• Journal of Korean Neurosurgical Society
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• 제46권4호
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• pp.328-332
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• 2009

Objective : The purpose of this study was to establish new fusion criteria to complement existing Brantigan-Steffee fusion criteria. The primary purpose of intervertebral cage placement is to create a proper biomechanical environment through successful fusion. The existence of a traction spur is an essential predictable radiologic factor which shows that there is instability of a fusion segment. We studied the relationship between the existence of a traction spur and fusion after a posterior lumbar interbody fusion (PLIF) procedure. Methods : This study was conducted using retrospective radiological findings from patients who underwent a PLIF procedure with the use of a cage without posterior fixation between 1993 and 1997 at a single institution. We enrolled 183 patients who were followed for a minimum of five years after the procedure, and used the Brantigan-Steffee classification to confirm the fusion. These criteria include a denser and more mature bone fusion area than originally achieved during surgery, no interspace between the cage and the vertebral body, and mature bony trabeculae bridging the fusion area. We also confirmed the existence of traction spurs on fusion segments and non-fusion segments. Results : The PLIF procedure was done on a total of 251 segments in 183 patients (71 men and 112 women). The average follow-up period was $80.4{\pm}12.7$ months. The mean age at the time of surgery was $48.3{\pm}11.3$ years (range, 25 to 84 years). Among the 251 segments, 213 segments (84.9%) were fused after five years. The remaining 38 segments (15.1%) were not fused. An analysis of the 38 segments that were not fused found traction spur formation in 20 of those segments (52.6%). No segments had traction spur formation with fusion. Conclusion : A new parameter should be added to the fusion criteria. These criteria should be referred to as 'no traction spur formation' and should be used to confirm fusion after a PLIF procedure.

• 대한의용생체공학회:의공학회지
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• 제39권1호
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• pp.22-29
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• 2018

Intervertebral disc(IVD) mainly consists of Annulus fibrosus(AF) and Nucleus pulposus(NP), playing a role of distributing a mechanical load on vertebral body. IVD tissue engineering has been developed the methods to achieve anatomic morphology and restoration of biological function. The goal of present study is to identify the possibilities for creating a substitute of IVD the morphology and biological functions are the same as undamaged complete IVD. To fabricate the AF and NP combine biphasic IVD tissue, AF tissue scaffolds have been printed by 3D bio-printing system with natural biomaterials and NP tissues have been prepared by scaffold-free culture system. We evaluated whether the combined structure of 3D printed AF scaffold and scaffold-free NP tissue construct could support the architecture and cell functions as IVD tissue. 3D printed AF scaffolds were printed with 60 degree angle stripe patterned lamella structure(the inner-diameter is 5mm, outer-diameter is 10 mm and height is 3 mm). In the cytotoxicity test, the 3D printed AF scaffold showed good cell compatibility. The results of histological and immunohistochemical staining also showed the newly synthesized collagens and glycosaminoglycans, which are specific makers of AF tissue. And scaffold-free NP tissue actively synthesized glycosaminoglycans and type 2 collagen, which are the major components of NP tissue. When we combined two engineered tissues to realize the IVD, combined biphasic tissues showed a good integration between the two tissues. In conclusion, this study describes the fabrication of Engineered biphasic IVD tissue by using enable techniques of tissue engineering. This fabricated biphasic tissue would be used as a model system for the study of the native IVD tissue. In the future, it may have the potential to replace the damaged IVD in the future.

• 한방재활의학과학회지
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• 제26권1호
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• pp.95-102
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• 2016

Objectives To investigate correlation between slip percentage (SP) of spondylolisthesis and cross-sectional area (CSA) of lumbar paraspinal muscles; psoas major (PM), multifidus (MU) and erector spinae (ES). Methods A retrospective study was carried out in 120 spondylolisthesis patients who had visited the Spine center of Kyung Hee University Hospital at Gangdong and had taken lumbar MRI. CSA of lumbar paraspinal muscles was measured from axial T2-weighted MRI and divided by CSA of vertebral body to avoid weight's influence. SP was also measured from sagittal MRI. Results SP increase has significant correlation with decreased CSA-MU (r=0.37, p<0.01) and increased CSA-ES (r=0.19, p<0.05). There was no significant correlation between SP and CSA-PM. Conclusions MU atrophy and ES hypertrophy have significant correlation with SP of spondylolisthesis. CSA of lumbar paraspinal muscles can be a risk factor of progression of spondylolisthesis and compensation for the instability.

