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1.  Feasibility of Translaminar Screw Placement in Korean Population: Morphometric Analysis of Cervical Spine 
Yonsei Medical Journal  2014;56(1):159-166.
To analyze the feasibility of unilateral and bilateral translaminar screw placement in Koran population, and compare the acceptance rate using previously reported data in American population.
Materials and Methods
The translaminar lengths, thickness, heights, and sagittal-diagonal measurements were performed. The feasibility analysis was performed using unilateral and bilateral 3.5 mm cervical screw placement on the CT scans within 0.5 mm of safety margin. We also performed radiographic analysis of the morphometric dimensions and the feasibility of unilateral and bilateral translaminar screw placement at C3-C7.
Korean population had similar or significantly shorter translaminar lengths and thickness (lengths and thickness in C7 among males; lengths in C6-C7 and thickness in C4 among females) than American population, but had similar or significantly longer translaminar heights and sagittal-diagonal measurements (heights in C3-C7 and sagittal-diagonal measurements in C3-C6 among males; heights in C7 and sagittal-diagonal measurements in C3-C7 among females). Unilaterally, translaminar screw acceptance rates in C3-C7 were similar between Korean and American male population, but the rates in C4-C6 were significantly smaller between Korean and American female population. Bilaterally, translaminar screw acceptance rates in C3 and C5-C6 were significantly larger between Korean and American male population, but the rates in C3-C7 were similar between Korean and American female population.
The feasibility of unilateral and bilateral translaminar screw placement is different depending on different ethnics. Subaxial cervical unilateral translaminar screw placement among Korean male population and bilateral placement at C4-C7 among Korean female population are more acceptable than American population.
PMCID: PMC4276750  PMID: 25510760
Translaminar; cervical fusion; cervical spine; ethics; Korean; American
2.  Interference of Detection Rate of Lumbar Disc Herniation by Socioeconomic Status 
Asian Spine Journal  2013;7(1):14-19.
Study Design
Retrospective study.
The objective of the study is to evaluate the relationship between the detection rate of lumbar disc herniation and socioeconomic status.
Overview of Literature
Income is one important determinant of public health. Yet, there are no reports about the relationship between socioeconomic status and the detective rate of disc herniation.
In this study, 443 cases were checked for lumbar computed tomography for lumbar disc herniation, and they reviewed questionnaires about their socioeconomic status, the presence of back pain or radiating pain and the presence of a medical certificate (to check the medical or surgical treatment for the pain) during the Korean conscription.
Without the consideration for the presence of a medical certificate, there was no difference in spinal physical grade according to socioeconomic status (p=0.290). But, with the consideration of the presence of a medical certificate, the significant statistical differences were observed according to socioeconomic status in 249 cases in the presence of a medical certificate (p=0.028). There was a lower detection rate in low economic status individuals than those in the high economic class. The common reason for not submitting a medical certificate is that it is neither necessary for the people of lower socioeconomic status nor is it financially affordable.
The prevalence of lumbar disc herniation is not different according to socioeconomic status, but the detective rate was affected by socioeconomic status. Socioeconomic status is an important factor for detecting lumbar disc herniation.
PMCID: PMC3596579  PMID: 23508288
Herniated disc; Prevalence; Socioeconomic status; Conscription
3.  HOX-7 suppresses body weight gain and adipogenesis-related gene expression in high-fat-diet-induced obese mice 
HOX-7 is a newly developed dietary formula composed of traditional oriental herbal medicines. The formula was developed with the aim of improving weight control. We investigated the anti-obesity effect of HOX-7 on high-fat-diet (HFD)-induced obesity in C57BL/6 mice.
The mice were divided into four groups and were fed a normal diet (ND), HFD, or HFD with oral administration of HOX-7 at 100 or 200 mg/kg/day for 12 weeks. Body and fat weight, histological changes of fat tissue, and the expression of key adipogenic transcription factors were investigated.
The body weight of mice fed the HFD with HOX-7 was significantly decreased compared to the HFD group. There were no obvious differences in weekly food intake among the 4 groups. The weight of the epididymal and total fat pads was reduced in mice fed the HFD with HOX-7. Treatment with HOX-7 also substantially attenuated the expression of key adipogenic transcription factors, including peroxisome proliferatoractivated receptor γ, CCAAT/enhancer binding protein α, sterol regulatory element binding protein 1c, adipocyte P2, liver X receptor, and lipoprotein lipase in the epididymal adipose tissue.
Overall, this study highlighted the anti-obesity effects of HOX-7, a finding that could contribute to the development of natural anti-obesity herbal medicines.
