Diagnostic Value of Biopsy Techniques in Lumbar Spondylodiscitis: Percutaneous Needle Biopsy and Open Biopsy

남경협,송근성,한인호,최병관,차승헌 대한척추신경외과학회 2011 Neurospine Vol.8 No.4

objective of this study was to evaluate and compare the diagnostic value of the open biopsy technique and the percutaneous biopsy techniques in lumbar spondylodiscitis. Methods: Between January 2004 and December 2009, we retrospectively reviewed the medical records of 57 patients with infectious lumbar spondylodiscitis. The etiologic diagnosis of the infectious spondylodiscitis was obtained by two methods. Of 57 cases, twenty-seven patients underwent open biopsy and thirty patients underwent percutaneous needle biopsy including computed tomography(CT)-guided and fluoroscopy-guided needle aspiration. All biopsies were performed by experienced two neurosurgeons and one interventional radiologist. Results: Of the 57 cases radiologically consistent with spinal infection, 29(50.9%) biopsy specimens resulted in positive cultures and 28(49.1%) returned negative cultures. According to the type of biopsy techniques, the culture-positive rate was higher(p=0.005) in the open biopsy group than the percutaneous needle biopsy group. 19(70.4%) of 27 biopsy specimens were positive in the open biopsy group, and 10(33.3%) of 30 biopsy specimens were positive in the percutaneous needle biopsy group. Furthermore, the open biopsy showed higher positive culture rate than the percutaneous needle biopsy in cases with administration of empirical antibiotics although there was no statistically significant(p=0.137). Conclusions: Open biopsy should be considered for administration of organism-specific antibiotics for the successful treat- ment when percutaneous needle yield negative result. Furthermore, empirical antibiotics should be delayed until results of cultures unless the patient is severely septic, critically ill, neutropenic or neurologically compromised. Objective: The objective of this study was to evaluate and compare the diagnostic value of the open biopsy technique and the percutaneous biopsy techniques in lumbar spondylodiscitis. Methods: Between January 2004 and December 2009, we retrospectively reviewed the medical records of 57 patients with infectious lumbar spondylodiscitis. The etiologic diagnosis of the infectious spondylodiscitis was obtained by two methods. Of 57 cases, twenty-seven patients underwent open biopsy and thirty patients underwent percutaneous needle biopsy including computed tomography(CT)-guided and fluoroscopy-guided needle aspiration. All biopsies were performed by experienced two neurosurgeons and one interventional radiologist. Results: Of the 57 cases radiologically consistent with spinal infection, 29(50.9%) biopsy specimens resulted in positive cultures and 28(49.1%) returned negative cultures. According to the type of biopsy techniques, the culture-positive rate was higher(p=0.005) in the open biopsy group than the percutaneous needle biopsy group. 19(70.4%) of 27 biopsy specimens were positive in the open biopsy group, and 10(33.3%) of 30 biopsy specimens were positive in the percutaneous needle biopsy group. Furthermore, the open biopsy showed higher positive culture rate than the percutaneous needle biopsy in cases with administration of empirical antibiotics although there was no statistically significant(p=0.137). Conclusions: Open biopsy should be considered for administration of organism-specific antibiotics for the successful treat- ment when percutaneous needle yield negative result. Furthermore, empirical antibiotics should be delayed until results of cultures unless the patient is severely septic, critically ill, neutropenic or neurologically compromised.

Conversational Artificial Intelligence for Spinal Pain Questionnaire: Validation and User Satisfaction

남경협,김다영,김동환,이정환,이재일,김미정,박주영,황재현,윤상석,최병관,김민규,한인호 대한척추신경외과학회 2022 Neurospine Vol.19 No.2

