Degenerative Changes of Spine in Helicopter Pilots

변주현,김정원,정호중,심영주,김동규,최종경,임형준,김기찬 대한재활의학회 2013 Annals of Rehabilitation Medicine Vol.37 No.5

Objective To determine the relationship between whole body vibration (WBV) induced helicopter flights and degenerative changes of the cervical and lumbar spine.Methods We examined 186 helicopter pilots who were exposed to WBV and 94 military clerical workers at a military hospital. Questionnaires and interviews were completed for 164 of the 186 pilots (response rate, 88.2%) and 88 of the 94 clerical workers (response rate, 93.6%). Radiographic examinations of the cervical and the lumbar spines were performed after obtaining informed consent in both groups. Degenerative changes of the cervical and lumbar spines were determined using four radiographs per subject, and diagnosed by two independent, blinded radiologists. Results There was no significant difference in general and work-related characteristics except for flight hours and frequency between helicopter pilots and clerical workers. Degenerative changes in the cervical spine were significantly more prevalent in the helicopter pilots compared with control group. In the cervical spine multivariate model, accumulated flight hours (per 100 hours) was associated with degenerative changes. And in the lumbar spine multivariate model, accumulated flight hours (per 100 hours) and age were associated with degenerative changes. Conclusion Accumulated flight hours were associated with degenerative changes of the cervical and lumbar spines in helicopter pilots.

가토 모델에서 성장호르몬이 퇴행성 요추 추간판의 변화에 미치는 영향

박영진,한성호,황인경 고신대학교 의과대학 2011 고신대학교 의과대학 학술지 Vol.26 No.2

OBJECTIVES: Growth hormone is expected to delay the degenerative changes of the intervertebral disc and affect the initial recovery process of cartilage injury, but these effects are still open to disputes. METHODS: This researcher injected growth hormone to the intervertebral disc and subcutaneous tissue of rabbits whose degenerative change were induced artificially, and evaluated the treatment effects of growth hormone through a comparison between the injected and control groups of rabbits. The intervertebral discs between the 3th and 4th vertebrae were extracted 4 weeks after the administration of growth hormone and then histologically graded in a quantitative method. Changes in the height of the intervertebral discs were measured after the induction of degenerative changes. After four weeks of the treatment, then, the height changes were measured. RESULTS: In the subcutaneous-growth hormone injected group, any consistent, sequential, and progressive degeneration of the annular fibrosus was not observed through histopathological studies. The disc height also sequentially did not decrease from that at the time of the injury set in this study. CONCLUSIONS: Considering the histopathological findings of the study, the researcher suggests that subcutaneous injection of growth hormone will be a therapeutic model of disc degeneration. But further biochemical or electromicroscopic studies are necessary to clarify the mechanism of delay degenerative disc changes by growth hormone.

일부 50대 척추전방전위증 환자의 유형별 자기공명영상상 추간판 변형 형태 고찰

김석,반효정,윤현석,한경완,우재혁,Kim, Seok,Bahn, Hyo-Jung,Yoon, Hyun-Seok,Han, Kyung-Wan,Woo, Jae-Hyuk 척추신경추나의학회 2011 척추신경추나의학회지 Vol.6 No.2

Objectives : The purpose of this study is to find out the characteristics of intervertebral disc changes and relative factors of the spondylolisthesis patients in fifties by type of spondylolisthesis. Methods : We investigated 69 cases of patients who visited one Korean traditional medicine hospital and were diagnosed as spondylolisthesis on L-spine X-ray and L-spine magnetic resonance imaging(MRI). We selected 37 lytic spondylolisthesis patients and 32 degenerative spondylolisthesis patients. We analysed the relativity between the numbers of changed discs, types of changed disc, locations of nerve compression and types of spondylolisthesis. Results : 1. The number of changed discs increase in lytic type, but there is no statistically significant difference. 2. Bulging disc is the dominant type of disc change. There is no significant difference between two types. 3. Both foraminal type was shown dominantly in lytic spondylolisthesis, diffuse type in degenerative spondylolisthesis by the analysis of the location of the nerve compression. But the symptoms of patients and dermatome did not match in most of the cases. Conculsions : The direction of nerve compression is different while the disc changing aspects are similar in both types. In several spondylolisthesis patients in fifties, symptoms of patient are related to degeneration of vertebrae, not to the type of spondylolisthesis.

