• The Journal of Korean Academy of Orthopedic Manual Physical Therapy
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• v.29 no.3
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• pp.73-84
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• 2023

Background: This study aimed to compare pressure pain thresholds (PPTs) in the vertebral segments between patients with chronic lower back pain (CLBP) and healthy participants without back pain and to determine the correlation between vertebral bone-segment PPT and pain level, lower back pain dysfunction, and psychological status in patients with CLBP. Methods: The subjects of this study were 23 healthy adults and 23 adults with CLBP. PPT was measured in 23 spinal bone segments using a PPT device, and the CLBP group was subjected to a pain level test (NRS) and a psychological test using the Korean version of the pain catastrophizing scale (KPCS). The functional level was assessed using the Korean version of the Oswestry disability index (KODI). Results: PPTs of the spinal sclerotomes were significantly lower in patients with CLBP than in healthy participants. In the CLBP group, the composite score of lumbar PPTs showed a high correlation with the composite scores for all segments, but not with the pain level (NRS), KPCS score, and spinal sclerotome PPT. Moreover, PPT in the sacral sclerotomes showed a significant negative correlation coefficient with function, with a KODI score of -.462 (p<.01). Conclusion: In this study, PPTs in all spinal segments in patients with CLBP was significantly lower than that in healthy subjects. The PPTs of the lumbar region was significantly correlated with the PPTs of other spinal regions. Through this study, it was found that there were changes in PPTs in CLBP patients not only in the lumbar region but also in other spinal regions. This information should be considered during clinical treatment of patients with low back pain.

• 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 Acupuncture Research
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• v.18 no.3
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• pp.143-153
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• 2001

Objective : To investigate the relation to the organs, shu points and mu points. The labeled common locations of the spinal cord and brain were observed following injection of pseudorabies virus(PRV) into the the kidney, UB23 and GB25. Methods : After survival times of 96 hours following injection of PRV, The fifteen rats were perfused, and their spinal cord and brain were frozen sectioned($30{\mu}m$). These sections were stained by PRV immunohistochemical staining method, and observed with light microscope. Results : In spinal cord, PRV labeled neurons projecting to the kidney, BL23 and GB25 were founded in cervical, thoracic, lumbar and sacral spinal segments. Dense labeled areas of cervical segments were overlap in lateral cervical n. and lamina III-V area. Thoracic segments were overlap in lateral spinal n., intermediolateral n. and lamina V-X areas. Lumbar segments were overlap in lamina I-V areas. Sacral segments were overlap in lamina IV, V and X areas. In brain, PRV labeled areas projecting to the kidney, UB23 and GB25 were overlap in the A1 noradrenalin cells/C1 adrenalin cells/caudoventrolateral reticular n./rostroventrolaterai n., raphe obscurus n,, raphe pallidus n., raphe magnus n., gigantocellular reticular n., locus coeruleus, subcoeruleus n., A5 cell group and paraventricular hypothalamic n.. Conclusions : This results suggest that PRV labeled overlap areas of projecting to the kidney may be correlated to shu and mu points related to the kidney. These morphological results provide that organs-shu(transport) and mu(alarm) points interrelationship may be related to the central autonomic pathways.

• Radiation Oncology Journal
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• v.32 no.4
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• pp.221-230
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• 2014

Purpose: To evaluate the risk of vertebral compression fracture (VCF) after conventional radiotherapy (RT) for colorectal cancer (CRC) with spine metastasis and to identify risk factors for VCF in metastatic and non-metastatic irradiated spines. Materials and Methods: We retrospectively reviewed 68 spinal segments in 16 patients who received conventional RT between 2009 and 2012. Fracture was defined as a newly developed VCF or progression of an existing fracture. The target volume included all metastatic spinal segments and one additional non-metastatic vertebra adjacent to the tumor-involved spines. Results: The median follow-up was 7.8 months. Among all 68 spinal segments, there were six fracture events (8.8%) including three new VCFs and three fracture progressions. Observed VCF rates in vertebral segments with prior irradiation or pre-existing compression fracture were 30.0% and 75.0% respectively, compared with 5.2% and 4.7% for segments without prior irradiation or pre-existing compression fracture, respectively (both p < 0.05). The 1-year fracture-free probability was 87.8% (95% CI, 78.2-97.4). On multivariate analysis, prior irradiation (HR, 7.30; 95% CI, 1.31-40.86) and pre-existing compression fracture (HR, 18.45; 95% CI, 3.42-99.52) were independent risk factors for VCF. Conclusion: The incidence of VCF following conventional RT to the spine is not particularly high, regardless of metastatic tumor involvement. Spines that received irradiation and/or have pre-existing compression fracture before RT have an increased risk of VCF and require close observation.

