• Journal of Preventive Medicine and Public Health
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• v.33 no.2
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• pp.184-192
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• 2000

Objectives : To inquire the prevalence and the risk factors for myofascial pain syndrome (MPS) on young boys in order to use these results as the fundamental data for the prevention of their MPS. Methods : For 7 days in May 1999, this research was taken on 489 male students ranging from 6th to 12th grade. We randomly selected a class for every group and from these classes we operated physical examinations, self-reported questionnaires and from a rehabilitation doctor, MPS test was taken. Thoracic kyphosis and lumbar lordosis were also taken by using the inclinometer. We defined MPS as a regional pain complaint, palpable taut band that is painful on compression. Results : The shoulder MPS prevalence of the subjects were 29.7 persons/100 persons. The statistics revealed that as grades went up, the percentage significantly increased in the MPS prevalence. As of case-control study, 145 students who were tested postive in all aspects were placed as cases, and 176 students who were perfectly normal as controls on risk factors. As a result of comparing the student groups who were stisfied with their chairs to the student groups were not satisfied, the taller showed a significantly higher odds ratio (p<0.01). By the multiple logistic regression test, we concluded that the MPS disease was prevailed far more in the students in the higher grades (Odds ratio: 1.16, 95% C.I.: 1.03-1.31), and also those who were dissatisfied with their chairs than in the ones who were satisfied (Odds ratio: 1.92, 95% C.I.: 1.17-3.17). Conclusions : Significant correlations showed between the MPS diagnosed group and the students who are dissatisfied with their chairs. As a result, more research and observation has to be made concerning this disease, and the desks and chairs should be adjusted to suit the student's physical standards.

• Archives of Plastic Surgery
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• v.40 no.5
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• pp.559-563
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• 2013

Background One of the reasons women with macromastia chose to undergo a breast reduction is to relieve their complaints of back, neck, and shoulder pain. We hypothesized that changes in posture after surgery may be the reason for the pain relief and that patient posture may correlate with symptomatic macromastia and may serve as an objective measure for complaints. The purpose of our study was to evaluate the effect of reduction mammaplasty on the posture of women with macromastia. Methods A prospective controlled study at a university medical center. Forty-two patients that underwent breast reduction were studied before surgery and an average of 4.3 years following surgery. Thirty-seven healthy women served as controls. Standardized lateral photos were taken. The inclination angle of the back was measured. Regression analysis was performed for the inclination angle. Results Preoperatively, the mean inclination angle was 1.61 degrees ventrally; this diminished postoperatively to 0.72 degrees ventrally. This change was not significant (P-value=0.104). In the control group that angle was 0.28 degrees dorsally. Univariate regression analysis revealed that the inclination was dependent on body mass index (BMI) and having symptomatic macromastia; on multiple regression it was only dependent on BMI. Conclusions The inclination angle of the back in breast reduction candidates is significantly different from that of controls; however, this difference is small and probably does not account for the symptoms associated with macromastia. Back inclination should not be used as a surrogate "objective" measure for symptomatic macromastia.

• Journal of Trauma and Injury
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• v.23 no.2
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• pp.175-179
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• 2010

Purpose: Sternal fractures after blunt thoracic trauma can cause significant pain and disability. They are relatively uncommon as a result of direct trauma to the sternum and open reduction is reserved for those with debilitating pain and fracture displacement. We reviewed consecutive 11 cases of open reduction and fixation of sternum and tried to find standard approach to the traumatic sternal fractures with severe displacement. Methods: From December 2008 to August 2010, the medical records of 11 patients who underwent surgical reduction and fixation of sternum for sternal fractures with severe displacement were reviewed. We investigated patients' characteristics, chest trauma, associated other injuries, type of open reduction and fixation, combined operations, preoerative ventilator support and postoperative complications. Results: The mean patient age was 59.3years (range, 41~79). The group comprised 6 male and 5 female subjects. Among 11 patients who underwent open reduction and fixation for sternal fracture with severe displacement, 6 cases had isolated sternal fractures and the other 5 patients had associated other injuries. Sternal fractures were caused by car accidents (9/11, 81.8%), falling down (1/11, 9.1%) and direct blunt trauma to the sternum (1/11, 9.1%), respectively. 3 of the 7 patients (42.9%) who underwent sternal plating with longitudinal plates showed loosening of fixation. Otherwise, none of the 4 patients who underwent surgical fixation using T-shaped plate had stable alignment of the fracture. Conclusion: Sternal fractures with severe displacement need to be repaired to prevent chronic pain, instability of the anterior chest wall, deformity of the sternum, and even kyphosis. In the present study, a T-shaped plate with a compression-tension mechanism constitutes the treatment of choice for displaced sternal fractures.

