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노인성 척추질환의 역학: 건강보험심사평가원 자료 기반 연구
Full text linkAccording to the Statistics Korea in 2020, the elderly population aged 65 or older accounted for 15.7% of the total population, and by 2025 it will reach 20.3%, which will enter the super-aged society. In an aging society, many degenerative diseases occur with age. In particular, the spine is a structure that acts as a pillar of our body, and as we age, degenerative changes come. Representative senile spinal diseases include disc disease, spinal stenosis, spinal spondylolisthesis, scoliosis, kyphosis, and flat back syndrome. This study intends to examine the epidemiologic characteristics and trends of senile spinal diseases using Korean Health Insurance Review & Assessment Service database from 2010 to 2019. All of the senile spinal diseases have gradually increased in the number of patients and cost over the last 10 years. In addition, the proportion of those aged 60 and over increased among those diagnosed. And fusion surgery and discectomy also increased in the last 10 years, and the treatment cost and ratio of over 60 years old increased. Korea has already become an aging society. So, in the future, senile diseases will increase further, and among them, senile spinal diseases will steadily increase. As a result, the frequency and cost of surgery will continue to increase. Efforts are needed to understand this trend and to prevent senile spinal diseases. For example, regular exercise, proper posture and habits, adequate nutrition, and efforts such as quitting smoking should be required. When these efforts are made, more healthy old life will be achieved
Response to letter to the Editor regarding “What are the risk factors for a second osteoporotic vertebral compression fracture?”
No full textDetermination of strut-and-tie models using evolutionary structural optimization
No full textThis paper introduces a method to determine strut-and-tie models in reinforced concrete (RC) structures using evolutionary structural optimization (ESO). Even though strut-and-tie models are broadly adapted in the design of reinforced concrete members subjected to shear and torsion, conventional methods can hardly offer useful models of RC members subjected to complex loadings and geometry conditions. In this paper, the basic idea of the ESO method is used to determine more rational strut-and-tie models. Since an optimum topology of structures, finally obtained by the ESO method, usually represents a truss-like structure, the ESO method using truss elements can effectively be used in finding the best strut-and-tie models in RC structures. To prevent the structural instability that may occur during the evolutionary optimization process, a brick element composed of six truss elements is designed as a basic element unit. Systematic removal of each brick element that has the least virtual strain energy follows, and the optimal load transfer mechanism of an RC structure, which is equivalent to the optimal topology of the strut-and-tie model, is finally characterized on the basis of an optimization criterion of minimizing the total elastic strain energy of the structure. Several RC structures are used as examples to demonstrate the capability of the proposed method in finding the best strut-and-tie model of each RC structure and to verify its efficiency in application to real design problems. (c) 2006 Elsevier Ltd. All rights reserved.The research reported in this paper was made possible by
the financial support from the Smart Infra-StructureTechnology
Center funded by the Korea Science and Engineering Foundation. The authors would like to express their gratitude
to this organization for the financial support
Commentary on “Cervical Inclination Angle: Normative Values in an Adult Multiethnic Asymptomatic Population”
Full text linkA new surgical method for treating syringomyelia secondary to arachnoiditis following cervical spine surgery: the syringo-cisterna magna shunt
No full textPURPOSE: The 5-year postoperative failure rate of conventional shunt treatment for syringomyelia is 50%, with arachnoditis, shunt obstruction, and shunt malfunction being the most common causes. We report a new syringo-cisterna magna (SCM) shunt that allows syrinx cerebrospinal fluid (CSF) drainage normally into the cerebellomedullary cisterns through the subarachnoid space. METHODS: Between November 2012 and February 2017, six patients (mean age: 57.25 years; sex: four male and two female) received the SCM shunt. They had spinal cord injury, abscess formation after a spine operation, and cerebral meningitis-related syringomyelia (syrinx between C0 and T9), and presented sensory changes and motor weakness. Preoperatively and at 1 year postoperatively, the syrinx length and diameter were assessed using magnetic resonance imaging (MRI). Clinical outcomes were evaluated using the visual analog scale (VAS) and Japanese Orthopedic Association (JOA) scores. RESULTS: Motor weakness improved, pain subsided, and sensory disturbance resolved in all patients who returned to work within 6 weeks postoperatively. In all cases, the syrinx collapsed (length: 3.3 levels decreased; diameter: decreased from 7.90 to 4.64 mm, p = 0.046) on postoperative MRI. No patient experienced syrinx recurrence and shunt malfunction on MRI or showed spinal instability signs on plain radiography. The VAS (pre- vs post-shunt: 6.50 vs 3.83, p = 0.027) and JOA scores (pre- vs post-shunt: 10.00 vs 11.17, p = 0.167) were improved postoperatively. CONCLUSION: We developed a new shunting system allowing syrinx CSF drainage to the posterior fossa, with symptomatic improvement, minimal complications, and syrinx decrease on follow-up MRI. The SCM shunt is effective for treating syringomyelia
