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Original Articles

Clinical Study – Surgical Complications

Incidence of Hoarseness After General Spine Surgery: Interim Report of Prospective Observational Study
Sum Kim, Yunhee Choi, Hangeul Park, Young-Rak Kim, Jun-Hoe Kim, Woo-Young Jo, Kyung Won Shin, Hyongmin Oh, Hyung-Chul Lee, Hee-Pyoung Park, Chang-Hyun Lee, Chi Heon Kim, Chun Kee Chung
Neurospine 2025;22(4):1041-1051.   Published online December 31, 2025
DOI: https://doi.org/10.14245/ns.2550636.318

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Incidence of Hoarseness After General Spine Surgery: Interim Report of Prospective Observational Study
Neurospine. 2025;22(4):1041-1051.   Published online December 31, 2025
DOI: https://doi.org/10.14245/ns.2550636.318
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Incidence of Hoarseness After General Spine Surgery: Interim Report of Prospective Observational Study
Neurospine. 2025;22(4):1041-1051.   Published online December 31, 2025
DOI: https://doi.org/10.14245/ns.2550636.318
Close
Objective
Hoarseness can occur after spinal surgery under general anesthesia, which has been assessed through self-report measures based on questionnaires. Given the inherent biases associated with self-report instruments, there is a need for more objective measures to assess hoarseness.
Methods
Single institute, a prospective observational study was planned to include 427 patients after spine surgery. This interim analysis was planned to include 215 patients who met the inclusion criteria. All subjects included in this study submitted a questionnaire of Korean Voice Handicap Index (KVHI)-10. Voice analysis including low or high pitch (Herz), frequency variation rate (jitter), amplitude variation rate (Shimmer), and noise-to-harmonic ratio (NHR) was performed with a software of Pratt.
Results
This interim report enrolled a total of 215 patients who met the inclusion criteria, and among them, 162 patients (75.5%) were subjected to interim analysis after excluding those with data loss (8 patients), operation cancellation (3 patients), and loss to follow-up (42 patients). The incidence of hoarseness was 35.0% on postoperative day (POD)0 and 5.5% on POD30. In the acoustic parameters analyzed, hertz and jitter were significantly positively correlated with the KVHI-10 scores on POD0, while only the jitter value significantly correlated with POD30. The optimal cutoff values of the acoustic parameter on POD30 from the receiver operating characteristic curve were 0.65% in jitter, 4.67% in shimmer, and 16.96 dB in NHR.
Conclusion
This study revealed a correlation between objective acoustic parameters obtained from voice analysis and subjective questionnaire scores for hoarseness.
  • 1,862 View
  • 38 Download

Oncology

The Role of D-Wave Monitoring in Motor-Evoked Potential Loss During Intramedullary Spinal Cord Tumors Resection
Hangeul Park, Woojin Kim, Jungbo Sim, Ho Sung Myeong, Young Doo Choi, Gilho Kwak, Bo Eun Kim, Jeongeum Park, Sung-Min Kim, Keewon Kim, Hee-Pyoung Park, Jun-Hoe Kim, Chang-Hyun Lee, Chun Kee Chung, Chi Heon Kim
Neurospine 2025;22(3):650-662.   Published online September 30, 2025
DOI: https://doi.org/10.14245/ns.2550594.297

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The Role of D-Wave Monitoring in Motor-Evoked Potential Loss During Intramedullary Spinal Cord Tumors Resection
Neurospine. 2025;22(3):650-662.   Published online September 30, 2025
DOI: https://doi.org/10.14245/ns.2550594.297
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The Role of D-Wave Monitoring in Motor-Evoked Potential Loss During Intramedullary Spinal Cord Tumors Resection
Neurospine. 2025;22(3):650-662.   Published online September 30, 2025
DOI: https://doi.org/10.14245/ns.2550594.297
Close
Objective
Motor-evoked potential (MEP) loss during intramedullary (IM) spinal cord tumor surgery impairs the ability to monitor further neural injury. Direct wave (D-wave) monitoring may allow continued assessment of corticospinal tract integrity after MEP loss. This study evaluates the role of D-wave-guided surgery in preserving function and enabling safe resection after MEP loss.
Methods
A retrospective study was conducted in adult patients with ependymoma (EPN), cavernous angioma (CA) or subependymoma who experienced MEP loss during IM tumor resection between January 2012 and May 2025. Patients who underwent continued resection under D-wave guidance after MEP loss were compared with those who did not.
Results
Among 37 eligible patients, 9 underwent D-wave-guided surgery and 28 did not. Functional improvement at the last follow-up was more frequent in the D-wave-guided surgery group (66.7% vs. 17.9%, p=0.011). This trend remained significant in EPN patients (74.4% vs. 9.1%, p=0.003), but not in CA patients. Immediate postoperative motor grade ≤3 was more common in the D-wave-guided surgery group (66.7% vs. 39.3%), although this difference was not statistically significant (p=0.251). By last follow-up, the proportions of patients self-ambulatory without external aids (88.9% vs. 89.3%, p=1.000) were similar between groups. Extent of resection, complications, and recurrence rates showed no significant differences.
Conclusion
D-wave-guided surgery may enable safe continuation of tumor resection after MEP loss without increasing morbidity. It offers a viable intraoperative strategy to preserve long-term motor function by extending monitoring beyond MEP limitations.