Biomechanical analysis of lumbar decompression surgery in relation to degenerative changes in the lumbar spine – Validated finite element analysis

Li, Quan You,Kim, Ho-Joong,Son, Juhyun,Kang, Kyoung-Tak,Chang, Bong-Soon,Lee, Choon-Ki,Seok, Hyun Sik,Yeom, Jin S. Elsevier 2017 Computers in biology and medicine Vol.89 No.-

<P><B>Abstract</B></P> <P><B>Background</B></P> <P>There are no studies about the biomechanical analysis of lumbar decompression surgery in relation to degenerative changes of the lumbar spine. Therefore, the purpose of this study was to compare, by using finite element (FE) analysis, the biomechanical changes of the lumbar spine in terms of annulus stress and nucleus pressure after two different kinds of lumbar decompression surgery in relation to disc degenerative changes.</P> <P><B>Methods</B></P> <P>The validated intact and degenerated FE models (L2-5) were used in this study. In these two models, two different decompression surgical scenarios at L3-4, including conventional laminectomy (ConLa) and the spinous process osteotomy (SpinO), were simulated. Therefore, a total of six models were simulated. Under preloading, 7.5 Nm moments of flexion, extension, lateral bending, and torsion were imposed. In each model, the maximal von Mises stress on the annulus fibrosus and nucleus pressure at the index segment (L3-4) and adjacent segments (L2-3 and L4-5) were analyzed.</P> <P><B>Results</B></P> <P>The ConLa model and disc degeneration model demonstrated a larger annulus stress at the decompression level (L3-4) under all four moments than were seen in the SpinO model and healthy disc model, respectively. Therefore, the ConLa model with moderate disc degeneration showed the highest annulus stress at the decompression level (L3-4). However, the percent change of annulus stress at L3-4 from the intact model to the matched decompression model was less in the moderate disc degeneration model than in the healthy disc model.</P> <P><B>Conclusions</B></P> <P>Although the ConLa model with moderate disc degeneration showed the highest annulus stress, the degenerative models would be less influenced by the decompression technique.</P>

요통환자 80례에 대한 임상적 고찰

전성하,류헌식,장병선,김수현,박희진 대한침구의학회 2007 대한침구의학회지 Vol.24 No.2

Objectives: This study was performed to evaluate the general distribution and the efficacy of oriental medical treatment for low back pain . Methods: The 80 cases of low back pain patients was analyzed according to the distribution of sex ,age, the period of disease, contributing factor, the patient-condition on admission , the symptom on admission, the duration of admission, the reading of the X-ray and the treatment efficacy was evaluated respectively. Results: 1. Female was more than male in the ratio of 1:1.2,and thirties and seventies 25% the most, the acutest phase 46.3% the most, reason unknown 33.8% the most, Grade Ⅲ 50% the most, L.B.P. only 51.3% the most, the day of 6-10 30% the most, compression Fx 30% the most. 2.In the total treatment result, the good was 51.3% ,the excellent 22.5%, the fair 17.5%, the poor 8.8% in order. About 'the effective rate' (the percentage of positive effective treatment cases) of each distribution, the fifties 100% the most, the acutest phase 97.3% the most, the slip down, weight lifting, overuse 100% the most respectively, Grade Ⅲ 97.5% the most, L.B.P. only 95.1% the most, the day of 11-15 100% the most, H.N.P. 93.3% the most. Conclusions: We have known the efficacy of oriental medical treatment for L.B.P. was good and early treatment was better than late treatment and main cause of L.B.P. was degenerative change.

