ASIA SPINE: The Past, Present, and Future

신동아,김영수,Hiroshi Nakagawa,서정근,김세훈 대한척추신경외과학회 2018 Neurospine Vol.15 No.1

The sharing of international academic accomplishment and friendship is important; furthermore, to better understand and anticipate the future, we should look back and remember where we started. Regarding ASIA SPINE, the authors aimed to record how the pioneers of Asian spinal surgery started this spine meeting series more than 20 years ago and that later developed into the present state of the conference. The authors will also explore the possible future of this conference. In June 1996, when Professor Hiroshi Nakagawa organized the 11th Annual Meeting of the Japanese Society of Spinal Surgery, spinal neurosurgeons from Korea and Japan including Professor Young Soo Kim, Professor Jung Keun Suh, and Professor Nakagawa discussed the establishment of a multinational conference on spinal surgery via a partnership between the 2 countries. Finally, from September 18 to 20, 1997, the First Biennial Meeting of the Japan-Korea Conference on Spinal Surgery was held in Nagoya, Japan, with Professor Hiroshi Nakagawa as the first organizing President. From then, a biennial meeting was held every other year in Korea or Japan until 2009. In September 2010, the next generation of spinal neurosurgeons decided to organize the first meeting of ASIA SPINE in Incheon, Korea, in order to represent all Asian spine specialists. This meeting has been since held annually around the region including in Taiwan. Remembering the pioneers in the field of spinal surgery is invaluable and extremely important. The authors hope that interest in ASIA SPINE will further expand to other nations in Asia who have advanced philosophies and refined technologies. We wish ASIA SPINE continued success and the ability to promote prolonged international friendship among the Asian countries.

Comparative Finite Element Analysis of Lumbar Cortical Screws and Pedicle Screws in Transforaminal and Posterior Lumbar Interbody Fusion

신동아,허동화 대한척추신경외과학회 2019 Neurospine Vol.16 No.2

Objective: Lumbar cortical screw fixation (CSF), rather than pedicle screw fixation (PSF), has recently been attempted in lumbar interbody fusion. The purpose of our study was to evaluate the biomechanical stability of lumbar CSF using a finite element (FE) model. Methods: A 3-FE model, including the L1 to S1 levels, was designed to evaluate and compare the biomechanical stability of lumbar CSF and PSF in single-level lumbar interbody fusion at L4–5. Cortical or pedicle screws were inserted bilaterally, and posterior lumbar interbody fusion (PLIF) and transforaminal lumbar interbody fusion (TLIF) were modeled at L4–5, respectively. We compared the stability of CSF to that of PSF in these 2 different anatomic variations of PLIF, as well as in TLIF. Results: Lumbar CSF showed less stability than PSF in PLIF when the midline posterior ligaments were not preserved, but demonstrated similar stability when the ligaments were preserved. The range of motion (ROM) at the treated level in CSF was larger than that observed for PSF, in all PLIF and TLIF models. Furthermore, the ROM in the posterior ligament-sacrificing PLIF with CSF model was larger than the ROM in the posterior ligament-preserving PLIF with CSF or PSF model. Conclusion: Based on our FE analysis, the stability of CSF is comparable to that of PSF in PLIF and TLIF when the midline posterior ligaments are preserved.

Posterior Atlantoaxial Fixation with Lateral Mass Screw in the Atlas and Pedicle Screw in the Axis

신동아,김긍년,윤도흠 대한신경외과학회 2003 Journal of Korean neurosurgical society Vol.34 No.5

Objective:The authors report the successful use of a recently described technique of posterior fixation of the C1 lateral mass and the C2 pedicle with polyaxial screws and rods. Methods : After posterior exposure of the C1-C2 complex, the polyaxial screws were inserted into the lateral mass of C1 and the pedicle of C2 with the guidance of anatomic landmarks and fluoroscopy. Then, the pedicle screws of each side were linked with a rod. Because the C1-C2 pedicle screw fixation was sufficiently rigid, an additional posterior wiring or structural bone graft is unnecessary. Results : The early clinical and radiologic follow-up data indicated solid fusion of C1 and C2 vertebrae with no observed neural or vascular damage related to this technique. Conclusion : The posterior fixation of the C1-C2 complex using polyaxial screws and rods seems to be a reliable technique and an efficient alternative to the more commonly accepted procedures. Key words:Atlantoaxial instability;Atlantoaxial fixation;Polyaxial screw.

