요통을 호소하는 환자에서의 자기공명영상 검사는 다른 영상 진단법에 비해 요추와 주변 조직에 대한 높은 대조도와 해상력, 다양한 영상면의 획득으로 해부학적 구조 파악과 다양한 척추 질환의 진단에 널리 활용되고 있다. 그러나 자기공명 영상 검사는 검사 시간이 길기 때문에 통증으로 협조가 되지 않는 환자들에게서 움직임에 의한 인공물을 유발하는 경우가 많아 검사 시간을 최소화하는 것이 중요하다. 이에 자기공명영상 검사 시간 단축을 위한 다양한 기법들이 개발되어 왔으며, 최근 높은 영상의 질을 유지하면서 검사 시간은 크게 줄이는 K-공간 기반 딥 러닝(K-space based Deep Learning, DL) 기법이 주목받고 있다. 본 연구는 요추 자기공명영상 검사에서 DL 기법의 유용성을 알아보기 위해 본원을 내원하여 척추 질환이 의심되는 환자를 대상으로 DL 기법 적용 전후 시상면 T2 강조 영상과 축상면 T2 강조 영상을 각각 획득하였으며, 신호대잡음비와 대조대잡음비, 영상 획득 시간, 전체적인 영상의 질 및 병변 진단 일치도를 비교 분석하였다. 연구 결과 영상의 질 향상과 검사 시간의 단축뿐만 아니라 빠른 영상 획득으로 움직임이나 호흡에 의한 인공물 또한 감소하는 것을 볼 수 있었다. 따라서 자기공명영상 검사에서 DL 기법 사용 시 진단적 가치가 보다 높은 영상을 제공하는 동시에 환자의 만족도를 높여 임상에서도 유용한 방법이 될 것으로 사료된다.

본 연구는 자가간호프로그램이 요추간판제거술 환자의 운동이행 자기효능감, 자가간호지식, 자가간호이행에 미치는 효과를 확인하기 위한 실험연구이다. 대상자는 D광역시 소재 일개 척추전문병원 입원환자 중 미세현미경 요추간판제거술을 받은 환자로 실험군 26명, 대조군 27명이다. 수집된 자료는 SPSS 25프로그램을 이용하여 평균, 백분율, 표준편차, t-test, χ2-test, t-test, repeated measures ANOVA로 분석하였다. 연구결과 자가간호프로그램 중재를 받은 실험군은 제공받지 않은 대조군에 비해 시간이 경과함에 따라 보조기 관리지식(p=.001)과 일상생활관리지식점수(p=.005)가 더 높아 지지되었다. 또한 자가간호 프로그램을 제공받은 실험군은 제공받지 않는 대조군보다 보조기 관리이행도(p=.011), 일상생활 이행도 (p=.007), 유해생활 습관관리 이행도(p=.011)가 높아 지지되었다. 따라서 자가간호프로그램은 요추간판제 거술 환자의 수술 전후 적용을 통해 운동이행 자기효능감, 자가간호지식 및 자가간호이행도를 향상시켜 보다 빠른 회복을 도울 수 있는 프로그램이라고 할 수 있다.

