364 results on '"Kee-Yong Ha"'
Search Results
102. Increased Osteoblastic Activity Suppressed Proliferation Of Multiple Myeloma Plasma Cells
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Sang Il Kim, Hyung-Youl Park, Kee-Yong Ha, Young Hoon Kim, and Yoo-Kyung Cho
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business.industry ,Cancer research ,medicine ,medicine.disease ,business ,Multiple myeloma - Published
- 2018
103. Clinical Outcomes Of Pathologic Vertebral Fractures In Patients With Multiple Myeloma
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Kee-Yong Ha, Sang Il Kim, Young Hoon Kim, Hyung-Ki Min, and Hyung-Youl Park
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medicine.medical_specialty ,business.industry ,medicine ,In patient ,Radiology ,business ,medicine.disease ,Multiple myeloma - Published
- 2018
104. Multiple Myeloma and Epidural Spinal Cord Compression : Case Presentation and a Spine Surgeon's Perspective
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Hyun-Woo Kim, Young Hoon Kim, and Kee-Yong Ha
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medicine.medical_specialty ,business.industry ,General Neuroscience ,medicine.medical_treatment ,Case Report ,Case presentation ,Spinal cord compression ,medicine.disease ,Primary tumor ,Spine ,Surgery ,Radiation therapy ,Therapeutic approach ,Multiple myeloma ,medicine ,Neurology (clinical) ,Neurosurgery ,business ,Paraplegia - Abstract
Multiple myeloma, a multicentric hematological malignancy, is the most common primary tumor of the spine. As epidural myeloma causing spinal cord compression is a rare condition, its therapeutic approach and clinical results have been reported to be diverse, and no clear guidelines for therapeutic decision have been established. Three patients presented with progressive paraplegia and sensory disturbance. Image and serological studies revealed multiple myeloma and spinal cord compression caused by epidural myeloma. Emergency radiotherapy and steroid therapy were performed in all three cases. However, their clinical courses and results were distinctly different. Following review of our cases and the related literature, we suggest a systematic therapeutic approach for these patients to achieve better clinical results.
- Published
- 2013
105. The analysis of spinopelvic parameters and stability following long fusions with S1, S2 or iliac fixation
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Seung Wook Baek, Seung Woo Suh, Kee Yong Ha, Ye Soo Park, and Cheol Kim
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Joint Instability ,Male ,Sacrum ,medicine.medical_specialty ,medicine.medical_treatment ,Lumbar vertebrae ,Ilium ,Lumbosacral region ,Disability Evaluation ,Fixation (surgical) ,Lumbar ,medicine ,Deformity ,Humans ,Orthopedics and Sports Medicine ,Pelvic Bones ,skin and connective tissue diseases ,Postural Balance ,Aged ,Retrospective Studies ,Aged, 80 and over ,Original Paper ,Lumbar Vertebrae ,business.industry ,Lumbosacral Region ,Middle Aged ,Spine ,Surgery ,Radiography ,Spinal Fusion ,Treatment Outcome ,medicine.anatomical_structure ,Spinal fusion ,Orthopedic surgery ,Female ,Spinal Diseases ,sense organs ,medicine.symptom ,business - Abstract
The purpose of this study was to analyse changes of spinopelvic parameters and stability in the treatment of degenerative lumbar deformity.A retrospective review was carried out on 70 cases of degenerative lumbar deformity treated by long fusion with uni-cortical S1 fixation alone (US1F group, n = 20), bi-cortical S1 fixation alone (BS1F group, n = 20), additional diagonal S2 fixation (DS2F group, n = 14), and additional iliac fixation (ILF group, n = 16) from July 2003 to April 2010. The sagittal vertical axis (SVA), lumbar lordosis (LL), sacral slope (SS), pelvic tilt (PT), pelvic incidence (PI), and stability were used to evaluate radiologic outcomes. The clinical outcome was evaluated using the Oswestry Disability Index (ODI).In all groups, the LL was significantly increased at three months (p0.05). The PI and the SS of ILF patients significantly increased at three months (p0.05), while none of these values changed over time in non-ILF patients. The PT did not change postoperatively in any groups. The LL, SS, and PI were significantly greater in the ILF group at three months postoperatively and later (p0.05). DS2F and ILF had statistically significant stability compared to US1F and BS1F (p0.05). The ODI scores were significantly improved after surgery in all groups compared to before surgery (p0.05).Patients who had ILF in long fusion for the treatment of degenerative lumbar deformity had significant restoration of spinopelvic parameters compared to the other groups. In addition, DS2F and ILF provided more stability of distal instruments.
- Published
- 2013
106. Percutaneous Posterior Instrumentation Followed by Direct Lateral Interbody Fusion for Lumbar Infectious Spondylitis
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Seung-Ho Bae, Jun-Yeong Seo, Kee-Yong Ha, and Young Hoon Kim
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Adult ,Male ,medicine.medical_specialty ,Percutaneous ,Lordosis ,Visual analogue scale ,medicine.medical_treatment ,Lumbar ,Streptococcal Infections ,medicine ,Humans ,Internal fixation ,Orthopedics and Sports Medicine ,Spondylitis ,Aged ,Retrospective Studies ,Aged, 80 and over ,Bone Transplantation ,Lumbar Vertebrae ,business.industry ,Retrospective cohort study ,Middle Aged ,Staphylococcal Infections ,medicine.disease ,Oswestry Disability Index ,Surgery ,Spinal Fusion ,Treatment Outcome ,Female ,Neurology (clinical) ,business - Abstract
Study design Retrospective study. Objectives To investigate the clinical feasibility and outcomes from direct lateral interbody fusion (DLIF) using autogenous bone grafts and percutaneous posterior instrumentation (PPI) for infectious spondylitis. Summary of background data As one of the minimally invasive techniques, PPI has been attempted for various degenerative lumbar spine disorders combined with anterior lumbar interbody fusion or transforaminal lumbar interbody fusion. PPI has been played more roles recently as an internal fixation method for infectious spondylitis. However, the clinical outcomes of DLIF using an autogenous bone graft combined with PPI for infectious spondylitis have been rarely reported. Materials and methods Sixteen patients (mean age, 60.3 ± 18.8 y) who suffered from pyogenic spondylitis underwent single-stage DLIF using an autogenous iliac bone graft combined with PPI. Clinical and radiologic outcomes were evaluated by visual analog scale (VAS), Oswestry Disability Index (ODI), and eradication of primary disease. Radiologic outcomes were evaluated by changes of affected segmental lordosis and fusion status. Results Bony fusion and eradication of primary disease were obtained in all patient except 1 case during the follow-up (mean, 31.3 ± 13.1 mo; range 14-46 mo). Preoperative VAS (7 ± 1.2) and ODI (61.3 ± 5.4) scores improved significantly at the last follow-up (VAS, 3.4 ± 1.5; ODI, 32.3 ± 15.4). C-reactive protein normalized at postoperative 20.1 ± 0.7 days (range, 15-28 d). Although height and lordosis in the affected segment were restored by surgery, all patients showed loss of the restored lordosis and height at the final follow-up. Loss of the restored lordosis and height were related to subsidence of the grafted bone. Conclusions Minimally invasive PPI followed by debridement and DLIF was a feasible surgical alternative in our consecutive 16 cases of pyogenic spondylitis. In most cases, however the subsidence of anteriorly grafted fusion was inevitable despite successful fusion and eradication of the primary lesion.
- Published
- 2013
107. Percutaneous Vertebroplasty for Cephalad Vertebral Fractures After Instrumented Lumbar Fusion
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Dong-Gune Chang, Jun-Yeong Seo, Il-Nam Son, Kee-Yong Ha, and Young Hoon Kim
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Male ,medicine.medical_specialty ,Visual analogue scale ,medicine.medical_treatment ,Osteoporosis ,Kyphosis ,Cohort Studies ,Percutaneous vertebroplasty ,Lumbar ,medicine ,Back pain ,Humans ,Orthopedics and Sports Medicine ,Prospective Studies ,Bone Resorption ,Aged ,Retrospective Studies ,Vertebroplasty ,Lumbar Vertebrae ,business.industry ,Middle Aged ,medicine.disease ,Bone cement ,Oswestry Disability Index ,Surgery ,Spinal Fusion ,Spinal Fractures ,Female ,Neurology (clinical) ,medicine.symptom ,business ,Follow-Up Studies - Abstract
Study design Retrospective cohort study. Objective To identify the effect of cement augmentation for cephalad vertebral fracture after instrumented lumbar fusion. Summary of background data Osteoporosis may contribute to cephalad vertebral fractures by an altered biomechanics in the adjacent segments due to the loss of motion at the fused segments. However, few studies on the treatment for cephalad fractures using bone cement augmentation after instrumented lumbar fusion have been published. Methods Seventeen patients who had cephalad vertebral fractures after instrumented lumbar fusion underwent percutaneous vertebroplasty (PVP). All patients were divided into 2 groups according to the presence of intravertebral vacuum clefts (IVC) on plain radiographs and magnetic resonance imaging: group 1 consisted of 9 patients without an associated IVC and group 2 consisted of 8 patients with an IVC. The Oswestry Disability Index and the Visual Analogue Scale were recorded prospectively. The radiologic parameters of kyphotic deformity, vertebral height changes, and leakage of cement were studied. Results The Oswestry Disability Index and Visual Analogue Scale scores in group 1 decreased after PVP, but the mean score in group 2 was higher than in group 1 at the last follow-up. The mean kyphosis measured 15.7±7.4 degrees preoperatively and 15.6±7.1 degrees at the final follow-up in group 1, and 16.9±8.8 degrees preoperatively and 27.2±8.8 degrees at the final follow-up in group 2.The mean preoperative anterior and posterior vertebral height ratio measured 0.6±0.2 preoperatively and 0.6±0.2 at the final follow-up in group 1, and 0.6±0.2 preoperatively and 0.5±0.2 at the final follow-up in group 2.The mean preoperative middle and posterior vertebral height ratio measured 0.5±0.1 preoperatively and 0.6±0.1 at the final follow-up in group 1, and 0.5±0.1 preoperatively and 0.4±0.2 at the final follow-up in group 2. Four patients underwent revision surgery in group 2 and 1 in group 1. Conclusions Although PVP treatment may be a useful method for cephalad vertebral fractures after instrumented lumbar fusion in elderly patients with persistent unremitting back pain, recollapse of the vertebral body can occur after a PVP for cephalad or adjacent vertebral fractures with an IVC.
- Published
- 2013
108. Risk factors for adjacent segment degeneration after surgical correction of degenerative lumbar scoliosis
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Jin-Hyung Im, In-Soo Oh, Jong-Min Son, and Kee-Yong Ha
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musculoskeletal diseases ,medicine.medical_specialty ,medicine.diagnostic_test ,Decompression ,business.industry ,Radiography ,lumbar/dorsolumbar fusion ,Magnetic resonance imaging ,Surgery ,Oswestry Disability Index ,lcsh:RD701-811 ,Lumbar ,risk factor ,lcsh:Orthopedic surgery ,Radiological weapon ,Orthopedic surgery ,Adjacent segment degeneration ,medicine ,Original Article ,Orthopedics and Sports Medicine ,Risk factor ,business ,degenerative lumbar scoliosis - Abstract
Background: Degenerative lumbar scoliosis surgery can lead to development of adjacent segment degeneration (ASD) after lumbar or thoracolumbar fusion. Its incidence, risk factors, morbidity and correlation between radiological and clinical symptoms of ASD have no consensus. We evaluated the correlation between the occurrence of radiologic adjacent segment disease and certain imperative parameters. Materials and Methods: 98 patients who had undergone surgical correction and lumbar/thoracolumbar fusion with pedicle screw instrumentation for degenerative lumbar scoliosis with a minimum 5 year followup were included in the study. We evaluated the correlation between the occurrence of radiologic adjacent segment disease and imperative patient parameters like age at operation, sex, body mass index (BMI), medical comorbidities and bone mineral density (BMD). The radiological parameters taken into consideration were Cobb′s angle, angle type, lumbar lordosis, pelvic incidence, intercristal line, preoperative existence of an ASD on plain radiograph and magnetic resonance imaging (MRI) and surgical parameters were number of the fusion level, decompression level, floating OP (interlumbar fusion excluding L5-S1 level) and posterolateral lumbar interbody fusion (PLIF). Clinical outcomes were assessed with the Visual Analogue Score (VAS) and Oswestry Disability Index (ODI). Results: ASD was present in 44 (44.9%) patients at an average period of 48.0 months (range 6-98 months). Factors related to occurrence of ASD were preoperative existence of disc degeneration (as revealed by MRI) and age at operation ( P = 0.0001, 0.0364). There were no statistically significant differences between radiological adjacent segment degeneration and clinical results (VAS, P = 0.446; ODI, P = 0.531). Conclusions: Patients over the age of 65 years and with preoperative disc degeneration (as revealed by plain radiograph and MRI) were at a higher risk of developing ASD.
