• Journal of Korean Neurosurgical Society
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• 제39권4호
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• pp.256-259
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• 2006

Objective : Having a reliable and reproducible measurement technique to measure the sagittal contour in vertebral fractures is paramount to clinical decision making. This study is designed to determine the most reliable measurement technique in osteoporotic vertebral compression fracture. Methods : Fifteen lateral radiographs of thoracic and lumbar fractures were selected and measured on two separate occasions by three spine surgeons using six different measurement techniques [Centroid, Harrison Posterior Tangent Methods and 4 different types of modified Cobb method]. The radiograph quality was assessed and the center beam location was determined. Statistical analysis including ANOVA for repeated measures was carried out using the SAS software [v 8.0]. Results : The inter and intraobserver variance of the Cobb method 4 and Harrison posterior tangent method were significantly lower than the other four methods. The intraobserver correlation coefficients were the most consistent using the Cobb method 4 [0.982]. which was followed by the Harrison posterior tangent [0.953] and Cobb methods 1 [0.874]. The intraobserver agreement [% of repeated measures within 5 degrees of the original measurement] ranged from 42% to 98% for each technique for all three observers, with the Cobb method 4 showing the best agreement [97.8%] followed by the Harrison posterior tangent method [937%]. Conclusion : The Cobb method-4 and Harrison posterior tangent methods, when applied to measuring the kyphosis, are reliable and have a similar small error range. The Cobb method 4 shows the best overall reliability. However, the centroid method and Cobb method using a fractured endplate do not produce an accurate result due to inter and intraobserver differences in determining the baseline.

• Journal of Korean Neurosurgical Society
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• 제60권5호
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• pp.560-566
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• 2017

Objectvie : The global sagittal postural patterns as characterized by Roussouly classification have been previously described in various ethnicities, there were no studies investigated in Koreans. To analyze the distribution of the global sagittal postural patterns in Korean adults using Roussouly classification, the author prospectively studied. Methods : 252 asymptomatic Korean adults was recruited. Data was obtained by reviewing the films for each subject. Spinopelvic parameters were measured and sagittal postural patterns were then determined according to Roussouly classification. We compared the data across different ethnicities from our study and a previous study to further characterize Korean sagittal postures. Results : The subject included 151 males and 101 females, with mean age of $33.2{\pm}8.2years$. The average descriptive results were as below : thoracic kyphosis $28.6{\pm}7.7^{\circ}$, lumbar lordosis $48.3{\pm}10.2^{\circ}$, sacral slope $37.8{\pm}5.8^{\circ}$, pelvic incidence $45.1{\pm}7.5^{\circ}$, pelvic tilt $9.4{\pm}6.7^{\circ}$, spinosacral angle $130.1{\pm}5.4^{\circ}$, and sagittal vertical axis $16.25{\pm}22.5mm$. 125 subjects among 252 (49.6%) belonged to Roussouly type 3 (namely neutral). There were also 58 (23%), 33 (13.1%), and 36 (14.3) subjects in type 1, 2, and 4 (namely non-neutral), respectively. Conclusion : Enrolling 252 asymptomatic Korean adults, this prospective study found that 49.6% of asymptomatic Korean adults possessed a sagittal posture of Roussouly type 3. All radiologic parameters follows general concept of spinal sagittal balance pattern. Overall, this study might be a basis for further investigation of spinal sagittal balance.

• Journal of Interdisciplinary Genomics
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• 제1권2호
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• pp.19-22
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• 2019