• Journal of Ginseng Research
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• 제22권2호
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• pp.114-121
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• 1998

Osteoporosis is defined as a pathologic condition in which there occurs no change in the chemical composition of the bone, while bone resorption is abnormally increased. This compares with osteogenesis, which leads to a decrease in the amount of bone. Though many varieties of therapies have been tried, no fully effective method has been found. Korean red ginseng is an important variety of Korean ginsengs and many studies have been performed to investigate its effectiveness. But there has been no report on red ginseng's effects on osteoporosis. The purpose of this study was to determine the clinical effects of Korean red ginseng on postmenopausal osteoporosis patients. The study was designed as a double-blind study. Group I consisted of 30 postmenopausal osteoporosis patients who were administered red ginseng extracts and 15 patients who were administered maltose capsules, were included in group II. The following results were obtained after one-year administration to both groups. 1. There were no significant differences in the degree of wedging, number of compression fractures in the vertebral body, trabeculations, and Cobb's angles between the experimental and control groups. 2. Even though bone mineral density increased in the lumbar spine, and decreased in the femur, there was no significant statistical difference. 3. The serum levels of parathyroid hormone (PTH), calcium, phosphate, and alkaline phosphates showed no difference between the two groups regardless of treatment. 4. Urine Deoxy-pyridinoline (DPYD) decreased in the red ginseng group while it increased in the maltose group, but statistically there was no significant difference between the two groups. 5. The clinical presentations showed no significant differences using Visual Analog Scale. 6. The specific complications related with the long-term use of red ginseng did not occur in all patients. In conclusion, there were no statistically significant differences in clinical presentations, biochemical, and radiological studies between the red gins eng and maltose groups. No definite effectiveness of red ginseng on patients with osteoporosis was found.

• 대한정형도수물리치료학회지
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• 제15권2호
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• pp.93-97
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• 2009

Anatomy: Facet joint syndrome most often affects the lower back and neck and refers to pain that occurs in the facet joints, which are the connections between the vertebrae in the spine that enable the spine to bend and twist. Many physicians have believed that the usual lesion of facet syndrome was an anatomical impairments of facet joint itself.. Facet joint injection using local anesthetics is a reliable method for the diagnosis and treatment for facet syndrome. Etiology: One of many possible causes is imbalances that can occur in stress levels, hormone levels, and nutritional levels. These imbalances can adversely affect posture, which can lead to neck and back pain. The common disorder called facet syndrome exhibits lower back pain, with or without, radiating pain to buttock and thigh due to facet joint arthropathy. Pain in the facet joint is supposedly the secondary effect of narrowing of joint space by sustained muscle contracture around joints. Syndrome: Facet joint syndrome tends to produce pain or tenderness in the lower back that increases with twisting or arching the body, as well as pain that moves to the buttocks or the back of the thighs. Other symptoms include stiffness or difficulty standing up straight or getting out of a chair. Pain can be felt in other areas such as the shoulders or mid-back area. Treatment: Non-drug treatments include hot packs, ultrasound, electrical stimulation, and therapeutic exercises. Stimulating blood flow using massage or a hot tub may also help. Alternative treatments include yoga and relaxation therapy. If your pain persists after trying these treatments, a surgical procedure called radiofrequency rhizotomy, which destroys the sensory nerves of the joint, may bring relief. Facet joint injection has been helpful in diagnosis and therapy for this facet syndrome. Radiofrequency thermocoagulation of medial branches is known to be an effective method of relieving pain caused by facet joint problems. We conclude that spasmolytic treatment of muscles connecting the two vertebral articular space would be better for treatment and diagnosis of facet syndrome rather than facet block with local anesthetic and steroid only.

