• Journal of Korean Neurosurgical Society
• /
• v.45 no.4
• /
• pp.213-218
• /
• 2009

Objective : This study is a retrospective clinical study over more than 4 years of follow up to understand the mechanism of load sharing across the graft-bone interface in the static locking plate (SLP) fixation compared with non-locking plate (NLP). Methods : Orion locking plates and Top non-locking plates were used for SLP fixation in 29 patients and NLP fixation in 24 patients, respectively. Successful interbody fusion was estimated by dynamic X-ray films. The checking parameters were as follows : screw angle (SA) between upper and lower screw, anterior and posterior height of fusion segment between upper and lower endplate (AH & PH), and upper and lower distance from vertebral endplate to the end of plate (UD & LD). Each follow-up value of AH and PH were compared to initial values. Contributions of upper and lower collapse to whole segment collapse were estimated. Results : Successful intervertebral bone fusion rate was 100% in the SLP group and 92% in the NLP group. The follow-up mean value of SA in SLP group was not significantly changed compared with initial value, but follow-up mean value of SA in NLP group decreased more than those in SLP group (p=0.0067). Statistical analysis did not show a significant difference in the change in AH and PH between SLP and NLP groups (p>0.05). Follow-up AH of NLP group showed more collapse than PH of same group (p=0.04). The upper portion of the vertebral body collapsed more than the lower portion in the SLP fixation (p=0.00058). Conclusion : The fused segments with SLP had successful bone fusion without change in initial screw angle, which was not observed in NLP fixation. It suggests that there was enough load sharing across bone-graft interface in SLP fixation.

• Proceedings of the Korea Contents Association Conference
• /
• 2012.05a
• /
• pp.173-174
• /
• 2012

To determine whether position affects measured lung capacity of spinal cord injury patients. The study subjects were 45 patients with spinal cord injury (cervical level 15, thoracic level 15, lumbar level 15). Subjects were provided with a full explanation of the experimental procedures and all provided written consent signifying their voluntary participation. We used a spirometer (Spirometer, Micromedical Ltd, UK) to measure pulmonary function in the supine and sitting positions (straightened upper body at an angle of $90^{\circ}$). Forced vital capacity (FVC), forced expiratory volume during the first second (FEV1), tidal volume (TV), and maximum insufflation capacity (MIC) were also measured. FVC, FEV1, TV, MIC (%) were greater in the supine than in the sitting position for those with injury at the cervical or thoracic injury level. On the other hand, FVC, FEV1, TV, MIC (%) were lower in the supine position for those with an injury at the lumbar level. More attention should be paid to the effect of injury level on measured lung capacity.

• Journal of Korean Neurosurgical Society
• /
• v.58 no.1
• /
• pp.43-49
• /
• 2015

Objective : $Dynesys^{(R)}$ is one of the pedicle-based dynamic lumbar stabilization systems and good clinical outcome has been reported. However, the cylindrical spacer between the heads of the screws undergoes deformation during assembly of the system. The pre-strain probably change the angle of instrumented spine with time and oblique-shaped spacer may reduce the pre-strain. We analyzed patients with single-level stabilization with $Dynesys^{(R)}$ and simulated oblique-shaped spacer with finite element (FE) model analysis. Methods : Consecutive 14 patients, who underwent surgery for single-level lumbar spinal stenosis and were followed-up more than 24 months (M : F=6 : 8; age, $58.7{\pm}8.0$ years), were analyzed. Lumbar lordosis and segmental angle at the index level were compared between preoperation and postoperative month 24. The von Mises stresses on the obliquely-cut spacer ($5^{\circ}$, $10^{\circ}$, $15^{\circ}$, $20^{\circ}$, $25^{\circ}$, and $30^{\circ}$) were calculated under the compressive force of 400 N and 10 Nm of moment with validated FE model of the L4-5 spinal motion segment with segmental angle of $16^{\circ}$. Results : Lumbar lordosis was not changed, while segmental angle was changed significantly from $-8.1{\pm}7.2^{\circ}$ to $-5.9{\pm}6.7^{\circ}$ (p<0.01) at postoperative month 24. The maximum von Mises stresses were markedly decreased with increased angle of the spacer up to $20^{\circ}$. The stress on the spacer was uneven with cylindrical spacer but it became even with the $15^{\circ}$ oblique spacer. Conclusion : The decreased segmental lordosis may be partially related to the pre-strain of Dynesys. Further clinical and biomechanical studies are required for relevant use of the system.

