Ki-Tack Kim

Inje University Paik Hospital, Sŏul, Seoul, South Korea

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Publications (70)71.02 Total impact

  • Journal of spinal disorders & techniques. 06/2014;
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    ABSTRACT: Study Design. A retrospective radiological studyObjective. To analyze the course of intra-axial vertebral artery (IAVA) and evaluate the relationship between the three-dimensional (3D) courses for IAVA with respect to safe trajectory for C2 pedicle screw (C2PS).Summary of Background Data. The vertebral artery at the level of C2 has a distinct 3D course. The traditional concept of 'high-riding' VA was based on sagittal plane but does not provide all the 3D course of IAVA for safe C2PS placement. However, 3D course of IAVA has not been previously analyzed.Methods. Three-dimensional, vascular enhanced CT images on the cervical spine of 100 patients, 200 IAVA (M:F = 50:50, mean age 58.4 years) were analyzed. 1) The arterial parameters including ①'Medial-shifting (MS)' (A: lateral. B: neutral, C: medial to C3 TF) and ②'High-riding (HR)' (0: below C2 TF, 1 within C2TF, 2: above C2TF) of IAVA was measured. 2) The bony parameters including pedicle diameter (PD), medial convergence angle (MCA), and sagittal angle (SA) of C2PS were measured. Correlation between the arterial and bony parameters, differences between gender, laterality, dominance of VA, and age were analyzed.Results. MS (grade A 37.5%, B 37%, and C 25.5%) and HR (grade 0 in 34%, 1 in 42%, and 2 in 24%) showed significant correlation with each other (p<0.001). The main patterns of IAVA were A-0 (26%), B-1(26.5%), and C-2(18.5%). Higher grade of MS and HR showed significantly smaller PD, larger MCA and smaller SA (p<0.001). Female sex and older age are factors that showed significantly higher grade of MS and HR (p<0.001).Conclusion. Tortuosity of IAVA was greater in the female gender and it also increased with aging. The different IAVA courses significantly influenced the pedicle diameter and the safe trajectory for C2PS; therefore, these factors should be considered before planning C2 pedicle screw placement.
    Spine 05/2014; · 2.16 Impact Factor
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    ABSTRACT: To determine whether ACE insertion/deletion (I/D) polymorphism is associated with the ossification of the posterior longitudinal ligament (OPLL) of the spine in the Korean population. A case-control study was conducted to investigate the association between I/D polymorphism of the angiotensin I converting enzyme (peptidyl-dipeptidase A) 1 (ACE) gene and OPLL. The 95 OPLL patients and 274 control subjects were recruited. Polymerase chain reaction for the genotyping of ACE I/D polymorphism was performed. The difference between the OPLL patients and the control subjects was compared using the contingency χ(2) test and the logistic regression analysis. For statistical analysis, SPSS, SNPStats, SNPAnalyzer, and Helixtree programs were used. The genotype and allele frequencies of ACE I/D polymorphism showed significant differences between the OPLL patients and the control subjects (genotype, p<0.001; allele, p=0.009). The frequencies of D/D genotype and D allele in the OPLL group were higher than those in the control group. In logistic regression analysis, ACE I/D polymorphism was associated with OPLL (dominant model; p=0.002; odd ratio, 2.20; 95% confidence interval, 1.33-3.65). These results suggest that the deletion polymorphism of the ACE gene may be a risk factor for the development of OPLL in the Korean population.
    Annals of rehabilitation medicine. 02/2014; 38(1):1-5.