PMCID: PMC4320579  PMID: 25515293
C/EBPα; Mice; Obesity; PPARγ; SREBP1c; Traditional herbal medicine
4.  The Impact of Primary Spontaneous Pneumothorax on Multiphasic Personal Inventory Test Results in Young South Korean Males 
Yonsei Medical Journal  2012;53(5):901-905.
Few reports have documented psychopathological abnormalities in patients with primary spontaneous pneumothorax (PSP). We analyzed the results of a multiphasic personal inventory test to investigate the psychopathologic impact of PSP in young Korean males.
Materials and Methods
The authors reviewed the results of a Korean military multiphasic personal inventory (KMPI) administered to military conscripts in South Korea. A total of 234 young males participated in this study. The normal volunteer group (n=175) comprised individuals who did not have any lung disease. The PSP group (n=59) included individuals with PSP. None of the examinees had any psychological problems. The KMPI results of both groups were compared.
There were more abnormal responses in the PSP group (17.0%) than the normal volunteer group (9.1%, p=0.002). The anxiety scale and depression scale scores of the neurosis category were greater for the PSP group than the normal group (p=0.039 and 0.014, respectively). The personality disorder and paranoia scale scores of the psychopathy category were greater for the PSP group than the normal group (p=0.007 and 0.018, respectively).
Young males with PSP may have greater tendencies to suffer from anxiety, depression, personality disorders, and paranoia compared to normal individuals. Clinicians should be advised to evaluate the psychopathological aspects of patients with PSP.
PMCID: PMC3423837  PMID: 22869471
Primary spontaneous pneumothorax; multiphasic personal inventory test; personality changes; psychopathology
5.  Mysterious Foreign Body in Transverse Sinus 
This case report describes a patient who had a foreign body in transverse sinus. A 35-year-old Korean-Chinese man visited the emergency room with lacerated wound in left eyelid and a foreign body which was stumbled upon in the skull. On examination, there was right side hemianopsia in his left eye. He did not complain any headache or show any abnormal neurological signs, but there was a foreign body at left transverse sinus in computed tomography which was taken at another hospital. There was no intracranial abnormality except the foreign body in computed tomography. Because of the financial problem, additional evaluations were not possible. We herein report a strange case in which the pathway of a foreign body to locate in transverse sinus was ambiguous, and suggest that the foreign body located in transverse sinus might have been the penetrated along the anterior fontanelle and passed through the superior sagittal sinus.
PMCID: PMC3358606  PMID: 22639716
Foreign body; Skull; Accident; Fontanelle; Sinus
6.  Surface Landmarks do not Correspond to Exact Levels of the Cervical Spine: References According to the Sex, Age and Height 
Korean Journal of Spine  2014;11(3):178-182.
A general orientation along the cervical spine could be estimated by external landmarks, and it was useful, quick and less exposable to radiation, but, sometimes it gave reference confusion of target cervical level. The authors reviewed the corresponding between the neck external landmarks and cervical levels.
Totally 1,031 cervical lateral radiographs of different patients were reviewed in single university hospital. Its compositions were 534 of males and 497 females; 86 of second decades (10-19 years-old), 169 of third decades, 159 of fourth decades, 209 of fifth decades, 275 of sixth decades, and 133 of more than seventh decades (>60 years-old). Reference external landmarks (mandible, hyoid bone, thyroid cartilage, and cricothyroid membrane) with compounding factors were reviewed.
The reference levels of cervical landmarks were C2.13 with mandible angle, C3.54 with hyoid bone, C5.12 with thyroid cartilage, and C6.01 with cricothyroid membrane. The reference levels of cervical landmarks were differently observed by sex, age, and somatometric measurement (height) accordingly mandible angle from C1 to C3, hyoid bone from disc level of C2 and C3 to C5, thyroid cartilage from disc level of C3 and C4 to C7, and cricothyroid membrane from C4 to disc level of C7 and T1.
Surface landmarks only provide general reference points, but not correspond to exact levels of the cervical spine. Intraoperative fluoroscopy ensures a more precise placement to the targeted cervical level.
PMCID: PMC4206974  PMID: 25346765
External landmark; Cervical level; Mandible; Hyoid bone; Thyroid cartilage; Cricothyroid membrane
7.  Cervical Arthroplasty for Moderate to Severe Disc Degeneration: Clinical and Radiological Assessments after a Minimum Follow-Up of 18 Months: Pfirrmann Grade and Cervical Arthroplasty 
Yonsei Medical Journal  2014;55(4):1072-1079.
