• Journal of Korean Neurosurgical Society
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• v.57 no.3
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• pp.185-191
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• 2015

Objective : In order to provide normal values of the pediatric sub-axial cervical spinal canal and vertebral body growth pattern using computed tomographic scans, a total of 318 patients less than 10 years old were included. Methods : The growth of the vertebral body and canal space was investigated using four different age groups. The Torg ratio (TR) was calculated and all patients were classified into a low TR group and a high TR group according to a cutoff value of 1.0. To account for spinal curvature, the C3-7 angle was measured. Results : Very little axial expansion and growth in height were observed (2.9 mm and 3.4 mm, respectively), and the spinal canal increments (1.8 mm) were much smaller than the dimensions of the vertebral body. The mean TR values were $1.03{\pm}0.14$ at the C3 vertebral level, $1.02{\pm}0.13$ at C4, $1.05{\pm}0.13$ at C5, $1.04{\pm}0.13$ at C6, and $1.02{\pm}0.12$ at C7 in all patients. The mean sub-axial angle (C3-7) was $7.9{\pm}10.6^{\circ}$ (range: $-17-47^{\circ}$). Conclusion : The upper sub-axial spinal canal continuously increased in size compared to the lower sub-axial spine after 8 years of age. Considerable decrements in the TR was found after late childhood compared to younger ages. Generally, there were no significant differences between boys and girls in vertical length of the cervical vertebrae. However, the axial dimension of the vertebral body and the spinal canal space varied according to gender.

• Journal of Korean Neurosurgical Society
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• v.56 no.2
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• pp.108-113
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• 2014

Objective : Ankylosing spondylitis is an inflammatory rheumatic disease mainly affecting the axial skeleton. The rigid spine may secondarily develop osteoporosis, further increasing the risk of spinal fracture. In this study, we reviewed fractures in patients with ankylosing spondylitis that had been clinically diagnosed to better define the mechanism of injury, associated neurological deficit, predisposing factors, and management strategies. Methods : Between January 2003 and December 2013, 12 patients with 13 fractures with neurological complications were treated. Neuroimaging evaluation was obtained in all patients by using plain radiography, CT scan, and MR imaging. The ASIA Impairment Scale was used in order to evaluate the neurologic status of the patients. Management was based on the presence or absence of spinal instability. Results : A total of 9 cervical and 4 thoracolumbar fractures were identified in a review of patients in whom ankylosing spondylitis had been diagnosed. Of these, 7 fractures were associated with a hyperextension mechanism. 10 cases resulted in a fracture by minor trauma. Posttraumatic neurological deficits were demonstrated in 11 cases and neurological improvement after surgery was observed in 5 of these cases. Conclusions : Patients with ankylosing spondylitis are highly susceptible to spinal fracture and spinal cord injury even after only mild trauma. Initial CT or MR imaging of the whole spine is recommended even if the patient's symptoms are mild. The patient should also have early surgical stabilization to correct spinal deformity and avoid worsening of the patient's neurological status.

• Journal of Biomedical Engineering Research
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• v.44 no.2
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• pp.139-146
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• 2023

Osteoporosis is a disease in which the risk of bone fractures increases due to a decrease in bone density caused by aging. Osteoporosis is diagnosed by measuring bone density in the total hip, femoral neck, and lumbar spine. To accurately measure bone density in the lumbar spine, the vertebral region must be segmented from the lumbar X-ray image. Deep learning-based automatic spinal segmentation methods can provide fast and precise information about the vertebral region. In this study, we used 695 lumbar spine images as training and test datasets for a deep learning segmentation model. We proposed a lumbar automatic segmentation model, CM-Net, which combines the center point of the spine and the modified U-Net network. As a result, the average Dice Similarity Coefficient(DSC) was 0.974, precision was 0.916, recall was 0.906, accuracy was 0.998, and Area under the Precision-Recall Curve (AUPRC) was 0.912. This study demonstrates a high-performance automatic segmentation model for lumbar X-ray images, which overcomes noise such as spinal fractures and implants. Furthermore, we can perform accurate measurement of bone density on lumbar X-ray images using an automatic segmentation methodology for the spine, which can prevent the risk of compression fractures at an early stage and improve the accuracy and efficiency of osteoporosis diagnosis.