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    ABSTRACT: Based on the previous studies, cervical lordosis (CL) is a parameter influenced by thoracic kyphosis (TK); however, the correlations still remain unclear. Few studies have analyzed the correlations between the cervical spine lordosis and global spinopelvic balance. To date, there has been no study focused on the factors determining cervical spine sagittal balance. Seventy-seven asymptomatic volunteers without the history of symptoms related to whole spine. Statistical significance of correlations of radiographic parameters on cervical spine and whole-spine standing lateral radiograph. To analyze the factors determining cervical spine sagittal balance, including global spinopelvic balance and thoracic inlet (TI) alignment in asymptomatic adults. A prospective radiographic study. Cervical and whole-spine standing lateral radiographs were taken to analyze the following parameters: spinopelvic parameters pelvic incidence (PI), sacral slope (SS), lumbar lordosis (LL), and TK; TI parameters thoracic inlet angle (TIA) and T1 slope; and cervical spine parameters C0-C2, C2-C7, and C0-C7 angles and cervical tilting. Statistical analysis was performed using the Pearson correlation coefficients and multiple regression analysis. All the parameters showed a normal distribution. There was a significant sequential linkage between PI and SS (r=0.653), SS and LL (r=0.807), LL and TK (r=-0.516), and TK and C0-C7 angle (r=-0.322). There was a significant relationship between TK and T1 slope (r=0.351) but no significant relationship between TK and TIA. There were significant sequential relationships between TIA and T1 slope (r=0.694), T1 slope and C2-C7 angle (r=-0.624), and C2-C7 and C0-C2 angles (r=-0.547). T1 slope was the only parameter that demonstrated a significant correlation with both SP and TI parameters. A linear regression model showed that T1 slope had a stronger relationship with TIA (r=0.694) than TK (r=0.351). T1 slope was a key factor determining cervical spine sagittal balance. Both spinopelvic balance and TI alignment have a significant influence on cervical spine sagittal balance via T1 slope, but TIA had a stronger effect than TK. An individual with large T1 slope required large CL to preserve physiologic sagittal balance of the cervical spine. The results of the present study could serve as baseline data for further studies on the cervical spine sagittal balance in various clinical conditions including the surgical reconstruction of lordosis.
    The spine journal: official journal of the North American Spine Society 09/2013; · 2.90 Impact Factor
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    ABSTRACT: Degenerative lumbar scoliosis (DLS) is a spinal deformity that develops after skeletal maturity and progresses with age. In contrast to adolescent idiopathic scoliosis, the genetic association of DLS has not yet been elucidated. The purpose of this study was to investigate the association between regulating synaptic membrane exocytosis 2 (RIMS2, OBOE) gene polymorphisms and DLS. Two coding single-nucleotide polymorphisms [rs2028945 (Gln1200Gln) and rs10461 (Ala1327Ala)] of RIMS2 were selected and genotyped by direct sequencing. As a result, the rs10461 was associated with DLS in allele frequencies (P=0.008) and genotype distributions (P=0.006 in the codominant model, 0.018 in the dominant model and 0.029 in the recessive model). In the analysis of haplotypes, two haplotypes exhibited significant differences between the control and DLS groups (CC haplotype, P=0.009 in the codominant model, 0.038 in the dominant model and 0.030 in the recessive model; CT haplotype, P=0.041 in the codominant model and 0.021 in the dominant model). These findings suggest that RIMS2 may be associated with the development of DLS.
    Biomedical reports. 07/2013; 1(4):619-623.
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    ABSTRACT: Intraspinal cystic lesions with different pathogeneses have been reported to cause neurological deficits; however, no one has focused on the intraspinal extradural cysts that develop after osteoporotic compression fracture. The reported case features a 66-year-old woman presenting with progressive neurological deficit, back pain, and no history of additional trauma after undergoing conservative treatment for an osteoporotic fracture of L-1. The authors present serial radiographs and MR images demonstrating an epidural cyst successfully treated via a single posterior approach. This appears to be the first such case reported in the literature.
