• 대한후두음성언어의학회지
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• 제17권2호
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• pp.111-114
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• 2006

Objective : The anterior approach to the cervical spine now selves as the surgical across of choice for cervical spine disease. Vocal cord paryalysis(VCP) follow the procedure as a complication, and it is most common complication of this procedure. However, the frequency and etiology of this injury are not clearly defined. This study was performed to establish the clinical features of vocal cord paralysis in anterior cervical spine surgery(ACSS). Material and Method : Retrospectively, medical records of patients who underwent ACSS at Hallym university medical center, Hangang Sacred Heart Hospital between January 2000 and March 2006 were reviewed. Further detailed review of the patients with documented VCP after surgery was then performed. Results : 242 ACSSs were performed and 9 patients with VCP were identified (3.71%) In 9 patients with VCP, 8 patients had right-sided approaches (6.01%) and 1 patient had left-sided approach (0.91%). All 9 patients had VCP on ipsilateral side and 8 patients were recovered completely on follow up period. Duration of ACSS, multilevel exposure and low-level (below the C6 level) exposure have been found to be associated with higher risk. Conclusion : For avoiding the recurrent laryngeal nerve injury, surgeon have to understand the clinical features of VCP in ACSS. As right-sided approach has a greater risk of recurrent laryngeal nerve injury, we suggest that the left-sided approach be given more consideration.

• 한방재활의학과학회지
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• 제25권3호
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• pp.91-102
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• 2015

Two patients, diagnosed as cervical spinal cord injury, were hospitalized and treated by Korean medical interventions with Functional Electrical Stimulation (FES). The range of motion of the shoulder joint, manual muscle test were adopted to measure the resulting motor recovery after treatment. And the Korean version of Barthel index (K-MBI) was adopted as a method of measuring the improvement of quality of life after treatment. The range of motions and muscle strengths of the shoulder joints were improved. The activities of daily living were slightly improved in case 2, but showed no improvement in case 1. FES was effective for upper extremities rehabilitation of spinal cord injured patients. Further studies are needed to set up an Korean medical protocol for spinal cord injury rehabilitation.

• Journal of Korean Neurosurgical Society
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• 제61권5호
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• pp.582-591
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• 2018

Objective : To evaluate the magnetic resonance (MR) imaging features that have a statistically significant association with the need for a tracheostomy in patients with cervical spinal cord injury (SCI) during the acute stage of injury. Methods : This study retrospectively reviewed the clinical data of 130 patients with cervical SCI. We analyzed the factors believed to increase the risk of requiring a tracheostomy, including the severity of SCI, the level of injury as determined by radiological assessment, three quantitative MR imaging parameters, and eleven qualitative MR imaging parameters. Results : Significant differences between the non-tracheostomy and tracheostomy groups were determined by the following five factors on multivariate analysis : complete SCI (p=0.007), the radiological level of C5 and above (p=0.038), maximum canal compromise (MCC) (p=0.010), lesion length (p=0.022), and osteophyte formation (p=0.015). For the MCC, the cut-off value was 46%, and the risk of requiring a tracheostomy was three times higher at an interval between 50-60% and ten times higher between 60-70%. For lesion length, the cut-off value was 20 mm, and the risk of requiring a tracheostomy was two times higher at an interval between 20-30 mm and fourteen times higher between 40-50 mm. Conclusion : The American Spinal Injury Association grade A, a radiological injury level of C5 and above, an MCC ${\geq}50%$, a lesion length ${\geq}20mm$, and osteophyte formation at the level of injury were considered to be predictive values for requiring tracheostomy intervention in patients with cervical SCI.

• 한방재활의학과학회지
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• 제26권3호
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• pp.143-151
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• 2016

A 57-year-old male patient was diagnosed as Incomplete cervical spinal cord injury and Neurogenic bladder after falling accident and suffered from tetraplegia and urinary retention. The patient was hospitalized and treated with Complex Korean Medical treatment such as acupuncture, electro-acupuncture, bee venom pharmacopuncture and herbal medication for 13 weeks. International Standard for Neurological Classification of Spinal Cord Injury (ISNCSCI) was adopted to evaluate the functional recovery and Korean version of Modified Barthel Index (K-MBI) was adopted to evaluate the recovery of activities of daily living (ADL). After treatment, Total scores of ISNCSCI and K-MBI were improved. Also patient's micturition reflex was recovered and symptoms of neurogenic bladder were improved. This result shows that Korean Medical treatment may be an effective treatment option for spinal cord injury and neurogenic bladder patients. Further clinical studies are needed to clarify the effect of Korean Medical treatment on spinal cord injury.

