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"Jun Jae Shin"

Original Articles

Clinical Study – Cervical Spine

Flexion K-Line Status Predicts Surgical Strategy in Multilevel Cervical Ossification of the Posterior Longitudinal Ligament: A Multicenter Comparison of Laminoplasty and Laminectomy With Fusion
Jun Jae Shin, Sun Joon Yoo, Se Jun Park, Dong Kyu Kim, Hyun Jun Jang, Bong Ju Moon, Kyung Hyun Kim, Jeong Yoon Park, Sung Uk Kuh, Dong Kyu Chin, Keun Su Kim, Yong Eun Cho, Chang Kyu Lee, Dong Ah Shin, Seong Yi, Keung Nyun Kim, Joongkyum Shin, Yoon Ha
Neurospine 2025;22(4):937-948.   Published online December 31, 2025
DOI: https://doi.org/10.14245/ns.2551108.554

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Flexion K-Line Status Predicts Surgical Strategy in Multilevel Cervical Ossification of the Posterior Longitudinal Ligament: A Multicenter Comparison of Laminoplasty and Laminectomy With Fusion
Neurospine. 2025;22(4):937-948.   Published online December 31, 2025
DOI: https://doi.org/10.14245/ns.2551108.554
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Flexion K-Line Status Predicts Surgical Strategy in Multilevel Cervical Ossification of the Posterior Longitudinal Ligament: A Multicenter Comparison of Laminoplasty and Laminectomy With Fusion
Neurospine. 2025;22(4):937-948.   Published online December 31, 2025
DOI: https://doi.org/10.14245/ns.2551108.554
Close
Objective
To evaluate the clinical significance of a negative K-line in the neck flexion position (FK-line [-]), which indicates that cervical ossification of the posterior longitudinal ligament (OPLL) crosses the K-line during flexion, and to compare surgical outcomes between laminoplasty (LP) and laminectomy with fusion (LF) for multilevel FK-line (-) cervical OPLL.
Methods
A total of 349 patients with multiple cervical OPLL who underwent posterior decompression surgery (LP or LF) with a minimum of 2 years of follow-up were stratified by FK-line status. Clinical and radiological parameters were compared between the FK-line (+) and FK-line (-) groups. Subgroup analysis of FK-line (-) patients evaluated the efficacy of LP versus LF. Multivariate regression identified predictors of neurological recovery.
Results
Patients with FK-line (-) OPLL exhibited a smaller FK-line distance, more kyphotic alignment, greater cervical flexion, and lower recovery ratios compared to those with FK-line (+). In the FK-line (-) subgroup, LF achieved a significantly greater increase in FK-line distance, better correction of the flexion angle, and more neurological recovery than LP. Multivariate analyses identified postoperative FK-line distance, C2–7 flexion angle, and preoperative dynamic extension reserve as independent predictors of neurological outcomes.
Conclusion
FK-line status reflects the sagittal cord position and predicts surgical outcomes in cervical OPLL. In FK-line (-) patients, LF provides better neurological recovery and more effective posterior cord shift and kyphotic alignment correction than LP. Incorporating FK-line assessment to guide surgical planning could improve individualized treatment outcomes for multilevel OPLL.

Citations

Citations to this article as recorded by  Crossref logo
  • A Commentary on “Flexion K-Line Status Predicts Surgical Strategy in Multilevel Cervical Ossification of the Posterior Longitudinal Ligament: A Multicenter Comparison of Laminoplasty and Laminectomy With Fusion”
    John H. Chi
    Neurospine.2025; 22(4): 951.     CrossRef
  • A Commentary on “Flexion K-Line Status Predicts Surgical Strategy in Multilevel Cervical Ossification of the Posterior Longitudinal Ligament: A Multicenter Comparison of Laminoplasty and Laminectomy With Fusion”
    Yutaro Kanda
    Neurospine.2025; 22(4): 949.     CrossRef
  • From the Editor-in-Chief: Featured Articles in the December 2025 Issue
    Inbo Han
    Neurospine.2025; 22(4): 877.     CrossRef
  • 2,006 View
  • 88 Download
  • 3 Web of Science
  • 3 Crossref

Cervical Spine

The Role of K-Line and Canal-Occupying Ratio in Surgical Outcomes for Multilevel Cervical Ossification of the Posterior Longitudinal Ligament: A Retrospective Multicenter Study
Jun Jae Shin, Sun Joon Yoo, Dong Kyu Kim, Hyun Jun Jang, Bong Ju Moon, Kyung Hyun Kim, Jeong Yoon Park, Sung Uk Kuh, Dong Kyu Chin, Keun Su Kim, Yong Eun Cho, Won Joo Jeong, Tae Woo Kim, Chang Kyu Lee, Dong Ah Shin, Seong Yi, Keung Nyun Kim, Joongkyum Shin, Yoon Ha
Neurospine 2025;22(2):337-348.   Published online June 30, 2025
DOI: https://doi.org/10.14245/ns.2550184.092