    Journal of neurosurgery. Spine 05/2013; · 1.61 Impact Factor
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    ABSTRACT: Degenerative lumbar scoliosis (DLS) progresses with aging after 50-60 years. The genetic association of DLS remains largely unclear. In this study, the genetic association between glutamate receptor, ionotropic, N-methyl D-aspartate (NMDA, GRIN) receptor genes and DLS was investigated. A total of 9 coding single nucleotide polymorphisms (cSNPs) in NMDA receptor genes [GRIN2A (rs8049651, Leu425Leu; rs9806806, Tyr730Tyr); GRIN2B (rs7301328, Pro122Pro; rs35025065, Asp447Asp; rs1805522, Ile602Ile; rs1806201, Thr888Thr; rs1805247, His1399His); and GRIN2C (rs689730, Ala33Ala; rs3744215, Arg1209Ser)] were selected and genotyped using direct sequencing in 70 patients with DLS and 141 healthy controls. Multiple logistic models (codominant, dominant and recessive) were calculated for the odds ratio (OR), 95% confidence interval (CI) and corresponding P-values. The SNPStats, SNPAnalyzer and HelixTree programs were used for the evaluation of the genetic data. Among the SNPs examined, no significant associations were observed between the NMDA receptor genes and DLS. When the patients were divided into two groups according to clinical characteristics based on Cobb's angle (<20° or ≥20°) and lateral listhesis (<6 mm or ≥6 mm), associations were observed between rs689730 of GRIN2C and Cobb's angle (codominant, P=0.038; dominant, P=0.022) and between rs7301328 of GRIN2B and lateral listhesis (codominant, P=0.003; dominant, P=0.015; recessive, P=0.015). These results indicate that the GRIN2A, GRIN2B and GRIN2C genes do not affect the development of DLS. However, the GRIN2C gene may be associated with Cobb's angle, while the GRIN2B gene may be associated with lateral listhesis.
    Experimental and therapeutic medicine 03/2013; 5(3):977-981. · 0.34 Impact Factor
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    ABSTRACT: Study Design. A retrospective study.Objective. To describe the technique of a partial pedicle subtraction osteotomy (PPSO) and to report on the clinical and radiologic outcomes.Summary of Background Data. Numerous corrective osteotomy techniques have been reported. Until now, there still has been no reported method that can achieve a correction angle between those of the Smith-Petersen osteotomy(SPO) and pedicle subtraction osteotomy(PSO) as a posterior closing osteotomy that can be safely performed on the thoracic spine.Methods. A total of 38 patients aged between 31 and 72 years old who underwent PPSO for spinal sagittal deformity correction were enrolled in this study. The mean postoperative follow-up period was 30.1 months (range 24-36 months). The assessments included the Oswestry Disability Index (ODI) scores, immediate postoperative and 2 year postoperative correction angles, correction loss, pseudoarthrosis and complications.Results. There were 6 patients who underwent PPSO alone and 32 patients who underwent PPSO combined with at least one other surgical procedure (PSO in 16 patients, ALIF in 12 patients, and SPO in 4 patients). The level of the osteotomy was T10 in 6 patients, T11 in 15 patients, T12 in 10 patients, 1 in 4 patients, L2 in 2 patients, and L3 in 1 patient. There were significant improvements in the overall ODI scores (p = 0.001). The mean post-operative correction angle immediately following the PPSO was 18.8° (range 12.4°-26.1°) and the mean postoperative correction angle at 2 years was 18.4° (range 11.9°-25.7°). There was no significant loss of correction found during the 2 year follow up. There was also no pseudoarthrosis or neurological complications.Conclusion. PPSO had resulted in intermediate correction rates between those of SPO and PSO. PPSO is considered to be a safe and reliable procedure for patients with spinal sagittal deformities even at the thoracic spine level.
    Spine 02/2013; · 2.16 Impact Factor
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    ABSTRACT: To present the accuracy and safety of cervical pedicle screw insertion using the technique with direct exposure of the pedicle by laminoforaminotomy. We retrospectively reviewed 12 consecutive patients. A total of 104 subaxial cervical pedicle screws in 12 patients had been inserted. We also assessed the clinical and radiological outcomes and analyzed the direction and grade of pedicle perforation (grade 0: no perforation, 1: <25%, 2: 20% to 50%, 3: >50% of screw diameter) on the postoperative vascular-enhanced computed tomography scans. Grade 2 and 3 were considered as incorrect position. The correct position was found in 95 screws (91.3%); grade 0-75 screws, grade 1-20 screws and the incorrect position in 9 screws (8.7%); grade 2-6 screws, grade 3-3 screws. There was no neurovascular complication related with cervical pedicle screw insertion. This technique (technique with direct exposure of the pedicle by laminoforaminotomy) could be considered relatively safe and easy method to insert cervical pedicle screw.
