• Journal of Korean Neurosurgical Society
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• v.46 no.4
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• pp.300-304
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• 2009

Objective : This is retrospective study of clinical and radiological outcomes of anterior cervical fusion using Bongros-$HA^{TM}$ (BioAlpha, Seongnam, Korea) which is a type of synthetic hydroxyapatite (HA) spacer to evaluate the efficacy in its clinical application and usefulness as a reliable alternative to autograft bone. Methods : Twenty-nine patients were enrolled in this study and 40 segments were involved. All patients were performed anterior cervical interbody fusion using HA spacer and plating system. Indications for surgery were radiculopathy caused by soft-disc herniation or spondylosis in 18 patients, spondylotic myelopathy in 1 patient, and spinal trauma in 10 patients. Cervical spine radiographs were obtained on postoperative 1day, 1week, and then at 1, 2, 6, and 12 months in all patients to evaluate intervertebral disc height, and the degrees of lordosis. Cervical computed tomography was done at postoperative 12 month in all patients to confirm the fusion status. The mean period of clinical follow-up was 17 months. Results : Complete interbody fusion was achieved in 100% of patients. Preoperative kyphotic deformities were corrected in all cases after surgery. Intervertebral disc height was well maintained during follow up period. There were no cases of graft extrusion, graft deterioration and graft fracture. Conclusion : HA spacer is very efficient in achieving cervical fusion, maintaining intervertebral disc height, and restoring lordosis. When combined with the placement of a cervical plate, immediate stability can be achieved and graft related complication can be prevented.

• Journal of the Korean Society of Physical Medicine
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• v.6 no.2
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• pp.235-246
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• 2011

Purpose: The aim of this study is to compare and assess the effects of lumbar stabilization exercise on the balance ability of young college studets with low back pain after having performed spinal stabilization exercise by using 3-dimensional air-balance system and gym ball. Methods: The subjects of this study were 34 low back patients in their early twenties. They were divided into two groups: 3-dimensional lumbar stabilization exercise group(N=17) and gym ball lumbar stabilization exercise group(N=17). The period of the intervention was for five weeks. VAS(Visual Analogue Scale) for pain test, ODI(Oswestry Disability Index) for ADL limitation test, Tetrax system for static balance test, and Air-balance system 3D for dynamic balance test were used as evaluation tools for this study. Results: Pain showed significant decrease in both groups after having performed the experiment, but ADL limitation of the groups did not show any remarkable difference between before and after the experiment. Dynamic balance ability in the 8-directional angle comparison test significantly increased in all directions except for the backward, left-backward, and right-backward directions. As for dynamic balance ability in the 8-directional postural test, 3D exercise group showed statistically significant reduction in every direction while gym ball exercise group did not(p<.05). However, when it comes to static balance ability in the weight distribution and stability test, there was not significantly change between pre and post test in both groups. Conclusion: This study shows 3-dimensional lumbar stabilization exercise is more effective in the lumbar stabilization of coordinated movement than gym ball exercise, which may imply that 3D air-balance system can be used for the therapeutic treatment of body imbalance for patients with low back pain.

• Journal of Korean Physical Therapy Science
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• v.27 no.1
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• pp.51-55
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• 2020

Background: A typical plank exercise (PE) strengthens the core muscles, stabilizes the spinal column, and provides stability around the pelvis and trunk when the trunk is aligned. However, because PE require that the hip joint be kept straight, they can activate the hamstring (HAM). Excessive HAM activation can induce tightness, which may cause low back pain. Therefore, it is necessary to explore PE methods that can minimize HAM activity while maximizing core muscle activity. Design: Cross-sectional study. Methods: This study included 30 healthy adults as subjects. We measured the activity of the HAM and the erector spinae (ES), rectus abdominis (RA), and external oblique (EO) muscles using surface electromyography during three PEs (typical PE, PE with balance pad, and PE with sling). Results: The RA, EO, and ES showed the highest muscular activity during PE with balance pad and the lowest during PE with sling; however, the differences were not significant. The HAM showed lower activity during PE with sling than during the other two PEs; however, these differences were also not significant. Conclusion: Although HAM activation was not significantly difference among PE positions, we should recognize altering activation of core and hamstring muscle according to PE postures.