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The Role of K-Line and Canal-Occupying Ratio in Surgical Outcomes for Multilevel Cervical Ossification of the Posterior Longitudinal Ligament: A Retrospective Multicenter Study
Neurospine. 2025;22(2):337-348.   Published online June 30, 2025
DOI: https://doi.org/10.14245/ns.2550184.092
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The Role of K-Line and Canal-Occupying Ratio in Surgical Outcomes for Multilevel Cervical Ossification of the Posterior Longitudinal Ligament: A Retrospective Multicenter Study
Neurospine. 2025;22(2):337-348.   Published online June 30, 2025
DOI: https://doi.org/10.14245/ns.2550184.092
Close
Objective
To evaluate the impact of the K-line and canal-occupying ratio (COR) on surgical outcomes in patients with multilevel cervical ossification of the posterior longitudinal ligament (OPLL).
Methods
Patients with cervical myelopathy due to multilevel OPLL who underwent decompression surgery (anterior or posterior) from 2013 to 2022, with 2-year minimum follow-up, were enrolled. Radiological evaluations included K-line, COR, OPLL type/level, and cervical parameters (C2 slope [C2S], T1 slope [T1S], K-line tilt). Clinical outcomes included Japanese Orthopaedic Association (JOA) score and neck-pain visual analogue scale. Patients were categorized by K-line status (+/-) and COR (<50% or ≥50%).
Results
Among 575 patients, JOA recovery was significantly better in the K-line (+) and in low COR (<50%). In high COR (≥50%), K-line (-) was associated with poorer recovery. In low COR, outcomes were similar regardless of K-line. Anterior decompression with fusion (ADF) yielded the best outcomes. Laminoplasty (LP) was optimal for COR ≥50% and/or K-line (+), while laminectomy with fusion (LF) was better for COR ≥50% and K-line (-). In high COR, K-line was influenced by cervical alignment, C2S, and T1S, while in low COR, it was mainly affected by COR percentage.
Conclusion
Combining K-line and COR is essential for surgical planning in multilevel OPLL. When COR is high, K-line plays a significant role in predicting neurological recovery. ADF led to superior recovery, whereas for patients with K-line (-) and high COR, LF offered better results than LP. Cervical parameters at high COR influence the K-line more.

Citations

Citations to this article as recorded by  Crossref logo
  • Evaluating the demographics and complications of North American surgical patients with ossification of the posterior longitudinal ligament
    Aaron Phung, Justin Hyde, Justin Azmoodeh, Theodore Quan, Lancelot Benn, Christopher P. Bellaire, Oliver Tannous, Joseph Ferguson, Seyed B Kalantar, David Weiner, Andrew Mo, Fred Mo, Sean Bae, Ala Alshomali, Crisanto L. Macaraeg, Kevin Yoon, Jonathan P. J
    Journal of Clinical Neuroscience.2026; 144: 111790.     CrossRef
  • Radiological assessment in cervical spine myelopathy
    Shanmuganathan Rajasekaran, Gnanaprakash Gurusamy, Pushpa Bhari Thippeswamy, Karthik Ramachandran, Stefano Conti
    Journal of Clinical Orthopaedics and Trauma.2026; 72: 103301.     CrossRef
  • C2-Involving Cervical Ossification of the Posterior Longitudinal Ligament (OPLL): Dome-like Laminoplasty Versus Laminectomy With Fusion
    Jun Jae Shin, Sun Joon Yoo, Se Jun Park, Dong Kyu Kim, Hyun Jun Jang, Bong Ju Moon, Kyung Hyun Kim, Jeong Yoon Park, Sung Uk Kuh, Dong Kyu Chin, Keun Su Kim, Joongkyum Shin, Yoon Ha
    Global Spine Journal.2026;[Epub]     CrossRef
  • Dynamic K-Line Status and Surgical Outcomes in Multilevel Cervical OPLL: A Multicenter Comparative Study
    Jun Jae Shin, Sun Joon Yoo, Se Jun Park, Dong Kyu Kim, Hyun Jun Jang, Bong Ju Moon, Kyung Hyun Kim, Jeong Yoon Park, Sung Uk Kuh, Dong Kyu Chin, Keun Su Kim, Chang Kyu Lee, Keung Nyun Kim, Tae Woo Kim, Yoon Ha
    Journal of Clinical Medicine.2026; 15(2): 520.     CrossRef
  • A comparative study on surgical management of long-course symptomatic cervical OPLL between anterior en bloc resection and posterior laminectomy with instrumented fusion
    Kefu Chen, Yiwei Lu, Shu Liu, Lianshun Jia, Xingcheng Dong, Tianwen Ye
    BMC Musculoskeletal Disorders.2026;[Epub]     CrossRef
  • Reduction of Spinal Cord Cross-Sectional Area Is Associated With Myelopathy in Severe Cervical Ossification of the Posterior Longitudinal Ligaments
    Hyun-Jun Jang, Dong-Kyu Kim, Bong-Ju Moon, Kyung-Hyun Kim, Jeong-Yoon Park, Sung-Uk Kuh, Keun-Su Kim, Yong-Eun Cho, Dong-Kyu Chin
    Neurosurgery.2026;[Epub]     CrossRef
  • 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
  • Surgical Technique and Technical Pearls of O-arm Navigation-assisted Anterior Cervical Corpectomy and Fusion for Cervical Ossification of the Posterior Longitudinal Ligament (OPLL)
    Yusuke Nishimura
    Spinal Surgery.2026; 40(1): 8.     CrossRef
  • Risk Factors for Persistent Neurological Deterioration After Biportal Endoscopic Posterior Decompression for Multilevel Cervical Myelopathy: The “Structural Mismatch” Concept
    Ji Yeon Kim, Woon Tak Yuh, Su Yong Choi, Min Gyu Kang, Seok Won Lee
    Journal of Minimally Invasive Spine Surgery and Technique.2026; 11(Suppl 2): S302.     CrossRef
  • Anterior Cervical Discectomy and Fusion Achieves Outcomes Comparable to Laminoplasty in Patients With Spinal Cord-Canal Mismatch
    Dong-Ho Lee, Sehan Park, Myeong G. Song, Chang J. Hwang, Jae H. Cho
    Clinical Spine Surgery.2026;[Epub]     CrossRef
  • Flexion K-Line Status Predicts Surgical Strategy in Multilevel Cervical Ossification of the Posterior Longitudinal Ligament: A Multicenter Comparison of Laminoplasty and Laminectomy With Fusion
    Jun Jae Shin, Sun Joon Yoo, Se Jun Park, Dong Kyu Kim, Hyun Jun Jang, Bong Ju Moon, Kyung Hyun Kim, Jeong Yoon Park, Sung Uk Kuh, Dong Kyu Chin, Keun Su Kim, Yong Eun Cho, Chang Kyu Lee, Dong Ah Shin, Seong Yi, Keung Nyun Kim, Joongkyum Shin, Yoon Ha
    Neurospine.2025; 22(4): 937.     CrossRef
  • 10,476 View
  • 280 Download
  • 10 Web of Science
  • 11 Crossref