• Journal of Korean Neurosurgical Society
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• v.49 no.5
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• pp.273-277
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• 2011

Objective : A single balloon extrapedicular kyphoplasty has been introduced as one of the unilateral approaches for thoracic compression fractures; however, the unilateral extrapedicular technique in the lumbar area needs a further understanding of structures in the lumbar area. The purpose of the present study is to describe methods and pitfalls of this procedure based on the anatomy of the lumbar area and to analyze clinical outcome and complications. Methods : Anatomical evaluation was performed with 2 human cadavers. A retrospective review of unilateral extrapedicular approaches yielded 74 vertebral levels in 55 patients that were treated with unilateral extrapedicular vertebroplasty and kyphoplasty. Radiographic assessment included the restoration rate of vertebral height and correction of kyphosis. Results : Anatomical evaluation indicates that the safe needle entry zone of bone for the extrapedicular approach was located in the supero-lateral aspect of the junction between the pedicle and vertebral body. The unilateral extrapedicular procedure achieved adequate pain relief with a mean decreases in pain severity of $7.25{\pm}1.5$ and $2.0{\pm}1.4$, respectively. Complications were 1 retroperitoneal hematoma, 6 unilateral fillings and 3 epidural leak of the polymethylmethacrylate. Conclusion : The method of a unilateral extrapedicular approach in kyphoplasty and vertebroplasty in the lumbar area might be similar to that in thoracic approach using a route via the extrapedicular space. However, different anatomical characteristics of the lumbar area should be considered.

• Journal of Korean Neurosurgical Society
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• v.39 no.4
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• pp.256-259
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• 2006

Objective : Having a reliable and reproducible measurement technique to measure the sagittal contour in vertebral fractures is paramount to clinical decision making. This study is designed to determine the most reliable measurement technique in osteoporotic vertebral compression fracture. Methods : Fifteen lateral radiographs of thoracic and lumbar fractures were selected and measured on two separate occasions by three spine surgeons using six different measurement techniques [Centroid, Harrison Posterior Tangent Methods and 4 different types of modified Cobb method]. The radiograph quality was assessed and the center beam location was determined. Statistical analysis including ANOVA for repeated measures was carried out using the SAS software [v 8.0]. Results : The inter and intraobserver variance of the Cobb method 4 and Harrison posterior tangent method were significantly lower than the other four methods. The intraobserver correlation coefficients were the most consistent using the Cobb method 4 [0.982]. which was followed by the Harrison posterior tangent [0.953] and Cobb methods 1 [0.874]. The intraobserver agreement [% of repeated measures within 5 degrees of the original measurement] ranged from 42% to 98% for each technique for all three observers, with the Cobb method 4 showing the best agreement [97.8%] followed by the Harrison posterior tangent method [937%]. Conclusion : The Cobb method-4 and Harrison posterior tangent methods, when applied to measuring the kyphosis, are reliable and have a similar small error range. The Cobb method 4 shows the best overall reliability. However, the centroid method and Cobb method using a fractured endplate do not produce an accurate result due to inter and intraobserver differences in determining the baseline.

