• Journal of Korean Neurosurgical Society
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• v.58 no.6
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• pp.578-581
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• 2015

A rigid spino-pelvic fixation to anchor long constructs is crucial to maintain the stability of long fusion in spinal deformity surgery. Besides obtaining immediate stability and proper biomechanical strength of constructs, the S2 alar-iliac (S2AI) screws have some more advantages. Four Korean fresh-frozen human cadavers were procured. Free hand S2AI screw placement is performed using anatomic landmarks. The starting point of the S2AI screw is located at the midpoint between the S1 and S2 foramen and 2 mm medial to the lateral sacral crest. Gearshift was advanced from the desired starting point toward the sacro-iliac joint directing approximately $20^{\circ}$ angulation caudally in sagittal plane and $30^{\circ}$ angulation horizontally in the coronal plane connecting the posterior superior iliac spine (PSIS). We made a S2AI screw trajectory through the cancellous channel using the gearshift. We measured caudal angle in the sagittal plane and horizontal angle in the coronal plane. A total of eight S2AI screws were inserted in four cadavers. All screws inserted into the iliac crest were evaluated by C-arm and naked eye examination by two spine surgeons. Among 8 S2AI screws, all screws were accurately placed (100%). The average caudal angle in the sagittal plane was $17.3{\pm}5.4^{\circ}$. The average horizontal angle in the coronal plane connecting the PSIS was $32.0{\pm}1.8^{\circ}$. The placement of S2AI screws using the free hand technique without any radiographic guidance appears to an acceptable method of insertion without more radiation or time consuming.

• Journal of Korean Neurosurgical Society
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• v.64 no.6
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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 the Korean Society of Physical Medicine
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• v.9 no.1
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• pp.1-10
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• 2014

PURPOSE: The purpose of this study was to investigate the effects of flexible derotator of femur orthosis (FDO) during treadmill gait training on the quadriceps-angle (Q-angle), lateral pelvic tilt, gait speed, and number of steps in children with cerebral palsy. METHODS: Seven children with cerebral palsy who had rotational deformity of the lower extremities participated in this study. We used single group repeated measure design. The procedure consisted of baseline phase, intervention phase, and post-intervention phase. The baseline phase consisted of stretching and strengthening exercise and treadmill gait training without FDO. The treatment phase not only included the same procedures as those for baseline, but also included FDO during treadmill gait training. Postural alignment of the lower extremities was assessed with the Q-angle, and lateral pelvic tilt using the Dartfish software program. A 10-m walk test was used to evaluate gait speed and number of steps. RESULTS: For postural alignment, there was significant differences after the application of FDO (p<.05). For gait ability, there was significant differences in all phases (p<.01). CONCLUSION: These finding suggest that the application of FDO during treadmill gait training had a positive effect on the improvement of postural alignment and gait ability in children with cerebral palsy having rotational deformity.

• Journal of Veterinary Clinics
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• v.32 no.6
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• pp.481-485
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• 2015

The present study determined the normal reference ranges for overall pelvic limb alignment of small-breed dogs. For this purpose, 60 cadaveric canine pelvic limbs from normal small-breed dogs (Maltese, Poodle, Shih Tzu, Yorkshire Terrier). A frontal full-limb radiograph of each pelvic limb was obtained, and mechanical tibiofemoral angle (mTFA), mechanical metatarsotibial angle (mMTTA), mechanical axis-femur angle (MAFA), and mechanical axis-metatarsus angle (MAMTA) were measured from each radiograph, along with mechanical deviation of the stifle (SMAD) and tarsal joints (TMAD). The 95% CI for radiographic values of all pelvic limbs were mTFA, 5.7-7.4; mMTTA, $-2.2--0.8^{\circ}$; MAFA, $3.5-4.5^{\circ}$; MAMTA, 1.0-2.0; SMAD, 2.1-2.7%; TMAD, 0.5-1.0%. There values varied among the breeds, except for mTFA. The reference ranges can be used for diagnosing pelvic limb deformities in small-breed dogs and for planning corrective osteotomies.

