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Article ; Online: Radiologic risk factors associated with development of myelopathy in patients with ossification of the posterior longitudinal ligament of the cervical spine.

Kwon, Woo-Keun / Ham, Chang Hwa / Moon, Hong Joo / Kim, Joo Han / Park, Youn-Kwan

2023 Volume 227, Page(s) 107668

Abstract: Study design: Retrospective Cohort Study OBJECTIVE: Myelopathy following ossification of the posterior longitudinal ligament (OPLL) is one of the devastating clinical features in these patients, while we still know little about which factors are ... ...

Abstract	Study design: Retrospective Cohort Study OBJECTIVE: Myelopathy following ossification of the posterior longitudinal ligament (OPLL) is one of the devastating clinical features in these patients, while we still know little about which factors are associated with development of myelopathy. We evaluated the difference of radiologic measurements between OPLL patients with or without myelopathy and searched for the clinical significance with emphasis on the impact of dynamic motion. Methods: 305 patients diagnosed of OPLL were enrolled for retrospective review. They were divided into two groups according to the coexistence of radiographic evidence of myelopathy. Demographic data as well as radiologic measures including the presence of disc degeneration (DD), anterior-posterior diameter (APD) of central canal, canal compromise (CC) ratio, global and segmental range of motion (gROM and sROM), OPLL type (morphologic classification) and K-line were collected. Results: APD (odds ratio (OR); 0.411), CC ratio (OR; 1.100) and sROM (OR; 1.371) were significantly associated with the presence of myelopathy in the multivariate analysis. While the statistically significant factors were same in OPLLs with CC larger than 50%, presence of DD (OR; 4.509) and sROM (OR; 1.295) were significantly associated with myelopathy but not the CC itself in OPLLs with CC smaller than 50%. Conclusions: We discovered that the APD, CC ratio and sROM had significant association with development of myelopathy in OPLLs. And the presence of dynamic factors had significant association with myelopathy in OPLLs with smaller CC ratios. This observation and its clinical significance on development of myelopathy might enhance our understanding of OPLL.
MeSH term(s)	Humans ; Longitudinal Ligaments ; Retrospective Studies ; Osteogenesis ; Treatment Outcome ; Spinal Cord Diseases/etiology ; Spinal Cord Diseases/complications ; Ossification of Posterior Longitudinal Ligament/complications ; Ossification of Posterior Longitudinal Ligament/diagnostic imaging ; Risk Factors ; Cervical Vertebrae/diagnostic imaging
Language	English
Publishing date	2023-03-09
Publishing country	Netherlands
Document type	Journal Article
ZDB-ID	193107-6
ISSN	1872-6968 ; 0303-8467
ISSN (online)	1872-6968
ISSN	0303-8467
DOI	10.1016/j.clineuro.2023.107668
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Article ; Online: Use of prophylactic perioperative antibiotics for lumbar spinal fusions: A nationwide population-based cohort study.

Ham, Chang Hwa / Kwon, Woo-Keun / Moon, Hong Joo / Kim, Joo Han / Park, Youn-Kwan / Hofstetter, Christoph P

Journal of infection and public health

2023 Volume 16, Issue 3, Page(s) 354–360

Abstract: Background: Perioperative prophylactic antibiotic (PPA) use in spine surgery is known to reduce the rate of surgical site infections. In the past decade, several evidence-based guidelines have been published and surveillance systems to monitor the ... ...

