• Physical Therapy Rehabilitation Science
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• v.12 no.3
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• pp.240-250
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• 2023

Objective: The purpose of this study was to characterize the movement of adjacent segments that occurred when posteroanterior joint mobilization was applied to the 3rd lumbar and thereby to provide basic clinical data. Design: Randomized controlled trial design. Methods: While the subjects were receiving posteroanterior joint mobilization of the 3rd lumbar vertebra, LD (lumbar displacement), LID (lumbar intervertebral distance), LIA (lumbar intervertebral angle), and LLA (lumbar lordosis angle) were measured using X-ray, and the data were then analyzed. Changes before and after posteroanterior joint mobilization were analyzed using a paired-sample t-test, and a one-way ANOVA of variance was performed to determine the difference between segmental movements. In addition, Pearson's correlation analysis was performed to determine the correlation between segmental movements. Results: The results revealed that there was a significant change in LD before and after the application of joint mobilization of the 3rd lumbar in all lumbar vertebrae (p<0.000), among which the 2nd lumbar vertebra, an adjacent segment, showed the most significant change. A significant change in LIA angle was observed in all segments (p<0.000), with the most significant change observed between the 2nd and 3rd lumbar vertebrae. There was a significant change in LLA before and after the application of posteroanterior joint mobilization (p<0.000). The correlation analysis showed a high correlation between displacement of the 3rd lumbar vertebra and displacement of all the other lumbar vertebrae. Conclusions: The presence of kinematic movements of the lumbar vertebrae when segmental movements were generated through the application of posteroanterior joint mobilization of the 3rd lumbar vertebra.

• The Journal of Churna Manual Medicine for Spine and Nerves
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• v.6 no.1
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• pp.53-61
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• 2011

Objective: The purpose of this study is to evaluate the disc block subluxation for lumbar scoliosis and herniation of nucleus pulpous (HNP). Methods: We used AP & Lateral view X-ray for patients. And we measured of disc wedge angle, vertebral body rotation to evaluate the typical and atypical disc block subluxation. Results: On the analysis of the lateral view X-ray, 4th lumbar intervertebral disc angle (I.V.D angle) showed $4^{\circ}$, $5^{\circ}$, $3^{\circ}$, $0^{\circ}$ in the cases. On the 4th lumbar analysis of the AP view X-ray, lumbar scoliosis showed right disc wedge angle was $11^{\circ}$ (case 1), $17^{\circ}$ (case 2) and left vertebral body rotation was 13mm, 6mm. Lumbar HNP showed left disc wedge angle was $5^{\circ}$ (case 3), $4^{\circ}$ (case 4) and left vertebral body rotation was 2mm, 4mm. Conclusions: Disc block subluxation has been in lumbar scoliosis, but not been in lumbar HNP.

• Journal of Korean Neurosurgical Society
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• v.59 no.4
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• pp.385-391
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• 2016

Objective : The purpose of this study was to evaluate long-term follow-up radiologic/clinical outcomes of patients who underwent anterior cervical discectomy and inter-body fusion (ACDF) with stand-alone cages (SAC) in a single academic institution. Methods : Total 99 patients who underwent ACDF with SAC between February 2004 and December 2012 were evaluated retrospectively. A total of 131 segments were enrolled in this study. Basic demographic information, radiographic [segmental subsidence rate, fusion rate, C2-7 global angle, and segmental angle changes)/clinical outcomes (by Odom's criteria and visual analog score (VAS)] and complications were evaluated to determine the long-term outcomes. Results : The majority were males (55 vs. 44) with average age of 53.2. Mean follow-up period was 62.9 months. The segmental subsidence rate was 53.4% and fusion rate was 73.3%. In the subsidence group, anterior intervertebral height (AIH) had more tendency of subsiding than middle or posterior intervertebral height (p=0.01). The segmental angle led kyphotic change related to the subsidence of the AIH. Adjacent segmental disease was occurred in 18 (18.2%) patients. Total 6 (6%) reoperations were performed at the index level. There was no statistical significance between clinical and radiological outcomes. But, overall long-term clinical outcome by Odom's criteria was unsatisfactory (64.64%). The neck and arm VAS score were increased by over time. Conclusion : Long-term outcomes of ACDF with SAC group were acceptable but not satisfactory. For optimal decision making, more additional comparative long-term outcome data is needed between ACDF with SAC and ACDF with plating.

