Approach strategies and application of metabolomics to biotechnology in plants.

Metabolomics refers to the technology for the comprehensive analysis of metabolites and low-molecular-weight compounds in a biological system, such as cells or tissues. Metabolites play an important role in biological phenomena through their direct involvement in the regulation of physiological mechanisms, such as maintaining cell homeostasis or signal transmission through protein-protein interactions. The current review aims provide a framework for how the integrated analysis of metabolites, their functional actions and inherent biological information can be used to understand biological phenomena related to the regulation of metabolites and how this information can be applied to safety assessments of crops created using biotechnology. Advancement in technology and analytical instrumentation have led new ways to examine the convergence between biology and chemistry, which has yielded a deeper understanding of complex biological phenomena. Metabolomics can be utilized and applied to safety assessments of biotechnology products through a systematic approach using metabolite-level data processing algorithms, statistical techniques, and database development. The integration of metabolomics data with sequencing data is a key step towards improving additional phenotypical evidence to elucidate the degree of environmental affects for variants found in genome associated with metabolic processes. Moreover, information analysis technology such as big data, machine learning, and IT investment must be introduced to establish a system for data extraction, selection, and metabolomic data analysis for the interpretation of biological implications of biotechnology innovations. This review outlines the integrity of metabolomics assessments in determining the consequences of genetic engineering and biotechnology in plants.

Learning curve for minimally invasive transforaminal lumbar interbody fusion: a systematic review.

PURPOSE: Minimally invasive transforaminal lumbar interbody fusion (MI-TLIF) is commonly used to treat degenerative lumbar spinal disorders. It facilitates a full-scale spinal decompression and interbody fusion with minimal neural retraction using the tubular retractor system. Despite the benefits of surgical efficiency and minimalism, this technique requires a long learning curve. There is currently no consensus on the learning curve characteristics and proper training methods for MI-TLIF. Thus, this systematic review aimed to discuss the cutoff point at which technical proficiency is achieved and ways to enhance the learning process. METHODS: Major databases, including PubMed, Embase, and Cochrane Library, were searched for learning curve studies that have evaluated the clinical outcome and learning progress of MI-TLIF using quantitative data. The qualities of the selected studies were assessed using the Newcastle‒Ottawa scale. The plateau points in the "learning curve" were analyzed according to various outcome measures. RESULTS: Nine full-text articles, representing 753 cases, were included from 9743 screened studies. The most commonly used outcome measures were the operative time, followed by the complication rate. The mean cutoff point for the operative time was 31.33 ± 11.98 (range 13‒45) cases. CONCLUSION: The plateau point in the learning curve for MI-TLIF may differ according to the outcome measures used. Most studies have demonstrated the learning progress based on simple task efficiency, rather than patient outcomes. Moreover, the learning rate may be affected by the patients' and technical conditions. Therefore, great care is required in interpreting the learning curve and cutoff point for MI-TLIF proficiency.

Copper-Coated Polypropylene Filter Face Mask with SARS-CoV-2 Antiviral Ability.

Face masks will be used to prevent pandemic recurrence and outbreaks of mutant SARS-CoV-2 strains until mass immunity is confirmed. The polypropylene (PP) filter is a representative disposable mask material that traps virus-containing bioaerosols, preventing secondary transmission. In this study, a copper thin film (20 nm) was deposited via vacuum coating on a spunbond PP filter surrounding a KF94 face mask to provide additional protection and lower the risk of secondary transmission. Film adhesion was improved using oxygen ion beam pretreatment, resulting in cuprous oxide formation on the PP fiber without structural deformation. The copper-coated mask exhibited filtration efficiencies of 95.1 ± 1.32% and 91.6 ± 0.83% for NaCl and paraffin oil particles, respectively. SARS-CoV-2 inactivation was evaluated by transferring virus-containing media onto the copper-coated PP filters and subsequently adding Vero cells. Infection was verified using real-time polymerase chain reaction and immunochemical staining. Vero cells added after contact with the copper-coated mask did not express the RNA-dependent RNA polymerase and envelope genes of SARS-CoV-2. The SARS-CoV-2 nucleocapsid immunofluorescence results indicated a reduction in the amount of virus of more than 75%. Therefore, copper-coated antiviral PP filters could be key materials in personal protective equipment, as well as in air-conditioning systems.

Compositional equivalence assessment of insect-resistant genetically modified rice using multiple statistical analyses.

The safety of transgenic Bt rice containing bacteria-derived mCry1Ac gene from Bacillus thuringiensis (Bt) was assessed by conducting field trials at two locations for two consecutive years in South Korea, using the near-isogenic line comparator rice cultivar ('Ilmi', non-Bt rice) and four commercial cultivars as references. Compositional analyses included measurement of proximates, minerals, amino acids, fatty acids, vitamins, and antinutrients. Significant differences between Bt rice and non-Bt rice were detected; however, all differences were within the reference range. The statistical analyses, including analysis of % variability, analysis of similarities (ANOISM), similarity percentage (SIMPER) analysis, and permutational multivariate analysis of variance (PERMANOVA) were performed to study factors contributing to compositional variability. The multivariate analyses revealed that environmental factors more influenced rice components' variability than by genetic factors. This approach was shown to be a powerful method to provide meaningful evaluations between Bt rice and its comparators. In this study, Bt rice was proved to be compositionally equivalent to conventional rice varieties through multiple statistical methods.