Abstract	Background: Perioperative prophylactic antibiotic (PPA) use in spine surgery is known to reduce the rate of surgical site infections. In the past decade, several evidence-based guidelines have been published and surveillance systems to monitor the proper use of antimicrobials had been adapted by many institutes. Objective: To report the trends of PPA prescription in lumbar fusion surgeries nationwide in the Republic of Korea. Methods: This is a nationwide registry study. Using the population-based data from the Republic of Korea provided by the Korean Health Insurance Review and Assessment Service, data of all lumbar spinal fusion surgeries performed between 2010 and 2018 in adult patients (age ≥19 years) were reviewed. Results: The most frequently used antibiotics were first-generation cephalosporins, which accounted for 38.2 % of total PPA prescriptions and were prescribed in 58.96 % of lumbar fusion surgeries. A gradual increase in prescription trends was observed. The second most frequently used PPAs were second-generation cephalosporins, which showed decrease in use from 2016. The frequency of vancomycin prescriptions gradually increased over the observation period and showed an almost four-fold increase in 2018 compared to 2010. First- and second-generation cephalosporins were prescribed less frequently to patients with renal disease. Conclusion: The pattern of PPA use has changed remarkably over the observation period. Furthermore, specific differences in PPA prescriptions were observed among patients with certain co-morbidities.
MeSH term(s)	Adult ; Humans ; Young Adult ; Spinal Fusion/adverse effects ; Cohort Studies ; Anti-Bacterial Agents/therapeutic use ; Vancomycin ; Cephalosporins/therapeutic use ; Retrospective Studies
Chemical Substances	Anti-Bacterial Agents ; Vancomycin (6Q205EH1VU) ; Cephalosporins
Language	English
Publishing date	2023-01-11
Publishing country	England
Document type	Journal Article
ZDB-ID	2467587-8
ISSN	1876-035X ; 1876-0341
ISSN (online)	1876-035X
ISSN	1876-0341
DOI	10.1016/j.jiph.2023.01.005
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Article ; Online: Characteristics of Sagittal Spinopelvic Alignment Changes After Symptom Relief After Simple Lumbar Decompression.

Ham, Chang Hwa / Park, Youn-Kwan / Kim, Joo Han / Kwon, Woo-Keun / Kim, Dong Wook / Moon, Hong Joo

Neurosurgery

2022 Volume 91, Issue 2, Page(s) 331–338

Abstract: Background: Sagittal spinopelvic alignment (SSPA) parameters are essential for the diagnosis of adult spinal deformities (ASDs) and their progression. Certain clinical symptoms that occur in patients with lumbar spinal stenosis (LSS) and herniated ... ...

Abstract	Background: Sagittal spinopelvic alignment (SSPA) parameters are essential for the diagnosis of adult spinal deformities (ASDs) and their progression. Certain clinical symptoms that occur in patients with lumbar spinal stenosis (LSS) and herniated nucleus pulposus (HNP) may distort the SSPA and mimic ASD. Objective: To differentiate SSPA in symptomatic patients from asymptomatic patients within 10 minutes in the standing position. Methods: This retrospective cohort study evaluated changes in SSPA after simple lumbar decompression surgery in patients with LSS and HNP. Relative sagittal alignment (RSA), relative pelvic version, relative lumbar lordosis (RLL), Lordosis Distribution Index (LDI), and global alignment and proportion (GAP) values were calculated using the conventional Schwab classification method. First, the preoperative and postoperative SSPA parameters were compared. Second, patients were subgrouped into symptomatic within 10 minutes of standing (SP group) and other symptoms of LSS and HNP as controls. Changes in SSPA parameters after symptom relief after simple lumbar decompression surgery were compared between the two groups. Results: Overall, all SSPA parameters improved after surgery. However, after subgrouping, patients in the control group did not show significant SSPA alterations, except for LDI, whereas patients in the SP group significantly improved in terms of their RSA, RLL, LDI, and GAP values after symptom relief after surgery. Conclusion: Patients with pain on standing within 10 minutes showed significant correction in RSA, RLL, and GAP values after simple lumbar decompression. Therefore, it is important to observe such clinical symptoms to avoid misdiagnosis of ASD.
MeSH term(s)	Adult ; Decompression ; Humans ; Lordosis/diagnostic imaging ; Lordosis/surgery ; Lumbar Vertebrae/diagnostic imaging ; Lumbar Vertebrae/surgery ; Retrospective Studies ; Spinal Stenosis/surgery
Language	English
Publishing date	2022-05-06
Publishing country	United States
Document type	Journal Article
ZDB-ID	135446-2
ISSN	1524-4040 ; 0148-396X
ISSN (online)	1524-4040
ISSN	0148-396X
DOI	10.1227/neu.0000000000002013
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Article ; Online: Postoperative survival after lumbar instrumented surgery for metastatic spinal tumors: a nationwide population-based cohort analysis.

Lee, Seung Hoon / Kwon, Woo-Keun / Ham, Chang Hwa / Na, Jung Hyun / Kim, Joo Han / Park, Youn-Kwan / Park, Jung Yul / Hur, Junseok W / Moon, Hong Joo

Irish journal of medical science

2023 Volume 193, Issue 1, Page(s) 51–56

Abstract: Background: It is difficult to predict the expected survival after lumbar instrumented surgery for metastases owing to the difference among different cancer origins and the relatively short survival after surgery.: Aims: The aim of this study is to ... ...

