• Journal of Mechanical Science and Technology
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• v.15 no.7
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• pp.1041-1050
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• 2001

Control of bone cement volume (PMMA) may be critical for preventing complications in vertebroplasty, the percutaneous injection of PMMA into vertebra. The purpose of this study was to predict the optimal volume of PMMA injection based on CT images. For this, correlation between PMMA volume and textural features of CT images was examined before and after surgery to evaluate the appropriate PMMA amount. The gray level run length analysis was used to determine the textural features of the trabecular bone. Extimation of PMMA volume was done using 3D visualization with semi-automatic segmentation on postoperative CT images. Then, finite element (FE) models were constructed based on the CT image data of patients and PMMA volume. Appropriate material properties for the trabecular bone were assigned by converting BMD to elastic modulus. Structural reinforcement due to the changes in PMMA volume and BMD was assessed in terms of axial displacement of the superior endplate. A strong correlation was found between the injected PMMA volume and the area of the intertrabecular space and that of trabecular bone calculated from the CT images (r=0.90 and -0.90, respectively). FE results suggested that vertebroplasty could effectively reinforce the osteoporotic vertebra regardless of BMD or PMMA volume. Effectiveness of additional PMMA injection tended to decrease. For patients with BMD well lower than 50mg/ml, injection of up to 30% volume of the vertebral body is recommended. However, less than 30% is recommended otherwise to avoid any complications from excessive PMMA because the strength has already reached the normal level.

• The Korean Journal of Pain
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• v.12 no.1
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• pp.114-118
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• 1999

Backgrouds: Cervical epidural blocks were used as part of a comprehensive multimodal treatment program for patients with chronic pain in the head, neck and upper extremities. The depth of the epidural space beneth the skin surface varies at different levels of the spinal column in the same patient. It also varies from patient to patient at the same vertebral level. We studied the distance the skin to the cervical epidural space in adults patients at different intervertebral spaces. Methods: Date were gathered from 628 patients having cervical epidural block for relief of cervical and upper extrimity pain. All blocks were performed using hanging drop method after loss of resistance with saline at C5-6, C6-7, C7-T1 intervertebral space. Results: Mean distances for skin to cervical epidural space (DSES) were 5.42 cm, 5.06 cm, 4.68 cm in male, 5.00 cm, 4.61 cm, 4.10 cm in female at C7-T1, C6-7, C5-6 intervertebral space. DSES correlated with body weight, neck circumference and body mass index significantly. Conclusion: In the cervical spine, DSES varies from space to space. The longest DSES were noted at C7-T1 level in male, and the shortest DSES were at C5-6 in female. DSES has significant relationships with weight, neck circumference and body mass index.

• Journal of Biomedical Engineering Research
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• v.26 no.3
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• pp.151-155
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• 2005

Interspinous spacers have been developed as an alternative surgical treatment for laminectomy or fusion with pedicle screws and rods for the treatment of lumbar spinal stenosis. However, its biomedical efficacies are well not known. In this study, we evaluated kinematic behaviors of the surgical and the adjacent levels before and after inserting interspinous spacers. Three porcine lumbar spines were prepared. On each specimen, an interspinous spacer was inserted at the L4-L5. Flexion-extension moments (0, 2.5, 5.0, 7.5, 10Nm) were applied. A stereophotogrammetric set-up with DLT algorithm was used to assess the three-dimensional motions of the specimen where three markers $({\square}0.8mm)$ were attached to each vertebra. Results showed that extension motion decreased by $15-24\%$ at the surgical level (L4-L5) after insertion of interspinous spacer. At the adjacent levels, the range of motion remained unchanged. In flexion, no significant changes in motion were observed regardless of levels. Therefore, our experimental results demonstrated the interspinous spacer is very effective in limiting the extension motion that may cause narrowing of the spinal canal and vertebral foramen while maintaining kinematic behaviors at the adjacent levels. Further, these results suggested that the use of interspinous spacer may be able to prevent lower back pain at the surgical level and to lower the incidence of degenerative changes at the adjacent levels.

• Journal of Korean Medicine Rehabilitation
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• v.30 no.1
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• pp.95-103
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• 2020

Objectives The purpose of this study is to assess the effect of korean medicinal admission treatment for degenerative lumbar diseases with spondylolysis and analyze their radiological findings. Methods This study was performed on 25 cases' medical records of spondylolysis patients with both X-rays and MRI images. Their general characteristics, morphologies of intervertebral discs, grades of spondylolisthesis, grades of intervertebral foraminal stenosis were analyzed. The efficacy of treatment was evaluated by numeric pain rating scale (NPRS) changes and statistically assessed by paired t-test using program R Studio. Results After admission treatment, NPRS scores significantly decreased from 6.76±2.07 to 2.38±1.22 (p<0.01). Spondylolysis was associated with degenerative disc change and intervertebral foraminal stenosis at the same or adjacent vertebral level. In spondylolisthesis cases (76%), forward slippage occurred at the same level of spondylolysis in every case. Conclusions Spondylolysis could play a key role in the lumbar degenerative mechanism and korean medicinal admission treatment is effective on pain relief of degenerative lumbar diseases with spondylolysis.

