• Journal of Korean Neurosurgical Society
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• v.65 no.4
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• pp.549-557
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• 2022

Objective : This study analyzed the risk factors in patients who developed distal junctional kyphosis (DJK) after posterior cervical fusion. Methods : We retrospectively analyzed the clinical and radiographic outcomes of 64 patients, aged ≥18 years (51 and 13 male and female patients, respectively), who underwent single-staged multilevel (3-6 levels) posterior cervical fusion surgery due to multiple cervical spondylotic myelopathy. The surgeries were performed by a single spinal surgeon between January 2012 and December 2017. Demographic data, clinical outcomes, and radiological results were collected. We divided the patients into a DJK group and a non-DJK group according to the presence of DJK and investigated the risk factors by comparing the differences between the two groups. Results : Of the 64 patients, 13 developed DJK. No significant differences in clinical results were observed between the two groups before and immediately after the surgery. At the final follow-up, a higher visual analog score for neck pain was observed in the DJK group compared to the non-DJK group (p<0.01). The DJK group had a significantly lower T1 slope and a significantly higher C2-7 sagittal vertical axis (SVA) before surgery compared to the non-DJK group (p=0.03 and p<0.01, respectively). Immediately after surgery, the difference between the two groups decreased and no significant difference was observed. However, at the last follow-up, a significantly higher C2-7 SVA was observed in the DJK group (p<0.01). At the last follow up, there is no discrepancy in T1S-CL. In multiple logistic regression analysis, preoperative higher C2-7 SVA and preoperative lower T1 slope were identified as independent risk factors (p=0.03 and p<0.01, respectively). As a result, it was confirmed that DJK occurred along the process of returning to preoperative values. Conclusion : DJK can be considered to be caused by cervical misalignment due to excessive change in the surgical site in patients with low T1 slope and high C2-7 SVA before surgery. This also affects the clinical outcome after surgery. It is recommended to refrain from excessive segmental lordosis changes during multilevel cervical post fusion surgery, especially in patients with a small preoperative T1 slope and a large SVA value.

• Journal of Korean Neurosurgical Society
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• v.30 no.sup2
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• pp.300-308
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• 2001

Objectives : Anterior cervical discectomy and interbody fusion has become a well-accepted surgical treatment of degenerative cervical diseases. Implatable cages have a stabilizing effect without plates and no need for autogenous bone graft. The authors evaluates the effect of implatable titanium cage(RABEA) on the clinical and radiological outcomes. Methods : 34 patients with symptomatic cervical degenerative diseases due to one level disc pathology were underwent anterior cervical discectomy and interbody fusion with titanium cages(RABEA) which were not filled with cancallous bone grafts from January 1999 to May 2001. Patients with osteoporosis and older than 65 years were not included. Among them, 15 patients could be followed-up for at least 1 year. The authors retrospectively reviewed the charts and radiographic data. Mean follow-up period was $1.3{\pm}0.2years$. Results : Clinical results according to the Odom's criteria was exellent and good in 14(93%) patients. One patient with fair result showed complete loss of the disc space height due to settlement of the cage. Preoperatively, the mean height of the disc space(${\pm}$standard deviation) was $3.42{\pm}1.10mm$(range 2.0-5.5mm), and at 1 day postoperatively it was $7.88{\pm}0.90mm$(range 6.50-9.0). The mean height of the disc space after 1 year was $6.50{\pm}1.38mm$(range 3.0-8.0). The restoration of the height was statistically significant(p<0.05). The mean height after 1 year was $82.7{\pm}15.9%$ of the height at 1 day postoperatively. Preoperatively the mean value of the cervical lodortic angle was $21.8{\pm}11.8^{\circ}$ and 1 year postopertively, it was $24.5{\pm}8.3^{\circ}$, which was statistically not significant. All patients showed no abnormal movements on flexion and extension lateral film after 6 months. Conclusion : Implantable titanium cages appear safe and effective in selected patients, and their use helps to avoid complications associated with bone graft harvest. Subsidence of the cage seems to be a potential risk factor for recurrence of the symptoms. For long-term results, a longer follow-up is required.

