• Journal of Korean Neurosurgical Society
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• 제64권6호
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• pp.843-852
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• 2021

The purpose of this review was to synthesize the research on global spinal alignment and reciprocal changes following cervical or thoracolumbar reconstruction surgery. We carried out a search of PubMed, EMBASE, and Cochrane Library for studies through May 2020, and ultimately included 11 articles. The optimal goal of a truly balanced spine is to maintain the head over the femoral heads. When spinal imbalance occurs, the human body reacts through various compensatory mechanisms to maintain the head over the pelvis and to retain a horizontal gaze. Historically, deformity correction has focused on correcting scoliosis and preventing scoliotic curve progression. Following substantial correction of a spinal deformity, reciprocal changes take place in the flexible segments proximal and distal to the area of correction. Restoration of lumbar lordosis following surgery to correct a thoracolumbar deformity induces reciprocal changes in T1 slope, cervical lordosis, pelvic shift, and lower extremity parameters. Patients with cervical kyphosis exhibit different patterns of reciprocal changes depending on whether they have head-balanced or trunk-balanced kyphosis. These reciprocal changes should be considered to in order to prevent secondary spine disorders. We emphasize the importance of evaluating the global spinal alignment to assess postoperative changes.

• Journal of Korean Neurosurgical Society
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• 제44권4호
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• pp.217-221
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• 2008

Objective : Although anterior cervical discectomy and fusion (ACDF) is the standard treatment for degenerative cervical disc disease, concerns regarding adjacent level degeneration and loss of motion have suggested that arthroplasty may be a better alternative. We have compared clinical and radiological results in patients with cervical disc herniations treated with arthroplasty and ACDF. Methods : We evaluated 53 patients treated for cervical disc herniations with radiculopathy, 21 of whom underwent arthroplasty and 32 of whom underwent ACDF. Clinical results included the Visual Analogue Scale (VAS) score for upper extremity radiculopathy, neck disability index (NDI), duration of hospital stay and convalescence time. All patients were assessed radiologically by measuring cervical lordosis, segmental lordosis and segmental range-of-movement (ROM) of operated and adjacent disc levels. Results : Mean hospital stay (5.62 vs. 6.26 days, p<0.05) and interval between surgery and return to work (1.10 vs 2.92 weeks, p<0.05) were significantly shorter in the arthroplasty than in the fusion group. Mean NDI and extremity VAS score improved after 12 months in both groups. Although it was not significant, segmental ROM of adjacent levels was higher in the fusion group than in the arthroplasty group. And, segmental motion of operated levels in arthroplasty group maintained more than preoperative value at last follow up. Conclusion : Although clinical results were similar in the two groups, postoperative recovery was significantly shorter in the arthroplasty group. Although it was not significant, ROM of adjacent segments was less in the arthroplasty group. Motion of operated levels in arthroplasty group was preserved at last follow up.

• Journal of Korean Neurosurgical Society
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• 제46권4호
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• pp.300-304
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• 2009

Objective : This is retrospective study of clinical and radiological outcomes of anterior cervical fusion using Bongros-$HA^{TM}$ (BioAlpha, Seongnam, Korea) which is a type of synthetic hydroxyapatite (HA) spacer to evaluate the efficacy in its clinical application and usefulness as a reliable alternative to autograft bone. Methods : Twenty-nine patients were enrolled in this study and 40 segments were involved. All patients were performed anterior cervical interbody fusion using HA spacer and plating system. Indications for surgery were radiculopathy caused by soft-disc herniation or spondylosis in 18 patients, spondylotic myelopathy in 1 patient, and spinal trauma in 10 patients. Cervical spine radiographs were obtained on postoperative 1day, 1week, and then at 1, 2, 6, and 12 months in all patients to evaluate intervertebral disc height, and the degrees of lordosis. Cervical computed tomography was done at postoperative 12 month in all patients to confirm the fusion status. The mean period of clinical follow-up was 17 months. Results : Complete interbody fusion was achieved in 100% of patients. Preoperative kyphotic deformities were corrected in all cases after surgery. Intervertebral disc height was well maintained during follow up period. There were no cases of graft extrusion, graft deterioration and graft fracture. Conclusion : HA spacer is very efficient in achieving cervical fusion, maintaining intervertebral disc height, and restoring lordosis. When combined with the placement of a cervical plate, immediate stability can be achieved and graft related complication can be prevented.

• The Journal of Korean Physical Therapy
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• 제25권6호
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• pp.417-421
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• 2013

Purpose: This study was to identify the effect of cervical stabilization exercise on pain and structure in patients with cervical artificial disc replacement. Methods: Forty-four individuals with cervical artificial disc replacement volunteered to participate from FEB 2012 to MAR 2013 in this study. They were allocated to either Experimental Group (EG) or Control Group (CG), with 22 subjects in each group. Subjects from the EG performed cervical stabilization exercise program and subjects from the CG performed isometric exercise program. Assessment tools were made with the Visual Analogue Scale (VAS), Neck Disability Index (NDI), and Cervical Lordosis Angle (CLA). Results: In this study, in within-group and between-group comparison, the EG and CG showed significant differences in all parameters(p<0.05). But EG showed more improvement than CG at all parameters. Conclusion: These findings suggest that cervical stabilization exercise may be favorably used to improve VAS, NDI and CLA in patients with cervical artificial disc replacement. Further studies with larger sample and long-term follow-up period need to generalize the results of this study.

