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Song KS, Lee J, Ham DW, Jung CW, Kang H, Park SW, Chang DG, Kim YB. Postoperative Segmental Motion up to 1 Year Following Single-Level Anterior Cervical Discectomy and Fusion: Plate versus Non-plate. Asian Spine J 2023:asj.2022.0192. [PMID: 36775832 DOI: 10.31616/asj.2022.0192] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2022] [Accepted: 08/30/2022] [Indexed: 02/14/2023] Open
Abstract
Study Design Retrospective observational study. Purpose This study aimed to investigate the impact of plating on postoperative serial segmental motion and its correlation with clinical outcomes in single-level anterior cervical discectomy and fusion (ACDF) for up to 1 year. Overview of Literature The advantages and disadvantages of using cervical plating in ACDF have been well discussed; however, few studies compared the early serial segmental motions at the postoperative level between plating and non-plating. Methods In retrospectively collected data, 149 patients who underwent single-level ACDF for degenerative disease were enrolled and divided into non-plating (n=66) and plating (n=83). Interspinous motion (ISM) at the arthrodesis segment, Numeric Rating Scale (NRS) for neck pain, and Neck Disability Index (NDI) were serially evaluated at 3, 6, and 12 months postoperatively. Predictable factors for fusion, including age, sex, plating, diabetes, smoking, and type of grafts, were investigated, and fusion was defined as ISM <1 mm. Results In both groups, ISM was the highest at 3 months and gradually decreased thereafter, and the plating group showed significantly lower serial ISM than the non-plating group at 12 months. The plating group had lower NRS and NDI scores than the nonplating group at 12 months, and the difference in the NRS scores was statistically significant, particularly at 3 and 6 months, although that of the NDI scores was not. In a multivariate analysis, plating was the most powerful predictor for fusion. Conclusions Plating significantly decreases the serial ISM compared with non-plating in single-level ACDF, and such decreased motion is correlated with decreased neck pain until 12 months postoperatively, particularly at 3 and 6 months. Given that plating was the most predictive factor for fusion, we recommend plating even in single-level ACDF for better early clinical outcomes.
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Affiliation(s)
- Kwang-Sup Song
- Department of Orthopaedic Surgery, Chung-Ang University Hospital, Chung-Ang University College of Medicine, Seoul, Korea
| | - Jeongik Lee
- Department of Orthopaedic Surgery, Chung-Ang University Hospital, Chung-Ang University College of Medicine, Seoul, Korea
| | - Dae Woong Ham
- Department of Orthopaedic Surgery, Chung-Ang University Hospital, Chung-Ang University College of Medicine, Seoul, Korea
| | - Chan-Woo Jung
- Department of Orthopaedic Surgery, Chung-Ang University Hospital, Chung-Ang University College of Medicine, Seoul, Korea
| | - Hyun Kang
- Department of Anesthesiology and Pain Medicine, Chung-Ang University Hospital, Chung-Ang University College of Medicine, Seoul, Korea
| | - Seung Won Park
- Department of Neurosurgery, Chung-Ang University Hospital, Chung-Ang University College of Medicine, Seoul, Korea
| | - Dong-Gune Chang
- Department of Orthopaedic Surgery, Inje University Sanggye Paik Hospital, College of Medicine, Inje University, Seoul, Korea
| | - Youngbae B Kim
- Department of Orthopaedic Surgery, VHS Medical Center, Seoul, Korea
