1.Robotic-Assisted Spine Surgery: Role in Training the Next Generation of Spine Surgeons
Jun Seok LEE ; Dong Wuk SON ; Su Hun LEE ; Jong Hyeok LEE ; Young Ha KIM ; Sang Weon LEE ; Bu Kwang OH ; Soon Ki SUNG ; Geun Sung SONG ; Seong YI
Neurospine 2024;21(1):116-127
Objective:
This study aimed to assess the degree of interest in robot-assisted spine surgery (RASS) among residents and to investigate the learning curve for beginners performing robotic surgery.
Methods:
We conducted a survey to assess awareness and interest in RASS among young neurosurgery residents. Subsequently, we offered a hands-on training program using a dummy to educate one resident. After completing the program, the trained resident performed spinal fusion surgery with robotic assistance under the supervision of a mentor. The clinical outcomes and learning curve associated with robotic surgery were then analyzed.
Results:
Neurosurgical residents had limited opportunities to participate in spinal surgery during their training. Despite this, there was a significant interest in the emerging field of robotic surgery. A trained resident performed RASS under the supervision of a senior surgeon. A total of 166 screw insertions were attempted in 28 patients, with 2 screws failing due to skiving. According to the Gertzbein-Robbins classification, 85.54% of the screws were rated as grade A, 11.58% as grade B, 0.6% as grade C, and 1.2% as grade D. The clinical acceptance rate was approximately 96.99%, which is comparable to the results reported by senior experts and time per screw statistically significantly decreased as experience was gained.
Conclusion
RASS can be performed with high accuracy within a relatively short timeframe, if residents receive adequate training.
2.Robotic-Assisted Spine Surgery: Role in Training the Next Generation of Spine Surgeons
Jun Seok LEE ; Dong Wuk SON ; Su Hun LEE ; Jong Hyeok LEE ; Young Ha KIM ; Sang Weon LEE ; Bu Kwang OH ; Soon Ki SUNG ; Geun Sung SONG ; Seong YI
Neurospine 2024;21(1):116-127
Objective:
This study aimed to assess the degree of interest in robot-assisted spine surgery (RASS) among residents and to investigate the learning curve for beginners performing robotic surgery.
Methods:
We conducted a survey to assess awareness and interest in RASS among young neurosurgery residents. Subsequently, we offered a hands-on training program using a dummy to educate one resident. After completing the program, the trained resident performed spinal fusion surgery with robotic assistance under the supervision of a mentor. The clinical outcomes and learning curve associated with robotic surgery were then analyzed.
Results:
Neurosurgical residents had limited opportunities to participate in spinal surgery during their training. Despite this, there was a significant interest in the emerging field of robotic surgery. A trained resident performed RASS under the supervision of a senior surgeon. A total of 166 screw insertions were attempted in 28 patients, with 2 screws failing due to skiving. According to the Gertzbein-Robbins classification, 85.54% of the screws were rated as grade A, 11.58% as grade B, 0.6% as grade C, and 1.2% as grade D. The clinical acceptance rate was approximately 96.99%, which is comparable to the results reported by senior experts and time per screw statistically significantly decreased as experience was gained.
Conclusion
RASS can be performed with high accuracy within a relatively short timeframe, if residents receive adequate training.
3.Caregiver Burden of Patients With Huntington’s Disease in South Korea
Chan Young LEE ; Chaewon SHIN ; Yun Su HWANG ; Eungseok OH ; Manho KIM ; Hyun Sook KIM ; Sun Ju CHUNG ; Young Hee SUNG ; Won Tae YOON ; Jin Whan CHO ; Jae-Hyeok LEE ; Han-Joon KIM ; Hee Jin CHANG ; Beomseok JEON ; Kyung Ah WOO ; Seong-Beom KOH ; Kyum-Yil KWON ; Jangsup MOON ; Young Eun KIM ; Jee-Young LEE
Journal of Movement Disorders 2024;17(1):30-37
Objective:
This is the first prospective cohort study of Huntington’s disease (HD) in Korea. This study aimed to investigate the caregiver burden in relation to the characteristics of patients and caregivers.