Deformity

Application of Transverse Process Hooks at Distal Thoracic Vertebrae in Uppermost Vertebral Instrumentation for Adult Spinal Deformity Surgery: Special Focus on Delayed-Onset Neurologic Deficits
Sun-Joon Yoo, Hyun-Jun Jang, Bong Ju Moon, Jeong-Yoon Park, Sung Uk Kuh, Dong-Kyu Chin, Keun-Su Kim, Jun Jae Shin, Yoon Ha, Kyung-Hyun Kim
Neurospine 2024;21(4):1219-1229.   Published online December 31, 2024
DOI: https://doi.org/10.14245/ns.2448804.402

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Application of Transverse Process Hooks at Distal Thoracic Vertebrae in Uppermost Vertebral Instrumentation for Adult Spinal Deformity Surgery: Special Focus on Delayed-Onset Neurologic Deficits
Neurospine. 2024;21(4):1219-1229.   Published online December 31, 2024
DOI: https://doi.org/10.14245/ns.2448804.402
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Application of Transverse Process Hooks at Distal Thoracic Vertebrae in Uppermost Vertebral Instrumentation for Adult Spinal Deformity Surgery: Special Focus on Delayed-Onset Neurologic Deficits
Neurospine. 2024;21(4):1219-1229.   Published online December 31, 2024
DOI: https://doi.org/10.14245/ns.2448804.402
Close
Objective
We aimed to investigate the incidence of delayed-onset neurological deficits (DONDs), DOND-related reoperation rates following adult spinal deformity (ASD) surgery, and efficacy of transverse process hooks (TPHs) at the uppermost instrumented vertebra (UIV) compared to pedicle screws (PSs).
Methods
We included 90 consecutive patients who underwent instrumented fusion from the sacrum to the distal thoracic spine for ASD, with a minimum follow-up of 24 months. Clinical and radiological outcomes were compared between 33 patients in the TPH group and 57 patients in the PS group, using the Scoliosis Research Society-22 Outcomes questionnaire (SRS-22), Medical Outcomes Study Questionnaire Short-Form 36 (SF-36), and various spinal sagittal parameters.
Results
While absent in the TPH group, myelopathy occurred in 15.8% of the PS group, wherein 15 patients underwent reoperation. The change in the proximal junctional angle, from the pre- to postoperative assessment, was lower in the TPH group than in the PS group (0.2 vs. 6.6, p=0.002). Postoperative facet degeneration in the PS group progressed more significantly than in the TPH group (0.5 vs. 0.1, p=0.002). Surgical outcomes were comparable for both groups, except for the back visual analogue scale (3.5 vs. 4.1, p=0.010) and SRS-22 domains, including pain and satisfaction (3.3 vs. 2.9, p=0.033; 3.7 vs. 3.3, p=0.041). No intergroup difference was observed in SF-36.
Conclusion
Using TPHs at the UIV level can prevent DOND, and thereby prevent postoperative myelopathy that necessitates reoperation; thus, TPHs is preferable over PSs in ASD surgery.

Citations

Citations to this article as recorded by  Crossref logo
  • Clinical and radiological outcomes of transverse process hooks versus pedicle screws at the upper instrumented vertebra in adult spinal deformity patients undergoing three-column osteotomy: A retrospective comparative study
    Mohsen Rostami, Sadegh Bagherzadeh, Navid Moghadam, Faramarz Roohollahi, Cesar Carballo Cuello, Jay Kumar, Mark Greenberg, Puya Alikhani
    Clinical Neurology and Neurosurgery.2026; 261: 109263.     CrossRef
  • Comparison of Hook Fixation and Vertebroplasty for Prevention of Proximal Junctional Failure: A Retrospective Cohort Study
    Sung Tan Cho, Jae Hwan Cho, Dong-Ho Lee, Chang Ju Hwang, Sehan Park, Jin Hwan Kim, Wongthawat Liawrungrueang
    Global Spine Journal.2026;[Epub]     CrossRef
  • Prevalence and Risk Factors for Postoperative Neurological Complications in Spinal Deformity Surgery: A Systematic Review and Proportional Meta-Analysis
    Yam Wa Man, Jedidiah Yui Shing Lui, Chor Yin Lam, Jason Pui Yin Cheung, Prudence Wing Hang Cheung
    Neurospine.2025; 22(1): 243.     CrossRef
  • 5,114 View
  • 137 Download
  • 3 Web of Science
  • 3 Crossref
Radiological and Clinical Significance of Cervical Dynamic Magnetic Resonance Imaging for Cervical Spondylotic Myelopathy
Jun Jae Shin, Sun Joon Yoo, Tae Woo Kim, Jae-Young So, Won Joo Jeong, Mu Ha Lee, Joongkyum Shin, Yoon Ha
Neurospine 2024;21(2):443-454.   Published online June 30, 2024
DOI: https://doi.org/10.14245/ns.2448166.083