Citations

Citations to this article as recorded by  Crossref logo
  • Spinal cord extracellular matrix hydrogel enhances organoid maturation and functional regeneration after spinal cord injury
    Junghoon Kim, Songzi Zhang, Joon-Hyuk Jung, Mi-Jeong Lee, Inbo Han, Seung-Woo Cho
    Materials Today Bio.2026; 38: 103168.     CrossRef
  • The Role of Indocyanine Green Videoangiography in Intramedullary Spinal Cord Tumor Surgery: Focus on Lesion Localization Accuracy
    Jungbo SIM, Chang-Hyun LEE, Ayoung YOO, Yunhee CHOI, Woojin KIM, Hosung MYEONG, Hangeul PARK, Jun-Hoe KIM, Chi Heon KIM, Chun Kee CHUNG
    Neurologia medico-chirurgica.2026; 66(7): 426.     CrossRef
  • 6,418 View
  • 111 Download
  • 3 Web of Science
  • 2 Crossref

Regular Issue

Spinal Schwannoma Classification Based on the Presumed Origin With Preoperative Magnetic Resonance Images
Tae-Shin Kim, Jae Hee Kuh, Junhoe Kim, Woon Tak Yuh, Junghoon Han, Chang-Hyun Lee, Chi Heon Kim, Chun Kee Chung
Neurospine 2024;21(3):890-902.   Published online September 30, 2024
DOI: https://doi.org/10.14245/ns.2448468.234

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Spinal Schwannoma Classification Based on the Presumed Origin With Preoperative Magnetic Resonance Images
Neurospine. 2024;21(3):890-902.   Published online September 30, 2024
DOI: https://doi.org/10.14245/ns.2448468.234
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Spinal Schwannoma Classification Based on the Presumed Origin With Preoperative Magnetic Resonance Images
Neurospine. 2024;21(3):890-902.   Published online September 30, 2024
DOI: https://doi.org/10.14245/ns.2448468.234
Close
Objective
Classification guides the surgical approach and predicts prognosis. However, existing classifications of spinal schwannomas often result in a high ‘unclassified’ rate. Here, we aim to develop a new comprehensive classification for spinal schwannomas based on their presumed origin. We compared the new classification with the existing classifications regarding the rate of ‘unclassified’. Finally, we assessed the surgical strategies, outcomes, and complications according to each type of the new classification.
Methods
A new classification with 9 types was created by analyzing the anatomy of spinal nerves and the origin of significant tumor portions and cystic components in preoperative magnetic resonance images. A total of 482 patients with spinal schwannomas were analyzed to compare our new classification with the existing classifications. We defined ‘unclassified’ as the inability to classify a patient with spinal schwannoma using the classification criteria. Surgical approaches and outcomes were also aligned with our new classification.
Results
Our classification uniquely reported no ‘unclassified’ cases, indicating full applicability. Also, the classification has demonstrated usefulness in predicting the surgical outcome with the approach planned. Gross total removal rates reached 88.0% overall, with type 1 and type 2 tumors at 95.3% and 96.0% respectively. The approach varied with tumor type, with laminectomy predominantly used for types 1, 2, and 9, and facetectomy with posterior fixation used for type 3 tumors.
Conclusion
The new classification for spinal schwannomas based on presumed origin is applicable to all spinal schwannomas. It could help plan a surgical approach and predict its outcome, compared with existing classifications.

Citations

Citations to this article as recorded by  Crossref logo
  • Unilateral Biportal Endoscopic Removal of a Cervical Extradural Schwannoma at the C1–2 Level
    Woon Tak Yuh, Il Choi, Don Y. Park, Chi Heon Kim, Chun Kee Chung
    Journal of Minimally Invasive Spine Surgery and Technique.2026; 11(Suppl 1): S228.     CrossRef
  • Precise localization value of lumbar lamina and ligamentum flavum boundaries in minimally invasive tubular resection of intraspinal schwannomas
    Longfei Shu, Yan Liu, Feihu Dai, Chunmei Chen, Yuhai Wang, Wei Zhao
    Frontiers in Neurology.2026;[Epub]     CrossRef
  • Spinal schwannoma missed on lumbar MRI: a case report
    Pengfei Zhang, Ziyuan Zhang, Wenqin Sun
    Frontiers in Medicine.2026;[Epub]     CrossRef
  • Cervicodorsal extramedullary intraspinal schwannoma: A case report and literature review
    Juan Pedro Murillo Gutierrez, Ana Paula Banda Cespedes, Jahnie Madyson Supo Flores, Albert Gabriel Turpo-Peqqueña
    Surgical Neurology International.2026; 17: 290.     CrossRef
  • Analysis of modern methods for assessing endothelial condition
    A. V. Kudziev, A. Z. Gagiev, S. A. Turanov, A. Yu. Orlov
    Russian Journal for Personalized Medicine.2026; 6(2): 97.     CrossRef
  • A Radiomics-Driven Model to Distinguish Between Clinically Similar Myxopapillary Ependymomas and Lumbosacral Schwannomas
    Adhith Palla, Nicolas K. Goff, Blake Perdikis, Hammad A. Khan, Eric A. Grin, Aly Valliani, Roshni Patel, Jonathan T. Yang, J. Ricardo McFaline-Figueroa, Darryl Lau, Anthony Frempong-Boadu, Eric K. Oermann, Ilya Laufer
    Neurosurgery Practice.2026;[Epub]     CrossRef
  • Ancient schwannomas of the spine: a case report and review of confirmed cases
    Tommy Alfandy Nazwar, Nasim Amar, Farhad Bal’afif, Donny Wisnu Wardhana, Fachriy Bal’afif, Christin Panjaitan
    Interdisciplinary Neurosurgery.2025; 41: 102116.     CrossRef
  • Long-segment intraspinal schwannomas resection: What is the minimum number of laminectomy levels required?
    Zhiyu Xi, Li Jia, Yingfeng Wang, Qiyu Jia, Chengyu Xia, Jiang Liu
    Langenbeck's Archives of Surgery.2025;[Epub]     CrossRef
  • 12,102 View
  • 1,164 Download
  • 7 Web of Science
  • 8 Crossref
Development and Validation of an Online Calculator to Predict Proximal Junctional Kyphosis After Adult Spinal Deformity Surgery Using Machine Learning
Chang-Hyun Lee, Dae-Jean Jo, Jae Keun Oh, Seung-Jae Hyun, Jin Hoon Park, Kyung Hyun Kim, Jun Seok Bae, Bong Ju Moon, Chang-Kyu Lee, Myoung Hoon Shin, Hyun Jun Jang, Moon-Soo Han, Chi Heon Kim, Chun Kee Chung, Seung-Myung Moon, for the Korean Spinal Deformity Society
Neurospine 2023;20(4):1272-1280.   Published online December 31, 2023
DOI: https://doi.org/10.14245/ns.2342434.217

