Background: Cervical spine magnetic resonance imaging (MRI) can reveal incidental extraspinal findings (IESFs) unrelated to the primary evaluation of cervical radiculopathy or myelopathy. Recognizing these lesions is crucial because some may require further investigation or treatment. Methods: We retrospectively reviewed 2,286 non-contrast cervical spine MRI scans performed between January 2019 and July 2024 in patients presenting with neck pain, shoulder pain, or neurological deficits suggestive of cervical radiculopathy or myelopathy. Patients with a history of malignancy, known head and neck tumors, or previous cervical surgeries were excluded. Boardcertified radiologists initially interpreted all scans. Documented IESFs were categorized into 5 groups: thyroid nodules, lymphadenopathy, soft-tissue tumors, brain lesions, and other head and neck lesions. Clinical follow-up data were analyzed to determine lesion outcomes. Statistical comparisons of demographics were performed using chi-square, t-test, and Mann-Whitney U-test. Results: IESFs were identified in 103 of 2,286 scans (4.5%). Thyroid nodules were the most common (n = 64, 2.0%), followed by lymphadenopathy (n = 16, 0.5%). Females had a higher incidence of IESFs than males (64.4% vs. 35.6%, p < 0.001), and the mean age was significantly higher in the IESF group (58.4 vs. 54.7 years, p = 0.033). Of 94 patients with available follow-up, 7 (7.4%) were confirmed malignant: 5 thyroid nodules and 2 lymphadenopathies. Two additional cases underwent surgery for pituitary and parathyroid adenomas. Four IESFs went unrecognized on initial review, underscoring the risk of missed diagnoses when the clinical workload is high. Conclusions IESFs in cervical spine MRI were detected in 4.5% of cases, with a notable subset being malignant. These findings emphasize the importance of systematic review protocols and interdisciplinary collaboration to ensure clinically significant lesions are identified and managed promptly.

Background and Objectives: Hypertrophic cardiomyopathy (HCM) increases the risk of sudden cardiac death. Despite international guidelines for sudden death prevention and implantable cardiac defibrillator (ICD) use, clinical practices vary. This study assessed the practices and opinions of Korean cardiologists on HCM management, focusing on ICD use and reimbursement policies. Methods: A structured electronic survey was distributed to members of the Korean Society of Cardiology, covering HCM management, ICD preferences, and reimbursement policies. Results: A total of 119 cardiologists participated, with most being arrhythmia specialists (56.3%) and university professors (81.5%). Cardiac magnetic resonance imaging and genetic testing were underutilized (30.3% and 11.8%, respectively). Beta-blocker-refractory premature ventricular complexes were primarily managed with continued medical therapy (77.3%). ICD preferences varied by physician specialty and patient age, with subcutaneous ICDs preferred in younger patients and dual-chamber ICDs in older patients. Nearly half of respondents believed ICD reimbursement criteria required revision. Conclusions Significant variability in HCM management exists among Korean cardiologists, influenced by restrictive reimbursement criteria rather than clinical guidelines. Updated reimbursement policies and improved access to advanced diagnostics are needed to align with international standards and optimize patient care.

Background: Since the emergence of hypervirulent strains of Clostridioides difficile, the incidence of C. difficile infections (CDI) has increased significantly. Methods: To assess the incidence of CDI in Korea, we conducted a prospective multicentre observational study from October 2020 to October 2021. Additionally, we calculated the incidence of CDI from mass data obtained from the Health Insurance Review and Assessment Service (HIRA) from 2008 to 2020. Results: In the prospective study with active surveillance, 30,212 patients had diarrhoea and 907 patients were diagnosed with CDI over 1,288,571 patient-days and 193,264 admissions in 18 participating hospitals during 3 months of study period; the CDI per 10,000 patientdays was 7.04 and the CDI per 1,000 admission was 4.69. The incidence of CDI was higher in general hospitals than in tertiary hospitals: 6.38 per 10,000 patient-days (range: 3.25–12.05) and 4.18 per 1,000 admissions (range: 1.92–8.59) in 11 tertiary hospitals, vs. 9.45 per 10,000 patient-days (range: 5.68–13.90) and 6.73 per 1,000 admissions (range: 3.18–15.85) in seven general hospitals. With regard to HIRA data, the incidence of CDI in all hospitals has been increasing over the 13-year-period: from 0.3 to 1.8 per 10,000 patient-days, 0.3 to 1.6 per 1,000 admissions, and 6.9 to 56.9 per 100,000 population, respectively. Conclusion The incidence of CDI in Korea has been gradually increasing, and its recent value is as high as that in the United State and Europe. CDI is underestimated, particularly in general hospitals in Korea.