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Radiological and Clinical Significance of Cervical Dynamic Magnetic Resonance Imaging for Cervical Spondylotic Myelopathy
Neurospine. 2024;21(2):443-454.   Published online June 30, 2024
DOI: https://doi.org/10.14245/ns.2448166.083
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Radiological and Clinical Significance of Cervical Dynamic Magnetic Resonance Imaging for Cervical Spondylotic Myelopathy
Neurospine. 2024;21(2):443-454.   Published online June 30, 2024
DOI: https://doi.org/10.14245/ns.2448166.083
Close
Objective
The study compared the morphometric changes of the cervical spinal cord using dynamic magnetic resonance imaging (MRI) in patients with cervical spondylotic myelopathy (CSM) and assessed the correlation with kinematic changes, cord cross-sectional area (CSA), and high signal intensity (SI) on T2-weighted imaging (T2WI).
Methods
Patients with CSM were evaluated through dynamic MRI for sagittal and axial CSA changes of the cervical cord, cerebrospinal fluid (CSF) reserve ratio, degree of cord impingement, cord compression rate, range of motion (ROM), and severity of SI on T2WI. The degree of cord impingement was evaluated using the Muhle grading system. Clinical outcomes were assessed using Japanese Orthopaedic Association scoring and Nurick grade.
Results
The study included 191 patients (113 males) with a mean age of 55.34 ± 12.09 years. The lowest sagittal CSF reserve ratio and cord occupation rate were observed during extension. Cord impingement and SI change were more prevalent in extension-positioned MRI. There was no difference between ROM on dynamic radiographs and dynamic MRI. Preoperative cervical ROM was greater in patients with intensely high SI change.
Conclusion
Dynamic MRI is useful for evaluating neck movement. Patients with high SI had greater ROM before surgery but worse outcomes after. Neck extension exacerbated cervical stenosis and cord compression compared to flexion, and cervical spinal motion contributed to the severity of CSM. Cervical spinal motion should be carefully evaluated, particularly in hyperextension, to prevent worsening of CSM.

Citations

Citations to this article as recorded by  Crossref logo
  • Posture-dependent assessment of whole-spine curvature with a rotatable cryogen-free 1.5T MRI and automated Cobb angle analysis
    Shiying Ke, Hengyuan Guo, Yulin Wang, Jichang Zhang, Pengfei Xu, Jianjun Zheng, Bin Chen, Chendie Yao, Thomas Meersmann, Chengbo Wang
    European Spine Journal.2026; 35(8): 4849.     CrossRef
  • Dynamic K-Line Status and Surgical Outcomes in Multilevel Cervical OPLL: A Multicenter Comparative Study
    Jun Jae Shin, Sun Joon Yoo, Se Jun Park, Dong Kyu Kim, Hyun Jun Jang, Bong Ju Moon, Kyung Hyun Kim, Jeong Yoon Park, Sung Uk Kuh, Dong Kyu Chin, Keun Su Kim, Chang Kyu Lee, Keung Nyun Kim, Tae Woo Kim, Yoon Ha
    Journal of Clinical Medicine.2026; 15(2): 520.     CrossRef
  • Dynamic Cervical Myelopathy Misleading on Neutral Imaging: The Role of Flexion–Extension MRI
    Leonardo Anselmi, Donato Creatura, Mario De Robertis, Ali Baram, Emanuele Stucchi, Gabriele Capo, Jad El Choueiri, Federico Pessina, Maurizio Fornari, Carlo Brembilla
    Journal of Clinical Medicine.2026; 15(4): 1333.     CrossRef
  • Intramedullary Strain During Neck Extension is Associated with Microstructural Spinal Cord Injury in Degenerative Cervical Myelopathy
    Mahmudur Rahman, Karthik Banurekha Devaraj, Balaji Harinathan, Omkar Chauhan, Matthew Budde, Narayan Yoganandan, Aditya Vedantam
    Annals of Biomedical Engineering.2026; 54(7): 2015.     CrossRef
  • Predictive factors for outcomes of anterior-only surgery in multilevel pincer-type cervical spondylotic myelopathy: The role of the posterior compression score
    Lin Xie, Wenbo Wu, Kun Wang, Yu Song, Xianlin Zeng, Cao Yang, Xiaobo Feng
    Journal of Orthopaedics.2026; 75: 305.     CrossRef
  • Clinical and Radiological Characterization of Cervical Spinal Stenosis Using Muhle Grading on Flexion-Extension Dynamic MRI: Correlation With mJOA in an Institutional Cohort
    José Ramón Rodríguez-Fonseca, Daniel Alberto Reyes-Navarro, Armando Saúl Ruiz-Treviño, Alejandro Miranda González, José Oscar Chávez-Bejar, Alexis Agustín Altamirano Carrizoza, Christian Gabriel de Jesús Ordaz-Pérez, María Maldonado-Vega
    Global Spine Journal.2026;[Epub]     CrossRef
  • Radiograph-based intervertebral sagittal translation-to-canal diameter ratio as a quantitative imaging marker for suspected lower cervical instability
    Tao Gao, Yi Tong, Tao Li, Jiandong Tang, Zhiyu Cheng, Xu Lin, Haigang Hu, Shenyu Wan, Chao Wu
    European Spine Journal.2026; 35(9): 5731.     CrossRef
  • Modern Capabilities of in vivo Positional Topographic Human Anatomy
    E. M. Trunin, V. V. Tatarkin, D. A. Starchik, S. S. Dydykin, Yu. L. Vasil'ev, K. N. Movchan, A. I. Shchegolev, A. M. Bakunov, V. A. Yakovlev, E. O. Stetsik, S. Yu. Nikulin
    Journal of Anatomy and Histopathology.2026; 15(2): 64.     CrossRef
  • Cervical Positional Changes Alter Supra-Aortic Branching Geometry: Implications for Transradial Neurointervention
    Takuya Nakamura, Yoshiki Hanaoka, Masaaki Takahashi, Fumihito Ichinohe, Takumi Maruyama, Kohei Kanaya, Jun-ichi Koyama, Yasunari Fujinaga, Tetsuyoshi Horiuchi
    World Neurosurgery.2026; 214: 125250.     CrossRef
  • The Role of Dynamic Cervical Magnetic Resonance Imaging in Determining the Level of Posterior Decompression in Cervical Spondylotic Myelopathy
    Luay Şerifoğlu, Abdulmutalip Karaaslanlı
    World Neurosurgery.2025; 195: 123698.     CrossRef
  • T2-weighted MRI high signal in cervical spondylotic myelopathy is associated with dynamic change
    Xiangzhen Kong, Zhenchuan Liu, Kangle Song, Keyu Pan, Yuanqiang Zhang, Jianlu Wei, Lei Cheng
    Journal of Orthopaedic Surgery and Research.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
  • Weight-bearing MRI of the cervical spine: A scoping review of clinical utility and emerging applications
    Jonathan Verderame, Muhammad Shakib Arslan, Farhan Mukhtar, Zaheer Abbas
    European Journal of Radiology Open.2025; 15: 100694.     CrossRef
  • Evaluation of Cases Diagnosed with Cervical Myelopathy or Syringomyelia Referred with a Preliminary Diagnosis of Amyotrophic Lateral Sclerosis
    Nimet Ucaroglu Can
    Online Türk Sağlık Bilimleri Dergisi.2025; 10(3): 239.     CrossRef
  • Dynamic MRI in Degenerative Cervical Myelopathy: A Systematic Review of Radiological Markers, Correlations, and Outcomes
    Ali Baram, Jad El Choueiri, Carlo Brembilla, Francesca Pellicanò, Lorenzo De Rossi, Leonardo Di Cosmo, Mario De Robertis, Emanuele Stucchi, Donato Creatura, Gabriele Capo, Maurizio Fornari, Marco Riva, Letterio S. Politi, Federico Pessina
    Journal of Clinical Medicine.2025; 15(1): 265.     CrossRef
  • Flexion K-Line Status Predicts Surgical Strategy in Multilevel Cervical Ossification of the Posterior Longitudinal Ligament: A Multicenter Comparison of Laminoplasty and Laminectomy With Fusion
    Jun Jae Shin, Sun Joon Yoo, Se Jun Park, Dong Kyu Kim, Hyun Jun Jang, Bong Ju Moon, Kyung Hyun Kim, Jeong Yoon Park, Sung Uk Kuh, Dong Kyu Chin, Keun Su Kim, Yong Eun Cho, Chang Kyu Lee, Dong Ah Shin, Seong Yi, Keung Nyun Kim, Joongkyum Shin, Yoon Ha
    Neurospine.2025; 22(4): 937.     CrossRef
  • From the Editor-in-Chief: Featured Articles in the June 2024 Issue
    Inbo Han
    Neurospine.2024; 21(2): 373.     CrossRef
  • Commentary on “Radiological and Clinical Significance of Cervical Dynamic Magnetic Resonance Imaging for Cervical Spondylotic Myelopathy”
    Aydin Sinan Apaydin, Khoi Than
    Neurospine.2024; 21(2): 455.     CrossRef
  • 18,180 View
  • 274 Download
  • 15 Web of Science
  • 18 Crossref

