성인 척추질환자의 발균형 및 보행형태에 대한 운동역학적 분석

박재승,이중숙 한국운동역학회 2019 한국운동역학회지 Vol.29 No.1

Objective: The aim of this study was to provide kinematic data on the characteristics of spinal disease patients by comparing and analyzing kinematic variables related to foot balance and gait pattern of spinal disease. Method: The subjects of the study included 40 adult men and 60 adult women who visited the hospital in Busan. Patients who were diagnosed with spinal disease by a physician through Xray examination were selected as subjects for the diagnosis of vertebral disc herniation, spinal stenosis, spinal disease diagnosed with spinal disease and the general public. Left and right foot pressure and contact area were checked by Gaitview pro meter. X-ray photographs were taken with a Zen-2090 mobile fluoroscopy under physicians' direct participation. One-way ANOVA was performed to compare the differences between the kinematic variables and post-hoc was performed by the Duncan method. Results: The difference in contact area between the left foot and the right foot was 115.30 ± 14.15 cm 2 in the left side and 124.25 ± 13.65 cm 2 in the left side in the spinal disease patients. The difference in pressure between the left and right side of the spinal disease patients was wider than that of the general people. Especially, the right side of the spinal disease patients showed a larger area of left foot contact than the general population. Conclusion: Spinal disease patients have wider contact area of the left foot than those of the general population. In the case of right spinal disease, the left foot support area is widened due to pain. In the gait, women showed slightly more posterior body center than men, and the upper body muscle imbalance and immobilization due to the spinal disease caused imbalance of the muscles moving to the lower limb, It was analyzed to inhibit movement.

성인 척추질환자의 발균형 및 보행형태에 대한 운동역학적 분석

( Jae Soung Park ),( Joong Sook Lee ) 한국운동역학회 2019 한국운동역학회지 Vol.29 No.1

Objective: The aim of this study was to provide kinematic data on the characteristics of spinal disease patients by comparing and analyzing kinematic variables related to foot balance and gait pattern of spinal disease. Method: The subjects of the study included 40 adult men and 60 adult women who visited the hospital in Busan. Patients who were diagnosed with spinal disease by a physician through Xray examination were selected as subjects for the diagnosis of vertebral disc herniation, spinal stenosis, spinal disease diagnosed with spinal disease and the general public. Left and right foot pressure and contact area were checked by Gaitview pro meter. X-ray photographs were taken with a Zen-2090 mobile fluoroscopy under physicians' direct participation. One-way ANOVA was performed to compare the differences between the kinematic variables and post-hoc was performed by the Duncan method. Results: The difference in contact area between the left foot and the right foot was 115.30 ± 14.15 cm2 in the left side and 124.25 ± 13.65 cm2 in the left side in the spinal disease patients. The difference in pressure between the left and right side of the spinal disease patients was wider than that of the general people. Especially, the right side of the spinal disease patients showed a larger area of left foot contact than the general population. Conclusion: Spinal disease patients have wider contact area of the left foot than those of the general population. In the case of right spinal disease, the left foot support area is widened due to pain. In the gait, women showed slightly more posterior body center than men, and the upper body muscle imbalance and immobilization due to the spinal disease caused imbalance of the muscles moving to the lower limb, It was analyzed to inhibit movement.