• Journal of Korean Neurosurgical Society
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• v.64 no.4
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• pp.585-591
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• 2021

Objective : Filum transection is one of the most commonly performed operative procedure in pediatric neurosurgery. However, the clinical and pathological features as well as the surgical indication are not well-established. This study aimed to analyze the characteristics of patients who underwent transection of the filum during the last 10 years in a single institute. Methods : A total of 82 patients underwent transection of the filum during the period. As a general rule, we performed the transection in patients who are symptomatic or have abnormality in the urologic or neuromuscular evaluations. There were exceptions as asymptomatic patients who only fit the definition of thickened filum (width greater than 2.0 mm or conus level below L3 vertebral body) were operated by parent's wish or surgeon's preference according to radiological findings, etc. Results : Seventy-six out of 82 patients had fibrous tissue in the pathologic specimen of filum. Interestingly, patients who had glial cells were more correlated with no preoperative syrinx, and no progression of syrinx even for those who did have syrinx initially. Also, larger percentage of symptomatic patients had peripheral nerve twigs than asymptomatic patients. No difference in conus level or thickness of filum was found between patients with or without preoperative syrinx. Significantly more patients with syrinx (56%) were chosen to be operated without any symptom or abnormality in study i.e., solely based on radiological findings than those without syrinx (21%). The surgical outcome for syrinx was favorable, as all but one patient had either improved or static syrinx. The exceptional case had increase in size due to the upward displacement of the proximal end of the cut filum. Conclusion : This study evaluated the pathological, clinical, radiological features of patients who underwent transection of the filum. Interesting correlations between pathological findings and clinical features were found. Excellent outcome regarding preoperative syrinx was also shown.

• Physical Therapy Korea
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• v.31 no.1
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• pp.8-17
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• 2024

Background: Sleep accounts for approximately one-third of a person's lifetime. It is a relaxing activity that relieves mental and physical fatigue. Pillows of different sizes, shapes, and materials have been designed to improve sleep quality by achieving an optimal sleep posture. Objects: This study aimed to determine which pillow provides the most comfortable and supports the head and neck during sleep, which may enhance sleep quality. Methods: Twenty-eight healthy adults (19 males and 9 females) with an average age of 29 years participated in this cross-sectional study. This experiment was conducted while the participants laid down for 5 minutes in four different pillow conditions: (1) no pillow (NP), (2) neck support foam pillow (NSFP), (3) standard microfiber filled pillow (SFP), and (4) hybrid foam pillow (HFP). The head-neck peak pressure, cranio-vertebral angle in supine (CVAs), cranio-horizontal angle in supine (CHAs), chin-sternum distance (CSD), and muscle tone of sternocleidomastoid were analyzed using one-way repeated measures analysis of variance (ANOVA). The significance level was set at p < 0.05. Results: The head-neck peak pressure was the highest in the NSFP condition, followed by the NP, SFP, and HFP conditions. The CVAs, CHAs, and CSD of the SFP were lower than those of the other pillows. Muscle tone was the highest in the NP condition, followed by the of NSFP, HFP, and SFP conditions. The participants subjective comfort level in both the supine and side-lying postures was highest in the HFP condition, followed by the SFP and NSFP conditions. Conclusion: This study can be used to establish the importance of pillow selection for high-quality sleep. The results of this study, suggest that a hybrid pillow with a good supportive core and appropriate fluffiness can maintain comfort and correct cervical spine alignment during sleep.

• Journal of Korean Neurosurgical Society
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• v.30 no.2
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• pp.201-206
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• 2001

Objective : The purpose of this study was to assess the complications, duration of admission, cost effectiveness, radiologic stabilization of the anterior cervical bone fusion in the treatment of cervical disc disease with and without plating. Materials and Methods : Fifty-two surgically treated patients for cervical disc disease were reviewed. Group I consisted of consecutive treated patients with iliac auto-bone graft without instrumentation after anterior cervical discectomy. Group II consisted of consecutive treated patients with iliac autologous-bone graft with CASPER cervical plate fixations. Radiologic fusion was decided when loss of end plate boundary between graft bone and vertebral body and immobile, maintenance of the disc space were evident on simple dynamic plain films. The patients were discharged after the stabilization of cervical motion by films was of tained. These groups were analysed multiple variably with Mann-Whitney U-test. Results : Group I consisted of 18 patients, group II consisted of 34 patients. Mean age was $49.0{\pm}8.1years$, mean duration of admission was $17.27{\pm}10.51days$, mean costs for treatment was $1,970,000{\pm}475,000won$. In group I, mean age was 47.7(34-60) years, 16 patients had undergo on one-level operation, 2-patients had undergo on two-level operation, mean duration of admission was $28.7{\pm}10.4days$, mean costs for treatment was $2,194,473{\pm}561,639won$. The periods of stabilization was $6.6{\pm}3.36weeks$ on radiologic study. Mean periods of out patient follow up was 16.8(6-64) weeks after discharge. Mean period of radiologic follow up was 17.3(4-6) weeks after surgical operation. In group II, mean age was 49.7(37-62) years and 18 patients one-level operation, 14- patients had undergo on two-level operation and 2-patients three-level operation. Mean duration of admission was $11.24{\pm}3.29days$, mean costs for treatment was $1,850,823{\pm}389,372won$. The periods of stabilization was $5.88{\pm}7.07weeks$ on radiologic study. Mean period of out patients follow up was 16.7(4-60) weeks after discharge. Mean period of radiologic follow up was 12.4(3-52) weeks after surgical operation. The duration of admission showed statistical significance in Group II but other items showed no significant difference between two groups. Conclusions : The more economic, early life return and effective method of cervical disc disease in our series were evident in patients who had undergone, iliac bone graft and plate fixations after anterior discectomy.