    Journal of Korean Neurosurgical Society 11/2012; 52(5):459-65. · 0.56 Impact Factor
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    ABSTRACT: The prevalence of intervertebral disc herniation (IDH) of the thoracic spine is rare compared to the cervical or lumbar spine. In particular, IDH of the upper thoracic spine is extremely rare. We report the case of T1-2 IDH and its treatment, with a literature review. A 37-year-old male patient visited our hospital due to radiating pain at the left upper extremity and weakness of grip power. In cervical spine magnetic resonance images, T1-2 disc space showed herniated disc material and compressed T1 root was identified. Laminoforaminotomy was performed with a posterior approach. The radiating pain and weakness of grip power improved immediately after the surgery. Of patients who show radiating pain or numbness at the medial aspect of forearm, or weakness of intrinsic muscle of hand, can be suspected to have T1 radiculopathy. A detailed physical examination and a radiologic evaluation including this area should be required for the T1 radiculopathy.
    Asian spine journal 09/2012; 6(3):199-202.
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    ABSTRACT: Study Design. A technical note and a retrospective review of cervical osteotomy using an innovative reduction technique.Objectives. To present the clinical and radiological outcomes and effectiveness of the sterile-freehand (SF) reduction technique for cervical osteotomy.Summary of Backgroud Data. For a successful osteotomy, controlled reduction of deformity after complete release of bony deformity is the most critical step. Conventional 'unscrubbed-scrubbed' manual reduction techniques necessitate multiple releases and retightening of the clamp and are inconvenient for surgeon to control the force and monitor the surgical field closely.Methods. A total of seven consecutive patients (5 males and 2 females, the mean age 52.6 years) who underwent corrective osteotomy of the fixed cervical kyphosis by a single surgeon were enrolled. Radiographically, C2-7 sagittal and coronal angle, and the chin-brow vertical angle (CBVA) were measured. In the prone position, the entire head and the Gardner-Wells tong were included in the surgical field and a sterile rope was connected to a weight trough a hole made in the surgical drape. After complete release of bony element and fixation of the caudal part of osteotomy with a pre-bent lordotic rod, the operator held the tong with right hand and gradually reduced the deformity to place the rod within the screw heads on the cranial part of osteotomy under close visual observation, with the support of the caudal part with left hand.Results. The type of osteotomy performed was pedicle subtraction osteotomy in 5 cases and anterior release-posterior osteotomy in 2 cases. The mean correction angle was 39.7˚ (28-63˚) on the sagittal plane and 9.3˚ (0-16˚) on the coronal plane. The mean correction of CBVA was 37.1˚ (18-61˚). There was no neurovascular complication.Conclusions. Using the SF reduction technique, the operator can obtain a safe, controlled reduction with close monitoring of the surgical field. The technique is potentially a simple and effective method to provide stable, three-dimensional reduction for corrective osteotomies of the cervical spine.
    Spine 07/2012; · 2.16 Impact Factor
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    ABSTRACT: A retrospective study. To evaluate the efficacy and safety of the pedicle subtraction osteotomy (PSO) as a technique for correction of fixed sagittal imbalance with multiple etiologies. This report represents the largest and longest series of patients with fixed sagittal imbalance other than ankylosing spondylitis who were managed with PSO. A total of 140 consecutive patients who had undergone PSO for the management of sagittal imbalance with any etiology were reviewed. Etiologic diagnoses were ankylosing spondylitis in 86 patients, flatback syndrome in 20, post-traumatic kyphosis in 17, congenital kyphoscoliosis in 9, and post-tuberculotic kyphosis in 8 patients. The average duration of the follow-up period was 8 years (range, 5-12.5 yr). Radiological and clinical outcome analyses were performed. All patients showed a solid union upon follow-up radiographs and no pseudarthrosis was noted. Correction with PSO averaged 36.2°. Blood loss averaged 1515.6 mL. The Oswestry Disability Index improved from 40.5 to 18.8 at the last follow-up, and 90.7% of the patients were very or somewhat satisfied. There were 15 cases (10.7%) of reversible complications including transient radiculopathy and 3 cases (2.1%) of irreversible complications. Based on the results of this study, PSO is considered a reliable and relatively safe procedure for the correction of fixed sagittal imbalance with multiple etiologies.