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- 2013
109. Posterior dynamic stabilization in the treatment of degenerative lumbar stenosis: validity of its rationale
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Soon-Eok Kwon, Kee-Yong Ha, Il-Nam Son, Ki-Won Kim, Jun-Yeong Seo, and Young Hoon Kim
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medicine.medical_specialty ,business.industry ,Spinal stenosis ,medicine.medical_treatment ,General Medicine ,Lumbar vertebrae ,medicine.disease ,Sagittal plane ,Oswestry Disability Index ,medicine.anatomical_structure ,Lumbar ,Spinal fusion ,Medicine ,Radiology ,business ,Range of motion ,Retrolisthesis - Abstract
Object The authors undertook this study to investigate the validity of the rationale for posterior dynamic stabilization using the Device for Intervertebral Assisted Motion (DIAM) in the treatment of degenerative lumbar stenosis. Methods A cohort of 31 patients who underwent single-level decompression and DIAM placement for degenerative lumbar stenosis were followed up for at least 2 years and data pertaining to their cases were analyzed prospectively. Of these patients, 7 had retrolisthesis. Preoperative and postoperative plain lumbar radiographs obtained in all patients and CT images obtained in 14 patients were analyzed. Posterior disc heights; range of motion (ROM) of proximal, distal, and implant segments; lordotic angles of implant segments; percentage of retrolisthesis; and cross-sectional area and heights of intervertebral foramina on CT sagittal images were analyzed. Clinical outcomes were evaluated using visual analog scale scores and Oswestry Disability Index scores. Results The mean values for posterior disc height before surgery, at 1 week after surgery, and at the final follow-up visits were 6.4 ± 2.0 mm, 9.7 ± 2.8 mm, and 6.8 ± 2.5 mm, respectively. The mean lordotic angles at the implant levels before surgery, at 1 week after surgery, and at the final follow-up visits were 7.1° ± 3.3°, 4.1° ± 2.7°, and 7.0° ± 3.7°, respectively. No statistically significant difference was found between the preoperative values and values from final follow-up visits for posterior disc height and lordotic angles at implant levels (p = 0.17 and p = 0.10, respectively). There was no statistically significant difference between the preoperative and final follow-up visit values for intervertebral foramen cross-sectional area and heights on CT images. The ROMs of proximal and distal segments also showed no significant decrease (p = 0.98 and p = 0.92, respectively). However, the ROMs of implant segments decreased significantly (p = 0.02). The average 31.4-month improvement for all clinical outcome measures was significant (p < 0.001). Conclusions Based on radiological findings, the DIAM failed to show validity in terms of the rationale of indirect decompression, but it did restrict motion at the instrumented level without significant change in adjacent-segment ROM. The clinical condition of the patients, however, was improved, and improvement was maintained despite progressive loss of posterior disc height after surgery.
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- 2013
110. Neuroprotective Effects of Hypothermia After Spinal Cord Injury in Rats
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Ji-Hoon Ok, Kee-Yong Ha, and Young Hoon Kim
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Epidural Space ,Male ,Time Factors ,p38 mitogen-activated protein kinases ,Fluorescent Antibody Technique ,Apoptosis ,Motor Activity ,p38 Mitogen-Activated Protein Kinases ,Neuroprotection ,Rats, Sprague-Dawley ,Hypothermia, Induced ,In Situ Nick-End Labeling ,medicine ,Animals ,Orthopedics and Sports Medicine ,Infusions, Spinal ,Spinal cord injury ,Spinal Cord Injuries ,Neurons ,CD11b Antigen ,business.industry ,Body Weight ,Water ,Recovery of Function ,Hypothermia ,medicine.disease ,Epidural space ,Rats ,Cold Temperature ,Disease Models, Animal ,medicine.anatomical_structure ,Spinal Cord ,Terminal deoxynucleotidyl transferase ,Methylprednisolone ,Caspases ,Anesthesia ,Neurology (clinical) ,medicine.symptom ,business ,medicine.drug - Abstract
Study design An experimental comparative study on moderate epidural hypothermia (MEH) versus moderate systemic hypothermia (MSH) after spinal cord injury (SCI). Objective To compare neuroprotective effects of hypothermia between MEH and MSH after SCI in rats. Summary of background data Experimental MEH or MSH has been attempted for neuroprotection after ischemic or traumatic SCI. However, there is no comparative study on neuroprotective effect of MEH and MSH after SCI. If hypothermia is to be considered as 1 modality for treating SCI, further studies on the advantages and disadvantages of hypothermia will be mandatory. Methods A spinal cord contusion was produced in all 32 rats, and these rats were randomly divided into 4 groups-8 rats in each group: (1) the control group (spinal cord contusion only), (2) the methylprednisolone group, (3) the MEH group (28°C for 48 hr), and (4) the MSH group (32°C for 48 hr). The functional recovery was assessed using Basso, Beattie, Bresnahan scale and antiapoptotic and anti-inflammatory effects were assessed. Results The Basso, Beattie, Bresnahan scale scores in both the hypothermia groups were significantly higher than that in the control group at 6 weeks. The numbers of terminal deoxynucleotidyl transferase dUTP nick end labeling-positive cells and OX-42 positive cells were significantly lower in both the MEH and MSH groups than that in the control group. The p38 mitogen-activated protein kinases expression of the treated groups was significantly lower than that of the control group. The expression of caspase-8 and caspase-9 significantly decreased in the treated groups compared with that of the control group. However, in terms of caspase-3, only the MSH group has shown to be significantly lower than that of the control group. Conclusion This study presented that both systemic and epidural hypothermia demonstrated neuroprotective effects after SCI. Systemic hypothermia showed more neuroprotective effect by antiapoptotic and anti-inflammatory effects.
- Published
- 2012
111. Congenital Kyphoscoliosis in Monozygotic Twins: Ten-Year Follow-up Treated by Posterior Vertebral Column Resection (PVCR): A Case Report
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Jung-Hee Lee, Young Hoon Kim, Kee Yong Ha, Jin Hyok Kim, Dong-Gune Chang, Se Il Suk, Jae Hyuk Yang, and Seung Woo Suh
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Male ,medicine.medical_specialty ,Adolescent ,medicine.medical_treatment ,Kyphosis ,Lumbar vertebrae ,Scoliosis ,Thoracic Vertebrae ,03 medical and health sciences ,Young Adult ,0302 clinical medicine ,medicine ,Diseases in Twins ,Humans ,Clinical Case Report ,Child ,Kyphoscoliosis ,030222 orthopedics ,Lumbar Vertebrae ,business.industry ,Infant, Newborn ,Infant ,General Medicine ,Prostheses and Implants ,Twins, Monozygotic ,medicine.disease ,Surgery ,medicine.anatomical_structure ,Spinal Fusion ,Spinal fusion ,Child, Preschool ,Thoracic vertebrae ,Etiology ,business ,030217 neurology & neurosurgery ,Vertebral column ,Follow-Up Studies ,Research Article - Abstract
The etiology of congenital scoliosis and its development remains unclear and has not yet been fully identified, even there are theories that congenital scoliosis could be derived from the failure of formation or failure of segmentation, which are etiologically heterogeneous with genetic, epigenetic, and environmental factors contributing to their occurrence. We reported a case of long-term follow-up after posterior vertebral column resection (PVCR) in both identical twins with similar congenital kyphoscoliosis at thoracolumbar levels. Twin I had been noticed by his parents to have asymmetry of his back at age 5 years, but no treatment was given. Twin II was first noticed to have a spinal problem at 11 years of age by his parents. Overtime, spine of both twins became further deviated to the left with kyphosis and was referred to our hospital. Both monozygotic twins were treated by PVCR and satisfactory results were demonstrated at 10-year follow-up. This case is the first report on the surgical treatment with PVCR, almost simultaneously, in both identical twins who had similar congenital vertebral anomalies causing kyphoscoliosis. Both identical twins with congenital kyphoscoliosis had undergone surgical correction by PVCR, anterior support with a mesh cage and posterior fusion using pedicle screws at the age of 14 years and achieved a satisfactory correction and a stable spine without curve progression with 10-year follow-up.
- Published
- 2016
112. Dose bisphosphonate-based anti-osteoporosis medication affect osteoporotic spinal fracture healing?
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Young Hoon Kim, Kee-Yong Ha, and Sang Il Kim
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Oncology ,medicine.medical_specialty ,business.industry ,Internal medicine ,medicine.medical_treatment ,Anti osteoporosis ,Spinal fracture ,medicine ,General Medicine ,Bisphosphonate ,business ,medicine.disease ,Affect (psychology) - Published
- 2016
113. Long-term management of congenital lordoscoliosis of the thoracic spine
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Sang Il Kim, Kee Yong Ha, Seung Woo Suh, and Young Hoon Kim
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Male ,medicine.medical_specialty ,Lordosis ,medicine.medical_treatment ,Hyperlordosis ,Scoliosis ,Osteotomy ,Thoracic Vertebrae ,03 medical and health sciences ,0302 clinical medicine ,medicine ,Deformity ,Humans ,Orthopedics and Sports Medicine ,030222 orthopedics ,business.industry ,Laminectomy ,medicine.disease ,Surgery ,medicine.anatomical_structure ,Treatment Outcome ,Child, Preschool ,Thoracic vertebrae ,Disease Progression ,Neurosurgery ,Radiology ,medicine.symptom ,business ,030217 neurology & neurosurgery - Abstract
The objective of this study is to report the progression of congenital hyperlordoscoliosis in a 2-year-old patient and the use of multiple surgical interventions in the treatment of hyperlordoscoliosis of the thoracic spine. A 2-year-old patient with thoracic hyperlordosis underwent observation for 1 year. To halt the progression of hyperlordosis, a posterior laminectomy was carried out to remove all the fused segments. Despite surgery, lordosis progressed via spontaneous autofusion with development of scoliosis with unilateral unsegmented bar. At the age of 9 years, the patient underwent posterior osteotomy at the fused segments, which was unsuccessful in the correction of hyperlordosis, but was successful in the correction of scoliosis. At the age of 12 years, the patient complained of mild breathing difficulties resulting from hyperlordosis of the thoracic spine, and underwent posterior multilevel vertebral osteotomy (PMVO) again to correct lordoscoliosis. Follow-up in the 3 years after PMVO showed that correction of the deformity was well maintained, with a good clinical outcome and a well-balanced spine. PMVO is a potential intervention to manage rigid and severe congenital lordoscoliosis of the thoracic spine.
- Published
- 2016
114. Pure hyperextension injury of the lower lumbar spine with an ureteral impingement
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Young Hoon Kim, Dong-Gune Chang, In-Soo Oh, and Kee-Yong Ha
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musculoskeletal diseases ,medicine.medical_specialty ,medicine.medical_treatment ,Hyperextension ,Case Report ,Lumbar vertebrae ,Ureter ,Humans ,Medicine ,Orthopedics and Sports Medicine ,Diffuse Idiopathic Skeletal Hyperostosis ,Hyperextension injury ,Ankylosing spondylitis ,Lumbar Vertebrae ,business.industry ,Accidents, Traffic ,Anatomy ,Middle Aged ,musculoskeletal system ,medicine.disease ,Surgery ,Spinal Fusion ,medicine.anatomical_structure ,Spinal fusion ,Spinal Fractures ,Female ,Neurosurgery ,business - Abstract
Pure hyperextension thoracolumbar spinal fractures are unusual and occur primarily in patients with ankylosing spondylitis and diffuse idiopathic skeletal hyperostosis due to the rigidity of the spine.A 62-year-old female with osteoporosis presented with a significantly displaced fourth vertebral body fracture after being hit by a motorcycle. An imaging study showed widening of the vertebral height of L4 anteriorly with a horizontal fracture extending across the vertebral body. An in situ instrumented lumbar fusion from the second to fifth lumbar vertebrae was performed. Postoperatively, the patient complained of abdominal pain and difficulty in voiding. Computed tomography and intravenous pyelography showed that the right ureter was impinged between the fractured gaps of the vertebral body of L4.Solid bony union was obtained with surgical intervention.This case reports a rare distractive extension injury in the lower lumbar spine with ureteral impingement. One should be aware of possible complications such as ureteral impingement following a pure hyperextension injury in the lower lumbar spine.