본 연구의 목적은 해부학적 근거로 제작한 5가지의 EMS 요추 복압 벨트가 요추 안정화에 미치는 영향을 연구하는 것이다. 본 연구는 요방형근, 척추세움근, 내복사근, 외복사근, 대요근으로 총 5가지의 코어 근육을 선정하여 이에 맞는 근육 모양과 통증 유발점인 압통점을 고려해 전도성 원단으로 패턴을 설계하여 복압 벨트에 결합했다. 총 4가지 동작으로 실험을 진행하여 각각 다른 EMS복압 벨트가 요추 안정화에 미치는 영향을 알아보았다. 건강한 신체의 20대 남성 5명을 대상으로 진행하였고 선정 조건은 최근 3개월 동안 요통 과거력이 없고 사전 검사를 통해 제한되는 동작이 없고, 체간의 근력이 정상등급에 속한 대상이다. 실험 동작의 순서는 하지직거상 검사, 좌전굴, 체전굴, 배근력으로 다음 동작에 제한되지 않게 선정하였다. 동작 간의 휴식은 2분으로 진행하였고, EMS복압 벨트를 착용 후 실험을 진행할 때는 혈류량 증가와 근 활성화를 위해 전기자극을 10분씩 적용하고 진행하였다. 실험 결과의 통계는 비모수 검정으로 윌콕슨 검정과 프리드만 검정을 실시함으로 구체적인 차이를 분석하였다. 본 연구의 결과 5가지의 패턴 중 5,4,3,1,2 순으로 Type별 순위 결과를 확인할 수 있었으며 각 근육의 움직임과 연관성이 있는 실험 동작에 조금 더 유의미한 결과를 확인할 수 있었다. 본 연구의 결론은 해부학적 근거로 제작된 패턴으로 인해 각 근육에 각기 다른 모양으로 전기자극을 전달하였을 때 구분되는 효과를 확인할 수 있었으며 일반인 대상으로 일상생활이나 트레이닝에 있어 요추 안정화를 향상할 수 있을 것으로 기대된다.

Background: The continuous co-contraction of the trunk muscles through trunk stabilization exercises is important to patients with lumbar spinal stenosis (LSS). However, intentional abdominal muscle contraction (IAMC) for trunk stabilization has been used only for specific training in the treatment room. Objects: The purpose of this study was to provide feedback to adults with LSS to enable IAMC during activities of daily living (ADLs). Methods: The participants with spinal stenosis were divided into an experimental group of 15 adults and a control group of 16 adults. Electromyographic signals were measured while the subjects kept their both hands held up at 90°. The measured muscles were the rectus abdominis (RA), external oblique (EO), internal oblique (IO), and erector spinae (ES). Pelvic tilt was measured using a digital pelvic inclinometer. The degree of pain was measured using the visual analogue scale (VAS) and functional capacity was measured using the Korean version of the Oswestry disability index (KODI). Results: While the experimental group showed statistically significantly higher activities in the RA, EO, and IO after the intervention compared with the control group. Pelvic tilt was significantly decreased only in the experimental group. Both the experimental and control groups exhibited statistically significant declines in the VAS and KODI (p<.01). In terms of the levels of changes, the experimental group exhibited a statistically significant larger decline only in the VAS and the pelvic tilt when compared with the control group (p<.05). Conclusions: The subjects could stabilize their trunks, and relieve their pain and dysfunctions and reduce pelvic tilt by learning abdominal muscle contraction during ADLs.