Regular Issue

Surgical Versus Conservative Management for Treating Unstable Atlas Fractures: A Multicenter Study
Jun Jae Shin, Kwang-Ryeol Kim, Joongkyum Shin, Jiin Kang, Ho Jin Lee, Tae Woo Kim, Jae Taek Hong, Sang-Woo Kim, Yoon Ha
Neurospine 2022;19(4):1013-1025.   Published online October 23, 2022
DOI: https://doi.org/10.14245/ns.2244352.176

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Surgical Versus Conservative Management for Treating Unstable Atlas Fractures: A Multicenter Study
Neurospine. 2022;19(4):1013-1025.   Published online October 23, 2022
DOI: https://doi.org/10.14245/ns.2244352.176
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Surgical Versus Conservative Management for Treating Unstable Atlas Fractures: A Multicenter Study
Neurospine. 2022;19(4):1013-1025.   Published online October 23, 2022
DOI: https://doi.org/10.14245/ns.2244352.176
Close
Objective
This multicenter study compared radiological parameters and clinical outcomes between surgical and nonsurgical management and investigated treatment characteristics associated with the successful management of unstable atlas fractures.
Methods
We retrospectively evaluated 53 consecutive patients with unstable atlas fracture who underwent halo-vest immobilization (HVI) or surgical fixation. Clinical outcomes were assessed using neck visual analogue scale and disability index. The radiological assessment included total lateral mass displacement (LMD) and the anterior atlantodental interval (AADI).
Results
Thirty-two patients underwent surgical fixation and 21 received HVI (mean follow-up, 24.9 months). In the surgical fixation, but not in the HVI, LMD, and AADI showed statistically significant improvements at the last follow-up. The osseous healing rate and time-to-healing were 100% and 14.3 weeks with surgical fixation, compared with 71.43% and 20.0 weeks with HVI, respectively. Patients treated with HVI showed poorer neck pain and neck disability outcomes than those who received surgical treatment. LMD showed an association with osseous healing outcomes in nonoperative management. Clinical outcomes and osseous healing showed no significant differences according to Dickman’s classification of transverse atlantal ligament injuries.
Conclusion
Surgical internal fixation had a higher fusion rate, shorter fracture healing time, more favorable clinical outcomes, and a more significant reduction in LMD and AADI compared to nonoperative management. The pitfalls of external immobilization are inadequate maintenance and a lower probability of reducing fractured lateral masses. Stabilization by surgical reduction with interconnected fixation proved to be a more practical management strategy than nonoperative treatment for unstable atlas fractures.