    Spine 03/2012; 37(19):1667-75. · 2.16 Impact Factor
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    ABSTRACT: We performed L1 posterior vertebral columnar resection and posterior correction for Andersson's lesion and thoracolumbar kyphosis in an ankylosing spondylitis patient during motor evoked potential (MEP) monitoring. We checked MEP intra-operatively, whenever a dangerous procedure for neural elements was performed, and no abnormal findings were seen during surgery. After the operation, we examined neurologic function in the recovery room; the patient showed a progressive neurologic deficit and no response to MEP. After emergency neural exploration and decompression surgery, the neurologic deficit was recovered. We questioned whether to acknowledge the results of this case as a false negative. We think the possible reason for this result may be delayed development of paralysis. So, we recommend that MEP monitoring should be performed not only after important operative steps but also after all steps, including skin suturing, for final confirmation.
    Asian spine journal 03/2012; 6(1):50-4.
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    ABSTRACT: A case report. To report the successful consecutive spinal osteotomies of multiple segments performed on a patient with extremely severe kyphotic deformity. There have been no reports on the experience and surgical strategy of spinal osteotomy on multiple segments for severe global spine deformity. A 48-year-old man, a patient with ankylosing spondylitis with "chin-on-pubis" deformity, underwent consecutive spinal osteotomies to correct the severe, fixed global kyphosis. The axial skeletons from the skull, all vertebrae, and both sacroiliac joints and hip joint were fused into a single bone. After both hip resectional arthroplasties for the first step, staged, sequential spinal osteotomies, including pedicle subtraction osteotomy (PSO) on C6, posterior vertebral column resection on T11-T12, and PSO on L3, were performed. Finally, both total hip arthoroplasties were performed. The chin-brow vertical angle improved from 140° to 15°. Correction angles of 45°, 70°, and 30° in the cervical, thoracic, and lumbar spines, respectively, were achieved without complication. At the last follow-up, excellent improvement in activities of daily living and horizontal gaze were achieved. This is the first report on C6 PSO and spinal osteotomies in whole spine segments. For patients with a severe global kyphotic deformity, it is important to place the patient in a stable prone position so that corrective surgery can be performed on the thoracolumbar spine. To accomplish this, initially correcting the deformities in the hip joints and the cervical spine can yield excellent clinical results.
    Spine 02/2012; 37(16):E1017-21. · 2.16 Impact Factor
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    ABSTRACT: A prospective, randomized study. To analyze the effect of local retropharyngeal steroid to reduce prevertebral soft tissue swelling (PSTS) after anterior cervical discectomy and fusion (ACDF). There have been several reports on intravenous corticosteroid to prevent airway complication without a consensus; however, there have been no reports to date that have discussed the use of local steroids to reduce PSTS. Fifty cases that underwent ACDF involving 1 or 2 segments were enrolled. The mean follow-up period was 22 months. Of the 25 cases randomly selected as the steroid group, a mixture of triamcinolone and morcellized collagen sponge was applied to the retropharyngeal space before wound closure. For the control group, the other 25 cases received the operation without steroid. We measured the PSTS ratio to vertebral body from C3 to 7 and PSTS index (PSTSI; mean of PSTS ratio at C3, 4, and 5) on cervical spine. Simple lateral radiographs were taken preoperatively, immediately after operation, and at postoperative 2 days, 4 days, 2 weeks, and the last follow-up. The changes in odynophagia, radiological union, Neck Disability Index were analyzed. The PSTS ratio of the steroid group was significantly lower on C3 and C4 immediately after operation, on C3, 4, 5 and C6 at postoperative 2 days, on C3, 4, and 5 at 4 days. The differences of PSTSI (the steroid: control group) maintained at 58.2: 74.3% (P = 0.004) immediately after operation, 57.9: 84.1% (P = 0.000) at 2 days, 56.3: 82.9% (P = 0.000) at 4 days, and 44.9: 51.4% (P = 0.037) at 2 weeks. The mean Visual Analogue Scale for odynophagia was significantly lower in the steroid group until postoperative 2 weeks. The last follow-up showed no significant difference in the radiological and clinical outcome. Using the retropharyngeal local steroid, we significantly reduced PSTS and odynophagia following ACDF without additional complication. This method may be considered a simple and effective method to decrease PSTS following anterior cervical spine surgery.