Intraoperative Facet Joint Block Reduces Pain After Oblique Lumbar Interbody Fusion: A Double-Blinded, Randomized, Placebo-Controlled Clinical Trial
No full textBACKGROUND: Oblique lumbar interbody fusion (OLIF) results in less tissue damage than in other surgeries, but immediate postoperative pain occurs. Notably, facet joint widening occurs in the vertebral body after OLIF. We hypothesized that the application of a facet joint block to the area of widening would relieve facet joint pain. The purpose of this study was to evaluate the analgesic effects of such injections on postoperative pain. METHODS: This double-blinded, placebo-controlled study randomized patients into 2 groups. Patients assigned to the active group received an intra-articular injection of a compound mixture of bupivacaine and triamcinolone, whereas patients in the placebo group received an equivalent volume of normal saline solution injection. Back and dominant leg pain were evaluated with use of a visual analog scale (VAS) at 12, 24, 48, and 72 hours postoperatively. Clinical outcomes were evaluated preoperatively and at 6 months postoperatively with use of the Oswestry Disability Index (ODI) and VAS for back and dominant leg pain. RESULTS: Of the 61 patients who were included, 31 were randomized to the placebo group and 30 were randomized to the active group. Postoperative fentanyl consumption from patient-controlled analgesia was higher in the placebo group than in the active group at up to 36 hours postoperatively (p < 0.001) and decreased gradually in both groups. VAS back pain scores were significantly higher in the placebo group than in the active group at up to 48 hours postoperatively. On average, patients in the active group had a higher satisfaction score (p = 0.038) and were discharged 1.3 days earlier than those in the placebo group. CONCLUSIONS: The use of an intraoperative facet joint block decreased pain perception during OLIF, thereby reducing opioid consumption and the severity of postoperative pain. This effect was also associated with a reduction in the length of the stay. LEVEL OF EVIDENCE: Therapeutic Level I. See Instructions for Authors for a complete description of levels of evidence
Comparison of spinal instability and postoperative complications between laminoplasty and laminectomy surgery for spinal cord tumors
No full textThis study aimed to compare kyphotic changes and postoperative complications between laminectomy and laminoplasty for spinal cord tumors. We retrospectively included 110 patients who underwent spinal cord tumor resection at the Ajou University Medical Center, Korea, between January 1994 and March 2022 to compare the complications and postoperative kyphotic changes between laminectomy and laminoplasty. A total of 59 and 51 patients underwent laminectomy and laminoplasty, respectively. The groups had similar demographic characteristics. Tumor locations were classified as cervical, thoracic, and lumbar lesions and were compared. We measured preoperative and postoperative radiological parameters and identified postoperative complications. In the laminoplasty group, we studied 7, 19, and 25 cases at the cervical, thoracic, and lumbar levels, respectively. In the laminectomy group, we studied 13, 31, and 15 cases at the cervical, thoracic, and lumbar levels, respectively. At the cervical level, lordosis from C2 to C7 was 8.66 +/- 5.06 degrees before and 15.86 +/- 12.54 degrees after surgery and was 10.5 +/- 6.82 degrees before and 9.16 +/- 6.5 degrees after surgery in the laminoplasty and laminectomy groups, respectively. At the thoracic level, kyphosis from T5 to T12 was 27.89 +/- 9.93 degrees before and 23.18 +/- 9.10 degrees after surgery and was 29.94 +/- 9.56 degrees before and 28.41 +/- 12.58 degrees after surgery in the laminoplasty and laminectomy groups, respectively. At the lumbar level, lordosis from L1 to S1 was 40.86 +/- 14.12 degrees before and 42.62 +/- 10.39 degrees after surgery and was 43.65 +/- 8.47 degrees before and 37.44 +/- 13.32 degrees after surgery in the laminoplasty and laminectomy groups, respectively. Postoperative complications, such as cerebrospinal fluid leakage, infection, and hematoma, were more frequent in the laminectomy group than in the laminoplasty group. Laminoplasty rather than laminectomy for spinal cord tumor surgery can reduce postoperative complications and prevent kyphosis
