• Journal of the Korean Orthopaedic Association
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• v.55 no.1
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• pp.85-89
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• 2020

Bow hunter's syndrome is a rare disease that shows the symptoms of vertebrobasilar insufficiency resulting from a dynamic obstruction or stenosis of the vertebral arteries during neck movement. This paper reports a case of a 59-year-old male who visited the emergency room with diplopia, tinnitus, and gait disturbance. Magnetic resonance imaging and angiography revealed a multiple cerebellar infarct, total obstruction of the right vertebral artery, and dynamic obstruction of the left vertebral artery during neck extension. As the infarction worsened, a thrombectomy was done. Posterior decompression and fusion at C5-6 were performed for the left vertebral artery. The left vertebral arterial patency was confirmed by intraoperative and postoperative angiography. No recurrence of the symptoms was observed for six months after surgery. Physicians need to pay attention to the diagnosis of vertebrobasilar insufficiency caused by an obstruction of the vertebral arteries during neck extension in cervical instability patients.

• Journal of Korean Society of Spine Surgery
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• v.25 no.4
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• pp.154-159
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• 2018

Study Design: Retrospective radiographic study. Objective: To evaluate the characteristics of concurrent degenerative cervical and lumbar spondylolisthesis. Summary of Literature Review: Concurrent degenerative cervical and lumbar spondylotic diseases have been reported. Given that severe spondylosis can result in spondylolisthesis, one might expect that concurrent spondylolisthesis of the cervical and lumbar spines might also be prevalent. However, the incidence of spondylolistheses in the lumbar and cervical spines might differ due to anatomical differences between the 2 areas. Nonetheless, there is minimal information in the literature concerning the incidence of concurrent cervical and lumbar spondylolisthesis. Material and Methods: We evaluated standing cervical and lumbar lateral radiographs of 2510 patients with spondylosis. Concurrence, age group, gender, and direction of spondylolisthesis were evaluated. Lumbar spondylolisthesis was defined as at least Meyerding grade I and degenerative cervical spondylolisthesis was defined as over 2 mm of displacement on standing lateral radiographs. Results: Lumbar spondylolisthesis was found in 125 patients (5.0%) and cervical spondylolisthesis was found in 193 patients (7.7%). Seventeen patients had both degenerative cervical and lumbar spondylolistheses (0.7%). Lumbar spondylolisthesis is a risk factor for coexisting cervical spondylolisthesis. Lumbar spondylolisthesis was more common in females than males, independent of advancing age. In contrast, degenerative cervical spondylolisthesis was more common in older patients, independent of gender. Anterolisthesis was more common in the lumbar spine. Retrolisthesis was more common in the cervical spine. Conclusions: There was a higher prevalence of degenerative cervical spondylolisthesis in patients with degenerative lumbar spondylolisthesis.

• Journal of Physiology & Pathology in Korean Medicine
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• v.27 no.3
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• pp.280-288
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• 2013

Hua-Tuo(145-208) created five "WuQinXi" exercise by imitating the movements of a tiger, a deer, a bear, a monkey and a bird. The "WuQinXi" exercise, one of the medical Qi-gongs, is an exercise maximizing human's self healing power and has been effective significantly at several modern researches. There are many exercise therapies in western medcine, such as Willamss flexion exercise, Mckenzie's extension exercise, vertebral stabilization exercise and so on. However, there isn't a special exercise therapy which can be applied for medical practice in oriental medicine. So We selected some motions from "WuQinXi" exercise, which are suitable for lumbar spinal disease, and analyzed them. After that, We assorted them by kinds of lumbar spinal disease. First, We selected 22 motions which are related with lumbar movements from 3 type "WuQinXi" exercises ; 10 mode, 15 mode, 18 mode. And then, We classified them according to lumbar movements as flexion, extention, lateral bending and rotation, and also functions as stabilization and rubbing. Next, with these classifications, We assorted those motions by kinds of lumbar spinal disease as HIVD(herniation of intervertebral disc), spinal stenosis, spondylolysis and spondylolisthesis, facet joint syndrome, compression fracture and spondylosis. We expect that trying "WuQinXi" exercise at clinic in this way, the particular exercise therapy of oriental medicine, "WuQinXi" exercise will become more popular. And Oriental medical doctors will be able to teach patients "WuQinXi" exercise's motions easily at clinic, depending on kinds of lumbar spinal disease each patient suffers from. We plan to study more about 20 mode, 30 mode, 40 mode and the effect of "WuQinXi" exercise by comparing patients who do the "WuQinXi" exercise with the patients who do the western medical exercise therapy.

