• Journal of Korean Neurosurgical Society
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• 제48권3호
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• pp.193-198
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• 2010

Objective : The purpose of this study is to compare the incidence of possible complications of cervical lateral screw fixation and the achievements of bicortical purchase using the Roy-Camille, Magerl and the modified methods. Methods : Six fresh-frozen cervical spine segments were harvested. The Roy-Camille technique was applied to C3 and C4, and the Magerl technique was applied to C5, C6, and C7 of one side of each cadaver. The modified technique was applied to the other side of each cadaver. The nerve root injury, violation of the facet joint, vertebral artery injury, and the bicortication were examined at each screwing level. Results : No vertebral artery injury was observed in any of the three methods. One nerve root injury was observed in each cervical spine segment using the Roy-Camille method (8.3%), the Magerl method (5.6%), and the modified method (3.3%). Facet joint injuries were observed in two cervical spinal segments using the Roy-Camille method (16.7%) and three with the Magerl method (16.7%), while five facet joint violations occurred when using the modified method (16.7%). Bicortical purchases were achieved on ten cervical spinal segments with the Roy-Camille method (83.3%) and Magerl method (55.6%), while twenty bicortical purchases were achieved in the modified method (66.7%). Conclusion : The advantages of the modified method are that it is performed by using given anatomical structures and that the complication rate is as low as those of other known methods. This modified method can be performed easily and safely without fluoroscopic assistance for the treatment of many cervical diseases.

• The Korean Journal of Pain
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• 제20권1호
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• pp.60-65
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• 2007

Complex Regional Pain Syndromes (CRPS) type I and type II are neuropathic pain conditions that are being increasingly recognized in children and adolescents. The special distinctive features of pediatric CRPS are the milder course, the better response to treatment and the higher recurrence rate than that of adults and the lower extremity is commonly affected. We report here on a case of pediatric CRPS that was derived from ankle trauma and long term splint application at the left ankle. The final diagnoses were CRPS type I in the right upper limb, CRPS type II in the left lower limb and unclassified neuropathy in the head, neck and precordium. The results of various treatments such as medication, physical therapy and nerve blocks, including lumbar sympathetic ganglion blocks, were not effective, so implantation of a spinal cord stimulator was performed. In order to control the pain in his left lower limb, one electrode tip was located at the 7th thoracic vertebral level and two electrode tips were located at the 7th and 2nd cervical vertebral levels for pain control in right upper limb, head, neck and right precordium. After the permanent insertion of the stimulator, the patient's pain was significantly resolved and his disabilities were restored without recurrence. The patient's pain worsened irregularly, which might have been caused by psychological stress. But the patient has been treated with medicine at our pain clinic and he is being followed up by a psychiatrist. (Korean J Pain 2007; 20: 60-65)

• Journal of Trauma and Injury
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• 제34권1호
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• pp.31-38
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• 2021

Purpose: Traumatic vertebral injuries have a prevalence of 4-5% at level I centers. Studies have demonstrated that isolated thoracolumbar transverse process fractures (iTPF) rarely require brace or surgical interventions. We hypothesized that similarly isolated thoracolumbar spinous process fractures (iSPF) would have less need for bracing and operative interventions than SPFs with associated vertebral body (VB) fractures (SPF+VB). We performed a similar analysis for iTPF compared to transverse process fractures associated with VB injury (TPF+VB). Methods: In this single-center, retrospective study from 2012 to 2016, patients were classified into iSPF, SPF+VB, iTPF, and TPF+VB groups. Data including the fracture pattern, neurologic deficits, and operative intervention were obtained. The primary outcome studied was the need for bracing and/or surgery. A statistical analysis was conducted. Results: Of 98 patients with spinous process fractures, 21 had iSPF and 77 had SPF+VB. No iSPF patients underwent surgery, whereas 24 (31.17%) SPF+VB patients did undergo surgery (p=0.012). In the iSPF group, three patients (15%) received braces only for comfort, whereas 37 (48.68%) of the SPF+VB group required bracing (p=0.058). Of 474 patients with transverse process fractures, 335 had iTPF and 139 had TPF+VB. No iTPF patients underwent surgery, whereas 28 (20.14%) TPF+VB patients did (p≤0.001). Of the iTPF patients, six (1.86%) were recommended to receive braces only for comfort, while 68 (50.75%) of the TPF+VB patients required bracing (p<0.001). Conclusions: No patients with iSPF or iTPF required surgical intervention, and bracing was recommended to patients in these groups for comfort only. It appears that these injures may be safely managed without interventions, calling into question the need for spine consultation.