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Lee J, Chang G, Kang H, Ham DW, Lee JS, Jung HS, Song KS. Impact of Bone Mineral Density on the Incidence of Age-Related Vertebral Fragility Fracture. J Korean Med Sci 2020; 35:e116. [PMID: 32356418 PMCID: PMC7200181 DOI: 10.3346/jkms.2020.35.e116] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2019] [Accepted: 02/25/2020] [Indexed: 01/27/2023] Open
Abstract
BACKGROUND Vertebral fragility fracture (VFF) is a common fracture related to osteoporosis. However, VFF might be asymptomatic and often occurs in patients without osteoporosis. Therefore, we investigated the characteristics of age-related VFF and their correlation with bone mineral density (BMD). Furthermore, we analyzed other factors affecting VFF. METHODS Medical records from a single center were retrospectively reviewed for 2,216 patients over 50 years old with vertebral fractures conservatively treated from 2005 to 2016. Patients' age, gender, body mass index (BMI), BMD, fracture level, previous vertebral fractures, and anti-osteoporosis medications were obtained. Patients were divided into fragility/non-fragility groups and age sub-groups. The odds ratio for VFF in relation to BMD was evaluated. We also identified other predictive factors for VFF by age groups. RESULTS The fragility group had a higher women ratio, older age, lower BMI, lower BMD, and greater incidence of previous vertebral fractures than the non-fragility group. VFFs were seen in 41.18% of normal BMD patients aged 50-59 and 67.82% of those aged 60-69. The proportion of VFFs increased with age in all WHO osteoporosis classifications. Patients with osteopenia and osteoporosis were 1.57 and 2.62 fold more likely to develop VFFs than normal BMD. In the younger group (under 70), age, women, BMD, and previous vertebral fracture were significant factors affecting VFF, and in the older group (70 and over), age, women, and BMD were factors. In the fragility group, anti-osteoporosis medication rates were 25.08% before and 45.96% after fracture. CONCLUSION Considerable VFFs occurred in the younger age groups without osteoporosis and age itself was another important predictor of VFF especially in older age groups. The discrepancy between the incidence of VFF and BMD suggests the necessity of supplemental screening factors and anti-osteoporosis treatment guidelines using only BMD should be reconsidered.
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Affiliation(s)
- Jeongik Lee
- Department of Orthopaedic Surgery, Chung-Ang University Hospital, Chung-Ang University College of Medicine, Seoul, Korea
| | - Geunwu Chang
- Department of Orthopaedic Surgery, Chung-Ang University Hospital, Chung-Ang University College of Medicine, Seoul, Korea
| | - Hyun Kang
- Department of Anesthesiology and Pain Medicine, Chung-Ang University Hospital, Chung-Ang University College of Medicine, Seoul, Korea
| | - Dae Woong Ham
- Department of Orthopaedic Surgery, Chung-Ang University Hospital, Chung-Ang University College of Medicine, Seoul, Korea
| | - Jae Sung Lee
- Department of Orthopaedic Surgery, Chung-Ang University Hospital, Chung-Ang University College of Medicine, Seoul, Korea
| | - Hyoung Seok Jung
- Department of Orthopaedic Surgery, Chung-Ang University Hospital, Chung-Ang University College of Medicine, Seoul, Korea
| | - Kwang Sup Song
- Department of Orthopaedic Surgery, Chung-Ang University Hospital, Chung-Ang University College of Medicine, Seoul, Korea.