목 적 : 물과 지방의 신호가 동 위상에 있을 때와 역 위상에 있을 때의 신호를 독자적인 알고리즘을 이용하여 물 소거 영상과 지방 소거 영상을 제공하는 mDixon기법은 지방소거 영상에서 균일한 영상을 제공하며, 금속물에 의한 인공물을 줄일 수 있다고 알려져 있다. 하지만 mDixon 기법을 통해 영상화 된 T2 영상과 T2 FS(지방소거) 영상에 대한 영상 비교를 한 연구는 부족한 실정이며, 이에 본 연구에서는 요추 자기공명 영상검사에서 mDixon 기법이 기존의 T2 TSE, T2 SPIR 영상과 비교하여 Scan Time, L3 body(요추 체), Back fat(등 지방), Spinal cord, CSF의 SNR과 CNR이 어떻게 변하는지 알아보고자 하였다. 대상 및 방법 : 2015년 11월부터 2016년 1월까지 Lower Back Pain으로 요추 자기공명 영상검사를 위해 내원한 성인 30명(남22, 여8, 평균연령 46.1±16.37, 평균 BMI 22.9±3.2)을 대상으로 하였다. 사용한 장비는 Philips사의 Achieva Release 3.0 T와 Spine 전용코일을 이용하였으며, 요추 시상면 mDixon 검사와 T2 TSE, T2 SPIR 검사를 하였다. 검사 시 mDixon과 T2 TSE, T2 SPIR검사는 SNR에 영향을 미치는 인자(TR, TE, TSE factor, FOV, Matrix, Thickness, NSA)를 고정하였고, 이에 따른 Scan time을 비교하였다. 검사한 영상은 세 번째 요추를 가로 기준선으로 L3 Body, Back fat, Spinal cord, CSF에 대해 각각 20mm²의 원형 ROI를 설정하여 신호강도를 측정하였고, SNR과 L3 Body-Back fat의 CNR, Spinal cord와 CSF의 CNR값을 구하였다. 각각의 SNR, CNR 값은 대응표본 t-검정(SPSS win 18.0)을 통해 분석하였고, 0.05이하를 통계적으로 유의한 값으로 보았다. 결 과 : mDixon의 Scan time은 1분 55초, T2 TSE는 1분 00초, T2 SPIR는 1분 00초였다. mDixon T2영상은 T2 TSE 영상보다 L3 body에서 SNR이 높았고, back fat과 CSF에서는 SNR이 낮았으며(p<0.05) Spinal cord에서는 비슷한 SNR을 가졌다(p>0.05). L3 body와 back fat의 CNR은 mDixon T2영상이 높았으며, CSF와 Spinal cord의 CNR은 T2 TSE가 높았다(p<0.05). mDixon T2 FS영상은 T2 SPIR영상 보다 L3 body, back fat에서 낮았고, Spinal cord, CSF에서는 높았다(p<0.05). L3 body와 back fat의 CNR은 mDixon T2 FS영상이 높았으며(p<0.05), CSF와 Spinal cord의 CNR은 두 영상이 차이가 없었다(p>0.05). 결 론 : 결론적으로 LBP환자의 요추 시상면 자기공명 영상검사에서 mDixon 기법이 기존의 T2 TSE, T2 SPIR 기법에 비해 Scan time, 각 부위의 SNR, CNR에서 보다 우수한 영상이라 하기 어려웠다. 하지만 본 연구는 단순 LBP환자를 대상으로 제한하였다는 한계로, 기존의 연구에서 보고된 특정 환자군의 설정(금속물 삽입, 척추 종양, 골절 환자 등)을 통한 추가 연구들이 필요할 것으로 사료된다.

목적 및 배경 : 본 연구의 목적은 Lumbar Spine Routine 자기공명영상에서 ProSet(Principles of the selective excitation technique)기법이 유용한 검사임에도 임상에서 많이 사용되지 않으며 2D영상만 주로 사용하고 3D영상으로 잘 분석되지 않고 있다. 이에 ProSet기법의 3D영상의 중요성과 요추 자기공명영상에서의 ProSet기법의 유용성을 알리고자 한다. 대상 및 방법 : 본원을 내원하여 2011~2014년 요추 자기공명영상 검사를 시행한 환자를 대상으로 ProSet 2D영상과 3D영상을 분석하였다. 연구에 이용한 실험 장비는 Philips사의 Gyroscan Intera 1.5Tesla로 Spine Array coil을 사용하였다. 결 과 : 요추 자기공명영상 검사의 ProSet 2D영상과 3D영상을 영상의학과 전문의 3명에게 보여주었다. 2D영상보다는 3D영상에서의 신경근 압박(Nerve root compression)정도와 신경근의 부종 등이 잘 묘사되어 3D영상의 진단적 가치가 더 높았다. 결 론 : 요추(Lumbar spine) 자기공명영상에서 ProSet의 2D영상보다 3D영상의 신경근 압박 및 부종 등의 진단적 가치가 높았다

