No abstract available.
Gait* ; Humans ; Spinal Cord Diseases*

OBJECTIVE: To evaluate the effects of the dilution volume of botulinum toxin A on spasticity of children with cerebral palsy. METHOD: Total 18 legs of 9 children with cerebral palsy were enrolled. 100 units of botulinum toxin were diluted with 4 cc or 2 cc of normal saline and injected to the medial and lateral heads of Gastrocnemius. Modified Ashworth scale, modified Tardieu test and range of motion (ROM) of ankle and knee were measured. Measurements were obtained before and at 1, 7, 14, 30, 60, 90, and 180 days after injection, respectively. RESULTS: Spasticity tested by modified Ashworth scale and modified Tardieu test decreased and ROM of ankle and knee increased after 14 days since injection in both groups (p<0.05). In low dilution group, maximal ROM of ankle and knee was obtained at 30th day after injection. In high dilution group, maximal ROM of ankle and knee was achieved at 14th day after injection and maximal ROM of knee at 30th day after injection. However, there was no significant differences between high dilution group and low dilution group in different times. CONCLUSION: Management of spasticity with botulinum toxin in cerebral palsy was not related to dilution volume.
Animals ; Ankle ; Botulinum Toxins ; Cerebral Palsy ; Child ; Head ; Humans ; Knee ; Leg ; Muscle Spasticity ; Range of Motion, Articular

OBJECTIVE: The purpose of this study was to evaluate the mobility and ratio of the bone-implant contact (BIC) of a sandblasted, large grit and acid-etched (SLA) orthodontic micro-implant. METHODS: Ninety-six micro-implants (48 SLA and 48 machined) were implanted in the upper and lower buccal alveolar bone, and palatal bone of four beagle dogs. Two weeks after surgery, orthodontic force (150 - 200 g) was applied. Two beagles were sacrificed at 4-weeks and the other two at 12-weeks. Histomorphometric comparisons were made between the SLA experimental group and the machined micro-implant as a control group to determine the ratio of contact between the bone and implant. Micro-implant mobility was also evaluated using Periotest(R). RESULTS: Periotest values showed no statistically significant difference in the upper alveolar and palatal bone between groups except for the lower buccal area. BIC in the upper buccal area showed no significant difference between groups both at 4-weeks and 12-weeks. However, both the groups showed a significant difference in BIC ratio in the rest of the experimental areas between 4 weeks and 12 weeks. The experimental group showed active bone remodeling around the bone-implant interface compared to the control group. CONCLUSIONS: There were significant differences in the BIC and the Periotest values between the surface-treated and machined micro-implants according to bone quality in the early stage.
Animals ; Bone Remodeling ; Dogs ; Nitrogen Mustard Compounds ; Osseointegration

OBJECTIVE: Proximal junctional kyphosis (PJK) is radiologic finding, and is defined as kyphosis of >10° at the proximal end of a construct. The aim of this study is to identify factors associated with PJK after segmental spinal instrumented fusion in adults with spinal deformity with a minimum follow-up of 2 years. METHODS: A total of 49 cases of adult spinal deformity treated by segmental spinal instrumented fusion at two university hospitals from 2004 to 2011 were enrolled in this study. All enrolled cases included at least 4 or more levels from L5 or the sacral level. The patients were divided into two groups based on the presence of PJK during follow-up, and these two groups were compared to identify factors related to PJK. RESULTS: PJK was observed in 16 of the 49 cases. Age, sex and mean follow-up duration were not statistically different between two groups. However, mean bone marrow density (BMD) and mean back muscle volume at the T10 to L2 level was significantly lower in the PJK group. Preoperatively, the distance between the C7 plumb line and uppermost instrumented vertebra (UIV) were no different in the two groups, but at final follow-up a significant intergroup difference was observed. Interestingly, spinal instrumentation factors, such as, receipt of a revision operation, the use of a cross-link, and screw fracture were no different in the two groups at final follow-up. CONCLUSION: Preoperative BMD, sagittal imbalance at UIV, and thoracolumbar muscle volume were found to be strongly associated with the presence of PJK.
Adult ; Back Muscles ; Bone Marrow ; Congenital Abnormalities ; Follow-Up Studies* ; Hospitals, University ; Humans ; Kyphosis* ; Osteoporosis ; Risk Factors* ; Sarcopenia ; Spine

OBJECTIVE: Stroke is the third leading cause of death in the Republic of Korea. Time is the most important factor in hyperacute stroke. Yet, there had been no protocol for mechanical thrombolysis. We have treated patients with hyperacute stroke by mechanical thrombolysis for 3 years. In current study, we analyzed the outcome of mechanical thrombolysis. METHODS: From March 2008 to February 2011, 36 patients were treated with mechanical thrombolysis. Initially we treated the patients by aggressive mechanical clot disruption (AMCD) who were admitted within 6 hours after the symptom onset. If revascularization was not achieved, balloon angioplasty was performed, followed by stenting or temporary endovascular bypass was performed. The result in 15 cases was not so successful. Since then, we started using the thromboaspiration method as the first line treatment of the mechanical thrombolysis. RESULTS: After using the thromboaspiration, we had better results in recanalization rate, modified Rankin Score (mRS) and reperfusion injury compared to AMCD. The recanalization rate was 80.85%, mRS is 2.85, and there was only 0.09% hemorrhagic formation. CONCLUSION: Even though thromboaspiration is not statistically significant due to the limited numbers of patients enrolled in this study, we think it is a good way in mechanical thronbolysis for hyperacute stroke.
Angioplasty, Balloon ; Cause of Death ; Humans ; Mechanical Thrombolysis ; Reperfusion Injury ; Republic of Korea ; Stents ; Stroke

