis during bone fusion although severe neurologic aggravation was not found, and therefore cylindrical cages should be used in selected cases.

• 한국암반공학회:학술대회논문집
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• 한국암반공학회 2000년도 암반공학문제의 수치해석(Numerical Analysis in Rock Engineering Problems)
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• pp.139-146
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• 2000

지하 채굴에 따른 침하와 수리전도도의 변화 양상에 관하여 조사를 하였다. 채굴 후 암반내 발생하는 변형률과 변형률 의존 수리전도도와의 상호 관계를 나타내는 식을 얻기 위하여 절리 암반을 등가 다공질 매질로 고려하였으며, 단일 절리의 수리전도도는 평행판 이론을 적용하여 결정하였다. 해석 결과에 따르면 채굴 후 암반내 수리전도도의 변화는 침하에 의해 발생한 변형률에 직접적으로 연관이 있는 것으로 나타났다. 채굴적의 폭을 증가시킴에 따라 최대 침하량과 수리전도도의 크기가 증가하였다. 절리 간격은 수리전도도의 변화에 영향을 주는 것으로 나타났다.

• 터널과지하공간
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• 제10권3호
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• pp.387-394
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• 2000

지하 채굴에 따른 침하와 수리전도도의 변화 양상에 관하여 조사를 하였다. 채굴 후 암반내 발생하는 변형률과 변형률 의존 수리전도도와의 상호 관계를 나타내는 식을 얻기 위하여 절리 암반을 등가 다공질 매질로 고려하였으며, 단일 절리의 수리전도도는 평행판 이론을 적용하여 결정하였다. 해석 결과에 따르면 채굴 후 암반내 수리전도도의 변화는 침하에 의해 발생한 변형률에 직접적으로 연관이 있는 것으로 나타났다. 채굴적의 폭을 증가시킴에 따라 최대 침하량과 수리전도도의 크기가 증가하였다. 절리 간격은 수리전도도의 변화에 영향을 주는 것으로 나타났다.

• Journal of Korean Neurosurgical Society
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• 제51권3호
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• pp.135-140
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• 2012

Objective : To evaluate radiographic results of anterior fusion methods in two-level cervical disc disease : tricortical autograft and plate fixation (ACDF-AP), cage and plate fixation (ACDF-CP), stand-alone cage (ACDF-CA), and corpectomy and plate fixation (ACCF). Methods: The numbers of patients were 70 with a minimum 6 month follow-up (ACDF-AP : 12, ACDF-CP : 27, ACDF-CA : 15, and ACCF : 16). Dynamic simple X-ray and computed tomography were evaluated preoperatively, postoperatively, 6 month, and at the final follow-up. The fusion and subsidence rates at the final were determined, and global cervical lordosis (GCL), cervical range of motion, fused segment angle (FSA), and fused segment height (FSH) were analyzed. Results: Nonunion was observed in 4 (25%) patients with ACDF-CA, 1 (8%) patient with ACDF-AP, 1 (4%) patient with ACDF-CP. The number of loss of FSH (%) more than 3 mm were 2 patients (16%) in ACDF-AP, 3 patients (11%) in ACDF-CP, 5 patients (33%) in ACDF-CA, and 3 patients (20%) in ACCF. The GCL was decreased with ACDF-CA and increased with others. The FSA was increased with ACDF-AP, ACDF-CP, and ACCF, but ACDF-CA was decreased. At the final follow-up, the FSH was slightly decreased in ACDF-CP, ACDF-AP, and ACCF, but ACDF-CA was more decreased. Graft related complication were minimal. Screw loosening, plate fracture, cage subsidence and migration were not identified. Conclusion: ACDF-CP demonstrated a higher fusion rate and less minimal FSH loss than the other fusions in two-level cervical disc disease. The ACDF-AP and ACCF methods had a better outcome than the ACDF-CA with respect to GCL, FSA, and FSH.