요추간반 탈출증으로 인한 마미총 증후군

신동아,공민호,진동규,조용은,윤도흠,김영수 대한신경외과학회 2002 Journal of Korean neurosurgical society Vol.32 No.3

Objective:Acute cauda equina syndrome secondary to lumbar disc herniation is a rare clinical entity, but its sequelae such as bladder and sexual dysfunction are too severe to overlook. The purpose of this study is to determine the relationship between surgical timing and outcome. Methods:Between 1994 and 1999, 43 patients(34 male and 9 female), ranging in age from 19 to 67 years(mean:44.5), were operated due to acute cauda equina syndrome secondary to lumbar disc herniation. All presented with bladder and bowel dysfunction;36(83.7%) had motor weakness and 32(74.4%) had sensory deficit. The levels of herniations were L4/5 in 16 patients, L5/S1 in 10 and L3/4 in 5. Results:The time to surgery from the onset of the symptom ranged from less than 24 hours to more than 14 days;10 patients underwent surgery within 48 hours of onset. The mean follow-up period was 54 months. In motor function recovery, there was no significant difference, but in bladder and sexual functions, there was significant difference according to the duration of symptoms before surgery. Conclusion:In acute cauda equina syndrome, emergency decompression surgery should be done. The outcome is good in patients operated within 48 hours compared to those treated more than 48 hours after the onset of the syndrome. Key words:Acute cauda equina syndrome;Herniated lumbar disc;Neurogenic bladder;Outcome.

소뇌충부에 발생한 신경절교종

신동아,양국희,김태성,최중언 대한신경외과학회 2002 Journal of Korean neurosurgical society Vol.32 No.3

We present a case of ganglioglioma in the cerebellar vermis. A 2-year-old boy presented with symptoms and signs of raised intracranial pressure and the physical examination revealed large head and developmental delay. Magnetic resonance image demonstrated a hypointense mass in the cerebellar vermis on T1-weighted image with heterogeneous enhancement after gadolinium administration, mimicking a malignant tumor. A gross total resection was performed and pathologic findings demonstrated a ganglioglioma. There was no evidence of recurrence of the tumor during 16 months follow up period. Key words:Ganglioglioma;Cerebellum.

학교 내 생태계 모델 정원의 도입 효과: 해외 사례를 통해 본 아쿠아포닉의 교육적 활용

신동아,장미정,마틴산야 한국환경교육학회 2020 한국환경교육학회 학술대회 자료집 Vol.2020 No.7

요추간판탈출증의 수술 전 보존적 치료 기간과 각종 수술 방법의 과학적 근거에 대한 분석

신동아,김은상,임승철 대한척추신경외과학회 2009 Neurospine Vol.6 No.3

Background: The purpose of this study was 1) to review the length of an adequate period of conservative treatment and the appropriate surgical indications for herniated lumbar disc (HLD), 2) to collate the scientific evidences on surgeries for HLD, and 3) to collect expert opinions on HLD. Methods: We searched for articles in PubMed, the Cochrane Library and KoreaMed up to 1 October 2008, and these articles were concerned with the natural history of HDL, systemic reviews of HDL and expert opinions on HLD. We also searched for meta-analyses and randomized or quasi-randomized controlled trials (RCTs or QRCTs) of surgery for HLD. We performed a meta-analysis using the Cochrane method. The survey consisting of 21 questions was delivered to all the members of the Korean Spinal Neurosurgery Society (KSNS) via E-mail. Results: A total of 59 articles were included in this study. There were 16 articles concerning the period of conservative management and the surgical indications. Among the 33 articles on surgery for HLD, there were 4 meta-analyses, 27 RCTs, and 2 QRCTs. Among the 938 members of the KSNS, 72 responded to the survey. A minimum of 1 to 3 months of conservative management was the most preferred answer (58%), followed by a conservative management period of less than 1 month (33%). Percutaneous endoscopic discectomy was more preferred by the hospitals that specialized in spinetreatment than by the university hospitals (p<0.05). Conclusion: Conservative management for a minimum of 2 weeks to 3 months is recommended for patients with tolerable pain only. The patients with neurological compromise or intolerable pain should be considered for surgery. There is strong evidence on the relative effectiveness of surgical discectomy versus chemonucleolysis versus placebo. There is no scientific evidence on the effectiveness of any other form of minimally invasive procedure. Background: The purpose of this study was 1) to review the length of an adequate period of conservative treatment and the appropriate surgical indications for herniated lumbar disc (HLD), 2) to collate the scientific evidences on surgeries for HLD, and 3) to collect expert opinions on HLD. Methods: We searched for articles in PubMed, the Cochrane Library and KoreaMed up to 1 October 2008, and these articles were concerned with the natural history of HDL, systemic reviews of HDL and expert opinions on HLD. We also searched for meta-analyses and randomized or quasi-randomized controlled trials (RCTs or QRCTs) of surgery for HLD. We performed a meta-analysis using the Cochrane method. The survey consisting of 21 questions was delivered to all the members of the Korean Spinal Neurosurgery Society (KSNS) via E-mail. Results: A total of 59 articles were included in this study. There were 16 articles concerning the period of conservative management and the surgical indications. Among the 33 articles on surgery for HLD, there were 4 meta-analyses, 27 RCTs, and 2 QRCTs. Among the 938 members of the KSNS, 72 responded to the survey. A minimum of 1 to 3 months of conservative management was the most preferred answer (58%), followed by a conservative management period of less than 1 month (33%). Percutaneous endoscopic discectomy was more preferred by the hospitals that specialized in spinetreatment than by the university hospitals (p<0.05). Conclusion: Conservative management for a minimum of 2 weeks to 3 months is recommended for patients with tolerable pain only. The patients with neurological compromise or intolerable pain should be considered for surgery. There is strong evidence on the relative effectiveness of surgical discectomy versus chemonucleolysis versus placebo. There is no scientific evidence on the effectiveness of any other form of minimally invasive procedure.