Fifty-eight patients were subjects in this study. The clinical diagnosis was the presumed osteoporotic spine fractures in 48 patients, infections in seven patients, and tumors in three patients. Image-intensifier-guided closed transpedicular needle biopsy with a vertebroplasty needle (11 gauge, 120-mm length needle with a stylet Luer lock syringe) for the thoracolumbar lesions were performed under local anesthesia. The overall results showed a high histological diagnostic yield: in the 48 osteoporotic fractures, 36 (75%) were confirmed to be osteoporotic bones. In the seven infectious lesions, the lesions were confirmed to be tuberculosis in five and pyogenic in two. In the three tumors one was a malignant lymphoma, while tumor tissues were not found in two cases. No biopsy associated complications were found. The image-intensifier-guided closed vertebroplasty needle biopsy is a safe and reliable procedure with high diagnostic accuracy and should be an integral part of managing the spinal pathology.

Background: There are many studies on the vertebral body-to-canal ratio, the so-called Pavlov’s ratio of the cervical spine. However, there are no studies on its relation with age to clarify each bony component’s contribution to the spinal canal formation and its size. The aim of this study was to investigate differences and changes in the vertebral body-to-canal ratio according to age in an asymptomatic population. Methods: This is a cross-sectional study of 280 asymptomatic individuals. A total of 140 men and 140 women representing each decade of life from the first to the seventh were included in this study. The anteroposterior length of the vertebral body and canal from C3 to C6 was measured on sagittal radiographs to calculate the vertebral body-to-canal ratio. Results: The average Pavlov’s ratio was significantly larger (p < 0.001) in the first decade of life. The average Pavlov’s ratio of the individuals in the first decade of life was 1.09 between C3 and C6 (1.08 at C3, 1.07 at C4, 1.11 at C5, and 1.13 at C6; range, 0.78–1.51). There was no significant difference among the other decades of life. Conclusions We assessed the Pavlov’s ratio of the cervical spine in an asymptomatic population. It is our belief that the spinal canal size is the largest in the first decade of life, and the Pavlov’s ratio becomes almost fixed throughout life after maturity.

Methods: Multimodality IONM data, including somatosensory-evoked potentials (SSEP) and motor-evoked potentials (MEP), were reviewed in 64 patients who underwent three-column spinal surgery from 2011 to 2015. Surgical procedures included posterior vertebral column resection, pedicle subtraction osteotomy, total en bloc spondylectomy, piecemeal spondylectomy, and corpectomy with laminectomy (n=27) in three cervical, 34 thoracic, and 31 lumbar procedures. Results: Significant IONM signal changes occurred in 11 of 64 (17.1%) patients. SSEP and MEP were changed in 11 patients. Postoperative neurologic deterioration occurred in 54.5% (6 of 11) of the patients, and two of them were permanent. There was no postoperative neurologic deterioration in patients without significant signal change. Suspected causes of IONM data changes are as follows: adhesion/tethering, translation, contusion, and perfusion. Conclusions Based on the results of this study, to enhance neurologic safety in three-column spinal surgery, surgeons should pay attention to protect the spinal cord from mechanical insult, especially when the spinal column was totally destabilized during surgery, and not to compromise perfusion to the spinal cord in close cooperation with a neurologist and anesthesiologist.

Methods: We reviewed all spine surgery cases with IONM data treated at our department between January 2013 and May 2017. We found cases showing significant IONM signal improvements. We prospectively analyzed the neurological and clinical outcomes of these patients and compared outcomes pre- and postoperatively. Results: Among 317 cases with the IONM data, we found 29 cases that showed IONM signal improvement compared with baseline. There were 27 cases of compressive myelopathy: 22 had a degenerative cause at the cervical spine, and five, at the thoracic spine. There were two cases of huge neurogenic tumor each at the craniovertebral junction and at the lumbar spine. Both motor-evoked potentials (MEPs) and somatosensory-evoked potentials (SSEPs) signals were improved in six cases, only the MEPs signal improved in 10, and only SSEP signal improved in 13 cases. All cases showed the IONM signal improvement consistently after the decompression procedure during surgery. All patients had a significant improvement in neurological function and subjective symptoms, and none had neurologic deterioration postoperatively. Conclusions Improvement of IONM signals during surgery may indicate that no unrecognized neural injury occurred during surgery and a favorable postoperative neurological outcome can be expected.