CATCH 22 syndrome is rare genetic disease that has various manifestations. Cervical vertebral anomaly, such as Klippel-Feil anomaly, is frequently observed in the patients with CATCH22 syndrome. We present the case of an 11-year-old female patient with CATCH22 syndrome and Klippel-Feil anomaly who had been treated torticollis using the customized soft neck collar. During the patient's first visit to our clinic, she presented with low ear set, skull deformity, intellectual disability, and tilting of the head to the left by approximately 25 degrees. Imaging studies revealed multisegmental fusion and C3 hemivertebrae of the cervical spine and left thoracic scoliosis at T4 with 50 degrees of Cobb's angle. We instructed passive stretching and applied the customized soft neck collar we invented. The ipsilateral aspect of the neck collar is designed to provide vertical support between the clavicle and mandibular angle and is adjustable in height. The Velcro was attached to the neck collar at the point of contact with the ipsilesional mandibular angle, which provides negative sensory feedback, inducing her to tilt neck to the contralesional side. We applied the neck collar for 2 hours a day. After 1 year of treatment, her neck inclination angle improved from 25 to 10 degrees. Providing negative sensory feedback using the customized soft neck collar can be one of the treatment options of postural management in patients with torticollis in cases of CATCH 22 syndrome combined with Klippel-Feil anomaly.

• Journal of Korean Neurosurgical Society
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• 제62권5호
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• pp.567-576
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• 2019

Objective : Minimal data exist regarding non-operative management of suspected pseudarthrosis after pedicle subtraction osteotomy (PSO). This study reports radiographic and clinical outcomes of non-operative management for post-PSO pseudarthrosis at a minimum 5 years post-detection. Methods : Nineteen consecutive patients with implant breakage indicating probable pseudarthrosis after PSO surgery (13 women/six men; mean age at surgery, 58 years) without severe pain and disability were treated with non-operative management (mean follow-up, 5.8 years; range, 5-10 years). Non-operative management included medication, intermittent brace wearing and avoidance of excessive back strain. Radiographic and clinical outcomes analysis was performed. Results : Sagittal vertical axis (SVA), proximal junctional angle, thoracic kyphosis achieved by a PSO were maintained after detection of pseudarthrosis through ultimate follow-up. Lumbar lordosis and PSO angle decreased at final follow-up. There was no significant change in Oswestry Disability Index (ODI) scores and Scoliosis Research Society (SRS) total score, or subscales of pain, self-image, function, satisfaction and mental health between detection of pseudarthrosis and ultimate follow-up. SVA greater than 11 cm showed poorer ODI and SRS total score, as well as the pain, self-image, and function subscales (p<0.05). Conclusion : Non-operative management of implant failure of probable pseudarthrosis after PSO offers acceptable outcomes even at 5 years after detection of implant breakage, provided SVA is maintained. As SVA increased, outcome scores decreased in this patient population.

• Clinical Pain
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• 제19권2호
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• pp.116-119
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• 2020

Cervical transforaminal epidural steroid injection (TFESI) is commonly performed to provide relief of pain caused by radiculopathy. Intra-arterial injection of particulate steroid or direct needle injury can lead to spinal artery embolism or thrombosis. Also there is a possibility of vascular spasm. To our knowledge, this is the first reported case of spinal cord infarction that occurred after TFESI with non-particulate steroid in Korea. A 47-year-old female patient underwent C7 TFESI at local pain clinic. Injected materials were dexamethasone and mepivacaine. Right after the intervention, she felt muscle weakness and decreased sensation. On physical examination, she had decreased sensation from C4 to T2 dermatome in light touch and pin-prick test. Proprioception and vibration were intact. The motor grades of upper extremities were grade 1. Cervical and thoracic spine MRI was checked. Diffusion-weighted image and apparent diffusion coefficient image showed long extension of spinal cord infarction from C2 to T1 level.

• Clinics in Shoulder and Elbow
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• 제25권4호
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• pp.274-281
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• 2022

