• The Journal of Korean Physical Therapy
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• v.33 no.4
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• pp.179-186
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• 2021

Background: Patients with advanced asthma and chronic obstructive pulmonary disease (COPD) have postural deviations such as thoracic hyperkyphosis, forward shoulder posture (FSP) due to an increase in head and cervical protraction, reduced shoulder range of motion and a corresponding increase in scapula elevation and upward rotation. Unlike congenital vertebral kyphosis that are permanent and rigid deformities with bony and other structural deformations which cause respiratory impairment, these deformities in these patients may be more flexible. Since the thoracic hyperkyphosis has been implicated as having adverse health consequences it is necessary to evaluated the relationship between thoracic kyphosis and cardiopulmonary functions of patients with COPD and asthma. Methods: It was a cross-sectional analytical study. Eighty-four eligible patients with COPD and asthma were recruited from the Respiratory Unit, Department of Medicine, Lagos University Teaching Hospital (LUTH), and basic anthropometric parameters, pulmonary parameters, cardiovascular parameters, thoracic kyphosis (Cobb) angle and presence of respiratory symptoms of participants were assessed. Data was analyzed using SPSS version 20. Results: There was no significant correlation between the thoracic kyphosis and selected pulmonary parameters (Forced Expiratory Volume in one second (FEV1, p=0.36), Forced Vital Capacity (FVC, p=0.95), Peak Expiratory Flow Rate (PEFR, p=0.16), Thoracic expansion (TE, p=0.27)/cardiovascular parameters (Systolic Blood Pressure (SBP, p=0.108), Diastolic Blood Pressure (DBP, p=0.17) and Pulse Rate (PR, p=0.93) as well as the respiratory symptoms (SGRQ scores, p=0.11) in all subjects. Conclusion: There was no relationship between thoracic kyphosis and selected pulmonary/cardiovascular parameters as well as respiratory symptoms in patients with COPD and asthma.

• Journal of Korean Neurosurgical Society
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• v.64 no.3
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• pp.447-459
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• 2021

Objective : Oblique lateral interbody fusion (OLIF) is becoming the preferred treatment for degenerative lumbar diseases. As beginners, we performed 143 surgeries over 19 months. In these consecutive cases, we analyzed the learning curve and reviewed the complications in our experience. Methods : This was a retrospective study; however, complications that were well known in the previous literature were strictly recorded prospectively. We followed up the changes in estimated blood loss (EBL), operation time, and transient psoas paresis according to case accumulation to analyze the learning curve. Results : Complication-free patients accounted for 43.6% (12.9%, early stage 70 patients and 74.3%, late stage 70 patients). The most common complication was transient psoas paresis (n=52). Most of these complications occurred in the early stages of learning. C-reactive protein normalization was delayed in seven patients (4.89%). The operation time showed a decreasing trend with the cases; however, EBL did not show any significant change. Notable operation-induced complications were cage malposition, vertebral body fracture, injury to the ureter, and injury to the lumbar vein. Conclusion : According to the learning curve, the operation time and psoas paresis decreased. It is important to select an appropriately sized cage along with clear dissection of the anterior border of the psoas muscle to prevent OLIF-specific complications.

• Asian Spine Journal
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• v.12 no.6
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• pp.1017-1027
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• 2018

