Ki-Tack Kim

Kyung Hee University Medical Center, Sŏul, Seoul, South Korea

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Publications (83)102.6 Total impact

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    ABSTRACT: Study design: A retrospective study OBJECTIVE.: To analyze the clinical outcomes and related factors of C5 palsy (C5P) following posterior cervical laminectomy with fusion (LF) compared with laminoplasty (LP). Summary of background data: C5P is more common after LF than after LP. There have not been any studies on C5P-LF compared with C5P-LP. Methods: We retrospectively analyzed consecutive cases that underwent cervical LF for non-traumatic cervical myelopathy or myeloradiculopathy (CMR). (1) To analyze the related factors, C5P-LF and non-C5P-LF groups were compared. To assess the clinical parameters, preoperative diagnosis, clinical symptoms, surgical procedures, and outcome instruments were analyzed. Radiographically, we analyzed preoperative maximal spinal cord compression ratio, presence of C4-5 foraminal stenosis (FS), and correction angles on the sagittal plane. (2) To compare with C5P-LP, we analyzed the incidence, time of onset, grade of muscle weakness, other accompanying cervical nerve root palsies, recovery time, and degree of final recovery in the C5P-LF and the C5P-LP groups of 100 consecutive LPs. Results: A total of 90 LF patients were enrolled (M:F = 54:36, mean age 61.1 years, mean follow-up 35 months). C5P occurred in 26 patients (28.9%), and 14 cases (53.8%) demonstrated other cervical nerve root palsies. Clinically, significant differences were observed between the C5P-LF and non-C5P-LF groups with regard to preoperative clinical diagnosis (CMR 88.5:42.2%, p < 0.001) and presence of preoperative upper extremity weakness (57.7:32.3%, p = 0.02). Comparison between the C5P-LF and C5P-LP groups showed significant differences between incidence (28.9:4%), mean grade of weakness (2.1:3.5), accompanying nerve root symptoms (53.8:0%), recovery time (20.8:10.5 weeks), and incidence of incomplete recovery (15.4:0%). Conclusions: C5P-LF patients showed higher incidence, more severe weakness, frequent involvement of multiple cervical nerve roots, and longer recovery time than C5P-LP patients. Preoperative clinical manifestation of CMR and preexisting upper extremity weakness were the related factors of C5 palsy. Level of evidence: 3.
    No preview · Article · Dec 2015 · Spine
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    ABSTRACT: Vitamin D is considered essential for bone and muscle health, and some studies have demonstrated the positive effects of vitamin D on metabolic diseases and cancer. Nevertheless, a high prevalence of vitamin D deficiency has been reported in various populations, regardless of country or race. However, no studies regarding the prevalence of vitamin D deficiency in Korean orthopedic patients currently exist. This cross-sectional study included 272 male and 937 female patients aged 50 years and older who were consecutively admitted to the authors' orthopedic department. Vitamin D (25-hydroxy vitamin D), bone turnover markers (osteocalcin, c-telopeptide), and bone mineral density were measured. The prevalence of vitamin D deficiency and its association with other factors were evaluated. Mean patient age was 67.2±8.9 years, and mean level of vitamin D was 16.1±9.1 ng/mL. Overall, 91.2% of patients had deficient (<20 ng/mL; 70.6%) or insufficient (20-30 ng/mL; 20.6%) levels of vitamin D. Vitamin D level did not vary by age group or sex. The level of vitamin D was significantly associated with osteocalcin, c-telopeptide, calcium, alkaline phosphatase, total cholesterol, triglycerides, low-density lipoprotein cholesterol, and glucose (P<.01). Vitamin D level in Korean orthopedic patients of this region was extremely low, regardless of sex and age. Although vitamin D was not directly associated with bone mineral density, there were significant associations between vitamin D and other factors related to bone health and metabolic diseases. [Orthopedics. 2015; 38(10):e898-e903.].