Clinical outcomes and radiologic results after cervical arthroplasty have been reported in many articles, yet relatively few studies after cervical arthroplasty have been conducted in severe degenerative cervical disc disease.
Materials and Methods
Sixty patients who underwent cervical arthroplasty (Mobi-C®) between April 2006 and November 2011 with a minimum follow-up of 18 months were enrolled in this study. Patients were divided into two groups according to Pfirrmann classification on preoperative cervical MR images: group A (Pfirrmann disc grade III, n=38) and group B (Pfirrmann disc grades IV or V, n=22). Visual analogue scale (VAS) scores of neck and arm pain, modified Oswestry Disability Index (mODI) score, and radiological results including cervical range of motion (ROM) were assessed before and after surgery.
VAS and mean mODI scores decreased after surgery from 5.1 and 57.6 to 2.7 and 31.5 in group A and from 6.1 and 59.9 to 3.7 and 38.4 in group B, respectively. In both groups, VAS and mODI scores significantly improved postoperatively (p<0.001), although no significant intergroup differences were found. Also, cervical dynamic ROM was preserved or gradually improved up to 18 months after cervical arthroplasty in both groups. Global, segmental and adjacent ROM was similar for both groups during follow-up. No cases of device subsidence or extrusion were recorded.
Clinical and radiological results following cervical arthroplasty in patients with severe degenerative cervical disc disease were no different from those in patients with mild degenerative cervical disc disease after 18 months of follow-up.
PMCID: PMC4075369  PMID: 24954339
Total disc replacement; cervical arthroplasty; disc degeneration; clinical outcome; range of motion
8.  The Effectiveness Evaluation of Helicopter Ambulance Transport among Neurotrauma Patients in Korea 
Helicopter ambulance transport (HAT) is a highly resource-intensive facility that is a well-established part of the trauma transport system in many developed countries. Here, we review the benefit of HAT for neurosurgical patients in Korea.
This retrospective study followed neurotrauma patients who were transferred by HAT to a single emergency trauma center over a period of 2 years. The clinical benefits of HAT were measured according to the necessity of emergency surgical intervention and the differences in the time taken to transport patients by ground ambulance transport (GAT) and HAT.
Ninety-nine patients were transferred to a single university hospital using HAT, of whom 32 were taken to the neurosurgery department. Of these 32 patients, 10 (31.3%) needed neurosurgical intervention, 14 (43.8%) needed non-neurosurgical intervention, 3 (9.4%) required both, and 11 (34.4%) did not require any intervention. The transfer time was faster using HAT than the estimated time needed for GAT, although for a relatively close distance (<50 km) without ground obstacles (mountain or sea) HAT did not improve transfer time. The cost comparison showed that HAT was more expensive than GAT (3,292,000 vs. 84,000 KRW, p<0.001).
In this Korean-based study, we found that HAT has a clinical benefit for neurotrauma cases involving a transfer from a distant site or an isolated area. A more precise triage for using HAT should be considered to prevent overuse of this expensive transport method.
PMCID: PMC4185318  PMID: 25289124
Helicopter ambulance transport; Aeromedical evacuation; Neurotrauma; Clinical benefit; Korea
9.  Comparison of Outcomes after Atlantoaxial Fusion with Transarticular Screws and Screw-Rod Constructs 
The purpose of this study was to compare the radiological and neurological outcomes between two atlantoaxial fusion method for atlantoaxial stabilization; C1 lateral mass-C2 pedicle screws (screw-rod constructs, SRC) versus C1-2 transarticular screws (TAS).
Forty-one patients in whom atlantoaxial instability was treated with atlantoaxial fixation by SRC group (27 patients, from March 2005 to May 2011) or TAS group (14 patients, from May 2000 to December 2005) were retrospectively reviewed. Numeric rating scale (NRS) for pain assessment, Oswestry disability index (ODI), and Frankel grade were also checked for neurological outcome. In radiologic outcome assessment, proper screw position and fusion rate were checked. Perioperative parameters such as blood loss during operation, operation time, and radiation exposure time were also reviewed.
The improvement of NRS and ODI were not different between both groups significantly. Good to excellent response in Frankel grade is shown similarly in both groups. Proper screw position and fusion rate were also observed similarly between two groups. Total bleeding amount during operation is lesser in SRC group than TAS group, but not significantly (p=0.06). Operation time and X-ray exposure time were shorter in SRC group than in TAS group (all p<0.001).
Both TAS and SRC could be selected as safe and effective treatment options for C1-2 instability. But the perioperative result, which is technical demanding and X-ray exposure might be expected better in SRC group compared to TAS group.