• 대한치과의사협회지
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• 제56권2호
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• pp.94-102
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• 2018

The present study was conducted to assess the growth changes of human chin in childhood and adolescence at various stages of skeletal maturation using metallic implant installed in mandibular body. Lateral cephalographs including 23 subjects (9 males and 14 females) between 7-18 years old were used, which had been taken at University of California in San Francisco and kept at University of the Pacific. Three lateral cephalographs were chosen for each subject according to CVM (Cervical Vertebral Maturation) method (CVM stage 1 to 2, CVM stage 3 to 4, and CVM stage 5 to 6) which assess the extent of the skeletal maturation using the second, third, and fourth cervical vertebrae. V-ceph was used in order to mark the 8 landmarks (S, N, A, B, Pog, Me, Go, Imp) on lateral cephalographs and obtain 8 angular and linear measurements(ANB, SNPog, SN-GoMe, Imp-B, Imp-Pog, B-Pog//GoMe, $GoMe{\bot}B$, $GoMe{\bot}Pog$). Among 8 measurements, ANB, SNPog, SN-GoMe, B-Pog//GoMe, $GoMe{\bot}B$ showed statistically significant growth changes at various stages of skeletal maturation according to CVM method, while there were no significant differences on Imp-B, Imp-Pog, $GoMe{\bot}Pog$. The results suggest that the increasing prominence of human chin is greatly influenced by the vertical growth of B point area, in addition to the change and growth in chin and mandible proper.

• Journal of Korean Neurosurgical Society
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• 제38권6호
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• pp.435-441
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• 2005

Objective : Expandable cage used for spinal reconstruction after corpectomy has several advantages over nonexpendable cages. Here we present our clinical experience with the use of this cage after anterior column corpectomy with an average of one year follow up. Methods : Ten patients underwent expandable cage reconstruction of the anterior column after single-level or multilevel corpectomy for various cervical spinal disorders. Anterior plating with or without additional posterior instrumentation were performed in all patients. Functional outcomes, complications, and radiographic outcomes were determined. Results : There was no cage-related complication. Functionally, neurological examination revealed improvement in 7 of 10 patients and no patient had neurological deterioration after the surgery. Immediate stability was achieved and maintained throughout the period of follow-up. There was minimal subsidence [<2mm] noticeable in three of the cases that underwent a two-level corpectomy. Subsidence was noted in osteoporotic patients and patients undergoing multi-level corpectomies. Average pre-operative kyphotic angle was 9 degrees. This was corrected to an average of 5.4 degrees in lordosis postoperatively. Conclusion : In conclusion, expandable cages are safe and effective devices for vertebral body replacement after cervical corpectomy when used in combination with anterior plating with or without additional posterior stabilization. The advantages of using expandable cages include its ability to easily accommodate itself into the corpectomy defect, its ability to tightly purchase into the end plates after expansion and thus minimizing the potential for migration, and finally, its ability to correct kyphosis deformity via its in vivo expansion properties.

• Journal of Korean Neurosurgical Society
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• 제56권3호
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• pp.211-217
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• 2014

