Analysis on Structural Variation and Disability Index of Spinal-Pelvic in the High School Students with Low Back Pain / 대한스포츠의학회지

The purpose of this study was to evaluate the prevalence rate of low back pain (LBP) in the high school students and to analyze the differences and correlations with the spinal-pelvic structural variations and disability index with LBP. The subjects are 499 high school students (236 males, 263 females: mean age, 16.38 years). They were assessed for LBP with the numerical rating scale (NRS) and for disability with the Korean version Oswestry disability index (KODI). All subjects were to take the plain radiographic examination for spinal-pelvic structural variations including thoracic, lumbar, thoracolumbar Cobb's angle, lumbar lordotic curve, sacral slope, pelvic tilt and pelvic incidence. All subjects were divided into two groups by NRS scores (0, 1=no/minimum pain group [NMP group], 2-10=low back pain group [LBP group]). The prevalence rate of LBP of all subjects was 56.7% (n=283). NRS and total KODI scores were higher in the LBP group (3.38 cm/11.83%) than NMP group (0.07 cm/2.74%) (p0.05). NRS had significantly positive correlation with KODI (p0.05). In conclusion, this study showed high prevalence rate of LBP in the high school students, but did not show significant correlations with the spinal-pelvic structural variations and disability index.

Gamma Knife Radiosurgery for Brainstem Metastasis

OBJECTIVE: Brainstem metastases are rarely operable and generally unresponsive to conventional radiation therapy or chemotherapy. Recently, Gamma Knife Radiosurgery (GKRS) was used as feasible treatment option for brainstem metastasis. The present study evaluated our experience of brainstem metastasis which was treated with GKRS. METHODS: Between November 1992 and June 2010, 32 patients (23 men and 9 women, mean age 56.1 years, range 39-73) were treated with GKRS for brainstem metastases. There were metastatic lesions in pons in 23, the midbrain in 6, and the medulla oblongata in 3 patients, respectively. The primary tumor site was lung in 21, breast in 3, kidney in 2 and other locations in 6 patients. The mean tumor volume was 1,517 mm3 (range, 9-6,000), and the mean marginal dose was 15.9 Gy (range, 6-23). Magnetic Resonance Imaging (MRI) was obtained every 2-3 months following GKRS. Follow-up MRI was possible in 24 patients at a mean follow-up duration of 12.0 months (range, 1-45). Kaplan-Meier survival analysis was used to evaluate the prognostic factors. RESULTS: Follow-up MRI showed tumor disappearance in 6, tumor shrinkage in 14, no change in tumor size in 1, and tumor growth in 3 patients, which translated into a local tumor control rate of 87.5% (21 of 24 tumors). The mean progression free survival was 12.2 months (range, 2-45) after GKRS. Nine patients were alive at the completion of the study, and the overall mean survival time after GKRS was 7.7 months (range, 1-22). One patient with metastatic melanoma experienced intratumoral hemorrhage during the follow-up period. Survival was found to be associated with score of more than 70 on Karnofsky performance status and low recursive partitioning analysis class (class 1 or 2), in terms of favorable prognostic factors. CONCLUSION: GKRS was found to be safe and effective for management of brainstem metastasis. The integral clinical status of patient seems to be important in determining the overall survival time.

Follow up Survey of Non-invasive Intermittent Positive Pressure Ventilatory Support in Patients with Neuromuscular Diseases

OBJECTIVE: To report an overall survey of the application state of non-invasive intermittent positive pressure ventilator (NIPPV) in patients with neuromuscular diseases who were managed successfully in this hospital. METHOD: To estimate current state of NIPPV application, chart review and telephone survey were performed in neuromuscular patients who applied NIPPV successfully from March 2001 to January 2006 in this hospital. RESULTS: Among 161 patients who once tried NIPPV, 100 patients applied NIPPV successfully. The composition was 66 patients with myopathy, 20 patients with amyotrophic lateral scoliosis, 6 patients with spinal muscular atrophy, 3 patients with cervical cord injury, and 5 patients with other neuromuscular diseases. Among them, 12 patients who had undertaken tracheostomy were switched into NIPPV, however 3 ALS paients who had first applied NIPPV successfully were taken tracheostomy later. CONCLUSION: NIPPV is an equally effective and safe tool for ventilatory support, which can be used as an alternative method of invasive ventilatory support for patients with advanced neuromuscular diseases. We assume that more neuromuscular patients can improve their quality of life, and prolong their life span through application of NIPPV.

