• Journal of Korean Neurosurgical Society
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• v.37 no.5
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• pp.380-382
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• 2005

We report a case of atlantoaxial subluxation with bilateral high-riding vertebral artery with narrow isthmus. Because of the potential risk of bilateral vertebral artery injury, we performed atlantoaxial fixation using rod and screw instead of transarticular screw fixation. Although postoperative computed tomography reconstruction demonstrated slight breach of bilateral vertebral artery groove, postoperative angiography showed no evidence of vertebral artery injury. Though technically demanding, atlantoaxial fixation using rod and screw can be a one of the treatment options for atlantoaxial instability with bilateral high riding vertebral artery.

• Journal of Korean Neurosurgical Society
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• v.30 no.5
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• pp.666-669
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• 2001

We report a case of meningeal hemangiopericytoma presenting as metastasis in the vertebral body and pedicle of the thoracic spine. Hemangiopericytoma is a rare vascular neoplasm. Although the tumor has a strong propensity for both local recurrence and extracranial metastasis, metastasis to thoracic spine is very rare and only two cases were found in the literature. A 44-year-old woman with paraparesis and pain in the thoracic and lower legs was examined by plain radiographs and magnetic resonance imaging. The intracranial hemangiopericytoma was operated 3 years ago. Magnetic resonance imaging demonstrated a tumor invading the left vertebral body and pedicle of the 11th thoracic spine, and compressing the dural sac. The patient was gradually improved after surgical removal of the lesions and the histologic findings were characteristics of hemangiopericytoma.

• Journal of Korean Neurosurgical Society
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• v.43 no.2
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• pp.117-118
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• 2008

Aortic abdominal aneurysm rarely has been reported as causing osteolytic lesions of the spine. It may produce back and radiating pain patterns similar to those of several commonly encountered neurosurgical processes. We report a uncommon complication of huge pulsating aortic aneurysm causing severe vertebral erosion with incapacitating back and radiating pain.

• Journal of the Korea Academia-Industrial cooperation Society
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• v.14 no.9
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• pp.4429-4436
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• 2013

Measurements of CNR(Contrast to Noise Ratio) and SNR(Signal to Noise Ratio) of T-spine breathing technique (TBT) using spontaneous breathing and T-spine exhalation technique (TET) with full exhalation were carried out, and with which the more appropriate method was suggested. Both TBT and TET were examined in a sample of fifty-three patients who visit to our hospital for spinal disease from June 2012 to November 2012. All images were evaluated with CNR measured from the differences between the mean pixels and contrast density as setting ROI of spinous process, pedicle, vertebral body, intervertebral foramen, and intervertebral disk using Image J. SNR was measured with the mean pixels and the standard deviation as setting ROI of vertebral body using Image J. In CNR comparison and SNR comparison of TET and TBT, TBT was indicated as excellent in ROI of pedicle, vertebral body, intervertebral foramen and intervertebral disk, and statistical analysis were significant(p<.01). As TBT indicated excellent images compared to the existing T-spine lateral radiography, T-spine lateral radiography would be reestablished and significant as applying to various medical institutions.

• Fibers and Polymers
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• v.4 no.2
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• pp.89-96
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• 2003

A vertebral cage is a hollow medical device which is used in spine forgery. By implanting the cage into the spine column, it is possible to restore disc and relieve pressure on the nerve roots. Most cages have been made of titanium alloys but they detract the biocompatibility. Currently PEEK (polyether ether ketone) if applied to various implants because it has good properties like heat resistance, chemical resistance, strength, and especially biocompatibility. A new shape of vertebral cage is designed and injection molding of PEEK is considered for production. Before injection molding of the cage, it is needed to evaluate process conditions and properties of the final product. Variables affecting the shrinkage of the cage are considered, e.g., injection time, packing pressure, mold temperature, and melt temperature. By using the numerical simula-tion program, MOLDFLOW, several cases are studied. Data files obtained by MOLDFLOW analysis are used for stress anal-ysis with ABAQUS, and shrinkage and residual stress fields are predicted. With these results, optimum process conditions are determined.