만성 무릎관절 통증환자에서 내측 반월상연골 손상과 관절 퇴행성 변화의 감별을 위한 ^99mTc-MDP 무릎관절 SPECT의 진단기준

팽진철,정준기,정환정,유재호,강원준,소영,이동수,이명철,성상철,이명철 대한핵의학회 2003 핵의학 분자영상 Vol.37 No.2

목적 : 만성 무릎관절 통증환자에서 관절의 퇴행성 변화로 인하여 ^99mTc-MDP SPECT를 이용한 관절 내 장애의 진단성능이 떨어지게 된다. 이 연구에서는 내측 구획의 섭취 증가가 관찰될 때 이를 내측 반월상연골 손상(MMI)과 퇴행성 변화(DC)로 감별 진단하기 위한 진단기준을 찾고자 하였다. 대상 및 방법 : 3개월 이상의 만성 통증으로 무릎관절 SPECT를 시행하고 이후 관절경 검사를 통해 관절 병소의 확진을 받은 환자 중 SPECT 상 내측 구회에 섭취 증가를 보인 47명, 49예의 영상을 대상으로 하였다. SPECT 영상에서 내측 경골 고원부에 초승달 모양의 섭취가 관찰될 때 MMI로 진단하는 기준(진단기준 Ⅰ), 초승달 모양 섭취 양상에 따라 전측, 중앙측, 후측 및 미만성으로 구분하고 이 중 중앙측, 후측, 미만성만을 MMI로 진단하는 기준(진단기준 Ⅱ), 이에 더해 섭취의 정도를 등급화하여 내측 구획에서 대퇴골 부위보다 경골 고원부의 섭취가 더 높을 때만 MMI로 진단하는 기준(진단기준 Ⅲ)의 세 가지 진단기준을 설정하고 이들의 진단성능을 비교하였다. 결과 : MMI 진단의 예민도와 특이도가 진단기준 Ⅰ에서 각각 93%, 14%, 진단기준 Ⅱ에서 각각 89%, 38%, 진단기준 Ⅲ에서 75%. 67%로 형태학적 기준과 섭취 정도에 의한 기준을 첨가할수록 진단성능이 향상되었다. 결론 : 이 연구에서는 무릎관절 SPECT가 적용되는 실제 임상 적응중에 가까운 만성 무릎관절 통증에서, 퇴행성 변화와 관절 내 장애를 감별하는 향상된 진단기준을 제시하였다. 이를 통하여 선별검사로서 무릎관절 SPECT의 진단적 가치를 더욱 높일 것으로 기대된다. Purpose: In patients with chronic knee pain, the diagnostic performance of ^99mTc-MDP knee SPECT for internal derangement of knee is deteriorated due to degenerative changes. In this study, we tried to establish diagnostic criteria to differentiate medial meniscal injury (MMI) from degenerative change (DC) when the uptake is increased in medial compartment. Materials and Methods: A total of 49 knee SPECT of the patients with chronic (more than 3 months) knee pain, which showed increased ^99mTc-MDP uptake in the medial compartment, were included in this study. The diagnosis was confirmed by arthroscopy. On knee SPECT, 3 diagnosic criteria for MMI were investigated. In Criterion Ⅰ, MMI was diagnosed when crescentic uptake was observed in the medial tibial plateau. In Criterion Ⅱ, crescentic uptake was further classified into anterior, mid, posterior, and diffuse patterns, according to the location of maximal uptake; and only crescentic mid posterior, and diffuse patterns were diagnosed as MMI. In Criterion Ⅲ, MMI was diagnosed when medial tibial plateau showed higher activity then medial femoral condyle. The diagnostic performance of the 3 criteria was compared. Results: The sensitivity and specificity were 93% and 14% in Criterion Ⅰ, 89% and 38% in Criterion Ⅱ, and 75% and 67% in Criterion Ⅲ, respectively. Criterion Ⅲhad significantly improved diagnostic performance, especially, specificity. Conclusion: In this study, we established a practical diagnostic criterion to differentiate MMI from DC on knee SPECT. The result is helpful to improve the diagnostic value of knee SPECT as a screening test for chronic knee pain.

다양한 중간엽 줄기 세포를 척추 추간판 디스크로 진단된 젊은 군인 환자에서 얻은 추간판 세포에 공배양할 때 재생 반응 연구

윤상훈 ( Sang Hoon Yoon ),김대희 ( Dae Hee Kim ),조샘 ( Sam Cho ) 국군의무사령부 2020 대한군진의학학술지 Vol.51 No.1

