• Neurospine
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• 제15권4호
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• pp.368-375
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• 2018

Objective: To evaluate the results of operative management of subaxial spine injuries managed with 2-level anterior cervical corpectomy and fusion with a cervical locking plate and autologous bone-filled titanium mesh cage. Methods: This study included 23 patients with a subaxial spine injury who matched the inclusion criteria, underwent 2-level anterior cervical corpectomy and fusion at our institution between 2013 and 2016, and were followed up for neurological recovery, axial pain, fusion, pseudarthrosis, and implant failure. Results: According to Allen and Ferguson classification, there were 9 cases of distractive extension; 4 of compressive extension; 3 each of compressive flexion, vertical compression, and distractive flexion; and 1 of lateral flexion. Sixteen patients had a score of 6 on the Subaxial Injury Classification system, and the rest had a score of more than 6. The mean follow-up period was 19 months (range, 12-48 months). Neurological recovery was observed in most of the patients (78.21%). All patients experienced relief of axial pain. None of the patients received a blood transfusion. Twenty-one patients (91.3%) showed solid fusion and 2 (8.69%) showed possible pseudarthrosis, with no complications related to the cage or plate. Conclusion: Two-level anterior cervical corpectomy and fusion, along with stabilization with a cervical locking plate and autologous bone graft-filled titanium mesh cage, can be considered a feasible and safe method for treating specific subaxial spine injuries, with the benefits of high primary stability, anatomical reduction, and direct decompression of the spinal cord.

• Journal of Korean Neurosurgical Society
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• 제67권1호
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• pp.6-13
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• 2024

The integrity of the high cervical spine, the transition zone from the brainstem to the spinal cord, is crucial for survival and daily life. The region protects the enclosed neurovascular structure and allows a substantial portion of the head motion. Injuries of the high cervical spine are frequent, and the fractures of the C2 vertebra account for approximately 17-25% of acute cervical fractures. We review the two major types of C2 vertebral fractures, odontoid fracture and Hangman's fracture. For both types of fractures, favorable outcomes could be obtained if the delicately selected conservative treatment is performed. In odontoid fractures, as the most common fracture on the C2 vertebrae, anterior screw fixation is considered first for type II fractures, and C1-2 fusion is suggested when nonunion is a concern or occurs. Hangman's fractures are the second most common fracture. Many stable extension type I and II fractures can be treated with external immobilization, whereas the predominant flexion type IIA and III fractures require surgical stabilization. No result proves that either anterior or posterior surgery is superior, and the surgeon should decide on the surgical method after careful consideration according to each clinical situation. This review will briefly describe the basic principles and current treatment concepts of C2 fractures.

• 한국전문물리치료학회지
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• 제26권4호
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• pp.1-9
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• 2019

Background: Cervical dysfunction is a common pathomechanical marker in individuals with forward head posture (FHP). To overcome the limitations of the isometric chin-tuck (ICT) exercise, dynamic neuromuscular stabilization (DNS), which emphasizes an entire spinal chain exercise, has recently shown promising clinical results. Objects: Purpose of this study was to compare the immediate effects between ICT and DNS techniques. Methods: 43 young subjects (mean age, $24.0{\pm}5.0$ years) were recruited. Group of subjects with FHP were measured under baseline, ICT, and DNS conditions. Outcome measures included sitting height, longus colli (LC) and sternocleidomastoid (SCM) muscle thickness and LC/SCM thickness ratio. One-way repeated measures ANOVA was used to compare the continuous dependent variables among FHP, ICT, and DNS conditions at p<.016. Results: Both ICT and DNS exercise conditions yielded significantly increased LC muscle thickness, LC/SCM thickness ratio and sitting height than did FHP condition (p<.0001, respectively). Sitting height was significantly greater in DNS exercise than in the ICT exercise (p<.0001). Conclusion: The present results demonstrated that sitting height was greater in the DNS exercise than in the ICT exercise, as well as both corrective postural training exercises were effective on LC/SCM muscle balance ratio when compared with the baseline FHP condition. Therefore, it is considered that DNS exercise can be the recommended exercise for people with FHP.