Background: In the present study, the age- and sex-adjusted Constant score (CS) in a normal Indian population was calculated and any differences with other population cohorts assessed. Methods: The study participants were patients who visited the outpatient department for problems other than shoulder and healthy volunteers from the local population. Patients without shoulder pain/discomfort during activity were included in the study. Subjects with any problem that might affect shoulder function (e.g., cervical, thoracic spine, rib cage deformity, inflammatory arthritis) were excluded. Constant scoring of all participants was performed by trained senior residents under the supervision of the senior faculty. Shoulder range of movement and strength were measured following recommendations given by the research and Development Committee of the European Society for Shoulder and Elbow Surgery (2008). A fixed spring balance was used for strength measurement; one end was fixed on the floor and the other end tied with a strap to the wrist of the participant, arm in 90° abduction in scapular plane with palm facing down. Results: Among the 248 subjects (496 shoulders), the average age was 37 years (range, 18-78 years), 65.7% were males (326 shoulders) and 34.3% females (170 shoulders). The mean CS was 84.6±2.9 (males, 86.1±3.0; females, 81.8±2.9). CS decreased significantly after 50 years of age in males and 40 years of age in females (p<0.05). The mean CS was lower than in previous studies for both males and females. Heavy occupation workers had higher mean CS (p<0.05). A linear standardized equation was estimated for calculating the adjusted CS for any age. Conclusions: Mean CS and its change with age differed from previous studies among various population cohorts.

• 대한한방내과학회지
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• 제44권2호
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• pp.269-276
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• 2023

Objective: This study reported the effectiveness of Korean medicine for a patient with Type-1 diabetes mellitus after pancreatectomy with a compression fracture of the thoracic spine. Methods: A patient diagnosed with Type-1 diabetes mellitus after a pancreatectomy was treated with acupuncture, pharmacopuncture, Gami-hwanggigyejiomul-tang (modified Huangqi Guizhi Wuwu decotion), Jindang-won, etc. The conventional treatment was maintained using an insulin pump and insulin injection. Results: Blood glucose (FBS/PP2hrs), ESR and CRP decreased after one month of treatment. Conclusion: Gami-hwanggigyejiomul-tang and Jindang-won may be effective treatments for Type-1 diabetes mellitus. Further studies are needed to confirm the findings of this case.

• Journal of Radiation Protection and Research
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• 제40권2호
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• pp.118-123
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• 2015

최근 의료기관에서의 진단방사선검사 빈도는 2011년 2억 2천만건, 연간 일인당 피폭선량은 1.4 mSv로 2007년 대비 각 51%, 35% 증가하였다. 여기서 흉부촬영건수는 일반촬영 중 가장 높은 빈도인 27.59%로 나타났다. 따라서 본 연구에서는 흉부 방사선 촬영 시 영상판독에 불필요한 신체부위를 차폐하여 피폭선량을 최소화 시키는 차폐기구를 개발하고, 그 유용성 평가를 위해 국제 표준 소아(10세) 팬텀과 유리선량계를 사용하여 기구 사용 전, 후의 입사표면선량(entrance surface dose; ESD)과 장기의 흡수선량 차를 측정하였다. 또한 몬테카를로 시뮬레이션 기반 프로그램(PCXMC 2.0.1)을 이용하여 유효선량을 산출하였고 암발생의 생애귀속위험도(lifetime attributable risk of cancer incidence; LAR)를 비교하여 그 감소율을 간접적으로 평가하였다. 방어기구를 사용할 때, 입사표면선량(감소율)은 비강 $0.55{\mu}Sv$ (74.06%), 갑상선 $1.43{\mu}Sv$ (95.15%), 식도 $6.35{\mu}Sv$ (78.42%)로 평균 86.36% 감소되었고, 심부선량(감소율)은 경추 $1.23{\mu}Sv$ (89.73%), 침샘 $0.5{\mu}Sv$ (92.31%), 식도 $3.85{\mu}Sv$ (59.39%), 갑상선 $2.02{\mu}Sv$ (73.53%) 흉추 $5.68{\mu}Sv$ (54.01%) 로 평균 72.30%로 감소되어 차폐기구의 유용성을 확인할 수 있었다. 또한, 유효선량은 착용 전 $8.33{\mu}Sv$에서 착용 후 $7.35{\mu}Sv$로 11.76% 감소하였고, LAR 평가에서는 갑상선 암은 10세 소아 백만 명당 남아 0.14명(95.12%), 여아 0.77명(95.16%), 모든 암은 남아 0.14명(11.70%), 여아 0.25명(11.70%)의 감소(감소율)를 확인할 수 있었다. 진단방사선검사는 질병과 치료 등 건강을 위해 꼭 필요한 검사이지만, 가능한 진단에 불필요한 부위에 이러한 차폐기구를 적극적으로 사용하여 ALARA 개념에 입각한 의료방사선 최적화를 도모해야 할 것이다.