- Published
- 2012
115. Thoracic myelopathy caused by ossification of the yellow ligament in patients with posterior instrumented lumbar fusion
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Il-Nam Son, Young Hoon Kim, Jun-Yeong Seo, Kee-Yong Ha, and Ki-Won Kim
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Male ,medicine.medical_specialty ,medicine.medical_treatment ,Lumbar vertebrae ,Ossification of Posterior Longitudinal Ligament ,Spinal Cord Diseases ,Thoracic Vertebrae ,Postoperative Complications ,Lumbar ,medicine ,Humans ,Orthopedics and Sports Medicine ,In patient ,Aged ,Aged, 80 and over ,Lumbar Vertebrae ,Ossification ,business.industry ,Anatomy ,Middle Aged ,Surgery ,Spinal Fusion ,Thoracic myelopathy ,medicine.anatomical_structure ,Spinal fusion ,Thoracic vertebrae ,Ligament ,Female ,Original Article ,medicine.symptom ,business - Abstract
The objective of this study was to investigate thoracic myelopathy caused by ossification of the yellow ligament (OYL) in patients with posterior instrumented lumbar fusion.Seven patients, who had undergone posterior instrumented lumbar fusion, presented with thoracic myelopathy caused by OYL. No patient had a history of thoracic myelopathy at previous surgery. Instrumented fusions were performed from L1-5 in two patients, L2-5 in three patients and L1-S1 and L2-S1 in one patient each, respectively. MRI and CT scans were performed to confirm cord compression by OYL. Of the seven patients, six patients underwent decompressive laminectomy and OYL removal while one was treated conservatively.The average time to presentation after first surgery was 63.4 months. OYL was located at T9-10 in two patients, T11-12 in three patients, and T10-11 and T9-11 in one patient each, respectively. All patients had a myelopathic gait and the average Japanese Orthopaedic Association (JOA) score was 3.9, preoperatively. The average JOA score improved from 3.7 to 8 and the average recovery rate was 58.9 % in the six patients who underwent surgical intervention. However, the JOA score fell from 5 to 4 in the one patient who was treated conservatively.We report seven patients who suffered from thoracic myelopathy after instrumented lumbar fusion. Surgeons must be aware of the possibility of thoracic myelopathy caused by OYL at the thoracolumbar junction, especially in patients with a complaint of gait disturbance after long instrumented lumbar fusion.
- Published
- 2012
116. Unstable Pathological Fracture of the Odontoid Process Caused by Langerhans Cell Histiocytosis
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Il-Nam Son, Kee-Yong Ha, Young Hoon Kim, and Hyun-Ho Yoo
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Male ,Odontoid process ,medicine.medical_specialty ,Neck pain ,business.industry ,Systemic chemotherapy ,Background data ,medicine.disease ,Surgery ,Histiocytosis, Langerhans-Cell ,Histiocytosis ,Langerhans cell histiocytosis ,Odontoid Process ,medicine ,Humans ,Spinal Fractures ,Orthopedics and Sports Medicine ,Neurology (clinical) ,medicine.symptom ,Child ,business ,Pathological ,Torticollis - Abstract
Study design A case report and literature review. Objective To illustrate the spontaneous resolution of unstable pathological fracture of the odontoid process of the C2 caused by Langerhans cell histiocytosis (LCH) in early childhood. Summary of background data The involvement of atlantoaxial LCH is very rare and its treatment is unfamiliar to surgeons. Therefore, the management of pediatric LCH of the odontoid process and the C2 body is challenging and must be adapted according to the patient's needs; it could range from observation to surgical intervention. Methods A case of pathological fracture of the odontoid process with torticollis diagnosed with LCH of the odontoid process and C2 body and involving right femur in early childhood is presented. A histopathological study showed LCH. The patient underwent brace immobilization and systemic chemotherapy. Results The patient showed successful bony remodeling without LCH recurrence on CT. The neck pain was resolved, and there was no limitation in neck movement. Conclusion Immobilization and systemic chemotherapy with close observation are adequate for the management of patients despite the unstable pathological fracture of the odontoid process.
- Published
- 2012
117. Complicated osteoporotic spinal fractures with neurologic compromise: its clinical characteristics and clinical outcomes
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Sang Il Kim, Young Hoon Kim, Kee-Yong Ha, and Hyung-Ryul Park
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musculoskeletal diseases ,medicine.medical_specialty ,lcsh:Diseases of the musculoskeletal system ,business.industry ,Compromise ,media_common.quotation_subject ,Medicine ,lcsh:RC925-935 ,musculoskeletal system ,business ,Intensive care medicine ,media_common - Published
- 2017
118. Risk of progression of degenerative lumbar scoliosis
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Jun-Yeong Seo, Young Hoon Kim, Tae-Hyok Hwang, Ki-Won Kim, and Kee-Yong Ha
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Orthodontics ,medicine.medical_specialty ,Lordosis ,business.industry ,Visual analogue scale ,Radiography ,Osteoporosis ,General Medicine ,Scoliosis ,medicine.disease ,Surgery ,Oswestry Disability Index ,Vertebra ,medicine.anatomical_structure ,medicine ,Lumbar scoliosis ,business - Abstract
ObjectIn this paper the authors' goal was to determine the factors associated with the progression of degenerative lumbar scoliosis (DLS).MethodsTwenty-seven patients (3 men and 24 women; mean age 64.9 years) with more than 10° of lumbar scoliosis at baseline were monitored for a mean period of 10 years. The radiological evaluation included measurement of the scoliosis angle using the Cobb method, the direction of the scoliosis, the relationship between the intercrest line and the L-5 vertebra, lateral listhesis, segmental angle, distance from the center of the sacral line to the apical vertebra, degenerative listhesis anteriorly or posteriorly or both, and lordosis angle. In addition, the lateral osteophyte difference, disc index, and severity of osteoporosis were measured. The pain and disability outcomes were assessed using the visual analog scale and the Oswestry Disability Index (ODI) relative to severity of the angle of scoliosis.ResultsThe mean initial and final scoliosis angles were 14° ± 5.4° and 25° ± 8.5°, respectively. The initial disc index at the L-3 vertebra (Spearman ρ = 0.7, p < 0.001), the sum of the segmental wedging angles above and below the L-3 vertebra (ρ = 0.6, p < 0.001), and the initial disc index at the apical vertebra (ρ = 0.6, p < 0.001) were correlated with the last follow-up angle of the scoliosis. By contrast, there was no statistically significant correlation between the initial segmental angles at L2–3 and L3–4 and the final follow-up scoliosis angle (ρ = 0.2, p = 0.67; and ρ = 0.1, p = 0.22; respectively). When the authors separated the patients into 3 groups according to the sum of the segmental angles above and below L-3 (< 5°, 5° to 10°, and > 10°), they found that 3 (42.9%) of 7, 8 (66.7%) of 12, and 6 (75.0%) of 8 patients in the 3 groups showed increases of greater than 10° in scoliosis angle. The mean distance from the center of the sacral line to the apical vertebra was 36.0 ± 9.7 mm, and the distance correlated with the measurement of the last follow-up angle of the scoliosis (ρ = 0.6, p < 0.001). The mean angle of the scoliosis was significantly greater when the intercrest line passed through the L-5 or L4–5 disc space than when the line passed through the L-4 vertebral body (31.4° ± 7.9° vs 21.8° ± 6.7°, p = 0.01). The ODI correlated with the measurement of the angle of the scoliosis (ρ = 0.6, p < 0.001). Age, sex, osteoporosis, the direction of the scoliosis, listhesis of coronal and sagittal planes, the lateral osteophyte difference, and the vertebral body index did not correlate with curve progression.ConclusionsThe findings of this study demonstrated that the progression of DLS was affected by the relationship between the intercrest line and the L-5 vertebra. When L-5 was deep seated, progression of DLS was found. Asymmetrical change in the disc space above and below the L-3 or apical vertebra may also be an important predictor of curve progression.
- Published
- 2011
119. Cervical intraspinal extradural ganglion cyst: a case report and review of literature
- Author
-
Kee-Yong Ha and Jun-Yeong Seo
- Subjects
musculoskeletal diseases ,Dense connective tissue ,Facet (geometry) ,business.industry ,Anatomy ,medicine.disease ,Ganglion ,Facet joint ,Ganglion cyst ,medicine.anatomical_structure ,Synovial Cell ,parasitic diseases ,Medicine ,Orthopedics and Sports Medicine ,Surgery ,Spinal canal ,Cyst ,business - Abstract
Intraspinal extradural ganglion cysts rarely occur in the cervical spine, and their etiology is unknown. A 77-year-old female complaining of right upper extremity weakness presented with a cystic mass located in the spinal canal of the right C3-4 facet joint. A C3-4 right hemilaminectomy and excision of the cysts were performed. The cyst contained a translucent viscous material and was easily decompressed. No communication between the cyst and facet joints was found in the surgical field. The neurologic symptoms improved rapidly after surgery. The histology examination showed that the cystic wall was composed of dense fibrous tissue without a synovial cell lining concordant with a ganglion cyst. This report describes a rare case of a ganglion cyst of the cervical spine arising at the C3-4. This case highlights the need to consider a ganglion cyst as one of the causes of cervical radiculo-myelopathy.
- Published
- 2011
120. Significant predictive values for the life expectancy in patients with spinal metastasis following surgical treatment
- Author
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Sang Il Kim, Kee-Yong Ha, and In-Soo Oh
- Subjects
medicine.medical_specialty ,business.industry ,Spine metastasis ,Predictive value ,Surgery ,Bony metastasis ,Life expectancy ,Medicine ,Spinal metastasis ,Orthopedics and Sports Medicine ,In patient ,business ,Surgical treatment - Abstract
Background Spinal metastasis is a common manifestation of bony metastasis, but for surgeons involved in the treatment of individual patients, it is not easy to choose optimal treatments. Various scoring systems have been designed to predict survival periods and to select optimal treatments, but prognosis is still unpredictable. Objectives are to evaluate the efficiency of the predictive value of preoperative Tokuhashi scores for life expectancy in patients with spinal metastasis and to estimate other prognostic factors affected survival of patients with spinal metastasis.
- Published
- 2011
121. Pancreatic cancer metastasis presenting as an arachnoid cyst of the cervical spine: a case report
- Author
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Il-Nam Son, Dong-Cheul Shin, Ki-Won Kim, Kee-Yong Ha, In-Soo Oh, and Jun-Yeong Seo
- Subjects
Subluxation ,medicine.medical_specialty ,business.industry ,medicine.medical_treatment ,Laminectomy ,medicine.disease ,Surgery ,Metastasis ,medicine.anatomical_structure ,Arachnoid cyst ,Pancreatic cancer ,medicine ,Orthopedics and Sports Medicine ,Spinal canal ,Radiology ,Subarachnoid space ,Differential diagnosis ,business - Abstract
Spinal extradural arachnoid cysts are rare expanding lesions, and their etiology is mainly unknown. The authors present a rare case of metastatic pancreatic cancer presenting as an arachnoid cyst of the cervical spine. A 61-year-old woman with progressive neurological deficits was presented with a very large cystic mass from C3 to C6 and C7 and T1 that was a metastatic lesion causing severe collapse of vertebral bodies and subluxation. A posterior laminectomy from C3 to C6 for excision of the cysts and marginal excision including laminectomy around C7 and T1 were performed with instrumented fusion to prevent further collapse and subluxation of T1. No communication between the cysts and the subarachnoid space was found in the surgical field. The neurological symptoms rapidly improved immediately after the surgery. The histology of resected specimens was metastatic mucin-producing adenocarcinoma. This report describes a rare case of metastasis of pancreatic cancer presenting as an arachnoid cyst of the cervical spine. The significance of this study is that metastatic cystic lesions from pancreatic cancer should be considered in the differential diagnosis of arachnoid cysts of the spinal canal.
- Published
- 2011
122. Delayed bilateral facet dislocation at L4-5
- Author
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Young Hoon Kim, Kee-Yong Ha, Jun-Yeong Seo, Dong-Gune Chang, Mohammed Ali Alhazmi, Hyung-Ki Min, Joon-Hyung Cho, Sang Il Kim, In-Soo Oh, and Hyung-Youl Park
- Subjects
musculoskeletal diseases ,medicine.medical_specialty ,Lordosis ,business.industry ,Radiography ,Kyphosis ,Facet dislocation ,General Medicine ,medicine.disease ,Surgery ,Conservative treatment ,03 medical and health sciences ,0302 clinical medicine ,Lumbar ,Surgical reduction ,medicine ,Back pain ,030212 general & internal medicine ,medicine.symptom ,business ,030217 neurology & neurosurgery - Abstract
Rationale Traumatic bilateral facet dislocation in the lumbar (L) spine has rarely been reported. All reported cases were presented with acute facet dislocation. However, we present the first case of delayed bilateral facet dislocation at L4-5. Patient concerns A 34-year-old woman presented with back pain after a head-on collision. The patient was treated conservatively for 3 months with rigid orthosis and activity restriction. Even after this conservative treatment, she continued to suffer from persistent back pain that radiated down her left leg and a progressively kyphotic posture. Diagnoses Initial imaging studies revealed a fracture of the left L5 superior articular process with a posterior ligament complex (PLC) injury. Subsequent radiographs showed the locked facet dislocation with kyphotic changes. Interventions The patient underwent surgical reduction and fusion, and the operative findings revealed the L4-5 bilateral facet dislocation and rupture of the PLC at the index level. Outcomes After surgical reduction and fusion at L4-5 by posterior interbody fusion, we achieved a satisfactory clinical outcome. Lessons Injury of the PLC in the lower lumbar region deserves careful attention for the development of sequelae. The anatomic transition from lordosis to kyphosis, in the lumbosacral region may be related to this type of injury.