• The Journal of Korean Medicine
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• v.22 no.2
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• pp.31-40
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• 2001

This experimental studies was to investigate location of labeled neurons in CNS following injection of pseudorabies virus(PRV), Bartha strain, into the uterus and Sanyinjiao(Sp6) of rats. After survival times of 4-5 days following the injection of PRV, the rats were perfused, and their brain and spinal cord were frozen sectioned($30\mu\textrm{m}$). These sections were stained by PRV immunohistochemical staining methods, and observed with light microscope. The results were as follows: 1. In the spinal cord, overlap areas of PRV labeled neurons projecting to uterus and Sp6 were observed in lamina VII, IX and X areas of cervical segments. In thoracic segments, overlap areas were observed in lamina IV, VII, X and intermediolateral n.. In lumbar segments, overlap area of PRV labeled neurons were observed in lamina I, V-VII, IX, X and intermediolateral n.. In sacral segments, overlap areas of PRY labeled neurons were observed in lamina N, V, VII, X and sacral parasympathetic n.. 2. In the brain, overlap areas of PR V labeled neurons projecting to the uterus and Sp6 were observed in lateral paragigantocellular n., rostroventrolateral reticular n., raphe obscurus n., raphe pallidus n., raphe magnus n., locus coeruleus n., Barrington's n., A5 cell group, central gray n., paraventricular hypothalamic n. and arcuate n. This results suggest that overlap areas of PRV labeled neurons of the spinal cord projecting to the uterus and Sp6 might be the first-order neurons related to the viscera-somatic sensory and sympathetic preganglionic neurons. PRV labeled neurons of the brain may be the second and third-order neurons response to the movement of smooth muscle of uterus. These PRV labeled neurons may be central autonomic center related to the integration and modulation of reflex control linked to the sensory and motor system monitoring the internal environment. These overlap areas of spinal cord and brainmay be related to autonomic centers related to regulation of uterus.

• Journal of Korean Neurosurgical Society
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• v.48 no.3
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• pp.219-224
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• 2010

Objective : A minimally invasive transforaminal lumbar interbody fusion (MIS TLlF) has recently been introduced. However, MIS TLlF is a technically challenging procedure. The authors performed retrospective analysis about MIS TLlF using a single interbody cage. Methods : Twenty-eight consecutive patients were treated by MIS TLlF. Of these 28 patients, 20 patients were included in this retrospective study. Perioperative, clinical, and radiologic outcomes were assessed. Clinical outcomes were assessed using Oswestry Disability Index (ODI) and Visual Analogue Scores (VAS). Fusion rates and cross-sections of operated spinal canals were assessed by CT. Results : Twelve patients underwent MIS TLlF at one segment and 8 patients at two segments (L3/4: 4, L4/5: 17, L5/S1: 7). Operation time for a single segment was 131.7 min and for two segment was 201.4 min, and corresponding blood losses were 208.3 mL and 481.2 mL, respectively. ODI and VAS scores were significantly improved at 6 months postop (ODI from 30.32 to 15.54, VAS from 7.80 to 2.20, p = 0.001) Twenty-two segments (78.6%) achieved grade I fusion, 4 segments (14.3%) achieved grade II, 2 segments (7.1%) achieved grade III and 0 segments achieved grade IV at 12 months. Postoperatively at 12 months, spinal canal cross sectional areas at disc spaces significantly increased from 157.5 to $294.3\;mm^2$ (p = 0.012). Conclusion : MIS TLlF achieved good clinical outcomes and high fusion rates. Our findings show that MIS TLlF performed with a single Interbody cage and a tubular retractor system can be used as a standard MIS TLlF technique.

• Korean Journal of Acupuncture
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• v.19 no.2
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• pp.97-117
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• 2002

Chiropractic is very similar to Oriental Medicine in philosophy on the cause of diseases and in utilization of spinal articulations for diagnosis and treatment. In this paper the spinal area used to treat liver dysfunction in S.O.T. technique, one of chiropractic techniques, was compared to the acupncture points used to cure the same conditions. Because both Oriental medicine and Chiropractic are dealing with autonomic nervous system in regulating abnormal conditions, also the innervation of spinal nerves to those areas was checked. The spinal area that S.O.T. technique utilizes to correct liver dysfunction is transverse processes of T8, which corresponds to B16. Acupncture points from this level down to T12/L1, which are B16, B17, B18, B19, B20, B21, B45, B46, B47, B48, B49, B50, GV6, GV7, GV8 and GV9, all have been applied to control liver function. Apparent discrepency exists in therapeutic areas for liver malfunction between the two natural healing arts. According to the neurology texts, liver is innervated by sympathetic fibers from the 7th-10th thoracic segments and by parasympathetic fibers from vagus nerve. Sympathetic afferent nerves from the liver reach the 7th-12th thoracic spinal cord segments. It can be said all the 7th-12th thoracic spinal cord segments are related to liver function. Therefore the areas used for liver dysfunction in both natural medicine are appropriately selected. However, B16, the Oriental medical equivalent of the main spinal area which is used for lowered liver function in C.M.R.T. Technique, is not utilized as frequent as in Oriental medicine.