• Journal of Korean Neurosurgical Society
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• 제64권5호
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• pp.791-798
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• 2021

Objective : The period of mechanical ventilator (MV)-dependent respiratory failure after cervical spinal cord injury (CSCI) varies from patient to patient. This study aimed to identify predictors of MV at hospital discharge (MVDC) due to prolonged respiratory failure among patients with MV after CSCI. Methods : Two hundred forty-three patients with CSCI were admitted to our institution between May 2006 and April 2018. Their medical records and radiographic data were retrospectively reviewed. Level and completeness of injury were defined according to the American Spinal Injury Association (ASIA) standards. Respiratory failure was defined as the requirement for definitive airway and assistance of MV. We also evaluated magnetic resonance imaging characteristics of the cervical spine. These characteristics included : maximum canal compromise (MCC); intramedullary hematoma or cord transection; and integrity of the disco-ligamentous complex for assessment of the Subaxial Cervical Spine Injury Classification (SLIC) scoring. The inclusion criteria were patients with CSCI who underwent decompression surgery within 48 hours after trauma with respiratory failure during hospital stay. Patients with Glasgow coma scale 12 or lower, major fatal trauma of vital organs, or stroke caused by vertebral artery injury were excluded from the study. Results : Out of 243 patients with CSCI, 30 required MV during their hospital stay, and 27 met the inclusion criteria. Among them, 48.1% (13/27) of patients had MVDC with greater than 30 days MV or death caused by aspiration pneumonia. In total, 51.9% (14/27) of patients could be weaned from MV during 30 days or less of hospital stay (MV days : MVDC 38.23±20.79 vs. MV weaning, 13.57±8.40; p<0.001). Vital signs at hospital arrival, smoking, the American Society of Anesthesiologists classification, Associated injury with Injury Severity Score, SLIC score, and length of cord edema did not differ between the MVDC and MV weaning groups. The ASIA impairment scale, level of injury within C3 to C6, and MCC significantly affected MVDC. The MCC significantly correlated with MVDC, and the optimal cutoff value was 51.40%, with 76.9% sensitivity and 78.6% specificity. In multivariate logistic regression analysis, MCC >51.4% was a significant risk factor for MVDC (odds ratio, 7.574; p=0.039). Conclusion : As a method of predicting which patients would be able to undergo weaning from MV early, the MCC is a valid factor. If the MCC exceeds 51.4%, prognosis of respiratory function becomes poor and the probability of MVDC is increased.

• The Journal of Korean Physical Therapy
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• 제25권5호
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• pp.273-281
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• 2013

Purpose: The purpose of this study is to determine the effect of motor imagery training on residual upper extremity strength and activities of daily living of chronic cervical spinal cord injury patients. Methods: Twelve ASIA A B patients, who had more than a 12-month duration of illness and C5 or 6 motor nerve injury level, were randomly divided into experimental group (n=6) and control group (n=6). Patients in the experimental group performed motor imagery training for five minutes prior to general muscle strengthening training, while those in the control group performed general muscle strengthening training only. The training was performed five times per week, 30 minutes per day, for a period of four weeks. General muscle strengthening training consisted of a progressive resistive exercise for residual upper extremity. Motor imagery training consisted of imagining this task performance. Before and after the training, EMG activity using BTS Pocket Electromyography and Spinal Cord Independent Measure III(SCIM III) were compared and analyzed. Results: The residual upper extremity muscle strengths showed improvement in both groups after training. Comparison of muscle strength improvement between the two groups showed a statistically significant improvement in the experimental group compared to the control group (p<0.05). SCIM III measurements showed significant improvement in the scores for Self-care and Transfer items in the experimental group. Conclusion: Motor imagery training was more effective than general muscle strengthening training in improving the residual upper extremity muscle strength and activities of daily living of patients with chronic cervical spinal cord injury.

• Journal of Trauma and Injury
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• 제26권3호
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• pp.151-156
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• 2013