- Published
- 2018
123. Thoracic Disc Herniation of the Adjacent Segment With Acutely Progressing Myelopathy
- Author
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Yoon-Chung Kim, Jun-Yeong Seo, In-Soo Oh, and Kee-Yong Ha
- Subjects
Adjacent segment ,Paraplegia ,medicine.medical_specialty ,medicine.diagnostic_test ,business.industry ,Spinal stenosis ,medicine.medical_treatment ,Thoracic ,Magnetic resonance imaging ,Case Report ,medicine.disease ,Spinal cord ,Surgery ,Myelopathy ,medicine.anatomical_structure ,Discectomy ,medicine ,Adjacent ,Orthopedics and Sports Medicine ,Lumbar kyphosis ,business ,Disc herniation - Abstract
We report a case of a 66-year-old woman with progressing myelopathy. Her history revealed instrumented fusion from T10 to S1 for degenerative lumbar kyphosis and spinal stenosis. The plain radiographs showed narrowing of the intervertebral disc space with a gas shadow and sclerotic end-plate changes at T9-T10. Magnetic resonance imaging revealed a posterolateral mass compressing the spinal cord at the T9-T10 level. The patient was treated with a discectomy through the posterior approach combined with posterior instrumentation. The patient's symptoms and myelopathy resolved completely after the discectomy and instrumented fusion. The thoracic disc herniation might have been caused by the increased motion and stress concentration at the adjacent segment.
- Published
- 2010
124. Notochordal cells stimulate migration of cartilage end plate chondrocytes of the intervertebral disc in in vitro cell migration assays
- Author
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Tae-Hong Lim, Jun-Seok Lee, Ki-Won Kim, Kee-Yong Ha, Howard S. An, Young-Kyun Woo, and Suk Woo Nam
- Subjects
Male ,animal structures ,Notochord ,Context (language use) ,In Vitro Techniques ,Chondrocyte ,chemistry.chemical_compound ,Chondrocytes ,Cell Movement ,In vivo ,Lysophosphatidic acid ,medicine ,Animals ,Orthopedics and Sports Medicine ,Growth Plate ,Rats, Wistar ,Intervertebral Disc ,business.industry ,Hyaline cartilage ,Chemotaxis ,Cartilage ,Intervertebral disc ,Anatomy ,In vitro ,Rats ,Cell biology ,medicine.anatomical_structure ,Solubility ,chemistry ,Culture Media, Conditioned ,embryonic structures ,Surgery ,Neurology (clinical) ,business - Abstract
It was recently demonstrated that the postnatal transition from a notochordal to a fibrocartilaginous nucleus pulposus (NP) is accomplished exogenously by chondrocytes migrating from hyaline cartilage end plates (CEs) into the ectopic notochordal NP region. Although our previous in vivo studies showed evidences for the migration of CE chondrocyte from hyaline CEs into the notochordal NP, it is unknown whether CE chondrocytes of the intervertebral disc (IVD) really have a motile property. In addition, the effect of notochordal cells on this property has not been elucidated.The purpose of this in vitro study was to demonstrate whether CE chondrocytes of the IVD are capable of migration, and whether there is any biological link between notochordal cells and CE chondrocytes that may regulate the CE chondrocyte migration.In vitro cell migration assays were performed using rat IVDs.Notochordal cells and chondrocytes were obtained from the NP and CE tissues, respectively, and were cultured separately. The different numbers of notochordal cells and the supernatant (conditioned medium) that contained soluble factors produced by notochordal cells were used to demonstrate their effects on the migration of CE chondrocytes. Bovine serum albumin (BSA) and lysophosphatidic acid (LPA) were used as negative and positive controls, respectively.Compared with BSA, LPA, notochordal cells (N=4x, 2x, 1x, and 0.5 x 10(5)), and its conditioned media (unconcentrated and fivefold concentrated) significantly increased migration of CE chondrocytes (p.05 in all comparisons). Particularly, notochordal cells and its conditioned media increased migration in a number- and concentration-dependent manner, respectively.This study demonstrates that CE chondrocytes of the IVD are capable of migration and that soluble factors produced by notochordal cells stimulate the migration. These results provide a plausible explanation to the question of why CE chondrocytes of the IVD migrate into the ectopic NP region during the natural transition from the notochordal to fibrocartilaginous NP.
- Published
- 2009
125. Sagittal Plane Lumbar Responses after Anterior Selective Thoracic Fusion for Main Thoracic Adolescent Idiopathic Scoliosis
- Author
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Ki-Ho Na, Nam-Yong Choi, Jürgen Harms, and Kee-Yong Ha
- Subjects
Anterior spinal fusion ,business.industry ,Radiography ,Idiopathic scoliosis ,Scoliosis ,Anatomy ,medicine.disease ,Sagittal plane ,Adolescent idiopathic scoliosis ,medicine.anatomical_structure ,Lumbar ,Selective thoracic fusion ,Coronal plane ,Deformity ,medicine ,Clinical Study ,Orthopedics and Sports Medicine ,Surgery ,medicine.symptom ,business ,Lumbar lordosis - Abstract
Study Design: A retrospective radiographic study. Purpose: To verify the correlation of sagittal and coronal plane changes after selective thoracic fusion in main thoracic (MT) adolescent idiopathic scoliosis (AIS). Overview of Literature: Sagittal plane deformity is known to be essential in the evolution of scoliosis. Methods: Twenty-eight MT AIS patients treated by anterior selective thoracic fusion were evaluated after minimal follow- up of two years. The unfused lumbar area was divided into proximal and distal parts by the lumbar apex in the coronal plane, and into proximal and distal lumbar lordosis by L2 in the sagittal plane. Surgical motion (the difference between pre- operative and postoperative values) and follow-up motion (the difference between postoperative and the last follow-up val- ues) were compared. Results: Immediately after surgery, as thoracic kyphosis increased, lumbar lordosis decreased (r=0.734); proximal lumbar lordosis increased, and distal lumbar lordosis decreased. The proximal lumbar area was mobilized in the sagittal plane, and was straightened in the coronal plane. However, the distal lumbar area was stabilized in the sagittal plane, and showed resistant motion against MT translation in the coronal plane. The surgical motion was correlated to the follow-up motion, i. e., was regulated during follow-up, and the regulatory motion was more precise in the distal than proximal lumbar area in both sagittal and coronal planes. Conclusions: Sagittal and coronal motions were co-related; optimal sagittal motions were necessary for optimal coronal motions after anterior selective thoracic fusion for MT AIS. Proximal and distal lumbar motions were different for different roles; the proximal lumbar area played a role as a bumper to absorb the MT translatory force, and the distal lumbar area played a role of resistance against MT translation.
- Published
- 2007
126. Aspergillus Spondylitis involving the Cervico-Thoraco-Lumbar Spine in an Immunocompromised Patient: a Case Report
- Author
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Won-Hee Jee, Jeong-Min Son, Chan Kwon Jung, Kee-Yong Ha, and Sang Il Kim
- Subjects
musculoskeletal diseases ,Male ,medicine.medical_specialty ,medicine.medical_treatment ,Case Report ,Lumbar vertebrae ,Liver transplantation ,Aspergillosis ,Spine, infection ,Thoracic Vertebrae ,Immunocompromised Host ,Postoperative Complications ,Rare Diseases ,medicine ,Humans ,Radiology, Nuclear Medicine and imaging ,Spondylitis ,Aspergillus ,Bone Transplantation ,Lumbar Vertebrae ,medicine.diagnostic_test ,biology ,business.industry ,Magnetic resonance imaging ,Magnetic resonance (MR) ,Middle Aged ,medicine.disease ,biology.organism_classification ,musculoskeletal system ,Magnetic Resonance Imaging ,Surgery ,Liver Transplantation ,medicine.anatomical_structure ,Thoracic vertebrae ,Cervical Vertebrae ,Radiology ,business ,Cervical vertebrae - Abstract
Aspergillosis is a rare cause of spondylitis. Moreover, early diagnosis by MR imaging and adequate treatment can prevent the serious complications of fungal infection. To our knowledge, the MR findings of multilevel aspergillus spondylitis in the cervico-thoraco-lumbar spine have not been previously described. Here, we report the MR findings of aspergillus spondylitis involving the cervical, thoracic, and lumbar spine in a liver transplant recipient.
- Published
- 2007
127. The Fate of Anterior Autogenous Bone Graft After Anterior Radical Surgery With or Without Posterior Instrumentation in the Treatment of Pyogenic Lumbar Spondylodiscitis
- Author
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Jae-Hyuk Shin, Kee-Yong Ha, Ki-Ho Na, and Ki-Won Kim
- Subjects
Male ,Spondylodiscitis ,medicine.medical_specialty ,Discitis ,Time Factors ,medicine.medical_treatment ,Transplantation, Autologous ,Central nervous system disease ,Lumbar ,medicine ,Humans ,Orthopedics and Sports Medicine ,Bone Resorption ,Radical surgery ,Spondylitis ,Reduction (orthopedic surgery) ,Aged ,Retrospective Studies ,Aged, 80 and over ,Bone Transplantation ,Lumbar Vertebrae ,business.industry ,Middle Aged ,medicine.disease ,Internal Fixators ,Sagittal plane ,Surgery ,Transplantation ,Spinal Fusion ,Treatment Outcome ,medicine.anatomical_structure ,Lordosis ,Female ,Bone Remodeling ,Neurology (clinical) ,business ,Follow-Up Studies - Abstract
A retrospective clinical study.To assess the results of anterior strut grafting and the loss of the reduction in anterior interbody fusion and anterior interbody fusion combined with posterior instrumental fusion in pyogenic spondylodiscitis.Resorption of the anterior graft is an ominous sign following most anterior surgery. Thus, additional posterior instrumentation has been used to prevent collapse of the anterior graft. However, its effect is controversial, and few studies have examined the fate of the anterior strut graft.Twenty-four consecutive patients underwent surgical treatment for pyogenic spondylodiscitis. The patients were divided into Group I (anterior interbody fusion) and Group II (anterior interbody fusion + posterior instrumented fusion). The sagittal angle, intervertebral height, and complications relating to the anterior graft were compared.Solid bone fusion was achieved in 23 (95.8%) patients. The sagittal angle and the intervertebral height were similar in Groups I and II (P = 0.61, P = 0.89, respectively). In Groups I and II, the postoperative sagittal angle was maintained until 1 month after surgery (P0.05), but it decreased significantly by 3 months after surgery (P0.05). In Groups I and II, intervertebral height correction was maintained until 1 month after surgery (P0.05), but by 3 months after surgery, it had collapsed significantly (P0.05). Subsidence of the graft occurred through the damaged endplate. Group I included 1 case of graft dislodgement necessitating revision; there were no such cases in Group II. There were no recurrences of infection in either group.Reduction of intervertebral height and loss of sagittal profile occurred in both groups. Complications relating to the bone graft were more common in Group I than in Group II. Despite loss of correction, both groups had a high fusion rate without recurrence of infection. The reduction of intervertebral graft height appears to be the result of destruction of the endplate either due to surgical debridement or the infective process.
- Published
- 2007
128. Does bisphosphonate-based anti-osteoporosis medication affect osteoporotic spinal fracture healing?
- Author
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K.-S. Park, Young Hoon Kim, Kee-Yong Ha, and Sun Kim
- Subjects
Male ,medicine.medical_specialty ,Medication history ,Visual analogue scale ,Endocrinology, Diabetes and Metabolism ,medicine.medical_treatment ,Osteoporosis ,030209 endocrinology & metabolism ,Bone healing ,03 medical and health sciences ,0302 clinical medicine ,Bone Density ,Internal medicine ,Spinal fracture ,medicine ,Humans ,Prospective Studies ,Aged ,Fracture Healing ,Bone Density Conservation Agents ,Diphosphonates ,business.industry ,Odds ratio ,Bisphosphonate ,Middle Aged ,medicine.disease ,Oswestry Disability Index ,Fractures, Ununited ,Spinal Fractures ,Female ,business ,030217 neurology & neurosurgery ,Osteoporotic Fractures ,Follow-Up Studies - Abstract
Effects of bisphosphonate on fracture healing were prospectively investigated for osteoporotic spinal fracture. Although there were no significant differences in clinical outcomes, the presence of intravertebral cleft was related to the medication use. These results suggest that suspension of bisphosphonate use should be considered during the fracture healing period. The purpose of this prospective study is to investigate whether bisphosphonate-based anti-osteoporosis medication affects fracture healing and clinical outcomes of conservatively treated osteoporotic spinal fractures (OSFs). A total of 105 patients who were diagnosed with acute OSFs were prospectively enrolled. According to their previous medication history, the patients were allocated into group I (n = 39, no history of bisphosphonate use) or group II (n = 66, history of bisphosphonate use). Clinical outcomes were assessed using visual analogue scale (VAS), and Oswestry disability index (ODI). Radiographic parameters including changes in height loss and kyphotic angle at the index vertebra were measured, and radiographic findings suggesting impaired fracture healing such as the intravertebral cleft (IVC) sign and fracture instability were evaluated. Univariate and multivariate regression analyses were used to identify related factors. There were no significant differences in the last VAS and ODI between groups. There were also no significant differences in the radiographic parameters. Although the IVC sign was seen more commonly in group II (30.3 %) than in group I (20.5 %), fracture instability combined with IVC was noted in the same number of cases. On multiple regression analysis, medication history showed no significant relationship with the clinical parameters. However, the presence of the IVC sign was related to medication history (odds ratio 4.8; 95 % confidence interval [CI] 1.02–22.69). Bisphosphonate use does not significantly affect the clinical results during conservative treatment for OSFs. However, the occurrence of the IVC sign was related to medication history. Although further studies are needed to verify our findings, these results suggest that suspension of bisphosphonate use should be considered during the fracture healing period for acute OSFs.