PMCID: PMC4130950  PMID: 25132931
Atlantoaxial fixation; C-1 lateral mass screw; C-2 pedicle screw; Transarticular screw; Complications; Fusion
10.  Incidence of Post-Traumatic Stress Disorder after a Mild Traumatic Brain Injury: Preliminary Investigation Using the Brief Neuropsychological Screening Test 
Post-traumatic stress disorder (PTSD) is a group of diseases that are observed in patients who had experienced a serious trauma or accident. However, some experienced it even after only a mild traumatic brain injury (TBI), and they are easily ignored due to the relatively favorable course of mild TBI. Herein, the authors investigated the incidence of PTSD in mild TBI using brief neuropsychological screening test (PTSD checklist, PCL).
This study was conducted on patients with mild TBI (Glasgow coma scale ≥13) who were admitted from January 2012 to December 2012. As for PCL, it was done on patients who showed no difficulties in communication upon admission and agreed to participate in this study. By using sum of PCL, the patients were divided into high-risk group and low-risk group. PTSD was diagnosed as the three major symptoms of PTSD according to the Diagnostic and Statistical Manual of Mental Disorders, fourth-edifion.
A total of 314 TBI patients were admitted and 71 of them met the criteria and were included in this study. The mean age was 52.9 years-old (range: 15-94). The mean PCL score was 28.8 (range: 17-68), and 10 patients were classified as high-risk group. During follow-up, 2 patients (2.7%) of high risk group, were confirmed as PTSD and there was no patient who was suspected of PTSD in the low-risk group (p=0.017).
PTSD is observed 2.8% in mild TBI. Although PTSD after mild TBI is rare, PCL could be considered as a useful tool for screening of PTSD after mild TBI.
PMCID: PMC4094742  PMID: 25024821
Post-trauamatic stress disorder; Mild traumatic brain injury; PTSD checklist
11.  Repeated Complication Following Atlantoaxial Fusion: A Case Report 
Korean Journal of Spine  2014;11(1):7-11.
A patients with atlantoaixial instability and osodontoideum underwent atlantoaixial fusion (Harms and Melcher technique) with demineralized bone matrix. But, unfortunately, the both pedicle screws in C2 were fractured within 9 weeks follow-up periods after several suspected episode of neck hyper-flexion. Fractured screws were not contact to occipital bone in several imaging studies, but it could irritate the occipital bone when neck extension because the relatively close distance between the occipital bone and C1 posterior arch. The patient underwent revision operation with translaminar screw fixation with autologus iliac bone graft. Postsurgical course were uneventful except donor site pain, but the bony fusion was not satisfied after 4 months follow-up. The patient re-underwent revision operation in other hospital. Continuous complication after atlantoaixial fusion is rare, but the clinical course could be unlucky to patients. Postoperative immobilization could be important to prevent the unintended clinical course of patients.
PMCID: PMC4040632  PMID: 24891865
Atlantoaxial fusion; Cervical spine; Transpedicle screw; Pedicle screw fracture; Bone fusion; Complication
12.  Radiological anatomical consideration of conjoined nerve root with a case review 
Anatomy & Cell Biology  2013;46(4):291-295.
Nerve root anomalies are frequently underrecognized regardless of the advances in imaging studies; they are also underappreciated and underreported when encountered surgically. The classification of conjoined nerve roots is based on whether the nerve root emerges at an abnormal level or from an anastomotic branch. In the present report, we describe case with a conjoined nerve root that emerged at a more caudal level than that normally observed that was an undiagnosed on preoperative imaging studies. We also discuss the atypical imaging features obtained through preoperative imaging studies. As observed in the present case, preoperative recognition and diagnosis of such anomalies offer the best opportunity of performing a successful procedure and preventing inadvertent damage to nerve roots intraoperatively.
PMCID: PMC3875847  PMID: 24386602
Conjoined nerve roots; Sagittal shoulder sign; Corner sign; Fat crescent sign; Parallel sign
13.  Spinal Subdural Hematoma Following Cranial Subdural Hematoma : A Case Report with a Literature Review 
Coexistence of cranial and spinal subdural hematomas is rare and only a few cases have been reported in the literature. Herein, we report a case of cranial and spinal subdural hematomas after previous head trauma. As the pathogenesis of simultaneous intracranial and spinal subdural hematoma yet remains unclear, we developed an alternative theory to those proposed in the literature for their coexistence, the migration of blood through the subdural space.
