경추부 편타성 손상에서의 적외선 체열 진단의 유용성

팽성화,표세영,김무성,정영균,정용태 대한척추신경외과학회 2009 Neurospine Vol.6 No.4

Objective: The name of whiplash Injury derives from the etiopathogenic description of the sudden sharp whipping movement of the head and neck, symptoms are varied, manifesting as neck pain, occipital pain, dysesthesia, and weakness of arm, and so on. But there is no objective diagnostic tool for the evaluation of its symptoms. The purpose of the study is to visualize the symptomatic region before and after treatment and comparing the images obtained by infrared study. Methods: From march 2006 to June 2008, 20 patients diagnosed as whiplash injuries were examined by digital infrared thermographic imaging system (DITI, DOREX, USA). The male-to-female ratio was 14:6 and their ages were ranging in age from 20 to 67 years, with mean age of 38.5 years. We evaluated thermal change (ΔT) in lesion area(neck and shoulder) and also compared thermal difference (ΔT (2wk-I)) after pre- & post- treatment. Results: Initial DITI was 34.28 ± 2.90 on anterior neck, 34.29 ± 2.98 on posterior neck, 33.42 ± 2.93 on right shoulder shoulder (Lt), and 33.59 ± 2.81 on left shoulder. DITI after 2weeks treatment was 33.60 ± 2.88 on anterior neck, 33.78 ± 2.99 on posterior neck, 32.79 ± 2.78 on right shoulder, and 33.05 ± 2.74 on left shoulder. The thermal difference of lesional area on the initial treatment and after treatment (ΔT (2wk-I)) was 0.68 ± 0.45 on anterior neck, 0.51 ± 0.36 on posterior neck, 0.63 ± 0.32 on right shoulder, and 0.54 ± 0.64 on left shoulder, and these result were statistically significant (p<0.05). Thermal difference (ΔT) was neck 0.34 and shoulder 0.33 on initial injury, and 0.39, 0.31 after 2 weeks respectively. This finding was symmetrical and below ΔT 0.5 based on pathologic body temperature. Initial VAS (Visual Analogue Scale) of Neck was 7.9 ± 0.78 and after 2 weeks was 3.6 ± 1.21 the initial VAS of shoulder was 7.4 ± 0.52 and after 2 weeks was 3.2±0.97. There was statistically significant (p=0.001). Conclusion: Therefore DITI was perceived as a reliable tool in the objective assessment of treatment effect after sustaining whiplash injuries, in clinical practice. Objective: The name of whiplash Injury derives from the etiopathogenic description of the sudden sharp whipping movement of the head and neck, symptoms are varied, manifesting as neck pain, occipital pain, dysesthesia, and weakness of arm, and so on. But there is no objective diagnostic tool for the evaluation of its symptoms. The purpose of the study is to visualize the symptomatic region before and after treatment and comparing the images obtained by infrared study. Methods: From march 2006 to June 2008, 20 patients diagnosed as whiplash injuries were examined by digital infrared thermographic imaging system (DITI, DOREX, USA). The male-to-female ratio was 14:6 and their ages were ranging in age from 20 to 67 years, with mean age of 38.5 years. We evaluated thermal change (ΔT) in lesion area(neck and shoulder) and also compared thermal difference (ΔT (2wk-I)) after pre- & post- treatment. Results: Initial DITI was 34.28 ± 2.90 on anterior neck, 34.29 ± 2.98 on posterior neck, 33.42 ± 2.93 on right shoulder shoulder (Lt), and 33.59 ± 2.81 on left shoulder. DITI after 2weeks treatment was 33.60 ± 2.88 on anterior neck, 33.78 ± 2.99 on posterior neck, 32.79 ± 2.78 on right shoulder, and 33.05 ± 2.74 on left shoulder. The thermal difference of lesional area on the initial treatment and after treatment (ΔT (2wk-I)) was 0.68 ± 0.45 on anterior neck, 0.51 ± 0.36 on posterior neck, 0.63 ± 0.32 on right shoulder, and 0.54 ± 0.64 on left shoulder, and these result were statistically significant (p<0.05). Thermal difference (ΔT) was neck 0.34 and shoulder 0.33 on initial injury, and 0.39, 0.31 after 2 weeks respectively. This finding was symmetrical and below ΔT 0.5 based on pathologic body temperature. Initial VAS (Visual Analogue Scale) of Neck was 7.9 ± 0.78 and after 2 weeks was 3.6 ± 1.21 the initial VAS of shoulder was 7.4 ± 0.52 and after 2 weeks was 3.2±0.97. There was statistically significant (p=0.001). Conclusion: Therefore DITI was perceived as a reliable tool in the objective assessment of treatment effect after sustaining whiplash injuries, in clinical practice.