    Preview · Article · Oct 2015 · Orthopedics
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    ABSTRACT: OBJECT The aim of this study was to examine the results of microbiological cultures from local bone autografts used in posterior lumbar interbody fusion (PLIF) and to identify their association with postoperative spinal infection. METHODS The authors retrospectively evaluated cases involving 328 patients who had no previous spinal surgeries and underwent PLIF for degenerative diseases with a minimum 1-year follow-up. Local bone was obtained during laminectomy, and microbiological culture was performed immediately prior to bone grafting. The associations between culture results from local bone autografts and postoperative spinal infections were evaluated. RESULTS The contamination rate of local bone was 4.3% (14 of 328 cases). Coagulase-negative Staphylococcus (29%) was the most common contaminant isolated, followed by Streptococcus species and methicillin-sensitive Staphylococcus aureus. Of 14 patients with positive culture results, 5 (35.7%) had postoperative spinal infections and were treated with intravenous antibiotics for a minimum of 4 weeks. One of these 5 patients also underwent reoperation for debridement during this 4-week period. Regardless of the microbiological culture results, the infection rate after PLIF with local bone autograft was 2.4% (8 of 328 cases), with 5 (62.5%) of 8 patients showing positive results on autograft culture. CONCLUSIONS The incidence of contamination of local bone autograft during PLIF was considerable, and positive culture results were significantly associated with postoperative spinal infection. Special attention focused on the preparation of local bone for autograft and its microbiological culture will be helpful for the control of postoperative spinal infection.
    No preview · Article · Sep 2015 · Journal of neurosurgery. Spine
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    Ki-Tack Kim · Dae-Hyun Park · Sang-Hun Lee · Jung-Hee Lee
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    ABSTRACT: To report the radiological and clinical results after corrective osteotomy in ankylosing spondylitis patients. Furthermore, this study intended to classify the types of deformity and to suggest appropriate surgical treatment options. We retrospectively analyzed ankylosing spondylitis patients who underwent corrective osteotomy between 1996 and 2009. The radiographic assessments included the sagittal vertical axis (SVA), spinopelvic alignment parameters, correction angle, correction loss, type of deformity related to the location of the apex, and the craniocervical range of motion (CCROM). The clinical outcomes were assessed by the Oswestry Disability Index (ODI) scores. A total of 292 corrective osteotomies were performed in 248 patients with a mean follow-up of 40.1 months (range, 24 to 78 months). There were 183 cases of single pedicle subtraction osteotomy (PSO), 19 cases of multiple Smith-Petersen osteotomy (SPO), 17 cases of PSO + SPO, 14 cases of single SPO, six cases of posterior vertebral column resection (PVCR), five cases of PSO + partial pedicle subtraction osteotomy (PPSO), and four cases of PPSO. The mean correction angles were 31.9° ± 11.7° with PSO, 14.3° ± 8.4° with SPO, 38.3° ± 12.7° with PVCR, and 19.3° ± 7.1° with PPSO. The thoracolumbar type was the most common. The outcome analysis showed a significant improvement in the ODI score (p < 0.05). Statistical analysis revealed that the ODI score improvements correlated significantly with the postoperative SVA and CCROM (p < 0.05). There was no correlation between the clinical outcomes and spinopelvic parameters. There were 38 surgery-related complications in 25 patients (10.1%). Corrective osteotomy is an effective method for treating a fixed kyphotic deformity occurring in ankylosing spondylitis, resulting in satisfactory outcomes with acceptable complications. The CCROM and postoperative SVA were important factors in determining the outcome.