Objective : In Korea, early vertebroplasty (EVP) or delayed vertebroplasty (DVP, which is performed at least 2 weeks after diagnosis) were performed for the treatment of acute osteoporotic compression fracture (OCF) of the spine. The present study compared the outcomes of two surgical strategies for the treatment of single-level acute OCF in the thoracolumbar junction (T12-L2). Methods : From 2004 to 2010, 23 patients were allocated to the EVP group (EVPG) and 27 patients to the DVP group (DVPG). Overall mean age was $68.3{\pm}7.9$ and minimum follow-up period was 1.0 year. Retrospective study of clinical and radiological results was conducted. Results : No significant differences in baseline characteristics were observed between the two groups. As expected, mean duration from onset to vertebroplasty and mean duration of hospital stay were significantly longer in the DVPG ($17.1{\pm}2.1$ and $17.5{\pm}4.2$) than in the EVPG ($3.8{\pm}3.3$ and $10.8{\pm}5.1$, p=0.001). Final clinical outcome including visual analogue scale (VAS), Oswestry Disability Index, and Odom's criteria did not differ between the two groups. However, immediate improvement of the VAS after vertebroplasty was greater in the EVPG ($5.1{\pm}1.3$) than in the DVPG ($4.0{\pm}1.0$, p=0.002). The proportion of cement leakage was lower in the EVPG (30.4%) than in the DVPG (59.3%, p=0.039). In addition, semiquantitative grade of cement interdigitation was significantly more favorable in the EVPG than in the DVPG (p=0.003). Final vertebral body collapse and segmental kyphosis did not differ significantly between the two groups. Conclusion : Our findings suggest that EVP achieves a better immediate surgical effect with more favorable cost-effectiveness.

• Journal of Korean Neurosurgical Society
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• 제53권6호
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• pp.331-336
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• 2013

Objective : The offset connector can allow medial and lateral variability and facilitate intralaminar screw incorporation into the construct. The aim of this study was to compare the biomechanical characteristics of C7 intralaminar screw constructs with and without offset connector using a three dimensional finite element model of a C6-7 cervical spine segment. Methods : Finite element models representing C7 intralaminar screw constructs with and without the offset connector were developed. Range of motion (ROM) and maximum von Mises stresses in the vertebra for the two techniques were compared under pure moments in flexion, extension, lateral bending and axial rotation. Results : ROM for intralaminar screw construct with offset connector was less than the construct without the offset connector in the three principal directions. The maximum von Misses stress was observed in the C7 vertebra around the pedicle in both constructs. Maximum von Mises stress in the construct without offset connector was found to be 12-30% higher than the corresponding stresses in the construct with offset connector in the three principal directions. Conclusion : This study demonstrated that the intralaminar screw fixation with offset connector is better than the construct without offset connector in terms of biomechanical stability. Construct with the offset connector reduces the ROM of C6-7 segment more significantly compared to the construct without the offset connector and causes lower stresses around the C7 pedicle-vertebral body complex.

• Journal of Korean Neurosurgical Society
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• 제60권1호
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• pp.30-39
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• 2017

Objective : To compare the clinical outcomes and biomechanical effects of total disc replacement (TDR) and posterior cervical foraminotomy (PCF) and to propose relative inclusion criteria. Methods : Thirty-five patients who underwent surgery between 2006 and 2008 were included. All patients had single-level disease and only radiculopathy. The overall sagittal balance and angle and height of a functional segmental unit (FSU; upper and lower vertebral body of the operative lesion) were assessed by preoperative and follow-up radiographs. C2-7 range of motion (ROM), FSU, and the adjacent segment were also checked. Results : The clinical outcome of TDR (group A) was tended to be superior to that of PCF (group B) without statistical significance. In the group A, preoperative and postoperative upper adjacent segment level motion values were $8.6{\pm}2.3$ and $8.4{\pm}2.0$, and lower level motion values were $8.4{\pm}2.2$ and $8.3{\pm}1.9$. Preoperative and postoperative FSU heights were $37.0{\pm}2.1$ and $37.1{\pm}1.8$. In the group B, upper level adjacent segment motion values were $8.1{\pm}2.6$ and $8.2{\pm}2.8$, and lower level motion values were $6.5{\pm}3.3$ and $6.3{\pm}3.1$. FSU heights were $37.1{\pm}2.0$ and $36.2{\pm}1.8$. The postoperative FSU motion and height changes were significant (p<0.05). The patient's satisfaction rates for surgery were 88.2% in group A and 88.8% in group B. Conclusion : TDR and PCF have favorable outcomes in patients with unilateral soft disc herniation. However, patients have different biomechanical backgrounds, so the patient's biomechanical characteristics and economic status should be understood and treated using the optimal procedure.