Methods:
From August 2020 to February 2022, we enrolled patients with HD from 13 university hospitals in Korea. We used the 12-item Zarit Burden Interview (ZBI-12) to evaluate the caregiver burden. We evaluated the clinical associations of the ZBI-12 scores by linear regression analysis and investigated the differences between the low- and high-burden groups.
Results:
Sixty-five patients with HD and 45 caregivers were enrolled in this cohort study. The average age at onset of motor symptoms was 49.3 ± 12.3 years, with an average cytosine-adenine-guanine (CAG)n of 42.9 ± 4.0 (38–65). The median ZBI-12 score among our caregivers was 17.6 ± 14.2. A higher caregiver burden was associated with a more severe Shoulson–Fahn stage (p = 0.038) of the patients. A higher ZBI-12 score was also associated with lower independence scale (B = -0.154, p = 0.006) and functional capacity (B = -1.082, p = 0.002) scores of patients. The caregiving duration was longer in the high- than in the low-burden group. Caregivers’ demographics, blood relation, and marital and social status did not affect the burden significantly.
Conclusion
HD patients’ neurological status exerts an enormous impact on the caregiver burden regardless of the demographic or social status of the caregiver. This study emphasizes the need to establish an optimal support system for families dealing with HD in Korea. A future longitudinal analysis could help us understand how disease progression aggravates the caregiver burden throughout the entire disease course.
4.Evaluating the Validity and Reliability of the Korean Version of the Scales for Outcomes in Parkinson’s Disease–Cognition
Jinse PARK ; Eungseok OH ; Seong-Beom KOH ; In-Uk SONG ; Tae-Beom AHN ; Sang Jin KIM ; Sang-Myung CHEON ; Yoon-Joong KIM ; Jin Whan CHO ; Hyeo-Il MA ; Mee Young PARK ; Jong Sam BAIK ; Phil Hyu LEE ; Sun Ju CHUNG ; Jong-Min KIM ; Han-Joon KIM ; Young-Hee SUNG ; Do Young KWON ; Jae-Hyeok LEE ; Jee-Young LEE ; Ji Seon KIM ; Ji Young YUN ; Hee Jin KIM ; Jin Yong HONG ; Mi-Jung KIM ; Jinyoung YOUN ; Hui-Jun YANG ; Won Tae YOON ; Sooyeoun YOU ; Kyum-Yil KWON ; Su-Yun LEE ; Younsoo KIM ; Hee-Tae KIM ; Joong-Seok KIM ; Ji-Young KIM
Journal of Movement Disorders 2024;17(3):328-332
Objective:
The Scales for Outcomes in Parkinson’s Disease–Cognition (SCOPA-Cog) was developed to assess cognition in patients with Parkinson’s disease (PD). In this study, we aimed to evaluate the validity and reliability of the Korean version of the SCOPACog (K-SCOPA-Cog).
Methods:
We enrolled 129 PD patients with movement disorders from 31 clinics in South Korea. The original version of the SCOPA-Cog was translated into Korean using the translation-retranslation method. The test–retest method with an intraclass correlation coefficient (ICC) and Cronbach’s alpha coefficient were used to assess reliability. Spearman’s rank correlation analysis with the Montreal Cognitive Assessment-Korean version (MOCA-K) and the Korean Mini-Mental State Examination (K-MMSE) were used to assess concurrent validity.
Results:
The Cronbach’s alpha coefficient was 0.797, and the ICC was 0.887. Spearman’s rank correlation analysis revealed a significant correlation with the K-MMSE and MOCA-K scores (r = 0.546 and r = 0.683, respectively).
Conclusion
Our results demonstrate that the K-SCOPA-Cog has good reliability and validity.