Abstract	Background: It is difficult to predict the expected survival after lumbar instrumented surgery for metastases owing to the difference among different cancer origins and the relatively short survival after surgery. Aims: The aim of this study is to analyze the postoperative survival period of lumbar spinal metastasis patients who underwent lumbar instrumented surgery. Methods: Data were collected from the Korean National Health Insurance Review and Assessment Service database. Patients who underwent lumbar spinal surgery with instrumentation between January 2011 and December 2015 for metastatic lumbar diseases were reviewed. The mean postoperative survival period of patients with metastatic lumbar cancer according to each primary cancer type was evaluated. Results: A total of 628 patients were enrolled and categorized according to primary cancer type. The overall median survival rate was 1.11±1.30 years. The three most prevalent primary cancer groups were lung, hepatobiliary, and colorectal cancers, presenting relatively short postoperative survival rates (0.93±1.25, 0.74±0.75 and 0.74±0.88 years, respectively). The best postoperative survival period was observed in breast cancer (2.23±1.83 years), while urinary tract cancer showed the shortest postoperative survival period (0.59±0.69 years). Conclusion: The postoperative survival period of patients with lumbar metastatic spinal tumors according to different primary cancers after instrumented fusion was ˃1 year overall, with differences according to different primary origins. This result may provide information regarding the expected postoperative survival after instrumented surgery for lumbar spinal metastases.
MeSH term(s)	Humans ; Spinal Neoplasms ; Lumbar Vertebrae ; Cohort Studies ; Central Nervous System Neoplasms ; Spinal Fusion ; Retrospective Studies ; Treatment Outcome
Language	English
Publishing date	2023-07-14
Publishing country	Ireland
Document type	Journal Article
ZDB-ID	390895-1
ISSN	1863-4362 ; 0021-1265
ISSN (online)	1863-4362
ISSN	0021-1265
DOI	10.1007/s11845-023-03459-7
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Article ; Online: Elucidating the effect of mechanical stretch stress on the mechanism of ligamentum flavum hypertrophy: Development of a novel in vitro multi-torsional stretch loading device.

Kwon, Woo-Keun / Ham, Chang Hwa / Choi, Hyuk / Baek, Seung Min / Lee, Jae Won / Park, Youn-Kwan / Moon, Hong Joo / Park, Woong Bae / Kim, Joo Han

PloS one

2022 Volume 17, Issue 10, Page(s) e0275239

Abstract: Objective: We developed a novel multi-torsional mechanical stretch stress loading device for ligamentum flavum cells and evaluated its influence on the development of ligamentum flavum hypertrophy, a common cause of lumbar spinal canal stenosis.: ... ...