• Journal of Korean Neurosurgical Society
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• 제60권2호
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• pp.225-231
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• 2017

Objective : Solid bone fusion is an essential process in spinal stabilization surgery. Recently, as several minimally invasive spinal surgeries have developed, a need of artificial bone substitutes such as demineralized bone matrix (DBM), has arisen. We investigated the in vivo bone growth rate of DBM as a bone void filler compared to a local autologous bone grafts. Methods : From April 2014 to August 2015, 20 patients with a one or two-level spinal stenosis were included. A posterior lumbar interbody fusion using two cages and pedicle screw fixation was performed for every patient, and each cage was packed with autologous local bone and DBM. Clinical outcomes were assessed using the Numeric Rating Scale (NRS) of leg pain and back pain and the Korean Oswestry Disability Index (K-ODI). Clinical outcome parameters and range of motion (ROM) of the operated level were collected preoperatively and at 3 months, 6 months, and 1 year postoperatively. Computed tomography was performed 1 year after fusion surgery and bone growth of the autologous bone grafts and DBM were analyzed by ImageJ software. Results : Eighteen patients completed 1 year of follow-up, including 10 men and 8 women, and the mean age was 56.4 (32-71). The operated level ranged from L3/4 to L5/S1. Eleven patients had single level and 7 patients had two-level repairs. The mean back pain NRS improved from 4.61 to 2.78 (p=0.003) and the leg pain NRS improved from 6.89 to 2.39 (p<0.001). The mean K-ODI score also improved from 27.33 to 13.83 (p<0.001). The ROM decreased below 2.0 degrees at the 3-month assessment, and remained less than 2 degrees through the 1 year postoperative assessment. Every local autologous bone graft and DBM packed cage showed bone bridge formation. On the quantitative analysis of bone growth, the autologous bone grafts showed significantly higher bone growth compared to DBM on both coronal and sagittal images (p<0.001 and p=0.028, respectively). Osteoporotic patients showed less bone growth on sagittal images. Conclusion : Though DBM alone can induce favorable bone bridging in lumbar interbody fusion, it is still inferior to autologous bone grafts. Therefore, DBM is recommended as a bone graft extender rather than bone void filler, particularly in patients with osteoporosis.

• Journal of Korean Neurosurgical Society
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• 제42권4호
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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.

• 대한정형도수물리치료학회지
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• 제11권1호
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• pp.37-48
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• 2005

Objects: This study is designed to analysis improvement and maintaince of trunk stability targeting patients who need post operative rehabilitation exercise after undergoing opened microscopic laser discectomy(OMLD) due to HNP. Method: Between March 2004 and February 2005 a total sixty patients who underwent OMLD due to $L_4/L_5$, $L_5/S_1$ HNP and who agreed to the experiment were subject for this study. Experimental group consisted of 18 subjects, and they underwent 45 minutes dynamic lumbar stabilization exercise And control group consisted of 18 subjects who conducted conservative physical therapy based on the use of physical modality for 45 minutes except to exercise. Results: Experimental group that was lumbar extensor's isometric peak torque, weight distribution of both leg, trunk muscle balance and Oswestry LBP disability index increased during 12 weeks in a statistically significant manner compared to before exercise (p<.05). When re-test was tried, isometric peak torque (p>.05) and Oswestry LBP disability index(p<.05) maintained 12th week level or improved. Weight distribution rate of both leg and trunk muscle balance maintained the level of 8th week of exercise execution(p<.05). Control group that was lumbar extensor's isometric peak torque, weight distribution rate of both leg and trunk muscle balance aggravated during 12 weeks compared to pre-test(p>.05) But, Oswestry LBP disability index increased in a statistically significant level compared to pre-test(p<.05). When re-test was tried, isometric peak torque increased slightly compared to pre-test, but decreased when at least $60^{\circ}$ flexion angle(p>.05). Weight distribution rate of both leg and trunk muscle balance also aggravated compared to pre-test(p>.05), and Oswestry LBP disability index was similar to the 4th week of physical therapy execution(p>.05). Conclusion: Successive postoperative Especially, Application of dynamic lumbar stabilization exercise program is important than traditional lumbar strengthening exercise program in the maintaince of spinal stability.

• 대한물리치료과학회지
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• 제18권2호
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• pp.1-8
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• 2011

Background: The purpose of this study was to systematic review the effect of exercise programs for chronic low back pain patients. We needs systematic development of low back pain exercise program to reduce economic cost further doing great service to public health promotion. Methods: We searched to the effects of exercise programs for chronic low back pain patients by Dankook University electronic library databases of DBPIA, KSI KISS, CINAHL, MEDLINE and PEDro combined with a hand search of papers published in relevant journals. Any type of study relevant to the topic published during time period from 1970 to 2007 was included. Results: The literature search identified 30 studies. 1.Performing the flexion exercise increased abdominal muscle activity but acute herniated intervertebral disc should be avoided. 2.The general lumbar extension exercise used lumbar extension machine and the muscle power increases, significant probability the change. 3.The spinal segments exercise for the patients offered significant efficacy and appeared to be a reasonable therapeutic option. 4.Spinal stabilization exercises appear to improve trunk endurance and balance to patients with chronic low back pain. This exercise programs had effective decrease pain and disability. Conclusion: The review suggests that although the exercise programs for chronic low back pain patients, and we expected the efficacy of the exercise programs for chronic low back pain patients used in this study should be further investigated in a long period study and objective outcomes.

