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  • Author or Editor: Sang-Min Parkx
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The importance of thoracolumbar junctional orientation, change in thoracolumbar angle, and overcorrection of lumbar lordosis in development of proximal junctional kyphosis in adult spinal deformity surgery

Dae-Woong Ham, Ho-Joong Kim, Sang-Min Park, Se Jin Park, Jiwon Park, and Jin S. Yeom

OBJECTIVE

胸腰椎角的变化(TLA)解放军y a pivotal role in the reciprocal changes following spine realignment surgery, thereby leading to the development of proximal junctional kyphosis (PJK). This study aimed to investigate the association between TLA and the development of PJK following adult spinal deformity surgery.

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A total of 107 patients were divided into PJK+ and PJK− groups according to the development of PJK within 12 months after surgery. The TLA and spinopelvic radiological parameters were compared between the PJK+ and PJK− groups. A multivariate logistic regression model was used to identify the risk factors for PJK. The receiver operating characteristic curves of the regression models were used to investigate the cutoff values of significant parameters needed so that PJK would not occur.

RESULTS

The change in TLA (ΔTLA) in the PJK+ group was significantly larger than in the PJK− group (6.7° ± 7.9° and 2.2° ± 8.1°, respectively; p = 0.006). Multivariate logistic regression analysis demonstrated that age, postoperative pelvic incidence–lumbar lordosis, and ΔTLA were significant risk factors for PJK. The risk of developing PJK was higher when the postoperative pelvic incidence–lumbar lordosis was < 5.2 and the ΔTLA was > 3.58°.

CONCLUSIONS

The present study highlights the thinking that extensive correction of TLA and lumbar lordosis should be avoided in patients with adult spinal deformity. Overcorrection of TLA of > 3.58° could result in higher odds of PJK.

In开云手机版app下载安装最新版《神经urgery: Spine Volume 37: Issue 6 (Dec 2022)

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Minimally invasive anterior lumbar interbody fusion followed by percutaneous translaminar facet screw fixation in elderly patients

Clinical article

Sung Hun Park, Woo Min Park, Cheul Woong Park, Kwan Soo Kang, Young Keun Lee, and Sang Rak Lim

Object

The purpose of this study was to determine whether anterior lumbar interbody fusion (ALIF) followed by percutaneous translaminar facet screw fixation is effective in elderly patients with degenerative spinal disease.

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Twenty-nine patients > 60 years old who underwent ALIF with percutaneous translaminar facet screw fixation from January to June 2004 were studied. The radiological and clinical data of these patients were collected and analyzed. The mean follow-up period was 14.6 months (range 12–17 months).

Results

The mean preoperative, immediate postoperative, and 6- and 12-month postoperative posterior disc heights were 7.1, 11.6, 9.8, and 9.8 mm, respectively. Subsidences of posterior disc height > 20% developed in 9 patients (30%). The significant risk factor for subsidence was found to be 2-level operations (p = 0.023). The mean preoperative Oswestry Disability Index score and visual analog scale scores for the back and leg were 24.4, 6.6, and 7.5, respectively, and improved postoperatively to 14.2, 1.5, and 1.8, respectively.

Conclusions

Minimally invasive ALIF followed by percutaneous translaminar facet screw fixation was performed as a minimally invasive surgical technique in elderly patients. However, in certain circumstances such as multilevel operations or in patients with severe osteoporosis, significant cage subsidence can develop.

In开云手机版app下载安装最新版《神经urgery: Spine Volume 10: Issue 6 (Jun 2009)

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Posterolateral percutaneous endoscopic lumbar foraminotomy for L5—S1 foraminal or lateral exit zone stenosis

Technical note

Yong Ahn, Sang-Ho Lee, Woo-Min Park, and Ho-Yeon Lee

✓ The purpose of this study was to determine the efficacy and feasibility of posterolateral percutaneous endoscopic lumbar foraminotomy (PELF) for foraminal or lateral exit zone stenosis of the L5—S1 level in the awake patient.

Twelve consecutive patients with L5—S1 foraminal stenosis and associated leg pain underwent PELF between May 2001 and July 2002. Under fluoroscopic guidance, posterolateral endoscopic foraminal decompression was performed using a bone reamer, endoscopic forceps, and a laser. Using this new technique, the authors removed part of the hypertrophied superior facet, thickened ligamentum flavum, and protruded disc compressing the exiting (L-5) nerve root. Clinical outcome was measured using the Macnab criteria. The mean follow-up period was 12.9 months. All the patients were discharged within 24 hours. Satisfactory (excellent or good) results were demonstrated in 10 patients. There was no complication.

The PELF procedure provides a simple alternative for treating lumbar foraminal or lateral exit zone stenosis in selected cases. The authors found that the posterolateral endoscopic approach to the L5—S1 foramen was usually possible and that using a bone reamer to undercut the superior facet was effective.