• Journal of Korean Neurosurgical Society
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• v.42 no.4
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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.

• Journal of Korean Neurosurgical Society
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• v.61 no.5
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• pp.574-581
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• 2018

Objective : The zero-profile implant (Zero-P) is accepted for use in anterior cervical fusion for the treatment of degenerative cervical disease. However, evidence pertaining to its efficiency and safety in traumatic cervical injury is largely insufficient. This study aimed to compare the overall outcomes of patients who underwent Zero-P for traumatic cervical disc injury. Methods : Data from a total of 53 consecutive patients who underwent surgery for traumatic or degenerative cervical disc disease using the Zero-P were reviewed. Seventeen patients (group A) had traumatic cervical disc injury and the remaining 36 (group B) had degenerative cervical disc herniation. The fusion and subsidence rates and Cobb angle were measured retrospectively from plain radiographs. The patients' clinical outcomes were evaluated using the Japanese Orthopedic Association (JOA) score and Odom's criteria. Results : The C2-7 Cobb and operative segmental angles increased by $3.45{\pm}7.61$ and $2.94{\pm}4.59$ in group A; and $2.46{\pm}7.31$ and $2.88{\pm}5.49$ in group B over 12 postoperative months, respectively. The subsidence and fusion rate was 35.0% and 95.0% in group A; and 36.6% and 95.1% in group B, respectively. None of the parameters differed significantly between groups. The clinical outcomes were similar in both groups in terms of increasing the JOA score and producing a grade higher than "good" using Odom's criteria. Conclusion : The application of Zero-P in patients with traumatic cervical disc injury was found to be acceptable when compared with the clinical and radiological outcomes of degenerative cervical spondylosis.

• Journal of Korean Neurosurgical Society
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• v.51 no.1
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• pp.14-19
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• 2012

Objective : The authors performed a retrospective study to assess the clinical and radiological outcome in symptomatic lumbar spondylolysis patients who underwent a direct pars repair surgery using two different surgical methods; pedicle screw with universal hook system (PSUH) and direct pars screw fixation (DPSF), and compared the results between two different treated groups. Methods : Forty-seven consecutive patients (PSUH; 23, DPSF; 15) with symptomatic lumbar spondylolysis who underwent a direct pars repair surgery were included. The average follow-up period was 37 months in the PSUH group, and 28 months in the DPSF group. The clinical outcome was measured using visual analogue pain scale (VAS) and Oswestry disability index (ODI). The length of operation time, the amount of blood loss, the duration of hospital stay, surgical complications, and fusion status were also assessed. Results : When compared to the DPSF group, the average preoperative VAS and ODI score of the PSUH group were less decreased at the last follow-up; (the PSUH group; back VAS : 4.9 vs. 3.0, leg VAS : 6.8 vs. 2.2, ODI : 50.6% vs. 24.6%, the DPSF group; back VAS : 5.7 vs. 1.1, leg VAS : 6.1 vs. 1.2, ODI : 57.4% vs. 18.2%). The average operation time was 174.9 minutes in the PSUH group, and 141.7 minutes in the DPSF group. The average blood loss during operation was 468.8 cc in the PSUH group, and 298.8 cc in the DPSF group. The average hospital stay after operation was 8.9 days in the PSUH group, and 7 days in the DPSF group. In the PSUH group, there was one case of a screw misplacement requiring revision surgery. In the DPSF group, one patient suffered from transient leg pain. The successful bone fusion rate was 78.3% in the PSUH group, and 93.3% in the DPSF group. Conclusion : The present study suggests that the technique using direct pars screw would be more effective than the method using pedicle screw with lamina hook system, in terms of decreased operation time, amount of blood loss, hospital stay, and increased fusion success rate, as well as better clinical outcome.