Clinical Implication of Sniff Nasal Inspiratory Pressure in Patients with Duchenne Muscular Dystrophy

OBJECTIVE: To evaluate sniff nasal inspiratory pressure (SNIP) in patients with Duchenne muscular dystrophy (DMD), to analyse the relationship SNIP and other pulmonary function test and to verify the usefulness of SNIP in patients with DMD. METHOD: Twenty-seven patients with DMD who were able to follow commend were studied. Among them two patients were unable to perform maximal inspiratory pressure (MIP) mesurement. SNIP and MIP were measured using respiratory pressure meter in sitting position. Forced vital capacity (FVC) and peak cough flow (PCF) were evaluated using spirometer and peak flow meter respectively. The relationship between SNIP and other pulmonary function parameters were analysed. RESULTS: The mean value of SNIP was -44.9 cmH2O (41.6% predicted) and the mean value of MIP was -32.9 cmH2O (43.9% predicted). SNIP was correlated with MIP. When expressed absolute value, SNIP was higher than MIP in 23 of the 25 patients with DMD. SNIP and MIP were correlated with FVC. SNIP and MIP were correlated with PCF as well. CONCLUSION: SNIP in patients with DMD is useful method to assess inspiratory muscle strength in addition to MIP and more easier to perform than MIP.

Cognition Associated with Dystrophin Deletion in Duchenne Muscular Dystrophy

OBJECTIVE: To find correlations between the deletion of dystrophin gene and cognitive status in Duchenne muscular dystrophy (DMD). METHOD: Cognitive abilities of 49 DMD children with dystrophin deletion were tested. Korean Wechsler Intelligence Scale for children was used to evaluate the cognitive status in DMD. Gene deletion was classified into two groups according to the location of the rearrangement (proximal region: central and 3' region of the gene). RESULTS: Molecular study by multiplex PCR (Polymerase Chain Reaction) of dystrophin exons was performed to identify 49 deletions in the 110 DMD patients. 13 out of 49 DMD were mentally impaired. In patients with distal deletions, total IQ (Intelligence Quotient) score was lower than the those with proximal deletions; which was not statistically significant. And the difference of the verbal and performance intelligence scale was not statistically significant. But comparisons of molecular and neuropsychological features showed that deletions localized in the central and 3' regions of the gene were preferentially associated with the mental impairement. CONCLUSION: We concluded that deletions in the distal portions of the gene were more related to the mental retardation, although deletions with variable locations might lead to cognitive impairments.

Follow-up Magnetic Resonance Imaging Study of Patients with Herniated Cervical Intervertebral Disc

OBJECTIVE: To clarify the relationship between the morphologic changes of and the clinical course of conservatively treated herniated cervical disc patients METHOD: Follow-up magnetic resonance imaging (MRI) and clinical assessment by the visual analogue scale were performed in 21 patients at a mean interval of 22.7 months. RESULTS: An average reduction ratio of herniation on the sagittal and axial images were 11.65% and 19.5%, respectively. The clinical features improved significantly and the degree of clinical improvement was unrelated to the reduction ratio of herniation. CONCLUSION: 8 out of 21 (38.09%) showed reduction of herniated mass on follow up MRI after conservative treatment. The patients with extruded and sequestered disc herniation showed more morphologic changes on MRI. There was no correlation between the clinical state and the morphological change of herniated cervical disc.

