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Publications (6)12.68 Total impact

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    ABSTRACT: Study Design. Observational study with three examinersObjectives. To compare the reliability of shoulder balance measurement methodsSummary of Background Data. There are several measurement methods for shoulder balance. No reliability analysis has been performed, despite the clinical importance of this measurement.Methods. Whole spine postero-anterior radiographs (n = 270) were collected to compare the reliability of the four shoulder balance measures in adolescent idiopathic scoliosis patients. Each radiograph was measured twice by each of the three examiners using the four measurement methods. The data was analyzed statistically to determine the inter- and intraobserver reliability.Result. Overall, the four radiographic methods showed an excellent intraclass correlation coefficient (ICC) regardless of severity in intraobserver comparisons (>0.904). In addition, the mean absolute difference (MAD) values in all methods were low and were comparatively similar (<1.73˚). However, in interobserver comparisons, reliabilities were significantly decreased in the less severe radiographs, firstly on radiographic shoulder height measures (ICCs>0.445, MAD<3.91˚). However, the ICCs in the coracoid height difference and clavicular angle methods were in the excellent range (>0.810 and >0.787, respectively) regardless of severity. In addition, the MAD values in the clavicular angle method were lower (<0.62˚) than others.Conclusions. The higher reliability of the clavicular angle and coracoids height difference methods indicate the clinical usefulness of these methods. Physicians should selectively use the shoulder balance measurement method clinically.
    Spine 06/2013; · 2.16 Impact Factor
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    ABSTRACT: PURPOSE: To identify factors that can affect postoperative shoulder balance in AIS. METHOD: 89 adolescent idiopathic scoliosis patients with six types of curvatures who underwent surgery were included in this study. Whole spine antero-posterior and lateral radiographs were obtained pre- and postoperatively. In radiograms, shape and changes in curvatures were analyzed. In addition, four shoulder parameters and coronal balance were analyzed in an effort to identify factors significantly related to postoperative shoulder balance. RESULT: In general, all the four shoulder parameters (CHD, CA, CRID, RSH) were slightly increased at final follow up (t test, P < 0.05), although there was a decrease in Lenke type II and IV curvatures. However, pre- and postoperative shoulder parameters were not significantly different between each curvature types (ANOVA, P > 0.05). Moreover, no significant differences of pre- and postoperative shoulder level between different level of proximal fusion groups (ANOVA, P > 0.05) existed. In the analysis of coronal curvature changes, no difference was observed in every individual coronal curvatures between improved shoulder balance and aggravated groups (P > 0.05). However, the middle to distal curve change ratio was significantly lower in patients with aggravated shoulder balance (P < 0.05). In addition, patients with smaller preoperative shoulder imbalance showed the higher chance of aggravation after surgery with similar postoperative changes (P < 0.05). CONCLUSIONS: Significant relations were found between correction rate of middle, and distal curvature, and postoperative shoulder balance. In addition, preoperative shoulder level difference can be a determinant of postoperative shoulder balance.
    European Spine Journal 03/2013; · 2.47 Impact Factor
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    ABSTRACT: BACKGROUND CONTEXT: Although the Cobb method is considered the gold standard, the centroid method may offer a reasonable alternative in adult scoliosis because it has better inter- and intraobserver reliabilities in adolescent scoliosis. PURPOSE: To compare the reliabilities of the Cobb and the centroid methods for measuring coronal curvature in degenerative scoliosis in older patients. STUDY DESIGN: Observational study involving three examiners. PATIENT SAMPLE: Sixty whole spine posteroanterior (PA) radiographs were collected. OUTCOME MEASURES: Data were analyzed to determine inter- and intraobserver reliabilities. METHODS: Sixty whole spine PA radiographs of patients older than 60 years were collected to compare the reliabilities of the centroid and the Cobb methods for measuring coronal curvature in degenerative scoliosis. Three examiners using both methods independently measured radiographs twice. Data were analyzed to determine inter- and intraobserver reliabilities. RESULTS: Intraobserver comparisons of all the 60 radiographs revealed that inter- and intraclass correlation coefficients (ICCs) of the Cobb and the centroid methods were both excellent (greater than 0.979 vs. greater than 0.918), and mean absolute differences (MADs) were similar (less than 1.58 vs. less than 2.02). In interobserver comparisons, ICCs of the Cobb method were higher than that of the centroid method (greater than 0.922 vs. greater than 0.799), and the MADs of the Cobb method were lower than that of the centroid method (less than 2.91 vs. less than 4.84). Comparisons of radiographs subdivided by severity showed that the ICCs of the Cobb and the centroid methods were both excellent (greater than 0.819 vs. greater than 0.801), and their MADs were similar (less than 2.29 vs. less than 2.53) for intraobserver comparisons. Interobserver comparisons showed that ICCs and MADs were dependent on the severity of coronal curvature, and the ICCs of the Cobb method (greater than 0.698) were greater than that of the centroid method (greater than 0.507). Furthermore, MAD values for the Cobb method were lower than that for the centroid method (less than 3.59 vs. less than 6.07). Moreover, these results are contradictory to the previous study, which showed the higher reliability of the centroid method in measures of adolescent scoliosis. CONCLUSIONS: In the present study, the reliability of the centroid method was found to be more susceptible to the severity of disease in older patients, despite its demonstrated greater reliability in adolescent scoliosis. Our findings show that the selective use of these two methods in old and young patients can increase the reliabilities of measurements made.
