• Title/Summary/Keyword: L segment

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Survival Rates and Risk Factors for Cephalad and L5-S1 Adjacent Segment Degeneration after L5 Floating Lumbar Fusion : A Minimum 2-Year Follow-Up

  • Lee, Young-Seok;Kim, Young-Baeg;Park, Seung-Won
    • Journal of Korean Neurosurgical Society
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    • v.57 no.2
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    • pp.108-113
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    • 2015
  • Objective : Although the L5-S1 has distinct structural features in comparison with other lumbar spine segments, not much is known about adjacent segment degeneration (ASD) at the L5-S1 segment. The aim of study was to compare the incidence and character of ASD of the cephalad and L5-S1 segments after L5 floating lumbar fusion. Methods : From 2005 to 2010, 115 patients who underwent L5 floating lumber fusion were investigated. The mean follow-up period was 46.1 months. The incidence of radiological and clinical ASD of the cephalad and the L5-S1 segments was compared using survival analysis. Risk factors affecting ASD were analyzed using a log rank test and the Cox proportional hazard model. Results : Radiological ASD of the L5-S1 segment had a statistically significant higher survival rate than that of the cephalad segment (p=0.001). However, clinical ASD of the L5-S1 segment was significantly lower survival rates than that of the cephalad segment (p=0.038). Risk factor analysis showed that disc degeneration of the cephalad segment and preoperative spinal stenosis of the L5-S1 segment were risk factors. Conclusion : In L5 floating fusion, radiological ASD was more common in the cephalad segment and clinical ASD was more common in the L5-S1 segment. At the L5-S1 segment, the degree of spinal stenosis appears to be the most influential risk factor in ASD incidences, unlike the cephalad segment.

Accelerated L5-S1 Segment Degeneration after Spinal Fusion on and above L4-5 : Minimum 4-Year Follow-Up Results

  • Park, Jeong-Yoon;Chin, Dong-Kyu;Cho, Yong-Eun
    • Journal of Korean Neurosurgical Society
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    • v.45 no.2
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    • pp.81-84
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    • 2009
  • Objective : Many biomechanical and clinical studies on adjacent segment degeneration (ASD) have addressed cranial segment. No study has been conducted on caudal segment degeneration after upper segment multiple lumbar fusions. This is a retrospective investigation of the L5-S1 segment after spinal fusion at and above L4-5, which was undertaken to analyze the rate of caudal ASD at L5-S1 after spinal fusion on and above L4-5 and to determine that factors that might have influenced it. Methods : The authors included 67 patients with L4-5, L3-5, or L2-5 posterior fusions. Among these patients, 28 underwent L4-5 fusion, 23 L3-5, and 16 L2-5 fusions. Pre- and postoperative radiographs were analyzed to assess degenerative changes at L5-S1. Also, clinical results after fusion surgery were analyzed. Results : Among the 67 patients, 3 had pseudoarthrosis, and 35 had no evidence of ASD, cranially and caudally. Thirteen patients (19.4%) showed caudal ASD, 23 (34.3%) cranial ASD, and 4 (6.0%) both cranial and caudal ASD. Correlation analysis for caudal ASD at L5-S1 showed that pre-existing L5-S1 degeneration was most strongly correlated. In addition, numbers of fusion segments and age were also found to be correlated. Clinical outcome was not correlated with caudal ASD at L5-S1. Conclusion : If caudal and cranial ASD are considered, the overall occurrence rate of ASD increases to 50%. The incidence rate of caudal ASD at L5-S1 was significantly lower than that of cranial ASD. Furthermore, the occurrence of caudal ASD was found to be significantly correlated with pre-existing disc degeneration.

A Two-Segment Trunk Model for Reach Prediction (동작 자세 예측을 위한 2-지체 몸통 모델)

  • Jung, Eui-S.;Lim, Sung-Hyun
    • Journal of Korean Institute of Industrial Engineers
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    • v.25 no.3
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    • pp.393-403
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    • 1999
  • In this research, a reach posture prediction based on a two-segment trunk model was made. Recently, reach posture prediction models have used inverse kinematics to provide a single posture that a person naturally takes, with a single segment trunk model that had some shortcomings. A two-segment trunk model was first developed with two links; pelvis link and lumbar-thoracic link. The former refers to the link from the hip joint to L5/S1 joint while the latter does the link from L5/S1 to the shoulder joint. Second, a reach prediction model was developed using the two-segment trunk model. As a result, more reliable equations for two-segment trunk motion were obtained, and the lean direction which refers to the movement direction of the trunk was not found to have a significant effect on the two-segment trunk motion. The results also showed that the hip joint is more preferred over L5/S1 to serve as a reference point for trunk models and the reach prediction model being developed predicted the real posture accurately.