This study aimed to investigate the effect of the abdominal drawing-in maneuver (ADIM) and abdominal expansion maneuver (AEM) on trunk stabilization, as well as trunk muscle activities and differences in quadruple visual analogue scale, Korean Oswestry Disability Index, and Fear Avoidance Beliefs Questionnaire scores, in patients with chronic low back pain and lumbar spine instability. To increase intra-abdominal pressure during the trunk stabilization exercise, the technique of pushing the abdomen out using diaphragmatic abdominal breathing suggested by Pavel Koral was used, which we termed the AEM. Fifty patients who tested positive on more than three of the five lumbar spine instability tests were separated from 138 patients with chronic low back pain of these patients, 16 were placed in the control group (trunk stabilization exercise), 17 were placed in the ADIM group (trunk stabilization exercise with ADIM), and 17 were placed in the AEM group (trunk stabilization exercise with AEM). Each group participated in the study for 30 minutes three times weekly for 4 weeks. Surface electromyography was used to measure the trunk muscle activities during the kneeling forward and supine bridging positions, and one-way repeated analysis of variance was used to determine the statistical significance of the trunk muscle activities in the rectus abdominis, internal oblique (IO), erector spinae, and multifidus (MF) muscles. The ADIM and AEM groups showed relatively larger improvements in psychosocial and functional disability level than control group. There were significant changes among the three groups, those from the measured values of the AEM group was significantly higher than the other two groups in changes in IO and MF trunk muscle activities (p＜05). This finding demonstrates that trunk stabilization exercises with AEM is more effective than ADIM for increasing trunk deep muscle activity of chronic low back pain patients with lumbar spine instability.

Even though two-hands lifting/lowering activity of manual materials handling tasks are prevalent at the industrial site, many manual materials handling tasks which require the worker to perform one-hand lifting/lowering are also very common at the industrial site, forestry, farming, and daily life. The objective of this study was to compare one-hand lowering activity to lifting activity in terms of biomechanical stress for the range of lowering heights from knuckle height to 10cm above floor level with two workload 7.5kg and 15.0kg. Eight male subjects with LMM were asked to perform lifting/lowering tasks using both a one-handed (left-hand and right-hand) as well as a two-handed technique. Spinal loading was estimated through an EMG-assisted free-dynamic biomechanical model. The biomechanical stress of one-hand lowering activity was shown to be 43% lower than that of one-hand lifting activity. It was claimed that the biomechanical stress for one-hand lifting/lowering activity is almost twice (194%) of the one for two-hands lifting/lowering activity. It was also found that biomechanical stress by one-hand lowering/lifting activity with the half workload of two-hands lowering/lifting activity was greater than that of the two-hands lowering/lifting activity. Therefore, it might be a risk to consider the RWL of one-hand lowering/lifting activity to simply be a half of the RWL of two-hands lowering/lifting activity recommended by NIOSH.

The purpose of this study was to provide a practical guide to the proper way of lifting a patient using various types of stretcher that rescue crews use by analyzing the load on the lumbar region. The experiment was conducted with working male and female rescue crews. Having mixed groups of gender complete tasks such as lifting, moving, and unloading a patient using four different types of stretcher, we recorded variations of the lumbar bending angle and calculated the load on the lumbar region using 3D SSPP. The data showed, in terms of the lumbar bending angle, it was greater when only females were involved in the work, and there were very significant differences in the angle depending on the types of stretcher used and body sizes of each subject. In the analysis of the load on the lumbar based on the bending angle, NIOSH was over the recommended limit in certain groups. Utilizing the analysis, it is recommended, in the medium and long term, to improve equipments for rescue personnel and to guide them to the proper way of working.

