Machine Learning Model to Predict Osteoporotic Spine with Hounsfield Units on Lumbar Computed Tomography

Nam, Kyoung Hyup,Seo, Il,Kim, Dong Hwan,Lee, Jae Il,Choi, Byung Kwan,Han, In Ho The Korean Neurosurgical Society 2019 Journal of Korean neurosurgical society Vol.62 No.4

Objective : Bone mineral density (BMD) is an important consideration during fusion surgery. Although dual X-ray absorptiometry is considered as the gold standard for assessing BMD, quantitative computed tomography (QCT) provides more accurate data in spine osteoporosis. However, QCT has the disadvantage of additional radiation hazard and cost. The present study was to demonstrate the utility of artificial intelligence and machine learning algorithm for assessing osteoporosis using Hounsfield units (HU) of preoperative lumbar CT coupling with data of QCT. Methods : We reviewed 70 patients undergoing both QCT and conventional lumbar CT for spine surgery. The T-scores of 198 lumbar vertebra was assessed in QCT and the HU of vertebral body at the same level were measured in conventional CT by the picture archiving and communication system (PACS) system. A multiple regression algorithm was applied to predict the T-score using three independent variables (age, sex, and HU of vertebral body on conventional CT) coupling with T-score of QCT. Next, a logistic regression algorithm was applied to predict osteoporotic or non-osteoporotic vertebra. The Tensor flow and Python were used as the machine learning tools. The Tensor flow user interface developed in our institute was used for easy code generation. Results : The predictive model with multiple regression algorithm estimated similar T-scores with data of QCT. HU demonstrates the similar results as QCT without the discordance in only one non-osteoporotic vertebra that indicated osteoporosis. From the training set, the predictive model classified the lumbar vertebra into two groups (osteoporotic vs. non-osteoporotic spine) with 88.0% accuracy. In a test set of 40 vertebrae, classification accuracy was 92.5% when the learning rate was 0.0001 (precision, 0.939; recall, 0.969; F1 score, 0.954; area under the curve, 0.900). Conclusion : This study is a simple machine learning model applicable in the spine research field. The machine learning model can predict the T-score and osteoporotic vertebrae solely by measuring the HU of conventional CT, and this would help spine surgeons not to under-estimate the osteoporotic spine preoperatively. If applied to a bigger data set, we believe the predictive accuracy of our model will further increase. We propose that machine learning is an important modality of the medical research field.

Spinal Epidural Hematoma after Pain Control Procedure

Nam, Kyoung-Hyup,Choi, Chang-Hwa,Yang, Moon-Seok,Kang, Dong-Wan The Korean Neurosurgical Society 2010 Journal of Korean neurosurgical society Vol.48 No.3

Spinal epidural hematoma is a rare complication associated with pain control procedures such as facet block, acupuncture, epidural injection, etc. Although it is an uncommon cause of acute myelopathy, and it may require surgical evacuation. We report four patients with epidural hematoma developed after pain control procedures. Two procedures were facet joint blocks and the others were epidural blocks. Pain was the predominant initial symptom in these patients while two patients presented with post-procedural neurological deficits. Surgical evacuation of the hematoma was performed in two patients while in remaining two patients, surgery was initially recommended but not performed since symptoms were progressively improved. Three patients showed near complete recovery except for one patient who recovered with residual deficits. Although, spinal epidural hematoma is a rare condition, it can lead to serious complications like spinal cord compression. Therefore, it is important to be cautious while performing spinal pain control procedure to avoid such complications. Surgical treatment is an effective option to resolve the spinal epidural hematoma.

Intracranial Extension of Spinal Subarachnoid Hematoma Causing Severe Cerebral Vasospasm

Nam, Kyoung Hyup,Lee, Jae Il,Choi, Byung Kwan,Han, In Ho The Korean Neurosurgical Society 2014 Journal of Korean neurosurgical society Vol.56 No.6

Spinal subarachnoid hemorrhages (SAH) can extend into the intracranial subarachnoid space, but, severe cerebral vasospasm is rare complication of the extension of intracranial SAH from a spinal subarachnoid hematoma. A 67-year-old woman started anticoagulant therapy for unstable angina. The next day, she developed severe back pain and paraplegia. MRI showed intradural and extramedullar low signal intensity at the T2-3, consistent with intradural hematoma. High signal intensity was also noted in the spinal cord from C5 to T4. We removed subarachnoid hematoma compressing the spinal cord. The following day, the patient complained of severe headache. Brain CT revealed SAH around both parietal lobes. Three days later, her consciousness decreased and left hemiplegia also developed. Brain MRI demonstrated multiple cerebral infarctions, mainly in the right posterior cerebral artery territory, left parietal lobe and right watershed area. Conventional cerebral angiography confirmed diffuse severe vasospasm of the cerebral arteries. After intensive care for a month, the patient was transferred to the rehabilitation department. After 6 months, neurologic deterioration improved partially. We speculate that surgeons should anticipate possible delayed neurological complications due to cerebral vasospasm if intracranial SAH is detected after spinal subarachnoid hematoma.