• Journal of Korean Medicine Rehabilitation
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• v.19 no.2
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• pp.227-239
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• 2009

Objectives : The purpose of this study is to investigate the relation of Ferguson's angle, Lumbar lordotic angle, Lumbar IVD angle in traffic accident patients. Methods : Total patients were classified into TA(traffic accident) inpatients and non-TA(lumbago) inpatients. We analyzed the characteristics of each group Ferguson's angle, Lumbar lordotic angle, L4-5 IVD angle, L5-S1 IVD angle on X-ray film. Results : 1. Ferguson's angle and Lumbar lordotic angle were smaller than normal range. Non-TA group's angles were smaller than TA group's angles. 2. L4-5 IVD angle of female showed smaller than that of male in TA groups. The older age was, the smaller L4-5 IVD angle was at non-TA groups. 3. L5-S1 IVD angle of female showed smaller than that of male in total groups. The older age was, the smaller L5-S1 IVD angle was at non-TA groups. 4. Ferguson's angle, Lumbar lordotic angle, Lumbar IVD angle were related with direct proportion in total groups. 5. Non-TA groups showed more effective VAS variation than TA groups. Conclusions : Lumbar angles were intimately related with each others. And lumbar angles have an effect on curative value.

• Journal of Biomedical Engineering Research
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• v.39 no.1
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• pp.22-29
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• 2018

Intervertebral disc(IVD) mainly consists of Annulus fibrosus(AF) and Nucleus pulposus(NP), playing a role of distributing a mechanical load on vertebral body. IVD tissue engineering has been developed the methods to achieve anatomic morphology and restoration of biological function. The goal of present study is to identify the possibilities for creating a substitute of IVD the morphology and biological functions are the same as undamaged complete IVD. To fabricate the AF and NP combine biphasic IVD tissue, AF tissue scaffolds have been printed by 3D bio-printing system with natural biomaterials and NP tissues have been prepared by scaffold-free culture system. We evaluated whether the combined structure of 3D printed AF scaffold and scaffold-free NP tissue construct could support the architecture and cell functions as IVD tissue. 3D printed AF scaffolds were printed with 60 degree angle stripe patterned lamella structure(the inner-diameter is 5mm, outer-diameter is 10 mm and height is 3 mm). In the cytotoxicity test, the 3D printed AF scaffold showed good cell compatibility. The results of histological and immunohistochemical staining also showed the newly synthesized collagens and glycosaminoglycans, which are specific makers of AF tissue. And scaffold-free NP tissue actively synthesized glycosaminoglycans and type 2 collagen, which are the major components of NP tissue. When we combined two engineered tissues to realize the IVD, combined biphasic tissues showed a good integration between the two tissues. In conclusion, this study describes the fabrication of Engineered biphasic IVD tissue by using enable techniques of tissue engineering. This fabricated biphasic tissue would be used as a model system for the study of the native IVD tissue. In the future, it may have the potential to replace the damaged IVD in the future.

• The Journal of Korea Institute of Information, Electronics, and Communication Technology
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• v.4 no.2
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• pp.88-95
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• 2011

In this study, Image Processing Algorithms which can make intervertebral disk images distinct and be easy to apply when measuring X-ray image of spine by using Cobb's angle and can measure the stage of scoliosis pertaining to X-ray image including the whole length of spine by converting to just one spinal functional graph without appling Cobb's angle in every disk are proposed. In addition, The calculated average value of L per $1^{\circ}$ Cobb's angle as to X-ray image of spine results in 0.568 which can be a standard for detecting the stage of scoliosis.

