Hyun Yoon Ko

Effect of increased axial rotation angle on bone mineral density measurements of the lumbar spine.

BACKGROUND CONTEXT Osteoporosis frequently occurs in elderly people and is commonly associated with neuromuscular diseases or severe cerebral palsy. Osteoporosis can cause pain via compression fractures or secondary neurologic deficits; thus, accurate evaluation of bone mineral density (BMD) is essential for the prevention and treatment of osteoporosis. However, spinal axial rotation caused by scoliosis may affect the outcome of BMD tests, such that BMD measurements may be significantly greater than actual BMD in patients with severe scoliosis of the spine. PURPOSE We investigated the effect of axial rotation angle on BMD measurements of the phantom spine. STUDY DESIGN/SETTING Investigation for the effect of axial rotation with aluminum phantom spine. METHODS A GE-Lunar Aluminum Spine Phantom was used to assess BMD. Bone mineral content (BMC), BMD, and cross-sectional area were measured 100 times at L1-L4 using a GE Lunar Prodigy Vision system. Dual-energy X-ray absorptiometry was performed at axial rotation angles of 0° to 25° (5° intervals). RESULTS Cross-sectional area decreased and BMD values increased as the axial rotation angle increased, whereas BMC did not change significantly. A fitting function was obtained to evaluate the relationships among axial rotation angle, cross-sectional area, and BMD. We obtained an equation to estimate BMD at L1-L4: 1.000-0.001674x+0.0001043x(2)-0.000005333x(3), where x denotes the axial rotation angle. We found that the observed BMD needed adjustment when the angle was more than 5°. CONCLUSIONS Bone mineral density values may be overestimated in patients with even slight (>5°) axial rotation. When osteoporosis is suspected in a clinical setting, the degree of axial rotation should be measured on a lumbar spine X-ray.

Botulinum Toxin in the Treatment of Drooling in Tetraplegic Patients With Brain Injury

Objective To investigate the effect of botulinum toxin type A (BTA) injection into the salivary gland and to evaluate the changes of drooling in varied postures in tetraplegic patients with brain injury. Methods Eight tetraplegic patients with brain injury were enrolled. BTA was injected into each parotid and submandibular gland of both sides under ultrasonographic guidance. Drooling was measured by a questionnaire-based scoring system for drooling severity and frequency, and the sialorrhea was measured by a modified Schirmer test for the patients before the injection, 3 weeks and 3 months after the injection. Drooling was evaluated in each posture, such as supine, sitting, and tilt table standing, and during involuntary mastication, before and after the injection. Results The severity and frequency of drooling and the modified Schirmer test improved significantly at 3 weeks and 3 months after the injection (p<0.05). Drooling was more severe and frequent in tilt table standing than in the sitting position and in sitting versus supine position (p<0.05). The severity of drooling was significantly increased in the patients with involuntary mastication (p<0.05). Conclusion Salivary gland injection of BTA in patients with tetraplegia resulting from brain injury who had drooling and sialorrhea could improve the symptoms for 3 months without complications. The severity and frequency of drooling were dependent on posture and involuntary mastication. Proper posture and involuntary mastication of the patients should be taken into account in planning drooling treatment.

People with Spinal Cord Injury in Korea

EPIDEMIOLOGY OF SPINAL CORD INJURY IN KOREA Korea performs a national disability survey every 3 years, and epidemiological data concerning 15 official disability categories set by the government are provided in open access. It is estimated that 91.7% of the population of persons with disabilities are registered in the National Disability Registry system. The most recent results of the National Disability Survey (2014) estimates the disability prevalence in Korea to be 5.59% (2,726,910 persons). There is no national spinal cord injury (SCI) registry in Korea. However, the Korean government officially categorizes spinal cord injury–related paralysis into the paralysis section of “physical disability.” Physical disability is further divided into amputation, joint contracture, and deformities, but epidemiological data specific to spinal cord injury are lacking, and thus only an estimation of SCI persons in Korea is possible: According to the 2014 National Disability Survey, estimated persons with physical disability was 1,373,737 with a prevalence of 2.82%.1 Among the diagnoses that make up Physical disability, the percentage of SCI (cervical, thoracic, lumbar) and myelitis add up to 4.9%, and thus a figure of 67,313 (excluding nonresponders) is a rough estimate of spinal cord injury persons. According to the Statistics Korea (KOSTAT), the total population in Korea is 50,617,000, and thus SCI persons would make up approximately 0.1% of the total Korean population. (Because very mild SCI persons (ASIA impairment scale D, E) may not be included in these statistics, this figure is only an extremely rough estimate.) There is no national demographic data specific to SCI. In 1999, Park et al. analyzed demographics of 590 SCI patients. Men accounted for 79.6% and the peak age group were those in their twenties (32.5%). Etiologically, 91.2% were traumatic in origin. The National Rehabilitation Center analyzed 3076 SCI patients admitted to the National Rehabilitation Center

Effects of Botulinum Toxin on Reducing the Co-contraction of Antagonists in Birth Brachial Plexus Palsy

Birth brachial plexus palsy (BBPP) is usually caused by plexus traction during difficult delivery. Although the possibility of complete recovery is relatively high, 5% to 25% of BBPP cases result in prolonged and persistent disability. In particular, muscle imbalance and co-contraction around the shoulder and elbow cause abnormal motor performance, osseous deformities, and joint contracture. Physical and occupational therapies have most commonly been used, but these conventional therapeutic strategies have often been inadequate, in managing the residual muscle imbalance and muscle co-contraction. Therefore, we attempted to improve the functional movements, by using botulinum toxin type A, to reduce the abnormal co-contraction of the antagonist muscles.

Anorectal Manometric and Urodynamic Parameters According to the Spinal Cord Injury Lesion

Objective To assess the correlation between the anorectal function and bladder detrusor function in patients with complete spinal cord injury (SCI) according to the type of lesion. Methods Medical records of twenty-eight patients with SCI were included in this study. We compared the anorectal manometric and urodynamic (UD) parameters in total subjects. We analyzed the anorectal manometric and UD parameters between the two groups: upper motor neuron (UMN) lesion and lower motor neuron (LMN) lesion. In addition, we reclassified the total subjects into two groups according to the bladder detrusor function: overactive and non-overactive. Results In the group with LMN lesion, the mean value of maximal anal squeeze pressure (MSP) was slightly higher than that in the group with UMN lesion, and the ratio of MSP to maximal anal resting pressure (MRP) was statistically significant different between the two groups. In addition, although the mean value of MSP was slightly higher in the group with non-overactive detrusor function, there was no statistical correlation of anorectal manometric parameters between the groups with overactive and non-overactive detrusor function. Conclusion The MSP and the ratio of MSP to MRP were higher in the group with LMN lesion. In this study, we could not identify the correlation between bladder and bowel function in total subjects. We conclude that the results of UD study alone cannot predict the outcome of anorectal manometry in patients with SCI. Therefore, it is recommended to perform assessment of anorectal function with anorectal manometry in patients with SCI.