Change in Forced Vital Capacity with Postures according to Neuromuscular Disease

OBJECTIVE: To evaluate the difference in forced vital capacity (FVC) between sitting and supine position in patients with amyotrophic lateral sclerosis (ALS), cervical spinal cord injury (SCI) and Duchenne muscular dystrophy (DMD). METHOD: FVC was measured in sitting and supine position for 32 patients with DMD, 32 patients with cervical SCI and for 28 patients with ALS. The highest value in three or more attempts in each position was chosen. RESULTS: FVCs measured in cervical SCI and ALS patients in the sitting and supine position were 1612.8+/-291.0 ml, 1393.2+/-286.7 ml and 2054.7+/-545.8 ml, 1104.3+/-425.4 ml respectively. Cervical SCI patients showed significantly higher value in the supine position (p<0.05). And ALS patients showed significantly higher value in the sitting position (p<0.05). FVCs measured in DMD patients were 1311.6+/-260.7 ml and 1213.8+/-378.9 ml respectively. There was no statistically significant difference between the measurements in both positions. CONCLUSION: Difference in postural change of FVC was observed in patients with different types of neuromuscular disorders. Such difference in FVC suggest that postural change of FVC should be considered in management of neuromuscular disease with respiratory muscle weakness.

A New Communication Device Using the Anal Sphincter

OBJECTIVE: The purpose of this study was to invent a new communication device by utilizing the function of anal sphincter muscles that was another residual motor function to the last in amyotrophic lateral sclerosis (ALS) patients. METHOD: We designed a sensor which worked by changing intensity of the contraction and was enable severely paralyzed patients to communicate by means of self-regulation of the anal sphincter contraction. This device made sentences through combination of selected Korean letters deprived from sphincter contractions. RESULTS: This device was composed of three parts. Anal sensor: the head part of the sensor regulated by sphincters was located in the rectum, signal processing module: the raw signal from the sensor was boosted up and set up on the baseline voltage equal to threshold by threshold detector, and device program: the icon mode which was composed of routine questions and requested to their care-givers. And in user-writing mode, patients could choose syllable elements using the sensor operating by sphincter. CONCLUSION: This system was designed for advanced ALS patients with only the available function of sphincter muscles and could give them another new option in selecting communication devices.

Assisted Cough and Pulmonary Compliance in Patients with Duchenne Muscular Dystrophy

The aim of this study was to investigate the factors affecting cough ability, and to compare the assisted cough methods in patients with Duchenne muscular dystrophy (DMD). A total seventy-one male patients with DMD were included in the study. The vital capacity (VC) and maximum insufflation capacity (MIC) were measured. The unassisted peak cough flow (UPCF) and three different techniques of assisted peak cough flow were evaluated. UPCF measurements were possible for all 71 subjects. But when performing the three different assisted cough techniques, peak cough flows (PCFs) could be obtained from only 51 subjects. The mean value of MICs (1801+/-780cc) was higher than that of VCs (1502+/-765cc) (p< 0.01). All three assisted cough methods showed a significantly higher value than the unassisted method (F=80.92, p< 0.01). The manual assisted PCF under MIC (MPCFmic) significantly exceeded those produced by manual assisted PCF (MPCF) or PCF under MIC (PCFmic). The positive correlation between the MIC, VC difference (MIC-VC), and the difference between PCFmic and UPCF (PCFmic-UPCF) was seen (r= 0.572, p< 0.01). The preservation of pulmonary compliance is important for the development of an effective cough as well as assisting the compression and expulsive phases. Thus, the clinical importance of the inspiratory phase and pulmonary compliance in assisting a cough should be emphasized.