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Huang EG, Wang RY, Xie L, Chang P, Yao G, Zhang B, Ham DW, Lin Y, Blakely EA, Sachs RK. Simulating galactic cosmic ray effects: Synergy modeling of murine tumor prevalence after exposure to two one-ion beams in rapid sequence. Life Sci Space Res (Amst) 2020; 25:107-118. [PMID: 32414484 DOI: 10.1016/j.lssr.2020.01.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/30/2019] [Revised: 12/24/2019] [Accepted: 01/02/2020] [Indexed: 06/11/2023]
Abstract
Health risks from galactic cosmic rays (GCR) in space travel above low earth orbit remain a concern. For many years accelerator experiments investigating space radiation induced prevalence of murine Harderian gland (HG) tumorigenesis have been performed to help estimate GCR risks. Most studies used acute, relatively low fluence, exposures. Results on a broad spectrum of individual ions and linear energy transfers (LETs) have become available. However, in space, the crew are exposed simultaneously to many different GCR. Recent upgrades at the Brookhaven NASA Space Radiation Laboratory (NSRL) now allow mixtures in the form of different one-ion beams delivered in rapid sequence. This paper uses the results of three two-ion mixture experiments to illustrate conceptual, mathematical, computational, and statistical aspects of synergy analyses and also acts as an interim report on the mixture experiments' results. The results were interpreted using the following: (a) accumulated data from HG one-ion accelerator experiments; (b) incremental effect additivity synergy theory rather than simple effect additivity synergy theory; (c) parsimonious models for one-ion dose-effect relations; and (d), computer-implemented numerical methods encapsulated in freely available open source customized software. The main conclusions are the following. As yet, the murine HG tumorigenesis experimental studies show synergy in only one case out of three. Moreover, some theoretical arguments suggest GCR-simulating mixed beams are not likely to be synergistic. However, more studies relevant to possible synergy are needed by various groups that are studying various endpoints. Especially important is the possibility of synergy among high-LET radiations, since individual high-LET ions have large relative biological effectiveness for many endpoints. Selected terminology, symbols, and abbreviations. DER - dose-effect relation; E(d) - DER of a one-ion beam, where d is dose; HG prevalence p - in this paper, p is the number of mice with at least one Harderian gland tumor divided by the number of mice that are at risk of developing Harderian gland tumors (so that in this paper prevalence p can never, conceptually speaking, be greater than 1); IEA - incremental effect additivity synergy theory; synergy level - a specification, exemplified in Fig. 5, of how clear-cut an observed synergy is; mixmix principle - a consistency condition on a synergy theory which insures that the synergy theory treats mixtures of agent mixtures in a mathematically self-consistent way; NTE - non-targeted effect(s); NSNA - neither synergy nor antagonism; SEA - simple effect additivity synergy theory; TE - targeted effect(s); β* - ion speed relative to the speed of light, with 0 < β* < 1; SLI - swift light ion(s).
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Affiliation(s)
- Edward Greg Huang
- Department of Mathematics, University of California at Berkeley, United States
| | - Ren-Yi Wang
- Department of Mathematics, University of California at Berkeley, United States
| | - Liyang Xie
- Department of Mathematics, University of California at Berkeley, United States
| | - Polly Chang
- SRI International, Menlo Park, CA 94025, United States
| | - Gracie Yao
- Department of Statistics, University of California at Berkeley, United States
| | - Borong Zhang
- Department of Mathematics, University of California at Berkeley, United States
| | - Dae Woong Ham
- Department of Statistics, University of California at Berkeley, United States
| | - Yimin Lin
- Department of Mathematics, University of California at Berkeley, United States
| | | | - Rainer K Sachs
- Department of Mathematics, University of California at Berkeley, United States.
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Kim SH, Ham DW, Lee JI, Park SW, Ko MJ, Koo SB, Song KS. Locating the Instant Center of Rotation in the Subaxial Cervical Spine with Biplanar Fluoroscopy during In Vivo Dynamic Flexion-Extension. Clin Orthop Surg 2019; 11:482-489. [PMID: 31788173 PMCID: PMC6867919 DOI: 10.4055/cios.2019.11.4.482] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2019] [Accepted: 05/29/2019] [Indexed: 11/24/2022] Open
Abstract
Background Recently, biplanar fluoroscopy is used to evaluate the cervical kinematics, especially to locate the instant center of rotation (ICR) during in vivo motion. This study aims to ascertain the ICR at each cervical segment in the sagittal plane during dynamic motion and assess the differences from previous studies. Methods While three healthy subjects were performing full flexion-extension, two oblique views aligned horizontally and angled at approximately 55° were obtained by biplanar fluoroscopy. The minimum degree to detect significant movement in a helical axis model was set at 2°, and anterior-posterior and superior-inferior locations of each ICR were defined. To evaluate the possible distribution area and overlapping area of the ICR with disc space, we drew a circle by using the calculated distance between each coordination and the mean coordination of ICR as the radius. Results During flexion-extension motion, the mean superior-inferior location of the ICR became progressively more superior, except the C5–6 segment (p = 0.015), and the mean anterior-posterior location of the ICR became progressively more anterior without exception from C2–3 to C6–7 segments, but anterior-posterior ICR locations were not significantly different among segments. The overlapping area with the distribution circle of ICR was mainly located in the posterior half in the C3–4 segment, but the overlapping area was about 80% of the total disc space in C4–5 and C6–7 segments. The overlapping was more noticeable in the lower cervical segments after exclusion of the outlier data of the C5–6 segment in subject 1. Conclusions The ICR in the cervical spine showed a trend of moving progressively more superiorly and anteriorly and the disc space overlapping the distribution circle of ICR increased along the lower motion segments except the C5–6 segment. These findings could provide a good basis for level-specific cervical arthroplasty designs.