• Journal of Korean Neurosurgical Society
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• v.38 no.6
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• pp.435-441
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• 2005

Objective : Expandable cage used for spinal reconstruction after corpectomy has several advantages over nonexpendable cages. Here we present our clinical experience with the use of this cage after anterior column corpectomy with an average of one year follow up. Methods : Ten patients underwent expandable cage reconstruction of the anterior column after single-level or multilevel corpectomy for various cervical spinal disorders. Anterior plating with or without additional posterior instrumentation were performed in all patients. Functional outcomes, complications, and radiographic outcomes were determined. Results : There was no cage-related complication. Functionally, neurological examination revealed improvement in 7 of 10 patients and no patient had neurological deterioration after the surgery. Immediate stability was achieved and maintained throughout the period of follow-up. There was minimal subsidence [<2mm] noticeable in three of the cases that underwent a two-level corpectomy. Subsidence was noted in osteoporotic patients and patients undergoing multi-level corpectomies. Average pre-operative kyphotic angle was 9 degrees. This was corrected to an average of 5.4 degrees in lordosis postoperatively. Conclusion : In conclusion, expandable cages are safe and effective devices for vertebral body replacement after cervical corpectomy when used in combination with anterior plating with or without additional posterior stabilization. The advantages of using expandable cages include its ability to easily accommodate itself into the corpectomy defect, its ability to tightly purchase into the end plates after expansion and thus minimizing the potential for migration, and finally, its ability to correct kyphosis deformity via its in vivo expansion properties.

• Journal of Korean Neurosurgical Society
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• v.56 no.3
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• pp.211-217
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• 2014

Objective : In Korea, early vertebroplasty (EVP) or delayed vertebroplasty (DVP, which is performed at least 2 weeks after diagnosis) were performed for the treatment of acute osteoporotic compression fracture (OCF) of the spine. The present study compared the outcomes of two surgical strategies for the treatment of single-level acute OCF in the thoracolumbar junction (T12-L2). Methods : From 2004 to 2010, 23 patients were allocated to the EVP group (EVPG) and 27 patients to the DVP group (DVPG). Overall mean age was $68.3{\pm}7.9$ and minimum follow-up period was 1.0 year. Retrospective study of clinical and radiological results was conducted. Results : No significant differences in baseline characteristics were observed between the two groups. As expected, mean duration from onset to vertebroplasty and mean duration of hospital stay were significantly longer in the DVPG ($17.1{\pm}2.1$ and $17.5{\pm}4.2$) than in the EVPG ($3.8{\pm}3.3$ and $10.8{\pm}5.1$, p=0.001). Final clinical outcome including visual analogue scale (VAS), Oswestry Disability Index, and Odom's criteria did not differ between the two groups. However, immediate improvement of the VAS after vertebroplasty was greater in the EVPG ($5.1{\pm}1.3$) than in the DVPG ($4.0{\pm}1.0$, p=0.002). The proportion of cement leakage was lower in the EVPG (30.4%) than in the DVPG (59.3%, p=0.039). In addition, semiquantitative grade of cement interdigitation was significantly more favorable in the EVPG than in the DVPG (p=0.003). Final vertebral body collapse and segmental kyphosis did not differ significantly between the two groups. Conclusion : Our findings suggest that EVP achieves a better immediate surgical effect with more favorable cost-effectiveness.

• Journal of Korean Neurosurgical Society
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• v.60 no.5
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• pp.560-566
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• 2017

Objectvie : The global sagittal postural patterns as characterized by Roussouly classification have been previously described in various ethnicities, there were no studies investigated in Koreans. To analyze the distribution of the global sagittal postural patterns in Korean adults using Roussouly classification, the author prospectively studied. Methods : 252 asymptomatic Korean adults was recruited. Data was obtained by reviewing the films for each subject. Spinopelvic parameters were measured and sagittal postural patterns were then determined according to Roussouly classification. We compared the data across different ethnicities from our study and a previous study to further characterize Korean sagittal postures. Results : The subject included 151 males and 101 females, with mean age of $33.2{\pm}8.2years$. The average descriptive results were as below : thoracic kyphosis $28.6{\pm}7.7^{\circ}$, lumbar lordosis $48.3{\pm}10.2^{\circ}$, sacral slope $37.8{\pm}5.8^{\circ}$, pelvic incidence $45.1{\pm}7.5^{\circ}$, pelvic tilt $9.4{\pm}6.7^{\circ}$, spinosacral angle $130.1{\pm}5.4^{\circ}$, and sagittal vertical axis $16.25{\pm}22.5mm$. 125 subjects among 252 (49.6%) belonged to Roussouly type 3 (namely neutral). There were also 58 (23%), 33 (13.1%), and 36 (14.3) subjects in type 1, 2, and 4 (namely non-neutral), respectively. Conclusion : Enrolling 252 asymptomatic Korean adults, this prospective study found that 49.6% of asymptomatic Korean adults possessed a sagittal posture of Roussouly type 3. All radiologic parameters follows general concept of spinal sagittal balance pattern. Overall, this study might be a basis for further investigation of spinal sagittal balance.