Study Design: This retrospective study was conducted including 18 patients who underwent posterior-only stabilization and fusion procedure for pseudoarthrosis in the ankylosed spine from October 2007 to May 2015. Purpose: This study aimed to describe the treatment outcomes in 18 patients with Andersson lesion (AL) who were managed using the posterior-only approach. Literature Review: AL is an unstable, localized, vertebral, or discovertebral lesion of the spine. It is observed in patients with ankylosing spondylitis. The exact etiology of this disorder remains unclear, and the treatment guidelines are not clearly described. Methods: We analyzed 18 patients with AL who were treated with posterior long segment spinal fusion without any anterior interbody grafting or posterior osteotomy. Pre- and postoperative radiography, computed tomography, and recent follow-up images were examined. The pre- and postoperative Visual Analog Scale score and the Oswestry Disability Index score were evaluated for all patients. Whiteclouds' outcome analysis criteria were applied at the follow-up. Moreover, at study completion, patient feedback was collected; all the patients were asked to provide their opinion regarding the surgery and were asked whether they would recommend this procedure to other patients and them self undergo the same procedure again if required. Results: The most common site was the thoracolumbar junction. The symptom duration ranged from 1 month to 10 years preoperatively. Most patients experienced fusion by the end of 1 year, and the fusion mass could be observed as early as 4 months. Pseudoarthrosis void of up to 2.5 cm was noted to be healed in subsequent imaging. In addition, clinically, the patients reported good symptomatic relief. No patient required revision surgery. Whiteclouds' outcome analysis score at the latest follow-up revealed goodto-excellent outcomes in all patients. Conclusions: ALs can be treated using the posterior-only approach with long segment fixation and posterior spinal fusion. This is a safe, simple, and quick procedure that prevents the morbidity of anterior surgery.

• Journal of Veterinary Clinics
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• v.36 no.2
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• pp.102-105
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• 2019

Nitrotyrosine was found to be dependent on the severity of myxomatous mitral valve disease (MMVD). However, a correlation of serum nitrotyrosine concentration in dogs with MMVD and the progression of the disease has not been investigated. This study compared changes in serum nitrotyrosine concentration with the progression of MMVD. Nine client-owned dogs were recruited for the study. Dogs were classified by measuring the amount of regurgitation using echocardiography into mild, moderate, or severe MMVD groups. Serum nitrotyrosine concentration was measured by an enzyme-linked immunosorbent assay test. Serum nitrotyrosine concentration was significantly higher at 180 days than at 0 day (P < 0.05). However, serum nitrotyrosine concentration at 360 days was lower than that at 180 days (P < 0.05). Serum nitrotyrosine concentration at 540 days was lower than at 180 days (P < 0.05). There was no correlation between serum nitrotyrosine and left atrial to aortic root diameter ratio (LA/Ao ratio) (n = 33, $R^2=0.003$, P = 0.759). Also, there was no correlation between serum nitrotyrosine and vertebral heart score (VHS) (n = 33, $R^2=0.026$, P = 0.368) and left ventricular end-diastolic diameter, normalized for body weight by the formula (LVEDDN) (n = 33, $R^2=0.053$, P = 0.196). The results of the study suggest that the progression of MMVD is correlated with changes in serum nitrotyrosine concentration, which shows potential for use as a cardiac biomarker which can be used to analyze the progression of disease in MMVD.

• Annals of Rehabilitation Medicine
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• v.42 no.6
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• pp.814-821
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• 2018

Objective To suggest rotation angles of fluoroscopy that can bypass the carotid sheath according to vertebral levels for cervical transforaminal epidural steroid injection (TFESI). Methods Patients who underwent cervical spine magnetic resonance imaging (MRI) from January 2009 to October 2017 were analyzed. In axial sections of cervical spine MRI, three angles to the vertical line (${\alpha}$, angle not to insult carotid sheath; ${\beta}$, angle for the conventional TFESI; ${\gamma}$, angle not to penetrate carotid artery) were measured. Results Alpha (${\alpha}$) angles tended to increase for upper cervical levels ($53.3^{\circ}$ in C6-7, $65.2^{\circ}$ in C5-6, $75.3^{\circ}$ in C4-5, $82.3^{\circ}$ in C3-4). Beta (${\beta}$) angles for conventional TFESI showed a constant value of $45^{\circ}$ to $47^{\circ}$ ($47.5^{\circ}$ in C6-7, $47.4^{\circ}$ in C5-6, $45.7^{\circ}$ in C4-5, $45.0^{\circ}$ in C3-4). Gamma (${\gamma}$) angles increased at higher cervical levels as did ${\alpha}$ angles ($25.2^{\circ}$ in C6-7, $33.6^{\circ}$ in C5-6, $43.0^{\circ}$ in C4-5, $56.2^{\circ}$ in C3-4). Conclusion The risk of causing injury by penetrating major vessels in the carotid sheath tends to increase at upper cervical levels. Therefore, prior to cervical TFESI, measuring the angle is necessary to avoid carotid vessels in the axial section of CT or MRI, thus contributing to a safer procedure.