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Affiliation(s)
- Seong Hwan Kim
- Department of Orthopedic Surgery, Chung-Ang University College of Medicine, Seoul, Korea
| | - Dae Woong Ham
- Department of Orthopedic Surgery, Chung-Ang University College of Medicine, Seoul, Korea
| | - Jeong Ik Lee
- Department of Orthopedic Surgery, Chung-Ang University College of Medicine, Seoul, Korea
| | - Seung Won Park
- Department of Neurosurgery, Chung-Ang University College of Medicine, Seoul, Korea
| | - Myeong Jin Ko
- Department of Neurosurgery, Chung-Ang University College of Medicine, Seoul, Korea
| | - Seung-Bum Koo
- Department of Bioengineering, Chung-Ang University College of Engineering, Seoul, Korea
| | - Kwang-Sup Song
- Department of Orthopedic Surgery, Chung-Ang University College of Medicine, Seoul, Korea
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Huang EG, Lin Y, Ebert M, Ham DW, Zhang CY, Sachs RK. Synergy theory for murine Harderian gland tumours after irradiation by mixtures of high-energy ionized atomic nuclei. Radiat Environ Biophys 2019; 58:151-166. [PMID: 30712093 DOI: 10.1007/s00411-018-00774-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/02/2018] [Accepted: 12/24/2018] [Indexed: 06/09/2023]
Abstract
Experimental studies reporting murine Harderian gland (HG) tumourigenesis have been a NASA concern for many years. Studies used particle accelerators to produce beams that, on beam entry, consist of a single isotope also present in the galactic cosmic ray (GCR) spectrum. In this paper synergy theory is described, potentially applicable to corresponding mixed-field experiments, in progress, planned, or hypothetical. The "obvious" simple effect additivity (SEA) approach of comparing an observed mixture dose-effect relationship (DER) to the sum of the components' DERs is known from other fields of biology to be unreliable when the components' DERs are highly curvilinear. Such curvilinearity may be present at low fluxes such as those used in the one-ion HG experiments due to non-targeted ('bystander') effects, in which case a replacement for SEA synergy theory is needed. This paper comprises in silico modeling of published experimental data using a recently introduced, arguably optimal, replacement for SEA: incremental effect additivity (IEA). Customized open-source software is used. IEA is based on computer numerical integration of non-linear ordinary differential equations. To illustrate IEA synergy theory, possible rapidly-sequential-beam mixture experiments are discussed, including tight 95% confidence intervals calculated by Monte-Carlo sampling from variance-covariance matrices. The importance of having matched one-ion and mixed-beam experiments is emphasized. Arguments are presented against NASA over-emphasizing accelerator experiments with mixed beams whose dosing protocols are standardized rather than being adjustable to take biological variability into account. It is currently unknown whether mixed GCR beams sometimes have statistically significant synergy for the carcinogenesis endpoint. Synergy would increase risks for prolonged astronaut voyages in interplanetary space.