• Journal of Korean Neurosurgical Society
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• v.52 no.1
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• pp.27-31
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• 2012

Objective : Although hydroxyapatite (HA) spacer has been used for laminoplasty, there have been no reports on factors associated with fusion and on the effects of HA shape. Methods : During January 2004 and January 2010, 45 patients with compressive cervical myelopathy underwent midline-splitting open door laminoplasty with winged (33 cases) and wingless (12 cases) HAs by a single surgeon. Minimal and mean follow up times were 12 and 28.1 months, respectively. Japanese Orthopedic Association (JOA) score was used for clinical outcome measurement. Cervical X-rays were taken preoperatively, immediately post-operatively, and after 3, 6, and 12 months and computed tomography scans were performed preoperatively, immediately post-operatively and after 12 months. Cervical lordosis, canal dimension, fusion between lamina and HA, and affecting factors of fusion were analyzed. Results : All surgeries were performed on 142 levels, 99 in the winged and 43 in the wingless HA groups. JOA scores of the winged group changed from $10.4{\pm}2.94$ to $13.3{\pm}2.35$ and scores of the wingless group changed from $10.8{\pm}2.87$ to $13.8{\pm}3.05$. There was no significant difference on lordotic and canal dimensional change between two groups. Post-operative 12 month fusion rate between lamina and HA was significantly lower in the winged group (18.2 vs. 48.8% p=0.001). Multivariate analysis showed that ossification of the posterior longitudinal ligament, male gender, and wingless type HA were significantly associated with fusion. Conclusion : Clinical outcome was similar in patients receiving winged and wingless HA, but the wingless type was associated with a higher rate of fusion between HA and lamina at 12 months post-operatively.

• Journal of The Korean Society of Integrative Medicine
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• v.7 no.4
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• pp.265-272
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• 2019

Purpose : Excessive computer use frequently results in musculoskeletal disorders of the neck and shoulder such as forward head posture (FHP). The purpose of this study was to investigate effects of neck and shoulder exercise program on spino-pelvic alignment and the correlation between change in head and neck posture and spino-pelvic alignment in FHP. Methods : The study included 44 participants with FHP. The participants performed the exercise for correction of FHP 2-3 times a week for 4 weeks. We examined whole spine X-ray images in the lateral standing position with both arms crossed. We measured anterior head translation distance (AHT), craniovertebral angle (CVA), cervical lordosis (CL), thoracic kyphosis (TK), lumbosacral lordosis (LSL), sacral slope (SS), pelvic tilt (PT), and pelvic incidence (PI) of the subjects. The association between change in AHT and each spino-pelvic parameter was also subjected to Pearson's correlation coefficient analysis. Results : There were statistically significant differences before and after exercise in the parameters of AHT, CVA, and SS (p<.05). Significant negative correlation was observed between the change in AHT and CVA (r=-.768, p<.001), and CL (r=-.388, p<.05). There was significant positive correlation between the change in AHT and SS (r=.328, p<.05), and PI (r=.333, p<.05). However, no significant correlation was observed in change in AHT with that of TK, LSL, and PT. Conclusion : Based on the above results, we conclude that there is a relationship between change in AHT, which is a parameter associated with forward displacement of the head, and that of CVA, CL, SS, and PI after exercise in cases of FHP.

• Journal of Korean Neurosurgical Society
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• v.60 no.6
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• pp.691-700
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• 2017