The lumbar multifidus muscle, which can be separated into deep fascicles (DM) and superficial fascicles (SM), is important for lumbar segmental stability. However, no previous studies have investigated the effect of lumbar stabilization exercises on the thickness of DM and SM. Thus, the purpose of this study was to assess DM thickness after three different lumbar segmental stabilization exercises. In total, 30 healthy male participants were recruited and randomly assigned to one of three exercise groups: hollowing in the quadruped position (H-Quad), contralateral arm and leg lift (CALL), and bilateral arm and leg lift (BALL). Each lumbar segmental stabilization exercise was conducted over 4 weeks. Ultrasonography was used to compare the DM and SM thickness before and after the 4 weeks of exercise. A mixed-model analysis of variance using Scheffe's post-hoc test was used for statistical analysis. The results showed a significant effect for the measurement time (before vs. after 4 weeks of exercise) in the DM (F=31.26, p<.05) and SM (F=4.56, p<.05). At the end of the 4 weeks, the DM thickness had increased significantly in the H-Quad exercise group, and the SM thickness had increased significantly in the CALL and BALL exercise groups. Also in the BALL exercise group, the SM thickness was greater compared with that in the H-Quad exercise group. These findings suggest that the thickness of the DM and SM were increased by different types of lumbar segmental stability exercise after 4 weeks.

The purpose of this study was to determine the effect of contralateral hip adduction (CHA) on thickness of lumbar stabilizers during hip abduction in side-lying. Twenty healthy subjects without back pain were recruited for this study. The thickness of transverse abdominis (TrA), internal oblique (IO) and quadratus lumborum (QL) were measured by ultrasonography. Pelvic lateral tilting motion was measured using a three-dimensional motion analysis system. Measurements were performed at rest position (RP), preferred hip abduction (PHA) and abduction with contralateral hip adduction (CHA) in side-lying at the end of expiration. During the measurements, subjects were asked to maintain steady trunk alignment without hand support. Thickness of TrA and IO was significantly greater in CHA than in PHA and RP conditions. There was no significant difference in thickness of TrA and IO between PHA and RP conditions. Medio-lateral (M-L) thickness of QL was not significant between PHA and CHA conditions. Anterio-posterior (A-P) thickness of QL in PHA and CHA significantly decreased compared to RP condition. Angle of pelvic lateral tilting was significantly decreased in CHA compared to PHA condition. In conclusion, CHA can be recommended for increasing trunk stability without compensatory pelvic motion during hip abduction exercise in side-lying.

The purpose of this study was to establish the reliability and validity of the passive lumbar extension (PLE) test and prone instability test (PIT). Thirty-three subjects (14 males, 19 females) with lower back pain enrolled in the study and the subjects were divided into 2 groups (positive and negative instability groups) on the basis of radiographies of flexion and extension. Reliability was determined by the kappa coefficient and validity was examined using calculated sensitivity, specificity, and the likelihood ratio. The results showed that the reliability of the PLE test was higher than the PIT (intra-rater reliability: k=.86 and k=.81, interrater reliability: k=.65 and k=.62) and the validity of the PLE test was also higher than the PIT (sensitivity: 91% and 62%, specificity: 95% and 85% positive likelihood ratio: 20.00 and 4.10, negative likelihood ratio: .10 and .45). In conclusion, we think that the PLE test was a more reliable and valid method for lumbar instability than the PIT.

The purpose of this study was to identify the effects of manual facilitation and a stick on lumbar and hip joint flexion angles in subject with lumbar flexion syndrome during forward bending from a sitting position. Fifteen subjects with lumbar flexion syndrome were recruited for this study. As a pretest, all subjects performed three repetitions of bending the trunk forward until the tips of their fingers touched the target bar. After this pretest, the subjects practiced the forward bending of the trunk 10 times, using either manual facilitation or a stick. Then, as a posttest, all subjects repeated the pretest procedure. The flexion angles of lumbar spine and hip joint during forward bending in a sitting position were measured using a three-dimensional motion analysis system. A paired t-test was used to determine the statistical differences between pre-test and post-test flexion angles and pre- and post-test flexion angle differences between forward bending with manual facilitation and forward bending with a stick. The level of statistical significance was set at p=.05. The results of the study showed that the angle of the lumbar flexion decreased significantly and the bilateral hip flexion angle increased significantly when performing forward bending with stick and manual facilitation. Furthermore, the angle of lumbar flexion decreased significantly and the angle of bilateral hip flexion increased significantly in forward bending with a stick compared to forward bending with manual facilitation. The findings of this study indicate that both forward bending with manual facilitation and sticks could be used to prevent excessive lumbar flexion and increase hip flexion, and that forward bending with a stick is more effective than forward bending with manual facilitation for inducing lumbar spine and hip joint angle changes.

