Seung-Woo Suh

Cobb Angle Measurement of Scoliosis Using Computer Measurement of Digitally Acquired Radiographs-Intraobserver and Interobserver Variability

Study Design We evaluated computer assisted digital measurement of radiographic parameters in patients with idiopathic scoliosis. Purpose To assess the reliability of digital measurements. Overview of Literature Various authors analyzed scoliotic deformities by conventional radiographs, but very few studies have addressed the reliability of digital radiographic measurement using computer software. Methods Three independent, blinded observers measured 318 whole spine pre-operative antero-posterior radiograms of children with varying degrees of idiopathic scoliosis. Only one curve per radiograph was measured. Each observer measured the Cobb angle three times with a 1-week gap between each measurement. The computer system, picture archiving and communication system (PACS, PiViewSTAR version 5) was used in all cases. The end vertebrae were pre-selected to avoid this as a potential source of error. The results were statistically analyzed for intraobserver and interobserver reliability and variability. Results The 95% confidence intervals for intraobserver and interobserver variability were ±1.30 and ±1.260, respectively. There was better reliability in larger curves. Conclusions Measurement using a digitized system may help to minimize measurement discrepancies by eliminating an intrinsic cause of error.

Clinical anatomy of vertebrae in scoliosis: global analysis in four different diseases by multiplanar reconstructive computed tomography

BACKGROUND CONTEXT Few accurate analyses of clinically useful vertebral anatomy have been conducted, and most have focused on thoracic idiopathic scoliosis. PURPOSE To evaluate the different anatomic characteristics in scoliosis by disease type and level. STUDY DESIGN Observational cohort study. PATIENT SAMPLE Forty-eight patients with scoliosis were included in this study. OUTCOME MEASURES Subjects underwent computed tomography (CT) of the whole spine. METHODS Forty-eight patients with scoliosis were included in this study: 15 adolescent idiopathic, 11 cerebral palsy (CP), 10 muscular dystrophy (MD), and 12 congenital (CG) scoliosis patients with similar demographics. Subjects underwent CT of the whole spine, preoperatively. Eight anatomic parameters were measured in multiplanar reconstructive CT images, and statistical analysis was performed to investigate differences. RESULTS In general, values in the anatomic parameters were similar for the four diseases. Each parameter showed the unique change pattern according to the spinal level regardless of curvature shape, direction, or magnitude. In particular, chord length (CL) in MD and CG scoliosis was lower than in adolescent idiopathic scoliosis (AIS) and CP, and pedicle rib unit length was lower in CG scoliosis than in the other diseases (p<.05). Comparisons of convex and concave anatomies in AIS showed that inner pedicle width (PWI) and outer pedicle width (PWO) were wider for convex side, CL, pedicle width, and transverse pedicle angle were greater for concave side (p<.05), and differences were more significant at apices. However, in CP, PWI and PWO were similar between convex and concaves sides (p>.05). Although PWI and PWO were wider for convex sides and CL and pedicle length were greater for concave sides in MD (p<.05), differences were less significant at apices. Particularly, CG scoliosis showed severely deformed anatomy, with differences of seven parameters at apical vertebrae (p<.05). CONCLUSION Clinical anatomies of vertebrae in scoliosis were found to differ significantly at different levels and in terms of convexity and disease type.

Trends in the prevalence and incidence of ankylosing spondylitis in South Korea, 2010–2015 and estimated differences according to income status

The aim of this study is to determine the prevalence and incidence of ankylosing spondylitis (AS) in South Korea, 2010–2015. This study was conducted using the Health Insurance Review Agency (HIRA) database, which includes information on every patient diagnosed with AS. The incidence and prevalence of AS were evaluated by age, sex, and income status. The prevalence increased linearly by 7.7% annually, i.e., 31.62 in 2010 to 52.30 in 2015 (per 100,000 persons). During the study period, the incidence was 6.34 per 100,000 person-years. The prevalence peaked for both men and women in the age range 30–39 years. Incidence peaked for men in the age range 20–29 years, but peaked for women between ages 70 and 89. AS was 3.6 times more prevalent in men than in women, and the incidence in men was 2.1 times greater than in women. With respect to income status, the prevalence and incidence of AS were 3 times greater and 5 times greater, respectively, in medical aid recipients compared to individuals with other income levels. The trend of increasing AS prevalence and the observation that 14.3% of all patients newly diagnosed with AS are medical aid recipients have significant implications for healthcare planning.

Carpal tunnel release without a tourniquet: A simple local anesthesia technique

C arpal tunnel syndrome is the most common entrapment neuropathy resulting from compression of the median nerve within the carpal tunnel at the wrist. Surgery forms the mainstay of treatment in advanced disease. The hand is an extremely vascular region and a good bloodless field is necessary to ensure completeness of the transverse carpal ligament (TCL) release to prevent any complications such as median nerve injury. Most surgeons use a tourniquet while performing carpal tunnel release; however, it has been observed that when the surgery is performed using a local anesthetic, patients do not complain of discomfort from the operation but from the use of the tourniquet. In this report, we describe our experience with a new technique using a mini-open exposure under local anesthesia and the use of a simple mastoid retractor for hemostasis, thus obviating the need for a tourniquet. This technique was found to be a safe, effective and painless alternative to the standard tourniquet-dependent procedure.