• Journal of Korean Neurosurgical Society
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• v.60 no.1
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• pp.114-117
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• 2017

A 42-year-old man was admitted to our hospital with complaints of low back pain and intermittent right thigh pain. Twelve weeks before admission, the patient received intradiscal electrothermal therapy (IDET) at a local hospital. The patient still reported low back pain after the procedure that was managed with narcotic analgesics. Follow-up magnetic resonance imaging (MRI) was performed, and his referring physician thought the likely diagnosis was spondylodiscitis at the L4-5 spinal segment with a small epidural abscess. At admission to our department, the patient reported aggravated low back pain. Blood test results, including the erythrocyte sedimentation rate and C-reactive protein levels, were slightly elevated. Biopsy samples of the L4, L5 vertebral bodies and disk were obtained. The material underwent aerobic, anaerobic, fungal, mycobacterial cultures and histologic examination. Results of all cultures were negative. Histologically, necrosis of the bone was evident from the number of empty osteocyte lacunae. In addition, there was no evidence of infection based on biopsy results. No antibiotic treatment was administered on discharge. Repeat computed tomography and MRI performed 12 months after IDET showed a bony defect in the L4 and L5 vertebral bodies, and a decrease in the size of the L4-5 intervertebral disc lesion. We report a case of lumbar vertebral osteonecrosis induced by IDET and discuss etiology and radiologic features.

• The Journal of Churna Manual Medicine for Spine and Nerves
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• v.18 no.2
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• pp.1-8
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• 2023

Objectives This study aimed to propose biomarkers for diagnosing Chuna manual therapy (CMT) based on X-ray images in the thoracic and lumbar spines. Methods Through a literature review and expert consensus process, diagnostic biomarkers for CMT were selected based on the listing system in thoracic and lumbar radiograph anterior-posterior (AP) and lateral views. Results 1. Diagnostic biomarkers were derived from four points on the outer contour of the vertebral body in the thoracic and lumbar spine radiograph lateral view, enabling the diagnosis of flexion and extension malposition. 2. Additional diagnostic biomarkers were identified in the thoracic and lumbar radiographAP view, utilizing points on the outer contour of the vertebral body. These biomarkers facilitate the diagnosis of lateral bending. Moreover, biomarkers derived from the innermost point of the pedicle contour allow for the diagnosis of rotation malposition. 3. Furthermore, through the biomarkers proposed in this study, all malpositions of the thoracolumbar spines and complex Type I and II malpositions can be diagnosed in CMT. Conclusions The biomarkers reported in this study consist of minimal points to determine the position of the vertebral body, providing the advantage of simplicity while minimizing potential errors during the CMT diagnostic process. Further clinical research and the development of related programs should be pursued to expand the evidence for CMT.

• Journal of Biomedical Engineering Research
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• v.24 no.5
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• pp.447-451
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• 2003

A new method for analyzing the bone-remodeling process using quasi-molecular dynamics was proposed in this study. The effect of pressure due to bone marrow, which could not be considered in previous methods, was also considered in this method. Bone-remodeling response of the 2D vertebral body of lumbar spine to a uniaxial compressive displacement of 1.8564mm. corresponding to approximately 2kN of compressive load, was studied. Converged shape change of the cortical shell and rearrangement of cancellous bone structure matched well with a normal shape of the vertebral body. The calculated responses in the spinal elements also shows closed results compared with experimental results.

• Journal of Korean Neurosurgical Society
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• v.47 no.2
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• pp.143-147
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• 2010

We report here on an uncommon case of metastatic choriocarcinoma to the lung, brain and lumbar spine. A 33-year-old woman was admitted to the pulmonary department with headache, dyspnea and hemoptysis. There was a history of cesarean section due to intrauterine fetal death at 37-weeks gestation and this occurred 2 weeks before admission to the pulmonary department. The radiological studies revealed a nodular lung mass with hypervascularity in the left upper lobe and also a brain parenchymal lesion in the parietal lobe with marginal bleeding and surrounding edema. She underwent embolization for the lung lesion, which was suspected to be an arteriovenous malformation according to the pulmonary arteriogram. Approximately 10 days after discharge from the pulmonary department, she was readmitted due to back pain and progressive paraparesis. The neuroradiological studies revealed a hypervascular tumor occupying the entire L3 vertebral body and pedicle, and the tumor extended to the epidural area. She underwent embolization of the hypervascular lesion of the lumbar spine, and after which injection of polymethylmethacrylate in the L3 vertebral body, total laminectomy of L3, subtotal removal of the epidural mass and screw fixation of L2 and L4 were performed. The result of biopsy was a choriocarcinoma.