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Affiliation(s)
- Edward Greg Huang
- Department of Mathematics, University of California at Berkeley, Berkeley, CA, 94720, USA
| | - Yimin Lin
- Department of Mathematics, University of California at Berkeley, Berkeley, CA, 94720, USA
| | - Mark Ebert
- Department of Mathematics, University of California at Berkeley, Berkeley, CA, 94720, USA
| | - Dae Woong Ham
- Department of Statistics, University of California at Berkeley, Berkeley, CA, 94720, USA
| | - Claire Yunzhi Zhang
- Department of Mathematics, University of California at Berkeley, Berkeley, CA, 94720, USA
| | - Rainer K Sachs
- Department of Mathematics, University of California at Berkeley, Berkeley, CA, 94720, USA.
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Ham DW, Son TI, Lee TJ, Song KS. Osteogenic effectiveness of photo-immobilized bone morphogenetic protein-2 using different azidophenyl-natural polymer carriers in rat calvarial defect model. Int J Biol Macromol 2018; 121:333-341. [PMID: 30300698 DOI: 10.1016/j.ijbiomac.2018.10.024] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2018] [Revised: 09/20/2018] [Accepted: 10/05/2018] [Indexed: 11/25/2022]
Abstract
The osteogenetic potential of photo-immobilized azdiophenyl (Az)-natural polymers as a carrier of bone morphogenetic protein-2 (BMP-2) was assessed in 56 rats randomized to four groups. The control group comprised implanted collagen sheet with BMP-2. In the three experimental groups, the implant comprised collagen sheet with photo-immobilized BMP-2 on Az-gelatin (Az-Gel), Az-O-carboxymethyl chitosan (Az-OMC), or Az‑O‑carboxymethyl low molecular chitosan (Az-LMC). Micro-computed tomography analysis revealed more regenerated bone in Az-Gel at 8weeks. Immunohistochemical analysis at 4weeks revealed that the positively expressed cellular ratio in RUNX2-stained cells was significantly higher in Az-Gel and Az-OMC groups. At 8weeks, only the Az-Gel group showed higher positively expressed cellular ratio compared with the control group. These results demonstrate the superior osteogenetic potential of photo-immobilized BMP-2 using Az-Gel carrier in a rat calvarial defect model compared with control group. Photo-immobilization of BMP-2 using Az-gelatin could be a more effective carrier system of BMP-2 than a chitosan-based carrier system.
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Affiliation(s)
- Dae Woong Ham
- Department of Orthopaedic Surgery, Chung-Ang University Hospital, College of Medicine, 224-1 Heukseok-dong, Dongjak-gu, Seoul 06973, South Korea
| | - Tae-Il Son
- Department of Systems Biotechnology, Chung-Ang University, Anseong-si, Gyenggi-do, South Korea
| | - Tae Jin Lee
- Department of Pathology, Chung-Ang University Hospital, College of Medicine, 224-1 Heukseok-dong, Dongjak-gu, Seoul 06973, South Korea
| | - Kwang-Sup Song
- Department of Orthopaedic Surgery, Chung-Ang University Hospital, College of Medicine, 224-1 Heukseok-dong, Dongjak-gu, Seoul 06973, South Korea.
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Affiliation(s)
| | - Binglin Song
- Mathematics, University of California at Berkeley, Berkeley, California
| | | | | | - Rainer K. Sachs
- Mathematics, University of California at Berkeley, Berkeley, California
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Ham DW, Pitman KT, Lassen LF. Fibrous dysplasia of the clivus and sphenoid sinus. Mil Med 1998; 163:186-9. [PMID: 9542863] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
Fibrous dysplasia is a primary disease of bone that may lead to bony distortion, expansion, and weakness. Craniofacial involvement is an important entity for physicians to be aware of because of the potential for impingement on neurovascular structures, intracranial extension, and cosmetic deformity. We report two cases of craniofacial fibrous dysplasia and discuss the clinical presentation, radiographic and histologic findings, and the management of affected patients.
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Affiliation(s)
- D W Ham
- Otolaryngology-Head and Neck Surgery Department, Naval Medical Center, Portsmouth, VA, USA
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