• Journal of Korean Neurosurgical Society
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• v.29 no.6
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• pp.763-771
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• 2000

Objectives : Thoracolumbar burst fractures(TBLF) result in not only compressive deformity of vertebral body but also spinal cord compression by bony fragments. Many thoracolumbar burst fractures demand both anterior decompression and intervertebral fusion. Most of spinal surgeons use anterior instrumentation for anteior intervertebral bony fusion. The use of Z-plate has been increased recently, however there has been only a few reports regarding its clinical long-term strength. We studied nineteen patients with TBLF to find out the long-term stability of Z-plate. Methods : We have operated 19 patients from March 1996 to August 1998. They were treated with anterior decompression through either a transthoracic, retroperitoneal extrapleural or retroperitoneal approach. Retropulsed bony fragments were removed completely by corpectomy. Iliac bone graft was used for interbody fusion in all of the cases. They were evaluated by plain X-ray films including flexion and extention lateral films. Cobbs angle was used to evaluate kyphotic and lateral wedging deformity. Results : Burst fractured sites were T11 in two, three T12, nine L1, and five L2. Mean follow-up duration was fifteen months. Preoperative average kyphotic angle was 23.7 degree. Immediate postoperative kyphotic angle was 10.2 degree. Follow-up resluts of average kyphotic angles revealed 14 degrees. Four patients(21%), including two spinal 3-column injury, showed increasement of kyphotic angle more than 5 degree or breakage of intrumentation. Two patients showed the difference of kyphotic angle more than 3 degree. Five patients(26%) revealed lateral wedging deformity more than 3 degrees. Postoperative complications were two meralgia parestheticas, one pulmonary atelectasis and two donor site infections. Four of the eight patients, who initially showed incomplete spinal cord deficits, were nerologically improved by Frankel's grade. Conclusion : Z-plate fixation and iliac bone graft after anterior decompression in thoracolumbar burst fractures is a safe and easy method. Immediate postoperative results revealed excellent correction of posttraumatic kyphosis, but long-term follow-up evalution showed insufficient strength. Therefore we believe that use of Z-plate should be carefully decided, especially in the case of large lumbar fracture or 3-column injury.

• Journal of Korean Neurosurgical Society
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• v.65 no.1
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• pp.96-106
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• 2022

Objective : The most common complication of anterior cervical discectomy and fusion (ACDF) is cage subsidence and maintenance of disc height affects postoperative clinical outcomes. We considered cage subsidence as an inappropriate indicator for evaluating preservation of disc height. Thus, this study aimed to consider patients with complications such as reduced total disc height compared to that before surgery and evaluate the relevance of several factors before ACDF. Methods : We retrospectively reviewed the medical records of 40 patients who underwent stand-alone single-level ACDF using a polyetheretherketone (PEEK) cage at our institution between January 2012 and December 2018. Our study population comprised 19 male and 21 female patients aged 24-70 years. The minimum follow-up period was 1 year. Twenty-seven patients had preoperative bone mineral density (BMD) data on dual-energy X-ray absorptiometry. Clinical parameters included sex, age, body mass index, smoking history, and prior medical history. Radiologic parameters included the C2-7 cobb angle, segmental angle, sagittal vertical axis, disc height, and total intervertebral height (TIH) at the preoperative and postoperative periods. Cage decrement was defined as the reduction in TIH at the 6-month follow-up compared to preoperative TIH. To evaluate the bone quality, Hounsfield unit (HU) value was calculated in the axial and sagittal images of conventional computed tomography. Results : Lumbar BMD values and cervical HU values were significantly correlated (r=0.733, p<0.001). We divided the patients into two groups based on cage decrement, and 47.5% of the total patients were regarded as cage decrement. There were statistically significant differences in the parameters of measuring the HU value of the vertebra and intraoperative distraction between the two groups. Using these identified factors, we performed a receiver operating characteristic (ROC) curve analysis. Based on the ROC curve, the cut-off point was 530 at the HU value of the upper cortical and cancellous vertebrae (p=0.014; area under the curve [AUC], 0.727; sensitivity, 94.7%; specificity, 42.9%) and 22.41 at intraoperative distraction (p=0.017; AUC, 0.722; sensitivity, 85.7%; specificity, 57.9%). Using this value, we converted these parameters into a bifurcated variable and assessed the multinomial regression analysis to evaluate the risk factors for cage decrement in ACDF. Intraoperative distraction and HU value of the upper vertebral body were independent factors of postoperative subsidence. Conclusion : Insufficient intraoperative distraction and low HU value showed a strong relationship with postoperative intervertebral height reduction following single stand-alone PEEK cage ACDF.