• The Journal of Churna Manual Medicine for Spine and Nerves
• /
• v.4 no.1
• /
• pp.103-117
• /
• 2009

Objective : The purpose of this study is to research the trend of the theses related to conservative treatment of spinal scoliosis and to establish the direction of futher studies into the spinal scoliosis Methods : We reviewed and analyzed all theses published by Korean research institution. And these theses were classified by field of study, theses type, symptoms and illnesses, evaluation methods, treatment type, clinical outcome. Result and conclusion : 1. Classified by the major field of study, oriental rehabilitation medicine and physical education accounted for 9 papers, followed by 6 in orthopedics medicine. 2. Upon classifying theses according to research method type, clinical trial theses were more than casuistic theses. 3. Upon classifying theses according to symptoms and illnesses in scoliosis, the most was idiopathic scoliosis. 4. Theses used mostly Cobb's angle for evaluating in scoliosis. 5. Some few of theses used chuna therapy for treating in scoliosis. 6. Chuna therapies side by side with correction exercises were the most efficient for treating in scoliosis.

• Archives of Plastic Surgery
• /
• v.49 no.3
• /
• pp.440-443
• /
• 2022

Spinal accessory nerve (SAN) palsy is typically a result of posterior triangle surgery and can present with partial or complete paralysis of the trapezius muscle and severe shoulder dysfunction. We share an atypical case of a patient who presented with SAN palsy following an injury sustained playing competitive volleyball. A 19-year-old right hand dominant competitive volleyball player presented with right shoulder weakness, dyskinesia, and pain. She injured the right shoulder during a volleyball game 2 years prior when diving routinely for a ball. On physical examination she had weakness of shoulder shrug and a pronounced shift of the scapula when abducting or forward flexing her shoulder greater than 90 degrees. Manual stabilization of the scapula eliminated this shift, so we performed scapulopexy to stabilize the inferior angle of the scapula. At 6 months postoperative, she had full active range of motion of the shoulder. SAN palsy can occur following what would seem to be a routine volleyball maneuver. This could be due to a combination of muscle hypertrophy from intensive volleyball training and stretch sustained while diving for a ball. Despite delayed presentation and complete atrophy of the trapezius, a satisfactory outcome was achieved with scapulopexy.

• Journal of radiological science and technology
• /
• v.28 no.4
• /
• pp.327-332
• /
• 2005

The purpose of this Study was to investigate the prevalence rate of idiopathic scoliosis to the students from the elementary to the university in S city of Chung-Nam using 100 mm Mirror Camera radiation indirect examination units, with on age range of between eight and thirteen (1.526 subjects), fourteen and sixteen (462 subjects), seventeen and eighteen (291 subjects), nineteen and twenty four(508 subjects) and total of 2,787 participants with the 590 male subjects and 2,197 female subjects. The results of this study can be summarized and compared the primary examination with the secondary test of greater than $10^{\circ}$of Cobb's Angle were obtained as follows; 1. Indirect Examination were conducted to find idiopathic scoliosis amomg total 2.787 subjects, 257 subjects (9.2%) who showed positive sign greater than $10^{\circ}$in the Cobb's Angle ; below age of thirteen (132 subjects), between fourteen and sixteen (52 subjects), seventeen and eighteen (35 subjects), nineteen and twenty four (38 subjects). The $x^2-test$ analysis of Indirect Examination showed no statistical significant difference association between the age range and $10^{\circ}$Cobb's Angle of spinal curve(P>0.059). 2. The numbers of idiopathic scoliosis of greater than $10^{\circ}$Cobb's Angle of spinal curve in the primary examination were observed in 147 subjects (57.2%) at the Thoracolumbar region, 81subjects (31.5%) at the Thoracic region, 20 subjects (7.8%) at the Cervicothoracic region, 7 subjects (2.7%) at the Lumbar region, 2 subjects (0.8%) at the Cervical region. So, the large numbers were Thoracolumbar region, 183 participants (71.2%) showed the right side curve of scoliosis and 74 participant (28.8%) showed the left side curve of scoliosis. 3. The main region of the pain in one's own self more than $10^{\circ}$ Cobb's angle of spinal curve were no pain 219 subjects (85.2%), 18 subjects (7.0%) at the Lumbar region, 9 subjects (3.5%) at the Cervical region, 7 subjects (2.7%) at the Thoracic region, 2 subjects (0.7%) at the shoulder girdle region, 1 subjects (0.39%) at the pelvis and whole body region. There was statistical significant difference association between the Cobb's Angle of spinal curve and the main pain region of one's (P<0.006). This study may be significant to an early stage investigate of the prevalence rate of idiopathic scoliosis in the juveniles using 100 mm Mirror Camera radiation indirect examination units. The results of this study help that the students in a stage on growth the basis of data early discovery and therapy of idiopathic scoliosis.