Abstract	Objective: We developed a novel multi-torsional mechanical stretch stress loading device for ligamentum flavum cells and evaluated its influence on the development of ligamentum flavum hypertrophy, a common cause of lumbar spinal canal stenosis. Materials and methods: Stretch strength of the device was optimized by applying 5% and 15% MSS loads for 24, 48, and 72 h. A cytotoxicity assay of human ligamentum flavum cells was performed and the results were compared to control (0% stress). Inflammatory markers (interleukin [IL]-6, IL-8), vascular endothelial growth factor [VEGF], and extracellular matrix (ECM)-regulating cytokines (matrix metalloproteinase [MMP]-1, MMP-3 and MMP-9, and tissue inhibitor of metalloproteinase [TIMP]-1 and TIMP-2) were quantified via enzyme-linked immunosorbent assay. Results: Using our multi-torsional mechanical stretch stress loading device, 5% stress for 24 hour was optimal for ligamentum flavum cells. Under this condition, the IL-6 and IL-8 levels, VEGF level, and MMP-1, MMP-3, and TIMP-2 were significantly increased, compared to the control. Conclusion: Using the novel multi-torsional mechanical stretch stress loading device we confirmed that, mechanical stress enhances the production of inflammatory cytokines and angiogenic factors, and altered the expression of ECM-regulating enzymes, possibly triggering ligamentum flavum hypertrophy.
MeSH term(s)	Humans ; Ligamentum Flavum/metabolism ; Vascular Endothelial Growth Factor A/metabolism ; Tissue Inhibitor of Metalloproteinase-2/metabolism ; Matrix Metalloproteinase 9/metabolism ; Matrix Metalloproteinase 3/metabolism ; Matrix Metalloproteinase 1/metabolism ; Stress, Mechanical ; Interleukin-6/metabolism ; Interleukin-8/metabolism ; Spinal Stenosis/etiology ; Hypertrophy/metabolism ; Tissue Inhibitor of Metalloproteinase-1/metabolism ; Cytokines/metabolism ; Lumbar Vertebrae/metabolism
Chemical Substances	Vascular Endothelial Growth Factor A ; Tissue Inhibitor of Metalloproteinase-2 (127497-59-0) ; Matrix Metalloproteinase 9 (EC 3.4.24.35) ; Matrix Metalloproteinase 3 (EC 3.4.24.17) ; Matrix Metalloproteinase 1 (EC 3.4.24.7) ; Interleukin-6 ; Interleukin-8 ; Tissue Inhibitor of Metalloproteinase-1 ; Cytokines
Language	English
Publishing date	2022-10-21
Publishing country	United States
Document type	Journal Article ; Research Support, Non-U.S. Gov't
ZDB-ID	2267670-3
ISSN	1932-6203 ; 1932-6203
ISSN (online)	1932-6203
ISSN	1932-6203
DOI	10.1371/journal.pone.0275239
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Article: Coronavirus Disease (COVID-19) Outbreak and Its Impact on Spinal Daily Practice : Preliminary Report from a Single (Regional) University Hospital in Republic of Korea.

Ham, Chang Hwa / Moon, Hong Joo / Kim, Joo Han / Park, Youn-Kwan / Lee, Tae Hoon / Kwon, Woo-Keun

Journal of Korean Neurosurgical Society

2020 Volume 63, Issue 4, Page(s) 407–414

Abstract: Objective: Since the first discovery of the 2019 novel coronavirus (COVID-19), rapid and wide spread of the disease has been reported and the World Health Organization announced that a 'pandemic' has started. Up to date there is little known regarding ... ...

Abstract	Objective: Since the first discovery of the 2019 novel coronavirus (COVID-19), rapid and wide spread of the disease has been reported and the World Health Organization announced that a 'pandemic' has started. Up to date there is little known regarding the impact of this outbreak on spinal specialists' daily clinical practice. We intended to evaluate how COVID-19 has affected the number of spinal disease patients we meet and operate in daily practice. Methods: The de-identified data regarding number of patients visiting the spine clinic at a tertiary referral hospital and a secondary level hospital from January, February and March of 2017 to 2020 were retrospectively reviewed. The number of out-patient department (OPD) visits, number of emergency room (ER) visits as well as number of surgeries performed during the reviewed period were collected and analyzed, comparing 2020 to the previous 3 years. Results: The number of daily OPD visits showed a steady decrease starting from January, and presented a statistically significant decrease by early March 2020, compared to the previous 3 years. During the same period, decrease in number of daily ER visits was statistically significant as well. The number of elective surgeries or number of surgeries for patients admitted via ER during COVID-19 outbreak remained similar to that of 2017-2019 suggesting, despite the decrease of patients visiting the hospital for spinal diseases, those whom required surgery still visited the hospital. The results were consistant among other hospital level. Conclusion: The outbreak of COVID-19 affected our daily practice as OPD and ER visits reduced but did not affect the number of surgeries. We believe that this report will be informative to spinal specialists worldwide fighting the COVID-19 pandemic.
Keywords	covid19
Language	English
Publishing date	2020-05-27
Publishing country	Korea (South)
Document type	Journal Article
ZDB-ID	2253817-3
ISSN	1598-7876 ; 2005-3711 ; 1225-8245
ISSN (online)	1598-7876
ISSN	2005-3711 ; 1225-8245
DOI	10.3340/jkns.2020.0114
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Article: A New Classification for Cervical Ossification of the Posterior Longitudinal Ligament Based on the Coexistence of Segmental Disc Degeneration.