• Korean Journal of Radiology
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• v.19 no.6
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• pp.1140-1146
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• 2018

Objective: To compare the spinal enumeration methods that establish the first lumbar vertebra in patients with spinal variants. Materials and Methods: Of the 1446 consecutive patients who had undergone computed tomography of the spine from March 2012 to July 2016, 100 patients (62 men, 38 women; mean age, 47.9 years; age range, 19-88 years) with spinal variants were included. Two radiologists (readers 1 and 2) established the first lumbar vertebra through morphologic analysis of the thoracolumbar junction, and labeled the vertebra by counting in a cranial-to-caudal manner. Inter-observer agreement was established. Additionally, reader 1 detected the 20th vertebra under the assumption that there are 12 thoracic vertebra, and then classified it as a thoracic vertebra, lumbar vertebra, or thoracolumbar transitional vertebra (TLTV), on the basis of morphologic analysis. Results: The first lumbar vertebra, as established by morphologic analysis, was labeled by each reader as the 21st segment in 65.0% of the patients, as the 20th segment in 31.0%, and as the 19th segment in 4.0%. Inter-observer agreement between the two readers in determining the first lumbar vertebra, based on morphologic analysis, was nearly perfect (${\kappa}$ value: 1.00). The 20th vertebra was morphologically classified as a TLTV in 60.0% of the patients, as the first lumbar segment in 31.0%, as the second lumbar segment in 4.0%, and as a thoracic segment in 5.0%. Conclusion: The establishment of the first lumbar vertebra using morphologic characteristics of the thoracolumbar junction in patients with spinal variants was consistent with the morphologic traits of vertebral segmentation.

• Journal of Korean Neurosurgical Society
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• v.62 no.2
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• pp.209-216
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• 2019

Objective : Hydatid cyst disease is caused by the parasite Echinococcus granulosus. It is rarely seen in the vertebral system, occurring at a rate of 0.2-1%. The aim of this study is to present 12 spinal hydatid cyst cases, and propose a new type of drainage of the cyst. Methods : Twelve cases of spinal hydatid cysts, surgical operations, multiple operations, chronic recurrences, and spinal hydatic cyst excision methods are discussed in the context of the literature. Patients are operated between 2005 and 2016. All the patients are kept under routine follow up. Patient demographic data and clinicopathologic characteristics are examined. Results : Six male and six female patients with a median age of 38.6 at the time of surgery were included in the study. Spinal cyst hydatid infection sites were one odontoid, one cervical, five thoracic, two lumbar, and three sacral. In all cases, surgery was performed, with the aim of total excision of the cyst, decompression of the spinal cord, and if necessary, stabilization of the spinal column. Mean follow up was 61.3 months (10-156). All the patients were prescribed Albendazole. Three patients had secondary hydatid cyst infection (one lung and two hepatic). Conclusion : The two-way drainage catheter placed inside a cyst provides post-operative chlorhexidine washing inside the cavity. Although a spinal hydatid cyst is a benign pathology and seen rarely, it is extremely difficult to achieve a real cure for patients with this disease. Treatment modalities should be aggressive and include total excision of cyst without rupture, decompression of spinal cord, flushing of the area with scolicidal drugs, and ensuring spinal stabilization. After the operation the patients should be kept under routine follow up. Radiological and clinical examinations are useful in spotting a recurrence.