• Journal of Korean Clinical Nursing Research
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• v.26 no.3
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• pp.296-304
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• 2020

Purpose: This study was conducted to demonstrate objective stability of postoperative pain management status managed by nurse-based, anesthesiologist-supervised Acute Pain Service (APS). Methods: A retrospective descriptive review was conducted with 5,748 patients who had used intravenous Patient Controlled Analgesia (PCA) from January to December 2017. Data were analyzed using descriptive statics, Frequency analysis, ANOVA, Cross tabulation with χ2test, and Correlation coefficient. Results: As the APS nurse's education date increased, the period of using PCA was statistically significantly longer, and the period of stopping PCA while using it became shorter (p<.001). Statistically significant, the most painful operations were extremities, spine, upper abdomen, and thorax, while the least painful surgery was lower abdomen (p<.001). Lower abdominal surgery used the highest amount of PCA (p<.001), and extremities and spinal surgery, the lowest amount of PCA and frequently stop using it (p<.001). The most common side effects were nausea and vomiting after surgery, with an incidence of 16.0% within 24 hours and 9.8% within 48 hours. The overall error caused by PCA was 1.5%, with 84.3% being caused by human errors. Conclusion: With the pain management effect of APS nurses, patients used PCA more effectively. There were also fewer side effects and error rates compared to prior studies. Therefore, it is suggested that this system is safe and effective for pain management.

• Journal of radiological science and technology
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• v.45 no.5
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• pp.391-396
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• 2022

The purpose of this study was to investigate the effect of cross arms and palms facing forward on spinopelvic parameters during the whole spine lateral radiography. In addition, we would like to present the usefulness of a posture with the palm facing forward during whole spine lateral radiography of the spine using EOS. The subjects of this study were images of a total of 50 patients (18 males, 32 females) who whole spine lateral radiography using the conventional method and the EOS method from October 2020 to March 2021. The posture used in this study was set as 'CAP' for cross arms and 'PUSH' for posture with palms facing forward. In this study, among the spinal stability factors, thoracic kyphosis (thoracic vertebrae 4 to 12), lumbar lordosis (lumbar vertebrae 1 to sacrum 1), sagittal vertical axis, sacral slope, and shoulder flexion angle were compared on average. The mean thoracic kyphosis was 34.52±12.46° for CAP and 28.46±10.81° for PUSH (p<0.01). The lumbar lordosis of CAP was 42.45±17.45°and that of PUSH was 40.56±16.14°(p>0.57). The sagittal vertical axis was 26.59±34.34 mm in CAP and 21.21±35.41 mm in PUSH (p>0.44). In CAP, the sacral slope was 30.96±10.29°, and in PUSH, it was 31.01±10.19° (p>0.98). shoulder flexion angle was 38.31±8.24° for CAP and 26,08±6.71° for PUSH(p<0.01). As a result of this study, the PUSH posture is considered to be a posture that can minimize the shoulder flexion angle and can perform a stable examination while minimizing changes in spino-pelvic parameter.

• Journal of Korean Neurosurgical Society
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• v.30 no.7
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• pp.883-890
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• 2001