• Journal of Korean Neurosurgical Society
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• 제58권4호
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• pp.346-349
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• 2015

Objective : To investigate the value of lumbar bone mineral density (BMD) in fracture risk assessment (FRAX) tool. Methods : One hundred and ten patients aged over 60 years were enrolled and divided into 2 groups as non-osteoporotic vertebral fracture (OVF) and OVF groups. The 10-year-risk of major osteoporotic vertebral fracture of each group was calculated by FRAX tool with femoral and lumbar spine BMDs to compare the usefulness of lumbar spine BMD in prediction of OVF. The blood level of osteocalcin and C-terminal telopeptide (CTX) as markers of activities of osteoblast and osteoclast, respectively were analyzed using the institutional database. Results : In the OVF group, the ratio of patients with previous fracture history or use of glucocorticoid was higher than those in non-OVF group (p=0.000 and 0.030, respectively). The levels of T-score of femur neck and lumbar spine in OVF group were significantly lower than those in non-OVF group (p=0.001 and 0.000, respectively). The risk of OVF in FRAX using femur BMD in non-OVF and OVF groups was $6.7{\pm}6.13$ and $11.4{\pm}10.06$, respectively (p=0.007). The risk of using lumbar BMD in the 2 groups was $6.9{\pm}8.91$ and $15.1{\pm}15.08$, respectively (p=0.002). The areas under the receiver operator characteristic curve in the FRAX risk with lumbar and femur neck BMD were 0.726 and 0.684, respectively. The comparison of osteocalcin and CTX was not significant (p=0.162 and 0.369, respectively). Conclusion : In our study, the 10-year risk of major osteoporotic fracture in the OVF group of our study was lower than the recommended threshold of intervention for osteoporosis. Hence, a lower threshold for the treatment of osteoporosis may be set for the Korean population to prevent OVF. In the prediction of symptomatic OVF, FRAX tool using lumbar spine BMD may be more useful than that using femur neck BMD.

• The Korean Journal of Pain
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• 제18권2호
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• pp.204-207
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• 2005

Background: Transpedicular percutaneous vertebroplasty, along with kyphoplasty of the thoracic vertebrae, is technically more difficult than those of the lumbar vertebrae due to the anatomical differences. During the last four years, all the percutaneous vertebroplasty and kyphoplasty of the thoracic vertebrae carried out at our institution were performed using a transpedicular approach; therefore, we tried to find if there were any problems or complications associated with the process. Methods: The medical records of all the patients who had undergone thoracic percutaneous vertebroplasty or kyphoplasty were retrospectively reviewed. The following were looked up: the procedure name, unipedicular or bipedicular, the level of the thoracic vertebrae treated, and the pre- and postoperative changes in the Visual Analog Scales (VAS), the volume of cement injected and complications. Results: In the last four years, 58 vertebral bodies in 58 patients were treated. Twelve and 46 vertebral bodies were treated by kyphoplasty and vertebroplasty, respectively. A total of 58 mid and lower thoracic levels were treated: T5 (n=1), T6 (n=1), T7 (n=3), T8 (n=4), T9 (n=1), T10 (n=4), T11 (n=14) and T12 (n=30). The mean preoperative and postoperative VAS scores were $8.1{\pm}1.4$ and $5.2{\pm}1.7$, respectively. The mean volume of cement injected was $4.01{\pm}1.85ml$; $3.18{\pm}0.60ml$ at T5-8 and $4.22{\pm}2.27ml$ at T9-12. There were no clinical complications, such as pedicular fracture or cement leakage. Conclusions: Although transpedicular vertebroplasty and kyphoplasty at the mid to lower thoracic vertebral bodies is technically difficult compared to that at the lumbar region, the procedures can be performed safely.

