Global Sagittal Alignment and Clinical Outcomes after 1–3 Short-Segment Lumbar Fusion in Degenerative Spinal Diseases

Youn Yung-Hun,조규정,Na Yeop,Kim Jeong-Seok 대한척추외과학회 2022 Asian Spine Journal Vol.16 No.4

Study Design: Level III retrospective study.Purpose: We investigated the impact of short-segment lumbar fusion on the restoration of global sagittal alignment and the correlations between spino-pelvic parameters and clinical outcomes.Overview of Literature: Sagittal imbalance leads to energy consumption and pain in maintaining a standing position. For adult spinal deformity, it is critical to create optimal lumbar lordosis (LL) in order to achieve restoration of sagittal imbalance. However, surgeons do not pay attention to correcting LL in short-segment lumbar fusion.Methods: A total of 69 patients with transforaminal lumbar interbody fusion (TLIF) for degenerative spinal disease were evaluated with a minimum 2-year follow-up. All patients underwent TLIF with hyper-lordotic angle cages to achieve higher LL. Radiological spino-pelvic parameters including sagittal vertical axis (SVA) and clinical outcomes using the Oswestry Disability Index (ODI) and Numeric Rating Scale (NRS) were evaluated.Results: The average LL was 35.8°±9.9° before surgery, 42.3°±9.3° 1 year after surgery, and 40.3°±10.2° 2 years after surgery (<i>p</i> <0.01). The average SVA was 43.1±6.2 mm before surgery, 21.2±4.9 mm 1 year after surgery, and 34.0±4.7 mm 2 years after surgery (<i>p</i> <0.01). The average LL and SVA improved in two- or three-segment fusion, but not in one-segment fusion. The correlation between ΔLL and ΔSVA was significant in all segment fusions. The correlation between ΔLL and ΔSVA was more significant at the L4–5 and L5–S1 segments than at L3–4. ODI was significantly correlated with SVA (<i>p</i> <0.05). NRS showed no correlation with the radiological parameters.Conclusions: Two- or three-segment lumbar fusion using hyper-lordotic angle cages improved LL and SVA. A significant correlation between the correction of LL and SVA was found. Higher correction of LL using hyper-lordotic angle cages is thus recommended in short-segment lumbar fusion, since postoperative improvements of SVA significantly affect clinical outcomes.

Revision Rod를 이용한 흉요추 유합 재수술 예비 결과

윤영훈(Yung-Hun Youn),조규정(Kyu-Jung Cho),박예수(Ye-Su Park),박재우(Jae-Woo Park),박진성(Jin-Sung Park),권원환(Won-Hwan Kwon) 대한정형외과학회 2020 대한정형외과학회지 Vol.55 No.6