Objective : The authors prospectively analyzed the effect of one-level or two-level anterior cervical discectomy and fusion (ACDF), comparing stand-alone cages and cage-with-plate fixation constructs with respect to clinical outcomes and radiologic changes. Methods : A total of 84 patients who underwent one-level (n=52) or two-level ACDF (n=32) for cervical disc disease and who completed 2 years of follow-up were included in this study. The patients were divided by cervical level and grouped into ACDF-Cage-only and ACDF-Cage-with-plate groups. The following parameters were assessed using radiographs : subsidence, C2-C7 lordosis angle, fusion segment angle, adjacent disc space narrowing, and fusion status. Clinical outcomes were assessed using the neck disability index (NDI) and visual analog scale scores for arm pain. Results : In the comparison of one-level ACDF-cage-only and ACDF-cage-with-plate groups, the NDI score was better in the cage-only group at the 3-, 12-, and 24-month follow-ups : however, no significant difference in clinical outcomes was observed. In the comparison of two-level ACDF-cage-only and ACDF-cage-with-plate groups, no difference in any clinical outcome was observed between the two groups. At the 24-month follow-up, subsidence was observed in 45.8% of patients in the one-level cage-only group and 32.1% of patients in the one-level cage-with-plate fixation group. There was no statistically significant difference in the incidence rate between the two groups (p=0.312). Subsidence in the two-level cage-only group (66.6%) was significantly more frequent than in the two-level cage-with-plate fixation group (30%; p=0.049). The fusion rate for patients in the one-level cage-only group was not significantly different from that in the one-level cage-with-plate fixation group (cage-only, 87.5%; cage-with-plate fixation, 92.9%; p=0.425) ; fusion rate in the two-level patients were also similar between groups (cage-only, 83.3%; cage-with-plate fixation, 95%; p=0.31). Conclusion : Our clinical results showed that for single-level cases, plate fixation had no additional benefit versus cage-only; for two-level ACDF cases, the fusion rate and clinical outcomes were similar, although the cage-with-plate fixation group had a lower incidence of cage subsidence than did the cage-only group. We conclude that physicians should be aware of this possible disadvantage associated with using cervical plates in one-level ACDF. However, in two-level ACDF, subsidence is more likely to occur without plate fixation, and thus the addition of plate fixation should be considered.

• The Journal of Korean Physical Therapy
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• v.14 no.1
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• pp.187-195
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• 2002

This study was performed to assess the efficacy of Activator for the patient with chronic neck pain. Mail, 26 years old, is treated with Activator, which was applied for 15 minutes every two days during the 4 weeks. The results of this study are as follows: 1. The treated case compared with the previous case showed that R.O.M particularly increased in flexion and extension. 2. The atlas/skull angle compared with the previous case showed that the angle increased from $0.8^{\circ}$ to $1.5^{\circ}$. In the atlas/skull, normal angle is $5.6^{\circ}$. 3. The angle of cervical curve lordosis compared with the previous case showed that the angle increased from $38.3^{\circ}$ to $48.1^{\circ}$. In the healthy spine, the angle is $42.0^{\circ}$. 4. The anterior curvature compared with the previous case showed that curve radii decreased from 7,220mm to 200mm. In the spine, normal curvature is 165mm. 5. Rush Jackson's angle compared with the previous case showed that the angle increased from $14.8^{\circ}$ to $29.1^{\circ}$. In the healthy spine, normal angle is $39.9^{\circ}$. We can not find significant level for Activator, but it is considered that activator method of chiropractic technique is effective.

• Journal of the Korean Society of Physical Medicine
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• v.9 no.1
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• pp.125-132
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• 2014

PURPOSE: This study aims to determine the optimal knee joint angle and hip joint angle for minimizing the cervical muscle tension and maximizing the muscle activity of the trunk during the bridging exercise for trunk stabilization. METHODS: The bridging exercise in this study included seven forms of exercise: having a knee joint flexion angle of $120^{\circ}$, $90^{\circ}$, $60^{\circ}$, $45^{\circ}$ and hip joint abduction angle of $15^{\circ}$, $10^{\circ}$, $5^{\circ}$. The posture of the bridging exercise was as follows. To prevent the increase of hyper lumbar lordosis during the bridging exercise, the exercise was practiced after maintaining the lumbar neutral position through the pelvic posterior tilting exercise. RESULTS: The abduction angles did not result in statistically significant effects on the cervical erector, external oblique, rectus abdominis and erector spinae muscles. However, in relation to the knee joint angles, during the bridging exercise, statistically significant results were exhibited. CONCLUSION: The knee joint angle affected the muscle activity of the neck muscle. The greater the knee joint angle, the lower the load placed on the neck muscle. In contrast, the load increased as the knee joint angle decreased. In addition, the muscle activity of the neck muscle and trunk muscle increased as the knee joint angle decreased.

