• The Journal of Korea CHUNA Manual Medicine
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• v.2 no.1
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• pp.85-92
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• 2001

Objectives : To study the cervical lordosis and disc degeneration in neck pain patients with or without low back pain. Subjects. The study was composed of 57 neck pain patients with low back pain(LBP group) and 40 neck pain patients without low back pain(Non-LBP group). Methods : Radiographic measures of spinal lordosis(cervical and lumbar) and disc degeneration were collected, and statistically analyzed. Results: LBP group showed a significant increase in cervical lordotic angle as compared with Non-LBP group, whereas no significant change in cervical disc degeneration. A relationship was found between cervical and lumbar disc degeneration in LBP $group({\gamma}-0.3064)$. Conclusions : The findings from this study suggest that the curvature of the cervical spine is related to the subject's low back pain.

• The Journal of Korean Medicine
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• v.25 no.4
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• pp.43-50
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• 2004

Objective : Obesity is associated with degenerative arthropathy giving stress on joints. It also amplifies loads of weight bearing joints by changing the gravity line of the body. Our aim is to investigate the correlation between obesity and lumbar lordosis in obese pre-menopausal Korean females. The hypothesis was tested that there is a correlation between obesity and lumbar lordosis. Methods : A cross-sectional evaluation of 44 Females (baseline age 30.77 ± 6.46) with BMI 31.53 ± 3.82 (kg/㎡) was done. Body composition was measured using bio-impedance analysis (BIA), and anthropometry was done by the same observer. A lateral whole spine X-ray was taken in standing position to measure the lumbar lordotic angle (LLA), Ferguson angle (FA) and lumbar gravity line (LGL). A Pearson correlation was used to measure the correlation between obesity and lumbar lordosis (SPSS 10.0 for windows). Results : Body mass index (BMI kg/㎡) had a negative relationship with LLA((equation omitted)=-0.469), FA((equation omitted) =-0.347) and LGL((equation omitted)=-0.389). Body fat rate had a negative relationship with LLA only(γ=-0.385). Waist circumference had a negative relationship with LLA((equation omitted)=-0.345) and LGL((equation omitted)=-0.346). WH ratio had no relationship with lumbar lordosis. Conclusion : These data show that obesity is related to mechanical structures, such as lumbar lordosis. BMI was the most useful index, which reflects a change of mechanical structure of lumbar, more than other variables in this study.

• Journal of Korean Neurosurgical Society
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• v.58 no.4
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• pp.357-362
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• 2015

Objective : To investigate risk factors for S1 screw loosening after lumbosacral fusion, including spinopelvic parameters and paraspinal muscles. Methods : We studied with 156 patients with degenerative lumbar disease who underwent lumbosacral interbody fusion and pedicle screw fixation including the level of L5-S1 between 2005 and 2012. The patients were divided into loosening and non-loosening groups. Screw loosening was defined as a halo sign larger than 1 mm around a screw. We checked cross sectional area of paraspinal muscles, mean signal intensity of the muscles on T2 weight MRI as a degree of fatty degeneration, spinopelvic parameters, bone mineral density, number of fusion level, and the characteristic of S1 screw. Results : Twenty seven patients showed S1 screw loosening, which is 24.4% of total. The mean duration for S1 screw loosening was $7.3{\pm}4.1$ months after surgery. Statistically significant risk factors were increased age, poor BMD, 3 or more fusion levels (p<0.05). Among spinopelvic parameters, a high pelvic incidence (p<0.01), a greater difference between pelvic incidence and lumbar lordotic angle preoperatively (p<0.01) and postoperatively (p<0.05). Smaller cross-sectional area and high T2 signal intensity in both multifidus and erector spinae muscles were also significant muscular risk factors (p<0.05). Small converging angle (p<0.001) and short intraosseous length (p<0.05) of S1 screw were significant screw related risk factors (p<0.05). Conclusion : In addition to well known risk factors, spinopelvic parameters and the degeneration of paraspinal muscles also showed significant effects on the S1 screw loosening.

