• Journal of Trauma and Injury
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• v.19 no.2
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• pp.164-172
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• 2006

Background: The authors conducted a retrospective study to evaluate the mechanism of injury, the surgical techniques, the clinical features, the combined injuries, the treatment results, and the surgical complications in patients with atlantoaxial fracture/subluxations. Methods: The authors reviewed 71 cervical fracture/dislocations during a four-year period from September 2002 to August 2006. Among them, there were twenty one C1,2 fracture/subluxations. There were thirteen men (mean age : 43.5 years) and eight women (mean age : 50 years). Their follow-up period was at least 6 months, and the mean follow-up period was 9.6 months. Gardner-Wells tongs traction was used in all patients immediately on presentation. Surgical treatment was performed, depending on the pathologic conditions. Results: Of all 21 cases, 14 cases were injured in motor vehicle accidents, 5 were falls, and 2 were miscellaneous. There were four C1 fracture (5.6%), fourteen C2 fracture (66.7%), one C1 and 2 combined fracture (4.8%), and one C1-2 subluxation (4.8%). The C1 fractures in our series were classified as two Jefferson's fractures and two C1 lateral mass fracture. The C2 fractures were classified as one odontoid type I fracture, two odontoid type II fractures, five odontoid type III fractures, one hangman's fracture, and four C2 body tear-drop fractures. Atlantoaxial fractures were associated with six (28.6%) head injuries, four (19.0%) other spinal injuries, two (9.5%) chest injuries, and three (14.3%) spinal cord injuries. Surgical treatment was performed in nine cases, which included anterior odontoid screw fixation in two cases, transarticular screw fixation with iliac bone graft in one case, posterior fixation by using C2 pedicle screw and C3 lateral mass screw in three cases, lateral mass screw fixation C1-2 with iliac bone graft in one case, O(occipito)-C1-3-4 screw fixation in one case, posterior C2-3 wiring with allograft in one case, and halo vest in six cases. Conservative management was used in the rest of the patients in our trials. Bone fusion was complete in all cases. There were no operation-related complication, except one pin site infection in the case of halo vest. Conclusion: In this study, the choice of appropriate treatment according to the fracture types resulted in safe and effective management of unique atlantoaxial fracture/subluxations.

• Journal of Korean Neurosurgical Society
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• v.42 no.4
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• pp.311-316
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• 2007

Objective : The objective of this study is to investigate the safety, surgical efficacy, and advantages of a polyaxial screw-rod system for posterior occipitocervicothoracic arthrodesis. Methods : Charts and radiographs of 32 patients who underwent posterior cervical fixation between October 2004 and February 2006 were retrospectively reviewed. Posterior cervical polyaxial screw-rod fixation was applied on the cervical spine and/or upper thoracic spine. The surgical indication was fracture or dislocation in 18, C1-2 ligamentous injury with trauma in 5, atlantoaxial instability by rheumatoid arthritis (RA) or diffuse idiopathic skeletal hyperostosis (DISH) in 4, cervical spondylosis with myelopathy in 4, and spinal metastatic tumor in 1. The patients were followed up and evaluated based on their clinical status and radiographs at 1, 3, 6 months and 1 year after surgery. Results : A total of 189 screws were implanted in 32 patients. Fixation was carried out over an average of 3.3 spinal segment (range, 2 to 7). The mean follow-up interval was 20.2 months. This system allowed for screw placement in the occiput, C1 lateral mass, C2 pars, C3-7 lateral masses, as well as the lower cervical and upper thoracic pedicles. Satisfactory bony fusion and reduction were achieved and confirmed in postoperative flexion-extension lateral radiographs and computed tomography (CT) scans in all cases. Revision surgery was required in two cases due to deep wound infection. One case needed a skin graft due to necrotic change. There was one case of kyphotic change due to adjacent segmental degeneration. There were no other complications, such as cord or vertebral artery injury, cerebrospinal fluid leak, screw malposition or back-out, or implant failure, and there were no cases of postoperative radiculopathy due to foraminal stenosis. Conclusion : Posterior cervical stabilization with a polyaxial screw-rod system is a safe and reliable technique that appears to offer several advantages over existing methods. Further biomechanical testings and clinical experiences are needed in order to determine the true benefits of this procedure.