• Journal of Korean Neurosurgical Society
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• v.66 no.6
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• pp.611-617
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• 2023

The cervical spine plays a critical role in supporting the skull, maintaining horizontal gaze, and facilitating walking. Its unique characteristics, including the widest range of motion among spinal segments, have led to extensive research on cervical sagittal alignment. Various parameters have been proposed to evaluate cervical alignment, with studies investigating their clinical significance, correlation with symptoms, and implications for surgical interventions. Recent findings suggest that cervical sagittal alignment not only impacts the cervical spine but also influences global spine-pelvic alignment through compensatory mechanisms. This comprehensive review examines classical and new parameters of cervical sagittal alignment and considers the dynamic and muscular factors associated with it.

• Journal of Korean Neurosurgical Society
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• v.61 no.6
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• pp.716-722
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• 2018

Objective : Lateral interbody fusion (LIF) is attractive as a less invasive technique to address anterior spinal pathology in the treatment of adult spinal deformity. Its own uses and benefits in treatment of adult degenerative scoliosis are undefined. To investigate the radiographic and clinical outcomes of LIF, and staged LIF and posterior spinal fusion (PSF) for the treatment of adult degenerative scoliosis patients, we analyzed radiographic and clinical outcomes of adult degenerative scoliosis patients who underwent LIF and posterior spinal fusion. Methods : Forty consecutive adult degenerative scoliosis patients who underwent LIF followed by staged PSF at a single institution were retrospectively reviewed. Long-standing 36" anterior-posterior and lateral radiographs were taken preoperatively, at inter-stage, 3 months, 1 year, and 2 years after surgery were reviewed. Outcomes were assessed through the visual analogue scale (VAS), 36-Item Short Form Health Survey (SF-36), and Oswestry Disability Index (ODI). Results : Forty patients with a mean age of 66.3 (range, 49-79) met inclusion criteria. A mean of 3.8 levels (range, 2-5) were fused using LIF, while a mean of 9.0 levels (range, 3-16) were fused during the posterior approach. The mean time between stages was 1.4 days (range, 1-6). The mean follow-up was 19.6 months. Lumbar lordosis was significantly restored from $36.4^{\circ}$ preoperatively up to $48.9^{\circ}$ (71.4% of total correction) after LIF and $53.9^{\circ}$ after PSF. Lumbar coronal Cobb was prominently improved from $38.6^{\circ}$ preoperatively to $24.1^{\circ}$ (55.8% of total correction) after LIF, $12.6^{\circ}$ after PSF respectively. The mean pelvic incidence-lumbar lordosis mismatch was markedly improved from $22.2^{\circ}$ preoperatively to $8.1^{\circ}$ (86.5% of total correction) after LIF, $5.9^{\circ}$ after PSF. Correction of coronal imbalance and sagittal vertebral axis did not reach significance. The rate of perioperative complication was 37.5%. Five patients underwent revision surgery due to wound infection. No major perioperative medical complications occurred. At last follow-up, there were significant improvements in VAS, SF-36 Physical Component Summary and ODI scores. Conclusion : LIF provides significant corrections in the coronal and sagittal plane in the patients with adult degenerative scoliosis. However, LIF combined with staged PSF provides more excellent radiographic and clinical outcomes, with reduced perioperative risk in the treatment of adult degenerative scoliosis.

• Journal of Naturopathy
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• v.12 no.1
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• pp.1-6
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• 2023

Background: Despite the positive effects of the self-gravity acupressure program on genu varum correction, no systematic observation has yet to be made. Purpose: In this study, the effect of the self-gravity acupressure program on varus knee correction was confirmed retrospectively by comparing the medial angle of the knee before and after the self-gravity acupressure program. Methods: Fifty people with varus knees were subjected to a 75-minute acupressure program while lying on an acupressure tool, and then the medial knee angles were compared before and after the program. Results: The average angle of the inside of the knee of the study subjects increased by 7.29±3.85° (p<.000) on the left side and 7.08±3.86° (p<.000) on the right side after the acupressure program was implemented, indicating that the study subject's varus knee significantly improved even after applying for a short period time. It was confirmed. Conclusion: This study confirmed that the self-gravity acupressure is a valuable program for correcting the genus varus. However, to use the results of this study clinically in the future, further studies are required to optimize the mechanism and clinical effects of the self-gravity acupressure program on the improvement of the genu varus knee.