성인 척추질환자의 발균형 및 보행형태에 대한 운동역학적 분석

Park, Jae Soung,Lee, Joong Sook 한국운동역학회 2019 한국운동역학회지 Vol.29 No.1

Objective: The aim of this study was to provide kinematic data on the characteristics of spinal disease patients by comparing and analyzing kinematic variables related to foot balance and gait pattern of spinal disease. Method: The subjects of the study included 40 adult men and 60 adult women who visited the hospital in Busan. Patients who were diagnosed with spinal disease by a physician through X-ray examination were selected as subjects for the diagnosis of vertebral disc herniation, spinal stenosis, spinal disease diagnosed with spinal disease and the general public. Left and right foot pressure and contact area were checked by Gaitview pro meter. X-ray photographs were taken with a Zen-2090 mobile fluoroscopy under physicians' direct participation. One-way ANOVA was performed to compare the differences between the kinematic variables and post-hoc was performed by the Duncan method. Results: The difference in contact area between the left foot and the right foot was $115.30{\pm}14.15cm^2$ in the left side and $124.25{\pm}13.65cm^2$ in the left side in the spinal disease patients. The difference in pressure between the left and right side of the spinal disease patients was wider than that of the general people. Especially, the right side of the spinal disease patients showed a larger area of left foot contact than the general population. Conclusion: Spinal disease patients have wider contact area of the left foot than those of the general population. In the case of right spinal disease, the left foot support area is widened due to pain. In the gait, women showed slightly more posterior body center than men, and the upper body muscle imbalance and immobilization due to the spinal disease caused imbalance of the muscles moving to the lower limb, It was analyzed to inhibit movement.

노인성 척추질환의 역학: 건강보험심사평가원 자료 기반 연구

노성현 대한의사협회 2021 대한의사협회지 Vol.64 No.3

According to the Statistics Korea in 2020, the elderly population aged 65 or older accounted for 15.7% of the total population, and by 2025 it will reach 20.3%, which will enter the super-aged society. In an aging society, many degenerative diseases occur with age. In particular, the spine is a structure that acts as a pillar of our body, and as we age, degenerative changes come. Representative senile spinal diseases include disc disease, spinal stenosis, spinal spondylolisthesis, scoliosis, kyphosis, and flat back syndrome. This study intends to examine the epidemiologic characteristics and trends of senile spinal diseases using Korean Health Insurance Review & Assessment Service database from 2010 to 2019. All of the senile spinal diseases have gradually increased in the number of patients and cost over the last 10 years. In addition, the proportion of those aged 60 and over increased among those diagnosed. And fusion surgery and discectomy also increased in the last 10 years, and the treatment cost and ratio of over 60 years old increased. Korea has already become an aging society. So, in the future, senile diseases will increase further, and among them, senile spinal diseases will steadily increase. As a result, the frequency and cost of surgery will continue to increase. Efforts are needed to understand this trend and to prevent senile spinal diseases. For example, regular exercise, proper posture and habits, adequate nutrition, and efforts such as quitting smoking should be required. When these efforts are made, more healthy old life will be achieved.