Unruptured Intracranial Aneurysms with Oculomotor Nerve Palsy : Clinical Outcome between Surgical Clipping and Coil Embolization

Nam, Kyoung-Hyup,Choi, Chang-Hwa,Lee, Jae-Il,Ko, Jun-Gyeong,Lee, Tae-Hong,Lee, Sang-Weon The Korean Neurosurgical Society 2010 Journal of Korean neurosurgical society Vol.48 No.2

Objective : To evaluate the clinical outcome of coil embolization for unruptured intracranial aneurysm (UIA) with oculomotor nerve palsy (ONP) compared with surgical clipping. Methods : A total of 19 patients presented with ONP caused by UIAs between Jan 2004 and June 2008. Ten patients underwent coil embolization and nine patients surgical clipping. The following parameters were retrospectively analyzed to evaluate the differences in clinical outcome observed in both coil embolization and surgical clipping : 1) gender, 2) age, 3) location of the aneurysm, 4) duration of the symptom, and 5) degree of ONP. Results : Following treatment, complete symptomatic recovery or partial relief from ONP was observed in 15 patients. Seven of the ten patients were treated by coil embolization, compared to eight of the nine patients treated by surgical clipping (p = 0.582). Patient's gender, age, location of the aneurysm, size of the aneurysm, duration of symptom, and degree of the ONP did not statistically correlate with recovery of symptoms between the two groups. No significant differences were observed in mean improvement time in either group (55 days in coil embolization and 60 days in surgical clipping). Conclusion : This study indicates that no significant differences were observed in the clinical outcome between coil embolization and surgical clipping techniques in the treatment of aneurysms causing ONP. Coil embolization seems to be more feasible and safe treatment modality for the relief and recovery of oculomotor nerve palsy.

One Stage Posterior Minimal Laminectomy and Video-Assisted Thoracoscopic Surgery (VATS) for Removal of Thoracic Dumbbell Tumor

Nam, Kyoung Hyup,Ahn, Hyo Yeoung,Cho, Jeong Su,Kim, Yeoung Dae,Choi, Byung Kwan,Han, In Ho The Korean Neurosurgical Society 2017 Journal of Korean neurosurgical society Vol.60 No.2

Objective : This study was conducted to assess the surgical results of one-stage posterior minimal laminectomy and video-assisted thoracoscopic surgery (VATS) for the treatment of thoracic dumbbell tumor and to describe its precise technique. In addition, we investigated the technique's usefulness and limitations. Methods : Seven cases of thoracic dumbbell tumor (two men and five women, mean age, 43 years) were analyzed retrospectively. Pathological findings included schwannoma in four patients, neurofibroma in two patients, and hemangioma in one patient. The location of tumors varied from T2/3 to T12/L1. Dumbbell tumors were resected by one-stage operation using posterior laminectomy followed by VATS without instrumentation. Clinical data were reviewed. Results : The mean follow-up period was 25 months (range, 3-58 months), and the operative time ranged from 255 to 385 min (mean, 331 min), with estimated blood loss ranging from 110 to 930 mL (mean, 348 mL). The tumor was completely resected without instrumentation and postoperative instability in all cases. Postoperative complications included atelectasis and facial anhydrosis in one case each. Conclusion : One-stage posterior minimal laminectomy and VATS may be a safe and less invasive technique for removal of thoracic dumbbell tumor without instability. This method has the advantage of early ambulation and rapid recovery because it reduces blood loss and postoperative pain.

응급 수술을 시행한 신경외상 환자들에 있어 전염성 바이러스 감염의 유병율에 대한 분석

남경협 ( Kyoung Hyup Nam ),최혁진 ( Hyuk Jin Choi ),이재일 ( Jae Il Lee ),고준경 ( Jun Kyeung Ko ),한인호 ( In Ho Han ),조원호 ( Won Ho Cho ) 대한외상학회 2015 大韓外傷學會誌 Vol.28 No.1

Purpose: The aim of this study was to estimate the seropositive prevalence of blood-borne infection in neurotrauma patients who underwent emergent surgical intervention, especially patients with hepatitis B virus (HBV), hepatitis C virus (HCV), syphilis and human immunodefIciency virus (HIV). Methods: A retrospective review identified 559 patients with traumatic brain injury and spinal trauma who underwent emergent surgery between 2007 and 2014. We reviewed the medical records and extracted data, including age, sex, location of lesion, result of serologic tests, time interval of admission and surgery after presenting to emergency room. Serologic tests for HBV, HCV, syphilis and HIV were performed and analyzed to determine whether the seropositive results were confirmed by the surgeon before surgery. Results: The majority of the patients were male (74.6%), and the mean age was 55.4±20.2 years. Most patients underwent surgery due to traumatic brain injury (90.0%). Fifty-three patients (10.0%) showed a positive result on at least one serologic test. Seropositive rates according to pathogens were 0.5% for syphilis, 5.2% for HBV and 3.9% for HCV. No positive results were noted on the serologic tests for HIV. HBV in patients with spinal cord injury and age from 40 to 49 years were associated with high serologic positive rate, and that result was statistically significant. However, no statistically significant differences were found in the other variables. Serologic results could not confirmed before surgery in the majority of the cases (62.1%), and 10.4% of these patients showed seropositive results. Conclusion: The results of this study emphasize the importance of taking precautions and conducting rapid serologic testing in preventing the occupational transmission of blood-borne viruses to health-care workers. [ J Trauma Inj 2015; 28: 9-14 ]