Effect of surface sealant on surface roughness of dental composite with different surface roughness

신동아,진선주,배꽃별,황인남 대한턱관절교합학회 2023 구강회복응용과학지 Vol.39 No.4

Purpose: This study aimed to evaluate the influence of surface sealants on the surface roughness of composite resins. Materials and Methods: The study used microfilled composite resin (Metafil CX, Sun Medical Co.) and hybrid composite resin (Aelite™ LS posterior, Bisco). Sixty specimens (8 mm in diameter and 4 mm in height) of each composite resin type were prepared and divided into 3 groups. Each specimen was ground with 600, 1000, and 2000-grit sandpaper. The Surface roughness (Ra) values were measured using a surface roughness tester (SJ-301, Mytutoyo) before and after surface sealant application. Surface sealants, BisCover™ LV (Bisco), Optiguard® (Kerr), and Seal-n-Shine™ (Pulpdent), were applied to the specimens, as instructed and observed by scanning electron microscope (JSM-7500, JEOL) and atomic force microscope (MultiMode IV, Veeco Instruments). Results: Specimens ground with 600-grit sandpaper coated with surface sealants exhibited significantly lower Ra values than the untreated group (P < 0.05). Specimens ground with 1000 and 2000-grit sandpaper showed statistically no difference. There was no significant difference in surface roughness among BisCover™ LV, Optiguard®, and Seal-n-Shine™. SEM and AFM revealed remarkably decreased micro-defects on the surfaces of composite resins after surface sealant application. Conclusion: Surface sealants can influence surface roughness when applied on the rough surface of composite resins but not on highly polished composite resins.

The Use of Magnetic Resonance Imaging in Predicting the Clinical Outcome of Spinal Arteriovenous Fistula

신동아,김긍년,박근영,지규열,이성,하윤,박승우,윤도흠 연세대학교의과대학 2015 Yonsei medical journal Vol.56 No.2

Purpose: Magnetic resonance imaging (MRI) has been used to screen and follow-up spinal dural arteriovenous fistulae (SDAVF). The purpose of this study was to evaluate the association between MRI findings and neurologic function in SDAVF. This study also investigated clinical features and treatment results of SDAVF. Materialsand Methods: A total of 15 consecutive patients who underwent embolizationor surgery for SDAVF were included. We treated seven (60%) patients with embolization and six (40%) with surgery. We analysed clinical features, MRI findings,treatment results, and neurologic function. Neurologic function was measuredby the Aminoff-Logue disability scale (ALS). Results: Patients with longer levels of intramedullary high signal intensity in preoperative T2-weighted images (T2WI) exhibited worse pre- and postoperative ALS scores (r=0.557, p=0.031; r=0.530, p=0.042, Pearson correlation). Preoperative ALS score was significantly correlated with postoperative ALS score (r=0.908, p=0.000, Pearson correlation). The number of levels showing intramedullary high signal intensity in T2WI decreasedsignificantly postoperatively (5.2±3.1 vs. 1.0±1.4, p=0.001, Wilcoxon ranked test). Conclusion: The number of involved levels of high signal intensity in preoperative T2WI is useful for predicting pre- and postoperative neurologic functionin SDAVF.

한국의 자기공명영상검사 건강보험정책

신동아 대한의사협회 2021 대한의사협회지 Vol.64 No.3

On August 9, 2017, the government announced a policy to strengthen health insurance coverage. The main goal is to increase the health insurance coverage rate and lower the national medical expense burden by an average of 18% by 2022. This policy was proposed without consulting doctors, a major medical care provider, and raised the impression of populism. It is a concern that this policy may place an additional financial burden on the medical clinics, which are already suffering due to poor financial circumstances. Although the policy is already in progress, it is necessary to carefully review whether the government and the medical community can afford it in terms of the national healthcare financial burden and the implementation possibility of this policy. There is no disagreement on the efficient supply of qualified medical care. However, it must be a sustainable system in Korea. Simply increasing the coverage rate does not increase the quality of healthcare. This study aims to analyze the government's health insurance policy for magnetic resonance imaging tests and suggest proper countermeasures.