Objective; We performed an experimental study that bone marrow derived stem cells(BMSC) can show effective regeneration of nucleus pulposus cell (NPC)s when they are co-cultured on NPC. Method; NPCs were separated from discarded nucleus pulposus tissue from 4 patients who underwent spinal surgery for cervical disc herniation(n=2) or lumbar disc herniation (n = 2). Total 12 nucleus pulposus cell passages were studied. For co-culture wells without contact, BMSC and Adipose Derived stem cell(ASC) were seeded on tissue culture plates. Co-cultured cells were maintained for 2 days and the supernatant was collected. Senescence associated-β-gal (SA-β-gal) staining was performed to analyze the rate of positive staining for degeneration in the ASC and BMSC co-cultured groups. Cells stained with SA-β-gal were calculated and presented as a rate that differs from the total number of cells(%). The total number of cells was counted on one slide stained with SA-β-gal. Glycosaminoglycan (GAG) secretion was measured at 450nm absorbance with the commercialized kit to analyze optical density. Results; In the case of cells stained with SA-β-gal, the proportion of cells stained in all cells decreased significantly when co-cultured with BMSC and ASC. (P=0.015 vs P=0.02) As a result of measuring the optical density related to GAG secretion, the BMSC co-cultured with NPCs group showed the decreased amount of GAG secretion (-5.55%) rather than the ASC co-cultured with NPCs group showed increased amount of GAG secretion (+10.34%). Conclusion; In the case of co-culturing NPCs with BMSC, SA-β-gal staining showed presumably regenerative changes. However, GAG secretion significantly decreases when co-cultured with BMSC rather than significantly increases when co-cultured with ASC. So it is necessary to confirm its meaning additionally to make much larger scaled experimental study.

경추전방 유합술후 인접분절의 퇴행성 변화

강종원,김환정,성환일,박건영,박재국,강성일,최원식 대한척추외과학회 2008 대한척추외과학회지 Vol.15 No.4

Study Design: A retrospective radiologic analysis of 34 patients Objectives: To evaluate the factors influencing the radiographic degenerative changes in the adjacent segments in one-level ACDF Summary of Literature Review: There is a 25% incidence of adjacent segment degeneration after 5 years. Materials and Method: From 2002 to 2005, 34 patients (male 23, female 11) underwent anterior cervical spine fusion using a cage or bone block for degenerative cervical spine. The mean age of the patients was 51 years and the mean follow-up period was 24 months. The degenerative findings of the upper and lower adjacent segment were measured from the pre-operative MRI. The fused segment curvature, disc heights of the adjacent segments, displacement of the vertebral bodies and angular mobility in the adjacent segments were measured from the pre-operative and final follow-up lateral views in the neutral position, in both flexion and extension. Results: Degenerative changes in the adjacent segments were observed in 19 of the 34 patients. The group with degenerative changes showed significantly more lordotic angular loss of the fusion segments (11.9±3.1˚) at the follow-up observation than the group with no degenerative changes (9.0±1.1˚) (p=0.04). The group with degenerative change showed a significantly larger increase in disc height of the fusion segments (2.8±0.2 mm) at the follow-up observation than the group with no degenerative changes (2.2±0.3 mm) (p=0.02).The group with a Grade IV or higher level of pre-operative disc degeneration showed more degenerative changes in the adjacent segments than those with Grade III or lower. Conclusions: It is important to preserve the lordotic angle of fused segments and avoid excessive increases in disc height. The recurrence of the neurological is not associated with the preoperative adjacent segmental degenerative changes in ACDF.

단순 방사선 사진에서 견봉 및 상완골 대결절의 퇴행성 변화와 MRI상 회전근 개 파열 정도와의 연관성

최정윤(Jung-Yun Choi),염재광(Jae-Mwang Yum),송민철(Min-Cheol Song) 대한견주관절의학회 2013 대한견주관절의학회지 Vol.16 No.1

