• Journal of the Korean Society of Physical Medicine
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• v.17 no.1
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• pp.41-48
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• 2022

PURPOSE: This study examined the relationship between the cervical lordosis angle (CLA) and the craniovertebral angle (CVA) and between CVA and a cross-sectional area (CSA) of the cervical muscles. METHODS: In 17 healthy college students, the CLA was measured using a posterior tangent technique. The CVA was analyzed using photographic images, and the CSA of the cervical muscles, including longus colli, longus capitis, and sternocleidomastoid, was evaluated using computerized tomography. The Pearson's correlation coefficient was used to determine the relationship between these variables and a neck disability index. RESULTS: The CVA correlated with the CLA and with a CSA of longus colli (r = .487, p = .047 and r = .592, p = .012, respectively). The CLA correlated with a CSA of longus colli (r = .578, p = .015). CONCLUSION: This study clarified the relationship between the postural, structural, and muscular changes in the cervical regions. A significant correlation was observed between the CVA and a CSA of the longus colli with the CLA and between the CVA and the CSA of the longus colli. Prescription strengthening exercises for the deep neck flexors for individuals with a forward head posture and reduced cervical lordosis are useful.

• Journal of Korean Neurosurgical Society
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• v.29 no.3
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• pp.379-388
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• 2000

Objective : Although transoral transpharyngeal approach is a very useful method for the lesions of craniovertebral junction, it is not frequently used because of anatomical unfamilarity, risk of cerebrospinal fluid(CSF) leakage, and resultant postoperative meningitis. To evaluate the usefulness of transoral transpharyngeal approach for various lesions of craniovertebral junction, clinical characteristics and the results of this approach are investigated. Methods : Transoral transpharyngeal approaches were performed in eight cases between 1996 and 1999. Among them, there were three basilar invaginations due to congenital anomalies, two odontoid type I fractures, two atlantoaxial dislocations, and one pseudotumor. Surgical methods included five cases of anterior decompression and posterior fusion, two anterior approaches for decompression and one transoral approach for biopsy. Results : This procedure allowed immediate clinical improvement in all cases. In seven patients with preoperative motor deficit showed a progressive neurological improvement. The follow-up plain x-rays demonstrated successful bony fusion in all patients. Only one patient suffered from postoperative wound dehiscence, but she completely recovered after wound revision. There was no complication of postoperative CSF leakages. Conclusions : Transoral transpharyngeal approach for the ventral lesions of craniovertebral junction, can be used as a relatively simple and effective method.

• Journal of Korean Neurosurgical Society
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• v.29 no.3
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• pp.309-316
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• 2000

Objective :The transoral approach allows direct view of the ventral craniovertebral junction and provides useful management of the various lesions of this area. We present a step by step guide to the performance of the transoral excision of the odontoid process in the cadaveric model. Methods : Ten cadaver heads were used in fixed or unfixed state. We describe the relevant surgical anatomy in the cadaveric dissection and surgical technique of transoral transpharyngeal odontoidectomy. Results : The surgical procedure of transoral odontoidectomy was categorized by six steps；soft palate, posterior pharyngeal wall, muscular structures, osseous structures, odontoid process and ligaments, cruciate ligament and dura. Conclusion : With anatomical knowledge of these regions neurosurgeons can deal with wide variety of lesions in the ventral craniovertebral junction.

• Journal of Korean Neurosurgical Society
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• v.57 no.4
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• pp.276-282
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• 2015

Objective : The purpose of this study was to investigate morphological change at the craniovertebral junction (CVJ) region using computed tomography. Methods : A total of 238 patients were included in this study, and mean age was $47.8{\pm}21.3months$. Spinal canal diameter, Power's ratio, McRae line, antero-posterior C1 ring height, atlantoaxial joint space, C2 growth, epidural space from the dens (M-PB-C2) and longitudinal distance (basion to C2 lower margin, B-C2) were measured. The mean value of each parameter was assessed for individual age groups. The cohorts were then divided into three larger age groups : infancy (I) (${\leq}2years$), very early (VE) childhood (2-5 years) and early (E) childhood ($5{\geq}years$). Results : Spinal canal diameter increased with age; however, this value did not increase with statistical significance after VE age. A significant age-related difference was found for all C2 body and odontoid parameters (p<0.05). Mean McRae line was 8.5, 8, and 7.5 mm in the I, VE, and E groups, respectively. The M-PB-C2 line showed up-and-down dynamic change during early pediatric periods. Conclusion : Expansion of the spinal canal was restricted to the very early childhood period (less than 5 years) in the CVJ region; however, the C2 body and odontoid process increased continuously with age. The above results induced a dynamic change in the M-PB-C2 line. Although C2 longitudinal growth continued with age, the McRae line showed relatively little change.