• Journal of Korean Neurosurgical Society
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• v.63 no.2
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• pp.237-247
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• 2020

Objective : Fixation of the C1-2 segment is challenging because of the complex anatomy in the region and the need for a high degree of accuracy to avoid complications. Preoperative 3D-computed tomography (CT) scans can help reduce the risk of complications in the vertebral artery, spinal cord, and nerve roots. However, the patient may be susceptible to injury if the patient's anatomy does not match the preoperative CT scans. The intraoperative 3D image-based navigation systems have reduced complications in instrument-assisted techniques due to greater accuracy. This study aimed to compare the radiologic outcomes of C1-2 fusion surgery between intraoperative CT image-guided operation and fluoroscopy-guided operation. Methods : We retrospectively reviewed the radiologic images of 34 patients who underwent C1-2 fusion spine surgery from January 2009 to November 2018 at our hospital. We assessed 17 cases each of degenerative cervical disease and trauma in a study population of 18 males and 16 females. The mean age was 54.8 years. A total of 139 screws were used and the surgical procedures included 68 screws in the C1 lateral mass, 58 screws in C2 pedicle, nine screws in C2 lamina and C2 pars screws, four lateral mass screws in sub-axial level. Of the 34 patients, 19 patients underwent screw insertion using intraoperative mobile CT. Other patients underwent atlantoaxial fusion with a standard fluoroscopy-guided device. Results : A total of 139 screws were correctly positioned. We analyzed the positions of 135 screws except for the four screws that performed the lateral mass screws in C3 vertebra. Minor screw penetration was observed in seven cases (5.2%), and major pedicle screw penetration was observed in three cases (2.2%). In one case, the malposition of a C2 pedicle screw was confirmed, which was subsequently corrected. There were no complications regarding vertebral artery injury or onset of new neurologic deficits. The screw malposition rate was lower (5.3%) in patients who underwent intraoperative CT-based navigation than that for fluoroscopy-guided cases (10.2%). And we confirmed that the operation time can be significantly reduced by surgery using intraoperative O-arm device. Conclusion : Spinal navigation using intraoperative cone-beam CT scans is reliable for posterior fixation in unstable C1-2 pathologies and can be reduced the operative time.

• Physical Therapy Korea
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• v.4 no.3
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• pp.17-33
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• 1997

The objective of this study was to identify pulmonary functional variations in relation to postural changes, lapse after changing position, and the use of abdominal band in the cervical cord injured. The subjects of this study were 19 quadriplegic patients who had been admitted to the department of the Rehabilitation Hospital, College of Medicine, Yousei University, from April, 1997 through May 3, 1997. A spiroanalyzer was used to measure pulmonary function in supine, standing, time after changing position, and recording to the position, application method, and tightness of the abdominal band. The data were analyzed by the repeated measure one-way ANOVA, and Wilcoxon signed rank test. The findings were as follows: 1. All phase of the patients' pulmonary function improved significantly in supine posture in contrast to standing (vital capacity by $0.46{\ell}$ and expiratory reserve volume by $0.09{\ell}$). 2. The longer the time lapsed from supine posture to standing, the patient's expiratory reserve volume, maximum ventilation volume, vital capacity, and forced expiratory volume increased. 3. When the patient lay in supine position, the maximum ventilation volume, vital capacity, and the forced vital capacity increased then the center line of the abdominal band was placed along iliac crest; on the other hand, when the patient was standing, placing the bottom line of the abdominal band along iliac crest increased the maximum ventilation volume, vital capacity, and forced expiratory volume. 4. In placing the abdominal band in the patients, leaving space between the top and bottom lines of the band helped increased in maximum ventilation volume, vital capacity, and forced vital capacity for patient in supine as well as in standing. 5. When placing the abdominal band to patients in supine posture, reducing the length of the band by 2.5% along the patient's waist line increased the patients' vital capacity, while reducing the length by 10% to patients in standing increased the maximum ventilation volume. The abdominal band should be placed in such a way that the bottom part of the band should be more tightly fastened while leaving enough room for a hand to be placed in between the body and the band for the top part of the hand. It should also be noted that in a supine position, the bottom line of the band should be placed along the iliac crest, while in standing, the center line should be placed along the iliac crest. The length of the band should also be reduced by 2.5% of the waist line in supine position, and in standing, the length should be reduced by 10%. It should also be noted that the pulmonary function of the patients should be measured at least 10 minutes after one position change.