    Preview · Article · Sep 2015 · Clinics in orthopedic surgery
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    ABSTRACT: OBJECT Most thoracolumbar fractures have a good healing outcome with adequate treatment. However, posttraumatic thoracolumbar kyphosis can occur in a proportion of thoracolumbar fractures after inappropriate treatment, osteoporosis, or osteonecrosis of the vertebral body. There are several surgical options to correct posttraumatic thoracolumbar kyphosis, including anterior, posterior, and combined approaches, which are associated with varying degrees of success. The aim of this study was to assess the use of a modified closing wedge osteotomy for the treatment of posttraumatic thoracolumbar kyphosis and to evaluate the radiographic findings and clinical outcomes of patients treated using this technique. METHODS Thirteen consecutive patients with symptomatic posttraumatic thoracolumbar kyphosis were treated using a modified closing wedge osteotomy. The mean patient age was 62 years. The kyphosis apex ranged from T-10 to L-2. The sagittal alignment, kyphotic angle, neurological function, visual analog scale for back pain, and Oswestry Disability Index were evaluated before surgery and at follow-up. RESULTS The mean preoperative regional angle was 27. 4°, and the mean correction angle was 29. 6°. Sagittal alignment improved with a mean correction rate of 58. 3%. The mean surgical time was 275 minutes, and the mean intraoperative blood loss was 1585 ml. The intraoperative complications included 2 dural tears, 1 nerve root injury, and 1 superficial wound infection. The mean visual analog scale score for back pain improved from 6. 6 to 2, and the Oswestry Disability Index score decreased from 55. 4 to 22. 6 at the last follow-up. All patients achieved bony anterior fusion based on the presence of trabecular bone bridging at the osteotomy site. CONCLUTIONS The modified posterior closing wedge osteotomy technique achieves satisfactory kyphosis correction with direct visualization of the circumferentially decompressed spinal cord, as well as good fusion with less blood loss and fewer complications. It is an alternative method for treating patients with posttraumatic thoracolumbar kyphosis.
    No preview · Article · Jul 2015 · Journal of neurosurgery. Spine
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    ABSTRACT: To present the incidence and management of dural tears and cerebrospinal fluid leakage during corrective osteotomy [Pedicle Subtraction Osteotomy (PSO) or Smith-Petersen Osteotomy (SPO)] for ankylosing spondylitis with kyphotic deformity. A retrospective study was performed for ankylosing spondylitis patients with fixed sagittal imbalance, who had undergone corrective osteotomy (PSO or SPO) at lumbar level. 87 patients were included in this study. 55 patients underwent PSO, 32 patients underwent SPO. The mean age of the patients at the time of surgery was 41.7 years (21-70 years). Of the 87 patients, 15 patients had intraoperative dural tears. The overall incidence of dural tears was 17.2%. The incidence of dural tears during PSO was 20.0%, SPO was 12.5%. There was significant difference in the incidence of dural tears based on surgical procedures (PSO vs. SPO) (p<0.05). The dural tears ranged in size from 12 to 221 mm(2). A nine of 15 patients had the relatively small dural tears, underwent direct repair via watertight closure. The remaining 6 patients had the large dural tears, consequently direct repair was impossible. The large dural tears were repaired with an on-lay graft of muscle, fascia or fat harvested from the adjacent operation site. All patients had a successful repair with no patient requiring reoperation for the cerebrospinal fluid leak. The overall incidence of dural tears during PSO or SPO for ankylosing spondylitis with kyphotic deformity was 17.2%. The risk factor of dural tears was complexity of surgery. All dural tears were repaired primarily using direct suture, muscle, fascia or fat graft.
    Full-text · Article · Jul 2015 · Journal of Korean Neurosurgical Society
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    ABSTRACT: Retrospective study. To evaluate the radiological and clinical results of three different methods in the deformity correction of a degenerative flat back. There are no comparative studies about different procedures in the treatment of degenerative flat back. Sixty-four patients who consecutively underwent corrective surgery for degenerative flat back were reviewed. The operations were performed by three different methods: posterior-only (group P, n=20), one-stage anterior-posterior (group AP, n=12), and two-stage anterior-posterior with iliac screw fixation (group AP-I, n=32). Medical and surgical complications were examined and radiological and clinical results were compared. The majority of medical and surgical complications were found in group AP (5/12) and group P (7/20). The sagittal vertical axes were within normal range immediately postoperatively in all groups, but only group AP-I showed normal sagittal alignment at the final follow-up. Postoperative lumbar lordosis was also significantly higher in group AP-I than in group P or group AP and the finding did not change through the last follow-up. The Oswestry disability index was significantly lower in groups AP and AP-I than in group P at the final follow-up. Meanwhile, the operating time was the longest in group AP-I, and total amount of blood loss was larger in group AP-I and group AP than in group P. Anterior-posterior correction showed better clinical results than posterior-only correction. Two-staged anterior-posterior correction with iliac screw fixation showed better radiological results than posterior-only or one-staged anterior-posterior correction. Two-staged anterior-posterior correction with iliac screw fixation also showed a lower complication rate than one-staged anterior-posterior correction.