• Korean Journal of Applied Biomechanics
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• v.29 no.1
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• pp.23-32
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• 2019

Objective: The aim of this study was to provide kinematic data on the characteristics of spinal disease patients by comparing and analyzing kinematic variables related to foot balance and gait pattern of spinal disease. Method: The subjects of the study included 40 adult men and 60 adult women who visited the hospital in Busan. Patients who were diagnosed with spinal disease by a physician through X-ray examination were selected as subjects for the diagnosis of vertebral disc herniation, spinal stenosis, spinal disease diagnosed with spinal disease and the general public. Left and right foot pressure and contact area were checked by Gaitview pro meter. X-ray photographs were taken with a Zen-2090 mobile fluoroscopy under physicians' direct participation. One-way ANOVA was performed to compare the differences between the kinematic variables and post-hoc was performed by the Duncan method. Results: The difference in contact area between the left foot and the right foot was $115.30{\pm}14.15cm^2$ in the left side and $124.25{\pm}13.65cm^2$ in the left side in the spinal disease patients. The difference in pressure between the left and right side of the spinal disease patients was wider than that of the general people. Especially, the right side of the spinal disease patients showed a larger area of left foot contact than the general population. Conclusion: Spinal disease patients have wider contact area of the left foot than those of the general population. In the case of right spinal disease, the left foot support area is widened due to pain. In the gait, women showed slightly more posterior body center than men, and the upper body muscle imbalance and immobilization due to the spinal disease caused imbalance of the muscles moving to the lower limb, It was analyzed to inhibit movement.

• Korean Journal of Acupuncture
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• v.38 no.3
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• pp.175-181
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• 2021

A 57-year-old female diagnosed with L5-S1 lumbar intervertebral disc herniation, suffering from severe pain despite taking tapentadol received combined Korean medicine treatment, including acupotomy, acupuncture, pharmacopuncture, and herbal therapies for 53 days. To assess pain, Numeric Rating Scale (NRS) and lumbar range of motion (ROM) were checked daily from the day of admission. Moreover, the Oswestry Disability Index (ODI) and European Quality of Life-5 Dimensions (EQ-5D) were used to evaluate function and quality of life. After combined Korean medicine treatment, reabsorptioin of intervertebral disc was confirmed by radiological examination; pain reduced from NRS 5~7 to NRS 1~2; lumbar ROM in extention increased from 20° to 30°; and function and quality of life improved. The results suggest the possibility that a combined Korean medical treatment, including acupotomy, can be used as an alternative to opioids for pain management of lumbar vertebral disc herniation.

• Journal of Korean Neurosurgical Society
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• v.64 no.1
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• pp.39-50
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• 2021

Objective : The treatment of large aneurysms of the posterior circulation is complicated and remains challenging. We here analyzed our institutional clinical outcomes of large unruptured aneurysms of the posterior circulation. Methods : This study included 56 patients who presented with a large (>10 mm) unruptured aneurysm of the posterior circulation between 2002 and 2018. Results : There were 18 (32.1%) male and 38 (67.9%) female patients, with a mean age of 53.4 years. The most common location was the vertebral artery, followed by the basilar tip and posterior cerebral artery. The median follow-up duration was 29 months. Eighteen patients (32.1%) were treated by transcranial surgery and 38 (67.9%) were treated by endovascular treatment (EVT). Post-treatment complications occurred in 16 patients (28.6%), with there being no significant difference between the transcranial surgery and EVT groups. Complete obliteration was achieved in 30 patients (53.6%), with there being no statistically significant difference between the transcranial surgery and EVT groups. Recurrence occurred in 17 patients (30.4%), and the rate of recurrence was higher in the EVT group than in the transcranial surgery group (39.5% vs. 11.1%, p=0.03). Forty-four (84%) of 56 patients showed a favorable functional outcome. In saccular aneurysm, EVT was negative predictor of worsening of functional status. Conclusion : Treatment of these aneurysms harbors an inherent high risk of morbidity. No superiority was found between transcranial surgery and EVT in terms of complications and complete obliteration, but transcranial surgery showed a higher treatment durability than EVT.