• Journal of Korean Neurosurgical Society
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• v.60 no.5
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• pp.577-583
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• 2017

Objective : Laminoplasty is an effective surgical method for treating cervical degenerative disease. However, postoperative complications such as kyphosis, restriction of neck motion, and instability are often reported. Despite sufficient preoperative lordosis, this procedure often aggravates the lordotic curve of the cervical spine and straightens cervical alignment. Hence, it is important to examine preoperative risk factors associated with postoperative kyphotic alignment changes. Our study aimed to investigate preoperative radiologic parameters associated with kyphotic deformity post laminoplasty. Methods : We retrospectively reviewed the medical records of 49 patients who underwent open door laminoplasty for cervical spondylotic myelopathy (CSM) or ossification of the posterior longitudinal ligament (OPLL) at Pusan National University Yangsan Hospital between January 2011 and December 2015. Inclusion criteria were as follows : 1) preoperative diagnosis of OPLL or CSM, 2) no previous history of cervical spinal surgery, cervical trauma, tumor, or infection, 3) minimum of one-year follow-up post laminoplasty with proper radiologic examinations performed in outpatient clinics, and 4) cases showing C7 and T1 vertebral body in the preoperative cervical sagittal plane. The radiologic parameters examined included C2-C7 Cobb angles, T1 slope, C2-C7 sagittal vertical axis (SVA), range of motion (ROM) from C2-C7, segmental instability, and T2 signal change observed on magnetic resonance imaging (MRI). Clinical factors examined included preoperative modified Japanese Orthopedic Association scores, disease classification, duration of symptoms, and the range of operation levels. Results : Mean preoperative sagittal alignment was $13.01^{\circ}$ lordotic; $6.94^{\circ}$ lordotic postoperatively. Percentage of postoperative kyphosis was 80%. Patients were subdivided into two groups according to postoperative Cobb angle change; a control group (n=22) and kyphotic group (n=27). The kyphotic group consisted of patients with more than $5^{\circ}$ kyphotic angle change postoperatively. There were no differences in age, sex, C2-C7 Cobb angle, T1 slope, C2-C7 SVA, ROM from C2-C7, segmental instability, or T2 signal change. Multiple regression analysis revealed T1 slope had a strong relationship with postoperative cervical kyphosis. Likewise, correlation analysis revealed there was a statistical significance between T1 slope and postoperative Cobb angle change (p=0.035), and that there was a statistically significant relationship between T1 slope and C2-C7 SVA (p=0.001). Patients with higher preoperative T1 slope demonstrated loss of lordotic curvature postoperatively. Conclusion : Laminoplasty has a high probability of aggravating sagittal balance of the cervical spine. T1 slope is a good predictor of postoperative kyphotic changes of the cervical spine. Similarly, T1 slope is strongly correlated with C2-C7 SVA.

• Journal of the Korean Society of Radiology
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• v.81 no.3
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• pp.654-664
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• 2020

Purpose To determine the frequency of ossification of the transverse ligament of the atlas (OTLA) and to investigate the associated findings on cervical spine CT and plain radiography. Materials and Methods We reviewed 5201 CT scans of the cervical spine of 3975 consecutive patients over an 11-year period for the presence of OTLA and compared them with those of age- and sex-matched controls. The frequency and associated findings of OTLA were investigated and statistically correlated. Results The overall frequency of OTLA was 1.1% (45 of 3975 patients) and increased with age (p < 0.005). The frequency of OTLA in patients over 80 years was 12%. The space available for the spinal cord (SAC) was smaller in patients with OTLA (p < 0.005). Mineralization of the complex of the anterior atlantooccipital membrane and Barkow ligament, ossification of the ligamentum flavum, and kyphosis of the cervical spine positively correlated to the presence of OTLA (p < 0.005). Conclusion OTLA was associated with age, SAC narrowing, cervical kyphosis, and ossification of other cervical ligaments and may be associated with degenerative spondylosis, systemic hyperostotic status, or mechanical stress or instability.