• Journal of Korean Neurosurgical Society
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• v.39 no.4
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• pp.260-264
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• 2006

Objective : The retrospective study is undertaken to report clinical results of anterior cervical interbody fusion with an intradiscal cage with an integrated plate [PCB cervical plating system]. Methods : 38 patients underwent anterior cervical interbody fusion with PCB cervical plating system and followed $6{\sim}24\;months$. The authors investigated overall surgical results; clinical outcome, fusion rate, change of interspace height & lordotic angle, and complications. Results : No complication was observed during the operation. Clinical improvement was identified in 34 cases [89.5%]. Bone fusion observed in 44 out of 49 sites [90.7%]. After operation, the interspace height increased from $5.4{\pm}1.3mm$ to $7.8{\pm}1.5mm$ and maintained $7.4{\pm}1.1mm$ and, interspace angle went up from $4.2{\pm}0.7^{\circ}$ to $4.8{\pm}1.1^{\circ}$ and maintained $4.6{\pm}$0.9^{\circ}. The loosening of screw was observed in 6 cases, one of which had reoperation because of the expulsion of the device accompanied. Conclusion : PCB cervical plating system could restore interbody height and lordosis in anterior cervical interbody fusion. But, if the insertion of the spacer is not precise, the frequencies of hardware failure are relatively high. It is considered necessary for the operator to be careful in the procedure.

• Journal of Korean Neurosurgical Society
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• v.29 no.1
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• pp.78-86
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• 2000

Objective : Lumbar spinal instability occurs when normal biomechanics support in lumbar vertebrae interrupted. Despite the recent enthusiastic studies, the precise radiological assessment has not been fully established, yet. Therefore, we carefully studied our cases to analyze the radiologic findings in lumbar spinal instability. Patients and Methods : We have put together radiological analysis and assessment based on 38 patients who have been diagnosed and treated for lumbar spinal instabilities from June 1994 to December 1998, Patients who have been diagnosed and treated for trauma were excluded from study. Results : The outcomes are as follows : 1) Lumbar lordotic curve was statistically significant in unstable group by 23.7, compared to the control group ($17.0^{\circ}$). 2) According to the resting x-ray, sagittal plane angulation measured on unstable group was $21.1^{\circ}$, control group $18.0^{\circ}$. Therefore unstable group was noticeably higher(p<0.01). 3) According to the resting x-ray sagittal plane displacement, unstable group had 4.3mm, the comparison had 1.2mm. Therefore measurement from the unstable group were significantly higher(p<0.01). 4) According to stress view, sagittal plane translation was 4.1mm for the unstables and 2.7mm for the comparisons. Therefore unstables were noticeably higher(p<0.01). 5) According to stress view, sagittal plane rotation was $15.1^{\circ}$ at L3-4, $22.0^{\circ}$ at L4-5, $27.9^{\circ}$ at L5S1 for the unstable group and $11.3^{\circ}$, $18.1^{\circ}$, $21.0^{\circ}$ each for the comparison. 6) Facet angle for unstable group, left $29.3^{\circ}-61.5^{\circ}$, right $24.4^{\circ}-63.2^{\circ}$ and the mean for each are $43.1^{\circ}$, $47.2^{\circ}$. The difference between left and right facet angle was $3.5^{\circ}-20.7^{\circ}$ and the mean value $15.3^{\circ}$. Facet angle for the comparisons for the left was $29.3^{\circ}-59.5^{\circ}$, right was in between $25.7^{\circ}-64.5^{\circ}$ range and the each mean are $44.9^{\circ}$ and $47.6^{\circ}$. Also, the difference between left and right facet angle was $4.1^{\circ}-9.3^{\circ}$ and the average was $17.1^{\circ}$. The average and the difference between the left and right angle are found not to have statistic necessity for both unstable and stable measurements(p>0.01). 7) 19 patients were found to have vacuum facet phenomenon among unstable group etc. results were collected. Conclusion : According to above results, we attempted to prepare the application to the patient of radiological analysis and assessment for lumbar spinal instability early checkup.