- Published
- 2015
129. Posterior hemivertebra resection and short segment fusion with pedicle screw fixation for congenital scoliosis in children younger than 10 years: greater than 7-year follow-up
- Author
-
Dong-Gune Chang, Se-Il Suk, Jung-Sub Lee, Jin-Hyok Kim, Ji-Seok Jang, and Kee-Yong Ha
- Subjects
Male ,medicine.medical_specialty ,Hemivertebra ,Time Factors ,Radiography ,Treatment outcome ,Bone Screws ,Thoracic Vertebrae ,Resection ,medicine ,Humans ,Orthopedics and Sports Medicine ,Kyphosis ,Pedicle screw fixation ,Child ,Congenital scoliosis ,Retrospective Studies ,Lumbar Vertebrae ,business.industry ,Retrospective cohort study ,Surgery ,Osteotomy ,Spinal Fusion ,Treatment Outcome ,Scoliosis ,Short segment ,Child, Preschool ,Lordosis ,Neurology (clinical) ,business ,Spinal Canal ,Follow-Up Studies - Abstract
A retrospective study.To evaluate the surgical outcomes of posterior hemivertebra resection and short segment fusion with segmental pedicle screw fixation in congenital scoliosis in children younger than 10 years.This is the first long-term follow-up on surgical outcomes of posterior hemivertebra resection and short segment fusion using segmental pedicle screw fixation in children younger than 10 years with congenital scoliosis.Patients with congenital scoliosis (n = 18) younger than 10 years at the time of the surgery were treated by posterior hemivertebra resection and bilateral pedicle screw fixation. The mean age at the time of surgery was 6.6 years (range, 2.6-9.8 yr). They were retrospectively studied with a mean follow-up of 11.4 years (range, 7.1-17.3 yr).The mean Cobb angle of the main curve was 34.4° before surgery, 8.6° after surgery, and 12.9° at last follow-up. In the compensatory cranial curve, the preoperative Cobb angle of 14.5° was corrected to 5.9° postoperatively and was 8.4° at last follow-up. In the compensatory caudal curve, the preoperative Cobb angle of 17.4° improved to 4° postoperatively and 6.6° at last follow-up. There were no crankshaft phenomena and no clinical and radiographical features suggestive of spinal stenosis during follow-up. There were no major vascular or neurological complications related to the pedicle screws.Posterior hemivertebra resection after pedicle screw fixation in congenital scoliosis is a safe and effective procedure that can achieve rigid fixation and deformity correction and restore spinal balance. This study showed that early posterior hemivertebra resection of congenital scoliosis before structural changes occur above or below can reduce fusion length, prevent curve progression, and effectively achieve a more satisfactory correction without hazardous iatrogenic spinal stenosis, crankshaft phenomena, or neurological complications.3.
- Published
- 2015
130. A study of sacral anthropometry to determine S1 screw placement for spinal lumbosacral fixation in the Korean population
- Author
-
Young-Yul Kim, Sang Il Kim, Kee-Yong Ha, and In-Soo Oh
- Subjects
musculoskeletal diseases ,Adult ,Male ,Models, Anatomic ,Sacrum ,medicine.medical_treatment ,Bone Screws ,Lumbar vertebrae ,Young Adult ,Sex Factors ,Cadaver ,Fracture Fixation ,Fracture fixation ,Republic of Korea ,Medicine ,Humans ,Orthopedics and Sports Medicine ,External iliac vein ,Fixation (histology) ,Lumbar Vertebrae ,Anthropometry ,business.industry ,Lumbosacral Region ,Anatomy ,Middle Aged ,musculoskeletal system ,medicine.anatomical_structure ,Spinal Fusion ,Spinal fusion ,Spinal Fractures ,Surgery ,Female ,business ,Tomography, X-Ray Computed ,Lumbosacral joint - Abstract
1. To investigate the incidence of closed-type PSIS in the Korean population. 2. To categorize the morphological features of Korean sacrum. 3. To measure the safe marginal length and angle for screw fixation considering the PSIS and course of the external iliac vein, using a Korean sacrum model.We performed our study in 160 sacra including the pelvic ring obtained from 80 Korean cadavers. The bony measurements were obtained by performing 1-mm computed tomography cuts from the L5 lumbar vertebra to the pelvic ring and excluding other structures. We evaluated the incidence of anatomic variation of the PSIS and measured the safe marginal length and angle for screw fixation considering the PSIS and course of the external iliac vein, using a Korean sacrum model.Our study showed that the closed type of PSIS is more frequent in males than in females. The optimal angle for screw fixation is 16.91 ± 6.85 (°), while the left side S1 pedicle insertion angle is 16.00 ± 6.20 (°). The average Korean optimal screw length is 58.35 ± 14.90 (cm) for the right side and 55.89 ± 16.16 (cm) for the left side.With reference to these parameters, the optimal screw length and angle can be chosen and bicortical anteromedial screw fixation can be easily and safely performed.
- Published
- 2015
131. Effects of Therapeutic Hypothermia on Apoptosis and Autophagy After Spinal Cord Injury in Rats
- Author
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Jun-Yeong Seo, Jang-Woon Kim, Kee-Yong Ha, Young Hoon Kim, and Shin-Il Kim
- Subjects
Male ,Time Factors ,Blotting, Western ,Apoptosis ,Pharmacology ,Motor Activity ,Neuroprotection ,Rats, Sprague-Dawley ,Microscopy, Electron, Transmission ,Hypothermia, Induced ,medicine ,Autophagy ,Animals ,Orthopedics and Sports Medicine ,Methylprednisolone Hemisuccinate ,Spinal cord injury ,Spinal Cord Injuries ,Behavior, Animal ,business.industry ,Hypothermia ,medicine.disease ,Spinal cord ,Immunohistochemistry ,Blot ,Disease Models, Animal ,medicine.anatomical_structure ,Neuroprotective Agents ,Spinal Cord ,Cytoprotection ,Anesthesia ,Thoracic vertebrae ,Neurology (clinical) ,medicine.symptom ,business ,Apoptosis Regulatory Proteins - Abstract
Study design Animal study. Objective To further investigate the effects of therapeutic hypothermia (TH), the present study compared autophagy and apoptosis after treatment with either therapeutic moderate systemic hypothermia or methylprednisolone sodium succinate (MP) in a rat model of acute spinal cord injury (SCI). Summary of background data The neuroprotective effects of TH have recently become an important topic in the field of SCI research. Methods All rats were subjected to a 25-g/cm spinal cord contusion over the ninth thoracic vertebrae. After the induction of SCI, the control group did not receive any further treatment, TH group immediately received moderate systemic hypothermia for 4 hours, and MP group was administered high-dose MP. The rats were killed either 2 or 7 days after SCI, and the injured spinal cord tissues were obtained. Apoptosis and autophagy were assessed by immunohistochemical analyses and Western blot analyses. In addition, the microarchitecture of the autophagosomes was evaluated using transmission electron microscopy, and the motor activity of the rats was assessed using the Basso-Beattie-Bresnahan (BBB) locomotor rating scale. Results Compared with controls, there was a significant reduction in the expression levels of cleaved caspase-8, -9, and -3 in the TH- and MP-treated groups 2 days after SCI. Moreover, compared with the control group, the expression of LC3II and Beclin-1 exhibited a significant decrease on day 2 after treatment with TH. The numbers of transferase dUTP nicked-end labeling and LC3-positive cells were significantly lower on days 2 and 7. The Basso-Beattie-Bresnahan ratings were significantly higher 6 weeks after SCI in both the TH- and MP-treated groups than in the control group. Conclusion Both TH and MP have neuroprotective effects on injured spinal cord tissues via the inhibition of apoptosis and autophagy. Thus, the application of moderate systemic hypothermia may be a useful treatment modality after acute SCI. Level of evidence N/A.
- Published
- 2015
132. Percutaneous vertebroplasty for vertebral compression fractures with and without intravertebral clefts
- Author
-
J.-S. Chon, K.-W. Kim, Jongmin Lee, and Kee-Yong Ha
- Subjects
Male ,medicine.medical_specialty ,Visual analogue scale ,medicine.medical_treatment ,Kyphosis ,Vertebral vein ,Dentistry ,Percutaneous vertebroplasty ,Disability Evaluation ,Postoperative Complications ,Fractures, Compression ,medicine ,Humans ,Orthopedics and Sports Medicine ,Arthroplasty, Replacement ,Bone Resorption ,Aged ,Pain Measurement ,Analysis of Variance ,business.industry ,Bone Cements ,Middle Aged ,medicine.disease ,Spine ,Surgery ,Vertebra ,Oswestry Disability Index ,Resorption ,Radiography ,Treatment Outcome ,medicine.anatomical_structure ,Orthopedic surgery ,Osteoporosis ,Spinal Fractures ,Female ,business - Abstract
We present the clinical and radiological results of percutaneous vertebroplasty in the treatment of 58 vertebral compression fractures in 51 patients at a minimum follow-up of two years. Group 1 consisted of 39 patients, in whom there was no associated intravertebral cleft, whilst group 2 comprised 12 patients with an intravertebral cleft. The Oswestry disability index (ODI) and visual analogue scale (VAS) scores were recorded prospectively. The radiological evidence of kyphotic deformity, vertebral height, leakage of cement and bone resorption around the cement were studied restrospectively, both before and after operation and at the final follow-up. The ODI and VAS scores in both groups decreased after treatment, but the mean score in group 2 was higher than that in group 1 (p = 0.02 (ODI), p = 0.02 (VAS)). There was a greater initial correction of the kyphosis in group 2 than in group 1, although the difference was not statistically significant. However, loss of correction was greater in group 2. Leakage of cement was seen in 24 (41.4%) of 58 vertebrae (group 1, 32.6% (15 of 46); group 2, 75% (9 of 12)), mainly of type B through the basal vertebral vein in group 1 and of type C through the cortical defect in group 2. Resorption of bone around the cement was seen in three vertebrae in group 2 and in one in group 1. There were seven adjacent vertebral fractures in group 1 and one in group 2. Percutaneous vertebroplasty is an effective treatment for osteoporotic compression fractures with or without an intravertebral cleft. Nonetheless, higher rates of complications related to the cement must be recognised in patients in the presence of an intravertebral cleft.
- Published
- 2006
133. The Expression of Hypoxia Inducible Factor-1α and Apoptosis in Herniated Discs
- Author
-
Chang Whan Han, Gil-Son Khang, Yun-Kyoung Cho, In-Jun Koh, Young-Yul Kim, Kee-Yong Ha, and Papni Arjandas Kirpalani
- Subjects
Adult ,Male ,Pathology ,medicine.medical_specialty ,Apoptosis ,In Vitro Techniques ,Lumbar ,medicine ,Humans ,Orthopedics and Sports Medicine ,Intervertebral Disc ,Lumbar Vertebrae ,business.industry ,Intervertebral disc ,Middle Aged ,Hypoxia-Inducible Factor 1, alpha Subunit ,Immunohistochemistry ,Resorption ,medicine.anatomical_structure ,Terminal deoxynucleotidyl transferase ,Hypoxia-inducible factors ,Intervertebral Disc Displacement ,Female ,Neurology (clinical) ,business - Abstract
STUDY DESIGN: Human intervertebral disc was obtained for the study of hypoxia inducible factor (HIF)-1alpha and apoptosis using immunohistochemical staining. OBJECTIVE: To study the expression of HIF-1alpha and apoptosis in herniated lumbar discs. SUMMARY OF BACKGROUND DATA: The presence of HIF-1alpha in human chondrocytes and rat intervertebral discs has been proven; however, to our knowledge, its expression in human intervertebral disc cells has not been reported. Apoptosis of the human intervertebral disc appears as a degenerative change caused by the aging of the intervertebral disc. To our knowledge, there is no reported study showing the correlation between apoptosis and HIF-1alpha in the human intervertebral disc. METHODS: There were 15 human intervertebral discs stained for HIF-1alpha immunohistochemically, and apoptosis was detected using the terminal deoxynucleotidyl transferase mediated-dUTP nick end labeling method. On average, the patients were 32.9 years old. The intervertebral discs were divided into noncontained (9 patients) and contained (6) groups. For the control group, 5 disc samples were used. RESULTS: The expression of HIF-1alpha was visualized in every case, with an average of 62.2% +/- 9.5% in the noncontained group, 30.5% +/- 3.6% in the contained group, and 11.4% +/- 9.3% in the control group. Apoptosis occurred in 74.3% +/- 7.3% of the cells in the noncontained group, 42.8% +/- 5.5% of the cells in the contained group, and 28% +/- 8.4% of the cells in the control group. HIF-1alpha and apoptosis expressions were both observed more frequently in the noncontained disc herniation group (P < 0.001). The correlation analysis between the degree of HIF-1alpha expression and apoptosis was also statistically significant. CONCLUSIONS: HIF-1alpha and apoptosis physiologically occur in human beings. Their expression was the highest in the noncontained group. HIF-1alpha may play a crucial role for the survival of disc cells and resorption of the herniated disc in human intervertebral discs.