• Journal of Korean Neurosurgical Society
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• v.61 no.2
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• pp.277-281
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• 2018

Objective : Craniovertebral junctional anomalies constitute a technical challenge. Surgical opening of atlantoaxial joint region is a complex procedure especially in patients with nuchal deformity like basilar invagination. This region has actually very complicated anatomical and functional characteristics, including multiple joints providing extension, flexion, and wide rotation. In fact, it is also a bottleneck region where bones, neural structures, and blood vessels are located. Stabilization surgery regarding this region should consider the fact that the area exposes excessive and life-long stress due to complex movements and human posture. Therefore, all options should be considered for surgical stabilization, and they could be interchanged during the surgery, if required. Methods : A 53-year-old male patient applied to outpatients' clinic with complaints of head and neck pain persisting for a long time. Physical examination was normal except increased deep tendon reflexes. The patient was on long-term corticosteroid due to an allergic disease. Magnetic resonance imaging and computed tomography findings indicated basilar invagination and atlantoaxial dislocation.The patient underwent C0-C3-C4 (lateral mass) and additional C0-C2 (translaminar) stabilization surgery. Results : In routine practice, the sites where rods are bound to occipital plates were placed as paramedian. Instead, we inserted lateral mass screw to the sites where occipital screws were inserted on the occipital plate, thereby creating a site where extra rod could be bound.When C2 translaminar screw is inserted, screw caps remain on the median plane, which makes them difficult to bind to contralateral system. These bind directly to occipital plate without any connection from this region to the contralateral system.Advantages of this technique include easy insertion of C2 translaminar screws, presence of increased screw sizes, and exclusion of pullout forces onto the screw from neck movements. Another advantage of the technique is the median placement of the rod; i.e., thick part of the occipital bone is in alignment with axial loading. Conclusion : We believe that this technique, which could be easily performed as adjuvant to classical stabilization surgery with no need for special screw and rod, may improve distraction force in patients with low bone density.

• Journal of Korean Neurosurgical Society
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• v.49 no.4
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• pp.248-251
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• 2011

Objective : In the field of spinal surgery, a few laboratory results or clinical cases about robotic spinal surgery have been reported. In vivo trials and development of related surgical instruments for spinal surgery are required before its clinical application. We investigated the use of the da $Vinci^{(R)}$ Surgical System in spinal surgery at the craniovertebral junction in a human cadaver to demonstrate the efficacy and pitfalls of robotic surgery. Methods : Dissection of pharyngeal wall to the exposure of C1 and odontoid process was performed with full robotic procedure. Although assistance of another surgeon was necessary for drilling and removal of odontoid process due to the lack of appropriate end-effectors, successful robotic procedures for dural sutures and exposing spinal cord proved its safety and dexterity. Results : Robot-assisted odontoidectomy was successfully performed in a human cadaver using the da $Vinci^{(R)}$ Surgical System with few robotic arm collisions and minimal soft tissue damages. Da $Vinci^{(R)}$ Surgical System manifested more dexterous movement than human hands in the deep and narrow oral cavity. Furthermore, sutures with robotic procedure in the oral cavity demonstrated the advantage over conventional procedure. Conclusion : Presenting cadaveric study proved the probability of robot-assisted transoral approach. However, the development of robotic instruments specific to spinal surgery must first precede its clinical application.

