• Journal of Korean Neurosurgical Society
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• v.62 no.5
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• pp.603-609
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• 2019

Objective : The purpose of this retrospective study was to determine which of the proximal adjacent segment disease (ASD) and distal ASD was more prevalent and what parameters is more related to ASD in proximal levels and distal levels after more than 2 levels fusions. Methods : The medical records were reviewed retrospectively for 856 cases. A total of 66 cases of ASD were enrolled. On preop magnetic resonance imaging, disc degeneration was measured at the upper and lower parts of surgically treated levels and confirmed by the commonly used Pfirrmann grade. Segmental flexibility in sagittal plane was embodied in segment range of motion (ROM) obtained through flexion and extension X-ray before surgery. Coronal angle was recorded as methods Cobb's angle including fusion levels preoperatively. For the comparison of categorical variables between two independent groups, the chi-square test and Fisher exact test were performed. Results : Proximal ASD and distal ASD were 37/856 (4.32%) and 29/856 (3.39%), respectively. The incidence of proximal ASD was relatively high but insignificant differences. In comparison between ASD group and non ASD group, proximal Pfirmman was higher in proximal ASD and distal Pfirmman was higher in distal ASD group (p=0.005, p<0.008, respectively). However, in the ROM, proximal ROM was higher in proximal ASD, but distal ROM was not different between the two groups (p<0.0001, p=0.995, respectively). Coronal angle was not quite different in both groups (p=0.846). Conclusion : In spite of higher frequency in ASD in proximal level in spinal fusion, it is not clear that incidence of ASD in proximal level is not higher than that of distal ASD group in more than 2 level thoracolumbar fusions. Not only Pfirrmann grade but also proximal segmental ROM is risk factor for predicting the occurrence of ASD in patients more than 2 level of thoracolumbar spine fusion operation excluding L5S1.

• Journal of Korean Neurosurgical Society
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• v.46 no.2
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• pp.144-151
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• 2009

Objective: To compare two testing protocols for evaluating range of motion (ROM) changes in the preloaded cadaveric spines implanted with a mobile core type Charite$^{TM}$ lumbar artificial disc. Methods: Using five human cadaveric lumbosacral spines (L2-S2), baseline ROMs were measured with a bending moment of 8 Nm for all motion modes (flexion/extension, lateral bending, and axial rotation) in intact spine. The ROM was tracked using a video-based motion-capturing system. After the Charite$^{TM}$ disc was implanted at the L4-L5 level, the measurement was repeated using two different methods: 1) loading up to 8 Nm with the compressive follower preload as in testing the intact spine (Load control protocol), 2) loading in displacement control until the total ROM of L2-S2 matches that when the intact spine was loaded under load control (Hybrid protocol). The comparison between the data of each protocol was performed. Results: The ROMs of the L4-L5 arthroplasty level were increased in all test modalities (p < 0.05 in bending and rotation) under both load and hybrid protocols. At the adjacent segments, the ROMs were increased in all modes except flexion under load control protocol. Under hybrid protocol, the adjacent segments demonstrated decreased ROMs in all modalities except extension at the inferior segment. Statistical significance between load and hybrid protocols was observed during bending and rotation at the operative and adjacent levels (p< 0.05). Conclusion: In hybrid protocol, the Charite$^{TM}$ disc provided a relatively better restoration of ROM, than in the load control protocol, reproducing clinical observations in terms of motion following surgery.

• Journal of Korean Neurosurgical Society
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• v.41 no.2
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• pp.88-94
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• 2007

Objective : The aim of this study is to investigate predictable risk factors for radiologic degeneration of adjacent segment after lumbar fusion and preoperative radiologic features of patients who underwent additional surgery with adjacent segment degeneration. Methods : Between January 1995 and December 2002, 201 patients who underwent lumbar fusion for degenerative conditions of lumbar spine were evaluated. We studied radiologic features, the method of operation, the length of fusion, age, sex, osteoporosis, and body mass index. Special attention was focused on, preoperative radiologic features of patients who required additional surgery were studied to detect risk factors for clinical deterioration. Results : Follow-up period ranged from 3 to 11 years. In our study, 61 [30%] patients developed adjacent segment degeneration, and 15 [7%] patients required additional surgery for neurologic deterioration. Age, the postoperative delay, facet volume, motion range, laminar inclination, facet tropism, and preexisting disc degeneration of adjacent segment considered as possible risk factors. Among these, laminar inclination and preexisting disc degeneration of adjacent segment were significantly correlated with clinical deterioration. Conclusion : The radiologic degeneration of adjacent segment after lumbar fusion can be predicted in terms of each preoperative radiologic factor, age and the postoperative delay. Laminar inclination and preexisting disc degeneration of adjacent segment have shown as strong risk factors for neurologic deterioration. Thus, careful consideration is warranted when these risk factors are present.