Objective: The purpose of our study is to develop a spoken dialogue system (SDS) for pain questionnaire in patients with spinal disease. We evaluate user satisfaction and validated the performance accuracy of the SDS in medical staff and patients. Methods: The SDS was developed to investigate pain and related psychological issues in patients with spinal diseases based on the pain questionnaire protocol. We recognized patients’ various answers, summarized important information, and documented them. User satisfaction and performance accuracy were evaluated in 30 potential users of SDS, including doctors, nurses, and patients and statistically analyzed. Results: The overall satisfaction score of 30 patients was 5.5 ± 1.4 out of 7 points. Satisfaction scores were 5.3 ± 0.8 for doctors, 6.0 ± 0.6 for nurses, and 5.3 ± 0.5 for patients. In terms of performance accuracy, the number of repetitions of the same question was 13, 16, and 33 (13.5%, 16.8%, and 34.7%) for doctors, nurses, and patients, respectively. The number of errors in the summarized comment by the SDS was 5, 0, and 11 (5.2%, 0.0%, and 11.6 %), respectively. The number of summarization omissions was 7, 5, and 7 (7.3%, 5.3%, and 7.4%), respectively. Conclusion: This is the first study in which voice-based conversational artificial intelligence (AI) was developed for a spinal pain questionnaire and validated by medical staff and patients. The conversational AI showed favorable results in terms of user satisfaction and performance accuracy. Conversational AI can be useful for the diagnosis and remote monitoring of various patients as well as for pain questionnaires in the future.

Internet of Things, Digital Biomarker, and Artificial Intelligence in Spine: Current and Future Perspectives

남경협,김동환,최병관,한인호 대한척추신경외과학회 2019 Neurospine Vol.16 No.4

Recent interest in medical artificial intelligence (AI) has increased with onset of the fourth industrial revolution. Real-time monitoring of patients is an important research area of medical AI. The medical AI is very closely related to the Internet of Things (IoT), a core element of the fourth industrial revolution. Attempts to diagnose and treat patients using IoT have been already applied to patients with chronic disease such as hypertension and arrhythmia. However, in the spine, research on IoT and digital biomarkers are still in the early stages. The digital biomarker obtained by IoT devices is objective and could represent real-time, real-world, and abundant data. Based on its characteristics, IoT and digital biomarkers can also be useful in the spine. Currently, research on real-time monitoring of physical activity or spinal posture is ongoing. Therefore, the authors introduce the basic concepts of IoT and digital biomarkers, their relationship to AI, and recent trends. Current and future perspectives of IoT and digital biomarker in spine are also discussed. In the future, it is expected that IoT, digital biomarkers, and AI will lead to a paradigm shift in the diagnosis and treatment of spinal diseases.

례뇌하수체 선종과 동반되어 안상조에 발생한 지주막 낭종

남경협 ( Kyoung Hyup Nam ),차승헌 ( Seung Heon Cha ),조원호 ( Won Ho Cho ),최병관 ( Byung Kwan Choi ) 대한뇌종양학회·대한신경종양학회·대한소아뇌종양학회 2012 대한뇌종양학회지 Vol.11 No.1

Objectives: Arachnoid cysts are a relatively rare pathological entity, and a suprasellar arachnoid cyst is quite rare. We report on an extremely rare case of a suprasellar arachnoid cyst associated pituitary adenoma and discuss the possible pathogenesis. Clinical Presentation: A 24-year-old man was admitted to the hospital with a history of headache, visual field defect, gait disturbance, syncope, and urinary incontinence. Computed tomography showed severe hydrocephalus. Preoperative magnetic resonance images revealed a mass lesion in the sella turcica with suprasellar extension and a coexisting large supra- and parasellar cyst. Transcranial surgery was performed for the removal of the tumor mass and cyst. Ventricle size normalized after the operation. He exhibited an uneventful recovery without neurologic deficits or endocrinologic abnor-malities. Conclusion: We present clinical, radiological, and histopathological findings and discuss the possible pathogenesis of a suprasellar arachnoid cyst associated pituitary adenoma.

응급 수술을 시행한 신경외상 환자들에 있어 전염성 바이러스 감염의 유병율에 대한 분석

남경협 ( Kyoung Hyup Nam ),최혁진 ( Hyuk Jin Choi ),이재일 ( Jae Il Lee ),고준경 ( Jun Kyeung Ko ),한인호 ( In Ho Han ),조원호 ( Won Ho Cho ) 대한외상학회 2015 大韓外傷學會誌 Vol.28 No.1