Lee, Jun Ki / Ham, Chang Hwa / Kwon, Woo-Keun / Moon, Hong Joo / Kim, Joo Han / Park, Youn-Kwan

Journal of Korean Neurosurgical Society

2020 Volume 64, Issue 1, Page(s) 69–77

Abstract: Objective: Classification systems for cervical ossification of the posterior longitudinal ligament (OPLL) have traditionally focused on the morphological characteristics of ossification. Although the classification describes many clinical features ... ...

Abstract	Objective: Classification systems for cervical ossification of the posterior longitudinal ligament (OPLL) have traditionally focused on the morphological characteristics of ossification. Although the classification describes many clinical features associated with the shape of the ossification, including the concept of spondylosis seems necessary because of the similarity in age distribution. Methods: Patients diagnosed with OPLL who presented with increase signal intensity (ISI) on magnetic resonance imaging were surgically treated in our department. The patients were divided into two groups (pure versus degenerative) according to the presence of disc degeneration. Results: Of 141 patients enrolled in this study, more than half (61%) were classified into the degenerative group. The pure group showed a profound male predominance, early presentation of myelopathy, and a different predilection for ISI compared to the degenerative group. The mean canal compromise ratio (CC) of the ISI was 47% in the degenerative group versus 61% in the pure group (p<0.0000). On the contrary, the global and segment motions were significantly larger in the degenerative group (p<0.0000 and p=0.003, respectively). The canal diameters and global angles did not differ between groups. Conclusion: Classifying cervical OPLL based on the presence of combined disc degeneration is beneficial for understanding the disorder's behavior. CC appears to be the main factor in the development of myelopathy in the pure group, whereas additional dynamic factors appear to affect its development in the degenerative group.
Language	English
Publishing date	2020-10-27
Publishing country	Korea (South)
Document type	Journal Article
ZDB-ID	2253817-3
ISSN	1598-7876 ; 2005-3711 ; 1225-8245
ISSN (online)	1598-7876
ISSN	2005-3711 ; 1225-8245
DOI	10.3340/jkns.2020.0080
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Article: The Korean Spinal Neurosurgery Society ; Are We Reimbursed Properly for Spinal Neurosurgical Practices under the Korean Resource Based Relative Value Scale Service?

Kwon, Woo-Keun / Kim, Joo Han / Moon, Hong Joo / Park, Youn-Kwan

Journal of Korean Neurosurgical Society

2016 Volume 60, Issue 1, Page(s) 47–53

Abstract: Objectives: The Korean Resource Based Relative Value Scale (K-RBRVS) was introduced in 2001 as an alternative of the previous medical fee schedule. Unfortunately, most neurosurgeons are unfamiliar with the details of the K-RBRVS and how it affects the ... ...

Abstract	Objectives: The Korean Resource Based Relative Value Scale (K-RBRVS) was introduced in 2001 as an alternative of the previous medical fee schedule. Unfortunately, most neurosurgeons are unfamiliar with the details of the K-RBRVS and how it affects the reimbursement rates for the surgical procedures we perform. We summarize the K-RBRVS in brief, and discuss on how the relative value (RV) of the spinal neurosurgical procedures have changed since the introduction in 2001. Methods: We analyzed the change of spinal procedure RVs since 2001, and compared it with the change of values in the brain neurosurgical procedures. RVs of 88 neurospinal procedures on the list of K-RBRVS were analyzed, while 24 procedures added during annual revisions were excluded. Results: During the past 15 years, RVs for spinal procedures have increased 62.8%, which is not so different with the cumulative increase of consumer prices during this time period or the increase rate of 92.3% for brain surgeries. When comparing the change of RVs in more complex procedures between spinal and brain neurosurgery, the increase rate was 125.3% and 133%, respectively. Conclusion: More effort of the society of spinal surgeons seems to be needed to get adequate reimbursement, as there have been some discrimination compared to brain surgeons in the increase of RVs. And considering the relative underestimation of spinal neurosurgeons' labor, more objective measures of neurospinal surgeons' work and productivity should be developed for impartial reimbursement.
Language	English
Publishing date	2016-12-29
Publishing country	Korea (South)
Document type	Journal Article
ZDB-ID	2253817-3
ISSN	1598-7876 ; 2005-3711 ; 1225-8245
ISSN (online)	1598-7876
ISSN	2005-3711 ; 1225-8245
DOI	10.3340/jkns.2016.0405.003
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Article ; Online: Chronic neck pain in young adults: perspectives on anatomic differences.