목적: 척추 유합술을 받은 환자 중에서 척추 유합 재수술을 받는 경우가 증가하고 있다. 척추 유합 재수술을 위해 기존 장치와 연결기를 통해 연결하여 고정술을 연장하는 revision rod를 새롭게 개발하였다. 본 연구에서는 revision rod를 이용하여 척추 유합 재수술을 시행한 후 임상적·방사선적 결과를 분석하였다. 대상 및 방법: 2개의 대학병원에서 척추 유합술 후 유합 연장술을 시행하고 최소 1년 추적관찰이 가능했던 21명의 환자가 포함되었다. 진단명은 인접 분절 병증 16명, 흉요추 골절 4명, 황색인대골화 1명이었다. 임상 결과는 Oswestry Disability Index (ODI)와 수치평가척도(numerical rating scale, NRS)로 평가하였고, 방사선 결과는 요추 전만각, 흉추 후만각, 재수술 부위의 시상면 각도, 그리고 근위부 인접부의 후만각 및 골유합률을 평가하였다. 결과: 수술 전 평균 ODI는 54.6±12.5에서 최종 추시 시 29.8±16.5로 향상되었다. 허리 통증과 다리 통증 NRS는 5.0±1.7, 6.4±2.0에서 2.9±1.6, 2.9±2.2로 향상되었다. 요추 전만각은 수술 전 18.1±11.9도가 최종 추시 시 21.1±10.3도였고, 근위부 인접부 후만각은 수술 전 10.8±10.1도가 최종 추시 시 9.2±10.5도로 유의미한 차이를 보이지는 않았다. 골유합률은 후외측 골유합을 시행한 1명을 제외하고는 모든 예에서 성공적인 유합이 이루어졌다. 결론: Revision rod를 사용한 흉요추의 재유합술에서 우수한 임상 결과를 보였다. 새롭게 개발된 revision rod와 관련된 문제는 발생하지 않았고 방사선상 골유합은 성공적이었다. Purpose: The need for revision fusion surgery after spinal fusion has increased. A revision rod that connects to the previous rod was newly developed for revision surgery. The purpose of this study was to analyze the clinical and radiological results after spinal fusion revision surgery using revision rods. Materials and Methods: Twenty-one patients who underwent revision fusion surgery after spinal fusion in two university hospitals with minimum 1 year follow-up were reviewed. This study assessed 16 cases of adjacent-segment disease, four cases of thoracolumbar fracture, and one case of ossification of ligament flavum. The Oswestry Disability Index (ODI) and numerical rating scale (NRS) were evaluated as clinical outcomes, and the union rate, lordosis or kyphosis of the revision level, lumbar lordosis, T5-12 kyphosis, and proximal junctional kyphosis angle were evaluated as the radiological outcomes. Results: The average ODI was 54.6±12.5 before surgery and improved to 29.8±16.5 at the final follow-up. The NRS for back pain and leg pain was 5.0±1.7 and 6.4±2.0 before surgery, which changed to 2.9±1.6 and 2.9±2.2 at the final follow-up. Lumbar lordosis was 18.1°±11.9° before surgery and 21.1°±10.3° at the final follow-up. Proximal junctional kyphosis was 10.8°±10.1° before surgery, and 9.2°±10.5° at the final follow-up. These angles were not changed significantly after surgery. Bony union was successful in all cases except for one case who underwent posterolateral fusion. Conclusion: Revision surgery using a newly developed revision rod on the thoracolumbar spine achieved good clinical outcomes with successful bony union. No problems with the newly developed revision rod were encountered.

Posterior Deltoid-to-Triceps Tendon Transfer for Elbow Extension in a Tetraplegia Patient: A Case Report

Ji Hun Jeong,Jong Bum Park,Dong Heun Ahn,Yong Rok Kim,Mi Jin Hong,Yung Jin Lee,Chang-il Park,Youn Moo Heo 대한재활의학회 2016 Annals of Rehabilitation Medicine Vol.40 No.2

In tetraplegia patients, activities of daily living are highly dependent on the remaining upper limb functions. In other countries, upper limb reconstruction surgery to improve function has been applied to diverse cases, but few cases have been reported in Korea. The current authors experienced a case of posterior deltoid-to-triceps tendon transfer and rehabilitation in a complete spinal cord injury with a C6 neurologic level, and we introduce the case—a 36-year-old man—with a literature review. The patient’s muscle strength in C5 C6 muscles were normal, but C7 muscles were trace, and the Spinal Cord Independence Measure III (SCIM III) score was 24. The tendon of the posterior deltoid was transferred to the triceps brachii muscle, and then the patient received comprehensive rehabilitative treatment. His C7 muscle strength in the right upper extremity was enhanced from trace to fair, and his SCIM III score improved to 29.

Phase II Trial of Gemcitabine Plus UFT as Salvage Treatment in Oxaliplatin, Irinotecan and fluoropyrimidine-Refractory Metastatic Colorectal Cancer

( Do Youn Oh ),( Yu Jung Kim ),( Yung Jue Bang ),( Jee Hyun Kim ),( In Sil Choi ),( Sae Won Han ),( Seock Ah Im ),( Kyung Hun Lee ),( Tae You Kim ),( Keun Wook Lee ),( Tae Yong Kim ) 대한내과학회 2014 대한내과학회 추계학술발표논문집 Vol.2014 No.1