• Journal of Korean Neurosurgical Society
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• v.56 no.4
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• pp.348-352
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• 2014

High-flow vertebral arteriovenous fistulas (VAVF) are rare complications of cervical spine surgery and characterized by iatrogenic direct-communication of the extracranial vertebral artery (VA) to the surrounding venous plexuses. The authors describe two patients with VAVF presenting with ischemic presentation after C1 pedicle screw insertion for a treatment of C2 fracture and nontraumatic atlatoaxial subluxation. The first patient presented with drowsy consciousness with blurred vision. The diffusion MRI showed an acute infarction on bilateral cerebellum and occipital lobes. The second patient presented with pulsatile tinnitus, dysarthria and a subjective weakness and numbness of extremities. In both cases, digital subtraction angiography demonstrated high-flow direct VAVFs adjacent to C1 screws. The VAVF of the second case occurred near the left posterior inferior cerebellar artery originated from the persistent first intersegmental artery of the left VA. Both cases were successfully treated by complete occlusion of the fistulous portion and the involved segment of the left VA using endovascular coil embolization. The authors reviewed the VAVFs after the upper-cervical spine surgery including C1 screw insertion and the feasibility with the attention notes of its endovascular treatment.

• The Journal of Churna Manual Medicine for Spine and Nerves
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• v.6 no.1
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• pp.53-61
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• 2011

Objective: The purpose of this study is to evaluate the disc block subluxation for lumbar scoliosis and herniation of nucleus pulpous (HNP). Methods: We used AP & Lateral view X-ray for patients. And we measured of disc wedge angle, vertebral body rotation to evaluate the typical and atypical disc block subluxation. Results: On the analysis of the lateral view X-ray, 4th lumbar intervertebral disc angle (I.V.D angle) showed $4^{\circ}$, $5^{\circ}$, $3^{\circ}$, $0^{\circ}$ in the cases. On the 4th lumbar analysis of the AP view X-ray, lumbar scoliosis showed right disc wedge angle was $11^{\circ}$ (case 1), $17^{\circ}$ (case 2) and left vertebral body rotation was 13mm, 6mm. Lumbar HNP showed left disc wedge angle was $5^{\circ}$ (case 3), $4^{\circ}$ (case 4) and left vertebral body rotation was 2mm, 4mm. Conclusions: Disc block subluxation has been in lumbar scoliosis, but not been in lumbar HNP.

• Progress in Medical Physics
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• v.24 no.3
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• pp.145-153
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• 2013

Stereotactic body radiation therapy (SBRT) is increasingly used to treat spinal metastases. To achieve the highest steep dose gradients and conformal dose distributions of target tumors, intensity-modulated radiation therapy (IMRT) and volumetric-modulated arc therapy (VMAT) techniques are essential to spine radiosurgery. The purpose of the study was to qualitatively compare IMRT and VMAT techniques with International Spine Radiosurgery Consortium (ISRC) contoured consensus guidelines for target volume definition. Planning target volume (PTV) was categorized as TB, $T_{BPT}$ and $T_{ST}$ depending on sectors involved; $T_B$ (vertebral body only), $T_{BPT}$ (vertebral body+pedicle+transverse process), and $T_{ST}$ (spinous process+transverse process). Three patients treated for spinal tumor in the cervical, thoracic, and lumbar region were selected. Eacg tumor was contoured by the definition from the ISRC guideline. Maximum spinal cord dose were 12.46 Gy, 12.17 Gy and 11.36 Gy for $T_B$, $T_{BPT}$ and $T_{ST}$ sites, and 11.81 Gy, 12.19 Gy and 11.99 Gy for the IMRT, RA1 and RA2 techniques, respectively. Average fall-off dose distance from 90% to 50% isodose line for $T_B$, $T_{BPT}$, and $T_{ST}$ sites were 3.5 mm, 3.3 mm and 3.9 mm and 3.7 mm, 3.7 mm and 3.3 mm for the IMRT, RA1 and RA2 techniques, respectively. For the most complicated target $T_{BPT}$ sites in the cervical, thoracic and lumbar regions, the conformity index of the IMRT, RA1 and RA2 is 0.621, 0.761 and 0.817 and 0.755, 0.796 and 0.824 for rDHI. Both IMRT and VMAT techniques delivered high conformal dose distributions in spine stereotactic radiosurgery. However, if the target volume includes the vertebral body, pedicle, and transverse process, IMRT planning resulted in insufficient conformity index, compared to VMAT planning. Nevertheless, IMRT technique was more effective in reducing the maximum spinal cord dose compared to RA1 and RA2 techniques at most sites.