In开云手机版app下载安装最新版《神经urgery: Spine Volume 99: Issue 3 (Oct 2003)

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Intravascular ultrasonography-guided stent angioplasty of an extracranial vertebral artery dissection

Case report

Won-Ki Yoon, Young-Woo Kim, Sang-Don Kim, Ik-Seong Park, Min-Woo Baik, and Seong-Rim Kim

The authors report on a case of intravascular ultrasonography (IVUS)-guided stent angioplasty for iatrogenic extracranial vertebral artery (VA) dissection in a 49-year-old man after coil embolization for an unruptured aneurysm of the right posterior inferior cerebellar artery. Insignificant dissections occurred during the procedure. Postoperatively, the patient experienced gradually worsening posterior neck pain and headache, and follow-up angiography 8 months after the coil embolization revealed expansion of the dissection. The patient underwent stent angioplasty with IVUS guidance and his symptoms improved.

To the authors' knowledge, this is the first report of IVUS-guided stent angioplasty of an extracranial VA dissection. It was safe and feasible to treat extracranial VA dissections with stent placement under IVUS guidance. Intravascular environments are in real time with IVUS, and this technique is useful in the confirmation of a true lumen and evaluation of appropriate stent apposition. More clinical experience with this technique is necessary and mandatory, and devices with smaller diameters with improved trackability are essential for further introduction of IVUS into the field of endovascular neurosurgery.

In开云手机版app下载安装最新版《神经urgery Volume 109: Issue 6 (Dec 2008)

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Stent fracture and restenosis after placement of a drug-eluting device in the vertebral artery origin and treatment with the stent-in-stent technique

Report of two cases

Seong-Rim Kim, Min-Woo Baik, Seung-Hoon Yoo, Ik-Seong Park, Sang-Don Kim, and Moon-Chan Kim

✓作者报告两例支架断裂nd restenosis after placement of a drug-eluting device in the vertebral artery (VA) origin, and describe management of restenosis with the stent-in-stent technique. Two women, one 62 and the other 67 years of age, underwent stent placement in the VA origin to treat symptomatic and angiographically significant stenosis in this vessel. Sirolimus-eluting coronary stents (Cypher) were used in both cases. Four months after placement of the devices, the symptoms recurred. Follow-up angiography performed 5 months after insertion of the devices revealed a transverse stent fracture with separation of the fragments and severe in-stent restenosis in both cases. The restenoses were treated with reinsertion of coronary stents (Cypher and Jostent FlexMaster) by using the stent-in-stent technique. After stent reinsertion, the patients exhibited relief of symptoms.

This paper is the first report of fracture in a drug-eluting stent and restenosis after stent placement in the VA origin. Restenosis caused by such a fracture can be managed successfully by performing the stent-in-stent maneuver. The physical properties of metallic devices, stent strut geometry, and anatomical peculiarities of the subclavian artery may be associated with stent fractures. Earlier follow-up angiography studies (within 6 months) are warranted.

In开云手机版app下载安装最新版《神经urgery Volume 106: Issue 5 (May 2007)

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Measurement of interspinous motion in dynamic cervical radiographs using a deep learning–based segmentation model

Dae-Woong Ham, Yang-seon Choi, Yisack Yoo, Sang-Min Park, and Kwang-Sup Song

OBJECTIVE

Interspinous motion (ISM) is a representative method for evaluating the functional fusion status following anterior cervical discectomy and fusion (ACDF) surgery, but the associated measuring difficulty and potential errors in the clinical setting remain concerns. The aim of this study was to investigate the feasibility of a deep learning–based segmentation model for measuring ISM in patients who underwent ACDF surgery.

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This study is a retrospective analysis of flexion-extension dynamic cervical radiographs from a single institution and a validation of a convolutional neural network (CNN)–based artificial intelligence (AI) algorithm for measuring ISM. Data from 150 lateral cervical radiographs from the normal adult population were used to train the AI algorithm. A total of 106 pairs of dynamic flexion-extension radiographs from patients who underwent ACDF at a single institution were analyzed and validated for measuring ISM. To evaluate the agreement power between human experts and the AI algorithm, the authors assessed the interrater reliability using the intraclass correlation coefficient and root mean square error (RMSE) and performed a Bland-Altman plot analysis. They processed 106 pairs of radiographs from ACDF patients into the AI algorithm for autosegmenting the spinous process created using 150 normal population radiographs. The algorithm automatically segmented the spinous process and converted it to a binary large object (BLOB) image. The rightmost coordinate value of each spinous process from the BLOB image was extracted, and the pixel distance between the upper and lower spinous process coordinate value was calculated. The AI-measured ISM was calculated by multiplying the pixel distance by the pixel spacing value included in the DICOM tag of each radiograph.