Citations

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  • Motion preserving C1 ring lateral mass screw fixation with transverse rod for isolated unstable Jefferson fracture of atlas vertebra: a multicentric study
    Nathan Beucler, Anis Choucha, Kaissar Farah, Mikael Meyer, Arnaud Dagain, Stéphane Fuentes
    European Spine Journal.2026; 35(2): 936.     CrossRef
  • Anatomical basis for a new method of atlas osteosynthesis in unstable C1 vertebra fractures
    V.N. Rashidov, I.Yu. Lisitskii, A.V. Lychagin, R.L. Kambiev, K.M. Kulakov, A.Yu. Zarov, A.L. Korkunov, V.G. Cherepanov, I.A. Vyazankin, E.Yu. Tselischeva
    Burdenko's Journal of Neurosurgery.2026; 90(2): 37.     CrossRef
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Clinical, Radiographic, and Genetic Analyses in a Population-Based Cohort of Adult Spinal Deformity in the Older Population
Jun Jae Shin, Byeongwoo Kim, Juwon Kang, Junjeong Choi, Bong Ju Moon, Dal Sung Ryu, Seung Hwan Yoon, Dong Kyu Chin, Jung-Kil Lee, Keung Nyun Kim, Yoon Ha
Neurospine 2021;18(3):608-617.   Published online September 30, 2021
DOI: https://doi.org/10.14245/ns.2142544.272

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Clinical, Radiographic, and Genetic Analyses in a Population-Based Cohort of Adult Spinal Deformity in the Older Population
Neurospine. 2021;18(3):608-617.   Published online September 30, 2021
DOI: https://doi.org/10.14245/ns.2142544.272
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Clinical, Radiographic, and Genetic Analyses in a Population-Based Cohort of Adult Spinal Deformity in the Older Population
Neurospine. 2021;18(3):608-617.   Published online September 30, 2021
DOI: https://doi.org/10.14245/ns.2142544.272
Close
Objective
This study aimed to identify the sagittal parameters associated with health-related quality of life and genetic variations that increase the risk of adult spinal deformity (ASD) onset in the older population.
Methods
We recruited 120 participants who had a sagittal vertical axis > 50 mm in a sagittal imbalance study. Sagittal radiographic parameters, cross-sectional area, and intramuscular fatty infiltration using the Goutallier classification in the paraspinal lumbar muscles were evaluated. Functional scales included the self-reported Oswestry Disability Index (ODI), 36-item Short Form Health Survey (SF-36), and visual analogue scales (VAS) for back and leg pain. We performed whole-exome sequencing and an exome-wide association study using the 100 control subjects and 63 individuals with severe phenotypes of sagittal imbalance.
Results
Pelvic incidence minus lumbar lordosis (PI–LL) mismatch was negatively associated with the SF-36 and positively correlated with ODI and VAS for back and leg pain. PI–LL was related to the quality and size of the paraspinal muscles, especially the multifidus muscle. We identified common individual variants that reached exome-wide significance using single-variant analysis. The most significant single-nucleotide polymorphism was rs78773460, situated in an exon of the SVIL gene (odds ratio, 9.61; p = 1.15 × 10-9).
Conclusion
Older age, higher body mass index, and a more significant PI–LL mismatch were associated with unfavorable results on functional scales. We found a genetic variation in the SVIL gene, which has been associated with the integrity of the cytoskeleton and the development of skeletal muscles, in severe ASD phenotypes. Our results help to elucidate the pathogenesis of ASD.

Citations

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  • Relationship Between Paralumbar Muscle Assessment Methods and Spinal Alignment in Adult Spinal Deformity
    Donghua Huang, Austin C. Kaidi, Zhan Wang, Ning Zhang, Robert N. Uzzo, Michael Mazzucco, Andrea Pezzi, Atahan Durbas, Gabrielle Dykhouse, Tejas Subramanian, Luis Felipe Colon, Stephane Owusu-Sarpong, Han Jo Kim, Francis C. Lovecchio
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    Ruifeng Xun, Liang Zhao, Weixing Han, Gang Chen, Wei Zhang, Kangkang Wang, Xiwen Sun, Qiang Zhang, Yunlei Zhai, Haiyang Yu, Xilong Cui, Giulia Pascoletti
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    Gait & Posture.2025; 117: 317.     CrossRef
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    Neurospine.2025; 22(1): 30.     CrossRef
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  • 150 Download
  • 13 Web of Science
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Review Article

Surgical Strategies for Cervical Deformities Associated With Neuromuscular Disorders
Jong Joo Lee, Sung Han Oh, Yeong Ha Jeong, Sang Man Park, Hyeong Seok Jeon, Hyung-Cheol Kim, Seong Bae An, Dong Ah Shin, Seong Yi, Keung Nyun Kim, Do Heum Yoon, Jun Jae Shin, Yoon Ha
Neurospine 2020;17(3):513-524.   Published online September 30, 2020
DOI: https://doi.org/10.14245/ns.2040464.232