• Journal of Acupuncture Research
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• 제30권4호
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• pp.45-53
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• 2013

Objectives : The purpose of this study was to evaluate the relationship between cross-sectional areas of the paraspinal and psoas muscles with low back pain. Methods : We assessed the cross-sectional area of the psoas and paraspinal muscles at the superior part of L4 level and vertebral body of L4 of 132 patients who were hospitalized with a chief complaint of low back pain at Jaseng Hospital of Korean Medicine from January 2013 to April 2013. After calculating the mean psoas area, we divided the patients into 2 groups by whether the psoas cross section was larger or smaller than the mean, and compared the admission period, verbal numeric rating scale(NRS) of low back pain(LBP), and improvement of verbal NRS of LBP. We also subcategorized the patients into acute and chronic groups according to the duration period, and compared the cross-sectional area of the psoas and paraspinal muscles. Results : Although analyses of the verbal NRS of LBP, and improvement of verbal NRS of LBP between groups with larger and smaller psoas cross section areas showed no significant difference, the admission period was significantly shorter in the group with larger psoas cross section areas. There was no significant difference in analyses of cross section areas in the acute and chronic groups. Of the possible prognostic variables, improvement of verbal NRS of LBP showed no correlation, while the admission period displayed a significant correlation. The cross-sectional area of the psoas and paraspinal muscles divided by the area of the vertebral body of L4 had a significant negative correlation with age. Conclusions : The cross-sectional area of the psoas and paraspinal muscles were correlated with the admission period in LBP patients, and the cross-sectional area of the surrounding muscles divided by the area of the L4 vertebral body was negatively correlated with age.

• 대한의용생체공학회:의공학회지
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• 제25권3호
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• pp.171-182
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• 2004

본 연구에서는 의료 영상과 유한요소 해석을 이용하여 골절된 척추체의 치료를 위해 골 시멘트를 주입하는 추체 성형술(vertebroplasty)에 영향을 미치는 여러 인자들에 대해 생체 역학적으로 분석하여 평가하고자 하였다. 의료 영상을 통해 구현된 모델들은 분석하고자 하는 인자에 대하여 크게 단분절과 다분절 유한요소 모델의 2 가지 형태로 구분하였다. 단분절 유한요소 모델을 통해 골다공증의 정도, 주입된 골 시멘트의 양, 골 시멘트의 주입량 및 환자에게 주입된 골 시멘트 양의 적절성을 평가하였으며, 골 시멘트의 주입이 척추체의 구조적 안정성에 미치는 효과를 분석하기 위하여 척추체 상종판에 수직 압축하중을 가하여 이때의 최대 수진 변위량을 분석하였다. 또한 단분절 척추체의 강성도(stiffness) 값을 산출한 뒤, 정상 상태의 척추체의 강성도 값으로 정규화 하였다. 다분절 유한요소 모델의 경우, 압박 골절 상태를 적용하여 척추 만곡의 변화가 인체에 미치는 영향을 분석하기 위하여 골절의 정도를 3 가지로 구현하였으며, 모델의 최상부에 압축 하중을 가한 후의 척추 만곡의 변화 정도를 분석하였다. 추체 성형술에 대한 다양한 인자들에 대한 분석 결과, 추체 성형술을 통해 환자의 골밀도가 상대적으로 높은 경우(BMD 50mg/$m\ell$이상)와 환자의 척추체 망상골 부피의 약 15%에 해당하는 골 시멘트 주입 시 가장 큰 척추체의 구조적 안정성의 증가 효과를 가져올 것으로 예측되었다. 또한 척추 골절이 미치는 영향에 대한 분석 결과, -2.8$^{\circ}$의 정상적인 후만곡을 가지는 T12∼L2 운동 분절이 골절의 모델링 후 약 9∼17$^{\circ}$의 큰 전만곡을 가지게 되었으며 이러한 척추 만곡의 변화는 동일한 하중 하에서 급격한 척추 만곡의 변화를 야기하는 것으로 나타났다. 또한 골절의 정도가 심할수록 척추 변형은 더욱 크게 증가하는 것으로 나타났다. 이러한 연구 결과들로부터, 전반적으로 추체 성형술은 골 시멘트의 주입량 또는 골밀도에 상관없이 약화된 척추체의 자체의 구조적 안정성의 증가 효과를 가져왔으며 골절로 인해 추체의 높이가 손상되었을 경우 이를 회복하는 것이 중요한 인자의 하나임을 나타내는 결과로 사료되어진다.