• Journal of Korean Neurosurgical Society
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• 제48권4호
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• pp.335-341
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• 2010

Objective : Anterior cervical corpectomy with fusion (ACF) or laminoplasty may be associated with substantial number of complications for treating multilevel cervical ossification of the posterior longitudinal ligament (OPLL) with significant cord compression. For more safe decompression and stabilization in multilevel cervical OPLL with prominent cord compression, we propose circumferential cervical surgery (selective ACF and laminoplasty) based on our favorable experience. Methods : Twelve patients with cervical myelopathy underwent circumferential cervical surgery and all patients showed multilevel OPLL with Signal change of the spinal cord on magnetic resonance imaging (MRI). A retrospective review of clinical, radiological. and surgical data was conducted. Results : There were 9 men and 3 women with mean age of 56.7 years and a mean follow up period of 15.6 months. The average corpectomy level was 1.16 and laminoplasty level was 4.58. The average Japanese Orthopedic Association score for recovery was 5.1 points and good clinical results were obtained in 11 patients (92%) (p < 0.05). The average space available for the cord improved from 58.2% to 87.9% and the average Cobb's angle changed from 7.63 to 12.27 at 6 months after operation without failure of fusion (p < 0.05). Average operation time was 8.36 hours, with an estimated blood loss of 760 mL and duration of bed rest of 2.0 days. There were no incidences of significant surgical complications, including wound infection. Conclusion : Although the current study examined a small sample with relatively short-term follow-up periods, our study results demonstrate that circumferential cervical surgery is considered favorable for safety and effectiveness in multilevel OPLL with prominent cord compression.

• Journal of Trauma and Injury
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• 제35권1호
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• pp.12-18
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• 2022

Purpose: Pedicle screw fixation provides 3-column stabilization, multidimensional control, and a higher rate of interbody fusion. Although computed tomography (CT) is recommended for the postoperative assessment of pedicle screw fixation, its use is limited due to the radiation exposure dose. The purpose of this preliminary retrospective study was to assess the clinical usefulness of low-dose mobile cone-beam CT (CBCT) for the postoperative evaluation of pedicle screw fixation. Methods: The author retrospectively reviewed postoperative mobile CBCT images of 15 patients who underwent posterior pedicle screw fixation for spinal disease from November 2019 to April 2020. Pedicle screw placement was assessed for breaches of the bony structures. The breaches were graded based on the Heary classification. Results: The patients included 11 men and four women, and their mean age was 66±12 years. Of the 122 pedicle screws, 34 (27.9%) were inserted in the thoracic segment (from T7 to T12), 82 (67.2%) in the lumbar segment (from L1 to L5), and six (4.9%) in the first sacral segment. Although there were metal-related artifacts, the image of the screw position (according to Heary classification) after surgery could be assessed using mobile CBCT at all levels (T7-S1). Conclusions: Mobile CBCT was accurate in determining the location and integrity of the pedicle screw and identifying the surrounding bony structures. In the postoperative setting, mobile CBCT can be used as a primary modality for assessing the accuracy of pedicle screw fixation and detecting postoperative complications.

• 대한물리의학회지
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• 제8권4호
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• pp.609-617
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• 2013

PURPOSE: This study aims to provide effects of therapeutic techniques as well as basic materials of safety by comparing and analyzing the effects of hamstring flexibility and dynamic stability of lower lumbar according to Stretching and Massage Techniques to adults with reduced the flexibility of hamstring. METHODS: This study conducted differential diagnosis through sit and reach test(SRT) and Schober test to select subjects who have shortened hamstring without any spinal problem. Selected subjects were divided into two groups randomly; HSG(Hamstring Stretching Group, n=8) and HMG(Hamstring Massage Group, n=8) and they received treatment for 2 weeks. To take statistics, SRT and dynamic view using x-ray were used. RESULTS: On SRT, HSG and HMG showed significant difference between pre and post test. A comparison of the difference value between HSG and HMG, HSG($9.73{\pm}1.78$) has more remarkable outcome than HMG($2.78{\pm}0.56$). Lower lumbar intervertebral disc length test for Intervertebral disc length(IDL)L45 and IDLL5S1 did not show significant differences between two groups and difference value. CONCLUSION: This study showed that stretching is more effective to improve hamstring flexibility than massage technique. Especially, flexibility increase of the hamstring in vertebral stabilization cannot affect improvement possibility will make a flexibility in order and the intervention and stabilization exercise of the spine.