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Surgical Strategies for Cervical Deformities Associated With Neuromuscular Disorders
Neurospine. 2020;17(3):513-524.   Published online September 30, 2020
DOI: https://doi.org/10.14245/ns.2040464.232
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Surgical Strategies for Cervical Deformities Associated With Neuromuscular Disorders
Neurospine. 2020;17(3):513-524.   Published online September 30, 2020
DOI: https://doi.org/10.14245/ns.2040464.232
Close
Neuromuscular disorders (NMDs) are diseases involving the upper and lower motor neurons and muscles. In patients with NMDs, cervical spinal deformities are a very common issue; however, unlike thoracolumbar spinal deformities, few studies have investigated these disorders. The patients with NMDs have irregular spinal curvature caused by poor balance and poor coordination of their head, neck, and trunk. Particularly, cervical deformity occurs at younger age, and is known to show more rigid and severe curvature at high cervical levels. Muscular physiologic dynamic characteristics such as spasticity or dystonia combined with static structural factors such as curvature flexibility can result in deformity and often lead to traumatic spinal cord injury. In addition, postoperative complication rate is higher due to abnormal involuntary movement and muscle tone. Therefore, it is important to control abnormal involuntary movement perioperatively along with strong instrumentation for correction of deformity. Various methods such as botulinum toxin injection, physical therapy, muscle division technique, or intrathecal baclofen pump implant may help control abnormal involuntary movements and improve spinal stability. Surgical management for cervical deformities associated with NMDs requires a multidisciplinary effort and a customized strategy.

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Original Articles

Comparison of Adjacent Segment Degeneration, Cervical Alignment, and Clinical Outcomes After One- and Multilevel Anterior Cervical Discectomy and Fusion
Jun Jae Shin
Neurospine 2019;16(3):589-600.   Published online September 30, 2019
DOI: https://doi.org/10.14245/ns.1938166.083

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Comparison of Adjacent Segment Degeneration, Cervical Alignment, and Clinical Outcomes After One- and Multilevel Anterior Cervical Discectomy and Fusion
Neurospine. 2019;16(3):589-600.   Published online September 30, 2019
DOI: https://doi.org/10.14245/ns.1938166.083
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Comparison of Adjacent Segment Degeneration, Cervical Alignment, and Clinical Outcomes After One- and Multilevel Anterior Cervical Discectomy and Fusion
Neurospine. 2019;16(3):589-600.   Published online September 30, 2019
DOI: https://doi.org/10.14245/ns.1938166.083
Close
Objective
This study aimed to assess the influence of a fused segment on cervical range of motion (ROM) and adjacent segmental kinematics and determine whether increasing number of fusion levels causes accelerated adjacent segment degeneration (ASD) after anterior cervical discectomy and fusion (ACDF).
Methods
A total of 165 patients treated with ACDF were recruited for assessment, and they were divided into 3 groups based on the number of fusion levels. Radiological measurements and clinical outcomes included visual analogue scale (VAS) and Neck Disability Index (NDI) assessed preoperatively and at ≥2 years of follow-up.
Results
ASD occurred in 41 of 165 patients who underwent ACDF (1-level, 12 of 78 [15.38%]; 2-level, 14 of 49 [28.57%]; 3-level, 15 of 38 [39.47%]; p=0.015) at final follow-up (mean, 31.9 months). Significant differences were found in reduction of global ROM based on the number of fusion levels (p<0.001). The upper adjacent segment ROM increased over time (p=0.004); however, lower segment ROM did not. Three-level ACDF did not obtain greater amounts of lordosis than did 1- or 2-level ACDF (p=0.003). Postoperative neck VAS scores and NDI were significantly higher for 3-level ACDF than for 1- or 2-level ACDF (p=0.033 and p=0.001).
Conclusion
ASD occurred predominantly in multilevel cervical fusion, more frequently in the upper segment of the prior fusion and as the number of fusion levels increased. Patients who underwent multilevel fusion had greater reduction of global ROM and increased compensatory motion at the upper adjacent segment. Three-level ACDF did not appear to restore cervical lordosis significantly compared with 1- or 2-level arthrodesis.

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  • Comparison of 10-year follow-up result of hybrid surgery and anterior cervical discectomy and fusion for the treatment of contiguous three-level cervical degenerative disc diseases: risk factors for heterotopic ossification
    Ziye Qiu, Yang Xiong, Xing Yu, Yongdong Yang, Qing Kang, Ningning Feng, Wenhao Li, Luchun Xu, Yukun Ma, Jiawei Song, Guozheng Jiang, Sixue Chen
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    Jeffrey Weinreb, Claire van Ekdom, Diarra Oden, Joseph O’Brien
    Current Orthopaedic Practice.2026;[Epub]     CrossRef
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    Richard D. Guyer, John A. Hipp, Seth C. Coomer, Amy A. Claeson, Trevor F. Grieco, Pierce D. Nunley
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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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Case Reports

Acute Spontaneous Cervical Epidural Hematoma Mimicking Cerebral Stroke: A Case Report and Literature Review
Jin Kyu Kim, Tae Hong Kim, Sang Keun Park, Yong Soon Hwang, Hyung Shik Shin, Jun Jae Shin
Korean J Spine 2013;10(3):170-173.   Published online September 30, 2013
DOI: https://doi.org/10.14245/kjs.2013.10.3.170

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Acute Spontaneous Cervical Epidural Hematoma Mimicking Cerebral Stroke: A Case Report and Literature Review
Korean J Spine. 2013;10(3):170-173.   Published online September 30, 2013
DOI: https://doi.org/10.14245/kjs.2013.10.3.170
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Acute Spontaneous Cervical Epidural Hematoma Mimicking Cerebral Stroke: A Case Report and Literature Review
Korean J Spine. 2013;10(3):170-173.   Published online September 30, 2013
DOI: https://doi.org/10.14245/kjs.2013.10.3.170
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Spontaneous cervical epidural hematoma (SCEDH) is a rare disease, but can cause severe neurologic impairment. We report a case of a 68-year-old female who presented with sudden onset, posterior neck pain, right shoulder pain, and progressive right hemiparesis mimicking stroke with no trauma history. Initial brain CT and diffusion MRI performed to rule out brain lesion did not show any positive findings. Laboratory examination presented only severe thrombocytopenia (45,000/mm3). Subsequent cervical MRI revealed a cervical epidural mass lesion. We confirmed that it was pure hematoma through C5 unilateral total laminectomy and C6 partial hemilaminectomy. She achieved complete neurologic recovery with active rehabilitation. Early surgical decompression for SCEDH with neurologic impairment should be recommended for better outcome.