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Molecular Characterization of the L Segment of Hantaan Virus, Strain Howang (한탄바이러스 호왕주의 L 유전자 절편의 염기서열)

  • Chu, Yong-Kyu;Song, Dae-Yong;Koo, Hyung-Mo;Lee, Ho-Wang
    • The Journal of Korean Society of Virology
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    • v.29 no.3
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    • pp.155-163
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    • 1999
  • Hantaan virus (HTNV), the etiologic agent of hemorrhagic fever with renal syndrome (HFRS), belongs to the genus Hantavirus, and has three single negative stranded RNA genome segments. HTNV strain Howang isolated from the blood of severe case of Korean HFRS is more virulent than HTNV 76/118 and the M and S genome segments' nucleotide sequence of Howang strain showed 93.5% and 94% homology to each segment of HTNV 76/118. We have obtained 6533 nucleotides long sequence of the L genome segment of Howang strain using reverse transcriptase in conjunction with PCR amplification and compared to other hantaviruses. The messenger sense of the L segment contains one long single long open reading frame of 2151 amino acids, which encodes a deduced RNA dependent RNA polymerase of 246.4 kDa caculated molecular weight protein. The nucleotide sequence of the L segment of Howang strain shows 93%, 74%, 66%, 65% homology to HTNV 76/118, Seoul virus 80/39, Puumala virus $H{\ddot{a}}lln{\ddot{a}}s$ B1 and Sin Nombre virus, respectively. The amino acid sequence of the L segment of Howang strain shows 99%, 85%, 68%, 68% homology to HTNV 76/118, Seoul virus 80/39, Puumala virus $H{\ddot{a}}lln{\ddot{a}}s$ B1 and Sin Nombre virus, respectively.

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Effects of Transversus Abdominal Muscle Stabilization Exercise to Spinal Segment Motion on Trunk Flexion-Extension (복횡근 강화운동이 체간 신전-굴곡 시 척추 분절 운동에 미치는 영향)

  • Kim, Suhn-Yeop;Baek, In-Hyeub
    • Physical Therapy Korea
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    • v.10 no.1
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    • pp.63-76
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    • 2003
  • This research was performed to compare spinal segment motion angle between low back pain (LBP) group and painless group during trunk flexion-extension and to investigate the effect of transversus abdominis strengthening exercise on spinal segment motion angle in LBP group. Nine subjects with LBP and ten subjects without LBP participated. Transversus abdominis strengthening exercise was performed in LBP group for three weeks, and spinal segment motion angles were compared before and after the exercise performance. Spinal segment motion angles were measured both in sitting and standing position. Results were as followed: 1) Subjects' average age was 24.79 years, height was 167.84 cm, and weight was 59.95 kg. 2) Spinal segment motion angle of T10/l1 was significantly higher in LBP group compared with painless group (p<.05) in sitting position during trunk flexion-extension. 3) In sitting position, whereas entire lumbar segment motion angles were lower in LBP group compared with painless group (p<.05), angle of L4/5 was higher in LBP group compared with painless group (p<.05). 4) There was no significant difference in thoracic segment motion angle in standing position. 5) After three weeks of transversus abdominis strengthening exercise, thoracic segment motion angle increased both in sitting and standing position (p<.05). 6) In painless group, there was no significant difference in entire spinal segment motion angles in sitting and standing position (p>.05). When spinal segment motion angles were compared between sitting and standing position, there were slight differences. In sitting position, there was no difference in spinal segment motion angle between LBP group and painless group while hip joint motion angle and sacral inclination angle of LBP group was lower than those of painless group (p<.05). In standing position, lumbar segment motion angle was significantly lower in LBP group than that of painless group. Transversus abdominis strengthening exercise influenced thoracic segment motion angle more significantly than lumbar segment motion angle.

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Analysis of Impact Response in a Poroelastic Spinal Motion Segment FE Model according to the Disc Degeneration (다공탄성체 척추운동분절 유한요소 모델에서 추간판의 변성이 충격 거동에 미치는 영향 해석)

  • 김영은;박덕용
    • Journal of the Korean Society for Precision Engineering
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    • v.20 no.11
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    • pp.188-193
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    • 2003
  • To predict changes in biomechanical parameters such as intradiscal pressure, and the shock absorbing mechanism in the spinal motion segment under different impact duration/loading rates, a three dimensional L3/L4 motion segment finite element model was modified to incorporate the poroelastic properties of the motion segment. The results were analyzed under variable impact duration for normal and degenerated discs. For short impact duration and a given maximum compressive force, relatively high cancellous pore pressure was generated as compared with a case of long impact duration, although the amount of impulse was increased. In contrast relatively constant pore pressure was generated in the nucleus. Disc degeneration increased pore pressure in the disc and decreased pore pressure in the cancellous core, which is more vulnerable to compressive fracture compared with intact case.