• The Journal of Churna Manual Medicine for Spine and Nerves
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• v.14 no.2
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• pp.113-122
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• 2019

Objectives : The purpose of this clinical study was to evaluate the effect of spinal decompression with Korean medicine treatment on the herniation of an intervertebral disc (HIVD) in a patient after fusion surgery of a cervical segment. Methods : A single patient was treated with spinal decompression, acupuncture, pharmacoacupuncture, and herbal medication. We measured the Numerical Rating Scale (NRS), Neck Disability Index (NDI), European Quality of Life-5 Dimension (EQ-5D), Cervical Range of Motion (cervical ROM) and the Beck Depression Inventory (BDI) score to evaluate the treatment effects. Results : The patient's post neck pain & pain in both arms improved significantly as suggested by the scores on the NRS, NDI, EQ5D, cervical ROM and BDI. Conclusions : Thus, spinal decompression, including Korean medicine treatment, could be taken into consideration for HIVD patients after fusion surgery.

• Journal of Korean Neurosurgical Society
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• v.30 no.11
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• pp.1314-1319
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• 2001

Objects : Because of the nonspecific nature of symptoms in tuberculous spondylitis, a delay in the diagnosis can result in progressive neurologic deficits. The authors evaluate the clinical and the radiological results of the 10 cases of surgically treated tuberculous spondylitis. Clinical materials & Methods : We retrospectively analyzed the medical records of 10 patients with tuberculous spondylitis who were treated between February 1996 and March 2000. Six patients were female, and four were male. Mean age was 43 years old, and mean follow-up period was 20.5 months. All patients were treated with 12 months of antituberculous medication postoperatively, and were followed by complete blood count, ESR, spine X-ray and MRI. Results : The lumbar spine was involved in 5 patients, the thoracic in 4, and the thoracolumbar in one. The infected vertebral bodies were 2.8 in average. The associated lesions were pulmonary tuberculosis in 3 cases, and renal tuberculosis in one. Five patients were treated by anterior debridement and fusion with bone graft using anterior instrumentation, 2 with anterior debridement and fusion with bone graft(Hong Kong procedure only), 1 with Hong Kong procedure with posterior spinal instrumentation, and 2 were managed with posterior debridement and posterior spinal instrumentation. All patients improved after operation, and the average kyphotic angle decreased postoperatively. Postoperatively, one patient had a fistula at the operative site. Conclusion : The debridement and minimal level fusion of motion segment with instrument fixation is one of surgical option for tuberculous spondyltis to preserve the spine motion segment as much as possible. Spine instability and kyphosis were prevented by anterior and posterior spinal instrumentation. But, large number of cases and longer period follow-up study in future will be needed to confirm the long term results.

• Korean Journal of Applied Biomechanics
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• v.23 no.4
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• pp.369-376
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• 2013

The purposes of this study were to assess dynamic stability toward pelvis-spine column distortion during running and to compare the typical three-dimensional angular kinematics of the trunk motion; cervical, thoracic, lumbar segment spine and the pelvis from the multi-segmental spine model between exercise group and non-exercise group. Subjects were recruited as exercise healthy women on regular basis (group A, n=10) and non-exercise idiopathic scoliosis women (group B, n=10). Data was collected by using a vicon motion capture system (MX-T40, UK). The pelvis, spine segments column and lower limbs analysiaed through the 3D kinematic angular ROM pattern. There were significant differences in the time-space variables, the rotation motion of knee joint in lower limbs and the pelvis variables; obliquity in side bending, inter/outer rotation in twisting during running leg movement. There were significant differences in the spinal column that is lower-lumbar, upper-lumbar, upper-thoracic, mid-upper thoracic, mid-lower thoracic, lower thoracic and cervical spine at inclination, lateral bending and twist rotation between group A and group B (<.05, <.01 and <.001). As a results, group B had more restrictive motion than group A in the spinal column and leg movement behaved like a 'shock absorber". And the number of asymmetry index (AI) showed that group B was much lager unbalance than group A. In conclusion, non-exercise group was known to much more influence the dynamic stability of equilibrium for bilateral balance. These finding suggested that dynamic stability aimed at increasing balance of the trunk ROM must involve methods and strategies intended to reduce left/right asymmetry and the exercise injury.

• Transactions of the Korean Society of Mechanical Engineers A
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• v.35 no.10
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• pp.1205-1210
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• 2011

Spinal instability known to be related to low back pain. However, the quantitative definition of spinal instability has not been established because there is a lack of consensus regarding clinical and radiological studies. In addition, the major factors affecting such instability have not been elucidated, although disc degeneration, disc injury, ligament injury, and isthmic defects are considered to result in such problems. In this study, individual and combined influences on spinal instability with a three-dimensional finite element model of a one-level lumbar spinal motion segment were investigated, under the assumption that the rotation and translation in the sagittal plane under flexion and extension represented the instability indices. The results could be helpful in understanding the causes and mechanisms of spinal instability in the lumbar spine.