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  • Idiopathic Spontaneous Cervical Epidural Hematoma: A Sudden Neurological Catastrophe
    Lena DeLorenzo, Danielle Thor, Brittany Kenny, Kelly A Schiers
    Cureus.2026;[Epub]     CrossRef
  • How to Avoid Misdiagnosing Spontaneous Cervical Spinal Epidural Hematoma as Ischemic Stroke: 3 Case Reports and Literature Review
    Yaowen Hu, Junhui Su, Xinxin Cui, Lizhen Pan, Lingjing Jin, Fei Teng
    Cerebrovascular Diseases.2023; 52(5): 597.     CrossRef
  • Surgical treatment of a spontaneous spinal epidural hematoma under antithrombotic treatment of a multisystem inflammatory syndrome in children associated with SARS-COV-2
    Alexander Romagna, Fabian Potthast, Marc-Matthias Steinborn, Stefan Burdach, Jens Lehmberg
    Child's Nervous System.2022; 38(6): 1213.     CrossRef
  • Recurrent Cervical Spontaneous Spinal Epidural Hematoma with Conservative Management: A Case Report
    Jung Myung Koo, Sung Hwan Hwang, Joonho Yoon, Sang Hoon Yoon, Byung-Kyu Cho
    Korean Journal of Neurotrauma.2021; 17(2): 186.     CrossRef
  • Characteristics of Manufacturing for Special Cement Using High Chlorine by-product
    Kiyeon Moon, Jinsang Cho, Moonkwan Choi, Kyehong Cho
    Resources Recycling.2021; 30(6): 68.     CrossRef
  • A Spontaneous Cervical Epidural Hematoma Mimicking a Stroke: A Challenging Case
    Goran Pavlićević, Milan Lepić, Toplica Lepić, Nemanja Jaćimović, Ksenija Radenović, Nenad Novaković, Lukas Rasulić, Stefan Mandić-Rajčević
    The Journal of Emergency Medicine.2019; 57(1): 70.     CrossRef
  • A brief review of literature of spontaneous spinal epidural hematoma in the context of an idiopathic spinal epidural hematoma
    Ajaya Kumar Ayyappan Unnithan
    Egyptian Journal of Neurosurgery.2019;[Epub]     CrossRef
  • Cervical Epidural Hematoma That Induced Sudden Paraparesis After Cervical Spine Massage: Case Report and Literature Review
    Je Il Ryu, Myung Hoon Han, Jae Min Kim, Choong Hyun Kim, Jin Hwan Cheong
    World Neurosurgery.2018; 112: 217.     CrossRef
  • Traumatic C1–C3 Spinal Epidural Hematoma Presented with Occipital Neuralgia
    Eui Hyun Hwang, Chang-Yong Park, Nam Kyu You, Sang Hyun Kim, Ki Hong Cho
    The Nerve.2018; 4(2): 90.     CrossRef
  • Spontaneous Spinal Epidural Hematoma: A Case Report
    Bin Zuo, YueHui Zhang, Jing Zhang, Jia Song, Shao Jiang, XiaoLing Zhang
    Case Reports in Orthopedic Research.2018; 1(1-3): 27.     CrossRef
  • A Letter to the Editor regarding “An Acute Cervical Subdural Hematoma as the Complication of Acupuncture: Case Report and Literature Review”
    Hai Lu, Ruya Sheng, Chunhong Zhang
    World Neurosurgery.2017; 98: 857.     CrossRef
  • In Reply to the Letter to the Editor regarding “An Acute Cervical Subdural Hematoma as the Complication of Acupuncture: Case Report and Literature Review”
    Keyvan Eghbal, Fariborz Ghaffarpasand
    World Neurosurgery.2017; 98: 858.     CrossRef
  • Inpatient rehabilitation following operative spontaneous spinal epidural hematoma mimicking stroke: a case report
    Juan C Perez, Myriam Crespo, Candido Velez, Jorge Caceres
    Spinal Cord Series and Cases.2016;[Epub]     CrossRef
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Intramedullary Epidermoid Cyst in Thoracolumbar Junctiont: A Case Report.
Jun Ho Lee, Jun Jae Shin, Yong Soon Hwang, Tae Hong Kim, Hyung Shik Shin, Sang Keun Park
Korean J Spine 2008;5(3):219-224.

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Intramedullary Epidermoid Cyst in Thoracolumbar Junctiont: A Case Report.
Korean J Spine. 2008;5(3):219-224.
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Intramedullary Epidermoid Cyst in Thoracolumbar Junctiont: A Case Report.
Korean J Spine. 2008;5(3):219-224.
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Intramedullary epidermoid cysts of the spinal cord are a rare disease. Around the world, there are few reported cases that involve the true intramedullary location. In this paper, we report a case of intramedullary epidermoid cyst which is not associated with congenital anomalies of the thoracolumbar region. A 53-year-old man suffered from lower extremity weakness, spasticity and fecal incontinence for 8 months. Magnetic resonance imaging revealed a 4 cm sized intradural intramedullary mass at the T11-L1 level. The tumor was resected through the posterior approach and complete removal of the mass was performed. Intraoperative and histological findings revealed an epidermoid cyst in the intramedullary region of the spinal cord. Although epidermoid cysts are very rare, these lesions should be considered in the differential diagnosis when an MRI is suggestive of an intradural, intramedullary mass. With early detection and complete resection, the patient had a good neurological outcome.
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