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Development and Validation of an Online Calculator to Predict Proximal Junctional Kyphosis After Adult Spinal Deformity Surgery Using Machine Learning
Neurospine. 2023;20(4):1272-1280.   Published online December 31, 2023
DOI: https://doi.org/10.14245/ns.2342434.217
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Development and Validation of an Online Calculator to Predict Proximal Junctional Kyphosis After Adult Spinal Deformity Surgery Using Machine Learning
Neurospine. 2023;20(4):1272-1280.   Published online December 31, 2023
DOI: https://doi.org/10.14245/ns.2342434.217
Close
Objective
Although adult spinal deformity (ASD) surgery aims to restore and maintain alignment, proximal junctional kyphosis (PJK) may occur. While existing scoring systems predict PJK, they predominantly offer a generalized 3-tier risk classification, limiting their utility for nuanced treatment decisions. This study seeks to establish a personalized risk calculator for PJK, aiming to enhance treatment planning precision.
Methods
Patient data for ASD were sourced from the Korean spinal deformity database. PJK was defined a proximal junctional angle (PJA) of ≥ 20° at the final follow-up, or an increase in PJA of ≥ 10° compared to the preoperative values. Multivariable analysis was performed to identify independent variables. Subsequently, 5 machine learning models were created to predict individualized PJK risk post-ASD surgery. The most efficacious model was deployed as an online and interactive calculator.
Results
From a pool of 201 patients, 49 (24.4%) exhibited PJK during the follow-up period. Through multivariable analysis, postoperative PJA, body mass index, and deformity type emerged as independent predictors for PJK. When testing machine learning models using study results and previously reported variables as hyperparameters, the random forest model exhibited the highest accuracy, reaching 83%, with an area under the receiver operating characteristics curve of 0.76. This model has been launched as a freely accessible tool at: (https://snuspine.shinyapps.io/PJKafterASD/).
Conclusion
An online calculator, founded on the random forest model, has been developed to gauge the risk of PJK following ASD surgery. This may be a useful clinical tool for surgeons, allowing them to better predict PJK probabilities and refine subsequent therapeutic strategies.

Citations

Citations to this article as recorded by  Crossref logo
  • THE INTEGRATION OF ARTIFICIAL INTELLIGENCE IN SPINAL CARE ASSESSMENT AND SURGERY: A COMPREHENSIVE NARRATIVE REVIEW
    Anıl Murat Öztürk, Cemre Aydın, Onur Süer, Erhan Sesli, Ömer Akçalı, Emin Alıcı
    Journal of Turkish Spinal Surgery.2026; 37(1): 49.     CrossRef
  • Machine learning-based prediction of proximal junctional pathology after adult spinal deformity surgery: a systematic review and diagnostic test accuracy meta-analysis
    Shaan Patel, Shiva A. Nischal, Yi Hein Chai, Kush M. Kale, Kevin Hines, Joshua Heller, Jack Jallo, James S. Harrop, Srinivas K. Prasad
    Acta Neurochirurgica.2026;[Epub]     CrossRef
  • Explainable Machine Learning Approach to Prediction of Prolonged Intensive Care Unit Stay in Adult Spinal Deformity Patients: Machine Learning Outperforms Logistic Regression
    Bashar Zaidat, Mark Kurapatti, Jonathan S. Gal, Samuel K. Cho, Jun S. Kim
    Global Spine Journal.2025; 15(4): 1992.     CrossRef
  • Machine-learning models for the prediction of ideal surgical outcomes in patients with adult spinal deformity
    Dongfan Wang, Qijun Wang, Peng Cui, Shuaikang Wang, Di Han, Xiaolong Chen, Shibao Lu
    The Bone & Joint Journal.2025; 107-B(3): 337.     CrossRef
  • The Application of Artificial Intelligence in Spine Surgery: A Scoping Review
    Liangyu Shi, Hongfei Wang, Graham Ka-Hon Shea
    JAAOS: Global Research and Reviews.2025;[Epub]     CrossRef
  • Harnessing machine learning to predict and prevent proximal junctional kyphosis and failure in adult spinal deformity surgery: A systematic review
    Paolo Brigato, Gianluca Vadalà, Sergio De Salvatore, Leonardo Oggiano, Giuseppe Francesco Papalia, Fabrizio Russo, Rocco Papalia, Pier Francesco Costici, Vincenzo Denaro
    Brain and Spine.2025; 5: 104273.     CrossRef
  • Artificial intelligence in spine surgery
    Cheng Zhang, Shanshan Liu, Jialin Shi, Xingyu Zhou, Peter Passias, Nanfang Xu, Weishi Li
    Spine Research.2025; 1(1): 13.     CrossRef
  • Novel risk factors and personalized risk calculator for predicting proximal junctional kyphosis after adult spinal deformity surgery
    Qijun Wang, Zheng Wang, Dongfan Wang, Xuan Zhao, Xiaolong Chen, Shibao Lu
    The Bone & Joint Journal.2025; 107-B(8): 829.     CrossRef
  • Implications of artificial intelligence
    Michael W. Fields, Nathan J. Lee, Ronald A. Lehman
    Seminars in Spine Surgery.2024; 36(3): 101122.     CrossRef
  • Machine learning applications in adult spinal deformity corrective surgery: a narrative review
    Nader Toossi, Ozhan Jerry
    Artificial Intelligence Surgery.2024; 4(3): 258.     CrossRef
  • Prediction of postoperative mechanical complications in ASD patients based on total sequence and proportional score of spinal sagittal plane
    Wenbin Jiang, Huagang Shi, Tao Gu, Zonglin Cai, Qinglong Li
    SLAS Technology.2024; 29(6): 100222.     CrossRef
  • Predicting Proximal Junctional Kyphosis After Adult Spinal Deformity Surgery: A Step Towards True “Precision” Medicine?: Commentary on “Development and Validation of an Online Calculator to Predict Proximal Junctional Kyphosis After Adult Spinal Deformity
    Lara M. Höbner, Alexandra Grob, Victor E. Staartjes
    Neurospine.2023; 20(4): 1284.     CrossRef
  • Commentary on “Development and Validation of an Online Calculator to Predict Proximal Junctional Kyphosis After Adult Spinal Deformity Surgery Using Machine Learning”
    In Ho Han
    Neurospine.2023; 20(4): 1281.     CrossRef
  • From the Editor-in-Chief: Featured Articles in the December 2023 Issue
    Inbo Han
    Neurospine.2023; 20(4): 1093.     CrossRef
  • 6,112 View
  • 198 Download
  • 14 Web of Science
  • 14 Crossref