• Journal of Korean Neurosurgical Society
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• v.60 no.5
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• pp.567-576
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• 2017

Objective : Preoperative parameters including the T1 slope (T1S) and C2-C7 sagittal vertical axis (SVA) have been recognized as predictors of kyphosis after laminoplasty, which is accompanied by posterior neck muscle damage. The importance of preoperative parameters has been under-estimated in anterior cervical discectomy and fusion (ACDF) because there is no posterior neck muscle damage. We aimed to determine whether postoperative subsidence and pseudarthrosis could be predicted according to specific parameters on preoperative plain radiographs. Methods : We retrospectively analyzed 41 consecutive patients (male : female, 22 : 19; mean age, $51.15{\pm}9.25years$) who underwent ACDF with a stand-alone polyether-ether-ketone (PEEK) cage (>1 year follow-up). Parameters including SVA, T1S, segmental angle and range of motion (ROM), C2-C7 cervical angle and ROM, and segmental inter-spinous distance were measured on preoperative plain radiographs. Risk factors of subsidence and pseudarthrosis were determined using multivariate logistic regression. Results : Fifty-five segments (27 single-segment and 14 two-segment fusions) were included. The subsidence and pseudarthrosis rates based on the number of segments were 36.4% and 29.1%, respectively. Demographic data and fusion level were unrelated to subsidence. A greater T1S was associated with a lower risk of subsidence (p=0.017, odds ratio=0.206). A cutoff value of T1S<$28^{\circ}$ significantly predicted subsidence (sensitivity : 70%, specificity : 68.6%). There were no preoperative predictors of pseudarthrosis except old age. Conclusion : A lower T1S (T1S<$28^{\circ}$) could be a risk factor of subsidence following ACDF. Surgeons need to be aware of this risk factor and should consider various supportive procedures to reduce the subsidence rates for such cases.

• Journal of Korean Neurosurgical Society
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• v.62 no.5
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• pp.567-576
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• 2019

Objective : Minimal data exist regarding non-operative management of suspected pseudarthrosis after pedicle subtraction osteotomy (PSO). This study reports radiographic and clinical outcomes of non-operative management for post-PSO pseudarthrosis at a minimum 5 years post-detection. Methods : Nineteen consecutive patients with implant breakage indicating probable pseudarthrosis after PSO surgery (13 women/six men; mean age at surgery, 58 years) without severe pain and disability were treated with non-operative management (mean follow-up, 5.8 years; range, 5-10 years). Non-operative management included medication, intermittent brace wearing and avoidance of excessive back strain. Radiographic and clinical outcomes analysis was performed. Results : Sagittal vertical axis (SVA), proximal junctional angle, thoracic kyphosis achieved by a PSO were maintained after detection of pseudarthrosis through ultimate follow-up. Lumbar lordosis and PSO angle decreased at final follow-up. There was no significant change in Oswestry Disability Index (ODI) scores and Scoliosis Research Society (SRS) total score, or subscales of pain, self-image, function, satisfaction and mental health between detection of pseudarthrosis and ultimate follow-up. SVA greater than 11 cm showed poorer ODI and SRS total score, as well as the pain, self-image, and function subscales (p<0.05). Conclusion : Non-operative management of implant failure of probable pseudarthrosis after PSO offers acceptable outcomes even at 5 years after detection of implant breakage, provided SVA is maintained. As SVA increased, outcome scores decreased in this patient population.