What Causes Severe Myelopathy Resulting in Acute Quadriplegia after a Surgery for Atlantoaxial Subluxation due to Os Odontoideum? A Case Report

팽성화 대한신경손상학회 2019 Korean Journal of Neurotrauma Vol.15 No.1

A case of acute quadriplegia resulting from reduction of atlantoaxial subluxation due toos odontoideum is rare. Patient with os odontoideum are at a greater risk for atlantoaxialinstability and resultant spinal cord compression. In our case, the patient exhibited mildmyelopathic symptoms before the onset of acute quadriplegia. Owing to the clinicalpresentations, the spinal cord not only seemed to suffer a mechanical compression but alsoan insufficiency of blood supply to the spinal artery and its branches. No other report hasdescribed the fndings from magnetic resonance imaging before and afer the onset of acutemyelopathy afer surgery. The aim of our case report is to highlight the pathophysiology andappropriate management strategy of a patient with severe progressive spinal cord myelopathyafer surgery, secondary to chronic atlantoaxial subluxation due to os odontoideum. This case depicts the presence of this rare yet possible complication, and emphasizesthe importance of preoperative evaluation in cases with chronic progressive myelopathy. Moreover, urgent postoperative treatment and rehabilitation are important for the recovery ofneurological symptoms.

청신경초종에 대한 감마나이프 방사선 수술

팽성화,김무성,심홍보,정영균,이선일,정용태,김수천,심재홍,Paeng, Sung Hwa,Kim, Moo Seong,Sim, Hong Bo,Jeong, Yeong Gyun,Lee, Sun Il,Jung, Yong Tae,Kim, Soo Chun,Sim, Jae Hong 대한신경외과학회 2001 Journal of Korean neurosurgical society Vol.30 No.11

Object : The goals of radiosurgery include preservation of neurological function and prevention of tumor growth. We document the results of gamma-knife radio-surgery for vestibular schwannoma. Method & Object : Eighty-two patients underwent stereotactic radiosurgery for an vestibular schwannoma from October, 1994 to December, 2000. Sixty-five of these patients were followed up for radiological and clinical evaluation. As pregamma-knife modality, surgical resection were done in 23 patients,and V-P shunt in 2 patients. Initial symptoms were headache(n=45), dizziness(n=16), tinnitus(n=17). While normal facial function(House-Brackmann grade 1) was present in 48 patients(73.8%), other patients showed grade 2 function in 8, grade 3 function in 7,and grade 4 function in 2. The Gardner/Robertson scale was used to code hearing function. Male to female ratio was 1:3. Mean tumor volume was $7.98cm^3$. Mean dose delivered to the tumor margin was 14.2Gy,and mean maximal dose was 28.3Gy. Results : Mean follow-up duration of 19.9 months. Thirty-five showed decrease(53.8%) in size, 19 patients(29.2%) stationary, 3(4.6%) initial decrease follow up increase, 5(7.6%) initial increase follow up decrease,and 59 patients (90.8%) were well controlled. Two patients experienced transient facial neuropathy, one transient trigeminal neuropathy, and one transient hearing deterioration. After gamma-knife radiosurgery, ventriculoperitoneal shunt was done in 4 patients. Conclusions : Gamma-knife radiosurgery can be used to treat postoperative residual tumors as well as in patients with concomitant medical problems in patients with preserved hearing function. Gamma-knife radiosurgery is safe and effective method to treat small, medium sized(less than 3cm in extracanalicular diameter), intracanalicular vestibular schwannoma, associated with low rate of cranial neuropathy.