Background: To investigate the effi cacy of gemcitabine plus UFT (uracil-tegafur) combination chemotherapy as a salvage treatment in patients with metastatic colorectal cancer (MCRC) Methods: This single-arm phase 2 study was conducted at 3 institutions in Korea. Patients with MCRC refractory to fiuoropyrimidine, oxaliplatin and irinotecan were enrolled. Gemcitabine 800 mg/m2 was administered intravenously on days 1, 8 and 15.UFT 200 mg/m2/day was taken orally in 3 divided doses on days 1-21. Cycles were repeated every 4 weeks and tumor evaluation was carried out every 8 weeks. The primary endpoint of this study was 8-week progression-free survival (PFS) rate. Results: Forty-one patients were enrolled. Fourteen patients received gemcitabine/UFT as a third-line treatment and 37 patients as a 4th-line or later-line therapy. Toxicities were easily manageable and non-hematologic toxicities of = grade 3 were rare. The most common toxicity of = grade 3 was neutropenia (20.0%). One patient showed partial response (response rate, 2.4%) and 14 (34.1%) showed stable disease. The 8-week PFS rate was 42.3%. The median PFS was 1.7 months [95% confi dence interval (CI), 1.6-1.8 months] and the median OS was 9.2 months (95% CI, 5.8-12.6 months). Conclusions: Overall effi cacy of gemcitabine/UFT in refractory MCRC was unsatisfactory. However, we could found a minor proportion of patients who showed prolonged tumor stabilization to gemcitabine/UFT. Further studies are warranted to identify a patient subgroup that might have benefi ts from gemcitabine/UFT therapy.

Pharmacogenetic analysis of adjuvant FOLFOX for Korean patients with colon cancer.

Lee, Kyung-Hun,Chang, Hye Jung,Han, Sae-Won,Oh, Do-Youn,Im, Seock-Ah,Bang, Yung-Jue,Kim, Sun Young,Lee, Keun-Wook,Kim, Jee Hyun,Hong, Yong Sang,Kim, Tae Won,Park, Young Suk,Kang, Won Ki,Shin, Sang Joo Springer 2013 Cancer chemotherapy and pharmacology Vol.71 No.4

<P>Ethnic diversity of genetic polymorphism can result in individual differences in the efficacy and toxicity of cancer chemotherapy.</P>

A phase II trial of erlotinib in combination with gemcitabine and capecitabine in previously untreated metastatic/recurrent pancreatic cancer: combined analysis with translational research.

Oh, Do-Youn,Lee, Keun Wook,Lee, Kyung-Hee,Sohn, Chang-Hak,Park, Young Suk,Zang, Dae Young,Ryoo, Hun-Mo,Song, Hong-Suk,Kim, Jin-Soo,Kang, Hye-Jin,Kim, Bong-Seog,Bang, Yung-Jue M. Nijhoff ; Kluwer Academic Publishers 2012 Investigational new drugs Vol.30 No.3

<P>To confirm the efficacy and toxicity of Erlotinib in combination with Gemcitabine and Capecitabine when used as a first-line therapy in metastatic/recurrent pancreatic cancer (PC).</P>

Streptozotocin과 5-FU 복합화학요법으로 부분관해를 보인 악성 인슐린종 1예

조보연,이홍규,고창순,민헌기,박도준,이병두,이가희,김노경,방영주 대한내분비학회 1988 Endocrinology and metabolism Vol.3 No.2

A 41 year-old male patient with hepatic metastasis of an insulin-producing tumor has been successfully treated with combination chemotherapy of streptozotocin and 5-FU. He visited our hospital because of hypoglycemic symptoms of dizziness, coldseating and loss of consciousness on fasting. Physical examination showed enlarged liver, which was palpable 11 cm, 10 cm and 2.5 cm below the right costal margin, xiphod process and left costal margin, respectively. On admission the fasting blood glucose level was 24 mg/dl and concomittent plasma immunoreactive insulin (IRI) and C-peptide levels were 195 U/ml and 12.0 ng/ml, respectively. Abdominal CT revealed multiple low density lesions in the liver, Aspiration of hepatic tissue was performed and cytologic examination revealed metastatic adenocarcinoma. We administerd 850 mg of streptozotocin and 750 mg of 5-FU to him intravenously for 5 days and repeated this treatment every 6 weeks. After the 6th treatment, partial remission of the disease was achieved without serious side effects. The liver shrinked and cannot be palpable. The blood showed fasting blood glucose of 75 mg/dl; C-peptide, 3.9 ng/dl. He has enjoyed an active daily schedule, eating three meals and maintaining his usual weight.