PMCID: PMC3921281  PMID: 24527196
Concomitant disease; Cranial subdural hematoma; Spinal subdural hematoma; Migration; Subdural space
14.  Slip Reduction Rate between Minimal Invasive and Conventional Unilateral Transforaminal Interbody Fusion in Patients with Low-Grade Isthmic Spondylolisthesis 
Korean Journal of Spine  2013;10(4):232-236.
To compare the slip reduction rate and clinical outcomes between unilateral conventional transforaminal lumbar interbody fusion (conventional TLIF) and unilateral minimal invasive TLIF (minimal TLIF) with pedicle screw fixation for treatment of one level low-grade symptomatic isthmic spondylolisthesis.
Between February 2008 and April 2012, 25 patients with low-grade isthmic spondylolisthesis underwent conventional TLIF (12 patients) and minimal TLIF (13 patients) in single university hospital by a single surgeon. Lateral radiographs of lumbar spine were taken 12 months after surgery to analyze the degree of slip reduction and the clinical outcome. All measurements were performed by a single observer.
The demographic data between conventional TLIF and minimal TLIF were not different. Slip percentage was reduced from 15.00% to 8.33% in conventional TLIF, and from 14.15% to 9.62% in minimal TLIF. In both groups, slip percentage was significantly improved postoperatively (p=0.002), but no significant intergroup differences of slip percentage in preoperative and postoperative were found. The reduction rate also not different between conventional TLIF (45.41±28.80%) and minimal TLIF (32.91±32.12%, p=0.318).
Conventional TLIF and minimal TLIF with pedicle screw fixation showed good slip reduction in patients with one level low-grade symptomatic isthmic spondylolisthesis. The slip percentage and reduction rate were similar in the conventional TLIF and minimal TLIF.
PMCID: PMC4040640  PMID: 24891854
Slip percentage; Reduction rate; Conventional; Minimal invasive; Transforamenal lumbar interbody fusion
15.  Vertebral Artery Dissect Injury with Brown-Séquard Syndrome by a Neural Foramen Penetrated Electric Screw Driver Bit : A Case Report 
Korean Journal of Spine  2013;10(4):258-260.
There are few reports in the literature of complete obstruction of the vertebral artery (VA) due to an electric screw driver bit penetration through the neural foramen into the spinal canal with Brown-Séquard syndrome (BSS). A 25-year-old man was admitted to the emergency department with a penetrated neck injury by an electric screw driver bit after a struggle. The patient presented the clinical features of BSS. Computed tomography scan revealed that the electric screw driver bit penetrated through the right neural foramen at the level of C3-4, and it caused an injury to the right half of the spinal cord. Emergent angiography revealed VA dissection, which was managed by immediate coil embolization at both proximal and distal ends of the injury site. After occlusion of the VA, the electric screw driver bit was extracted under general anesthesia. Bleeding was minimal and controlled without difficulties. No postoperative complications, such as wound dehiscence, CSF leakage, or infection, were noted. Endovascular approaches for occlusion of vertebral artery lesions are safe and effective methods of treatment.
PMCID: PMC4040642  PMID: 24891861
Cervical vertebrae; Penetrating wound; Brown-Séquard syndrome; Vertebral artery dissection; Embolization
16.  Prevalence and Geographic Distribution of Herniated Intervertebral Disc in Korean 19-Year-Old Male from 2008 to 2009: A Study Based on Korean Conscription -National and Geographic Prevalence of Herniated Intervertebral Disc in Korean 19YO Male- 
Yonsei Medical Journal  2013;54(5):1098-1103.
This study was to determine the prevalence of herniated intervertebral disc (HIVD) among Korean 19-year-old male in a large national sample and to compare the prevalence across geographic regions based on the data of conscription.
Materials and Methods
We analyzed the conscription data of 615508 cases who were 19-year-old male, given an examination for conscription at nationwide Korean Military Manpower Administration from January 2008 to December 2009. Prevalence was determined by dividing the number of cases by the number of persons enrolled for 2 years. The analyses included of a cross-tabulations and nonparametric chi-square to compare the prevalence according to geographic region, disc severity, and conscription year.
The prevalence of HIVD among 19-year-old male was 0.47%. Seoul had the highest prevalence of HIVD (total HIVD was 0.60%, and severe HIVD was 0.44%). The prevalence of HIVD was lower in Jeollabuk-do and Jeollanam-do (total HIVD was 0.25-0.27%, and severe HIVD was 0.16-0.17%). Annual prevalence of HIVD was slightly decreased in 2009, but geographic distribution annually was not different.
In Korean 19-year-old male, the national prevalence of adolescent HIVD was 0.60%, but different geographic distribution was observed. It is quite possible that secondary contributing factor(s) interfere with the different geographic prevalence of HIVD.