Purpose: The aim of this study was to estimate the seropositive prevalence of blood-borne infection in neurotrauma patients who underwent emergent surgical intervention, especially patients with hepatitis B virus (HBV), hepatitis C virus (HCV), syphilis and human immunodefIciency virus (HIV). Methods: A retrospective review identified 559 patients with traumatic brain injury and spinal trauma who underwent emergent surgery between 2007 and 2014. We reviewed the medical records and extracted data, including age, sex, location of lesion, result of serologic tests, time interval of admission and surgery after presenting to emergency room. Serologic tests for HBV, HCV, syphilis and HIV were performed and analyzed to determine whether the seropositive results were confirmed by the surgeon before surgery. Results: The majority of the patients were male (74.6%), and the mean age was 55.4±20.2 years. Most patients underwent surgery due to traumatic brain injury (90.0%). Fifty-three patients (10.0%) showed a positive result on at least one serologic test. Seropositive rates according to pathogens were 0.5% for syphilis, 5.2% for HBV and 3.9% for HCV. No positive results were noted on the serologic tests for HIV. HBV in patients with spinal cord injury and age from 40 to 49 years were associated with high serologic positive rate, and that result was statistically significant. However, no statistically significant differences were found in the other variables. Serologic results could not confirmed before surgery in the majority of the cases (62.1%), and 10.4% of these patients showed seropositive results. Conclusion: The results of this study emphasize the importance of taking precautions and conducting rapid serologic testing in preventing the occupational transmission of blood-borne viruses to health-care workers. [ J Trauma Inj 2015; 28: 9-14 ]

Lumbar Spinal Chondroma Presenting with Acute Sciatica

김동환,남경협,최병관,한인호 대한척추신경외과학회 2013 Neurospine Vol.10 No.4

A 47-year-old woman visited with lumbago and severe left leg pain that had been presented for 1 week. The patient complained of severe radiating pain on left L3 sensory dermatome area and reported aggravation of leg pain at 20 degrees of hip flexion by straight leg raising test (SLRT). However, there was no motor weakness on neurological examination. Magnetic resonance imaging (MRI) demonstrated contrast enhancing spinal extradural mass at L2-3 level that was iso-signal intensity (SI) on T1-weighted images (WI), hypo-SI on T2WI. She was not able to walk and sleep due to incapacitating pain. Thus, surgical removal was performed via left partial laminectomy. Postoperatively, the radiating pain was relieved completely. Histopathologic examination revealed that the tumor consisted of chondroma, which had mature hyaline cartilage with nests of benign-appearing cells and calcium deposits in lacunae.

Spontaneous Epidural Hematoma Associated with Venous Phlebolith in Cervical Spine and Possible Pathogenesis

김동환,김동하,남경협,최병관,한인호 대한척추신경외과학회 2017 Neurospine Vol.14 No.3

Although the etiology of spontaneous spinal epidural hematoma (SSEH) is unclear, SSEH is known to be associated with anticoagulants, coagulopathy, vascular malformation, hypertension, and pregnancy. However, no report has been issued on the relation between SSEH and venous phlebolith. Here, the authors present an extremely rare case of SSEH associated with phlebolith in the cervical spine and suggest a possible pathogenesis. A 36-year-old man without any relevant medical history presented with neck pain and numbness and severe radiating pain on the left arm. Magnetic resonance imaging showed epidural hematoma at the C5-7 level, and computed tomography revealed a calcified nodule in the left epidural hemorrhage at C6 level. During left partial laminectomy, epidural venous plexus, and thick epidural hematoma were found, and hematoma removal revealed a white, ovoid, smooth, hard mass of diameter 3 mm. Histopathologic examination confirmed the mass as a venous phlebolith. The presence of a calcified solitary nodule in dorsal epidural space indicates the presence of phlebolith and the risk of SSEH. In such cases, the authors recommend spine surgeons should take into consideration the possibility of epidural hemorrhage.

탄소섬유 강화 플라스틱의 드릴 가공 특성

이삼미(S. M. Lee),남경협(K. H. Nam),김운섭(W. S. Kim),박경수(K. S. Park),윤종선(J. S. Yoon),윤인준(I. J. Yoon) 한국기계가공학회 2022 한국기계가공학회 춘추계학술대회 논문집 Vol.2022 No.12