• 대한방사선기술학회지:방사선기술과학
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• 제28권3호
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• pp.219-226
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• 2005

목적 자기공명영상에 의해 진단된 척추 압박골절에 대하여 성별 및 나이별 발생빈도, 발생부위, 발생원인 등 임상적 특성을 분석하여 임상에서 참고 자료로 활용 할 수 있도록 하였다. 대상 및 방법 S 대학병원에서 2002년 1월부터 2004년12월 까지 자기공명영상 검사를 시행하여 척추 압박골절로 진단된 183명을 대상으로 하였다. 결과 1. 대상자 183명의 일반적 특성은 남자 70명(38.0%), 여자 113명(62.0%) 이었다. 2. 183명 중 단일 압박골절은 111명(60.7%)으로 남자는 38명(34.0%), 여자는 73명(66.0%)명 이었으며 60대 여성이 가장 많았다. 3. 다발성 압박골절은 183명 중 72명(39.3%) 이었고, 발생빈도 수는 182건으로 이는 한 명의 유소견자가 하나 이상의 level에 압박골절을 가지고 있는 경우를 분류한 것이며 남자가 70건(38.0%), 여자가 112건(62.0%)이었고, 60대와 70대 여자에서 많은 빈도를 보였다. 4. 압박골절의 발생부위는 $T11{\sim}L2$에 전체의 $70%{\sim}75%$가 발생하였다. 5. 전체 183명에 대한 압박골절의 원인별 발생 빈도는 남자의 경우 외상에 의한 골절이 41.4%로 가장 많았고, 여자는 골다공증에 의한 것이 70.0%로 가장 많았으며 남자와 여자를 합한 경우에는 골다공증에 의한 척추 압박골절이 56.8%로 가장 많았다. 결론 자기공명영상으로 진단된 척추 압박골절의 임상적 소견에서 단일 압박골절을 가지고 있는 경우가 다발성 압박골절 보다 약간 많았으며 단일성이나 다발성 모두 호발부위는 흉요추 이행 부위($T11{\sim}L2$)였다. 또한 원인별 발생 빈도는 골다공증에 의한 척추 압박골절이 가장 많은 것을 확인 하였다.

• Journal of Korean Neurosurgical Society
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• 제63권5호
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• pp.614-622
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• 2020

Objective : The method of approach during transforaminal endoscopic lumbar discectomy (TELD) has been the subject of repeated study. However, the ideal entry point during TELD has not been studied in detail. Therefore, this study investigated the ideal entry point for avoiding complications using computed tomography (CT) scans obtained from patients in the prone position. Methods : Using CT scans obtained from patients in the prone position, we checked for retroperitoneal or visceral violations and measured the angles of approach with five conventional approach lines drawn on axial CT scans at each disc space level (L2-3, L3-4, and L4-5). We also determined the ideal entry point distance and approach angles for avoiding retroperitoneal or visceral violations. Correlation analysis was performed to identify the patient characteristics related to the ideal entry point properties. Results : We found that the far lateral approach at the L2-3 level resulted in high rates of visceral violation. However, rates of visceral violation at the L3-4 and L4-5 levels were remarkably low or absent. The ideal angles of approach decreased moving caudally along the spine, and the ideal entry point distances increased moving caudally along the spine. Weight, body mass index (BMI), and the depth of the posterior vertebral line from the skin were positively associated with the distance of the ideal entry point from the midline. Conclusion : We reviewed the risk of the extreme lateral approach by analyzing rates of retroperitoneal and visceral violations during well-known methods of approach. We suggested an ideal entry point at each level of the lumbar spine and found a positive correlation between the distance of the entry point to the midline and patient characteristics such as BMI, weight, and the depth of the posterior vertebral line from the skin.

• Annals of Clinical Neurophysiology
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• 제1권1호
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• pp.39-46
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• 1999

Transcranial doppler ultrasonography (TCD) is a new, non-invasive and easily applicable method to evaluate cerebral hemodynamics. Last 10 years, its use in Korea has been dramatically expanded, but the qualification of TCD laboratory has yet to be settled. Since duplex sonography is seldom used in Korea, we have to depend totally on TCD to evaluate cerebral hemodynamic changes. Thus, all of the available data from every detectabler cerebral arteries has to be obtained for accurate interpretation of TCD measurements. Moreover, flow direction and wave form should be concerned in addition to the flow velocity. In this article, I present technique to measure the anterior, meddle and posterior cerebral arteries, the internal carotid artery siphon and at cervical level, and the vertebral and the basilar artery, and normal values for these measurements which is essential for the adequate interpretation.