PMCID: PMC3743194  PMID: 23918557
Herniated intervertebral disc; adolescent; prevalence; conscription
17.  Comparison of Drainage Volume of Chronic Subdural Hematoma According to Drainage Catheter Type 
Yonsei Medical Journal  2013;54(5):1091-1097.
To assess the therapeutic value of two different drainage catheters in treating chronic subdural hematoma (CSDH).
Materials and Methods
Two types of drainage catheters can be used to treat CSDH according to the position of holes in the catheter: open-type or closed-type catheter. In this retrospective study, 199 total patients with CSDH were reviewed according to catheter type. Among them, 84 patients were and 113 in the closed-type group (holes positioned within the distal-most 1 cm of the catheter). The surgeon selected the catheter type. Total drainage volume, initial drainage volume within 2 days, percentage of initial drainage volume per total drainage volume, duration of catheter insertion, and reoperation rate were compared.
Total drainage volume was not different between the two groups (p=0.333). The initial drainage volume within 2 days was larger in the open-type group than closed-type group (p=0.024), but the percentage of initial drainage volume per total drainage volume was not different (p=0.354). The duration of catheter insertion was shorter in the open-type group than closed-type group (p=0.015). The reoperation rate of CSDH was also higher in the open-type group than closed-type group (p=0.004).
CSDH drainage with an open-type catheter is faster compared with a closed-type catheter, but total drainage volume is similar and reoperation rate is higher. Therefore, the open-type catheter for CSDH drainage has limited clinical value.
PMCID: PMC3743203  PMID: 23918556
Chronic subdural hematoma; catheter; drainage
18.  Psychopathological Influence of Lumbar Disc Herniation in Male Adolescent 
Yonsei Medical Journal  2013;54(4):813-818.
There is no report about psychopathological effect causing by disc herniation. The disease could impose psychopathological influence on the social life, the treatment period, and response to the treatment. This study was to evaluate retrospectively the psychopathological influence of lumbar disc herniation (LDH) among Korean 19-year-old males.
Materials and Methods
We compared the Korean military multiphasic personality inventory (KMPI) profiles of 74 LDH cases with the KMPI profiles of 150 controls. The LDH groups were categorized to 2 groups according to the presence of thecal sac compression by disc materials, and evaluated the relation between the KMPI and LDH.
The decrease of the faking-good response scale and increase of the faking-bad response scale were observed more in the LDH group than in the normal volunteer group (p<0.05). The neurosis set such as anxiety, depression and somatization was markedly increased in the LDH group compared to the normal volunteers group (p<0.05). The scale of personality disorder was also increased more in the LDH group (p=0.002). The differences of KMPI scales were not correlated with the severe pathology of LDH.
Young male with LDH may tend to have more abnormal results of multiphasic personality inventory test compared to the normal volunteers, suggesting that LDH may be related to the psychopathology in young males in Korea. Therefore, clinicians are recommended to evaluate and treat the psychopathological aspects in patients with LDH.
PMCID: PMC3663227  PMID: 23709412
Lumbar disc herniation; multiphasic personal inventory; psychopathology; lumbar disc herniation; conscription
19.  Technical Report of Free Hand Pedicle Screw Placement using the Entry Points with Junction of Proximal Edge of Transverse Process and Lamina in Lumbar Spine: Analysis of 2601 Consecutive Screws 
Korean Journal of Spine  2013;10(1):7-13.
A variety of different pedicle screws entry point techniques are used for the lumbar pedicle screws placement. This study reported Kim's entry point of lumbar pedicle screws with free hand technique and the accuracy of this technique.
We retrospectively reviewed the 584 cases with free hand placed lumbar pedicle screw placement. The diagnosis included 491 cases with degenerative spine, 59 cases with trauma, 29 cases with metastatic disease, and 5 cases with scoliosis. A total of 2601 lumbar pedicle screws were placed, and the entry points of lumbar pedicle screws were the junction of proximal edge of transverse process and lamina. Incidence and extent of cortical breach by misplaced pedicle screw was determined by review of intra-operative and post-operative radiographs and/or computed tomography.
Among the total 2601 lumbar free hand placed pedicle screws, 114 screws (4.4%) in 79 patients (13.5%) were repositioned screws with suspected screw malposition during operation, and 37 screws (1.4%) in 31 patients (5.3%) were identified as moderate to severe breaching the pedicle after post-operative imaging studies. Among the patient with malpositioned screws, 3 patients showed nerve irritation sign of the lesion, and 2 cases were symptom improved after nerve block and conservative management, and 1 case was removed the screw after the failure of the treatment.