• Geomechanics and Engineering
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• 제18권1호
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• pp.97-109
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• 2019

Physical conditions play vital role on the mechanical properties of frozen soil, especially for the temperature and moisture content of frozen soil. Subsequently, they influence the subsidence and stress law of permafrost layer. Taking Jiangcang No. 1 Coal Mine as engineering background, combined with laboratory experiment, field measurements and empirical formula to obtain the mechanical parameters of frozen soil, the thick plate mechanical model of permafrost was established to evaluate the safety of permafrost roof. At the same time, $FLAC^{3D}$ was used to study the influence of temperature and moisture content on the deformation and stress law of frozen soil layer. The results show that the failure tensile stress of frozen soil is larger than the maximum tensile stress of permafrost roof occurring in the process of mining. It indicates that the permafrost roof cannot collapse under the conditions of moisture content in the range from 20% to 27% as well as temperature in the range from $-35^{\circ}C$ to $-15^{\circ}C$. Moreover, the maximum subsidence of the upper and lower boundary of the overlying permafrost layer decreases with the increase of moisture content in the range of 15% to 27% or the decrease of temperature in the range of $-35^{\circ}C$ to $-15^{\circ}C$ if the temperature or moisture content keeps consistent with $-25^{\circ}C$ or 20%, respectively.

• 한국지반환경공학회 논문집
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• 제21권11호
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• pp.5-10
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• 2020

건설 현장에서 항타기 전도 사고는 빈도는 낮으나 발생 시 심각한 피해를 야기한다. 항타기 전도 사고의 주원인은 침하에 의한 모멘트 발생임에도 불구하고 KOSHA-C-101-2014, KOSH-A-GUIDE-71-2012, 산업안전보건 기준, NCS 등의 규정에서 철판 사용에 대한 선언적 내용만 있을 뿐 구체적인 요구조건이 명시되어 있지 않다. 이에 항타기 자중, 지반조건에 따라 하부 철판의 제원이 바뀌어야 하지만 현장에서는 임의로 사용되고 있다. 본 연구에서는 수치 해석(Plaxis 2D)을 기반으로 요구되는 최소 철판 두께를 분석 하였다. 토양의 종류(모래, 점토), 하중 분포, 철판 두께(10mm, 20mm, 30mm, 40mm)에 따라 침하 정도와 및 지반 항복 유무를 산출하였으며, 그 결과 모든 조건에서 두께 10mm 철판은 지반 항복을 유발하였다. 두께 20mm부터는 지반 침하로 발생하는 회전각이 허용치인 2° 이내로 분석되었다.

• Journal of Korean Neurosurgical Society
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• 제54권6호
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• pp.496-500
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• 2013

Objective : To evaluate the successful fusion rate in postmenopausal women with single-level anterior cervical discectomy and successful fusion (ACDF) and identify the significant factors related to bone successful fusion in pre- and postmenopausal women. Methods : From July 2004 to December 2010, 108 consecutive patients who underwent single-level ACDF were prospectively selected as candidates. Among these, the charts and radiological data of 39 women were reviewed retrospectively. These 39 women were divided into two groups : a premenopausal group (n=11) and a postmenopausal group (n=28). To evaluate the significant factors affecting the successful fusion rate, the following were analyzed : the presence of successful fusion, successful fusion type, age, operated level, bone mineral density, graft materials, stand-alone cage or plating with autologous iliac bone, subsidence, adjacent segment degeneration, smoking, diabetes mellitus, and renal disease. Results : The successful fusion rates of the pre- and postmenopausal groups were 90.9% and 89.2%, respectively. There was no significant difference in the successful fusion rate or successful fusion type between the two groups. In the postmenopausal group, three patients (10.8%) had successful fusion failure. In the postmenopausal group, age and subsidence significantly affected the successful fusion rate (p=0.016 and 0.011, respectively), and the incidence of subsidence in patients with a cage was higher than that in patients with a plate (p=0.030). Conclusion : Menopausal status did not significantly affect bone successful fusion in patients with single-level ACDF. However, in older women with single-level ACDF, the combination of use of a cage and subsidence may unfavorably affect successful fusion.