No abstract available.
Animals ; Dizocilpine Maleate* ; Rats* ; Spinal Cord*

The authors report a rare case of aggravated myelopathy due to rebleeding of intramedullary cavernous angioma during pregnancy. A 29-year-old woman with a intramedullary cavernous angioma of the lower thoracic spinal cord was initially managed with a conservative treatment. She suffered the progressive paraparesis 16 months later during the 3rd trimester of her pregnancy. The follow-up magnetic resonance imaging revealed rebleeding of the previous cavernous angioma. The entire lesion was resected with a standard microsurgical technique after delivery, and her neurological symptoms subsequently resolved.
Adult ; Female ; Follow-Up Studies ; Hemangioma, Cavernous* ; Humans ; Magnetic Resonance Imaging ; Paraparesis ; Pregnancy* ; Spinal Cord ; Spinal Cord Diseases

OBJECTIVE: Gait pattern in patients with lumbar degenerative kyphosis (LDK) is disturbed because trunk bends forward due to decreased lumbar lordosis. Surgical therapy in LDK is required when conservative management fails. We investigated kinematic and kinetic changes of the pelvis, hip, and knee joints on the sagittal plane in patients with LDK before and after operation. METHOD: Fifteen patients underwent operations between March 1999 and September 2003. Gait analysis was performed for all patients. RESULTS: Total lumbar lordotic angle increased from 10.50 degrees +/-11.22 degrees to 26.71 degrees +/-8.80 degrees postoperation. In gait analysis, anterior pelvic tilting angle increased from maximum 7.86 degrees +/-9.69 degrees, minimum 4.40 degrees +/-9.82 degrees to maximum 12.61 degrees +/-5.36 degrees, minimum 9.68 degrees +/-5.63 degrees (p<0.05). Maximum hip flexion angle changed from 31.39 degrees +/-11.71 degrees to 35.83 degrees +/-5.84 degrees (p<0.05). Maximum knee flexion angle in terminal stance phase decreased from 13.32 degrees +/-7.34 degrees to 8.30 degrees +/-6.38 degrees (p<0.05). CONCLUSION: After corrective operation, an increase of lumbar spine lordosis and anterior pelvic tilt with decrease of knee flexion were observed. However, an increase of maximum hip flexion secondary to increased anterior pelvic tilting influenced ambulation negatively. Therefore, stretching of the hip flexor and strengthening of the hip extensor are required before and after operation.
Animals ; Decompression Sickness ; Gait ; Hip ; Humans ; Knee ; Knee Joint ; Kyphosis* ; Lordosis ; Lower Extremity* ; Pelvis* ; Spine ; Walking

Thoracic pedicle screw fixation techniques are still controversial for thoracic deformities because of possible complications including neurologic deficit. Methods to aid the surgeon in appropriate screw placement have included the use of intraoperative fluoroscopy and/or radiography as well as image-guided techniques. We describe our technique for free hand pedicle screw placement in the thoracic spine without any radiographic guidance and present the results of pedicle screw placement analyzed by computed tomographic scan in two human cadavers. This free hand technique of thoracic pedicle screw placement performed in a step-wise, consistent, and compulsive manner is an accurate, reliable, and safe method of insertion to treat a variety of spinal disorders, including spinal deformity.
Cadaver ; Congenital Abnormalities ; Fluoroscopy ; Hand ; Humans ; Neurologic Manifestations ; Spine

OBJECTIVE: To investigate objectively the postoperative change of the gait pattern in patients with cervical myelopathy through gait analysis. METHODS: Thirty nine patients who underwent cervical decompression and fusion for cervical myelopathy were studied. Preoperatively, gait disturbance was present in all patients. The patients were evaluated with Nurick classification, Functional Independence measure (FIM) score and gait analysis using three dimensional motion analyzer before surgery, 1 week and 3 months after surgery. RESULTS: In the Nurick classification there was statistically significant change but no significant change in FIM score after surgery. In the gait analysis there were statistically significant improvements in all the linear parameters, kinetic (ankle plantarflexion moment) and kinematic (knee range of motion in swing phase) parameters (p<0.05). CONCLUSION: This study suggests that gait analysis can be used as a quantitative tools of postoperative gait improvement in patient with cervical myelopathy.
Classification ; Decompression ; Gait* ; Humans ; Range of Motion, Articular ; Spinal Cord Diseases*