• 한방재활의학과학회지
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• 제27권1호
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• pp.37-51
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• 2017

Objectives This study was designed to identify the effect of acupuncture combined with wooden neck pillow self-exercise program (WSP). Methods 25 eligible subjects with chronic neck pain were recruited from September 2015 to August 2016. Subjects were treated by acupuncture twice a week for 4 weeks, also were educated WSP and exercised every day for 4 weeks. They were assessed using PI-NRS, NDI and the maximum muscle strength of deep cervical flexor muscles (DCF) before and after treatment. Also the Cobb's angle (C1-C7), Ishihara index, Park method were assessed for evaluating the radiographical changes. Variables were compared using paired t-test. And correlates analysis was used for analyzing relationship between differentials in the maximum muscle strength of DCF and differentials in cervical spine curvature measurement methods. Results Among the 25 subjects, 4 subjects were lost to follow-up or excluded in accordance with the criteria. Significant differences on NRS, NDI and the maximum muscle strength of DCF were seen after treatment (p<0.001). In radiological finding, cervical spine curvature measurement methods were significantly increased (p<0.001, p<0.05, p<0.05). Differentials in the maximum muscle strength of DCF significantly correlates to differentials in Ishihara index (R=0.479, p<0.05). Conclusions Acupuncture combined with WSP may decrease neck pain intensity and associated disability, and also increase the muscle strength of DCF and cervical lordosis, in patients with chronic neck pain. Especially, Improving the muscle strength of DCF has a relationship with improving Ishihara index. However, due to the design of this study, this treatment can not be compared with other treatments. Future randomized project should be needed.

• 대한물리의학회지
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• 제10권2호
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• pp.17-27
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• 2015

PURPOSE: The purpose of this study was to compare the effects of three interventions (intervention by passive range of motion exercise plus manual cervical traction, Mulligan's joint mobilization, and strengthening exercises) after Kaltenborn's joint mobilization on the cervical spine alignment, and muscle activity in patients with a forward head posture. METHODS: The subjects were 39 students from H University in Chungnam and C University in Jeonbuk. The subjects in each group attended training sessions three times a week for four weeks. We used one-way ANOVA and Scheffe's post hoc test to compare values between groups, and used paired t-test to compare the values of the dependent variables within groups. RESULTS: The results showed that the active intervention group experienced a significant increase compared to the passive intervention group in terms of the craniovertebral angle, cervical lordosis angle, and had significant decreases compared to the passive intervention group in terms of the upper trapezius muscle activity. The active intervention group also had significant increases in craniovertebral angle and decreased anterior scalene muscle activity than the active-assistive intervention group. The active-assistive intervention group had significant decreases compared to the active intervention group in terms of the serratus anterior, levator scapulae, and splenius capitis muscle activity. CONCLUSION: It appears that the subjects with a forward head posture had significant improvements in the cervical lordosis angle, cranial rotation angle, craniovertebral angle, and muscle activity after intervention by Mulligan's joint mobilization (active-assistive intervention component) and strengthening exercises (active intervention component) after applying Kaltenborn's joint mobilization.

• Journal of Korean Neurosurgical Society
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• 제64권6호
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• pp.913-921
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• 2021

Objective : Accurate measurement of T1 slope (a component of T1s minus cervical lordosis [CL]) is often constrained by anatomical limitations. In this situation, efforts should be made to find the exact meaning of T1s-CL and whether there are any alternatives to it. Methods : We enrolled 117 patients who received two-level anterior cervical discectomy and fusion (ACDF). Occipital slope, C2 slope (C2s), C7 slope (C7s), T1, O-C2 angle (O-C2A), C2-7 angle (C2-7A), O-C7 angle (O-C7A), T1s-CL, C7-T1 angle (C7-T1A), and C2-7 sagittal vertical axis were measured. We determined 16° (T1s-CL) as the reference point for dividing subjects into the mismatch group and the balance group, and a comparative analysis was performed. Results : The mean value of C7-T1A was constantly maintained within 2.6° peri-operatively. In addition, C2s and T1s-CL showed the same absolute change (Δ|0.8|°). The mean values of T1s-CL of the mismatch and balance groups were 23.0° and 7.6°, respectively. The five factors with the largest differences between the two groups were as follows : C2s (Δ13.3°), T1s-CL (Δ15.4°), O-C2A (Δ8.7°), C2-7A (Δ14.7°), and segmental angle (Δ7.9°) before surgery. Only four factors showed statistically significant change between the two groups after ACDF : T1s-CL (Δ4.0° vs. Δ0.2°), C2s (Δ3.2° vs. Δ0.7°), O-C2A (Δ2.6° vs. Δ1.3°), C2-7A (Δ6.3° vs. Δ1.3°). A very strong correlation between T1s-CL and C2s was also found (r=|0.88-0.96|). Conclusion : C2s itself may be the essential key to represent T1s-CL. The amounts and directions of change of these two factors (T1s-CL and C2s) were also almost identical. The above phenomenon was re-confirmed once again through the correlation analysis.