    Full-text · Article · Jun 2015 · Asian spine journal
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    ABSTRACT: A retrospective comparative study. To provide an ideal correction angle of lumbar lordosis (LL) in degenerative flat back deformity. The degree of correction in degenerative flat back in relation to pelvic incidence (PI) remains controversial. Forty-nine patients with flat back deformity who underwent corrective surgery were enrolled. Posterior-anterior-posterior sequential operation was performed. Mean age and mean follow-up period was 65.6 years and 24.2 months, respectively. We divided the patients into two groups based on immediate postoperative radiographs-optimal correction (OC) group (PI-9°≤LL<PI+9°) and under-correction (UC) group (LL<PI-9°). We also classified the patients according to the PI of each patient-low PI group (PI<55°) and high PI group (PI≥55°). Radiological and clinical results were analyzed. Patients in OC group had significantly less correction loss and maintained normal sagittal alignment (sagittal vertical axis<5 cm), as compared to patients in UC group (p<0.05). LL of low PI group significantly maintained within 9° better than high PI group (p<0.05). Oswestry disability index (ODI) significantly decreased at last follow-up, as compared to preoperative state. However, there was no significant difference in last follow-up ODI between the groups. In flat back deformity, correction of LL to within 9° of PI will result in better sagittal balance. Thus, we recommend sufficient LL to prevent correction loss, especially in patients with high PI.
    Preview · Article · Jun 2015 · Asian spine journal

  • No preview · Article · Jan 2015
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    ABSTRACT: Study Design: A prospective study. Objective: To provide methods for predicting ideal trajectory and position of C1 lateral mass screw (C1LMS) from plain radiographs. Summary of Background Data: There has been no study on prediction of C1LMS position using plain radiographs. Methods: A total of 40 consecutive subjects (with 79 screws) who had undergone C1LMS placement were enrolled. To evaluate the C1LMS position, the positions of screw head and tips on anteroposterior (AP) radiographs, screw length and height on lateral radiograph were graded; 0, I and II respectively. On the postoperative computed tomography (CT) images, we analyzed lateral mass (LM) perforation, screw thread engagement percent (%), bicortical fixation, extruded screw length and violation of adjacent joints. Results: Screws with tip located medial to LM (tip 0) showed LM perforation in all cases. Polyaxial head located within LM (head 0) or cross the lateral margin of LM (head I) showed no LM perforation. Screw thread engagement percent was highest with head I-tip I (medial half of LM) position (97.6%) and followed by head 0-tip I (90.5%), head I-tip II (lateral half of LM) (86.4%). Screws longer than posterior half of C1 anterior arch (AA) showed bicortical fixation in all cases with mean extruded screw length of 1.9[medium shade]mm. Adjacent joint was not violated in 98% with the screw height below half of C1AA. Conclusions: On an AP radiograph, a C1LMS with the screw head located on the lateral margin of the LM and with the screw tip in the medial half of the LM resulted in the safest and longest trajectory. On lateral radiograph, a screw tip that is placed within the anterior-inferior quadrant of the C1AA result in safe bicortical fixation without injury to the adjacent structures. These plain radiographic findings may be helpful both postperatively and intra-operatively for assessing the trajectory and length of the screw.
    No preview · Article · Jun 2014 · Journal of Spinal Disorders & Techniques
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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.
    No preview · Article · May 2014 · Spine
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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.