New Device for Improving Cough Function: Through Assisting Glottic Function

OBJECTIVE: The patients with glottic dysfunction cannot cough effectively. It is difficult to eliminate pulmonary secretions and to provide lung expansion exercise in those patients. Thus we made a device which substitutes the function of glottis and examines the effectiveness of the external glottic function of the device. METHOD: This new device was made of two parts: connection and control part. Connection part had three ports: patient connection, insufflation and connection port. The insufflation port with one-way valve allows additional air stacking using a manual resuscitation bag after a patients's deep inspiration. Control part had external glottic function by air flow control with button pushing simply. The vital capacity (VC), maximal insufflation capacity (MIC), MIC with device (MICdevice), unassistive peak cough flow (UPCF), assistive peak cough flow (APCF) and assistive peak cough flow with device (APCFdevice) were measured in six patients. RESULTS: In tested patients, four were amyotrophic lateral sclerosis patients and two were cervical spinal cord injury patients with tracheostomized. The value of MICdevice or APCFdevice was higher than MIC or APCF in all patients. CONCLUSION: This new device can improve the bronchial toileting by improving cough function and also provide lung expansion exercise effectively in patients with glottic dysfunction.

Change in Epidemiologic Characteristics of the Patients with Neck and Back Pain

OBJECTIVE: The purpose of this study was to investigate the associated symptom aggravating factors and epidemiologic characteristics in patients with neck and back pain. METHOD: The demographic characteristics and the total number of patients who visited the Department of Rehabilitation Medicine, Yong-dong Severance Hospital for the management of neck and back pain were evaluated. A total of 2800 patients sampled from this group of patients and the possible influential factors such as symptom aggravating factors were evaluated. The back school attendants were analyzed for the effectiveness of education on prevention and management of neck and back pain. RESULTS: The most common age group with neck and back pain were 5th decade (21.4%) and 6th decade (24.8%). The proportion of patients in acute stage were increased yearly. Of the aggravating factors, sports injury, driving and weight gain increased annually. In patients with neck pain, aggravation by typing and computer work was remarkable. The patients with desk type of job were increased each year and the patients in teenage group were also increased annually. CONCLUSION: Understanding of the current epidemiologic characteristics and the influential factors will be helpful for providing objective standards for assessment, management and preventioin of neck and back pain.

Postural Change of Vital Capacity in Patients with Neuromuscular Disease

OBJECTIVE: To evaluate the difference in vital capacity (VC) between sitting and supine position in patients with amyotrophic lateral sclerosis (ALS) and Duchenne muscular dystrophy (DMD). METHOD: VC was measured in the sitting and supine position for 30 patients with DMD and for 30 patients with ALS. The highest value in three or more attempts in each position was chosen. RESULTS: VCs measured in ALS patients in the sitting and supine position were 1591.7+/-634.6 ml and 1290.0+/-580.3 ml respectively. The VC in the sitting position showed significantly higher value than the VC in the supine position (p<0.05). VCs measured in DMD patients were 903.7+/-518.1 ml and 795.3+/-505.6 ml respectively. There was no statistically significant difference between the measurements in both positions. CONCLUSION: Difference in postural change of VC was observed in patients with different types of neuromuscular disorders. Such difference in VC suggest that postural change of VC should be considered in management of neuromuscular disease with respiratory muscle weakness.

Pulmonary Function in Cervical Spinal Cord Injured Men: Influence of Age and Height

OBJECTIVE: To evaluate the influences of age and height on pulmonary function in cervical spinal cord injury patients and to suggest the reference value of Pulmonary Function Test (PFT) with respect to each level of injury. METHOD: One hundred eighteen subjects with complete cervical spinal cord injury underwent PFT. Forced Vital Capacity (FVC) and Forced Expiratory Volume in 1 second (FEV1) were measured and percentages of normal predictive values were also calculated. RESULTS: Age, height and injury level were determinants of FVC and FEV1. But only injury level affected the percen-tages of FVC and FEV1 predictive values. The mean FVC of C4, C5, C6, C7, C8 tetraplegic subjects were 1.78 L, 2.00 L, 2.20 L, 2.74 L, 2.94 L respectively. The mean FEV1 of C4, C5, C6, C7, C8 tetraplegic subjects were 1.64 L, 1.83 L, 2.08 L, 2.59 L, 2.74 L respectively. CONCLUSION: Age and height should be considered when interpreting PFT of tetraplegic patients. The reference values suggested would help to evaluate the severity of pulmonary function loss in complete cervical spinal cord injury patients.