퇴행성 요추부 질환에 대한 치료에서 척추 고정술과 동반된 인접부 극돌기간 기구 삽입술의 유용성에 대한 예비 보고

최우진,장상근,김동천 대한척추신경외과학회 2009 Neurospine Vol.6 No.3

Objective: Posterior lumbar or lumbosacral spinal fusion in degenerative lumbar disease has the problems of adjacent level disease as well as surgical complications. An interspinous device used for dynamic stabilization can also be applied to the adjacent segment for spinal fusion to reduce the severity of these problems. The authors reviewed the adjacent interspinous stabilization using an interspinous spacer (CoflexTM paradigm spine, Germany) combined with posterior lumbar or lumbosacral spinal fusion in degenerative lumbar disease. Method: From January 2007 to July 2008, ten patients with degenerative lumbar disease underwent posterior lumbar or lumbosacral spinal fusion with adjacent interspinous stabilization using CoflexTM. The indications for this type were adjacent segmental disc protrusion, adjacent segmental degenerative changes or high surgical risk groups, such as elderly patients or osteoporotic patients undergoing multiple leveled fusions. CoflexTM was inserted into the adjacent segmental interspinous space. The control group consisted of fifteen patients, who underwent posterior lumbar or lumbosacral spinal fusion without interspinous stabilization. The radiological parameters and clinical outcomes were compared. All patients were followed-up for more than twelve months. Results: The visual analogue scale (VAS) in both groups postoperatively and at the twelve month follow-up were improved. In the CoflexTM group, the postoperative and twelve month follow-up X-ray showed no significant change in posterior disc height, interpedicular height, segmental lordotic angle, flextion-extension angulation and translation and no significant segmental instability. The control group showed a higher level of segmental lordotic angle, translation and a lower posterior disc height, interpedicular height, flextion-extension angulation and three patients showed adjacent segmental instability. Conclusion: CoflexTM can be used to stabilize the adjacent segment of spinal fusion in degenerative lumbar disease and might be effective in preventing adjacent segmental degeneration. However, further study will be needed to confirm this observation. Objective: Posterior lumbar or lumbosacral spinal fusion in degenerative lumbar disease has the problems of adjacent level disease as well as surgical complications. An interspinous device used for dynamic stabilization can also be applied to the adjacent segment for spinal fusion to reduce the severity of these problems. The authors reviewed the adjacent interspinous stabilization using an interspinous spacer (CoflexTM paradigm spine, Germany) combined with posterior lumbar or lumbosacral spinal fusion in degenerative lumbar disease. Method: From January 2007 to July 2008, ten patients with degenerative lumbar disease underwent posterior lumbar or lumbosacral spinal fusion with adjacent interspinous stabilization using CoflexTM. The indications for this type were adjacent segmental disc protrusion, adjacent segmental degenerative changes or high surgical risk groups, such as elderly patients or osteoporotic patients undergoing multiple leveled fusions. CoflexTM was inserted into the adjacent segmental interspinous space. The control group consisted of fifteen patients, who underwent posterior lumbar or lumbosacral spinal fusion without interspinous stabilization. The radiological parameters and clinical outcomes were compared. All patients were followed-up for more than twelve months. Results: The visual analogue scale (VAS) in both groups postoperatively and at the twelve month follow-up were improved. In the CoflexTM group, the postoperative and twelve month follow-up X-ray showed no significant change in posterior disc height, interpedicular height, segmental lordotic angle, flextion-extension angulation and translation and no significant segmental instability. The control group showed a higher level of segmental lordotic angle, translation and a lower posterior disc height, interpedicular height, flextion-extension angulation and three patients showed adjacent segmental instability. Conclusion: CoflexTM can be used to stabilize the adjacent segment of spinal fusion in degenerative lumbar disease and might be effective in preventing adjacent segmental degeneration. However, further study will be needed to confirm this observation.

노인성 척추질환의 보존적 치료: 약물치료와 신경 차단술

허준석 대한의사협회 2021 대한의사협회지 Vol.64 No.3

As we get closer to super-aged society, the prevalence of senile spinal diseases is constantly increasing and the burden on individuals and society grows high. Senile spinal disease is basically degenerative in nature. Pain and physical dysfunction occur due to various complex pathologic causes. For the diagnosis and treatment of such complex diseases, it is essential to understand common senile spinal diseases such as intervertebral disc herniation and spinal stenosis. Degenerative changes in intervertebral discs are caused by a combination of aging and excessive physical load, which results in structural damages and molecular biological changes in the intervertebral discs. Spinal stenosis is a disease in which nerves and blood vessels are compressed by hypertrophied ligamentum flavum, bulged disc, and a hypertrophied facet. Ligamentum flavum hypertrophy, which is the most important etiology in spinal stenosis, occurs due to mechanical stress and a cascade of inflammation and fibrosis reactions. Drug therapy targeting these pathologic mechanisms includes non-steroidal anti-inflammatory drugs, antidepressants, anticonvulsants, and agents that improve blood circulation. Nerve blocks, which prevent these pathophysiologic conditions, are also a good treatment modality. Typical nerve block techniques include medial nerve block and epidural block. It is necessary to understand the pathophysiology of senile spinal diseases and establish an appropriate treatment strategy that suit the patient's condition.