• Journal of the Korean Society for Precision Engineering
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• v.26 no.10
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• pp.116-121
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• 2009

It is important to consider lumbar lordotic angle for setup of training program in field of sports and rehabilitaton to prevent unexpected posture deviation and back pain. The purpose of this study was to analyze the biomechanical impact of the level of lumbar lordosis angle during isokinetic exercise through dynamic analysis using a 3-dimensional musculoskeletal model. We made each models for normal lordosis, excessive lordosis, lumbar kyphosis, and hypo-lordosis according to lordotic angle and inputted experimental data as initial values to perform inverse dynamic analysis. Comparing the joint torques, the largest torque of excessive lordosis was 16.6% larger and lumbar kyphosis was 11.7% less than normal lordosis. There existed no significant difference in the compressive intervertebral forces of each lumbar joint (p>0.05), but statistically significant difference in the anterioposterior shear force (p<0.05). For system energy lumbar kyphosis required the least and most energy during flexion and extension respectively. Therefore during the rehabilitation process, more efficient training will be possible by taking into consideration not simply weight and height but biomechanical effects on the skeletal muscle system according to lumbar lordosis angles.

• Journal of the Korean Society of Radiology
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• v.9 no.2
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• pp.101-107
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• 2015

In anteroposterior radiation test for cervical vertebra, it is general that the incidence angle of X-ray is $15^{\circ}$ to $20^{\circ}$ degrees to head regardless of position. So this study suggests appropriate incidence angle of cervical vertebra depended on the position. From 1 January 2013 to 31 December 2013, cervical spine radiographys and magnetic resonance imaging was performed in 107 people who visited P Hospital located in Pusan. Among them, 39 people(men 24, women 15) were below 80 above 20 years old(average age 54 years) with normal cervical lordosis(normal $40^{\circ}{\pm}5^{\circ}$). In erect position, the incidence angle of cervical vertebra is measured from lateral radiographic images. And in supine position, it measured from MRI sagittal images. Results based on gender, the incidence angle of cervical vertebra in erect position was $25.9^{\circ}$ for men, women was $23.1^{\circ}$, showed statistically significant (p<0.05). And the angle in supine was $11.6^{\circ}$ for men, women was $12.6^{\circ}$, showed not statistically significant (p>0.05) An analysis of age group shows, the incidence angle of cervical vertebra in erect position was $24.6^{\circ}$ under 50, and $25.0^{\circ}$ over 50. The angle in supine was $12.0^{\circ}$ under 50, and $11.9^{\circ}$ over 50. And all of them showed not statistically significant (p>0.05). At all ages, the average of incidence angles in erect position were $24.8^{\circ}$, and the angle in supine was $12.0^{\circ}$, showed statistically significant (p<0.05). The cervical vertebra incidence angle for X-ray was $15^{\circ}$ to $20^{\circ}$ degrees to head in general. But, through the results, it is recommended that the angle is $24.8^{\circ}$ in erect and $12.0^{\circ}$ in supine position. It could be shown true anteroposterior(AP) view of cervical vertebra and accurate intervertebral fusion fixing devices.