• Journal of Korean Medical Science
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• 제33권48호
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• pp.316.1-316.10
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• 2018

Background: Water pressure and muscle contraction may influence bone mineral density (BMD) in a positive way. However, divers experience weightlessness, which has a negative effect on BMD. The present study investigated BMD difference in normal controls and woman free-divers with vertebral fracture and with no fracture. Methods: Between January 2010 and December 2014, traditional woman divers (known as Haenyeo in Korean), and non-diving women were investigated. The study population was divided into osteoporotic vertebral fracture and non-fracture groups. The BMD of the lumbar spine and femoral neck was measured. The radiological parameters for global spinal sagittal balance were measured. Results: Thirty free-diving women and thirty-three non-diving women were enrolled in this study. The mean age of the divers was $72.1{\pm}4.7$ years and that of the controls was $72.7{\pm}4.0$ years (P = 0.61). There was no statistical difference in BMD between the divers and controls. In divers, cervical lordosis and pelvic tilt were significantly increased in the fracture subgroup compared to the non-fracture subgroup (P = 0.028 and P = 0.008, respectively). Sagittal vertical axis was statistically significantly correlated with cervical lordosis (Spearman's rho R = 0.41, P = 0.03), and pelvic tilt (Spearman's rho R = 0.46, P = 0.01) in divers. Conclusion: BMD did not differ significantly between divers and controls during their postmenopausal period. When osteoporotic spinal fractures develop, compensation mechanisms, such as increased cervical lordosis and pelvic tilt, was more evident in traditional woman divers. This may be due to the superior back muscle strength and spinal mobility of this group of women.

• Journal of Acupuncture Research
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• 제25권5호
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• pp.69-76
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• 2008

Objectives : The objective of this study was to observe the correlation between Cervical hypolordosis and Neck pain. Methods : Cervical lordosis(Cobb method[C1-C7], Cobb method[C2-C7], Ishihara index) was measured using the sagittal radiograph of the cervical spine and Neck pain(VAS scale, Neck Disability Index) was evaluated. Based on Cobb method[C1-C7], 48 subjects(Cobb method[C1-C7]${\leq}45^{\circ}$) were divided into Hypolordosis group and Normal group. Window version SPSS 12K was used for statistical analysis about correlation between Cervical lordosis and Neck pain, also about difference of the Neck pain between Normal and Hypolordosis group. Results : It was as follows, 1. Cobb method[C1-C7] and Neck pain(VAS scale, NDI) showed a significant correlation coefficient (p<0.05). Ishihara Index and NDI also showed a significant correlation coefficient of -0.297(p=0.040). 2. The VAS scale in the hypolordosis group was $5.62{\pm}2.34$ and that of the normal group was $3.41{\pm}2.01$(p=0.001). The NDI in the hypolordosis group was $2.30{\pm}0.66$ and that of the normal group was $1.81{\pm}0.51$(p=0.007). There was no significant difference in Age, Sex between both group. Conclusions : There was a significant correlation between Cervical hypolordosis and Neck pain. Hypolordosis group complained a severe neck pain.

• Journal of Korean Neurosurgical Society
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• 제64권6호
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• pp.901-912
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• 2021

Objective : In the cervical spine, many surgical procedures have been developed to achieve optimal results for various disorders, including degenerative diseases, traumatic injury, and tumor. In this study, we report our experience and follow-up results with a new surgical technique for cervical spine entitled posterior floating laminotomy (PFL) in comparison with conventional laminectomy and fusion (LF). Methods : Data for 85 patients who underwent conventional LF (n=66) or PFL (n=19) for cervical spine disorders between 2012 and 2019 were analyzed. Radiological parameters, including cervical lordosis (CL), T1 slope (T1S), segmental lordosis (SL), and C2-7 sagittal vertical axis (SVA), were measured with lateral spine X-rays. Functional outcomes, comprising the modified Japanese Orthopaedic Association (mJOA), neck disability index (NDI), and visual analog scale (VAS) scores, were also measured. For the patients who underwent PFL, postoperative magnetic resonance image (MRI) was performed in a month after the surgery, and the degree of decompression was evaluated at the T2-weighted axial image, and postoperative computed tomography (CT) was conducted immediately and 1 year after the operation to evaluate the gutter fusion. Results : There was no difference in CL, T1S, SL, and C2-7 SVA between the groups but there was a difference in the preoperative and postoperative SL angles. The mean difference in the preoperative SL angle compared with that at the last follow-up was -0.3° after conventional LF and 4.7° after PFL (p=0.04), respectively. mJOA, NDI, and VAS scores showed significant improvements (p<0.05) during follow-up in both groups. In the PFL group, postoperative MRI showed sufficient decompression and postoperative CT revealed gutter fusion at 1 year after the operation. Conclusion : PFL is a safe surgical method which can preserve postoperative CL and achieve good clinical outcomes.