Review Article

Genetic Odyssey to Ossification of the Posterior Longitudinal Ligament in the Cervical Spine: A Systematic Review
Young Il Won, Chang-Hyun Lee, Woon Tak Yuh, Shin Won Kwon, Chi Heon Kim, Chun Kee Chung
Neurospine 2022;19(2):299-306.   Published online June 30, 2022
DOI: https://doi.org/10.14245/ns.2244038.019

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Genetic Odyssey to Ossification of the Posterior Longitudinal Ligament in the Cervical Spine: A Systematic Review
Neurospine. 2022;19(2):299-306.   Published online June 30, 2022
DOI: https://doi.org/10.14245/ns.2244038.019
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Genetic Odyssey to Ossification of the Posterior Longitudinal Ligament in the Cervical Spine: A Systematic Review
Neurospine. 2022;19(2):299-306.   Published online June 30, 2022
DOI: https://doi.org/10.14245/ns.2244038.019
Close
Despite numerous studies, the pathogenesis of ossification of the posterior longitudinal ligament (OPLL) is still unclear. Previous genetic studies proposed variations in genes related to bone and collagen as a cause of OPLL. It is unclear whether the upregulations of those genes are the cause of OPLL or an intermediate result of endochondral ossification process. Causal variations may be in the inflammation-related genes supported by clinical and updated genomic studies. OPLL demonstrates features of genetic diseases but can also be induced by mechanical stress by itself. OPLL may be a combination of various diseases that share ossification as a common pathway and can be divided into genetic and idiopathic. The phenotype of OPLL can be divided into continuous (including mixed) and segmental (including localized) based on the histopathology, prognosis, and appearance. Continuous OPLL shows substantial overexpression of osteoblast-specific genes, frequent upper cervical involvement, common progression, and need for surgery, whereas segmental OPLL shows moderate-to-high expression of these genes and is often clinically silent. Genetic OPLL seems to share clinical features with the continuous type, while idiopathic OPLL shares features with the segmental type. Further genomic studies are needed to elucidate the relationship between genetic OPLL and phenotype of OPLL.