Artificial Intelligence for Neurosurgery: Current State and Future Directions
No full textArtificial intelligence (AI) is a field of computer science that equips machines with human-like intelligence and enables them to learn, reason, and solve problems when presented with data in various formats. Neurosurgery is often at the forefront of innovative and disruptive technologies, which have similarly altered the course of acute and chronic diseases. In diagnostic imaging, such as X-rays, computed tomography, and magnetic resonance imaging, AI is used to analyze images. The use of robots in the field of neurosurgery is also increasing. In neurointensive care units, AI is used to analyze data and provide care to critically ill patients. Moreover, AI can be used to predict a patient’s prognosis. Several AI applications have already been introduced in the field of neurosurgery, and many more are expected in the near future. Ultimately, it is our responsibility to keep pace with this evolution to provide meaningful outcomes and personalize each patient’s care. Rather than blindly relying on AI in the future, neurosurgeons should gain a thorough understanding of it and use it to enhance their patient care
Risk Factors for 90-Day Readmission Among Patients with Metastatic Spine Tumors in South Korea: A Nationwide Population-Based Study
No full textBackground: Population-based studies on the cause of readmission within 90 days after surgery or radiotherapy for metastatic spine tumors are scarce. We aimed to investigate the risk factors for readmission within 90 days after initial surgical or radiation treatment for metastatic spine tumors. Methods: Patients who were diagnosed with metastatic spine tumors between 2012 and 2019 and underwent spinal magnetic resonance imaging within 1 year were classified according to treatment (surgical or radiotherapy groups), and the causes of the 90-day readmission and patient characteristics were compared. Results: Overall, data from 15,815 patients (surgical group, 13,974 patients; radiotherapy group, 1841 patients) were evaluated. Radiotherapy was preferred in younger and male patients with a high Charlson Comorbidity Index, whereas surgery was mainly performed in patients with lumbar metastasis. Radiotherapy, age of 30–69 years, male sex, and Charlson Comorbidity Index >1 increased the risk of 90-day readmission in patients with metastatic spine tumors. The main causes of 90-day readmission among patients with metastatic spine tumors who received radiotherapy included tumor recurrence, chemotherapy, radiotherapy, and treatment of other organ metastases with radiotherapy. Conclusions: These study findings offer a better understanding of the causes of readmission following radiotherapy or surgical treatment in patients with metastatic spine tumors, and these results can help reduce postoperative morbidity and medical costs among these patients
Postoperative spinal deformity and instability after cervical spinal cord tumor resection in adults: A systematic review and meta-analysis
No full textOBJECTIVE: To investigate the incidence of cervical spine deformity and instability after posterior cervical spinal cord tumor (CSCT) resection without fusion or fixation in adults and examine relevant risk factors by reviewing and summarizing previously reported studies. METHODS: We selected peer reviewed articles published between January 1990 and December 2020 from the MEDLINE and Cochrane Library databases using relevant key words. Articles in which the authors mainly described spinal cord tumor resection through posterior surgery without fusion or fixation in adults were selected for analysis. Patient's data including age, sex, extensive number of laminectomy levels, laminectomy at C2, C3, or C7, multilevel facetectomy, facet destruction, preoperative cervical kyphosis, and preoperative motor deficit were documented. Comparable factors were assessed using the odds ratio (OR) and weighted mean difference (WMD) of 95% confidence intervals (CI). RESULTS: Among 133 articles identified, 18 met selection criteria. Overall incidence of deformity and instability after CSCT surgery was 0%-41.7% and 0%-20.5%, respectively. Younger age (WMD, -5.5; 95% CI, -10.52 approximately -0.49; P = 0.03), C2 laminectomy (OR, 5.33; 95% CI, 2.39 approximately 11.91; P < 0.0001), more laminectomy level (WMD, 2.77; 95% CI, 1.78 approximately 3.76; P < 0.00001) were identified as risk factors for deformity and instability after CSCT surgery. CONCLUSION: Patients undergoing CSCT resection should receive careful follow-up for postoperative spinal deformity and instability. Younger age, C2 laminectomy, and more laminectomy level were significantly associated with occurrence of deformity and instability after CSCT surgery. Upfront spinal fixation at the time of resection should be considered in selected patients
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