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1.  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.
Purpose
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.
Results
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.
Conclusion
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.
doi:10.3349/ymj.2014.55.4.1072
PMCID: PMC4075369  PMID: 24954339
Total disc replacement; cervical arthroplasty; disc degeneration; clinical outcome; range of motion
2.  Comparison of Outcomes after Atlantoaxial Fusion with Transarticular Screws and Screw-Rod Constructs 
Objective
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).
Methods
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.
Results
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).
Conclusion
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.
doi:10.3340/jkns.2014.55.5.255
PMCID: PMC4130950  PMID: 25132931
Atlantoaxial fixation; C-1 lateral mass screw; C-2 pedicle screw; Transarticular screw; Complications; Fusion
3.  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.
doi:10.14245/kjs.2014.11.1.7
PMCID: PMC4040632  PMID: 24891865
Atlantoaxial fusion; Cervical spine; Transpedicle screw; Pedicle screw fracture; Bone fusion; Complication
4.  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.
Purpose
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.
Results
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.
Conclusion
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.
doi:10.3349/ymj.2013.54.5.1098
PMCID: PMC3743194  PMID: 23918557
Herniated intervertebral disc; adolescent; prevalence; conscription
5.  Comparison of Drainage Volume of Chronic Subdural Hematoma According to Drainage Catheter Type 
Yonsei Medical Journal  2013;54(5):1091-1097.
Purpose
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.
Results
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).
Conclusion
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.
doi:10.3349/ymj.2013.54.5.1091
PMCID: PMC3743203  PMID: 23918556
Chronic subdural hematoma; catheter; drainage
6.  Psychopathological Influence of Lumbar Disc Herniation in Male Adolescent 
Yonsei Medical Journal  2013;54(4):813-818.
Purpose
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.
Results
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.
Conclusion
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.
doi:10.3349/ymj.2013.54.4.813
PMCID: PMC3663227  PMID: 23709412
Lumbar disc herniation; multiphasic personal inventory; psychopathology; lumbar disc herniation; conscription
7.  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.
Objective
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.
Methods
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.
Results
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.
Conclusion
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.
doi:10.14245/kjs.2013.10.1.7
PMCID: PMC3941737  PMID: 24757450
Lumbar spine; Pedicle screw placement; Free hand technique; Surgical technique
8.  The Psychopathological Influence of Adolescent Idiopathic Scoliosis in Korean Male : An Analysis of Multiphasic Personal Inventory Test Results 
Objective
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.
Methods
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.
Results
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.
Conclusion
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.
doi:10.3340/jkns.2013.53.1.13
PMCID: PMC3579076  PMID: 23440382
Adolescent idiopathic scoliosis; Multiphasic personal inventory; Psychopathology; Korea; Conscription
9.  Usefulness of Chest Radiographs for Scoliosis Screening: A Comparison with Thoraco-Lumbar Standing Radiographs 
Yonsei Medical Journal  2012;53(6):1183-1189.
Purpose
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.
Results
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.
Conclusion
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.
doi:10.3349/ymj.2012.53.6.1183
PMCID: PMC3481372  PMID: 23074120
Scoliosis; screening; chest radiographs; thoraco-lumbar standing radiographs
10.  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.
Purpose
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.
Results
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.
Conclusion
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.
doi:10.3349/ymj.2012.53.6.1107
PMCID: PMC3481384  PMID: 23074109
Congenital heart disease; multiphasic personal inventory; psychopathology; Korea; conscription
11.  Missed Diagnosis of Syrinx 
Asian Spine Journal  2012;6(1):1-5.
Study Design
Prospective, randomized, controlled human study.
Purpose
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.
Methods
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.
Results
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.
Conclusions
The missed diagnosis proportion of the syrinx is relatively high, therefore, a more careful imaging review is recommended.
doi:10.4184/asj.2012.6.1.1
PMCID: PMC3302909  PMID: 22439081
Syrinx; Diagnosis proportion; Conscription; Korea

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