The Effect of Bee Venom Acupuncture into Chok-samni (ST36) on Neuronal Activity in the Spinal Cord (족삼리(足三里) 봉독약침자극(蜂毒藥鍼刺戟)이 척수내(脊髓內) Fos 양성반응(陽性反應) 신경세포(神經細胞)의 활성(活性)에 미치는 영향(影響))

  • Yim, Yun-Kyoung;Kang, Sung-Keel;Choi, Do-Young
    • Journal of Pharmacopuncture
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    • v.3 no.1
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    • pp.141-155
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    • 2000
  • This study was designed to evaluate the analgesic effect of bee venom (BV) Acupuncture into different treatment points, Chok-samni (ST36) and blank loci of the gluteal muscle and back. We investigated neuronal activity in the spinal cord using the Fos immunohistochemical technique according to the pretreatment with different concentrations of BV, thirty minutes before the formalin injection. The results were summarized as follows: 1. The number of Fos-like immunoreactive (Fos-LI) neurons in L2 segment of the saline-formalin treated group was significantly increased in NECK and VENT of the spinal cord as compared with that of the room control group. However, there was no significant change in the number of the Fos-LI neurons in L2 segment of the BV-formalin treated group as compared with that of the room control group. 2. The number of Fos-LI neurons in L3-5 segment of the saline-formalin group was significantly increased in all the regions of 142 the spinal cord as compared with that of the room control group. However, the Fos-LI neurons in L3-5 segment of the BV-formalin treated group was dramatically decreased in all the regions of the spinal cord as compared with that of the saline-formalin group. Therefore, these results indicated that the BV acupuncture suppressed the nociceptive neuronal activities in L3-5 of the spinal cord induced by formalin injection. 3. There was a strong positive correlation between the formalin-induced pain behavior and the number of the Fos-LI neurons in L3-5 segment.

Improvement of Regeneration Efficiency from Mature Embryo and Leaf Base Segment in Korean Oat Genotypes

  • Kim Kyung-Hee;Moon Jung-Hun;Lee Sang-Kyu;Lee Byung-Moo
    • KOREAN JOURNAL OF CROP SCIENCE
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    • v.49 no.4
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    • pp.349-353
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    • 2004
  • Mature embryo and leaf base segment of Korean oat were used as materials in an experiment to check plant regeneration efficiency. MS media supplemented with 2,4-dichlorophenoxyacetic acid (2,4-D), kinetin, and picloram were used for callus induction from mature embryos and leaf base segments. Three mg/l of 2,4­D and 3 mg/l of picloram in callus induction medium showed high frequency for plant regeneration from mature embryos. Leaf base segments were transferred to callus induction medium and incubated at $25^{\circ}C$ in 16/8 hr light/dark cycle for 3 weeks. Callus induction from leaf base segments of Malgwiri showed high efficiency in medium containing 3 mg/l of 2,4-D and 1 mg/l of kinetin $(91.8\%)$. In case of Samhangwiri, the combinations of phytohormones did not show significant difference. Regeneration from leaf base segments showed high frequency in shoot medium containing 1 mg/l of antiauxin, tri-iodobenzoic acid (TIBA) and 1 mg/l of 6-benzyladenine (BA). Calli induced from leaf base segments of Samhangwiri and Malgwiri in media containing 3 mg/l of 2,4-D and 3 mg/l of picloram showed high regeneration frequency. It appears that the callus initiation medium may be an important factor for subsequent plant regeneration.

Ligamentum Flavum Hematoma in the Adjacent Segment after a long Level Fusion

  • Kim, Hyeun-Sung;Kim, Seok-Won;Lee, Sung-Myung;Shin, Ho
    • Journal of Korean Neurosurgical Society
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    • v.49 no.1
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    • pp.58-60
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    • 2011
  • Ligamentum flavum hematoma (LFH) is a very rare condition of dural compression; most are observed in the mobile cervical and lumbar spine regions. A 67-year-old man who had a long level interbody fusion at L3-S1 four years ago presented with symptoms suggestive of dural compression. Magnetic resonance imaging showed a posterior semicircular mass located at the adjacent L2-L3 level. After decompression of the spinal canal and removal of the mass lesion, pathological examination of the surgical specimen revealed a hematoma within the ligamentum. The patient fully recovered to normal status after surgery. Here, we report our experience with a LFH in the adjacent segment after a long level fusion procedure and discuss the possible associated mechanisms.

Spinal Stability Evaluation According to the Change in the Spinal Fixation Segment Based on Finite Element Analysis (유한요소해석 기반 척추 고정분절 변화에 따른 척추 안정성 평가)

  • Kim, Cheol-Jeong;Son, Seung Min;Heo, Jin-Young;Lee, Chi-Seung
    • Journal of the Computational Structural Engineering Institute of Korea
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    • v.33 no.3
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    • pp.145-152
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    • 2020
  • In this study, we evaluated spinal stability based on the change in the thoracolumbar fixation segment using finite element analysis (FEA). To accomplish this, a finite element (FE) model of a normal thoracolumbar spine (T10-L4), including intervertebral discs (IVD), ligaments, and facet joints, was constructed, and the material properties reported in previous studies were implemented. However, L1 was assumed as the lesion site, and three types of posterior fixation, namely, L1-L2, T12-L2, and T12-L1-L2, were implemented in the thoracolumbar FE model. In addition, the loading conditions for flexion, extension, lateral bending, and axial rotation were adopted. Through the series FEA, the deformation, equivalent stress, range of motion, and moment on the pedicle screws, vertebrae, and IVD were calculated, and the spinal stability was evaluated based on the FEA results.