Purpose: Traumatic cervical SCI is frequently accompanied by dural tear and the resulting cerebrospinal fluid (CSF) leak after surgery can be troublesome and delay rehabilitation with increasing morbidity. This study evaluated the incidence of intraoperative CSF leaks in patients with traumatic cervical spinal cord injury (SCI) who underwent anterior cervical surgery and described the reliable management of CSF leaks during the perioperative period. Methods: A retrospective study of medical records and radiological images was done on patients with CSF leaks after cervical spine trauma. Results: Seven patients(13.2%) were identified with CSF leaks during the intraoperative period. All patients were severely injured and showed structural abnormalities on the initial magnetic resonance image (MRI) of the cervical spine. Intraoperatively, no primary repair of dural tear was attempted because of a wide, rough defect size. Therefore, fibrin glue was applied to the operated site in all cases. Although a wound drainage was inserted, it was stopped within the first 24 hours after the operation. No lumbar drainage was performed. Postoperatively, the patients should kept their heads in an elevated position and early ambulation and rehabilitation were encouraged. None of the patients developed complications related to CSF leaks during admission. Conclusion: The incidence of CSF leaks after surgery for cervical spinal trauma is relatively higher than that of cervical spinal stenosis. Therefore, one should expect the possibility of a dural tear and have a simple and effective management protocol for CSF leaks in trauma cases established.

• Journal of Acupuncture Research
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• 제37권4호
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• pp.275-280
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• 2020

This study reports the effectiveness of traditional Korean medicine in treating tetraplegia and respiratory symptoms (including dyspnea) after traumatic cervical spinal cord injury surgery. The patient was treated with complex Korean medical treatment including electroacupuncture, pharmacopuncture, and herbal medicine. The manual muscle test (expanded Medical Research Council system) was used to measure the patient's muscle strength. The Korean version of the modified Barthel index and the functional independent measure were used to evaluate the patient's independence in performing daily activities. Following 2 hospitalizations and treatments, the patient's muscle strength improved > 4+ score for all joints, and the Korean version of the modified Barthel index and functional independent measure scores increased from 26 to 79 and 56 to 95, respectively. Symptoms of dyspnea, coughing, and sputum gradually improved and finally disappeared during hospitalization. This study suggests complex Korean medicine treatment may be effective in the rehabilitation of post-surgical cervical spinal cord injury patients.

• 재활간호학회지
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• 제10권2호
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• pp.108-115
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• 2007

Purpose: This study was to investigate the effects of respiratory rehabilitation training on the respiratory functions of hospitalized cervical spinal cord injury patients. Methods: One group pre and post test design was used. Subjects were 20 cervical spinal cord injury inpatients of the national rehabilitation center. Training program consisted of air cumulation training, manual assisted coughing training, and abdominal breathing. Trained rehabilitation nurse implemented 20 minutes program twice a day for 4 weeks. Respiratory function was measured as peak coughing flow rate, and perceived respiratory difficulty after activity on wheel chair for 30 minutes and during speaking and singing. Perceived respiratory difficulty was measured with modified Borg scale. Also content analysis was done with the result of open ended question about subjective feeling about training. All variables were measured 3 times before, 2weeks and 4 weeks after the program. Results: Peak coughing flow rate significantly improved after compared to before training. Also all three perceived respiratory difficulty variables decreased significantly after training. In the content analysis, 'it's easier to cough up phlegm' was the most frequent answered subjective feeling. 'Sound at speaking and coughing became louder', 'respiratory volume increased', and 'comfortable chest feeling' were frequent answered subjective feeling, in order. Conclusion: Although it is preliminary since no control group, respiratory rehabilitation training was found to be effective to improve respiratory function in terms of peak coughing flow rate, perceived respiratory difficulty, and subjective feeling. It is necessary further systemic research to investigate the effects of respiratory rehabilitation training.

• The Korean Journal of Pain
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• 제28권2호
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• pp.129-136
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• 2015

Background: Pain is one of the most important consequences of spinal cord injury (SCI). It may affect several aspects of life, especially the quality of life (QoL). Hence, this study was conducted to establish an understanding of pain and its correlates and effects on patients with SCI in our community. Methods: In a cross-sectional study, 58 male veterans suffering from SCI were admitted to our center for a regular follow-up. Demographic and SCI-related descriptive information were gathered using a self-reported questionnaire. To evaluate the patients' pain quality and the effect of pain on daily life, a questionnaire in 3 parts of lumbar, cervical and shoulder pain was administered. EuroQoL questionnaire and General Health Questionnaire (GHQ) 12 were also used to assess the patients' QoL. Results: The mean age of the participants was $45.91{\pm}6.69$ with mean injury time of $25.54{\pm}5.91$. forty-four patients (75.9%) reported pain, including lumbar pain (63%), cervical pain (39%) and shoulder pain (51%). The presence of pain was associated with lower QoL. Patients with lumbar pain reported a significant amount of pain affecting their daily life and this effect was higher in patients with lower GHQ score or anxiety/depressive disorder. Conclusions: Musculoskeletal pain, is a common complaint in veterans with SCI and is inversely associated with functioning and general health status. Lumbar and shoulder pain affects patient's daily living more than cervical pain.