• Journal of Korean Academy of Nursing
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• v.5 no.2
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• pp.23-28
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• 1975

One hundred and fifty seven cesarean sectioned patients among 2010 deliveries, were reviewed with the following clinical charts from January, 1973 to December, 1974 at Taegu Presby-terian medical Center. The results are as follows; 1) The section rate was 7.8% 2) In age distribution, the most frequent age was 26~30ys and it~s rate was 37%, and others were as follows : 31~35ys 24.2%, 21~25ys 21%, 36~40ys 10.8%, 41~45ys 7% respective]y- 3) In indication, the cephalopelvic disproportion was the most prevalent and it's rate was 29.3%, and others were as follows : malpresentation 14% previous cesarean section 10.8% uttering dysfunction 9.6%, totemic 4%, elderly primigravida 4%, fetal distress 2.5% post maturity 3.2%, wanted cesarean section 1, 9%, pelvic deformity 1.2% twin 1.9%, abruptio placenta 1.2%, Vaginal stricture 1.2%, and others 2.5%. 4) In type of operation, tower cervical transverse type was 82.1%, classical type 17%, ana cesarean hysterectomy was 0.9% respectively. 5) General Anesthesia was major type and it's rate was 63%, and spinal anesthesia 17.2%, epidermal anesthesia 14% and other combined type was 5.8%. 6) Percental mortality was 11.4%. 7) There was no maternal death. 8) Among the cesarean section complications, wound infection was 8,4%, headache 4.4%, urinary tract infection 1.2% and one case in endometritis. 9) In combined surgery, tubal legation was 31.2%, appenectomy 7.6%, posterior repair 1.2%, salpingoop-horectomy 1.9%, and one case in resection of uttering septum. 10) Cesarean section was performed 61.3% in multipara and 38.2% in primipara. 11) 47 (30%) had received artificial abortions. 12) 28 (17.8%) had previously experienced cesarean section.

• Clinics in Shoulder and Elbow
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• v.9 no.2
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• pp.235-241
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• 2006

Neglected adult Monteggia fracture could induce the pain, instability and malformation of elbow. Especially, compared with the chronic Monteggia fracture of child, that of adult is difficult to treat and could concur with valgus instability and deformity, limitation of range of motion and tardy ulnar nerve palsy. But recently, the chronic Monteggia fracture of adult could be treated by the 3.5 mm compression plate (DCP) or 3.5 mm pelvic reconstruction plate, so that the result improved more and more. The treatment of choice of the chronic Monteggia fracture of adult is the corrective osteotomy and reduction of radial head or resection of radial head. We experienced two patients who had neglected Monteggia fracture over 1 year 6 months and 25 years respectively and we want to report the result of surgical treatment of chronic Monteggia fracture of adult.

• Clinics in Orthopedic Surgery
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• v.10 no.4
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• pp.500-507
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• 2018

Background: The sagittal alignment of the spine and pelvis is not only closely related to the overall posture of the body but also to the evaluation and treatment of spine disease. In the last few years, the EOS imaging system, a new low-dose radiation X-ray device, became available for sagittal alignment assessment. However, there has been little research on the reliability of EOS. The purpose of this study was to evaluate the intrarater and interrater reliability of EOS for the sagittal alignment assessment of the spine and pelvis. Methods: Records of 46 patients were selected from the EOS recording system between November 2016 and April 2017. The exclusion criteria were congenital spinal anomaly and deformity, and previous history of spine and pelvis operation. Sagittal parameters of the spine and pelvis were measured by three examiners three times each using both manual and EOS methods. Means comparison t-test, Pearson bivariate correlation analysis, and reliability analysis by intraclass correlation coefficients (ICCs) for intrarater and interrater reliability were performed using R package "irr." Results: We found excellent intrarater and interrater reliability of EOS measurements. For intrarater reliability, the ICC ranged from 0.898 to 0.982. For interrater reliability, the ICC ranged from 0.794 to 0.837. We used a paired t-test to compare the values measured by manual and EOS methods: there was no statistically significant difference between the two methods. Correlation analysis also showed a statistically significant positive correlation. Conclusions: EOS showed excellent reliability for assessment of the sagittal alignment of the spine and pelvis.