5.Robotic-Assisted Spine Surgery: Role in Training the Next Generation of Spine Surgeons
Jun Seok LEE ; Dong Wuk SON ; Su Hun LEE ; Jong Hyeok LEE ; Young Ha KIM ; Sang Weon LEE ; Bu Kwang OH ; Soon Ki SUNG ; Geun Sung SONG ; Seong YI
Neurospine 2024;21(1):116-127
Objective:
This study aimed to assess the degree of interest in robot-assisted spine surgery (RASS) among residents and to investigate the learning curve for beginners performing robotic surgery.
Methods:
We conducted a survey to assess awareness and interest in RASS among young neurosurgery residents. Subsequently, we offered a hands-on training program using a dummy to educate one resident. After completing the program, the trained resident performed spinal fusion surgery with robotic assistance under the supervision of a mentor. The clinical outcomes and learning curve associated with robotic surgery were then analyzed.
Results:
Neurosurgical residents had limited opportunities to participate in spinal surgery during their training. Despite this, there was a significant interest in the emerging field of robotic surgery. A trained resident performed RASS under the supervision of a senior surgeon. A total of 166 screw insertions were attempted in 28 patients, with 2 screws failing due to skiving. According to the Gertzbein-Robbins classification, 85.54% of the screws were rated as grade A, 11.58% as grade B, 0.6% as grade C, and 1.2% as grade D. The clinical acceptance rate was approximately 96.99%, which is comparable to the results reported by senior experts and time per screw statistically significantly decreased as experience was gained.
Conclusion
RASS can be performed with high accuracy within a relatively short timeframe, if residents receive adequate training.
6.Glomerulonephritis following COVID-19 infection or vaccination: a multicenter study in South Korea
Hyung Woo KIM ; Eun Hwa KIM ; Yun Ho ROH ; Young Su JOO ; Minseob EOM ; Han Seong KIM ; Mi Seon KANG ; HoeIn JEONG ; Beom Jin LIM ; Seung Hyeok HAN ; Minsun JUNG ;
Kidney Research and Clinical Practice 2024;43(2):165-176
Despite the widespread impact of the severe acute respiratory syndrome coronavirus 2 (coronavirus disease 2019, COVID-19) and vaccination in South Korea, our understanding of kidney diseases following these events remains limited. We aimed to address this gap by investigating the characteristics of glomerular diseases following the COVID-19 infection and vaccination in South Korea. Methods: Data from multiple centers were used to identify de novo glomerulonephritis (GN) cases with suspected onset following COVID-19 infection or vaccination. Retrospective surveys were used to determine the COVID-19–related histories of patients who were initially not implicated. Bayesian structural time series and autoregressive integrated moving average models were used to determine causality. Results: Glomerular diseases occurred shortly after the infection or vaccination. The most prevalent postinfection GN was podocytopathy (42.9%), comprising primary focal segmental glomerulosclerosis and minimal change disease, whereas postvaccination GN mainly included immunoglobulin A nephropathy (IgAN; 57.9%) and Henoch-Schönlein purpura nephritis (HSP; 15.8%). No patient progressed to end-stage kidney disease. Among the patients who were initially not implicated, nine patients with IgAN/HSP were recently vaccinated against COVID-19. The proportion of glomerular diseases changed during the pandemic in South Korea, with an increase in acute interstitial nephritis and a decrease in pauci-immune crescentic GN. Conclusion: This study showed the characteristics of GNs following COVID-19 infection or vaccination in South Korea. Understanding these associations is crucial for developing effective patient management and vaccination strategies. Further investigation is required to fully comprehend COVID-19’s impact on GN.
7.Robotic-Assisted Spine Surgery: Role in Training the Next Generation of Spine Surgeons
Jun Seok LEE ; Dong Wuk SON ; Su Hun LEE ; Jong Hyeok LEE ; Young Ha KIM ; Sang Weon LEE ; Bu Kwang OH ; Soon Ki SUNG ; Geun Sung SONG ; Seong YI
Neurospine 2024;21(1):116-127
Objective:
This study aimed to assess the degree of interest in robot-assisted spine surgery (RASS) among residents and to investigate the learning curve for beginners performing robotic surgery.