• Journal of the Korean Orthopaedic Association
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• v.56 no.3
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• pp.208-214
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• 2021

Purpose: Verifying a reliable predictor of the progression of vertebral deformity in patients with acute osteoporotic fractures of the lumbar spine may be useful. A qualitative analysis of the muscle near the spine was performed using magnetic resonance imaging (MRI), and its correlation with a spinal deformity was determined under the hypothesis that the causes of the kyphotic deformity are associated with muscle reduction in the multifidus and erector spinae. Materials and Methods: The study was performed in a retrospective manner using the electronic medical records of patients who presented to the author's institution between January 2007 and March 2018, and were diagnosed with an acute lumbar fracture. The fat infiltration rates of the multifidus and erector spinae were measured using MRI taken at the time of injury, and the mean value was defined as the total fat infiltration rate (TFI). Based on lateral radiographs of the lumbar spine at the one-year follow-up, the loss of height of the vertebral body, the kyphotic angle and the wedge angle were measured. The statistical significance was confirmed by calculating the Pearson correlation coefficient. Results: One hundred twenty-nine patients, of which 30 were male and 99 were female, were examined. The mean age was 71.28 years. The mean T-score was -3.53±0.79 g/cm², and the mean fat infiltration was 15.20%±11.99%. TFI was positively correlated with age (R=0.373, p<0.001), compression rate (R=0.369, p<0.001), and Cobb's angle (R=0.386, p<0.001) after a one year follow-up, but negatively correlated with the BMD score (R=-0.252, p=0.004). As the fracture progressed to the lower lumbar level, the compression rate (R=-0191, p=0.030) and wedge angle (R=-0.428, p<0.001) at the time of injury tended to decrease. Conclusion: In patients with osteoporotic vertebral fractures, the fat infiltration rate may be an important predictor of conservative treatment. The prognosis of patients with a high-fat infiltration rate should be explained during patient education, and the patients must be monitored closely through short-term outpatient follow-up.

• Journal of Yeungnam Medical Science
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• v.20 no.2
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• pp.160-168
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• 2003

Background: Confirm the stability of intervertebral disc sustaining each fused lumbar spine cases, comparing vertical compression, A-P shear force and rotational moment on intervertebral disc of instrumented lumbar spine with simple vertical compression load and follower load using finite element analysis. Materials and Methods: We analyze the stability of intervertebral disc L4-5 supporting fused lumbar spine segments. After performing finite element modelling about L1-L5 lumbar vertebral column and L1-L4 each fusion level pedicle screw system for fused lumbar spine fine element model. Intervertebral discs with complex structure and mechanical properties was modeled using spring element that compensate stiffness and tube-to-tube contact element was employed to give follower load. Performing geometrical non-linear analysis. Results: The differences of intervertebral disc L4-5 behavior under the follower compression load in comparision with vertical compression load are as follows. Conclusion: As a result of finite element interpretation of instrumented lumbar spine, the stability of L4-5 sustaining fused lumbar segment, the long level fused lumbar spine observed hing stability under follower load. This research method can be the basis tool of effects prediction for instrumentation, a invention of a more precious finite element interpretation model which consider the role of muscle around the spine is loaded.

• Journal of Acupuncture Research
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• v.37 no.3
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• pp.193-201
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• 2020

This case report describes a 60-year-old female patient diagnosed with intercostal neuropathy and vertebral compression fractures which occurred following an electric shock injury. The patient received acupuncture, pharmacopuncture, and herbal medicine administration between February 10^th, 2020 and April 25^th, 2020. The pain level in the thoracic and left intercostal areas was assessed using the Numerical Rating Scale. The Self-report of the Leeds Assessment of Neuropathic Symptoms and Signs Pain Scale were used to diagnose neuropathic pain. The Neuropathic-Pain -Scale was used to evaluate the degree of neuropathic symptoms. The Oswestry Disability Index and the European Quality of Life-5 Dimensions were used to assess quality of life scales and functional disorder. Following combined Korean medicine treatment, the patient exhibited reduced levels of pain and significant improvement in functional disorder symptoms and quality of life.