퇴행성 요추질환 환자에서 후방경유 요추체간 유합술과 360˚척추 고정술의 비교에 대한 임상연구

오성훈,김주헌,이형중,정진환,이우택 한양대학교 의과대학 2002 한양의대 학술지 Vol.22 No.1

The goal of surgical treatment for degenerative lumbar diseases is to relieve radiculopathy by decompression of neural canal and to resolve mechanical low back pain through spinal fusion, therefore rendering them prevent from further degeneration. Authors analyzed the surgical results between posterior lumbar interbody fusion(PLIF) and 360° spinal fixation to evaluate the proper treatment policy among the patients with spinal stenosis, the degenerative spondylolisthesis and the low-grade isthmic spondylolisthesis. The authors performed PLIF on 92 patients and 360°spinal fixation on 138 patients with spinal stenosis, degenerative spondylolisthesis or low-grade isthmic spondylolisthesis. We retrospectively investigated clinical outcomes by using Prolo's economic and functional outcome sclae and subjective satisfaction scales of these patients by using several criteria such as visual analog scale (VAS), analgesic prescription after operation and questionnaire for overall outcome (1. successful?, 2. repeat if similar condition?, 3. recommend to others?). 1. Excellent and good outcomes on Prolo's scale was 81.5% in PLIF group and 82.6% in 360° spinal fixation group. 2. Pre- and postoperative VAS on back pain and leg pain showed marked decrease in the intensity of pain from 6.52±1.03, 6.74±0.93 to 2.23±1.15, 2.44±1.03 in PLIF group and from 7.04±1.05, 7.23±1.26 to 2.52±1.05, 2.74±1.12 in 360°spinal fixation group respectively. 3. Analgesic prescription after operation decreased in both group (79.3% in PLIF group and 78.3% in 360°spinal fixation group). 4. Patients' self-reported overall success rate of their procedure showed 82% in PLIF group and 84% in 360° spinal fixation group. Both groups of PLIF and 360°spinal fixation showed good outcomes and biomechanically stable fusion in spinal stenosis, degenerative spondylolisthesis or low-grade isthmic spondylolisthesis. Therefore, unless extensive laminectomy and facetectomy was carried out, PLIF should provide similar success rate compared to the 360°spinal fixation procedure in the above mentioned degenerative lumbar diseases. In PLIF procedures, we sould achieve a more stable bone fusion with performing partial hemilaminectomy, preserving supraspinous/interspinous ligaments and grafting autogenous harvested bone into the cages.

Microsurgical Treatment of Sporadic and von Hippel-Lindau Disease Associated Spinal Hemangioblastomas: A Single-Institution Experience

Joe M. Das,Krishnakumar Kesavapisharady,Saravanan Sadasivam,Suresh Narayanan Nair 대한척추외과학회 2017 Asian Spine Journal Vol.11 No.4

Study Design: Retrospective cohort study. Purpose: To examine the clinical profile and surgical complications in patients with spinal hemangioblastomas and to evaluate the long-term outcome in them. Overview of Literature: Although considered to be histologically benign, hemangioblastomas may cause significant neurological deficits. The proportion of spinal hemangioblastomas associated with von Hippel–Lindau (VHL) disease has been estimated be 13%–59%. Preoperative neurological function correlates with postoperative neurological status. Studies have shown no difference in outcomes between sporadic and VHL-associated spinal hemangioblastomas. Methods: This retrospective study included 14 consecutive patients treated for spinal hemangioblastomas at our institute between January 2000 and June 2013. The mean follow-up period was 5 years. Magnetic resonance imaging of the complete neuraxis was performed in all cases, and preoperative embolization was performed in two cases. Results: In total, 14 patients underwent 18 surgeries, of which 15 were for spinal hemangioblastomas. Of all the patients, 86% had motor weakness and 79% presented with sensory disturbances. Preoperative McCormick functional grades were grade I in 7 (50%), grade II in 3 (21%), and grade III in 4 (29%) patients; 50% patients were diagnosed with VHL disease. All patients underwent complete resection of the tumor. Eight patients experienced deterioration in their neurological status in the immediate postoperative period; among them, five had gradual improvement. At 5-year follow-up, 11 (78.57%) patients showed good functional outcomes. Conclusions: Microsurgical excision of spinal hemangioblastomas can cause postoperative morbidity, mainly in the form of neurological deterioration. Almost half of our patients had deterioration in the McCormick grade in the immediate postoperative period. However, a complete microsurgical excision can result in good long-term functional outcomes, as most of the immediate postoperative neurological deterioration in our patients was reversible. There was no difference in the long-term functional outcomes between sporadic and VHL-associated spinal hemangioblastomas.