총상으로 인한 경추부 및 척수손상 증례 보고

팽성화 ( Sung Hwa Paeng ) 대한외상학회 2012 大韓外傷學會誌 Vol.25 No.2

Gunshot wounds are rare in Korea, but they have tended to increase recently. We experienced an interesting case of penetrating gunshot injuries to the cervical spine with migration the fragments of the bullet within the dural sac of the cervical spine, so discuss the pathomechanics, treatment and complications of gunshot wounds to the spine and present a review of the literature. A 38-year-old man who had tried to commit suicide with a gun was admitted to our hospital with a penetrating injury to the anterior neck. the patient had quadriplegia. A Computed tomography (CT) scan and 3-dimensional CT of the spine showed destruction of the left lateral mass and lamina of the 5th cervical vertebra; the bullet and fragments were found at the level of the 5th cervical vertebra. The posterior approach was done. A total laminectomy and removal of the lateral mass of the 5th cervical vertebrae were performed, and bone fragments and pellets were removed from the spinal canal, but an intradurally retained pellets were not totally removed. A dural laceration was noted intraoperatively, and CSF leakage was observed, so dura repair was done watertightly with prolene 6-0. The dura repair site was covered with fibrin glue and Tachocomb^(R). Immediately, a lumbar drain was done. Radiographs included a postoperative CT scan and X-rays. The postoperative neurological status of the patient was improved compared with the preoperative neurological status. however, the patients developed symptoms of menigitis. He received lumbar drainage(200∼250 cc/day) and ventilator care. After two weeks, panperitonitis due to duodenal ulcer perforation was identified. Finally, the patient died because of sepsis. (J Korean Soc Traumatol 2012;25:57-62)

축추 이하 경추손상 환자에서 외상성 탈구에 의한 도수 정복의 실패 요인의 분석과 수술적 치료에 대한 분석

팽성화 ( Sung Hwa Paeng ) 대한외상학회 2012 大韓外傷學會誌 Vol.25 No.1

Purpose: Cervical dislocations with locked facets account for more than 50% of all cervical injuries. Thus, investigating a suitable management of cervical locked facets is important. This study examined factors of close reduction failure in traumatically locked facets of the subaxial cervical spine patients to determine suitable surgical management. Methods: We retrospectively analyzed of the case histories of 28 patients with unilateral/bilateral cervical locked facets from Nov. 2004 to Dec. 2010. Based on MRI evaluation of disc status at the injury level, we found unilateral dislocations in 9 cases, and bilateral dislocations in 19 cases, The patients were investigated for neurologic recovery, closed reduction rate, factors of the close reduction barrier, fusion rate and period, spinal alignment, and complications. Results: The closed reduction failed in 23(82%) patients. Disc herniation was an obstacle to closed reduction (p=0.015) and was more frequent in cases involving a unilateral dislocation (p=0.041). The pedicle or facet fracture was another factor, although some patients showed aggravation of neurologic symptoms, most patients had improved by the last follow up. The kyphotic angle were statistically significant (p=0.043). Sixs patient underwent anterior decompression/fusion, and 15 patients underwent circumferential fusion, and 7 patients underwent posterior fusion. All patients were fused at 3 months after surgery. The complications were 1 case of CSF leakage and 1 case of esphageal fistula, 1 case of infection. Conclusion: We recommend closed reduction be performed as soon as possible after injury to maximize the potential for neurological recovery. Patients fot whom closed reduction of the cervical locked facets have a higher incidence of anatomic obstacles to reduction, including facet fractures and disc herniation. Immediate direct open anterior reduction or circumferential fixation/fusion of locked cervical facets is recommended as a treatment of choice for traumatic locked cervical facet patients after closed reduction failure. (J Korean Soc Traumatol 2012;25:7-16)

두부외상 후 의식 명료기 이후 악화된 4개월된 영아에서 발생된 급성 두 개내 경막외 혈종

팽성화 ( Sung Hwa Paeng ) 대한외상학회 2012 大韓外傷學會誌 Vol.25 No.4

An eipdural hematoma in an infant is a very rare entity. We report a case of an acute traumatic intracranial epidural hematoma that developed with a lucid interval in a 4-month-old infant after a fall down from a bed. The infant was admitted at the emergency room. The child had initially cried and may have had a decreased level of consciouseness due to brain injury, but then returned to normal level of consciousness for several hours prior to admission. However, the infant had vomited twice after taking milk and then was lethargic. The brain CT revealed a lentiform-shaped huge hematoma on the right parietal area with a midline shift of 8 mm. An osteoplastic craniotomy was performed, and the intracranial epidural hematoma was totally removed. Postoperatively, the infant recovered well and was dischaged. (J Trauma Inj 2012;25:275-277)