Citations

Citations to this article as recorded by  Crossref logo
  • The Impact of Cervical Multifidus Sarcopenia on Outcomes After Laminoplasty for Cervical Ossification of the Posterior Longitudinal Ligament
    Yiwei Zhao, Ye Tian, Dihan Sun, Jianguo Zhang, Siyi Cai
    Journal of Bone and Joint Surgery.2026; 108(5): 370.     CrossRef
  • Comparative Analysis of Outcomes and Kyphotic Risk Factors After Cervical Laminoplasty in 2 Different Ossification of the Posterior Longitudinal Ligament Groups and Cervical Spondylotic Myelopathy
    Hyun Woong Mun, Jong Joo Lee, Hyun Chul Shin, Tae-Hwan Kim, Seok Woo Kim, Jae Keun Oh
    Neurosurgery.2025; 97(2): 320.     CrossRef
  • Correlation Between Facet Tropism and Ossification of the Posterior Longitudinal Ligament in the Cervical Spine
    Hao Zhou, Jianxi Wang, Wenyu Zhang, Chenfei Gao, Bo Hu, Genjiang Zhen, Xingyu Li, Hui Wang, Wen Yuan, Huajiang Chen, Lei Liang
    Global Spine Journal.2025; 15(6): 2947.     CrossRef
  • Ossification of the Posterior Longitudinal Ligament in the Cervical Spine: Etiology, Clinical Presentation, and Management
    Christopher P. Bellaire, Ambika E. Paulson, Chinonso F. Ani, Lancelot Benn, Austin H. Carroll, Addisu Mesfin
    JBJS Reviews.2025;[Epub]     CrossRef
  • Spinal hypermobility accelerates ossification in posterior longitudinal ligaments: insights from an in vivo mouse model
    Tao Tang, Zhengya Zhu, Zhongyuan He, Fuan Wang, Lin Chen, Jianfeng Li, Hongkun Chen, Jiaxiang Zhou, Jianmin Wang, Shaoyu Liu, Yunfeng Yao, Xizhe Liu, Zhiyu Zhou
    Frontiers in Physiology.2025;[Epub]     CrossRef
  • X-ray Diagnostics of Degenerative Spinal Canal Stenosis at the Cervical Level (Literature Review)
    V. S. Petrova, P. V. Seliverstov, V. A. Sorokovikov, S. N. Larionov
    Radiology - Practice.2025; (2): 28.     CrossRef
  • Factors Associated With Repeat Surgery in Cervical Ossification of the Posterior Longitudinal Ligaments
    Hyun Jun Jang, Bong Ju Moon, Kyung Hyun Kim, Jeong Yoon Park, Dong Kyu Chin, Keun Su Kim, Yong Eun Cho
    Clinical Spine Surgery.2024; 37(4): 131.     CrossRef
  • Association between Congestive Heart Failure and Ossification of the Posterior Longitudinal Ligament in Korea: A Nationwide Longitudinal Cohort Study
    Dong Soon Jang, Hakyung Kim, Seung Hun Sheen, Inbo Han, Soo Hyun Lee, Woo Seok Choi, Je Beom Hong, Min Jai Cho, Seil Sohn
    The Nerve.2024; 10(1): 19.     CrossRef
  • Integrin αVβ3 antagonist-c(RGDyk) peptide attenuates the progression of ossification of the posterior longitudinal ligament by inhibiting osteogenesis and angiogenesis
    Xiangwu Geng, Yifan Tang, Changjiang Gu, Junkai Zeng, Yin Zhao, Quanwei Zhou, Lianshun Jia, Shengyuan Zhou, Xiongsheng Chen
    Molecular Medicine.2024;[Epub]     CrossRef
  • Is the Ossification of the Posterior Longitudinal Ligament a Positive Factor for the Fusion after Posterior Cervical Fusion and Decompression?
    Jun-Woo Ha, Bong Ju Moon, Kwang-Ryeol Kim, Kyung Hyun Kim, Jeong Yoon Park, Dong Kyu Chin, Yong Eun Cho, Keun Su Kim, Hyun Jun Jang
    The Nerve.2024; 10(2): 89.     CrossRef
  • Concentration-Dependent Efficacy of Recombinant Human Bone Morphogenetic Protein-2 Using a HA/β-TCP Hydrogel Carrier in a Mini-Pig Vertebral Oblique Lateral Interbody Fusion Model
    Hye-Yeong Lee, Ji-In Kang, Hye-Lan Lee, Gwang-Yong Hwang, Keung-Nyun Kim, Yoon Ha
    International Journal of Molecular Sciences.2023; 24(1): 892.     CrossRef
  • Comparison of the outcome after anterior cervical ossified posterior longitudinal ligament en bloc resection versus posterior total laminectomy and fusion in patients with ossification of the cervical posterior longitudinal ligament: a prospective randomi
    Bing Cao, Jingxuan Chen, Bo Yuan, Yanqing Sun, Shengyuan Zhou, Yin Zhao, Zheng Xu, Yifan Tang, Xiongsheng Chen
    The Bone & Joint Journal.2023; 105-B(4): 412.     CrossRef
  • Assessment of Cervical Myelopathy Risk in Ossification of the Posterior Longitudinal Ligament Patients With Spinal Cord Compression Based on Segmental Dynamic Versus Static Factors
    Zhongyuan He, Nguyen Tran Canh Tung, Hiroto Makino, Taketoshi Yasuda, Shoji Seki, Kayo Suzuki, Kenta Watanabe, Hayato Futakawa, Katsuhiko Kamei, Yoshiharu Kawaguchi
    Neurospine.2023; 20(2): 651.     CrossRef
  • Correlation Between the Severity of Multifidus Fatty Degeneration and the Size of Ossification of Posterior Longitudinal Ligament at Each Spinal Level
    Jinyoung Park, Yong Eun Cho, Kyung Hyun Kim, Sanghoon Shin, Sungjun Kim, Chae Hwan Lim, Seok Young Chung, Yoon Ghil Park
    Neurospine.2023; 20(3): 921.     CrossRef
  • 11,693 View
  • 253 Download
  • 12 Web of Science
  • 14 Crossref

Original Articles

The Last Touched Vertebra on Supine Radiographs Can Be the Optimal Lower Instrumented Vertebra in Adolescent Idiopathic Scoliosis Patients
Do-Hyoung Kim, Seung-Jae Hyun, Chang-Hyun Lee, Ki-Jeong Kim
Neurospine 2022;19(1):236-243.   Published online March 31, 2022
DOI: https://doi.org/10.14245/ns.2143224.612