- Published
- 2006
134. Lumbar Disc Herniation Within Solid Fused Segments After Removal of Pedicle Screws.
- Author
-
Kee-Yong Ha, Young-Hoon Kim, Hyung-Youl Park, Hyung-Ki Min, and Sang-Il Kim
- Subjects
- *
INTERVERTEBRAL disk hernias , *HERNIA , *SCREWS , *INTERVERTEBRAL disk , *MAGNETIC resonance imaging , *INTERVERTEBRAL disk prostheses , *DISCECTOMY , *LEG pain - Abstract
Case: A 73-year-old man with instrumented fusion of L3-4-5 underwent the removal of previous pedicle screws and posterior instrumented fusion of L1-2-3. The solid dorsal fusion mass of L3-5 was identified intraoperatively and preoperatively. At 3 years after the second surgery, he presented with abrupt radiating pain in the left leg. Plain radiographs showed a collapse of the intervertebral disc space, and magnetic resonance imaging showed disc herniation of L3-4. Conclusions: Disc herniation even insolid fused segments may occur. Removal of pedicle screws and cranial extension of interbody fusion may increase the intradiscal stress associated with physiologic cantilever motion of the disc. [ABSTRACT FROM AUTHOR]
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- 2019
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135. Clinical Characteristics and Outcomes of Patients with Culture-Negative Pyogenic Spondylitis according to Empiric Glycopeptide Use.
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Yong Dae Lee, Yoon Hee Jeon, Young-Hoon Kim, Kee-Yong Ha, Jung-Woo Hur, Kyeong-Sik Ryu, Jin-Sung Kim, and Youn Jeong Kim
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GLYCOPEPTIDE antibiotics ,SPONDYLITIS ,INTRAVENOUS therapy ,C-reactive protein - Abstract
Background The optimal choice of antibiotics is challenging in culture-negative pyogenic spondylitis (PS). The empiric use of glycopeptides is suggested depending on various risk factors, although clinical data are sparse. This study aimed to analyze the clinical characteristics and outcomes of patients with culture-negative PS and evaluate the effect of empiric glycopeptide use on clinical outcomes in these patients. Materials and Methods : Data on the characteristics, treatment, and outcomes of 175 patients diagnosed with PS were retrospectively obtained from the electronic database of a tertiary referral hospital from 2009 to 2016. Patients with negative culture results were grouped by the duration of glycopeptide treatment: glycopeptide therapy <28 days (Group A) and glycopeptide therapy >28 days (Group B). Results: Of 89 patients with negative culture results, 78 were included in the analysis (Group A, n = 66; Group B, n = 12). The mean age of patients with negative culture results was 65.5 years, and 52.6% were male. The median follow-up duration was 573 (interquartile range [IQR], 83-1,037) days. The duration of intravenous glycopeptide therapy was 0.0 (IQR, 0.0 - 0.0) days and 55.5 (IQR, 37.0 - 75.7) days for Groups A and B, respectively. Patients who used glycopeptide longer empirically (Group B) had more commonly undergone a previous spinal procedure, including surgery (P= 0.024). The length of hospitalization, erythrocyte sedimentation rate, and C-reactive protein level were significantly higher in Group B compared with those in Group A (P <0.001, P <0.001, and P= 0.006, respectively). Regarding treatment modalities, patients in Group B underwent surgery more frequently (P= 0.017). The duration of parenteral antibiotic treatment was longer in Group B {P <0.001). Recurrence was noted in 7 patients (9.0%), and the recurrence rate was not significantly different between the 2 groups (Group A, 5/66 [7.6%]; Group B, 2/12 [16.7%]; P= 0.293). Conclusiot The recurrence rate among patients with culture-negative PS was not different based on the duration of empiric glycopeptide use. However, considering the small sample size and heterogeneity of our study population, we suggest that it is reasonable to administer glycopeptide antibiotics in these patients depending on clinical risk factors. Further large-scale prospective studies are needed to obtain more evidence for appropriate antibiotic treatment. [ABSTRACT FROM AUTHOR]
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- 2019
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136. Clinical Significance of Preoperative Embolization for Non-Hypervascular Metastatic Spine Tumors.
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Sung-Lim Yoo, Young-Hoon Kim, Hyung-Youl Park, Sang-Il Kim, Kee-Yong Ha, Hyung-Ki Min, Jun-Yeong Seo, In-Soo Oh, Dong-Gune Chang, Joo-Hyun Ahn, and Yong-Woo Kim
- Subjects
SPINAL cord tumors ,BLOOD loss estimation ,THYROID cancer ,SPINAL surgery ,CELL tumors ,SPINE - Abstract
Objective: The efficacy of preoperative embolization for hypervascular metastatic spine disease (MSD) such as renal cell and thyroid cancers has been reported. However, the debate on the efficacy of preoperative embolization for non-hypervascular MSD still remains unsettled. The purpose of this study is to determine whether preoperative embolization for non-hypervascular MSD decreases perioperative blood loss. Methods: A total of 79 patients (36 cases of preoperative embolization and 43 cases of non-embolization) who underwent surgery for metastatic spine lesions were included. Representative hypervascular tumors such as renal cell and thyroid cancers were excluded. Intraoperative and perioperative estimated blood losses (EBL), total number of transfusion and calibrated EBL were recorded in the embolization and non-embolization groups. The differences in EBL were also compared along with the type of surgery. In addition, the incidence of Adamkiewicz artery and complications of embolization were assessed. Results: The average age of 50 males and 29 females was 57.6±13.5 years. Lung (30), hepatocellular (14), gastrointestinal (nine) and others (26) were the primary cancers. The demographic data was not significantly different between the embolization and the non-embolization groups. There were no significant differences in intraoperative EBL, perioperative EBL, total transfusion and calibrated EBL between two groups. However, intraoperative EBL and total transfusion in patients with preoperative embolization were significantly lower than in non-embolization in the corpectomy group (1645.5 vs. 892.6 mL, p=0.017 for intraoperative EBL and 6.1 vs. 3.9, p=0.018 for number of transfusion). In addition, the presence of Adamkiewicz artery at the index level was noted in two patients. Disruption of this major feeder artery resulted in significant changes in intraoperative neuromonitoring. Conclusion: Preoperative embolization for non-hypervascular MSD did not reduce perioperative blood loss. However, the embolization significantly reduced intraoperative bleeding and total transfusion in corpectomy group. Moreover, the procedure provided insights into the anatomy of tumor and spinal cord vasculature. [ABSTRACT FROM AUTHOR]
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- 2019
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137. Discogenic lumbar pain: association with MR imaging and CT discography
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Kee-Yong Ha, Chun-Kun Park, Byung Chul Son, Donghyun Kim, Won-Hee Jee, and Chae-Hun Lim
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Adult ,Male ,medicine.medical_specialty ,Discography ,Lumbar vertebrae ,Lumbar ,Back pain ,medicine ,Humans ,Radiology, Nuclear Medicine and imaging ,Intervertebral Disc ,Retrospective Studies ,Chi-Square Distribution ,Lumbar Vertebrae ,medicine.diagnostic_test ,business.industry ,Magnetic resonance imaging ,General Medicine ,Middle Aged ,Magnetic Resonance Imaging ,Mr imaging ,Low back pain ,Intervertebral disk ,medicine.anatomical_structure ,Female ,Radiology ,medicine.symptom ,Tomography, X-Ray Computed ,business ,Low Back Pain - Abstract
To correlate MR and CT discography findings with pain response at provocative discography in patients with discogenic back pain.Forty-seven patients aged 25-54 years who underwent MR imaging and subsequent CT discography (97 discs) were included in this study. MR images were retrospectively evaluated regarding disc degeneration, endplate abnormalities, facet joint osteoarthritis, and high intensity zone. During discography concordant pain was regarded as positive, whereas discordant pain and no pain were regarded as negative. MR and CT discographic findings were analyzed on the base of concordant pain using the Chi-square test.: Concordant pain was significantly common in the following (P0.05): grade 4 or 5 disc degeneration [88% (30/34) in concordant pain versus 48% (30/63) in discordant pain and no pain], high intensity zone [56% (19/34) versus 30% (19/63)], combination of above two findings [53% (18/34) versus 25% (16/63)], fissured and ruptured disc at discogram [94% (32/34) versus 57% (36/63)], and contrast beyond inner annulus at CT discogram [97% (33/34) versus 57% (36/63)].Typical MR findings with concordant pain at discography include grade 4 or 5 disc degeneration and presence of a high intensity zone. Typical CT discography findings with concordant pain were fissured/ruptured discs and contrast extending into/beyond the outer annulus on CT.
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- 2005
138. An Autocrine or Paracrine Fas-Mediated Counterattack
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Young-Kyun Woo, Jong-Beom Park, Kee-Yong Ha, Howard S. An, Yong Sik Kim, Ki-Won Kim, and Won-Sang Park
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Aging ,Pathology ,medicine.medical_specialty ,Programmed cell death ,Notochord ,Apoptosis ,Caspase 3 ,Caspase 8 ,Fas ligand ,Immunoenzyme Techniques ,Paracrine signalling ,Paracrine Communication ,In Situ Nick-End Labeling ,medicine ,Animals ,Orthopedics and Sports Medicine ,fas Receptor ,Rats, Wistar ,Intervertebral Disc ,Autocrine signalling ,Caspase ,Lumbar Vertebrae ,biology ,Rats ,Cell biology ,Autocrine Communication ,embryonic structures ,biology.protein ,Neurology (clinical) - Abstract
STUDY DESIGN Immunohistochemistry and in situ nick end-labeling (TUNEL) were performed in rat lumbar intervertebral discs. OBJECTIVES To demonstrate the mechanism of notochordal cell death in the nucleus pulposus (NP). SUMMARY OF BACKGROUND DATA With age, notochordal cells gradually disappear in the NP. We hypothesized that this phenomenon might be related to Fas-mediated apoptosis. MATERIALS AND METHODS Expressions of Fas; Fas ligand (FasL); caspase 3, 8, 9, 10; Ki-67 protein; and TUNEL were examined in 4-week-, 6-month- and 12-month-old rat NPs. Apoptosis (TUNEL-positive) and proliferation potential (Ki-67-positive) indexes of notochordal cells were calculated and compared among age groups. RESULTS Notochordal cells constitutively expressed both Fas and FasL. Among their downstream initiator (caspase 8, 9, and 10) and executioner (caspase 3) caspases tested, caspase 9 and 3 were expressed. Proliferation potential of the notochordal cells was the highest at 4 weeks (1.96 +/- 1.3%) and decreased to a significantly lower level at 6 (0.81 +/- 0.68%) and 12 months (0.8 +/- 0.37%; P = 0.03 and 0.01, respectively). In contrast, apoptosis of the notochordal cells was the lowest at 4 weeks (3.52 +/- 1.07%) and increased to a significantly higher level at 6 (19.38 +/- 10.99%) and 12 months (21.51 +/- 16.99%; P < 0.001 in both comparisons). CONCLUSIONS Fas-mediated mitochondrial caspase 9 pathway is constitutively present in the rat notochordal cells. The constitutive expression of Fas, FasL and its downstream caspases, as well as the homogeneity ofnotochordal cell population suggests an autocrine or paracrine Fas-mediated counterattack to be a potential mechanism for apoptosis of rat notochordal cells. A regulated negative balance of notochordal cell proliferation against apoptosis is likely to involve the disappearance of notochordal cells in the rat NP. This information on the mechanism for apoptosis of notochordal cells could be important in the investigation of intervertebral disc development as well as aging and perhaps degeneration.