The purpose of this study was to compare the electromyography (EMG) activities of the lumbar extensor muscles during motion of trunk flexion-extension and compare range of motion (ROM) with a 3-dimensional motion analysis system of the lumbar region between subjects with chronic low back pain (CLBP) and healthy subjects during the trunk flexion-extension, trunk rotation and trunk lateral flexion cycle. Thirty CLBP subjects and thirty healthy subjects were included. We measured the root mean square (RMS) value of the lumbar extensor muscles from resting, standing, lumbar flexion and return position. The RMS ratio was normalized from maximal EMG activity of the lumbar extensor muscles during trunk motion. The results of this study showed that the RMS ratio of the lumbar extensor was significantly higher in CLBP subjects than healthy subjects during all of trunk motion (p<.05). The ratio of the highest RMS value during flexion and extension was higher in CLBP subjects than in healthy subjects (p<.05). The ROM of the lumbar region was significantly lower in CLBP subjects than healthy subjects during trunk flexion-extension, trunk rotation and lateral flexion cycle. The relationship between the RMS ratio for full lumbar flexion and the ROM of lumbar flexion was not correlated significantly. CLBP subjects have both decreased ROM of the lumbar region and higher muscle activities of the lumbar extensor muscle than healthy subjects.

This study is aimed at investigating the influence of different quantitative knowledge of results on the measurement error during lumbar proprioceptive sensation training. Twenty-eight healthy adult men participated and subjects were randomly assigned into four different feedback groups(100% relative frequency with an angle feedback, 50% relative frequency with an angle feedback, 100% relative frequency with a length feedback, 50% relative frequency with a length feedback). An electrogoniometer was used to determine performance error in an angle, and the Schober test with measurement tape was used to determine performance error in a length. Each subject was asked to maintain an upright position with both eyes closed and both upper limbs stabilized on their pelvis. Lumbar vertebrae flexion was maintained at for three seconds. Different verbal knowledge of results was provided in four groups. After lumbar flexion was performed, knowledge of results was offered immediately. The resting period between the sessions per block was five seconds. Training consisted of 6 blocks, 10 sessions per one block, with a resting period of one minute. A resting period of five minutes was provided between 3 blocks and 4 blocks. A retention test was performed between 10 minutes and 24 hours later following the training block without providing knowledge of results. To determine the training effects, a two-way analysis of variance and a one-way analysis of variance were used with SPSS Ver. 10.0. A level of significance was set at .05. A significant block effect was shown for the acquisition phase (p<.05), and a significant feedback effect was shown in the immediate retention phase (p>.05). There was a significant feedback effect in the delayed retention phase (p<.05), and a significant block effect in the first acquisition phase and the last retention phase (p<.05). In conclusion, it is determined that a 50% relative frequency with a length feedback is the most efficient feedback among different feedback types.

The purpose of this study was to compare the onset times of muscle activities and the order of muscle firing in hamstring gluteus maximus, and lumbar erector spinae muscle during active hip extension between subjects with low back pain (LBP) and healthy subjects. Thirty subjects, 15 with LBP and 15 healthy subjects, participated in this study. Electromyographic activity was recorded during active hip extension in prone and standing position. Relative onset times of these muscle activities were determined. Similar muscle firing order in hamstring, gluteus maximus, and lumbar erector spinae muscle showed in both groups and positions. However, the onset time of gluteus maximus was significantly later in prone and standing active hip extension in subjects with LBP than in healthy subjects. The onset time of lumber erector spinae muscle activity was significantly delayed in subjects with LBP in standing active hip extension, The delayed onset times of gluteus maximus and lumbar erector spinae muscles' activities were probably related to LBP. Further studies are needed to identify whether the delayed onset times of gluteus maximus and lumbar erector spinae muscle activities are the contributing factors to LBP.