• Journal of Biomedical Engineering Research
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• v.21 no.3 s.61
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• pp.295-301
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• 2000

It is known that among many factors, relative micromotion at bone/implant interfaces can hinder bone ingrowth into surface pores of an implant. Loading conditions, mechanical properties of spinal materials, friction coefficients at the interfaces and geometry of spinal segments would affect the relative micromotion and spinal stability. A finite clement model of the human lumbar spine segments (L4-L5) was constructed to investigate the mechanical sensitivity at the interfaces between bone and cage. Relative micromotion. Posterior axial displacement. bone stress, cage stress and friction force were predicted in changes of friction coefficients, loading conditions. bone density and age-related material/geometric properties of the spinal segments. Relative micromotion (slip distance in a static loading means relative micromotion in routine activity) at the interfaces increased significantly as the mechanical properties of cancellous bone, annulus fibers or/and ligaments decrease or/and as the friction coefficient at the interfaces decreases. The contact normal force at the interfaces decreased as cancellous bone density decreases or/and as the friction coefficient increases A significant increase of slip distance at anterior annulus occurred with an addition of torsion to compressive preload. Relative micromotion decreased with an increase of disc area. In conclusion. relative micromotion, stress response. Posterior axial displacement and contact normal force are sensitive to the friction coefficient of the interfaces, bone density, loading conditions and age-related geometric/material changes.

• Journal of Korean Neurosurgical Society
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• v.52 no.4
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• pp.384-390
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• 2012

Objective : The objective of this study was to investigate the morphologic characteristics between the vertebral body and the regions of the cervical and thoracic spinal cords where each rootlets branch out. Methods : Sixteen adult cadavers (12 males and 4 females) with a mean age of 57.9 (range of 33 to 70 years old) were used in this study. The anatomical relationship between the exit points of the nerve roots from the posterior root entry zone at each spinal cord segment and their corresponding relevant vertebral bodies were also analyzed. Results : Vertical span of the posterior root entry zone between the upper and lower rootlet originating from each spinal segment ranged from 10-12 mm. The lengths of the rootlets from their point of origin at the spinal cord to their entrance into the intervertebral foramen were 5.9 mm at the third cervical nerve root and increased to 14.5 mm at the eighth cervical nerve root. At the lower segments of the nerve roots (T3 to T12), the posterior root entry zone of the relevant nerve roots had a corresponding anatomical relationship with the vertebral body that is two segments above. The posterior root entry zones of the sixth (94%) and seventh (81%) cervical nerve roots were located at a vertebral body a segment above from relevant segment. Conclusion : Through these investigations, a more accurate diagnosis, the establishment of a better therapeutic plan, and a decrease in surgical complications can be expected when pathologic lesions occur in the spinal cord or vertebral body.

• The Journal of Korean Academy of Orthopedic Manual Physical Therapy
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• v.13 no.2
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• pp.12-20
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• 2007

The purpose of this study was designed to find out the effectiveness of vertebral segment instability, muscle fatigue response on lumbar spine after apply lumbosacral stabilization exercise program to 4 patients with chronic low back pain and for 12 weeks. In this study, the lumbar spine motion with blind by MedX test machine and the difference of instability to lumbar vertebra segments in flexion, extension test of standing position and spinal load test(Matthiass Test) by Spinal Mouse. The stabilization exercise program was applied 2 times a week for 12 weeks in hospital and 2 times a day for 20 minutes at home. The results of the present study were as follows: 1. Instability test of lumbar vertebra segment is 2 type differential angle test between vertebrae segment and loading test of spine(matthiass) by Spinal Mouse. It appeared to improve stability of segments in sagittal plane after applying program. So lumbar spine curve increased lordosis toward anterior and was improved of the lumbar spine flexibility in flexion and extension. Specially, in matthiass test, (-) value was increased between lumbar vertebra segment when was the load on spine. And so applying stability improved after program. 2. Fatigue response test(FRT) results, in male, was raised muscle fatigue rate during increase weight, on the other hand female appeared lower than male. As a results, lumbosacral stabilization exercise was aided to improvement of lumbar spine vertebra segments stabilization. Spine instability patients will have a risk when in lifting a load or working with slight flexion posture during the daily of living life and it is probably to increase recurrence rate. Thus, not only lumbar extension muscle strength but also stability of vertebra segments in lumbar spine may be very important.