• Journal of The Korean Society of Integrative Medicine
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• v.8 no.1
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• pp.113-124
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• 2020

Purpose : The purpose of this study was to investigate the effects of exercise intervention combined with 3D visual feedback and motion observation on postural alignment and cerebral cortical activity in subjects with forward head posture (FHP). Methods : The study included 28 participants with FHP, randomly divided into a 3D visual feedback plus motion observation group (n=14) or control group (n=14). The experimental group received corrective exercise combined with 3D visual feedback and motion observation for FHP, three times a week for four weeks. We examined cervical spine radiographs in the lateral standing position with both arms crossed to measure the craniovertebral angle (CVA) and cervical lordosis (CL). Relative alpha (RA) and beta waves (RB) were measured by wireless dry EEG. Results : The CVA value was significantly different between the groups, and the CL value was significantly different only in the experimental group. RA and RB values were not significantly different before and after intervention in the control group. RB values were significantly decreased before and after intervention in the experimental group. Conclusion : Based on the results of this study, we suggest that interventions combined with motion observation and 3D visual feedback may be effective as exercise methods to improve postural alignment and cerebral activity in subjects with FHP. Further research is required to generalize our results on technical supplementation complemented with 3D visual feedback devices.

• Journal of Acupuncture Research
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• v.21 no.6
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• pp.195-207
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• 2004

목적 : 경추통에 대한 침구치료의 효과여부가 현재까지 시행된 무작위 대조군 시험의 검토에서 논란이 되고 있는데, 경추통에 대한 치료 효과의 검증에 최근 들어 경추 전만각도의 변화를 측정하는 것이 점차 많이 사용되고 있는 실정이다. 하지만 아직까지 변형된 형태의 경추 견인 등 몇몇 요소들이 경추전만을 변화시켰다는 보고는 있었으나, 침치료 중 深刺의 방법이 경추의 만곡을 변화시켰다는 보고는 없었다. 방법 : 자침의 방법 중 深刻(五刺法 중 合谷刺 또는 關刺)방법이 경추 전만의 변화를 주는가에 대하여 검증하기 위하여 심자 치료를 시행한 19명의 실험군과 치료를 시행하지 않고 단순히 방사선 촬영만 시행한 21명의 대조군의 단순 방사선 사진을 후향적 연구의 방법으로 비교하였으며, 아울러 심자 자침군에서는 VAS를 측정하여 통증의 정도의 변화를 함께 연구하였다. 결과 : 연구결과 자침을 시행하지 않은 대조군에서는 VAS와 경추 전만의 Cobb각도에서 유의성 있는 변화가 나타나지 않았으나, 심자의 방법으로 자침한 군에서는 치료 전후의 VAS가 유의한 차이를 나타내었고, 경추의 전만 각도에서도 경추 2번과 7번 사이의 Cobb의 각도에서 유의성 있는 변화를 나타내었다(p < 0.05). 결론 : 이러한 연구 결과들은 심자의 자침방법이 경주의 통증을 줄여줄 뿐만 아니라 경추의 구조적 변화를 일으킬 수 있음을 나타내 주는 것이다.

• Journal of Korean Medicine Rehabilitation
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• v.23 no.4
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• pp.195-202
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• 2013

Objectives This study was designed to investigate the correlation between the forward head posture and the spinal alignment. Methods We examined the whole spine x-rays of the 144 student sample. We measured the Craniovertebral angle (CVA), Cervical angle (CA), Thoracic kyphotic angle (TKA), lumbar lordosis angle (LLA) and Ferguson's angle (FA) of the students. We then analyzed the relationship between these angles. Results CVA had correlation with CA, but it was weak. There was significant correlation between CVA and TKA. There were no significant correlation among CVA, LLA and FA. Conclusions According to above results, there is a negative relationship between the CVA and the TKA - in that higher CVAs yielded lower TKAs. But CVA had no significant correlation with LLA or FA.