• Journal of Chest Surgery
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• v.39 no.10 s.267
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• pp.739-748
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• 2006

Background: The purpose of this study is to ascertain the neuroprotective effect of cyclosporin A on the 25-min surgical ischemia model in the spinal cords of rabbits with neuropathological correlation and histoimmunochemical analyses, Material and Method: Thirty-two New Zealand white rabbits were randomly divided into four groups: Rabbits were randomly divided into four groups: the control 12 group (n=8), the control 17 group (n=8), the cyclosporin Cs2 group (n=8), and the cyclosporin Cs7 group (n=8). The 12 group underwent a 25-min aortic cross- clamp without intervention and were sacrificed on the 2nd day postoperatively, while the 17 group underwent a 25- min of aortic cross-clamp without intervention and were sacrificed on the 7th day postoperatively. The Cs2 group received cyclosporin A (25 mg/kg) intravenously 15 min after the 25-min cross-clamp and were sacrificed on the End day postoperatively, while the Cs7 group received cyclosporin A (25 mg/kg) intravenously 15 min after the 25-min cross-clamp and were sacrificed on the 7th day postoperatively. The rabbits underwent 25-min surgical aortic cross-clamp. Neurologic functions were evaluated on the 2nd day and 7th postoperative day using Tarlov scoring system. After scoring neurologic function, all rabbits were sacrificed for histopathologic observation. Result: All rabbits survived the experimental procedure. The values of Tarlov score did not show any differences between the control and cyclosporin groups on the 2nd day. The scores of group Cs7 ($2.75{\pm}0.89$) were significantly higher than those of group 17 ($1.25{\pm}1.39$) on the 7th day (p<0,05). On the histologic exanminations, specimens of the spinal cord showed necrosis and apoptosis. The pathologic scores of group Cs7 ($1,0{\pm}0.53$) was less than those of group 17 ($2.13{\pm}1.36$, p<0.05). TUNEL staing showed apoptosis of the specimen in group 12 and Cs2 but there was no stastically significant difference between groups on the score. There were more overexpression of HSP70 and nNOS in cyclosporine group than in control group. Conclusion: We think that cyclosporin A may decrease neuronal cell death with induced upregulation of HSP70 against 25-min ischemia of the spiral cord in the rabbit.

• The Journal of Internal Korean Medicine
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• v.27 no.1
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• pp.288-293
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• 2006

Background : Monoplegia is the paralysis of a limb. It is commonly caused by an injury to the cerebral cortex, and rarely caused by injury to the internal capsule, brain stem, or spinal cord. Most problems with cerebral cortex is derived from the occlusion of a brain cortex blood vessel due to thrombus or embolus. Objectives : This study is to see if there is a significance in thermal differences of acupoints in diagnosis and treatment of monoplegia on an upper extremity to test the validity of acupuncture and herbal treatment for it. Methods : By using Digital Infrared Thermographic Imaging(DITI), thermal differences$({\Delta}T)$ of acupoints on the upper extremity in a patient with monoplegia on the right upper extremity were measured after an attack of the disease. By giving Mangeum-tang(萬金湯) and treating the patient with acupuncture. the temperature changes of the upper extremity were examined through DITI and improvement was observed. Results : Compared with the left arm which suffered no such injury, the right recovered about 80% of sensation, and the grade of monoplegia improved from Grade O to Grade V. Also, the temperatures of right palmar-dorsal hand and the region of Weiguan(外關, Waiguan, TE5) were $1^{\circ}C$ and $1.45^{\circ}C$ higher than the same left region on admission day, but the thermal differences$({\Delta}T)$ narrowed to $0.5^{\circ}C$ by the last day. Conclusions : Results suggest that DITI screening is a reliable method of prognosis and that the time required for treatment can be estimated through this method in cases of monoplegia to an upper extremity. Also, progress in treatment is reflected in thermal differences of acupoints of the monoplegic upper extremity in accordance with the theory of meridian. This supports a role for acupuncture and herbal treatment for monoplegia.