• The Journal of Korean Medicine
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• v.16 no.1 s.29
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• pp.184-197
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• 1995

After 45 patients examined as to the result of medical treatment among the ones who came to Dept. of Pain Clinic, Oriental Medical Hospital, Chunju Woosuk University complaining low back pain chiefly from Dec/19/1994 to Feb/7/1995 for 50 days or so were observed clinically, the results were obtained as follows: 1. In duration of the case history, acute stage(37.8%) was the most predominant, and subacute stage(35.6%) and chronic stage(26.7%) were revealed in turn. 2. In opinions of radiation, Spondylosis(26.7%) was the most predominant, Scoliosis(15.6%) and HIVD(11.1%) were revealed in order, and 3 cases were revealed to be negative. 3. In the radiating pain of the lower limb, the radiating pains of the left lower limb were the most predominant and those of the right lower limb and those of both lower limbs were revealed in turn. By the way, 31.1% of patients didn't suffer from the radiating pain of the lower limb. 4. In the grade of the seriousness of subsective symptom, Grade 2(66.7%) was the most predominant, and Grade 3, Grade 4, and Grade 1 followed it in order. 5. In the period of the treatments of medi-acupuncture, 2-5 day treatments(31.1%) were major and 6-10 day treatments(26.7%), 16-20 day treatments(11.1%), 26-30 day treatments(11.1%), over 31 day treatments(11.1%), 11-15 day treatments(4.4%), and 21-25 day treatments(4.4%) followed it by turns. Thus 2-10 day treatments are 57.8% and under 30 day treatments are 57.8% of all. 6. In the frequency of use of each medi-acupuncture, V was most frequency used in 41 cases(91.1%), and 11 cases of HN(24.4%), 8 cases of MOK(17.8%), 4 cases of OK(8.9%), 2 cases of B(4.4%), and a case of I(2.2%) were revealed in turn. 7. In the effect of treatments, 10 cases(22.2%) were excellent, 25 cases(55.6%) were good, 5 cases(11.1%) were fair, and 5 cases(11.1%) were poor. As the result, 88.9% of all changed for the better and all of these were improved within the third trial. 8. The effect of the treatments per durations was 100% in acute stage, 93.8% in subacute stage, and 66.7% in chronic stage. According to that, it was reavealed that the rate of treatments decreased as it came near to the chronic stage. 9. The effect of treatments per radiating pains was 87.5% in the radiating pains of the left lower limb, 81.8% in those of the right lower limb, 100% in those of both lower limbs, and 92.9% in case that patients have no radiating pains. So in the rate of treatments on radiating pains of the lower limbs, the case of both sides or no radiating pains was higher than that of one side. 10. In the effect of treatments per the condition of patients, Grade 4 showed 100% of improvement, Grade 3 showed 90.9% of improvement, Grade 2 showed 86.7% of improvement, and Grade 1 showed 100% of improvement. 11. In the effect of treatments per contents of treatments, the group treated with medi-acupuncture therapy, herb medication therapy, acupuncture therapy, and physiothrapy at the same time(Group 1) showed 100% of improvement, the group treated with medi-acupuncture therapy, acupuncture therapy, and physiotherapy simultaneously(Group 2) showed 73.7% of improvement, and the group treated with medi-acupuncture therapy and acupuncture therapy at the same time(Group 3) showed 100% of improvement. 12. 2-5 day treatments showed 78.6% of improvement, 6-10 day treatments showed 91.7% of improvement, and over 31 day treatments showed 100% of improvement. As the result, genarally the longer the period of treatment was, the better the effect of treatment was. 13. When only V was used, the rate of treatment was 96.2%. When only HN was used, the rate of treatment was 100%. When only MOK was used, the rate of treatment was 100%. When V and HN were used at the same time, the rate of treatment was 33.3%. When V and MOK were used at the same time, the rate of treatment was 100%. When V and OK were used at the same time, the rate of treatment was 100%. When V, HN, and MOK were used at the same time, the rate of treatment was 100%. When V, OK, and MOK were used at the same time, the rate of treatment was 100%. When V, MOK, and B were used at the same time, the rate of treatment was 100%. When V, HN, OK, and I were used at the same time, the rate of treatment was 100%. When V, HN, and B were used at the same time, the rate of treatment was 100%.