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The Last Touched Vertebra on Supine Radiographs Can Be the Optimal Lower Instrumented Vertebra in Adolescent Idiopathic Scoliosis Patients
Neurospine. 2022;19(1):236-243.   Published online March 31, 2022
DOI: https://doi.org/10.14245/ns.2143224.612
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The Last Touched Vertebra on Supine Radiographs Can Be the Optimal Lower Instrumented Vertebra in Adolescent Idiopathic Scoliosis Patients
Neurospine. 2022;19(1):236-243.   Published online March 31, 2022
DOI: https://doi.org/10.14245/ns.2143224.612
Close
Objective
To determine whether the last touched vertebra (LTV) on supine radiographs is suitable for the lower instrumented vertebra (LIV) in adolescent idiopathic scoliosis (AIS) correction surgery.
Methods
In total, 57 patients were included in the study following posterior instrumentation and fusion. The average follow-up period was 2.2 years. Patients were classified into 4 groups according to the relationship of the location of LIV, LTV, and the last substantially touched vertebra (LSTV) on upright radiographs and the LTV on supine radiographs. In group 1, the upright LTV and supine LTV were the same. Group 1 was subdivided into group 1A and group 1B according to whether the LTV and LSTV were different or the same, respectively. In group 2, the upright LTV was selected as the LIV, whereas in group 3, the supine LTV was selected as the LIV. The baseline characteristics and the preoperative and postoperative radiographic/clinical outcomes of the groups were analyzed.
Results
No differences were found in the preoperative clinical and radiographic baseline characteristics of the 4 groups except the LIV-central sacral vertical line distance. The immediate, 6-month, 1-year, and 2-year postoperative outcomes were not significantly different among the 4 groups. One patient (4.3%) in group 1A experienced radiographic addingon without clinical symptoms. No patients underwent revision surgery.
Conclusion
The group in whom the LIV was selected as the LTV on supine x-rays showed similar postoperative radiographic and clinical results to other groups. The LTV on preoperative supine radiographs is acceptable as the LIV in AIS surgery to maximize motion segments.

Citations

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    Global Spine Journal.2026; 16(6): 2630.     CrossRef
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The Clinical Implications and Complications of Anterior Versus Posterior Surgery for Multilevel Cervical Ossification of the Posterior Longitudinal Ligament; An Updated Systematic Review and Meta-Analysis
Dong Hwan Kim, Chang-Hyun Lee, Young San Ko, Seung Heon Yang, Chi Heon Kim, Sung Bae Park, Chun Kee Chung
Neurospine 2019;16(3):530-541.   Published online September 30, 2019
DOI: https://doi.org/10.14245/ns.1938326.163

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The Clinical Implications and Complications of Anterior Versus Posterior Surgery for Multilevel Cervical Ossification of the Posterior Longitudinal Ligament; An Updated Systematic Review and Meta-Analysis
Neurospine. 2019;16(3):530-541.   Published online September 30, 2019
DOI: https://doi.org/10.14245/ns.1938326.163
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The Clinical Implications and Complications of Anterior Versus Posterior Surgery for Multilevel Cervical Ossification of the Posterior Longitudinal Ligament; An Updated Systematic Review and Meta-Analysis
Neurospine. 2019;16(3):530-541.   Published online September 30, 2019
DOI: https://doi.org/10.14245/ns.1938326.163
Close
Objective
Theoretically, the optimal approach is determined by the status of ossification of the posterior longitudinal ligament (OPLL) and sagittal alignment. However, there have long been disputes about the optimum surgical approach of OPLL. This study is to compare risk-effectiveness between anterior decompression and fusion (ADF) and laminoplasty and laminectomy with fusion (LP/LF) for the patient with cervical myelopathy due to multilevel cervical OPLL.
Methods
We searched core databases, and compared complication and outcomes between ADF and LP/LF for patients with multiple OPLL for the cervical spine. The incidence of complications such as neurologic deterioration, C5 palsy, and dura tear was assessed. Changes in JOA score between baseline and final evaluations were assessed for 2 groups. The minimal clinically important difference (MCID) was utilized for evaluating clinical significance. We calculated Peto odds ratio (POR) and mean difference for the incidence and continuous variables, respectively.
Results
We included data from 21 articles involving 3,872 patients with cervical myelopathy with OPLL. Major neurologic deficits such as paraplegia, quadriplegia developed 2.17% in the ADF group and 1.11% in the LP/LF group, and POR was 2.16. Mean difference of JOA score improvement of 2 groups was 1.30, and the mean difference showed a statistical significance. However, 1.3 points of JOA improvement cannot reach 2.5 points of the MCID.
Conclusion
Anterior surgery often led to rare but critical complications, and the difference of neurological improvement between 2 groups was below a clinically meaningful level. Posterior surgeries may be appropriate in the treatment of multilevel cervical myelopathy with OPLL.

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Epidemiology of C5 Palsy after Cervical Spine Surgery: A 21-Center Study
Jae Keun Oh, Jae Taek Hong, Dong Ho Kang, Sang-Woo Kim, Seok Won Kim, Young Jin Kim, Chun Kee Chung, Jun Jae Shin, Seong Yi, Jung Kil Lee, Jun Ho Lee, Chang-Hyun Lee, Ho Jin Lee, Hyoung-Joon Chun, Dae-Chul Cho, Yong Eun Cho, Yong Jun Jin, Kyung-Chul Choi, In Ho Han, Seung-Jae Hyun, Jung-Woo Hur, Ki-Jeong Kim
Neurospine 2019;16(3):558-562.   Published online September 30, 2019
DOI: https://doi.org/10.14245/ns.1938142.071