• PNF and Movement
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• v.15 no.2
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• pp.149-157
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• 2017

Purpose: The purpose of this study was to assess the effect of using smartphones for tele-rehabilitation on head position and neck dysfunction in workers with visual display terminal (VDT) syndromes over a four-week period. Methods: Sixteen VDT workers volunteered to participate in stretch exercise and posture education sessions. The subjects were divided into three groups as follows: five subjects in the visit group (VSG), six subjects in the video group (VEG), and five subjects in tele-rehabilitation group (TG). The subjects in all the groups performed the exercises three days per week for four weeks. Cranial rotation angle (CRA), craniovertebral angle (CVA) measurement, and neck disability index (NDI) tests were performed before and four weeks after the intervention. Results: No significant difference in the CRA and CVA variables was found among groups. No significant difference in the CRA variable was found within each group. A significant difference in the CRA variable was found in the VSG after the four-week intervention. No significant difference in NDI was found among the groups. The NDIs among all the groups were significantly decreased after the intervention when compared with the NDIs measured before the intervention. Conclusion: The use of smartphones in the tele-rehabilitation of VDT workers with neck pain was found to be as effective on neck function as the conventional intervention method. The tele-rehabilitation of VDT workers with neck dysfunctions may be presented as an alternative way.

• Journal of the Korean Society of Physical Medicine
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• v.13 no.2
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• pp.61-68
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• 2018

PURPOSE: This study aimed to examine the effects of self-stretching (SS) and joint mobilization (JM) on pain, craniovertebral angle (CVA), autonomic system function in chronic cervical pain patient with forward head posture (FHP). METHODS: A total of 30 male college students were selected as study subjects, and were divided into Group I (general physical therapy; GPT, n=10), Group II (GPT+SS, n=10), Group III (GPT+JM, n=10). All groups were evaluated three times a week for 4 weeks. Pain was measured by visual analogue scale (VAS), CVA was measured using digital goniometer and autonomic system function (heart rate; HR, skin conductivity; SC, LF norm, HF norm, LF/HF ratio) was measured by Biofeedback ProComp Infiniti. After 4 weeks, paired t-test was used to compare the changes within the group and one way ANOVA was used to compare those between the groups. RESULTS: In Group I, VAS was significantly decreased. In Group II and III was a significantly change in all items. In comparison between Group I and II was a difference in all items except HR. In comparison between Group I and III was a difference in all items. In comparison between Group II and III was a difference in VAS, LF norm and LF/HF ratio. CONCLUSION: This study showed that SS and JM can effectively reduce pain and normalize the autonomic system function.

• Journal of the Korea Society of Computer and Information
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• v.25 no.8
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• pp.145-150
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• 2020

Forward head posture is one of the most recognized types of poor head and neck alignment. Poor head and neck alignment posture is a major contributor to compromised balance and neck pain, due to abnormal joint position sense and proprioception. Kinesio taping is an intervention method used clinically for the management of pain. Kinesio taping may produce its effects through pain reduction, stimulation of blood circulation, induction of muscle relaxation which provides correction of joint position, and providing stability to the muscles and joints without limiting the range of motion. Many studies have proved that kinesio taping has positive effects on the reduction of pain and improves alignment, on the other hand, some studies have not found. Kinesio taping may provide immediate pain relief and improved alignment following the application, but there is insufficient evidence to support sustained relief beyond that time and they recommended future studies to examine the benefits of kinesio taping as this would have a greater value in clinical practice. Therefore, this study is to investigate the effects of kinesio taping on the alignment of head posture and dynamic balance ability in people with forward head posture.

• Physical Therapy Korea
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• v.27 no.3
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• pp.185-190
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• 2020

Background: Backward walking exercise may offer some unique and potentially beneficial differences compared with forward walking exercise. There is still a lack of research on backward walking exercises and forward head posture. Objects: The purpose of this study was to determine the effect of backward walking exercise on college students forward head posture in their 20s. Methods: Twenty-one subjects participated in the experiment. The subjects were those with a craniovertebral angle (CVA) of 55 degrees or less who understood the purpose and method of this study and voluntarily agreed. A camera capable of taking pictures of the lateral plane was installed at a distance of 1.5 meters before exercising. Pictures were taken before walking backward, and after walking for 15 minutes on the treadmill, the images were taken in the same way. The composition of the backward walking exercise was walking at a rate of 1.0 for 5 minutes, and the remaining 10 minutes were walking at a rate of 1.5. Wilcoxon signed rank test was used to compare CVA and craniorotational angle (CRA) before and after exercise. Results: As a result of this study, there was a significant difference in CVA before and after exercise (p < 0.05). There was a significant difference in CRA before and after exercise (p < 0.05). Conclusion: The backward walking exercise and verbal command seems to have positively influenced the changes in CVA and CRA among college students in their 20s. It seems that studies to confirm balance or muscle activity as well as changes in forward head posture through the long-term intervention of the backward walking exercise should be conducted.