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- 2005
139. Expressions of Membrane-Type I Matrix Metalloproteinase, Ki-67 Protein, and Type II Collagen by Chondrocytes Migrating from Cartilage Endplate into Nucleus Pulposus in Rat Intervertebral Discs
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Ha-Na Chung, Ki-Won Kim, Young-Kyun Woo, Jong-Beom Park, Howard S. An, and Kee-Yong Ha
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musculoskeletal diseases ,Pathology ,medicine.medical_specialty ,Type II collagen ,Cartilage metabolism ,Organ culture ,Chondrocyte ,Immunoenzyme Techniques ,Chondrocytes ,Organ Culture Techniques ,Cell Movement ,medicine ,Animals ,Orthopedics and Sports Medicine ,Growth Plate ,Intervertebral Disc ,Collagen Type II ,Hyaline ,Metalloproteinase ,Lumbar Vertebrae ,business.industry ,Cartilage ,Intervertebral disc ,musculoskeletal system ,Rats ,Ki-67 Antigen ,medicine.anatomical_structure ,Fluorescent Antibody Technique, Direct ,Neurology (clinical) ,Matrix Metalloproteinase 1 ,business - Abstract
Immunohistochemistry was performed in organ-cultured intact and cartilage endplate (CE)-fractured rat intervertebral discs (IVDs).To demonstrate biologic events associated with migration of chondrocytes from hyaline CE into nucleus pulposus (NP).It was recently revealed that the transition from a notochordal NP to a fibrocartilaginous NP in the rabbit IVD is accomplished exogenously by chondrocytes migrating from CEs into the NP. This observation has not been studied in other animal models, and the biologic events associated with chondrocyte migration have not been elucidated in the literature.IVDs including cranial and caudal CEs were obtained from 4-week, 6-month, 12-month, and 18-month old Wistar rats. To accelerate chondrocyte migration, CEs of IVDs were fractured and cultured for 48 hours. IVDs without CE-fracture were used as a control for each age group. Expressions of membrane-type I matrix metalloproteinase (MT1-MMP, as a marker for cell migration and extracellular matrix digestion) and Ki-67 protein (as a proliferation marker) and pericellular deposition of type II collagen (as a marker for fibrocartilaginous matrix) by the chondrocytes migrating from CE into NP were examined immunohistochemically.In the control groups, chondrocyte migration limited only along the periphery of the notochordal NP and no chondrocytes were inside the NP proper. However, all the IVDs in the CE-fracture groups showed direct and more extensive migration of chondrocytes from CEs into the NP proper. The migrating chondrocytes in both control and CE-fracture groups expressed MT1-MMP and Ki-67 protein and deposited type II collagen in the NP.This report demonstrates the chondrocyte migration from CE into NP in the organ-cultured rat IVDs. This phenomenon is accelerated in the presence of CE fracture. The chondrocytes migrating from CEs into the NP expressed MT1-MMP and Ki-67 protein and deposited type II collagen. These biologic strategies probably enable chondrocytes of the hyaline CE to migrate into the ectopic NP region, replace notochordal cells, and change the notochordal tissue into fibrocartilage. These results suggest that similar biologic mechanisms may be involved in the natural transition from the notochordal NP to the fibrocartilaginous NP in other animal models, including human.
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- 2005
140. Expression of Estrogen Receptor of the Facet Joints in Degenerative Spondylolisthesis
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Cheong-Ho Chang, Youn-Soo Kim, Kie-Ho Na, Jun-Seok Lee, Kee-Yong Ha, and Ki-Won Kim
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Adult ,Cartilage, Articular ,musculoskeletal diseases ,Pathology ,medicine.medical_specialty ,Spinal stenosis ,Estrogen receptor ,Articular cartilage ,Statistics, Nonparametric ,Zygapophyseal Joint ,Facet joint ,Central nervous system disease ,Humans ,Medicine ,Orthopedics and Sports Medicine ,Lumbar Vertebrae ,business.industry ,Middle Aged ,musculoskeletal system ,medicine.disease ,Degenerative spondylolisthesis ,Spondylolisthesis ,medicine.anatomical_structure ,Gene Expression Regulation ,Receptors, Estrogen ,Immunohistochemistry ,Female ,Neurology (clinical) ,business - Abstract
STUDY DESIGN Immunohistochemical study was done by harvesting articular cartilage of the facet joints during the decompressive surgery for spinal stenosis. OBJECTIVES To observe the expression of estrogen receptor on the articular cartilage of the facet joints in degenerative spondylolisthesis (DS) SUMMARY OF BACKGROUND DATA: Few attempts have been made to evaluate the effect of sex-hormone, although DS is more common in females than in males. METHODS After harvesting the articular cartilage of the facet joints in 17 DS and in 15 spinal stenosis (SS) patients, the expression of estrogen receptor and the severity of facet arthritis were observed by H-E and immunohistochemical staining, respectively. Measurements of both staining were made by using a semiquantitative analysis. RESULTS The significantly increased expression of estrogen receptor correlated with the severity of facet arthritis (r = 0.78, P < 0.05). There was a significantly increased expression of estrogen receptor of the facet joint in DS compared with SS (P < 0.01). The histologic-histochemical grading of cartilage lesion in DS was 12.4 (SEM, 0.6), which was significantly higher than in SS (P < 0.05). CONCLUSIONS These findings suggest that the higher expression of estrogen receptor might aggravate degenerative change of the facet articular cartilage and might also be considered one of the causative factors for DS in postmenopausal women.
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- 2005
141. Adherence and Biofilm Formation of Staphylococcus Epidermidis and Mycobacterium Tuberculosis on Various Spinal Implants
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Kee-Yong Ha, Seung-Joon Ryoo, and Yang-Guk Chung
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Microbiological Techniques ,Prosthesis-Related Infections ,Tuberculosis ,Micrococcaceae ,medicine.drug_class ,Antibiotics ,In Vitro Techniques ,Bacterial Adhesion ,Microbiology ,Mycobacterium tuberculosis ,Staphylococcus epidermidis ,Alloys ,medicine ,Orthopedics and Sports Medicine ,Titanium ,biology ,business.industry ,Biofilm ,Prostheses and Implants ,Staphylococcal Infections ,Stainless Steel ,medicine.disease ,biology.organism_classification ,Spinal Fusion ,Biofilms ,Microscopy, Electron, Scanning ,Tuberculosis, Spinal ,Neurology (clinical) ,Implant ,business ,Bacteria - Abstract
Study design Bacterial adherence and biofilm formation in implant-associated infection may vary depending on species of microorganisms and characteristics of implant surfaces. Objectives We evaluated the differences in adherence and biofilm formation between Staphylococcus epidermidis and Mycobacterium tuberculosis on various spinal implant surfaces. Summary of background data In implant-associated infections, bacteria in biofilm are resistant to antibiotics or host defense mechanism. The removal of implants is usually necessary to eradicate infection. On the contrary, in tuberculous infection, complete debridement and antituberculous chemotherapy without removal of implant have been regarded as a safe procedure. Methods S. epidermidis and M. tuberculosis were cultured with 4 types of metal segments, smooth or rough-surfaced stainless steel, and titanium alloy, respectively. After isolation of colonized microorganisms and biofilm with trypsin treatment and culture on plate media, colony-forming units were counted. The features of adherence and biofilm formation were observed under scanning electron microscopy. Results Biofilm-forming S. epidermidis showed heavy adhesion and multiplication on the surface of all 4 metal segments, 16.5 times more colony-forming units than nonbiofilm-forming ones. On scanning electron microscopy, there were many aggregated microcolonies with thick biofilm in biofilm-forming S. epidermidis but much less in nonbiofilm-forming S. epidermidis. M. tuberculosis were rarely adhered to metal surfaces and showed scanty biofilm formation. Conclusions On the contrary to S. epidermidis, adherence and biofilm formation of M. tuberculosis on implant surface are less likely, and it can provide the basis of successful instrumentation in spine tuberculosis.
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- 2005
142. Discrimination of Metastatic from Acute Osteoporotic Compression Spinal Fractures with MR Imaging1
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Thomas R. McCauley, Won-Hee Jee, Kee-Yong Ha, Hee-Sun Jung, and Kyu-Ho Choi
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medicine.medical_specialty ,medicine.diagnostic_test ,business.industry ,Osteoporosis ,Fat suppression ,Magnetic resonance imaging ,Lumbar vertebrae ,medicine.disease ,Compression (physics) ,Mr imaging ,medicine.anatomical_structure ,Thoracic vertebrae ,medicine ,Radiology, Nuclear Medicine and imaging ,Radiology ,Differential diagnosis ,business - Abstract
A study was performed to determine which magnetic resonance (MR) imaging findings are useful in discrimination between metastatic compression fractures and acute osteoporotic compression fractures of the spine. The MR imaging findings in 27 patients with metastatic compression fractures and 55 patients with acute osteoporotic compression fractures were compared by using the chi(2) test. MR imaging findings suggestive of metastatic compression fractures were as follows: a convex posterior border of the vertebral body, abnormal signal intensity of the pedicle or posterior element, an epidural mass, an encasing epidural mass, a focal paraspinal mass, and other spinal metastases. MR imaging findings suggestive of acute osteoporotic compression fractures were as follows: a low-signal-intensity band on T1- and T2-weighted images, spared normal bone marrow signal intensity of the vertebral body, retropulsion of a posterior bone fragment, and multiple compression fractures. The signal intensity on fast spin-echo T2-weighted images obtained without fat suppression played little role in distinguishing between metastatic compression fractures and acute osteoporotic compression fractures.
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- 2003
143. Risk factors for adjacent segment degeneration after iliac screw fixation in lumbar degenerative kyphoscoliosis
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In-Soo Oh, Sang Il Kim, Dongwhan Suh, and Kee-Yong Ha
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Male ,Pelvic tilt ,medicine.medical_specialty ,Kyphosis ,Intervertebral Disc Degeneration ,Scoliosis ,Lumbar vertebrae ,03 medical and health sciences ,0302 clinical medicine ,Lumbar ,lcsh:Orthopedic surgery ,Pedicle Screws ,Risk Factors ,medicine ,Deformity ,Humans ,Kyphoscoliosis ,Aged ,Retrospective Studies ,Aged, 80 and over ,030222 orthopedics ,Lumbar Vertebrae ,business.industry ,Middle Aged ,medicine.disease ,Sagittal plane ,Surgery ,lcsh:RD701-811 ,Spinal Fusion ,medicine.anatomical_structure ,Female ,medicine.symptom ,business ,030217 neurology & neurosurgery - Abstract
Purpose: To analyze pre- and postoperative spinopelvic parameters and sagittal profiles in lumbar degenerative kyphoscoliosis (LDK) patients who underwent surgery using iliac screw (IS) and the incidence and risk factor of radiological adjacent segment degeneration (ASD). Methods: A total of 32 patients, who had undergone surgical correction and lumbar/thoracolumbar fusion with pedicle screws and IS instrumentation for LDK with a minimum 2-year follow-up, were included. Ten cases with ASD (group 1) and 22 cases without ASD (group 2) were compared to see pre- and postoperative change in sagittal view of spine and adjacent segment. Parameters of both groups were analyzed before and after surgery with each parameters being tested on correlativity. All deformity types of patients were classified using Scoliosis Research Society (SRS)-Schwab classification. Risk factors of ASD were evaluated using variables of SRS-Schwab classification. Results: Group 1, rather than group 2, showed significant increment in pelvic incidence (PI). Curve types, classified using SRS-Schwab classification, were all corrected using IS; and after correction, coronal curve type was N curve and PI minus lumbar lordosis (LL) and pelvic tilt showed tendency to decrease. Cases with preoperative sagittal vertical axis (SVA) more than 10 cm and with postoperative PI minus LL more than 20° were at higher risk of developing ASD. Conclusion: For those with high PI, it might be a risk to cause ASD. Maintaining normal thoracic and lumbar angle, correction of SVA less than 4 cm, and PI minus LL below 20° are proper ways to avoid ASD after surgery.
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- 2017
144. Surfer's Myelopathy: A Case Report
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Dong-Ho Kwak, Joo-Hyun Ahn, Young Hoon Kim, Kee-Yong Ha, Hyung-Youl Park, and Sang Il Kim
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03 medical and health sciences ,medicine.medical_specialty ,0302 clinical medicine ,Surfer's myelopathy ,business.industry ,General surgery ,medicine ,business ,030217 neurology & neurosurgery ,030218 nuclear medicine & medical imaging - Published
- 2017
145. Diagnosis of Nerve Root Compromise of the Lumbar Spine: Evaluation of the Performance of Three-dimensional Isotropic T2-weighted Turbo Spin-Echo SPACE Sequence at 3T
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Kee-Yong Ha, Young Hoon Kim, Jin-Sung Kim, Jinkyeong Sung, Jinhee Jang, Joon-Yong Jung, and Won-Hee Jee
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Adult ,Male ,Nerve root ,Contrast Media ,Constriction, Pathologic ,Lumbar vertebrae ,030218 nuclear medicine & medical imaging ,Young Adult ,03 medical and health sciences ,Imaging, Three-Dimensional ,0302 clinical medicine ,Flip angle ,Diagnosis ,Image Interpretation, Computer-Assisted ,medicine ,Nerve root compromise ,Humans ,Radiology, Nuclear Medicine and imaging ,Aged ,Lumbar Vertebrae ,Receiver operating characteristic ,medicine.diagnostic_test ,business.industry ,Musculoskeletal Imaging ,Magnetic resonance imaging ,Anatomy ,Isotropic ,Middle Aged ,Magnetic Resonance Imaging ,Sagittal plane ,Lateral recess ,Lumbar spine ,medicine.anatomical_structure ,Sampling perfection with application optimized contrasts using different flip angle evolution (SPACE) ,ROC Curve ,Area Under Curve ,Intervertebral Disc Displacement ,Original Article ,Female ,Nuclear medicine ,business ,030217 neurology & neurosurgery - Abstract
Objective To explore the performance of three-dimensional (3D) isotropic T2-weighted turbo spin-echo (TSE) sampling perfection with application optimized contrasts using different flip angle evolution (SPACE) sequence on a 3T system, for the evaluation of nerve root compromise by disc herniation or stenosis from central to extraforaminal location of the lumbar spine, when used alone or in combination with conventional two-dimensional (2D) TSE sequence. Materials and methods Thirty-seven patients who had undergone 3T spine MRI including 2D and 3D sequences, and had subsequent spine surgery for nerve root compromise at a total of 39 nerve levels, were analyzed. A total of 78 nerve roots (48 symptomatic and 30 asymptomatic sites) were graded (0 to 3) using different MRI sets of 2D, 3D (axial plus sagittal), 3D (all planes), and combination of 2D and 3D sequences, with respect to the nerve root compromise caused by posterior disc herniations, lateral recess stenoses, neural foraminal stenoses, or extraforaminal disc herniations; grading was done independently by two readers. Diagnostic performance was compared between different imaging sets using the receiver operating characteristics (ROC) curve analysis. Results There were no statistically significant differences (p = 0.203 to > 0.999) in the ROC curve area between the imaging sets for both readers 1 and 2, except for combined 2D and 3D (0.843) vs. 2D (0.802) for reader 1 (p = 0.035), and combined 2D and 3D (0.820) vs. 3D including all planes (0.765) for reader 2 (p = 0.049). Conclusion The performance of 3D isotropic T2-weighted TSE sequence of the lumbar spine, whether axial plus sagittal images, or all planes of images, was not significantly different from that of 2D TSE sequences, for the evaluation of nerve root compromise of the lumbar spine. Combining 2D and 3D might possibly improve the diagnostic accuracy compared with either one.