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Epidemiology of C5 Palsy after Cervical Spine Surgery: A 21-Center Study
Neurospine. 2019;16(3):558-562.   Published online September 30, 2019
DOI: https://doi.org/10.14245/ns.1938142.071
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Epidemiology of C5 Palsy after Cervical Spine Surgery: A 21-Center Study
Neurospine. 2019;16(3):558-562.   Published online September 30, 2019
DOI: https://doi.org/10.14245/ns.1938142.071
Close
Objective
C5 palsy is a severe complication after cervical spine surgery, the pathophysiology of which remains unclear. This multicenter study investigated the incidence of C5 palsy following cervical spine surgery in Korea.
Methods
We conducted a retrospective multicenter study involving 21 centers from the Korean Cervical Spine Study Group. The inclusion criteria were cervical spine surgery patients between 2012 and 2016, excluding cases of neck surgery. In patients with C5 palsy, the operative methods, disease category, onset time of C5 palsy, recovery time, C5 manual muscle testing (MMT) grade, and post-C5 palsy management were analyzed.
Results
We collected 15,097 cervical spine surgery cases from 21 centers. C5 palsy occurred in 88 cases (0.58%). C5 palsy was more common in male patients (p=0.019) and after posterior approach procedures (p<0.001). C5 palsy usually occurred within 3 days after surgery (77 of 88, 87.5%) and most C5 palsy patients recovered within 6 months (51 of 88, 57.95%). Thirty C5 palsy patients (34.09%) had motor weakness, with an MMT grade≤2. Only four C5 palsy patients (4.5%) did not recover during follow-up. Posterior cervical foraminotomy was performed in 7 cases (7.95%), and steroids were used in 56 cases (63.63%). Twenty-six cases (29.55%) underwent close observation only.
Conclusion
The overall incidence of C5 palsy was relatively low (0.58%). C5 palsy was more common after posterior cervical surgery and in male patients. C5 palsy usually developed within 3 days after surgery, and more than half of patients with C5 palsy recovered within 6 months.

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Does Preservation of Ligamentum Flavum in Percutaneous Endoscopic Lumbar Interlaminar Discectomy Improve Clinical Outcomes?
Urim Lee, Chi Heon Kim, Calvin C. Kuo, Yunhee Choi, Sung Bae Park, Seung Heon Yang, Chang-Hyun Lee, Kyoung-Tae Kim, Chun Kee Chung
Neurospine 2019;16(1):113-119.   Published online March 31, 2019
DOI: https://doi.org/10.14245/ns.1938008.004

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Does Preservation of Ligamentum Flavum in Percutaneous Endoscopic Lumbar Interlaminar Discectomy Improve Clinical Outcomes?
Neurospine. 2019;16(1):113-119.   Published online March 31, 2019
DOI: https://doi.org/10.14245/ns.1938008.004
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Does Preservation of Ligamentum Flavum in Percutaneous Endoscopic Lumbar Interlaminar Discectomy Improve Clinical Outcomes?
Neurospine. 2019;16(1):113-119.   Published online March 31, 2019
DOI: https://doi.org/10.14245/ns.1938008.004
Close
Objective
Ligamentum flavum (LF) is an important anatomical structure for prevention of postoperative adhesions, but the opening of LF is necessary for percutaneous endoscopic lumbar interlaminar discectomy (PEID). Although the defect in LF is small with conventional PEID, the defect could be minimized with LF splitting technique. The objective of this study was to compare clinical outcomes of PEID with opening of LF versus splitting of LF.
Methods
A retrospective study was performed for patients underwent PEID for L5–S1. PEID with the opening of LF (open-group) was performed for 55 patients and with splitting of LF (split-group) was performed for 34 patients. The defect of LF in Open-group was 3–5 mm, but the defect was negligible in split-group because the split LF was reapproximated by its elasticity. Clinical outcomes were evaluated with Korean version of the Oswestry Disability Index (K-ODI) and visual analogue pain scores for back (VASB) and leg (VASL). The changes of clinical outcomes during postoperative 24 months between groups were evaluated with linear mixed-effects model.
Results
The clinical outcomes were similar between groups for K-ODI (p=0.98), VASB (p=0.52), and VASL (p=0.59). Each outcome demonstrated significant improvement from preoperative baseline throughout the postoperative 24 months (p<0.05). Complications included recurrence in 4 patients and dural tear in 1 in open-group (9.1%), and residual disc herniation in 2 patients and transient weakness in 1 in split-group (8.8%).
Conclusion
Splitting versus opening LF in PEID may be left to the surgeon’s discretion. The potential risks and benefits of LF handling should be considered when performing this surgical technique in PEID.

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Health Care Burden of Spinal Diseases in the Republic of Korea: Analysis of a Nationwide Database From 2012 Through 2016
Chang-Hyun Lee, Chun Kee Chung, Chi Heon Kim, Ji-Woong Kwon
Neurospine 2018;15(1):66-76.   Published online March 28, 2018
DOI: https://doi.org/10.14245/ns.1836038.019

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Health Care Burden of Spinal Diseases in the Republic of Korea: Analysis of a Nationwide Database From 2012 Through 2016
Neurospine. 2018;15(1):66-76.   Published online March 28, 2018
DOI: https://doi.org/10.14245/ns.1836038.019
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Health Care Burden of Spinal Diseases in the Republic of Korea: Analysis of a Nationwide Database From 2012 Through 2016
Neurospine. 2018;15(1):66-76.   Published online March 28, 2018
DOI: https://doi.org/10.14245/ns.1836038.019
Close
Objective
This study aimed to determine the incidence and analyze trends related to spinal diseases based on a national database in the Republic of Korea (ROK) and to elucidate the healthcare burden that will serve as a useful resource for researchers, clinicians, and patients.
Methods
This study was a retrospective analysis of data obtained from Healthcare Bigdata Hub, the Korean Statistical Information Service, and Open Data Portal from 2012 through 2016. The main disease codes for spinal diseases (M40–M54) were used for identification of these conditions.
Results
The overall annual incidence rates for spinal disease in the ROK was median 15,877 (men, 13,181; women, 18,588) per 100,000 population, and sex ratio was 1:1.41 (p<0.01). The incidence rate and annual costs per patient increased by 7.6% and 14.7% over 5 years continuously, respectively. The age-adjusted incidence rate increased with age; the highest rates were 42.6% in the 75–79 years group. Patients older than 65 years old accounted for median 31.0% of number of patients and 40.1% of medical expenses over 5 years. Lumbar disc herniation (M51) and spinal stenosis (M48) might accounted for both the highest incidence and medical expenses in patients under the age of 60 and over 60 years, respectively.
Conclusion
The incidence and medical expenditures of spinal disease increased continuously. As the population of ROK in aging, the incidence and medical expenditures due to spondylosis and stenosis (M48) for the old are also increasing. The social burden of spinal diseases in elder patients needs to be prudently considered in health policy makers.