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

• Journal of Korean Neurosurgical Society
• /
• v.62 no.1
• /
• pp.96-105
• /
• 2019

Objective : The aims in the management of thoracolumbar spinal fractures are not only to restore vertebral column stability, but also to obtain acceptable alignment of the thoracolumbar junction (T-L junction) to prevent complications. However, insufficient surgical correction of the thoracolumbar spine would be likely to cause late progression of abnormal kyphosis. Therefore, we identified the surgical factors that affected unfavorable radiologic outcomes of the thoracolumbar spine after surgery. Methods : This study was conducted in a single institution from January 2007 to December 2013. A total of 98 patients with unstable thoracolumbar spine fracture were included. In these patients, fixation was done through transpedicular screws with rods by three surgical patterns. We reviewed digital radiographs and analyzed the images preoperatively and postoperatively during follow-up visits to compare the change of the thoracolumbar Cobb angle with radiologic parameters and clinical outcomes. The unfavorable radiologic group was defined as the patients who were measured as having greater than 20 degrees of thoracolumbar Cobb angle on the last follow-up, or who underwent kyphotic progression of thoracolumbar Cobb angle greater than 10 degrees from the immediate postoperative state to final follow-up, or who had overt instrument failure with/without additional surgery. We assessed the risk factors that affected the unfavorable radiologic outcomes. Results : We had 43 patients with unfavorable radiologic outcomes, including 35 abnormal thoracolumbar alignments and 14 instrumental failures with/without additional surgery. The multivariate logistic regression test showed that immediate postoperative T-L junction Cobb angle less than 10.5 degrees was a statistically significant risk factor, as well as the presence of osteoporosis (p=0.017 and 0.049, respectively). Conclusion : Insufficient correction of thoracolumbar kyphosis was considered to be a major factor of an unfavorable radiological outcome. The spinal surgeon should consider that having a T-L junction Cobb angle larger than 10.5 degrees immediately after surgery could result in an unfavorable radiological outcome, which is related to a poor clinical outcome.

• Transactions of the Korean Society of Mechanical Engineers B
• /
• v.36 no.11
• /
• pp.1105-1110
• /
• 2012

The spine is one of the most important skeletal joints, and it strongly affects the health of the musculoskeletal system. A normal spine has an S-shape, and it is very important to maintain this shape. Recently, spinal diseases such as low back pain have increased rapidly, especially among the elderly. Some of these diseases are caused by congenital spinal disorders and sporting and accident injuries as well as by bad postures. Improper spinal postures could generate excessive disc pressure, which is related to degeneration and pain. Therefore, in this study, we investigated the three-dimensional kinematic parameters of the thoraco-lumbar joint in several bad postures using a motion capture analysis technique. Different bad postures created a significant amount of flexion/extension, side bending, and axial rotation angle compared with neutral postures. Further study is necessary to investigate the disc pressure and ligament force due to the increase in joint rotation from the bad postures.

• Journal of Korean Neurosurgical Society
• /
• v.55 no.3
• /
• pp.142-147
• /
• 2014

Objective : A thoracolumbar burst fracture is usually unstable and can cause neurological deficits and angular deformity. Patients with unstable thoracolumbar burst fracture usually need surgery for decompression of the spinal canal, correction of the angular deformity, and stabilization of the spinal column. We compared two struts, titanium mesh cages (TMCs) and expandable cages. Methods : 33 patients, who underwent anterior thoracolumbar reconstruction using either TMCs (n=16) or expandable cages (n=17) between June 2000 and September 2011 were included in this study. Clinical outcome was measured by visual analogue scale (VAS), American Spinal Injury Association (ASIA) scale and Low Back Outcome Score (LBOS) for functional neurological evaluation. The Cobb angle, body height of the fractured vertebra, the operation time and amount of intra-operative bleeding were measured in both groups. Results : In the expandable cage group, operation time and amount of intraoperative blood loss were lower than that in the TMC group. The mean VAS scores and LBOS in both groups were improved, but no significant difference. Cobb angle was corrected higher than that in expandable cage group from postoperative to the last follow-up. The change in Cobb angles between preoperative, postoperative, and the last follow-up did not show any significant difference. There was no difference in the subsidence of anterior body height between both groups. Conclusion : There was no significant difference in the change in Cobb angles with an inter-group comparison, the expandable cage group showed better results in loss of kyphosis correction, operation time, and amount of intraoperative blood loss.