• Journal of Korean Neurosurgical Society
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• v.64 no.4
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• pp.575-584
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• 2021

Objective : Cervical expansive laminoplasty is an effective surgical method to address multilevel cervical spinal stenosis. During surgery, the spinous processes of C2 and C7 are usually preserved to keep the insertion points of the cervical musculature and nuchal ligament intact. In this regard, dome-like laminectomy (undercutting of C7 lamina) instead of laminoplasty is performed on C7 in selected cases. However, resection of the lamina can weaken the C7 lamina, and stress fractures may occur, but this complication has not been characterized in the literature. The objective of the present study was to investigate the incidence and risk factors for C7 laminar fracture after C7 dome-like laminectomy and its impact on clinical and radiological outcomes. Methods : Patients who underwent cervical open-door laminoplasty combined with C7 dome-like laminectomy (n=123) were classified according to the presence of C7 laminar fracture. Clinical parameters (neck/arm pain score and neck disability index) and radiologic parameters (C2-7 angle, C2-7 sagittal vertical axis, and C7-T1 angle) were compared between the groups preoperatively and at postoperatively at 3, 6, 12, and 24 months. Risk factors for complications were evaluated, and a formula estimating C7 fracture risk was suggested. Results : C7 lamina fracture occurred in 32/123 (26%) patients and occurred at the bilateral isthmus in 29 patients and at the spinolaminar junction in three patients. All fractures appeared on X-ray within 3 months postoperatively, but patients did not present any neurological deterioration. The fracture spontaneously healed in 27/32 (84%) patients at 1 year and in 29/32 (91%) at 2 years. During follow-up, clinical outcomes were not significantly different between the groups. However, patients with C7 fractures showed a more lordotic C2-7 angle and kyphotic C7-T1 angle than patients without C7 fractures. C7 fracture was significantly associated with the extent of bone removal. By incorporating significant factors, the probability of C7 laminar fracture could be assessed with the formula 'Risk score = 1.08 × depth (%) + 1.03 × length (%, of the posterior height of C7 vertebral body)', and a cut-off value of 167.9% demonstrated a sensitivity of 90.3% and a specificity of 65.1% (area under the curve, 0.81). Conclusion : C7 laminar fracture can occur after C7 dome-like laminectomy when a substantial amount of lamina is resected. Although C7 fractures may not cause deleterious clinical outcomes, they can lead to an unharmonized cervical curvature. The chance of C7 fracture should be discussed in the shared decision-making process.

• Journal of Korean Neurosurgical Society
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• v.47 no.5
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• pp.338-344
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• 2010

Objective : This study assessed the safety and efficacy of one level unilateral laminotomy bilateral decompression (ULBD) with the placement of a device for intervertebral assisted motion (DIAM) compared with one level ULBD only in elderly patients with degenerative lumbar spinal stenosis (DLSS). Methods : A non randomized prospective analysis was performed on 16 patients who underwent one level ULBD with DIAM (Group A) and 20 patients with one level ULBD only (Group B) between February 2007 and March 2008. Radiographic imaging, visual analog scale (VAS) and MacNab outcome scale were obtained before and after surgery at a mean interval of 21 months (range 17-27 months). Results : The disc height, interpedicular distance, slip distance and segmental lordotic angle were similar between two groups. In the group A, there was no significant difference between the pre- and post-operative imaging in terms of the sagittal balance and disc height. Both groups showed significant improvement in the clinical outcomes. In addition, there was significantly less low-back pain in the group A than in the group B at the last follow up, while the clinical improvement of the leg pain and MacNab outcome scale showed no significant difference in the two groups. There were no major complications or DIAM associated complications. Conclusion : ULBD with DIAM is a safe and efficacious treatment for selective elderly patients with DLSS, particularly for relieving low back pain comparing to ULBD. ULBD with DIAM did not alter the disc height or sagittal alignment at the mean 21 months follow-up interval.