• Therapeutic Science for Rehabilitation
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• v.5 no.2
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• pp.35-47
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• 2016

Objective: The aim of this study was to identify the driving rehabilitation for on-road driving through a systematic review. Methods: We systematically examined papers published in journals from December 2014 to January 2015, using CINAH, Embase, Pubmed, PsycINFO, and The Cochrane Library. Eventually, 15 studies were included in the analyses. Results: The evidence of 15 studies was from levels I, III, and V. The subjects included in the analyses were patients with stroke(40.0%), older driver(20.0%), traumatic brain injury(20.0%), acquired brain injury(13.3%) and spinal cord injury(6.7%). The intervention types were driving simulator training(53.3%), cognitive skills training(26.6%), off-road educational training(6.7%), adaptation of assistive device(6.7%), and behind-the-wheel training(6.7%). The effects of driving rehabilitation were different depending on the types of intervention. However, driving simulator training showed significant improvement of on-road assessments in all studies included this study. Conclusions: Driving rehabilitation for on-road driving has been used in various types. Specially, the effect of the driving simulator training has been proved by many studies. Future studies are to be required with client from a range of diagnostic groups to establish evidence-based interventions and determine their effectiveness in improving on-road driving.

• Journal of Korean Neurosurgical Society
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• v.30 no.sup1
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• pp.85-90
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• 2001

Objective : DREZotomy is effective for the treatment of deafferentation pain as a consequence of root avulsion, postparaplegic pain, posttraumatic syrinx, postherpetic neuralgia, spinal cord injury, and peripheral nerve injury. We performed microsurgical DREZotomy to the patients with deafferentation pain and relieved pain without any serious complication. The purpose of this study is to evaluate the usefulness of the microsurgical DREZotomy for deafferentation pain. Methods : We evaluated 4 patients with deafferntation pain who were intractable to medical therapy. Two of them were brachial plexus injury with root avulsion owing to trauma, one was axillary metastasis of the squamous cell carcinoma of the left forearm, and the last was anesthesia dolorosa after surgical treatment(MVD and rhizotomy) of trigeminal neuralgia. Preoperative evaluation was based on the neurologic examination, radiologic imaging, and electrophysiological study. In the case of anesthesia dolorosa, we produced two parallel lesions in cephalocaudal direction, 2mm in distance, from the C2 dorsal rootlet to the 5mm superior to the obex including nucleus caudalis, after suboccipital craniectomy and C1-2 laminectomy, with use of microelectrode. In the others, we confirmed lesion site with identification of the nerve root after hemilaminectomy. We performed arachnoid dissection along the posterolateral sulcus and made lesion with microsurgical knife and microelectrocoagulation, 2mm in depth, 2mm in distance, to the direction of 30-45 degrees in the medial portion of the Lissauer's tract and the most dorsal layers of the posterior horn at the one root level above and below the lesion. Results : Compared with preoperative state, microsurgical DREZotomy significantly diminished dosage of the drugs and relieved pain meaningfully. One patient showed tansient ipsilateral ataxia, but recovered soon. There was not any serious complication. Conclusion : It may be concluded that microsurgical DREZotomy is very useful and safe therapeutic modality for deafferentation pain, especially segmentally distributed intermittent or evoke pain. Complete preoperative evaluation and proper selection of the patients and lesion making device are needed to improve the result.

• Journal of Digital Convergence
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• v.14 no.5
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• pp.369-376
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• 2016

The purpose of this study was to identify the effect the disability prevention program by spinal cord injury lecturer for elementary school students. 1,167 students participated and data were analyzed using Wilcoxon signed-rank test by SPSS 22.0 program and qualitative analysis. The disability prevention program was a 40minutes, program composed of cause of disability, watching cases of accidents, story of disabled lecturer. The result showed that there were significant improvements in self-efficacy(Z=-26.109, p<.01) and awareness for the disabled. This study suggests that the disability prevention program by disabled lecturer had a positive effect on elementary school students. So the program should be expanded for children.

• The Journal of Korean society of community based occupational therapy
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• v.4 no.1
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• pp.11-21
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• 2014

Objective : This study was aimed to survey the correlation between time usage and hope in 20s and 30s the disabled. Methods : From November to December 2012, 52 the disabled who have therapy in rehabilitation hospital in Busan and Gyeongnam, being diagnosed with spinal cord injury and stroke, were chosen. Semi-structured interview was carried out using a questionnaire involved time usage and hope. Results : The followings are the results of this study. First, the participants spent most time sleeping (10:47) and using media (3:41) on weekends. In additions, they spent most time sleeping (9:43) and health management (5:12) on weekdays. Second, doing household chores were positive correlation (.688) between time usage and hope (p<.05). However, no significant differences in time usage and hope. Conclusion : The results of this study would contribute to propose various activities for 20s and 30s the disabled.