RESULTS

The AI algorithm showed a favorable prediction power for detecting spinous processes with an accuracy of 99.2% in the test set radiographs. The interrater reliability between the human and AI algorithm of ISM was 0.88 (95% CI 0.83–0.91), and its RMSE was 0.68. In the Bland-Altman plot analysis, the 95% limit of interrater differences ranged from 0.11 to 1.36 mm, and a few observations were outside the 95% limit. The mean difference between observers was 0.02 ± 0.68 mm.

CONCLUSIONS

This novel CNN-based autosegmentation algorithm for measuring ISM in dynamic cervical radiographs showed strong agreement power to expert human raters and could help clinicians to evaluate segmental motion following ACDF surgery in clinical settings.

In开云手机版app下载安装最新版《神经urgery: Spine Volume 39: Issue 3 (Sep 2023)

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Formal protocol for emergency treatment of ruptured intracranial aneurysms to reduce in-hospital rebleeding and improve clinical outcomes

Jaechan Park, Hyunjin Woo, Dong-Hun Kang, Yong-Sun Kim, Min Young Kim, Im Hee Shin, and Sang Gyu Kwak

OBJECT

而反复出血的发生率是highest within 24 hours of subarachnoid hemorrhage (SAH) and increases with the severity of the clinical grade, a recurrent hemorrhage can occur anytime after the initial SAH in patients with both good and poor clinical grades. Therefore, the authors adopted a 24-hour-a-day, formal protocol, emergency treatment strategy for patients with ruptured aneurysms to secure the aneurysms as early as possible. The incidences of in-hospital rebleeding and clinical outcomes were investigated and compared with those from previous years when broadly defined early treatment was used (< 3 days of SAH).

开云体育世界杯赔率

During an 11-year period, a total of 1224 patients with a ruptured aneurysm were managed using a strategy of broadly defined early treatment between 2001 and 2004 (Period B, n = 423), a mixture of early or emergency treatment between 2005 and 2007, and a formal emergency treatment protocol between 2008 and 2011 (Period A, n = 442). Propensity score matching was used to adjust the differences in age, sex, modified Fisher grade, World Federation of Neurosurgical Societies (WFNS) clinical grade at admission, size and location of a ruptured aneurysm, treatment modality (clip placement vs coil embolization), and time interval from SAH to admission between the two time periods. The matched cases were allotted to Group A (n = 280) in Period A and Group B (n = 296) in Period B and then compared.

RESULTS

During Period A under the formal emergency treatment protocol strategy, the catheter angiogram, endovascular coiling, and surgical clip placement were started at a median time from admission of 2.0 hours, 2.9 hours, and 3.1 hours, respectively. After propensity score matching, Group A showed a significantly reduced incidence of in-hospital rebleeding (2.1% vs 7.4%, p = 0.003) and a higher proportion of patients with a favorable clinical outcome (modified Rankin Scale score 0–3) at 1 month (87.9% vs 79.7%, respectively; p = 0.008). In particular, the patients with good WFNS grades in Group A experienced significantly less in-hospital rebleeding (1.7% vs 5.7%, respectively; p = 0.018) and better clinical outcomes (1-month mRS score of 0–3: 93.8% vs 87.7%, respectively; p = 0.021) than the patients with good WFNS grades in Group B.

CONCLUSIONS

Patients with ruptured aneurysms may benefit from a strategy of emergency application of surgical clip placement or endovascular coiling due to the reduced incidence of recurrent bleeding and improved clinical outcomes.

In开云手机版app下载安装最新版《神经urgery Volume 122 (2015): Issue 2 (Feb 2015)

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Computed tomography angiography, perfusion computed tomography, and a drug-eluting stent for the treatment of in-stent restenosis of the middle cerebral artery

Case report

Seong-Rim Kim, Seung-Hoon You, Won-Ki Yoon, Young-Woo Kim, Sang-Don Kim, Ik-Seong Park, and Min-Woo Baik

作者报告一例的支架内再狭窄(ISR) of the middle cerebral artery (MCA) following bare-metal stent (BMS) deployment and subsequent treatment using a drug-eluting stent (DES). This 65-year-old woman presented with frequent transient ischemic attacks. Initial studies revealed occlusion of the left internal carotid artery and severe stenosis of the right MCA with decreased cerebral perfusion in the bilateral MCA territories. Stent-assisted angioplasty of the right MCA was performed using a BMS, and satisfactory results were obtained with no complications. Six months after the procedure the patient presented with recurrent symptoms, and workups revealed ISR with decreased cerebral perfusion. A DES was successfully placed without complications. Follow-up studies at 3 and 8 months after retreatment showed sustained luminal integrity and cerebral perfusion. A combination of CT angiography and perfusion CT exhibited the anatomical results and hemodynamic status of the stenotic lesion, and these findings coincided with the patient's clinical symptoms and the results of conventional cerebral angiography.