    Spine 12/2011; 36(26):2286-92. · 2.16 Impact Factor
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    ABSTRACT: Spondyloptosis is complete dislocation of the L-5 vertebral body on the sacrum anteriorly. Its optimal treatment is still controversial. In particular, choosing the optimal surgical technique is difficult in the osteoporotic elderly patient given the high incidence of instrumentation failure, pseudarthrosis, progressive slippage, and severe sagittal imbalance. The authors of this report used partial reduction and pedicular transvertebral screw fixation of the lumbosacral junction for the treatment of spondyloptosis in an osteoporotic elderly patient.
    Journal of neurosurgery. Spine 11/2011; 16(2):206-9. · 1.61 Impact Factor
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    ABSTRACT: A prospective radiographic study. To analyze the relationship between craniocervical sagittal balance and thoracic inlet (TI) alignment and to present the parameters that would help predict physiological lordosis of the cervical spine. The physiological cervical lordosis (CL) and related factors has not been clearly defined yet. No studies have reported correlations between TI alignment and sagittal balance of the cervical spine. Cervical spine lateral radiograph of 77 asymptomatic adult volunteers (aged between 21 and 50 y) were taken to analyze the following parameters. (1) Thoracic inlet parameters: thoracic inlet angle (TIA), T1 slope, neck tilting (NT); (2) cervical spine parameters: C0-2 angle, C2-7 angle, % ratio of (C0-2/C0-7 angle), (C2-7/C0-7 angle), and cervical tilting; (3) cranial parameters: C0 angle, cranial offset, and cranial tilting. Statistical analysis was performed using the Pearson correlation coefficients and multiple regression analysis. The mean TIA, T1 slope, NT were 69.5, 25.7, and 43.7, respectively. The mean C0-2 angle, C2-7 angle, C0 angle, cranial offset, cervical tilting, and cranial tilting were -22.4 degrees, -9.9 degrees, -9.3 degrees, 20.9 mm, 18 degrees, and 7.7 degrees, respectively. The ratio of C0-2:C2-7 angle was maintained as 77:23% and cervical tilting:cranial tilting was 70.2:29.8%. A significant correlation was found between TIA and T1 slope (r=0.694), T1 slope and C2-7 angle (r=-0.624), C2-7 angle and C0-2 angle (r=-0.547), C0-2 angle and cranial offset (r=-0.406). The thoracic inlet alignment had significant correlations with craniocervical sagittal balance. To preserve physiological NT around 44 degrees, large TIA increased T1 slope and CL and vice versa. TIA and T1 slope could be used as parameters to predict physiological alignment of the cervical spine. The results of this study may serve as baseline data for the evaluation of sagittal balance or planning of a fusion angle in the cervical spine.
    Journal of spinal disorders & techniques 10/2011; 25(2):E41-7. · 1.21 Impact Factor
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    ABSTRACT: A prospective clinical outcome study. To analyze clinical outcome and prognostic factors of the epidural steroid injection (ESI) for cervical radiculopathy (CR) patients who were considered surgical candidates. The clinical outcomes and prognostic factors of ESI for CR have not been consistently reported, and there has been no prospective study with long-term follow-up. ESI was administered in 98 patients (mean age = 50.1 yr, follow-up = 40.4 mo) with CR without major neurological deficit. A total of 3 or fewer ESIs were administered, using either the interlaminar or transforaminal technique. The patients were divided into 2 groups: those who did not have surgery and those who underwent surgery at the last follow-up. We analyzed statistical difference of relevant clinical (sex, age, duration of symptom, previous episode of CR, visual analogue scale [VAS] of arm pain, etc.), radiological factors (soft disc vs. hard disc, central disc vs. foraminal disc, single segment involvement vs. multiple segment involvement, degree of neural compression and degeneration, etc.) and clinical outcomes (VAS of arm pain, Odom's criteria, and neck disability index) between the 2 groups. The patients received mean 1.8 ESI treatments. At the final follow-up, 79 of the patients (80.6%) did not undergo surgery, whereas the other 19 patients (19.4%) underwent surgery. Of the clinical factors, recurred CR (15.2% vs. 42.1%, P = 0.022) and mean VAS score of arm pain before (6.1 vs. 8.2, P = 0.000) and after ESI (2.8 vs. 6.9, P = 0.000) were significantly different between both groups. Radiological factors and outcome parameters showed no significant difference. In more than 80% of patients with CR who were surgical candidates, surgery was avoided using ESI. The significant factors predisposing failure of ESI were intensity of symptom and a previous episode of CR. ESI is therefore considered a safe and effective treatment to choose before undergoing surgery.
