전이성 뇌종양에 있어서 감마나이프 방사선 수술에 대한 임상적 분석

손문준,권양,김정훈,전상룡,이동준,김창진,권병덕 대한신경외과학회 1999 Journal of Korean neurosurgical society Vol.28 No.5

수모세포종과 원시 신경외배엽 종양 : 임상 및 분자생물학적 분석과 예후에 관한 연구

손문준,전상룡,김저훈,나영신,이정교,권병덕,서재희,이인철 대한신경외과학회 1997 Journal of Korean neurosurgical society Vol.26 No.2

경막내 연수 주위 동정맥루(제Ⅳ형 척수 동정맥 기형)의 수술적 치료

손문준,박형천,박현선,김재중,김은영 대한신경외과학회 2002 Journal of Korean neurosurgical society Vol.31 No.4

불안정성을 동반한 흉요추부 척추질환의 TSRH기구를 이용한 수술치료

손문준,이호연,김정훈,나영신,권양,임승철,이정교,권병덕,황충진 대한신경외과학회 1996 Journal of Korean neurosurgical society Vol.25 No.8

The authors present surgical experience with 33 patients who had incurred unstable thoracic or lumbar spine pathology(22 degenerative lumbar spine disease, 6 trauma. 3 tumor, 2 vertebral tuberculosis) and who were intraoperatively stabilized with the Texas Scottish Rite Hospital(TSRH) universal instrumentation system over 20 months period. The 11 men and 22 women(mean age 45 years, range 23 to 71 years) presenting with signs or symptoms of neural compression underwent surgery consisting of neural decompression. internal fixation, and bone grafting. Spondylolistnesis were fused in situ without reduction. For thoracic and thoracolumbar junction pathology, multisegment fixations were performed. A 95% fusion rate was obtained with a mean follow-up period of 15 months. There were no cases of instrumentation failure. Major postoperative complications included 2 isolated nerve root deficits(one transient, one permanent) and 3 pulmonary embolism(one fatal). The construct design of the TSRH system offers some advantages compared to other forms of internal fixation : simple assembly, rigid stability, safety, and ability to remove easily. This system provides a highly successful method to obtain arthrodesis for unstable thoracic or lumbar spine.

Paraclinoid Aneurysm의 분류 및 수술적 치료

손문준,이채혁,나영신,김창진,권양,임승철,이정교,권병덕,황충진 대한신경외과학회 1996 Journal of Korean neurosurgical society Vol.25 No.9

Paraclinoid aneurysms arose from the proximal internal carotid artery between the site of emergence of carotid artery from the roof of the cavernous sinus and posterior communication artery. Surgery of these aneurysms presents special difficulties because of its complicated osseous, dura, and neurovascular structures ; sella trucica,cavernous sinus, optic nerve. The clinical and radiological characteristics in twenty-seven patients with the paraclinoid aneurysms were reviewed and classified into four subgroups according to their branch of origin in this segment ; 1) carotid cave aneurysm(2 cases), 2) ophthalmic artery aneurysm(11 cases), 3) superior hypophyseal artery aneurysm(11 cases), 4) proximal posterior carotid artery wall aneurysm or global type aneurysm(3 cases). Surgery required orbital unroofing and removal of anterior clinoid process with releases of dural ring. To provide easy proximal control, exposure of cervical carotid artery was helpful in some cases. Preoperative balloon occlusion testing was mandatory. Outcomes were considered as good to fair in 19 patients, poor in five, and three patients died. The patients who had poor results were poor preoperative status-four were grade Ⅳ, one was grade Ⅱ(Hunt-Hess grade). The causes of death were premature rupture(2 cases) and extensive vasospasm(1 case). Preoperative classification of these lesions provides excellent correlation of operative findings and surgical preparation to expose the proximal part of internal carotid artery.

Commentary on “Frailty Status Is a More Robust Predictor Than Age of Spinal Tumor Surgery Outcomes: A NSQIP Analysis of 4,662 Patients”

손문준 대한척추신경외과학회 2022 Neurospine Vol.19 No.1

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Atlantoaxial Rotatory Fixation - 3 례 보 고 -

손문준,임승철,노성우,박형천,Sohn, Moon Jun,Rhim, Seung Chul,Roh, Sung Woo,Park, Hyung Chun 대한신경외과학회 2000 Journal of Korean neurosurgical society Vol.29 No.4

The atlantoaxial rotatory fixation is a uncommon disease of deformity, occuring much more frequently in children than in adults. Despite of its benign clinical course, delayed recognition or improper management may cause persistent deformity or recurrence. We report three cases of typical atlantoaxial rotatory fixation. Successful reduction was achieved with posterior atlantoaxial fusion in one case and nonoperative treatment in others. We emphasize that it is necessary to perform dynamic CT scan to obtain correct diagnosis and to plan proper treatment for this disease entity.