• Journal of Acupuncture Research
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• 제30권5호
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• pp.1-9
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• 2013

Objectives : The purpose of this study was to present clinical utility of therapeutic exercise on the neck and shoulder parts based on the movement system impairment syndrome(MSIS) as Dong-Qi therapy of the Dong-Si Acupuncture and was to examine which Dong-Si acupoints were most effective and non-invasive when performing therapeutic exercise of the MSIS. Methods : Totally eight therapeutic exercises correspondent to eight neck and shoulder MSIS were summarized and tabulated from the Diagnosis and Treatment of Movement Impairment Syndrome and Movement System Impairment Syndromes Of The Extremities, Cervical and Thoracic Spines by Sahrmann SA. Together with the MSIS summaries, acupuncture points and Dong-Qi therapy were summarized and tabulated from Yangweijiequanji 1 and Yangweijiequanji 2 by Yangweijie. According to the posture and movement of the MSIS exercise, effective and non-invasive acupoints were selected. Thereafter, clinical pilot study which five normal volunteers participated in were performed to examine whether these acupoints resulted in any side effects of acupuncture therapy such as pain and distortion of the needle during the MSIS exercises. Results : Through clinical pilot study, ZhongZi, ZhongXian, ZhengJin, ZhengZong and MuLiu in a sitting position, and HuaGuYi, ZhongZi and ZhongXian in a supine position were finally determined as safe and non-invasive Dong-Si acupoints to treat cervical pain. In terms of shoulder pain, ZuQianJin, ZuWuJin, HuaGuEr and JianZhong in a supine position, SiHuaZhong, ZuQianJin, ZuWuJin, QuLing, JianZhong, ShenGuan and JiuLi in a standing position, and ZuQianJin, ZuWuJin, HuaGuEr, QuLing and JianZhong in a prone position were finally accepted as safe and non-invasive Dong-Si acupoints. Conclusion : It is concluded that Dong-Si acupoints can be safely and non-invasively used together with therapeutic exercises of the MSIS to treat cervical and shoulder pains.

• 한국방사선학회논문지
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• 제12권4호
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• pp.443-450
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• 2018

Geant4 코드는 직선 가속기의 헤드 구조를 사용하여 이전에 구현된 BEAMnrC 데이터를 기반으로 선형가속기 (VARIAN CLINAC.)를 시뮬레이션하였다, 10MV 광자 선속에서 물팬텀의 심부선량백분율과 측면선량의 측정값과 Geant4를 비교 평가하였다. 선량 계산을 인체부위에 적용하기 위해 실제 환자의 Lung 부위를 5mm 간격으로 스캔하였다. Water phantom의 조사야($5{\times}5cm^2$), SAD 100cm에서 10MV 광자를 조사하여 Geant4 선량분포를 구하였다. 이 결과는 실제 환자의 폐(lung)에 흡수되는 선량을 측정하기는 어렵다 그래서 치료계획 시스템에 의한 선량을 비교하였다. 물 팬텀에서 측정된 심부선량 곡선과 Geant4에 의해 계산된 심부선량 곡선은 build-up 영역을 제외한 대부분의 깊이에서 ${\pm}3%$ 이내로 잘 일치하였다. 그러나 5cm와 20cm 지점에서 2.95%와 2.87%로 Geant4를 사용한 선량 계산에서 다소 높은 값을 보이고 있다. 이 두 지점은 Genat4의 geometry 파일을 통해 확인할 수 있었으며, 흉추와 흉골이 위치되어 선량이 증가된 것으로 알 수 있었다. 또한, cone beam CT를 적용한 결과에서 폐(lung)의 선량분포 오차는 3% 이내로 유사한 값을 얻었다. 따라서 Geant4를 이용하여 선량을 계산할 때 DICOM 파일에 직접 선량의 contour map이 표현될 수 있다면 Geant4의 임상적 적용이 다양하게 사용될 것이다.