Free hand pedicle screw placement based on external landmark with the junction of proximal edge of transverse process and lamina showed acceptable safety and accuracy and avoidance of radiation exposure.
PMCID: PMC3941737  PMID: 24757450
Lumbar spine; Pedicle screw placement; Free hand technique; Surgical technique
20.  The Psychopathological Influence of Adolescent Idiopathic Scoliosis in Korean Male : An Analysis of Multiphasic Personal Inventory Test Results 
There are few published studies which have documented psychopathological abnormalities in patients with of adolescent idiopathic scoliosis (AIS) The aim of this study was to evaluate the psychopathological influence of AIS in Korean 19-year-old males.
The authors compared the Korean military multiphasic personal inventory (KMPI) military profiles of 105 AIS cases (more than 10 degrees of Cobb's angle without surgical treatment) with the KMPI profiles of 108 normal controls. The AIS group was split depending on Cobb's angle to further evaluate this relation by the severity of AIS.
A significantly decreased result on the faking-good response scale and an significantly increased result on the faking-bad response were observed in the AIS group compared to the control (p<0.012). The neurosis scale results, including anxiety, depression and somatization symptoms, were significantly increased in the AIS group compared to the control (p<0.010). The severity level of personality disorder and schizophrenia were also significantly increased in the AIS group (p<0.010). Differences in KMPI scale scores were not related to the severity of AIS.
Young males with AIS tend to have abnormal results on the multiphasic personal inventory test compared to normal volunteers, suggesting that AIS may be related to psychopathology in the young male group in Korea. Although these psychopathology in AIS were differently observed compared to normal controls, but not interfered with military life. Clinicians are recommended to pay attention the psychopathological traits of patients with AIS.
PMCID: PMC3579076  PMID: 23440382
Adolescent idiopathic scoliosis; Multiphasic personal inventory; Psychopathology; Korea; Conscription
21.  Usefulness of Chest Radiographs for Scoliosis Screening: A Comparison with Thoraco-Lumbar Standing Radiographs 
Yonsei Medical Journal  2012;53(6):1183-1189.
The purposes of this study were to evaluate the usefulness and limitations of chest radiographs in scoliosis screening and to compare these results with those of thoraco-lumbar standing radiographs (TLSR).
Materials and Methods
During Korean conscription, 419 males were retrospectively examined using both chest radiographs and TLSR to confirm the scoliosis and Cobb angle at the Regional Military Manpower. We compared the types of spinal curves and Cobb angles as measured from different radiographs.
In the pattern of spinal curves, the overall matching rate of chest radiographs using TLSR was about 58.2% (244 of 419 cases). Cobb angle differences between chest radiographs and TLSR with meaningful difference was observed in 156 cases (37.2%); a relatively high proportion (9.5%) of Cobb angle differences more than 10 degrees was also observed. The matching rate of both spinal curve types and Cobb angle accuracy between chest radiographs and TLSR was 27.9% (117 among 419 cases). Chest radiographs for scoliosis screening were observed with 93.94% of sensitivity and 61.67% of specificity in thoracic curves; however, less than 40% of sensitivity (38.27%, 20.00%, and 25.80%) and more than 95% of specificity (97.34%, 99.69%, and 98.45%) were observed in thoraco-lumbar, lumbar, and double major curves, respectively.
The accuracy of chest radiographs for scoliosis screening was low. The incidence of thoracic curve scoliosis was overestimated and lumbar curve scoliosis was easily missed by chest radiography. Scoliosis screening using chest radiography has limited values, nevertheless, it is useful method for detecting thoracic curve scoliosis.
PMCID: PMC3481372  PMID: 23074120
Scoliosis; screening; chest radiographs; thoraco-lumbar standing radiographs
22.  The Psychopathological Influence of Congenital Heart Disease in Korean Male Adolescents: An Analysis of Multiphasic Personal Inventory Test Results 
Yonsei Medical Journal  2012;53(6):1107-1112.
The aim of this study was to evaluate the psychopathological influence of congenital heart disease (CHD) in Korean 19-year-old males.
Materials and Methods
The authors compared the Korean military multiphasic personal inventory (KMPI) military profiles of 211 CHD cases (atrial septal defect, ventricular septal defect, patent ductus arteriosus, or combined CHD) with the KMPI profiles of 300 normal controls. The CHD group was also divided according to whether or not the subjects had undergone open cardiac surgery in order to evaluate the psychopathological effects of an operation among the subjects.