Methods:
We conducted a survey to assess awareness and interest in RASS among young neurosurgery residents. Subsequently, we offered a hands-on training program using a dummy to educate one resident. After completing the program, the trained resident performed spinal fusion surgery with robotic assistance under the supervision of a mentor. The clinical outcomes and learning curve associated with robotic surgery were then analyzed.
Results:
Neurosurgical residents had limited opportunities to participate in spinal surgery during their training. Despite this, there was a significant interest in the emerging field of robotic surgery. A trained resident performed RASS under the supervision of a senior surgeon. A total of 166 screw insertions were attempted in 28 patients, with 2 screws failing due to skiving. According to the Gertzbein-Robbins classification, 85.54% of the screws were rated as grade A, 11.58% as grade B, 0.6% as grade C, and 1.2% as grade D. The clinical acceptance rate was approximately 96.99%, which is comparable to the results reported by senior experts and time per screw statistically significantly decreased as experience was gained.
Conclusion
RASS can be performed with high accuracy within a relatively short timeframe, if residents receive adequate training.
8.Robotic-Assisted Spine Surgery: Role in Training the Next Generation of Spine Surgeons
Jun Seok LEE ; Dong Wuk SON ; Su Hun LEE ; Jong Hyeok LEE ; Young Ha KIM ; Sang Weon LEE ; Bu Kwang OH ; Soon Ki SUNG ; Geun Sung SONG ; Seong YI
Neurospine 2024;21(1):116-127
Objective:
This study aimed to assess the degree of interest in robot-assisted spine surgery (RASS) among residents and to investigate the learning curve for beginners performing robotic surgery.
Methods:
We conducted a survey to assess awareness and interest in RASS among young neurosurgery residents. Subsequently, we offered a hands-on training program using a dummy to educate one resident. After completing the program, the trained resident performed spinal fusion surgery with robotic assistance under the supervision of a mentor. The clinical outcomes and learning curve associated with robotic surgery were then analyzed.
Results:
Neurosurgical residents had limited opportunities to participate in spinal surgery during their training. Despite this, there was a significant interest in the emerging field of robotic surgery. A trained resident performed RASS under the supervision of a senior surgeon. A total of 166 screw insertions were attempted in 28 patients, with 2 screws failing due to skiving. According to the Gertzbein-Robbins classification, 85.54% of the screws were rated as grade A, 11.58% as grade B, 0.6% as grade C, and 1.2% as grade D. The clinical acceptance rate was approximately 96.99%, which is comparable to the results reported by senior experts and time per screw statistically significantly decreased as experience was gained.
Conclusion
RASS can be performed with high accuracy within a relatively short timeframe, if residents receive adequate training.
9.Accuracy and Clinical Outcomes of Fluoroscopy-Guided and Robotic-Assisted Percutaneous Pedicle Screw Fixation Performed by a Single Surgeon at a Single Center
Jong Hyeok LEE ; Dong Wuk SON ; Bu Kwang OH ; Jun Seok LEE ; Su Hun LEE ; Young Ha KIM ; Soon Ki SUNG ; Sang Weon LEE ; Geun Sung SONG ; Chang Hyeun KIM ; Chi Hyung LEE ; Seong YI
Journal of Minimally Invasive Spine Surgery and Technique 2024;9(1):61-68
Objective:
Fluoroscopy-guided percutaneous pedicle screw fixation (FGPSF) and its further development, robot-assisted percutaneous pedicle screw fixation (RAPSF), are minimally invasive spinal surgery (MISS) techniques. FGPSF is a standard technique at our hospital, and RAPSF incorporating artificial intelligence has been performed at our hospital since October 2021. This study compared these 2 techniques and analyzed their differences, accuracy, and clinical outcomes based on our experiences.