목적: 단순 방사선 사진상에서 견봉 및 상완골 대결절의 퇴행성 변화의 정도와 회전근 개 파열의 크기 사이의 연관성을 알아보고자 하였다. 대상 및 방법: 견관절의 자기 공명 영상을 시행한 퇴행성 회전근 개 파열 실험군 234예와 회전근 개 파열이 없는 대조군 284예 등 총 518예를 대상으로 하였다. 견관절 방사선 단순 촬영에서 퇴행성 변화의 정도를 관절와-상완 관절의 퇴행성 변화를 제외한 견봉과 대결절에서 골극의 길이와 형태의 변형에 따라 분류하였고, 자기 공명 영상에서 회전근 개의 파열의 정도 및 전층 파열의 크기를 분류하였다. 회전근 개의 파열의 정도와 크기에 따른 견봉 및 상완골 대결절의 퇴행성 변화 정도와의 연관성에 대해 알아 보았다. 결과: 견관절 단순 방사선 사진에서 보이는 견봉 및 상완골 대결절의 퇴행성 변화에 따른 MRI상 회전근개 파열의 정도는 유의한 차이를 보였고(p<0.001), 견봉 및 상완골 대결절의 단순 방사선상 퇴행성 변화가 증가할수록 회전근 개 파열의 크기가 커지는 경향이 있었으며(p<0.001), 부분층 파열 보다 전층 파열 가능성이 높은 것으로 나타났다(p<0.001). 또한 고령 및 여자에서 회전근 개의 파열이 더 심하다는 결과를 얻었다(p<0.001, p<0.001). 결론: 퇴행성 회전근 개 파열 환자에서 견관절의 단순 방사선 사진상 견봉 및 상완골 대결절의 퇴행성 변화가 심할수록 회전근 개 파열의 크기가 더 크고, 나이와 성별도 관련 인자 중 하나로 사료된다. Purpose: The purpose of this study is to analyze the correlation between the degree of torn rotator cuff as recorded by MRI and degenerative change of acromion and greater tuberosity of humerus determined by simple radiographs. Materials and Methods: Of the 518 cases included in this study, a group of 234 cases had a chronic rotator cuff tear and a control group of 284 cases had an intact rotator cuff in shoulder MRI. The degree of degenerative changes was classified according to the length of spur and morphological change of acromion and greater tuberosity through the true anteroposterior simple radiograph in supraspinatus outlet view. The degree of tear (partial-thickness or full-thickness tear) and the size of complete rotator cuff tear were analyzed according to the MRI findings of shoulder. The authors also evaluated the correlation between the degree and size of torn rotator cuff and the degenerative change of acromion and greater tuberosity. Results: There were significant differences in the size and extent of torn rotator cuff according to the age, sex and degenerative change of acromion and greater tuberosity of humerus (p<0.001). More degenerative changes of acromion and greater tuberosity in simple shoulder radiographs showed the increased degree and size of torn rotator cuff (p<0.001). In addition, the higher degree and larger size of torn rotator cuff were noted in older age subjects (p<0.001) and in the female group (p<0.001). Conclusion: More degenerative changes of acromion and greater tuberosity in simple shoulder radiographs showed the increased degree and size of torn rotator cuff. Therefore, if a high degree of degenerative change of the acromion and greater tuberosity on simple radiograph is noted, the possibility of degenerative rotator cuff tear should be considered. In addition, the age and sex could be associative factors for larger size of torn rotator cuff.

Correlation between pain and degenerative bony changes on cone-beam computed tomography images of temporomandibular joints

Bae, SunMee,Park, Moon-Soo,Han, Jin-Woo,Kim, Young-Jun Korean Association of Maxillofacial Plastic and Re 2017 Maxillofacial Plastic Reconstructive Surgery Vol.39 No.-

Background: The aim of this study was to assess correlation between pain and degenerative bony changes on cone-beam computed tomography (CBCT) images of temporomandibular joints (TMJs). Methods: Two hundred eighty-three temporomandibular joints with degenerative bony changes were evaluated. Pain intensity (numeric rating scale, NRS) and pain duration in patients with degenerative joint disease (DJD) were also analyzed. We classified condylar bony changes on CBCT into five types: osteophyte (Osp), erosion (Ero), flattening (Fla), subchondral sclerosis (Scl), and pseudocyst (Pse). Results: Degenerative bony changes were the most frequent in the age groups of 10~19, 20-29, and 50~59 years. The most frequent pain intensity was "none" (NRS 0, 34.6%) followed by "annoying" (NRS 3-5, 29.7%). The most frequent condylar bony change was Fla (219 joints, 77.4%) followed by Ero (169 joints, 59.7%). "Ero + Fla" was the most common combination of the bony changes (12.7%). The frequency of erosion was directly proportional to NRS, but the frequency of osteophyte was inversely proportional. The prevalence of Ero increased from onset until 2 years and gradually decreased thereafter. The prevalence of Osp, Ero, and Pse increased with age. Conclusions: Osp and Ero can be pain-related variables in degenerative joint disease (DJD) patients. "Six months to 2 years" may be a meaningful time point from the active, unstable phase to the stabilized late phase of DJD.