    Full-text · Article · Feb 2014 · Annals of Rehabilitation Medicine
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    ABSTRACT: To investigate the feasibility and sample size required for a full-scale randomised controlled trial of the effectiveness of acupuncture with non-steroidal anti-inflammatory drugs (NSAIDs) for chronic neck pain compared with acupuncture or NSAID treatment alone. A total of 45 patients with chronic neck pain participated in the study. For 3 weeks the acupuncture with NSAIDs treatment group took NSAIDs (zaltoprofen, 80 mg) daily while receiving acupuncture treatment three times a week. The acupuncture treatment group received treatment three times a week and the NSAID treatment group took NSAIDs daily. The primary outcomes were to determine the feasibility and to calculate the sample size. As secondary outcomes, pain intensity and pain-related symptoms for chronic neck pain were measured. With regard to enrolment and dropout rates, 88.2% of patients consented to be recruited to the trial and 15.6% of participants were lost to follow-up. The sample size for a full-scale trial was estimated to be 120 patients. Although preliminary, there was a significant change in the visual analogue scale (VAS) for neck pain intensity between the baseline measurement and each point of assessment in all groups. However, there was no difference in VAS scores between the three groups. This pilot study has provided the feasibility and sample size for a full-scale trial of acupuncture with NSAIDs for chronic neck pain compared with acupuncture or NSAID treatment alone. Further research is needed to validate the effects of acupuncture with NSAIDs. NIH ClinicalTrials.gov NCT01205958.
    Full-text · Article · Oct 2013 · Acupuncture in Medicine
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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.
    No preview · Article · Sep 2013 · The spine journal: official journal of the North American Spine Society
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    ABSTRACT: Study Design. Retrospective, radiographic analysisObjective. Evaluate pedicle subtraction osteotomy (PSO) as a means of correcting severe degenerative sagittal imbalance in elderly patients.Summary of Background Data. PSO in patients with degenerative sagittal imbalance is likely to cause more complications than in patients with iatrogenic flatback deformity.Methods. This study analyzed thirty four patients who underwent fusion to the sacrum, with a minimum 2-year follow up. Ages ranged from 58 to 73 with the mean at 65.5 years. PSO was performed at one segment in all cases, consisting of L3 (n = 26), L4 (n = 4), L2 (n = 3), and L1 (n = 1). The average number of levels fused was 8.15. Ten patients had structural interbody fusion at the lumbosacral junction.Results. Applying PSO at one segment, the mean correction of the lordotic angle at the osteotomy site was 33.3, of which the loss of correction (LOC) was 4.0 at the last visit. The correction of lumbar lordosis was 33.7 and the LOC was 8.5. The sagittal C7 plumb was 215.9mm before surgery, corrected to 35.1mm after surgery, and changed to 95.9mm by the last visit. The correction of the sagittal C7 plumb was 119.9mm and the LOC was 60.9mm. There was substantial LOC in lumbar lordosis and sagittal C7 plumb. In 10 patients with addition of posterior lumbar interbody fusion, the LOC of lumbar lordosis was 7.4, which was less than 9 in those who had not it.Conclusion. Pedicle subtraction osteotomy for the correction of degenerative sagittal imbalance in elderly patients resulted in correction of sagittal alignment with a significant LOC of lumbar lordosis and sagittal C7 plumb. The LOC of lumbar lordosis occurred at both the osteotomy and non-osteotomy site. The addition of anterior column support is helpful to maintain correction and reduce complications.
    No preview · Article · Aug 2013 · Spine
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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.
    No preview · Article · Jul 2013
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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.
    No preview · Article · May 2013 · Journal of neurosurgery. Spine
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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.
    Preview · Article · Mar 2013 · Experimental and therapeutic medicine
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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.
    No preview · Article · Feb 2013 · Spine
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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.
    Full-text · Article · Nov 2012 · Journal of Korean Neurosurgical Society

Publication Stats

732 Citations
102.60 Total Impact Points

Institutions

  • 2007-2015
    • Kyung Hee University Medical Center
      • • Department of Physical Medicine and Rehabilitation
      • • Department of Neurosurgery
      Sŏul, Seoul, South Korea
  • 2001-2015
    • Kyung Hee University
      • • Department of Medicine
      • • College of Medicine
      Sŏul, Seoul, South Korea
  • 2011
    • Hallym University
      Sŏul, Seoul, South Korea
  • 2002
    • University of Seoul
      Sŏul, Seoul, South Korea