• Journal of Korean Neurosurgical Society
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• v.57 no.1
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• pp.36-41
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• 2015

Objective : To investigate the causes for failed anterior cervical surgery and the outcomes of secondary laminoplasty. Methods : Seventeen patients failed anterior multilevel cervical surgery and the following conservative treatments between Feb 2003 and May 2011 underwent secondary laminoplasty. Outcomes were evaluated by the Japanese Orthopaedic Association (JOA) Scale and visual analogue scale (VAS) before the secondary surgery, at 1 week, 2 months, 6 months, and the final visit. Cervical alignment, causes for revision and complications were also assessed. Results : With a mean follow-up of $29.7{\pm}12.1$ months, JOA score, recovery rate and excellent to good rate improved significantly at 2 months (p< 0.05) and maintained thereafter (p>0.05). Mean VAS score decreased postoperatively (p<0.05). Lordotic angle maintained during the entire follow up (p>0.05). The causes for secondary surgery were inappropriate approach in 3 patients, insufficient decompression in 4 patients, adjacent degeneration in 2 patients, and disease progression in 8 patients. Complications included one case of C5 palsy, axial pain and cerebrospinal fluid leakage, respectively. Conclusion : Laminoplasty has satisfactory results in failed multilevel anterior surgery, with a low incidence of complications.

• Journal of Korean Neurosurgical Society
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• v.53 no.1
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• pp.19-25
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• 2013

Objective : We compared the results of two surgical techniques by retrospective study of 60 elderly patients (65 years or older) who underwent either decompression alone or fusion for the treatment of two-level or more lumbar spinal stenosis. Methods : During the period of 2003 and 2008, two-level or more decompression alone or fusion was performed for lumbar spinal stenosis by three surgeons at our institution. Patients were allocated to two groups by surgical modality, namely, to a decompression group (31 patients) or a fusion group (29 patients). Overall mean age was 71.1 years (range, 65-84) and mean follow-up was 5.5 years (range, 3-9). A retrospective review of clinical, radiological, and surgical data was conducted. Results : No significant difference between the two groups was found with respect to age, follow-up period, surgical levels, or preoperative condition. At the last follow-up, correction of lumbar lordotic angle (determined radiologically) was better in the fusion group. However, clinical outcomes including visual analogue scale, Oswestry Disability Index, and the Odom's criteria were not significantly different in the two groups. On the other hand, surgical outcomes, such as, operation time, estimated blood loss, and surgical complications were significantly better in the decompression alone group. Conclusion : Our findings suggest that decompressive laminectomy alone achieves good outcomes in patients with two-level or more lumbar spinal stenosis, associated with an advanced age, poor general condition, or osteoporosis.

• The Journal of Korean Academy of Orthopedic Manual Physical Therapy
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• v.23 no.1
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• pp.43-51
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• 2017

Background: This study was carried out to compare the effects of shoulder stabilization exercise and thoracic extension exercise including deep neck flexor exercise on posture and pain targeting physical therapists and occupational therapists with forward head posture. Methods: A total of 30 physical therapists and occupational therapists (15 males, 15 females), who are working in the nursing hospital at Daejeon, were randomly divided into a shoulder stabilization group (n=10), a thoracic extension exercise (n=10), and a control group (n=10), and 3 times were carried out for 8 weeks. Results: In the results of all measurements, 2 groups except for the control group showed a significant change in the recovery of forward head posture, and the should stabilization exercise group showed a relatively superior effect compared to the thoracic extension exercise group. Conclusions: These results of a study will be a basic data for the development of the forward head posture exercise therapy program.