Lee, Ji-Hye / Park, Youn-Kwan / Kim, Joo-Han

The spine journal : official journal of the North American Spine Society

2014 Volume 14, Issue 11, Page(s) 2628–2638

Abstract: Background context: Neck pain (NP) is a common musculoskeletal disorder, but little is known about the associated risk factors.: Purpose: We compared anatomic differences in the neck and trunk area of young adult patients with chronic NP and control ... ...

Abstract	Background context: Neck pain (NP) is a common musculoskeletal disorder, but little is known about the associated risk factors. Purpose: We compared anatomic differences in the neck and trunk area of young adult patients with chronic NP and control subjects without NP to identify risk factors and predictors. Study design: This is an age-, sex-, and body mass index-matched retrospective case-control study of a consecutive sample. Patient sample: Patients with axial NP for longer than 6 months (23 males and 25 females) and pain-free volunteers (23 males and 25 females) were included. Outcome measures: Outcome measures were linear and angular dimensions of the cervicothoracic junction. Methods: Midsagittal magnetic resonance imaging scans of the cervicothoracic spine were obtained. Four linear and four angular parameters were identified and measured. These parameters included depth of the T1-manubrium arch (T1AD), depth of the thoracic cage (TXD), tangential height of T1 (T1H1), relative height of T1 (T1H2), T1 slope (T1S), thoracic inlet inclination (TiI), T1-manubrium arch inclination (T1AI), and the angular difference between TiI and T1AI (TiI-T1AI). The measurements were taken by two neurosurgeons. Results: Depth of the T1-manubrium arch and TiI were identified as predictors for NP in the binary logistic regression analysis. Each millimeter increase in T1AD lessened the probability of NP with an adjusted odds ratio (OR) of 0.823 (95% confidence interval [CI], 0.701-0.966) in females and 0.809 (95% CI, 0.681-0.959) in males. Each degree increase in TiI was associated with the probability of NP with an adjusted OR of 1.247 (95% CI, 1.060-1.466) in males. Conclusions: Measurement of cervicothoracic junctional structures is a reliable and feasible method of estimating potential predictor of chronic NP in young adults. Forward inclination of the thoracic inlet in males and a shallow thoracic cage in females were identified as important predictors.
MeSH term(s)	Adult ; Body Mass Index ; Case-Control Studies ; Cervical Vertebrae/pathology ; Chronic Pain/pathology ; Female ; Humans ; Magnetic Resonance Imaging/methods ; Male ; Neck/pathology ; Neck Pain/pathology ; Thoracic Vertebrae/pathology ; Young Adult
Language	English
Publishing date	2014-11-01
Publishing country	United States
Document type	Journal Article ; Research Support, Non-U.S. Gov't
ZDB-ID	2037072-6
ISSN	1878-1632 ; 1529-9430
ISSN (online)	1878-1632
ISSN	1529-9430
DOI	10.1016/j.spinee.2014.02.039
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Article: Comparison of Operating Conditions, Postoperative Pain and Recovery, and Overall Satisfaction of Surgeons with Deep vs. No Neuromuscular Blockade for Spinal Surgery under General Anesthesia: A Prospective Randomized Controlled Trial.

Oh, Seok Kyeong / Kwon, Woo-Keun / Park, Sangwoo / Ji, Sul Gi / Kim, Joo Han / Park, Youn-Kwan / Lee, Shin Young / Lim, Byung Gun

Journal of clinical medicine

2019 Volume 8, Issue 4

Abstract: We aimed to investigate operating conditions, postoperative pain, and overall satisfaction of surgeons using deep neuromuscular blockade (NMB) vs. no NMB in patients undergoing lumbar spinal surgery under general anesthesia. Eighty-three patients ... ...

Abstract	We aimed to investigate operating conditions, postoperative pain, and overall satisfaction of surgeons using deep neuromuscular blockade (NMB) vs. no NMB in patients undergoing lumbar spinal surgery under general anesthesia. Eighty-three patients undergoing lumbar fusion were randomly assigned to receive deep NMB (
Language	English
Publishing date	2019-04-12
Publishing country	Switzerland
Document type	Journal Article
ZDB-ID	2662592-1
ISSN	2077-0383
ISSN	2077-0383
DOI	10.3390/jcm8040498
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