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Clinical Article

Comparative Analysis Between Thoracic Spinal Cord and Sacral Neuromodulation in a Rat Spinal Cord Injury Model: A Preliminary Report of a Rat Spinal Cord Stimulation Model
Seung-Jae Hyun, Chang-Hyun Lee, Ji Woong Kwon, Cheol-Yong Yoon, Jae-Young Lim, Ki-Jeong Kim, Tae-Ahn Jahng, Hyun-Jib Kim
Korean J Spine 2013;10(1):14-18.   Published online March 31, 2013
DOI: https://doi.org/10.14245/kjs.2013.10.1.14

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Comparative Analysis Between Thoracic Spinal Cord and Sacral Neuromodulation in a Rat Spinal Cord Injury Model: A Preliminary Report of a Rat Spinal Cord Stimulation Model
Korean J Spine. 2013;10(1):14-18.   Published online March 31, 2013
DOI: https://doi.org/10.14245/kjs.2013.10.1.14
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Comparative Analysis Between Thoracic Spinal Cord and Sacral Neuromodulation in a Rat Spinal Cord Injury Model: A Preliminary Report of a Rat Spinal Cord Stimulation Model
Korean J Spine. 2013;10(1):14-18.   Published online March 31, 2013
DOI: https://doi.org/10.14245/kjs.2013.10.1.14
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Objective

The purpose of this study is to compare a neuroprotective effect of thoracic cord neuromodulation to that of sacral nerve neuromodulation in rat thoracic spinal cord injury (SCI) model.

Methods

Twenty female Sprague Dawley rats were randomly divided into 4 groups: the normal control group (n=5), SCI with sham stimulation group (SCI, n=5), SCI with electrical stimulation at thoracic spinal cord (SCI + TES, n=5), and SCI with electrical stimulation at sacral nerve (SCI + SES, n=5). Spinal cord was injured by an impactor which dropped from 25mm height. Electrical stimulation was performed by the following protocol: pulse duration, 0.1ms; frequency, 20 Hz; stimulation time, 30 minutes; and stimulation duration at thoracic epidural space and S2 or 3 neural foramina for 4 weeks. Locomotor function, urodynamic study, muscle weights, and fiber cross sectional area (CSA) were investigated.

Results

All rats of the SCI + TES group expired within 3 days after the injury. The locomotor function of all survived rats improved over time but there was no significant difference between the SCI and the SCI + SES group. All rats experienced urinary retention after the injury and recovered self-voiding after 3-9 days. Voiding contraction interval was 25.5±7.5 minutes in the SCI group, 16.5±5.3 minutes in the SCI+SES group, and 12.5±4.2 minutes in the control group. The recovery of voiding contraction interval was significant in the SCI + SES group comparing to the SCI group (p<0.05). Muscle weight and CSA were slightly greater in the SCI + SES than in the SCI group, but the difference was not significant.

Conclusion

We failed to establish a rat spinal cord stimulation model. However, sacral neuromodulation have a therapeutic potential to improve neurogenic bladder and muscle atrophy.

Citations

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    F.M.J. Martens, K-D. Sievert
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Case Report

Intradural Extramedullary Metastasis of Small Cell Lung Cancer: A Case Report
Chang-Hyun Lee, Ki-Jeong Kim, Seung-Jae Hyun, Tae-Ahn Jahng, Hyun-Jib Kim
Korean J Spine 2012;9(3):293-296.   Published online September 30, 2012
DOI: https://doi.org/10.14245/kjs.2012.9.3.293

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Intradural Extramedullary Metastasis of Small Cell Lung Cancer: A Case Report
Korean J Spine. 2012;9(3):293-296.   Published online September 30, 2012
DOI: https://doi.org/10.14245/kjs.2012.9.3.293
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Intradural Extramedullary Metastasis of Small Cell Lung Cancer: A Case Report
Korean J Spine. 2012;9(3):293-296.   Published online September 30, 2012
DOI: https://doi.org/10.14245/kjs.2012.9.3.293
Close

A 60-year-old man presented with para-anesthesia and a tingling sensation in the saddle area. Intradural extramedullary (IDEM) tumors in conus medullaris were observed by radiologic studies. The patient underwent laminoplastic laminotomy at the T12-L2 level and subtotal removal of the tumor because of the ill-defined margin. Postoperatively, hypesthesia was improved up to 50%. The IDEM tumor revealed a metastatic cancer originated from small cell lung cancer (SCLC) by histologic examination, and additional studies showed multiple metastases including adrenal gland, brain, and bone. Clinicians need to consider IDEM metastasis when SCLC patients were complained of neurologic symptoms mimic paraneoplastic syndrome. The pathophysioloigy of IDEM metastasis may be not only tertiary drop metastasis, but also faster mechanisms such as direct invasion.

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