척추질환으로 입원한 환자의 임상적 분석

도은식,한동로,김오룡,지용철,최병연,조수호 대한신경외과학회 1988 Journal of Korean neurosurgical society Vol.17 No.4

11) 전체 척추질환 환자 1080례중, degenerative disease가 749명으로 69.3%, trauma가 265명으로 24.5%, tumor가 28명으로 2.5%를 각각 차지하였다. 2) Degenerative disease 중 disc disease는 1.7:1로 남자에서 더 많았고, degenerative spondylolisthesis는 여자에서 약 3배이였다. 나이별로는 disc disease는 20~40세에서 호발하였고 다른 퇴행성질환의 경우는 40~60세에서 가장 호발하였다. 3) Disc disease의 호발부위로는, cervical은 C5~6(40%), lumbar는 L4~5(79.4%)에서 가장 많았다. 4) Cervical disc disease 환자 총 42명중, 9명에서 operation을 시행하였고, lumbar disc disease 경우 총 643명 중 238명은 laminectomy, 57명에서는 chemonucleolysis를 시행하였다. 5) Degenerative spondylolisthesis 환자 16명 중 9명은 수술로 치료하였고, 이중 6례는 Knodt rod instrumentation을 시행하였다. 6) Trauma환자 265례중 soft tissue injury가 97명(36.6%), 단순한 fracture가 133명(50.1%), cord injury를 동반한 fracture가 35명(13.2%)이었다. 7) Cord injury는 complete injury인 경우는 17례중 15례에서 conservative treatment를 시행하였다. 9) Spinal tumor에서 남녀비는 비슷하였고, 나이는 40~60세에서 호발하였다. 10) 총 28례의 spinal tumor 중 extradural이 23례로서 제일 많았다. 11) Spinal tumor의 pathologic diagnosis는 metastatic carcinoma, vascular tumor 및 neurofibroma가 각각 5례씩이었고, 그외 meningioma 3례, lipoma 2례 등이었다. A total cases of 1080 inpatients of spinal disease in neurosurgical department of Yeungnam University Hospital(YUH) from May 1983 to March 1988 were analysed statistically. 1) Of the total 1080 cases, the vast majority was degenerative disease 749(69.3%), and others were trauma 265(24.5%), tumor 28(2.5%), congenital anomaly 4(0.3%), infection 22(2.0%) and miscellaneous 12(1.1%). 2) In degenerative disease, male to female ratio in disc disease was 1.7 : 1 and in degenerative spondylolisthesis 1 : 3. And frequent age group of disc disease was 20~40(50%) and other degenerative diseases were 40~60(66.6%). 3) Most frequent site of cervical disc disease was C5~6(40%) and lumbar disc disease was L4~5(79.4%). 4) There were 265 patients of trauma, among them, spinal fracture without neruological deficit was 97(36.6%), soft tissue injury was 133(50.0%) and fracture associated with cord injury was 35(13.2%). 5) In 28 cases of spinal tumors, the most frequent site was extradural space 23(82.1%).

내과질환에 대한 Chiropratic Spinal Manipulation의 적용 - pubmed를 중심으로 검색 -

권오봉,송윤경,임형호,이종수,Kwon, Oh-Bong,Song, Yun-Kyung,Lim, Hyung-Ho,Lee, Jong-Soo 척추신경추나의학회 2006 척추신경추나의학회지 Vol.1 No.2

Objectives: The aim of this study is to investigate chiropractic spinal manipulation and internal diseases in articles. Methods: It was investigated how many articles had been searched for spinal manipulation applied to internal disease in Pubmed Database Results: 1. There are 19 articles of chiropractic spinal manipulation and internal diseases were investigated. 2. It was reported that there are improvements of spinal manipulative therapy on asthma, injury of the optic nerve, hypertension, vertigo, tinnitus, hearing loss, etc. Conclusions: There are several reports on effectiveness of spinal manipulative therapy on asthma, injury of the optic nerve, hypertension, vertigo, tinnitus, hearing loss, etc. And It is considered that spinal manipulative therapy shows improvement on the internal diseases.