• Journal of Korean Neurosurgical Society
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• v.64 no.3
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• pp.437-446
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• 2021

Objective : To investigate the radiographic characteristics of the uppermost instrumented vertebrae (UIV) and UIV+1 compression fractures that are predictive of revision surgery following long-segment spinal fixation. Methods : A total 27 patients who presented newly developed compression fracture at UIV, UIV+1 after long segment spinal fixation (minimum 5 vertebral bodies, lowest instrumented vertebra of L5 or distal) were reviewed retrospectively. Patients were divided into two groups according to following management : revisional surgery (group A, n=13) and conservative care (group B, n=14). Pre- and postoperative images, and images taken shortly before and after the occurrence of fracture were evaluated for radiologic characteristics Results : Despite similar degrees of surgical correction of deformity, the fate of the two groups with proximal junctional compression fractures differed. Immediately after the fracture, the decrement of adjacent disc height in group A (32.3±7.6 mm to 23.7±8.4 mm, Δ=8.5±6.9 mm) was greater than group B (31.0±13.9 mm to 30.1±15.5 mm, Δ=0.9±2.9 mm, p=0.003). Pre-operative magnetic resonance imaging indicated that group A patients have a higher grade of disc degeneration adjacent to fractured vertebrae compared to group B (modified Pfirrmann grade, group A : 6.10±0.99, group B : 4.08±0.90, p=0.004). Binary logistic regression analysis indicated that decrement of disc height was the only associated risk factor for future revision surgery (odds ratio, 1.891; 95% confidence interval, 1.121-3.190; p=0.017). Conclusion : Proximal junctional vertebral compression fractures with greater early-stage decrement of adjacent disc height were associated with increased risk of future neurological deterioration and necessity of revision. The condition of adjacent disc degeneration should be considered regarding severity and revision rate of proximal junctional kyphosis/proximal junction failures.

• Journal of Korean Neurosurgical Society
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• v.56 no.5
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• pp.431-435
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• 2014

A fifty-year-old female non-smoker with no other specific medical history visited our institute. She complained of axial back pain with no other neurological deficit. Chest X-ray, chest computed tomography (CT) scan, CT-guided needle aspiration biopsy, whole-body positron emission tomography, spine CT and spine magnetic resonance image findings suggested NSCLC with epidermal growth factor receptor (EGFR) mutation, multiple brain metastases, and two isolated metastases to the T3 and L3 vertebral bodies. She underwent chemotherapy with gefitinib ($Iressa^{TM}$) for NSCLC and gamma knife surgery for multiple brain metastases. We performed a two-staged, total en bloc spondylectomy of the T3 and L3 vertebral bodies based on several good prognostic characteristics, such as the lack of metastases to the appendicular bone, good preoperative performance status, and being an excellent responder (Asian, never-smoker and adenocarcinoma histology) to EGFR inhibitors. Improved axial back pain after the surgery enabled her to walk with the aid of a thoracolumbosacral orthosis brace on the third postoperative day. Her Karnofsky performance status score (KPS) was 90 at the time of discharge and has been maintained to date 3 years after surgery. In selected NSCLC patients with good prognostic characteristics, we suggest that locally curative treatment such as total en bloc spondylectomy or radiosurgery should be emphasized to achieve longer term survival for the selected cases.

• Journal of Korean Neurosurgical Society
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• v.45 no.2
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• pp.122-126
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• 2009

Single-balloon kyphoplasty via an extrapedicular approach has been reported to be effective because it requires less time than conventional two-balloon kyphoplasty and has comparable therapeutic efficacy. However, single-balloon kyphoplasty is not popular because the extrapedicular approach is believed to be complicated and unsuitable for the thoracolumbar and lumbar spine. The authors describe a standardized surgical technique that utilizes a far-lateral extrapedicular approach for single-balloon kyphoplasty, which can be performed in any part of the spine by physicians without substantial difficulty.