BACKGROUND: In lumbar spinal stenosis, spinous process-splitting decompression has demonstrated good clinical outcomes with preservation of the posterior ligamentous complex and paraspinal muscles in comparison to conventional laminectomy, but the radiological consequence and clinical impact of the split spinous processes have not been fully understood. METHODS: Seventy-three patients who underwent spinous process-splitting decompression were included. The bone union rate and pattern were evaluated by computed tomography performed 6–18 months after surgery and compared among subgroups divided according to the number of levels decompressed and the extent of spinous process splitting. The bone union pattern was classified into three categories: complete union, partial union, and nonunion. The visual analog scale (VAS) score, Oswestry disability index (ODI), and walking distance assessed both before and 24–36 months after surgery were compared among subgroups divided according to the union pattern of the split spinous process. RESULTS: Overall, the rates of complete union, partial union, and nonunion were 51.7%, 43.2%, and 5.1%, respectively. In the subgroup with partial splitting of the spinous process, the rates were 85.7%, 14.3%, and 0%, respectively; those of the subgroup with total splitting of the spinous process were 32.9%, 59.2%, and 7.9%, respectively. With single-level decompression, a higher rate of union was observed compared with multilevel decompression. The VAS, ODI, and walking distance were significantly improved after surgery and did not differ according to the degree of union of the split spinous process. CONCLUSIONS: We found that the single-level operation and partial splitting of the spinous process were favourable factors for obtaining complete restoration of the posterior bony structure of the lumbar spine in spinous process-splitting decompression.
Decompression ; Humans ; Laminectomy ; Ligaments ; Paraspinal Muscles ; Spinal Stenosis ; Spine ; Visual Analog Scale ; Walking

PURPOSE: The authors measured the anteversion of the femoral neck and acetabulum and the sum of the two values in normal Korean people by computed tomography. The authors examined the normal range of the values to analyze the difference in sex and sides as well as the relationship between the femoral neck and acetabular anteversion. MATERIALS AND METHODS: The authors measured the anteversion of the femoral neck and acetabulum in 118 normal Korean adult males and 114 females aged between 21 and 49 on both the right and left sides by computed tomography and calculated the sum of anteversion. The authors analyzed the mean and standard deviation, and investigated the sex differences and side differences, as well as the relationship between the acetabular anteversion and femoral neck anteversion statistically. RESULTS: The anteversion of the acetabulum in males was 15.3°±6.1° on the right side and 15.3°±6.6° on the left side. The anteversion of the femoral neck in males was 5.3°±7.6° on the right side and 1.5°±9.2° on the left side according to the Hernandez et al. method. The anteversion of acetabulum in females was 16.8°±5.4° on the right side and 16.3°±5.8° on the left side. The anteversion of femoral neck in females was 10.3°±8.2° on the right side and 7.9°±8.2° on the left side according to Hernandez et al. method. No difference in acetabular anteversion, and a significant difference in the femoral neck anteversion on both the right and left sides were observed between males and females. No difference of acetabular anteversion was observed between the right and left sides, but a significant difference in femoral neck anteversion was noted between the right and left sides measured by either the Hernandez et al. method or Weiner et al. method. The Pearson coefficient revealed no correlation between the femoral neck anteversion and acetabular anteversion. CONCLUSION: No difference in the acetabular anteversion was observed, but there was a significant difference in femoral neck anteversion between males and females. A significant difference in femoral neck anteversion was observed between the right and left sides. No correlation was noted between the anteversion of the femoral neck and acetabulum.
Acetabulum ; Adult ; Female ; Femur Neck ; Humans ; Male ; Methods ; Reference Values ; Sex Characteristics

BACKGROUND: It is not clear whether the pronator quadratus (PQ) muscle actually heals and provides a meaningful pronation force after volar plating for distal radius fractures (DRFs). We aimed to determine whether the length of the PQ muscle, which is dissected and then repaired during volar plating for a DRF, affects the forearm rotation strength and clinical outcomes. METHODS: We examined 41 patients who requested hardware removal after volar plating. We measured the isokinetic forearm rotation strength and clinical outcomes including grip strength, wrist range of motion, and disabilities of the arm, shoulder and hand (DASH) scores at 6 months after fracture fixation. During the hardware removal surgery, which was performed at an average of 9 months (range, 8.3 to 11.5 months) after fracture fixation, we measured the PQ muscle length. RESULTS: The average PQ muscle length was 68% of the normal muscle length, and no significant relationship was found between the PQ muscle length and the outcomes including isokinetic forearm rotation strength, grip strength, wrist range of motion, and DASH scores. CONCLUSIONS: This study demonstrates that the length of the healed PQ muscle does not affect isokinetic forearm rotation strength and clinical outcomes after volar plating for DRFs. The results of this study support our current practice of loose repair of the PQ that is performed by most of the surgeons to prevent tendon irritation over the plate, and suggest that tight repair of the PQ is not necessary for achieving improved forearm function.
Adult ; Aged ; Bone Plates ; Device Removal ; Female ; Forearm/physiopathology/surgery ; Fracture Fixation, Internal/*methods ; Hand Strength ; Humans ; Male ; Middle Aged ; Muscle Strength ; Muscle, Skeletal/physiopathology/*surgery ; Radius Fractures/radiography/*surgery ; Range of Motion, Articular ; Wound Healing ; Young Adult