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- 2017
146. Spinal Cord Injury and Related Clinical Trials
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Young Hoon Kim, Kee-Yong Ha, and Sang Il Kim
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0301 basic medicine ,medicine.medical_specialty ,Injury control ,Cell Transplantation ,Poison control ,Review Article ,Neuroregenerative ,Bioinformatics ,Pathophysiology ,Neuroprotection ,Cell therapy ,03 medical and health sciences ,0302 clinical medicine ,Cell transplantation ,Physical medicine and rehabilitation ,Hypothermia, Induced ,Spinal cord injuries ,Humans ,Medicine ,Orthopedics and Sports Medicine ,Spinal cord injury ,Myelin Sheath ,Clinical Trials as Topic ,business.industry ,Endogenous regeneration ,medicine.disease ,Axons ,Nerve Regeneration ,Clinical trial ,Neuroprotective Agents ,030104 developmental biology ,Spinal Cord ,Surgery ,business ,Neuroprotective ,030217 neurology & neurosurgery - Abstract
Spinal cord injury (SCI) has been considered an incurable condition and it often causes devastating sequelae. In terms of the pathophysiology of SCI, reducing secondary damage is the key to its treatment. Various researches and clinical trials have been performed, and some of them showed promising results; however, there is still no gold standard treatment with sufficient evidence. Two therapeutic concepts for SCI are neuroprotective and neuroregenerative strategies. The neuroprotective strategy modulates the pathomechanism of SCI. The purpose of neuroprotective treatment is to minimize secondary damage following direct injury. The aim of neuroregenerative treatment is to enhance the endogenous regeneration process and to alter the intrinsic barrier. With advancement in biotechnology, cell therapy using cell transplantation is currently under investigation. This review discusses the pathophysiology of SCI and introduces the therapeutic candidates that have been developed so far.
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- 2017
147. Case Report: Lower Extremity Sparganosis in a Bursa
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Kee-Yong Ha and In-Soo Oh
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Male ,Pathology ,medicine.medical_specialty ,animal structures ,genetic structures ,Sparganosis ,Treatment outcome ,Antitubercular Agents ,Helminthiasis ,Case Report ,Soft Tissue Neoplasms ,Parasitic infection ,Diagnosis, Differential ,Sparganum ,parasitic diseases ,Plerocercoid ,Isoniazid ,Animals ,Humans ,Medicine ,Orthopedics and Sports Medicine ,Aged ,Tibia ,biology ,business.industry ,fungi ,General Medicine ,Anatomy ,Bursa, Synovial ,biology.organism_classification ,medicine.disease ,Treatment Outcome ,Spirometra ,Drug Therapy, Combination ,Surgery ,Rifampin ,business ,human activities ,Ethambutol - Abstract
Sparganosis is a rare parasitic infection caused by the plerocercoid tapeworm larva of the genus Spirometra.We report the case of a 67-year-old man with a mass over the anteromedial surface of the proximal extremity of the tibia. We surgically excised a bursa containing Spirometra larvae.Sparganosis is a rare parasitic infection. We found no cases of lower extremity sparganosis combined with bursitis reported in the literature.Sparganosis should be considered in the differential diagnosis of soft tissue tumors, especially among patients who frequently have consumed mountain water or raw snakes or frogs.
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- 2011
148. How to improve shoulder balance in the surgical correction of double thoracic adolescent idiopathic scoliosis
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Dong-Gune Chang, Kee-Yong Ha, Se-Il Suk, Dong-Ju Lim, Jin-Hyok Kim, and Sung-Soo Kim
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Male ,Shoulder ,Shoulder surgery ,Adolescent ,Radiography ,medicine.medical_treatment ,Bone Screws ,Idiopathic scoliosis ,Thoracic Vertebrae ,Pedicle screw instrumentation ,Vertebral rotation ,medicine ,Humans ,Orthopedics and Sports Medicine ,Orthopedic Procedures ,Pedicle screw ,Child ,Postural Balance ,Balance (ability) ,Retrospective Studies ,business.industry ,Surgical correction ,Treatment Outcome ,Scoliosis ,Female ,Neurology (clinical) ,business ,Nuclear medicine ,Follow-Up Studies - Abstract
Study design A retrospective comparative study. Objective To evaluate the shoulder balance resulting from the correction of double thoracic adolescent idiopathic scoliosis (AIS) comparing rod derotation (RD) with direct vertebral rotation (DVR) and RD only after pedicle screw instrumentations. Summary of background data This is the first report on the effect of DVR on the shoulder balance using segmental pedicle screw instrumentation in the treatment of double thoracic AIS with minimum 5-year follow-up. Methods Patients with double thoracic AIS (n = 57) were treated by fusing both thoracic curves with RD and DVR (n=35), or RD (n=22) methods and retrospectively studied with a minimum 5 years of follow-up. Results In the RD with DVR group, the preoperative proximal thoracic curve of 40.2° improved to 17.9° postoperatively and 19.9° at the last follow-up. In the RD group, the preoperative proximal thoracic curve of 37.5° improved to 22.4° postoperatively and 23.2° at the last follow-up. In the RD with DVR group, the preoperative distal thoracic curve of 56.6° improved to 16.1° postoperatively and 16.7° at the last follow-up. In the RD group, the preoperative distal thoracic curve of 50.6° improved to 17.8° postoperatively and 18.2° at the last follow-up. In the RD with DVR group, the average preoperative shoulder height difference of 16.3 mm had improved to 7.2 mm postoperatively and was 7.0 mm at the last follow-up. In the RD group, the average preoperative shoulder height difference of 15.1 mm had changed to 7.5 mm postoperatively and was 7.3 mm at the last follow-up. Conclusion Shoulder balance had not significantly improved even with additional correction method of DVR using segmental pedicle screw instrumentation in double thoracic AIS. The proximal thoracic curve was rigid and corrected less in both groups. Therefore, less correction of the distal thoracic curve effectively achieves better shoulder balance. Level of evidence 3.
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- 2014
149. Is it real adjacent segment pathology by stress concentration after limited fusion in degenerative lumbar scoliosis?
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Young Hoon Kim, Joo-Hyun Ahn, and Kee-Yong Ha
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Adjacent segment ,Male ,medicine.medical_specialty ,Pathology ,Visual analogue scale ,Disability Evaluation ,Lumbar ,Statistical significance ,medicine ,Humans ,Orthopedics and Sports Medicine ,Aged ,Retrospective Studies ,Aged, 80 and over ,Lumbar Vertebrae ,business.industry ,Rasp ,Laminectomy ,Middle Aged ,Decompression, Surgical ,Surgery ,Oswestry Disability Index ,Spinal Fusion ,Treatment Outcome ,Scoliosis ,Radiological weapon ,Lumbar scoliosis ,Female ,Neurology (clinical) ,Stress, Mechanical ,business ,Low Back Pain - Abstract
STUDY DESIGN A retrospective comparative study. OBJECTIVE To investigate adjacent segment pathology (ASP) after limited lumbar fusion in the treatment of degenerative lumbar scoliosis (DLS). SUMMARY OF BACKGROUND DATA The assessment of appropriate surgical techniques for DLS remains one of the most controversial topics in spinal surgery. So far, there has been no study specifically addressing why ASP shows different patterns with respect to different fusion levels after instrumented lumbar fusion for DLS. METHODS Fifty-nine patients were enrolled and divided into 2 groups with respect to the proximal fusion level: group I consisted of 29 patients who underwent fusion below the proximal neutral vertebrae, and group II consisted of 30 patients who underwent fusion to the proximal neutral vertebrae. Clinical and radiological assessments were performed with an average of 59.4 months of follow-up. The number of radiological findings for ASP was determined on the basis of a 7-point scale that gave 1 point for each radiological finding. The 2 groups were analyzed according to radiological ASP (RASP). The Oswestry Disability Index and visual analogue scale scores were recorded prospectively. RESULTS Overall, RASP developed in 16 (27.1%) patients. In group I, 12 (41.4%) of 29 patients, and in group II, 4 (13.3%) of 30 patients showed RASP. Group I yielded an average of 4.5 points, and group II, 1.8 points. RASP scores were much higher in group I than in group II, with statistical significance (P = 0.000). In group I, 4 patients underwent revision surgery, but in group II, only 1 patient did so. CONCLUSION RASP displayed variance according to different fusion levels. RASP in group I showed similar patterns to the natural progression of DLS. It is suggested that fusion be included at least at the proximal neutral vertebrae to reduce RASP although RASP with different patterns is unavoidable. LEVEL OF EVIDENCE 4.
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- 2014
150. Differentiation of acute osteoporotic and malignant compression fractures of the spine: use of additive qualitative and quantitative axial diffusion-weighted MR imaging to conventional MR imaging at 3.0 T
- Author
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Young Hoon Kim, Won-Hee Jee, Maria Choi, Kee-Yong Ha, Joon-Yong Jung, Chun-Kun Park, So-Yeon Lee, and Jin Kyeong Sung
- Subjects
Adult ,Male ,medicine.medical_specialty ,Biopsy ,Diagnostic accuracy ,Axial diffusion ,Diagnosis, Differential ,Fractures, Compression ,Image Interpretation, Computer-Assisted ,Medicine ,Humans ,Radiology, Nuclear Medicine and imaging ,Aged ,Pain Measurement ,Retrospective Studies ,Aged, 80 and over ,Spinal Neoplasms ,business.industry ,Middle Aged ,Compression (physics) ,Mr imaging ,Magnetic Resonance Imaging ,Diffusion Magnetic Resonance Imaging ,Acute Disease ,Osteoporosis ,Spinal Fractures ,Female ,Radiology ,business - Abstract
To retrospectively determine the value of adding qualitative and quantitative axial diffusion-weighted (DW) imaging to standard spine magnetic resonance (MR) imaging to differentiate between acute osteoporotic and malignant compression fractures at 3.0 T.The institutional ethics committee approved this retrospective study and waived the requirement to obtain informed consent. The authors retrospectively analyzed 3.0-T MR images, including DW images (b values: 0, 800, and 1400 sec/mm(2)), in 62 patients with acute compression fractures. Three radiologists independently interpreted MR images for the presence of malignancy by using conventional MR images alone and in combination with axial DW images with qualitative and quantitative analysis. Apparent diffusion coefficients (ADCs) were measured within solid portion with careful use of a small region of interest (ROI). The Mann-Whitney U test was performed.There were 30 malignant and 32 acute osteoporotic compression fractures. At qualitative analysis, hyperintensity relative to spinal cord was more frequent in malignant compression fractures than in acute osteoporotic compression fractures (87% vs 22%, respectively; P.001). Median ADCs of malignant fractures were significantly lower than those of benign fractures (P.001). With conventional MR imaging alone, sensitivity, specificity, and accuracy were 100%, 94%, and 97%, respectively, for reader 1; 97%, 78%, and 87% for reader 2; and 100%, 84%, and 92% for reader 3. With conventional and DW MR imaging combined, sensitivity, specificity, and accuracy were 100%, 97%, and 98% for all three readers. The addition of DW imaging led to correct changes in diagnosis: Reader 1 improved by 1.6% (one of 62 fractures), reader 2 improved by 11% (seven of 62 fractures), and reader 3 improved by 6.5% (four of 62 fractures).The addition of axial DW imaging to a conventional MR imaging protocol improved diagnostic accuracy in the differentiation of acute osteoporotic from malignant compression fractures by measuring ADCs in the solid portion with careful use of a small ROI.
- Published
- 2014
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