척추측만증 환자의 수술 효과 평가 수단으로서 웨어러블 스마트 깔창을 이용한 보행분석의 유용성

서민석,신명준,권애란,박태성,남경협 중소기업융합학회 2020 융합정보논문지 Vol.10 No.2

This study presents a gait analysis method (including time series analysis) using a smart insole as an objective and quantitative evaluating method after lumbar scoliosis surgery. The participant is a degenerative lumbar scoliosis patient. She took 3-min-gait-test four times(before and 8, 16, and 204-days after surgery) and 6-min-gait-test once(204-days after surgery) with smart-insoles in her shoes. Each insole has 8-pressure sensors, an accelerometer, and a gyroscope. The measured values were used to compare the characteristics of gait before and after surgery. The analysis showed that all of the patient's gait parameters improved after surgery. And after 6 months, the gait was more stable. However, after long walk, the swing duration of one leg was slightly shorter than that of the other again. It was a preclinical problem that could not be found in the visual examination by the practitioner. With this analysis method we could evaluate the improvement of patient quantitatively and objectively. And we could find a preclinical problem. This analysis method will lead to the studies that define and distinguish gait patterns of certain diseases, helping to determine appropriate treatments. 본 연구는 척추측만증 수술에 대한 객관적이고 정량적인 효과 평가 수단으로서 스마트 깔창을 이용한 보행분석 방법(시계열 분석 포함)을 제시한다. 실험 참가자는 척추측만증 환자이며 스마트 깔창을 착용하고 3분 보행검사를 4번(수술전, 수술 후 8일, 16일, 204일), 6분 보행검사를 1번(수술 후 204일) 받았다. 깔창에는 8개의 압력센서, 가속도 및 각속도 센서가 있고, 각각의 측정값을 저장하여 환자의 수술 전후 보행특성(운동역학 및 시공간 변수)을 비교하였다. 분석결과 수술 후 환자의 모든 보행 변수가 개선된 것을 알 수 있었고, 6개월 후 추적검사에서 환자의 보행이 더욱 안정된 것을 확인할 수 있었다. 하지만 환자가 오래 걸으면 한쪽 다리의 swing 시간이 다른 쪽에 비해 미세하게 짧은 현상이 다시 나타났는데, 이는 검사를 수행하는 의사의 육안으로는 발견할 수 없는 preclinical한 문제였다. 우리는 이러한 분석 방법을 통해 환자의 개선 정도를 정량적이고 객관적으로 평가할 수 있었고, preclinical한 문제도 찾을 수 있었다. 향후 이러한 분석 방법은 특정 질병의 보행 패턴을 정의하고 감별하여 적절한 치료방법을 결정하는 연구로 이어질 것이다.

Transiting Nerve Rootlet Abnormalities on MRI after Lumbar Laminectomy: Associations with Persistent Postoperative Pain

Park Chankue,이인숙,남경협,Song You Seon,이태홍,한인호,김동환 대한영상의학회 2021 Korean Journal of Radiology Vol.22 No.2

Objective: To determine whether changes in the transiting nerve rootlet or its surroundings, as seen on MRI performed after lumbar hemilaminectomy, are associated with persistent postoperative pain (PPP), commonly known as the failed back surgery syndrome. Materials and Methods: Seventy-three patients (mean age, 61 years; 43 males and 30 females) who underwent single-level partial hemilaminectomy of the lumbar spine without postoperative complications or other level spinal abnormalities between January 2010 and December 2018 were enrolled. Two musculoskeletal radiologists evaluated transiting nerve rootlet abnormalities (thickening, signal alteration, distinction, and displacement), epidural fibrosis, and intrathecal arachnoiditis on MRI obtained one year after the operations. A spine surgeon blinded to the radiologic findings evaluated each patient for PPP. Univariable and multivariable analyses were used to evaluate the association between the MRI findings and PPP. Results: The presence of transiting nerve rootlet thickening, signal alteration, and ill-distinction was significantly different between the patients with PPP and those without, for both readers (p ≤ 0.020). Conversely, the presence of transiting nerve rootlet displacement, epidural fibrosis, and intrathecal arachnoiditis was not significantly different between the two groups (p ≥ 0.128). Among the above radiologic findings, transiting nerve rootlet thickening and signal alteration were the most significant findings in the multivariable analyses (p ≤ 0.009). Conclusion: On MRI, PPP was associated with transiting nerve rootlet abnormalities, including thickening, signal alterations, and ill-distinction, but was not associated with epidural fibrosis or intrathecal arachnoiditis. The most relevant findings were the nerve rootlet thickening and signal alteration.