례뇌하수체 선종과 동반되어 안상조에 발생한 지주막 낭종

남경협 ( Kyoung Hyup Nam ),차승헌 ( Seung Heon Cha ),조원호 ( Won Ho Cho ),최병관 ( Byung Kwan Choi ) 대한뇌종양학회·대한신경종양학회·대한소아뇌종양학회 2012 대한뇌종양학회지 Vol.11 No.1

Objectives: Arachnoid cysts are a relatively rare pathological entity, and a suprasellar arachnoid cyst is quite rare. We report on an extremely rare case of a suprasellar arachnoid cyst associated pituitary adenoma and discuss the possible pathogenesis. Clinical Presentation: A 24-year-old man was admitted to the hospital with a history of headache, visual field defect, gait disturbance, syncope, and urinary incontinence. Computed tomography showed severe hydrocephalus. Preoperative magnetic resonance images revealed a mass lesion in the sella turcica with suprasellar extension and a coexisting large supra- and parasellar cyst. Transcranial surgery was performed for the removal of the tumor mass and cyst. Ventricle size normalized after the operation. He exhibited an uneventful recovery without neurologic deficits or endocrinologic abnor-malities. Conclusion: We present clinical, radiological, and histopathological findings and discuss the possible pathogenesis of a suprasellar arachnoid cyst associated pituitary adenoma.

노인 심방세동 환자의 원인기저 질환 분석

조대경,위준환,염주협,고재민,이태호,정성오,김태훈,정봉기,남홍우,이홍순,유수웅,문언수 대한노인병학회 2000 Annals of geriatric medicine and research Vol.4 No.3

Penetrating sacral injury with a metallic pipe: a case report and literature review

( Mahnjeong Ha ),( Kyoung Hyup Nam ),( Jae Hun Kim ),( In Ho Han ) 대한외상학회 2022 大韓外傷學會誌 Vol.35 No.2

Other than gunshot injuries, sacral penetrating injuries with a foreign body exiting to the other side are extremely rare. We encountered a case of sacral injury in which a long metallic pipe penetrated from the anus into the lower back of a patient. Since the pelvis contains various organs, management of a penetrating injury requires multidisciplinary treatment involving several medical specialties. Due to the infrequency of this type of injury, there are no definitive guidelines for effective management. We described our experience surgically treating a sacral penetrating injury and conducted a literature review. On this basis, we suggest a surgical strategy for treating this type of injury.

Modic Degenerative Marrow Changes in the Thoracic Spine : A Single Center Experience

Lee, Jae Meen,Nam, Kyoung Hyup,Lee, In Sook,Park, Se Kyung,Choi, Byung Kwan,Han, In Ho The Korean Neurosurgical Society 2013 Journal of Korean neurosurgical society Vol.54 No.1

Objective : The purposes of this study were to evaluate the prevalence, types, and locations of Modic changes (MCs) in the thoracic spine in a large number of subjects, and to investigate the relation between the distributions of MCs and disc herniations (DHs) in the thoracic spine. Methods : Two experienced musculoskeletal radiologists assessed the presence of MCs and DHs by consensus in the thoracic MRIs of 144 patients with non-specific back pain. Patient ages ranged from 22 to 88 years (mean=$53.3{\pm}14.66$ years), and 72 were female (50%). The prevalence, distribution, relation of MCs and DHs was recorded. Results : MC was observed in 8 of the 144 patients (5.6%) and 10 of 1728 segments (0.58%). The most common MC was type II. Of the 8 patients exhibiting MC, 6 had type II (75.0%), and 2 had mixed MCs (type I/II or type II/III). MCs were distributed mainly at the mid-thoracic level (from T5/6 to T9/10). DH was detected in 18 patients (12.5%), 36 of 1728 segments (2.1%). Of the 10 segments exhibiting MC, 5 had DHs at the same level (50.0%). Accordingly, DH was strongly associated with MC (p=0.000). Conclusion : A low prevalence of MC was observed in the thoracic spine, and type II MC predominated. The low prevalence of MC in the thoracic spine suggests that it was caused by a relative lack of mobility as compared with the cervical and lumbar spines. And DHs were found to be strongly associated with MCs even in the thoracic spine.