Objectives : An in vitro biomechanical study of posterior lumbar interbody fusion(PLIF) with threaded cage using two different approaches was performed on eighteen functional spinal units of bovine lumbar spines. The purpose of this study was to compare the segmental stiffnesses among PLIF with one long posterolateral cage, PLIF with one long posterolateral cage and simultaneous facet joint fixation, and PLIF with two posterior cages. Methods : Eighteen bovine lumbar functional spinal units were divided into three groups. All specimens were tested intact and with cage insertion. Group 1(n=12) had a long threaded cage($15{\times}36mm$) inserted posterolaterally and oriented counter anterolaterally on the left side by posterior approach with left unilateral facetectomy. Group 2(n=6) had two regular length cages($15{\times}24mm$) inserted posteriorly with bilateral facetectomy. Six specimens from group 1 were then retested after unilateral facet joint screw fixation in neutral(group 3). Likewise, the other six specimens from group 1 were retested after fixation with a facet joint screw in an extended position(group 4). Nondestructive tests were performed in pure compression, flexion, extension, lateral bending, and torsion. Results : PLIF with a single cage, group 1, had a significantly higher stiffnesses than PLIF with two cages, group 2, in left and right torsion(p<0.05). Group 1 showed higher stiffness values than group 2 in pure compression, flexion, left and right bending but were not significantly different. Group 3 showed a significant increase in stiffness in comparison to group 1 for pure compression, extension, left bending and right torsion(p<0.05). For group 4, the stiffness significantly increased in comparison to group 1 for extension, flexion and right torsion(p<0.05). Although there was no significant difference between groups 3 and 4, group 4 had increased stiffness in extension, flexion, right bending and torsion. Conclusion : Posterior lumbar interbody fusion with a single long threaded cage inserted posterolaterally with unilateral facetectomy enables sufficient decompression while maintaining a majority of the posterior elements. In combination with a facet joint screw fixation, adequate postoperative stability can be achieved. We suggest that posterolateral insertion of a long threaded cage is biomechanically an ideal alternative to PLIF.

• Journal of the Korean Society of Physical Medicine
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• v.3 no.2
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• pp.63-74
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• 2008

Purpose : The purpose of this study was to compare trunk repositioning errors between subjects with and without low back pain in sitting and standing. Methods : Total 81 participants were recruited who consisted of 41 subjects with low back pain and 40 normal subjects. The subjects were instructed to replicate the predetermined target positions of the trunk toward upright and $30^{\circ}$ flexion in sitting and standing. During each of movement, digital inclinometer was used to measure the angular movement of $T_{12}$ spinal process. Repositioning error was calculated as the absolute difference between the predetermined target positions and replicated target positions. Results : In subjects with low back pain, upright repositioning error was $1.26^{\circ}{\pm}0.14^{\circ}$ in sitting and $1.55^{\circ}{\pm}0.24^{\circ}$ in standing, and $30^{\circ}$ flexion repositioning error was $3.23^{\circ}{\pm}0.33^{\circ}$ in sitting and $5.50^{\circ}{\pm}0.50^{\circ}$ in standing. In subjects without low back pain, upright repositioning error was $1.38^{\circ}{\pm}0.15^{\circ}$ in sitting and $1.67^{\circ}{\pm}0.18^{\circ}$ in standing, and flexion repositioning error was $2.61^{\circ}{\pm}0.28^{\circ}$ in sitting and $3.70^{\circ}{\pm}0.52^{\circ}$ in standing. It was demonstrated that flexion repositioning error increased significantly in standing position. In subjects with low back pain, $30^{\circ}$ flexion repositioning error was significantly higher in standing than in sitting. Conclusion : The repositioning error of subjects with low back pain increased during flexion and it implies that some aspects of proprioception are decreased in subjects with low back pain. Therefore, it will be emphasis that a clinical trial to increase the trunk flexion stability of subjects with low back pain in standing.

• Journal of Korean Neurosurgical Society
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• v.50 no.4
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• pp.332-340
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• 2011