• Journal of Korean Neurosurgical Society
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• v.52 no.4
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• pp.384-390
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• 2012

Objective : The objective of this study was to investigate the morphologic characteristics between the vertebral body and the regions of the cervical and thoracic spinal cords where each rootlets branch out. Methods : Sixteen adult cadavers (12 males and 4 females) with a mean age of 57.9 (range of 33 to 70 years old) were used in this study. The anatomical relationship between the exit points of the nerve roots from the posterior root entry zone at each spinal cord segment and their corresponding relevant vertebral bodies were also analyzed. Results : Vertical span of the posterior root entry zone between the upper and lower rootlet originating from each spinal segment ranged from 10-12 mm. The lengths of the rootlets from their point of origin at the spinal cord to their entrance into the intervertebral foramen were 5.9 mm at the third cervical nerve root and increased to 14.5 mm at the eighth cervical nerve root. At the lower segments of the nerve roots (T3 to T12), the posterior root entry zone of the relevant nerve roots had a corresponding anatomical relationship with the vertebral body that is two segments above. The posterior root entry zones of the sixth (94%) and seventh (81%) cervical nerve roots were located at a vertebral body a segment above from relevant segment. Conclusion : Through these investigations, a more accurate diagnosis, the establishment of a better therapeutic plan, and a decrease in surgical complications can be expected when pathologic lesions occur in the spinal cord or vertebral body.

• Journal of Korean Neurosurgical Society
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• v.58 no.6
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• pp.534-538
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• 2015

Objective : To correct apical vertebral rotation for adolescent idiopathic scoliosis (AIS), direct vertebral derotation (DVD) or simple rod rotation (SRR) might be considered. The aim of the present study is to introduce the surgical experiences of AIS by a Korean neurosurgeon and to evaluate the effectiveness of SRR for apical vertebral rotation. Methods : A total of 9 patients (1 male and 8 females) underwent scoliosis surgery by a neurosurgeon of our hospital. The Lenke classifications of the patients were 1 of 1B, 2 of 1C, 1 of 2A, 1 of 2C, 3 of 5C and 1 of 6C. Surgery was done by manner of simple rod rotation on the concave side and in situ coronal bending. Coronal Cobb's angles, vertebral rotation angles and SRS-22 were measured on a plain standing X-ray and CT before and after surgery. Results : The mean follow up period was 25.7 months (range : 5-52). The mean number of screw positioning level was nine (6-12). The mean age was 16.4 years (range : 13-25) at surgery. The mean Risser grade was $3.7{\pm}0.9$. The apical vertebral rotation measured from the CT scans was $25.8{\pm}8.5^{\circ}$ vs. $9.3{\pm}6.7^{\circ}$ (p<0.001) and the Coronal Cobb's angle was $53.7{\pm}10.4^{\circ}$ vs. $15.4{\pm}6.5^{\circ}$ (p<0.001) preoperatively and postoperative, respectively. The SRS-22 improved from 71.9 preoperatively to 90.3 postoperatively. There were no complications related with the operations. Conclusion : SRR with pedicle screw instrumentation could be corrected successfully by axial rotation without complications. SRR might serve as a good option to correct AIS deformed curves of AIS.