• Journal of Trauma and Injury
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• 제32권2호
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• pp.80-85
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• 2019

Purpose: To compare the time intervals to magnetic resonance imaging (MRI) and surgical treatment in patients having traumatic cervical spinal cord injury (SCI) with and without bony lesions. Methods: Retrospectively analyzed adult patients visited Kyungpook National University Hospital and underwent surgical treatment for cervical SCI within 24 hours. The patients who were suspected of having cervical SCI underwent plain radiography and computed tomography (CT) upon arrival. After the initial evaluation, we evaluated the MRI findings to determine surgical treatment. Waiting times for MRI and surgery were evaluated. Results: Thirty-four patients were included. Patients' mean age was 57 (range, 23-80) years. Patients with definite bony lesions were classified into group A, and 10 cases were identified (fracture-dislocation, seven; fracture alone, three). Patients without bony lesions were classified into group B, and 24 cases were identified (ossification of the posterior longitudinal ligament, 16; cervical spondylotic myelopathy, eight). Mean intervals between emergency room arrival and start of MRI were 93.60 (${\pm}60.08$) minutes in group A and 313.75 (${\pm}264.89$) minutes in group B, and the interval was significantly shorter in group A than in group B (p=0.01). The mean times to surgery were 248.4 (${\pm}76.03$) minutes in group A and 560.5 (${\pm}372.56$) minutes in group B, and the difference was statistically significant (p=0.001). The American Spinal Injury Association scale at the time of arrival showed that group A had a relatively severe neurologic deficit compared with group B (p=0.046). There was no statistical significance, but it seems to be good neurological recovery, if we start treatment sooner among patients treated within 24 hours (p=0.198). Conclusions: If fracture or dislocation is detected by CT, cervical SCI can be easily predicted resulting in MRI and surgical treatment being performed more rapidly. Additionally, fracture or dislocation tends to cause more severe neurological damage, so it is assumed that rapid diagnosis and treatment are possible.

• Journal of Korean Neurosurgical Society
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• 제46권5호
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• pp.479-483
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• 2009

Objective : A mouse model of spinal cord injury (SCI) could further increase our basic understanding of the mechanisms involved in injury and repair of the nervous system. The purpose of this study was to investigate whether methods used to produce and evaluate photochemical graded ischemic SCI in rats, could be successfully adapted to mice, in a reliable and reproducible manner. Methods : Thirty female imprinting control region mice (weighting 25-30 g, 8 weeks of age) were used in this study. Following intraperitoneal injection of Rose bengal, the translucent dorsal surface of the T8-T9 vertebral laminae of the mice were illuminated with a fiber optic bundle of a cold light source. The mice were divided into three groups; Group 1 (20 mg/kg Rose bengal, 5 minutes illumination), Group 2 (20 mg/kg Rose bengal, 10 minutes illumination), and Group 3 (40 mg/kg Rose bengal, 10 minutes illumination). The locomotor function, according to the Basso-Beattie-Bresnahan scale, was assessed at three days after the injury and then once per week for four weeks. The animals were sacrificed at 28 days after the injury, and the histopathology of the lesions was assessed. Results : The mice in group 1 had no hindlimb movement until seven days after the injury. Most mice had later recovery with movement in more than two joints at 28 days after injury. There was limited recovery of one joint, with only slight movement, for the mice in groups 2 and 3. The histopathology showed that the mice in group 1 had a cystic cavity involving the dorsal and partial involvement of the dorsolateral funiculi. A larger cavity, involving the dorsal, dorsolateral funiculi and the gray matter of the dorsal and ventral horns was found in group 2. In group 3, most of the spinal cord was destroyed and only a thin rim of tissue remained. Conclusion : The results of this study show that the photochemical graded ischemic SCI model. described in rats, can be successfully adapted to mice, in a reliable and reproducible manner. The functional deficits are correlated an increase in the irradiation time and, therefore, to the severity of the injury. The photothrombotic model of SCI, in mice with 20 mg/kg Rose bengal for 5 minutes illumination, provides an effective model that could be used in future research. This photochemical model can be used for investigating secondary responses associated with traumatic SCI.

• The Korean Journal of Pain
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• 제36권1호
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• pp.72-83
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• 2023

Background: Globally, spinal cord injury (SCI) results in a big burden, including 90% suffering permanent disability, and 60%-69% experiencing neuropathic pain. The main causes are oxidative stress, inflammation, and degeneration. The efficacy of the stem cell secretome is promising, but the role of human neural stem cell (HNSC)-secretome in neuropathic pain is unclear. This study evaluated how the mechanism of HNSC-secretome improves neuropathic pain and locomotor function in SCI rat models through antioxidant, anti-inflammatory, anti-matrix degradation, and neurotrophic activities. Methods: A proper experimental study investigated 15 Rattus norvegicus divided into normal, control, and treatment groups (30 µL HNSC-secretome, intrathecal in the level of T10, three days post-traumatic SCI). Twenty-eight days post-injury, specimens were collected, and matrix metalloproteinase (MMP)-9, F2-Isoprostanes, tumor necrosis factor (TNF)-α, transforming growth factor (TGF)-β, and brain derived neurotrophic factor (BDNF) were analyzed. Locomotor recovery was evaluated via Basso, Beattie, and Bresnahan scores. Neuropathic pain was evaluated using the Rat Grimace Scale. Results: The HNSC-secretome could improve locomotor recovery and neuropathic pain, decrease F2-Isoprostane (antioxidant), decrease MMP-9 and TNF-α (anti-inflammatory), as well as modulate TGF-β and BDNF (neurotrophic factor). Moreover, HNSC-secretomes maintain the extracellular matrix of SCI by reducing the matrix degradation effect of MMP-9 and increasing the collagen formation effect of TGF-β as a resistor of glial scar formation. Conclusions: The present study demonstrated the mechanism of HNSC-secretome in improving neuropathic pain and locomotor function in SCI through antioxidant, anti-inflammatory, anti-matrix degradation, and neurotrophic activities.