인체공학적 좌석이 척추와 골반 자세에 미치는 영향에 대한 생체역학적 비교연구: 원추형 진자 스툴과 반강성 유연 등받이 의자

최우진,손문준 대한산업공학회 2022 대한산업공학회지 Vol.48 No.3

The most common health problem caused by long-term sitting lifestyle and degenerative changes due to aging was changes in spinal pelvic posture. Sitting posture was a more complex phenomenon because it follows a change in posture. The most common working environment occurs in working with your body tilted back from a chair with a backrest. While sitting down and working, the movement of the seat plate was restricted which result in stiff lumbar spine and pelvic muscles to become stiff that eventually causes fatigue, pain and pathological posture changes. The aim of this study was to analyze the biomechanical changes and effects by evaluating and measuring the changes in spino-pelvic posture including muscle tension in sitting posture according to the type of seat used. Two different type of ergonomic seats, such as conical pendulum stool (CPS) and semirigid flexible backrest chair (SFBC), were used in a total of 17 participants. Among two types of sitting, seat-buttock contact pressure and radiographic changes of coronal trunk imbalance distance (Gravitiy line/Hip axis distance), pelvic and shoulder height differences on the seats were measured and statistically analyzed using partied t-test. The seat-buttock contact pressure reduced from 51.13 ± 32.77 Ω and 59.13 ± 39.62 Ω on initial seated to 38.57 ± 25.61 Ω and 49.37 ± 29.22 Ω on 1hr seated on CPS and SFBC, respectively (p=0.486, p=0.332). Radiographically, changes in pelvic height differed statistically significantly between two sitting types of CPS versus SFBC (average of 2.12 + 2.61 mm versus 4.29 + 4.04 mm, respectively with one hour seating, p=0.008). Improvement in shoulder height difference was statistically significant (average of 8.27 + 6.28 mm to 5.37 + 6.06 mm using CPS from initial to one hour sitting, p=0.038). CPS seating showed better biomechanical effect in reducing the imbalance between pelvic height and shoulder height through the stimulating dynamic control of spinal stability and equilibrium by activation of the upper and lower back core muscles than static ergonomic seat.

척추의 전이암: 노발리스 방사선 수술 후의 자기공명영상소견

황윤준,손문준,황충진,이동준,허감,차순주,김용훈,김수영,서정욱,한윤희,김미영 대한영상의학회 2006 대한영상의학회지 Vol.55 No.5

Purpose: To assess the therapeutic effect of Novalis radiosurgery for metastatic spinal tumors and evaluate the changes after treatment using MR imaging. Materials and Methods: Between November 2003 and June 2005, 21 patients with metastatic spinal tumors underwent Novalis radiosurgery. Of these patients, the 7 with 13 metastatic spinal tumors who had undergone follow-up MR imaging were included in this study. The tumor locations were cervical spine in three, thoracic spine in four, lumbar spine in five and sacrum in one. During the first three months after Novalis radiosurgery, follow-up MRI was performed monthly and subsequently at 3-6-month intervals. On MR imaging, the volume of the tumors, the changes of their signal intensities and any changes in adjacent spinal cord were evaluated. Results: Among the 13 lesions, 9 were decreased in volume (69.2%), 2 were stable (15.4%) and 2 were slightly increased. Seven of 9 lesions showed decreased signal intensity on T2 weighted images and 4 had compressive deformity. Two of 9 lesions had increased T2 signal intensity and tumor necrosis were detected on contrast-enhanced MR imaging. No changes in spinal cord were noted in any of the lesions. Those changes were detected on MRI obtained 1 month after Novalis surgery and the lesion sizes were gradually changed up to 3 months. Conclusion: Novalis radiosurgery was effective for the treatment of metastatic spinal tumor and the suppression of tumor growth. The estimation of therapeutic effect and detecting complication were precisely evaluated on MR imaging. 목적: 척추의 전이암 환자에 있어서 노발리스 방사선 수술을 시행한 후 자기공명영상을 통하여 전이암의 변화를 알아보고자 한다. 대상과 방법: 노발리스 방사선 수술을 시행한 척추의 전이암 환자 21명 중 자기공명영상으로 추적 관찰이 가능하였던 7명의 환자에서 총 13개의 병변을 대상으로 하였다. 병변의 위치는 경추 3개, 흉추 4개, 요추 5개, 천추 1개였다. 노발리스 방사선 수술 후 첫 3개월간은 매달 자기공명영상으로 추적 관찰하였고 그 이후에는 3개월-6개월 마다 관찰하였다. 자기공명영상을 통하여 병변의 체적 및 신호강도의 변화를 관찰하였고 인접한 척수의 변화 유무도 관찰하였다. 결과: 총 13개의 병변 중 체적이 감소한 예가 9병소(69.2%), 변화가 없었던 예가 2병소(15.4%)였고, 2병소(15.4%)에서는 약간 증가하였다. 병변의 체적이 감소한 9병소 중 7병소에서 T2신호강도가 감소하였고 그 중 4병소에서는 압박 변형을 동반하고 있었다. 나머지 2병소에서는 T2 신호강도 증가 소견을 보였고 조영증강영상에서 병변의 괴사가 관찰되었다. 척수는 전 예에서 변화를 보이지 않았다. 이러한 변화들은 노발리스 방사선수술 후 1개월 후에 시행한 자기공명영상에서 관찰할 수 있었고 병변의 체적은 추적관찰 영상에서 더욱 감소하였다. 결론: 노발리스 방사선 수술은 척추 전이암의 치료 및 성장 억제에 유용하였고 자기공명영상을 통하여 치료 효과 판정 및 합병증 발병 유무를 정확히 관찰할 수 있었다.

Twelve Contiguous Spinous Process Fracture of Cervico-Thoracic Spine

한성록,손문준 대한척추신경외과학회 2014 Neurospine Vol.11 No.3

The clay-shoveler's fracture is an isolated avulsion fracture of the lower cervical or upper thoracic spinous process. Among them, multiple spinous process fractures are very rare. We present 34-year-old male patient who have multiple spinous process fractures with twelve contiguous levels of cervico-thoracic spine (from C4 to T8) after motorcycle accident. This case is multiple isolated spinous process fractures with good clinical outcome.