    Spine 10/2011; 37(12):1041-7. · 2.16 Impact Factor
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    ABSTRACT: STUDY DESIGN:: A retrospective study. OBJECTIVES:: To present the accuracy and safety of a novel "key slot (KS)" technique for cervical pedicle screw (CPS) placement with the learning curve. SUMMARY OF BACKGROUND DATA:: Safety and learning curve are the issues preventing wide acceptance of CPS. On the basis of the local anatomy of the pedicle, the authors modified the conventional technique to increase the accuracy and comfortableness of CPS placement with minimal bone loss. METHODS:: A total of 277 subaxial CPS in 50 patients had been inserted using author's technique were reviewed. The KS-shaped entry was created on the medial half of the lateral mass with a 3 mm cutting burr. The shape of entry was a right-angled triangle on the axial plane. The apex of triangle was the virtual pedicle inlet and the oblique side was same as pedicle axis. After making entry, the pedicle was probed with a curved awl along the medial wall. On the postoperative vascular-enhanced computed tomography scan, we analyzed the direction and grade of pedicle perforation (grade 0: no perforation, 1:<25%, 2: 20% to 50%, 3: >50% of screw diameter) on the chronological group of consecutive 10 cases. Grade 2 and 3 were considered as incorrect position. RESULTS:: The correct position was found in 250 screws (90.3%); grade 0 - 215 screws, 1 - 35 screws and the incorrect position in 27 screws (9.7%); grade 2 - 21 screws, grade 3 - 6 screws. The incidence of incorrect screw position was 18% in the initial 20 cases and 2.7% after that. There was no neurovascular complication related with CPS. CONCLUSIONS:: We performed CPS placement using the KS technique and with 90% correct position without clinical complications. After the learning curve, the incidence was 2.7%. This technique could be considered relatively concrete and safe modification of conventional technique with minimal bone loss.
    Journal of spinal disorders & techniques 09/2011; · 1.21 Impact Factor
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    ABSTRACT: The aim of this study was to determine whether anterior column support is required in Smith-Petersen osteotomy procedure with correction angles of more than 10°, while examining the subsequent healing patterns in relation to the disrupted area. An analysis was done on 26 segments of 19 patients who showed a correction angle of more than 10° in the anterior opening after SPO. There were 17 male and two female patients with a mean age of 40 years (24-56 years). The mean follow-up period was 6.5 years (2-9.1 years). The patients were classified according to the site of the anterior opening, as the disc level, the lower end-plate of the upper body (upper body), or the upper end-plate of the lower body (lower body). The healing patterns of anterior opening and the radiological correction angles were evaluated relative to the opening site. In all cases, bony fusion was confirmed at a mean period of 5.6 months (3-6.7 months) after surgery and the anterior opening gap was healed in 18 segments (69.2%). For patients that developed an opening in the upper body, all of the gaps were healed. The gaps in the lower body opening group were healed in 85.7% of the cases, and for the opening at the disc level, the gaps were healed only in 12.5% of the cases. The least amount of correction was obtained when anterior opening occurred in disc level. In our study of subjects presenting with anterior opening angles from 10° to 32°, we obtained successful fusion without the need for additional anterior interbody fusion. Improved gap healing and increased correction angles were obtained when the opening was present in the upper or lower body endplates compared to those at the disc space level.
    European Spine Journal 09/2011; 21(5):985-91. · 2.47 Impact Factor

Publication Stats

347 Citations
71.02 Total Impact Points

Institutions

  • 2013
    • Inje University Paik Hospital
      Sŏul, Seoul, South Korea
  • 2001–2013
    • Kyung Hee University Medical Center
      • Department of Neurosurgery
      Sŏul, Seoul, South Korea
  • 2002–2012
    • Kyung Hee University
      • Department of Medicine
      Seoul, Seoul, South Korea