    The spine journal: official journal of the North American Spine Society 01/2013; · 2.90 Impact Factor
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    ABSTRACT: The thickness of the human spine dural sac can show differences between individuals and levels, and these differences can alter clinical outcomes. To analyze spinal cord dural sac thicknesses. Anatomical study of human cadavers. The subjects of this study were 19 human cadavers with no prior history of spinal surgery or deformity. Seventeen specimens from T1/T2 to L5/S1 were obtained from each of 19 cadavers, a total of 323 specimens. Multiple sections were prepared from these specimens. Microscopic measurements were taken with an infrared laser-based confocal microscope to determine the mean dural sac thickness at each level. In addition, a magnetic resonance image of the lumbar spine was obtained from each subject. Relations between dural sac thicknesses at different levels were analyzed with respect to gender, age, and stenosis level. Overall mean dural sac thickness was 0.307±0.122 mm in this human cadaver series. Dura thicknesses differed significantly at different levels (p=.046). Overall, dural thickness was highest at T9/T10 and lowest at L2/L3 (p=.0007) as well as highest at the lower thoracic level followed by the upper thoracic and lumbar levels (p=.003). In addition, dural sac thickness was found to increase slightly but significantly with age (p=.019). However, dural thickness was similar between men and women (p=.123). And, no significant dural thickness differences were found for stenotic and nonstenotic lesions (p=.885). Dural sac thickness was found to be significantly dependent on spinal level and age in human cadavers. An appreciation of dural sac thickness differences can be useful in the clinical field, and it is hoped that this encourages further study of dural physiology.
    The spine journal: official journal of the North American Spine Society 12/2011; 11(12):1121-7. · 2.90 Impact Factor
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    ABSTRACT: Radiologic study of scoliosis in pectus excavatum patients. To determine the relation between pectus excavatum deformity and adolescent idiopathic scoliosis (AIS). AIS may be related to other whole body deformities, but few reports have addressed the relation between chest deformity and scoliosis. A total of 248 patients with a diagnosis of pectus excavatum were enrolled in this study. All study patients underwent whole spine anteroposterior radiographs and chest computed tomography. Severity and type of scoliosis and chest deformity were measured using radiographs, and relations between pectus deformity and AIS were analyzed. Overall, 56 of the 248 study patients had scoliosis (Cobb angle > 10 degrees)--a prevalence of 22.58%. The incidence of scoliosis was significantly higher in female patients (38.46%) (P = 0.002), and Lenke type 1 predominated in pectus patients (48.2%, P < 0.0001). Mean age was greater in the scoliosis group than in the nonscoliosis group (P < 0.0001), and the asymmetry of pectus deformity was more prominent in the scoliosis group (P = 0.007). However, pectus deformity severity was similar in the 2 groups (P = 0.061). Furthermore, although the scoliosis group showed a higher proportion of female patients (P = 0.002), the severities of chest and spinal deformities were similar in the 2 groups for both sexes (P = 0.314, P = 0.227). Pectus excavatum and AIS were found to have a high concomitant incidence. And, the age, sex, and type of disease were significantly different in the scoliosis and pectus excavatum groups. Surgeons should consider these relationships when deciding upon treatment in patients with chest and spinal deformities.
    Journal of pediatric orthopedics 12/2011; 31(8):870-4. · 1.23 Impact Factor
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    ABSTRACT: Kyphoplasty is advantageous over vertebroplasty in terms of better kyphosis correction and diminished risk of cement extravasations. Literature described cement leakage causing neurological injury mainly after vertebroplasty procedure; only a few case reports show cement leakage with kyphoplasty without neurological injury or proper cause of leakage. We present a report two cases of osteoporotic vertebral compression fracture treated with kyphoplasty and developed cement leakage causing significant neurological injury. In both cases CT scan was the diagnostic tool to identify cause of cement leakage. CT scan exhibited violation of medial pedicle wall causing cement leakage in the spinal canal. Both patients displayed clinical improvement after decompression surgery with or without instrumentation. Retrospectively looking at stored fluoroscopic images, we found that improper position of trocar in AP and lateral view simultaneously while taking entry caused pedicle wall violation. We suggest not to cross medial pedicle wall in AP image throughout the entire procedure and keeping the trocar in the center of pedicle in lateral image would be the most important precaution to prevent such complication. Our case reports adds the neurological complications with kyphoplasty procedure and suggested that along with other precautions described in the literature, entry with trocar along the entire procedure keeping the oval shape of pedicle in mind (under C-arm) will probably help to prevent such complications.
    Journal of Orthopaedic Surgery and Research 01/2010; 5:54. · 1.01 Impact Factor