• Journal of Biomedical Engineering Research
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• v.32 no.3
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• pp.230-236
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• 2011

The aim of this study was to investigate the alteration of lumbar spine and trunk postures on different load-carrying types and amounts under static loading. Two load-carrying types(unilateral carrying: UC vs. bilateral carrying: BC) and four different loads(0, 5, 10, and 15 kg) were randomly tested in this study. Carrying a heavy bag would affect human body posture, specifically lumbar spine curvature, which is considered as one of sources of back problems. Previous studies have not paid attention to the approach of the multisegment model of the lumbar spine and trunk. This study separated two compartments of trunk segment(the lumbar and thorax) in the analysis. The multisegment model of the lumbar spine in addition to Helen-Hayes marker set was used. Eight motion analysis cameras and a force plate were utilized. Ten male subjects(mean mass, $70.6{\pm}3.97$ kg; mean height, $178{\pm}4.18$ m) having no musculoskeletal disease participated in this study. We analyzed trunk angles in three anatomical planes and the spinal curvature in sagittal and frontal planes. Increased loading in both UC and BC significantly resulted in increases in trunk forward lean but only UC induced increases in trunk lateral lean. In addition, increased loading in BC produced flatten lumbar curvature in sagittal plane. As far as coupling motion, subjects tended to use axial rotation of the lumbar spine in transverse plane in response to increased UC loading. Finally, it is concluded that the increased static loading in UC rather than in BC tends to causes combined alterations of the spinal postures(sagittal and transverse planes together), which would be vulnerable to improper mechanical stresses on the spine.

• Journal of Korean Neurosurgical Society
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• v.43 no.5
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• pp.221-226
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• 2008

Objective : The aim of the present study was to assess the safety and efficacy of the dynamic stabilization system in the treatment of degenerative spinal diseases. Methods : The study population included 20 consecutive patients (13 females, 7 males) with a mean age of $61{\pm}6.98$ years (range 46-70) who underwent decompression and dynamic stabilization with the Dynesys system between January 2005 and August 2006. The diagnoses included spinal stenosis with degenerative spondylolisthesis (9/20, 45%), degenerative spinal stenosis (5/20, 25%), adjacent segmental disease after fusion (3/20, 15%), spinal stenosis with degenerative scoliosis (2/20, 10%) and recurrent intervertebral lumbar disc herniation (1/20, 5%). All of the patients completed the visual analogue scale (VAS) and the Korean version of the Oswestry Disability Index (ODI). The following radiologic parameters were measured in all patients : global lordotic angles and segmental lordotic angles (stabilized segments, above and below adjacent segments). The range of motion (ROM) was then calculated. Results : The mean follow-up period was $27.25{\pm}5.16$ months (range 16-35 months), and 19 patients (95%) were available for follow-up. One patient had to have the implant removed. There were 30 stabilized segments in 19 patients. Monosegmental stabilization was performed in 9 patients (47.3%), 9 patients (47.3%) underwent two segmental stabilizations and one patient (5.3%) underwent three segmental stabilizations. The most frequently treated segment was L4-5 (15/30, 50%), followed by L3-4 (12/30, 40%) and L5-S1 (3/30, 10%). The VAS decreased from $8.55{\pm}1.21$ to $2.20{\pm}1.70$ (p<0.001), and the patients' mean score on the Korean version of the ODI improved from $79.58%{\pm}15.93%$ to $22.17%{\pm}17.24%$ (p<0.001). No statistically significant changes were seen on the ROM at the stabilized segments (p=0.502) and adjacent segments (above segments, p=0.453, below segments, p=0.062). There were no patients with implant failure. Conclusion : The results of this study show that the Dynesys system could preserve the motion of stabilized segments and provide clinical improvement in patients with degenerative spinal stenosis with instability. Thus, dynamic stabilization systems with adequate decompression may be an alternative surgical option to conventional fusion in selected patients.

• Journal of Biomedical Engineering Research
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• v.21 no.3 s.61
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• pp.285-293
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• 2000

Age-related changes in the geometry of human lumbar spine would lead to changes of its mechanical behaviors. To investigate the effects of the geometric changes, no age-related changes in the material/mechanical properties were considered. Using the finite element method. two age-related models of lumbar spine segments (L3-L4) were constructed. The annulus of the models was modeled as laminate composite elements with 16 layers and 6 materials. The spinal stiffness and facet reaction of the lumbar spine increased with the age-related geometric changes in various combined loadings. Fiber and transverse tensile strains of the inner annulus. cancellous bone stress and end-plate stress decreased with the age-related geometric changes whereas fiber/layer compressive strains of the annulus. facet reaction. ligament reaction and end-plate rigidity increased. Consequently, it appears that in the normal age-related deterioration of discs, the age-related geometric change contributes to the increase of spinal stiffness (the decrease in range of the motion segment), preventing an excessive deformation of the disc.