Objective : Pyogenic spondylitis often results in acute neurological deterioration requiring adequate surgical intervention and appropriate antibiotic treatment. The purpose of this study was to conduct an analysis of the clinical effect of continuous irrigation via laminotomy in a series of patients with pyogenic spondylitis in thoracic and lumbar spine. Methods : The authors conducted a retrospective investigation of 31 consecutive patients with pyogenic thoracic and lumbar spondylitis who underwent continuous irrigation through laminotomy from 2004 to 2008. The study included 22 men and 9 women, ranging in age from 38 to 78 years (mean 58.1 years). The average follow-up duration was 13.4 months (range, 8-34 months). We performed debridement and abscess removal after simple laminotomy, and then washed out epidural and disc space using a continuous irrigation system. Broad spectrum antibiotics were administered empirically and changed according to the subsequent culture result. Clinical outcomes were based on the low back outcome scale (LBOS), visual analogue scale (VAS) score, and Frankel grade at the last follow-up. Radiological assessment involved plain radiographs, including functional views. Results : Common predisposing factors included local injection for pain therapy, diabetes mellitus, chronic renal failure, and liver cirrhosis. Causative microorganisms were identified in 22 cases (70.9%) : Staphylococcus aureus and Streptococcus spp. were the main organisms. After surgery, LBOS, VAS score, and Frankel grade showed significant improvement in most patients. Spinal stability was maintained during the follow-up period, making secondary reconstructive surgery unnecessary for all patients, except one. Conclusion : Simple laminotomy with continuous irrigation by insertion of a catheter into intervertebral disc space or epidural space was minimally invasive and effective in the treatment of pyogenic spondylitis. This procedure could be a beneficial treatment option in patients with thoracolumbar spondylitis combined with minimal or moderate destructive change of vertebrae.

• Composites Research
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• v.25 no.4
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• pp.98-104
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• 2012

In recent years, degenerative spinal instability has been effectively treated with a cage. However, little attention is focused on the stiffness of the cage. Recent advances in the medical implant industry have resulted in the use of medical carbon fiber reinforced polymer (CFRP) cages. The biomechanical advantages of using different cage material in terms of stability and stresses in bone graft are not fully understood. A previously validated three-dimensional, nonlinear finite element model of an intact L2-L5 segment was modified to simulate posterior interbody fusion cages made of CFRP and titanium at the L4-L5 disc with pedicle screw, to investigate the effect of cage stiffness on the biomechanics of the fused segment in the lumbar region. From the results, it could be found that the use of a CFRP cage would not only reduce stress shielding, but it might also have led to increased bony fusion.

• Journal of Biomedical Engineering Research
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• v.36 no.6
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• pp.276-282
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• 2015

Recently, during the multi-level fusion with pedicle screws, interspinous spacer are sometimes substituted for the most superior level of the fusion in an attempt to reduce the number of fusion level and likelihood of degeneration process at the adjacent level. In this study, a finite element (FE) study was performed to assess biomechanical efficacies of the interspinous spacer combined with posterior lumbar fusion with a previously-validated 3-dimensional FE model of the intact lumbar spine (L1-S1). The post-operative models were made by modifying the intact model to simulate the implantation of interspinous spacer and pedicle screws at the L3-4 and L4-5. Four different configurations of the post-op model were considered: (1) a normal spinal model; (2) Type 1, one-level fusion using posterior pedicle screws at the L4-5; (3) Type 2, two-level (L3-5) fusion; (4) Type 3, Type 1 plus Coflex$^{TM}$ at the L3-4. hybrid protocol (intact: 10 Nm) with a compressive follower load of 400N were used to flex, extend, axially rotate and laterally bend the FE model. As compared to the intact model, Type 2 showed the greatest increase in Range of motion (ROM) at the adjacent level (L2-3), followed Type 3, and Type 1 depending on the loading type. At L3-4, ROM of Type 2 was reduced by 34~56% regardless of loading mode, as compared to decrease of 55% in Type 3 only in extension. In case of normal bone strength model (Type 3_Normal), PVMS at the process and the pedicle remained less than 20% of their yield strengths regardless of loading, except in extension (about 35%). However, for the osteoporotic model (Type 3_Osteoporotic), it reached up to 56% in extension indicating increased susceptibility to fracture. This study suggested that substitution of the superior level fusion with the interspinous spacer in multi-level fusion may be able to offer similar biomechanical outcome and stability while reducing likelihood of adjacent level degeneration.