Methods:
This study conducted a detailed analysis of screw accuracy and the clinical outcomes of 2 MISS techniques, FGPSF, and RAPSF. Screw accuracy was evaluated using the Gertzbein and Robbins scale, categorizing placements into grades A–E, with grades A and B considered clinically acceptable. Accuracy was assessed using postoperative computed tomography images for FGPSF and intraoperative O-arm scan images for RAPSF. Clinical outcomes were compared by examining parameters, such as hospitalization duration, C-reactive protein (CRP) normalization period, estimated blood loss (EBL), and preoperative/postoperative visual analogue scale (VAS) scores. Screw-related complications were reviewed. Independent image evaluations by nonparticipating spine specialists ensured objective and reliable assessments.
Results:
Both FGPSF and RAPSF demonstrated high rates of clinically acceptable screw placement, with minimal breaches that required no repositioning. The clinically acceptable rates of FGPSF and RAPSF were similar (99.17% and 99.19%, respectively). Both groups also demonstrated similar clinical outcomes. The CRP normalization period, EBL, and ΔVAS (preoperative—postoperative) scores revealed no statistically significant differences between FGPSF and RAPSF. Neither group experienced screw-related complications; however, the RAPSF group exhibited a statistically significant shorter hospital stay than the FGPSF group.
Conclusion
This study compared the accuracy and clinical outcomes of FGPSF and RAPSF. Both methods demonstrated no significant differences in accuracy or clinical outcomes. Spine surgeons selected between the 2 methods based on individual patient needs, and additional research is required to fully understand the practical advantages of each technique in the clinical field.
10.Glycemic Control and Adverse Clinical Outcomes in Patients with Chronic Kidney Disease and Type 2 Diabetes Mellitus: Results from KNOW-CKD
Ga Young HEO ; Hee Byung KOH ; Hyung Woo KIM ; Jung Tak PARK ; Tae-Hyun YOO ; Shin-Wook KANG ; Jayoun KIM ; Soo Wan KIM ; Yeong Hoon KIM ; Su Ah SUNG ; Kook-Hwan OH ; Seung Hyeok HAN
Diabetes & Metabolism Journal 2023;47(4):535-546
Background:
The optimal level of glycosylated hemoglobin (HbA1c) to prevent adverse clinical outcomes is unknown in patients with chronic kidney disease (CKD) and type 2 diabetes mellitus (T2DM).
Methods:
We analyzed 707 patients with CKD G1-G5 without kidney replacement therapy and T2DM from the KoreaN Cohort Study for Outcome in Patients With Chronic Kidney Disease (KNOW-CKD), a nationwide prospective cohort study. The main predictor was time-varying HbA1c level at each visit. The primary outcome was a composite of development of major adverse cardiovascular events (MACEs) or all-cause mortality. Secondary outcomes included the individual endpoint of MACEs, all-cause mortality, and CKD progression. CKD progression was defined as a ≥50% decline in the estimated glomerular filtration rate from baseline or the onset of end-stage kidney disease.
Results:
During a median follow-up of 4.8 years, the primary outcome occurred in 129 (18.2%) patients. In time-varying Cox model, the adjusted hazard ratios (aHRs) for the primary outcome were 1.59 (95% confidence interval [CI], 1.01 to 2.49) and 1.99 (95% CI, 1.24 to 3.19) for HbA1c levels of 7.0%–7.9% and ≥8.0%, respectively, compared with <7.0%. Additional analysis of baseline HbA1c levels yielded a similar graded association. In secondary outcome analyses, the aHRs for the corresponding HbA1c categories were 2.17 (95% CI, 1.20 to 3.95) and 2.26 (95% CI, 1.17 to 4.37) for MACE, and 1.36 (95% CI, 0.68 to 2.72) and 2.08 (95% CI, 1.06 to 4.05) for all-cause mortality. However, the risk of CKD progression did not differ between the three groups.
Conclusion
This study showed that higher HbA1c levels were associated with an increased risk of MACE and mortality in patients with CKD and T2DM.

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