Epidermal Growth Factor Receptor Mutations and Response to Chemotherapy in Patients with Non-Small-Cell Lung Cancer

Lee, Kyung-Hun,Han, Sae-Won,Hwang, Pil Gyu,Oh, Do-Youn,Kim, Dong-Wan,Chung, Doo Hyun,Im, Seock-Ah,Kim, Tae-You,Heo, Dae Seog,Bang, Yung-Jue Oxford University Press 2006 Japanese journal of clinical oncology Vol.36 No.6

<P><B>Background:</B> The association of epidermal growth factor receptor (EGFR) mutations with the response to conventional cytotoxic chemotherapeutic agents in non-small-cell lung cancer patients has not been investigated. We retrospectively analyzed the associations between response to chemotherapy and molecular markers associated with gefitinib responsiveness including EGFR mutations.</P><P><B>Methods:</B> EGFR (exons 18, 19 and 21) and K-ras mutations (exon 2) were studied by direct sequencing and p-Erk and p-Akt expressions were studied by immunohistochemistry in archival paraffin embedded tissues. Response rate (RR) and time-to-progression (TTP) of prior chemotherapy by platinum, paclitaxel and gemcitabine were analyzed with respect to the presence of EGFR and K-ras mutations, and p-Erk and p-Akt expressions.</P><P><B>Results:</B> Of 90 patients investigated, 75 received platinums and 45 received paclitaxel as first-line chemotherapy agents. The RRS and TTPS of platinum- and paclitaxel-containing regimens were not affected by EGFR or K-ras mutations, nor by p-Erk or p-Akt expression. Fifty-seven patients received gemcitabine as first- or second-line chemotherapy. RR was not affected by EGFR or K-ras mutations or by p-Akt expression. However, all responders to gemcitabine exhibited (+) p-Erk expression [RR 30.6% for p-Erk (+) versus 0% for p-Erk (−), <I>P</I> = 0.01]. TTP was not affected by EGFR or K-ras mutations or by p-Erk or p-Akt expression.</P><P><B>Conclusions:</B> EGFR mutations did not affect response to conventional chemotherapeutic agents, namely platinums, paclitaxel and gemcitabine. Our results also suggest that it may be undesirable to use gemcitabine in patients with tumors not expressing p-Erk.</P>

Prognostic Role of Body Mass Index in Advanced Small Bowel Adenocarcinoma Patients Receiving Palliative Chemotherapy

Lee, Dae-Won,Lee, Kyung-Hun,Kim, Tae-Yong,Han, Sae-Won,Oh, Do-Youn,Im, Seock-Ah,Kim, Tae-You,Bang, Yung-Jue Taylor Francis 2016 Nutrition and cancer Vol.68 No.5

Is the Oral Chemical Prophylaxis Necessary for the Prevention of Venous Thromboembolism after Joint Arthroplasty in a Korean Population?

( Kyoung-ho Moon ),( Joon Soon Kang ),( Yung-hun Youn ) 대한고관절학회 2019 Hip and Pelvis Vol.31 No.3

Purpose: Venous thromboembolism (VTE) is a serious complication that may occur after a major orthopedic surgery. The aim of the present study was to determine the necessity of a chemical thromboprophylactic agent (rivaroxaban [RXB]) by analyzing the prevalence of VTE in Korean arthroplasty patients who received RXB for prophylaxis compared with those who did not receive RXB. Materials and Methods: A total of 2,603 patients who underwent knee or hip arthroplasty between 1996 and 2017 were prospectively evaluated. Of these, 1,608 patients underwent surgery before January 2010 and were not administered any type of prophylaxis after surgery; the remaining 995 underwent surgery after 2010 and received oral RXB once daily for 5-13 days from the day after hemovac drain removal to postoperative day 14. Results: The primary study outcome was the prevalence of VTE, pulmonary embolism or death during follow up. The overall incidence of VTE was 1.69% (n=44); of these, 12 occurred in the RXB group and 32 in the nonprophylactic group. The odds ratio of VTE in the RXB group was 0.61. However, the statistical power of the study was 0.313 due to the low incidence of VTE. Conclusion: Treatment with oral chemical prophylaxis decreased the incidence of VTE after knee or hip arthroplasty in a Korean population. Furthermore, no serious complications occurred after administering oral RXB, which, coupled with its convenience, suggests oral RXB offers an attractive alternative to other agents. However, we recommend that further studies, including a multicenter study, be conducted to achieve adequate statistical power.