• 한국임상수의학회지
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• 제28권3호
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• pp.318-322
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• 2011

심한 낙상으로 척수 손상을 입은 개 3 마리가 전북대학교 동물의료센터에 내원을 하였다. 내원을 할 당시 환자는 심부통, 정상적 배변 배뇨 반사가 관찰되지 않았다. 신체 검사, 신경계 검사, 컴퓨터 단층 촬영을 실시한 결과, 흉추의 아탈구와 골절로 진단 되었다. 각각의 증례는 등쪽 척추 후궁 절제술과 척추 고정술을 뼈 시멘트와 스테인만 핀을 이용하여 실시 하였다. 술 후 처치는 약 2 주간 실시하였지만 세 증례에서 신경 증상의 개선이 지연되어 나타났다. 전침과 독활기생탕을 이용하여 환자를 치료하였다. 전침 자극과 독활기생탕 투여 14~45일 후에 세 증례에서 운동성, 고유자세반응, 척추 자세 등이 개선되었으며 심부통이 회복되고 꼬리를 흔들었다. 특히 세 마리 중 두 마리는 거의 정상적인 보행과 배변 배뇨 반사를 나타냈지만 뼈 시멘트로 인한 술부의 염증으로 인하여 치료를 중간에 지연한 1 예에서 경과가 좋지 않았다. 이 증례를 바탕으로 술 후 2 주 이후에도 신경 증상의 개선이 없는 환자에서 전침과 독활기생탕의 적용은 환자의 상태를 개선시킬 수 있는 적당한 치료라 생각된다.

• Journal of Korean Neurosurgical Society
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• 제45권3호
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• pp.176-178
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• 2009

Traumatic brainstem hemorrhage after blunt head injury is an uncommon event. The most frequent site of hemorrhage is the midline rostral brainstem. The prognosis of these patients is poor because of its critical location. We experienced a case of traumatic brainstem hemorrhage. A 41-year-old male was presented with drowsy mentality and right hemiparesis after blunt head injury. Plain skull radiographs and brain computerized tomography scans revealed a depressed skull fracture, epidural hematoma, and hemorrhagic contusion in the right parieto-occipital region. But, these findings did not explain the right hemiparesis. T2-weighted magnetic resonance (MR) image of the cervical spine demonstrated a focal hyperintense lesion in the left pontomedullary junction. Brain diffusion-weighted and FLAIR MR images showed a focal hyperintensity in the ventral pontomedullary lesion and it was more prominent in the left side. His mentality and weakness were progressively improved with conservative treatment. We should keep in mind the possibility of brainstem hemorrhage if supratentorial lesions or spinal cord lesions that caused neurological deficits in the head injured patients are unexplainable.

• The Journal of Korean Physical Therapy
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• 제11권2호
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• pp.61-73
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• 1999

This study was performed to investigate the degree of demand and general features of services required of home visiting physical therapy for chronic ill patients. The study subjects were ambulatory and admitted patients treated with physical therapy at six general and one oriental hospitals, one welfare center, four health centers located in Taejon from March 2, 1999 to March 16. Authors developed structured questionnaire, and distributed it to each physical therapist of study organizations. Total number of distributed questionnaire was 500, and 405 questionnaire were collected and analysed finally. 1. $82.4\%$ of patients and $90.0\%$ of caregivers are showed that home visiting physical therapy was needed(p<0.05) 2. The rate of necessity for home visiting physical therapy by kinds of disease was $949\%$ in cerebral palsy, $95.0\%$ in upper spinal cord injury, $83.3\%$ in lower spinal cord injury, $84.5\%$ in cerebral vascular accident, $89.6\%$ in traumatic brain injury, $83.5\%$ in other diseases. 3. In the general features of required service for home visiting physical therapy, $33.7\%$ of patients and $34.4\%$ of caregivers want special isolated physical therapy center, $33.1\%$ of patients and $43.3\%$ of caregivers want 3 times per week in frequency, $46.7\%$ of patients and $45.0\%$ of caregivers want 30-60minutes in treatment duration, and $48.0\%$ of patients and $46.7\%$ of caregivers want more intensive care than general hospitals. 4. In the working place of home visiting physical therapy, $36.1\%$ of patients and $36.2\%$ of caregivers wants physical therapist worked in general hospital. Also, $53.3\%$ of patients and $52.2\%$ of caregivers answered no interested in physical therapist's gender. The most preferential age of home visiting physical therapist is thirties in $43.2\%$ of patients and $63.4\%$ in caregivers