A decreased result on the faking-good response scale and an increased result on the faking-bad response were observed in the CHD group compared to the control (p<0.01). The neurosis scale results, including anxiety, depression and somatization symptoms, were markedly increased in the CHD group compared to the control (p<0.01). The severity level of personality disorder was also increased in the CHD group (p<0.001). Differences in KMPI scale scores were not related to open cardiac surgery history.
In this study, young males with CHD tended to report more abnormal results on the multiphasic personal inventory test in comparison to normal subjects, suggesting that CHD may be related to psychopathology in young males in Korea. Therefore, clinicians are recommended to evaluate the psychopathological traits of patients with CHD.
PMCID: PMC3481384  PMID: 23074109
Congenital heart disease; multiphasic personal inventory; psychopathology; Korea; conscription
23.  Cerebrovascular Disease and Stroke in Korean Male Adolescent 
Yonsei Medical Journal  2012;53(3):467-476.
This study aimed to estimate the prevalence and incidence of cerebrovascular disease (CVD) and stroke in Korean male adolescents.
Materials and Methods
The authors reviewed all medical certificates, medical records, and radiologic images from the examinations of Korean military conscription from January 2008 to May 2011.
Of the 101156 examinees, 40 had CVD and stroke during adolescence. The overall prevalence and incidence of CVD and stroke was 39.54 cases per 100000 adolescents and 2.08 cases per 100000 adolescents per year, respectively and these were similar to the worldwide data. There were 3 cases of aneurysm, 3 cases of dural arteriovenous fistula, 11 cases of arteriovenous malformation, 4 cases of cavernous hemangioma, 4 cases of cerebrovascular infarction, 16 cases of Moyamoya disease, and 1 case of missing data. The incidence of arteriovenous malformation (0.57 cases per 100000 adolescents per year) was lower than the incidence for the worldwide general population. The incidence of Moyamoya disease was higher than that in any other country (15.82 cases per 100000 adolescents, vs. 0.83 cases per 100000 adolescents per year).
We observed ischemic and hemorrhagic stroke, each accounting for approximately half of cases, and high incidence of Moyamoya disease with low incidence of arteriovenous malformation in Korean male adolescents.
PMCID: PMC3343446  PMID: 22476988
Cerebrovascular disease; stroke; adolescent; male; Korea; conscription
24.  Missed Diagnosis of Syrinx 
Asian Spine Journal  2012;6(1):1-5.
Study Design
Prospective, randomized, controlled human study.
We checked the proportion of missed syrinx diagnoses among the examinees of the Korean military conscription.
Overview of Literature
A syrinx is a fluid-filled cavity within the spinal cord or brain stem and causes various neurological symptoms. A syrinx could easily be diagnosed by magnetic resonance image (MRI), but missed diagnoses seldom occur.
In this study, we reviewed 103 cases using cervical images, cervical MRI, or whole spine sagittal MRI, and syrinxes was observed in 18 of these cases. A review of medical certificates or interviews was conducted, and the proportion of syrinx diagnoses was calculated.
The proportion of syrinx diagnoses was about 66.7% (12 cases among 18). Missed diagnoses were not the result of the length of the syrinx, but due to the type of image used for the initial diagnosis.
The missed diagnosis proportion of the syrinx is relatively high, therefore, a more careful imaging review is recommended.
PMCID: PMC3302909  PMID: 22439081
Syrinx; Diagnosis proportion; Conscription; Korea
25.  Outcome Evaluation with Signal Activation of Functional MRI in Spinal Cord Injury 
The authors investigated the changes of cortical sensorimotor activity in functional MRI (fMRI) and functional recovery in spinal cord injury (SCI) patients who had been treated by bone marrow cell transplantation.
Nineteen patients with SCI were included in this study; ten patients with clinical improvement and nine without. The cortical sensorimotor activations were studied using the proprioceptive stimulation during the fMRI.
Diagnostic accuracy of fMRI with neurological improvement was 70.0% and 44.4% for sensitivity and specificity, respectively. Signal activation in the ipsilateral motor cortex in fMRI was commonly observed in the clinically neurological improved group (p-value=0.002). Signal activation in the contralateral temporal lobe and basal ganglia was more commonly found in the neurological unimproved group (p-value<0.001). Signal activation in other locations was not statistically different.
In patients with SCI, activation patterns of fMRI between patients with neurologic recovery and those without varied. Such plasticity should be considered in evaluating SCI interventions based on behavioral and neurological measurements.
PMCID: PMC3218180  PMID: 22102951
Sensorimotor; Functional MRI; Spinal cord injury; Bone marrow cell; Proprioceptive

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