In-stent restenosis of the MCA after placement of a BMS can be treated using a DES. A combination of CT angiography and perfusion CT can be an alternative to conventional angiography. Low-profile devices with an amelioration of trackability are essential for the further incorporation of the DES into the field of endovascular neurosurgery. More clinical experiences and long-term follow-ups are mandatory to evaluate the safety, efficacy, and durability of the DES.

In开云手机版app下载安装最新版《神经urgery Volume 112: Issue 4 (Apr 2010)

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辅酶Q效应10on spinal cord ischemia-reperfusion injury

Jin-Young Hwang, Seong-Won Min, Young-Tae Jeon, Jung-Won Hwang, Sang-Heon Park, Jin-Hee Kim, and Sung-Hee Han

OBJECT

Spinal cord ischemia remains a serious complication of thoracoabdominal aortic aneurysm surgery. Coenzyme Q10, a potent antioxidant, has been reported to exert a neuroprotective effect. In the present study, we evaluated the effect of coenzyme Q10pretreatment on spinal cord ischemia-reperfusion injury.

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Male Sprague-Dawley rats were treated with either 300 mg/kg coenzyme Q10(CoQ10group, n = 12) or saline (control and sham groups, n = 12 for each group) for 5 days before ischemia. Spinal cord ischemia was induced in the control and CoQ10组。神经功能评估using the Basso-Beattie-Bresnahan (BBB) motor rating scale until 7 days after reperfusion, and then the spinal cord was harvested for histopathological examinations and an evaluation of malondialdehyde level.

RESULTS

On post-reperfusion Day 1, the CoQ10group showed higher BBB scores compared with those in the control group, although the difference was not significant. However, on Day 2, the CoQ10group showed a significantly higher BBB score than the control group (14.0 [10.3–15.0] vs 8.0 [5.0–9.8], median [IQR], respectively; p = 0.021), and this trend was maintained until Day 7 (17.5 [16.0–18.0] vs 9.0 [6.5–12.8], respectively; p < 0.001). Compared with the control group, the CoQ10group had more normal motor neurons (p = 0.003), fewer apoptotic changes (p = 0.003) and a lower level of tissue malondialdehyde (p = 0.024).

CONCLUSIONS

Pretreatment with 300 mg/kg coenzyme Q10resulted in significantly improved neurological function and preservation of more normal motor neurons.

In开云手机版app下载安装最新版《神经urgery: Spine Volume 22 (2015): Issue 4 (Apr 2015)

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Development of an inside-out augmented reality technique for neurosurgical navigation

Yun-Sik Dho, Sang Joon Park, Haneul Choi, Youngdeok Kim, Hyeong Cheol Moon, Kyung Min Kim, Ho Kang, Eun Jung Lee, Min-Sung Kim, Jin Wook Kim, Yong Hwy Kim, Young Gyu Kim, and Chul-Kee Park

OBJECTIVE

With the advancement of 3D modeling techniques and visualization devices, augmented reality (AR)–based navigation (AR navigation) is being developed actively. The authors developed a pilot model of their newly developed inside-out tracking AR navigation system.

开云体育世界杯赔率

The inside-out AR navigation technique was developed based on the visual inertial odometry (VIO) algorithm. The Quick Response (QR) marker was created and used for the image feature–detection algorithm. Inside-out AR navigation works through the steps of visualization device recognition, marker recognition, AR implementation, and registration within the running environment. A virtual 3D patient model for AR rendering and a 3D-printed patient model for validating registration accuracy were created. Inside-out tracking was used for the registration. The registration accuracy was validated by using intuitive, visualization, and quantitative methods for identifying coordinates by matching errors. Fine-tuning and opacity-adjustment functions were developed.

RESULTS

ARKit-based inside-out AR navigation was developed. The fiducial marker of the AR model and those of the 3D-printed patient model were correctly overlapped at all locations without errors. The tumor and anatomical structures of AR navigation and the tumors and structures placed in the intracranial space of the 3D-printed patient model precisely overlapped. The registration accuracy was quantified using coordinates, and the average moving errors of the x-axis and y-axis were 0.52 ± 0.35 and 0.05 ± 0.16 mm, respectively. The gradients from the x-axis and y-axis were 0.35° and 1.02°, respectively. Application of the fine-tuning and opacity-adjustment functions was proven by the videos.

CONCLUSIONS

The authors developed a novel inside-out tracking–based AR navigation system and validated its registration accuracy. This technical system could be applied in the novel navigation system for patient-specific neurosurgery.

InNeurosurgical Focus Volume 51 (2021): Issue 2 (Aug 2021): Virtual and Augmented Reality

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