• Journal of Trauma and Injury
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• 제25권4호
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• pp.278-282
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• 2012

An esophageal perforation following anterior cervical fusion is rare. Early development of an esophageal perforation after anterior cervical fusion is usually due to iatrogenic injury from retraction, injury associated with the original traumatic incident, improperly placed instruments or a bone graft. A 31-year-old man had a cervical dislocation and spinal cord injury because of severe cervical trauma after a traffic accident. He was quadriplegic and had no feeling below T4 dermatome. Anterior decompression of the cervical spine and anterior fusion with mesh with autobone were performed. An esophagocutaneous fistula occurred 7 days after anterior cervical surgery. A second anterior surgery was done because of pus drainage. The mesh was changed with an iliac bone graft, and the esophagocutaneous fistula site was primary repaired, but pus continued to drain. Conservative treatment, which consisted of wound drainage and intravenous administration of antibiotics, was tried, but was unsuccessful. After all, we removed the plate and screws, but did not removed the iliac bone graft, We closed the esophageal fistula, and transposed the sternocleidomastoid muscle flap to the interspace between the esophagus and the cervical spine. The wound to the esophagus was well repaired. In conclusion, precautionary measures are needed to avoid the complication, and adequate treatment is necessary to resolve those complications when they occur.

• Journal of Korean Neurosurgical Society
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• 제61권5호
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• pp.574-581
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• 2018

Objective : The zero-profile implant (Zero-P) is accepted for use in anterior cervical fusion for the treatment of degenerative cervical disease. However, evidence pertaining to its efficiency and safety in traumatic cervical injury is largely insufficient. This study aimed to compare the overall outcomes of patients who underwent Zero-P for traumatic cervical disc injury. Methods : Data from a total of 53 consecutive patients who underwent surgery for traumatic or degenerative cervical disc disease using the Zero-P were reviewed. Seventeen patients (group A) had traumatic cervical disc injury and the remaining 36 (group B) had degenerative cervical disc herniation. The fusion and subsidence rates and Cobb angle were measured retrospectively from plain radiographs. The patients' clinical outcomes were evaluated using the Japanese Orthopedic Association (JOA) score and Odom's criteria. Results : The C2-7 Cobb and operative segmental angles increased by $3.45{\pm}7.61$ and $2.94{\pm}4.59$ in group A; and $2.46{\pm}7.31$ and $2.88{\pm}5.49$ in group B over 12 postoperative months, respectively. The subsidence and fusion rate was 35.0% and 95.0% in group A; and 36.6% and 95.1% in group B, respectively. None of the parameters differed significantly between groups. The clinical outcomes were similar in both groups in terms of increasing the JOA score and producing a grade higher than "good" using Odom's criteria. Conclusion : The application of Zero-P in patients with traumatic cervical disc injury was found to be acceptable when compared with the clinical and radiological outcomes of degenerative cervical spondylosis.

• 한국융합학회논문지
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• 제12권10호
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• pp.305-310
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• 2021

그리셀 증후군은 환축관절의 비외상성 탈구로 인하여 전신마취 시 경추손상이 발생할 가능성이 있어 신중한 마취관리를 요한다. 이에 우리는 과거에 그리셀 증후군을 받은 진단받은 환자의 전신마취 하 전립선 레이저절제술 시 I-gel을 이용한 기도관리를 성공적으로 진행하였고, 환자는 신경학적 합병증 없이 잘 회복된 사례를 보고하고자 한다. 그리셀 증후군 환자의 마취 관리 시 기도관리를 위하여 I-gel을 사용하는 것이 좋은 대안이 될 수 있을 것이다.

• Journal of Korean Neurosurgical Society
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• 제52권1호
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• pp.58-61
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• 2012

Various surgical procedures for the treatment of post-traumatic syringomyelia have been introduced recently, but most surgical strategies have been unreliable. We introduce the concept and technique of a new shunting procedure, syringo-subarachnoid-peritoneal shunt. A 54-year-old patient presented to our hospital with a progressive impairment of motion and position sense on the right side. Sixteen years before this admission, he had been treated by decompressive laminectomy for a burst fracture of L1. On his recent admission, magnetic resonance (MR) imaging studies of the whole spine revealed the presence of a huge syrinx extending from the medulla to the L1 vertebral level. We performed a syringo-subarachnoid-peritoneal shunt, including insertion of a T-tube into the syrinx, subarachnoid space and peritoneal cavity. Clinical manifestations and radiological findings improved after the operation. The syringo-subarachnoid-peritoneal shunt has several advantages. First, fluid can communicate freely between the syrinx, the subarachnoid space, and the peritoneal cavity. Secondly, we can prevent shunt catheter from migrating because dural anchoring of the T-tube is easy. Finally, we can perform shunt revision easily, because only one arm of the T-tube is inserted into the intraspinal syringx cavity. We think that this procedure is the most beneficial method among the various shunting procedures.