심한 경추부 외상후에 전방 경추부 수술 후 발생한 식도의 누공

팽성화 ( Sung Hwa Paeng ) 대한외상학회 2012 大韓外傷學會誌 Vol.25 No.4

An esophageal perforation following anterior cervical fusion is rare. Early development of an esophageal perforation after anterior cervical fusion is usually due to iatrogenic injury from retraction, injury associated with the original traumatic incident, improperly placed instruments or a bone graft. A 31-year-old man had a cervical dislocation and spinal cord injury because of severe cervical trauma after a traffic accident. He was quadriplegic and had no feeling below T4 dermatome. Anterior decompression of the cervical spine and anterior fusion with mesh with autobone were performed. An esophagocutaneous fistula occurred 7 days after anterior cervical surgery. A second anterior surgery was done because of pus drainage. The mesh was changed with an iliac bone graft, and the esophagocutaneous fistula site was primary repaired, but pus continued to drain. Conservative treatment, which consisted of wound drainage and intravenous administration of antibiotics, was tried, but was unsuccessful. After all, we removed the plate and screws, but did not removed the iliac bone graft, We closed the esophageal fistula, and transposed the sternocleidomastoid muscle flap to the interspace between the esophagus and the cervical spine. The wound to the esophagus was well repaired. In conclusion, precautionary measures are needed to avoid the complication, and adequate treatment is necessary to resolve those complications when they occur. (J Trauma Inj 2012;25:278-282)

Cervicothoracic Junction Approach using Modified Anterior Approach: J-type Manubriotomy and Low Cervical Incision

이진,팽성화,이원희,김성태,이근수 대한신경손상학회 2019 Korean Journal of Neurotrauma Vol.15 No.1

Spinal surgery of the anterior aspect of the cervicothoracic junction is difcult and hastechnological challenges because of the kyphotic alignment of the upper thoracic spine. Thisapproach requires knowledge of the cervicothoracic regional anatomy. Surgery in this regionis rare because of its indications; despite this rarity, surgeons must be prepared to exposethis region. In addition, surgery in this region demands extensive opening of the surgicalfeld and results in severe postoperative pain. Therefore, a less invasive procedure must beconsidered. Six cases of cervicothoracic lesion operation have been reported. The patientswere successfully treated using an anterior modifed approach (J-type manubriotomy). Anterior reconstruction and instrumentation of the cervicothoracic junction offers a distinctadvantage of a stable anterior implant bone construction while preserving the posteriorosseo-ligamentous tension band. Moreover, the modifed anterior approach (J-typemanubriotomy) provides the same exposure of the cervicothoracic junction without a fullmedian sternotomy and avoids injury to subclavian vessels during resection of the clavicleor sternoclavicular junction. Therefore, the anterior cervical approach combined with J-typemanubriotomy allows extensive exposure of the cervicothoracic junction and causes lesscomplications. We performed preoperative radiological evaluation to identify the cases inwhich J-type manubriotomy was necessary

Recurrent Spinal Meningioma: A Case Report

최회정,팽성화,김성태,정용태 대한척추신경외과학회 2012 Neurospine Vol.9 No.3

Meningiomas are the second most common intradural spinal tumors accounting for 25% of all spinal tumors. Being a slow growing and invariably benign tumor, it responds favorably to surgical excision. In addition, spinal meningioma has low recurrence rates. However, we experienced a case of intradural extramedullary spinal meningioma which recurred 16 years after the initial surgery on a 64-year-old woman. She presented with progressive neurological symptoms and had a surgical history of removal of thoracic spinal meningioma 16 years ago due to bilateral low leg weakness. She underwent a second operation at the same site and a pale yellowish tumor was excised, which was histopathologically confirmed as meningothelial meningioma, compared with previously transitional type. she showed neurological recovery after the operation. We, therefore, report the good results of this recurrent intradural spinal meningioma case developed after 16 years with literature review.

Swallowing Difculty in Diffuse Idiopathic Skeletal Hyperostosis with Metabolic Syndrome

이진호,팽성화,표세영,김성태,이원희 대한신경손상학회 2020 Korean Journal of Neurotrauma Vol.16 No.1

Diffuse idiopathic skeletal hyperostosis (DISH) is a disease of unknown etiology developingfollowing ossifcation of the antero-lateral ligaments of the spine. Mostly, prevailing elderlyadult males, it is an uncommon cause of dysphagia and dysphonia. We report three cases ofDISH with metabolic syndrome. They were complained of neck movement restriction anddysphagia. At frst, They all visited ear, nose, and throat outpatient department. The initialimpression was gastroesophageal reflux, and an endoscopy excluded esophageal lesion. Cervical spine radiologic imaging revealed ossifcation of the cervical anterior longitudinalligament with large, conspicuous osteophytes from cervical spine lesion, producingcompression of pharyngoesophagus and upper airway; these images corresponded to DISH. Cervical osteophyte surgical removal resulted in a complete alleviation from dysphagia forthe patient. DISH should be considered in the differential diagnosis of dysphagia.