Comparison of the seed nutritional composition between conventional varieties and transgenic soybean overexpressing Physaria FAD3-1.

BACKGROUND: PfFAD3 transgenic soybean expressing omega-3 fatty acid desaturase 3 of Physaria produces increased level of α-linolenic acid in seed. Composition data of non-transgenic conventional varieties is important in the safety assessment of the genetically-modified (GM) crops in the context of the natural variation. RESULTS: The natural variation was characterized in seed composition of 13 Korean soybean varieties grown in three locations in South Korea for 2 years. Univariate analysis of combined data showed significant differences by variety and cultivation environment for proximates, minerals, anti-nutrients, and fatty acids. Percent variability analysis demonstrated that genotype, environment and the interaction of environment with genotype contributed to soybean seed compositions. Principal component analysis and orthogonal projections to latent structure discriminant analysis indicated that significant variance in compositions was attributable to location and cultivation year. The composition of three PfFAD3 soybean lines for proximates, minerals, anti-nutrients, and fatty acids was compared to a non-transgenic commercial comparator (Kwangankong, KA), and three non-transgenic commercial varieties grown at two sites in South Korea. Only linoleic and linolenic acids significantly differed in PfFAD3-1 lines compared to KA, which were expected changes by the introduction of the PfFAD3-1 trait in KA. CONCLUSION: Genotype, environment, and the interaction of environment with genotype contributed to compositional variability in soybean. PfFAD3-1 soybean is equivalent to the conventional varieties with respect to these components. © 2020 The Authors. Journal of The Science of Food and Agriculture published by John Wiley & Sons Ltd on behalf of Society of Chemical Industry.

Transforaminal Endoscopic Decompression for Lumbar Lateral Recess Stenosis: An Advanced Surgical Technique and Clinical Outcomes.

OBJECTIVE: The clinical application of endoscopic techniques for lumbar lateral recess stenosis (LRS) is still challenging. This study aimed to describe a transforaminal endoscopic decompression (TED) technique for LRS and to demonstrate its clinical results. METHODS: Two-year follow-up data were collected from 45 consecutive patients who underwent TED for LRS. Full-scale endoscopic decompression was performed in the dorsal and ventral aspects of the lateral recess with combined partial pediculectomy using an articulating bone burr and endoscopic instruments. Surgical outcomes were evaluated using the Visual Analog Pain Score (VAS), Oswestry Disability Index (ODI), and modified Macnab criteria. RESULTS: The mean age of the 27 female and 18 male patients was 64.9 years. The mean VAS for leg pain and mean ODI improved from 7.93 and 75.87 at baseline to 1.71 and 17.87, respectively, at 2 years after surgery (P < 0.001 and P < 0.001, respectively). Based on the modified Macnab criteria, excellent or good results were obtained in 86.7% of the patients, and symptomatic improvements were obtained in 97.8%. One patient underwent revision surgery because of incomplete decompression, and 2 experienced transient dysesthesia. CONCLUSION: TED with the patient under local anesthesia can be effective for the treatment of LRS, especially for the elderly or patients at a high risk for general anesthesia.

Statistical study on the environmental effects on the natural variation of nutritional components in rice varieties.

This study was investigated to compare the natural variation of nutrients in rice variety by different environmental factors. Fifteen kinds of rices were used, which were cultivated in two locations for 2 years. All data were analyzed by the various statistical tools to identify the nutritional variations of nutrients. The results of variable importance in the prediction analysis were found to be consistent with the % variability. The nutrient compositions most affected by variety were fatty acids, and next were vitamins, proximate nutrients, minerals, and amino acids in order. The nutrient compositions most affected by location were proximate, followed by minerals, vitamins, fatty acids, and amino acids. For cultivation year, vitamins were most affected and then minerals, fatty acids, proximate nutrients, and amino acids in order. These findings could explain that each kind of nutrients can be naturally varied by different environmental factors.

[Child Safety Injury Experiences, Prevention Behaviors and Educational Needs among Immigrant Vietnamese Women on Jeju Island]. / ì œì£¼íŠ¹ë³„ìžì¹˜ë„ 거주 ë² íŠ¸ë‚¨ 결혼 이주민 여성의 ìžë € ì•ˆì „ì‚¬ê³ ê²½í—˜ê³¼ ì•ˆì „ì‚¬ê³ ì˜ˆë°©í–‰ë™ 및 교육요구.

PURPOSE: Study purpose was to describe the child safety injury experiences, injury prevention behaviors and educational needs of immigrant Vietnamese women on Jeju Island, and to explore associations among those factors. METHODS: A descriptive correlational study was conducted using structured questionnaires to collect data from immigrant Vietnamese women who visited a multicultural centers on Jeju Island from January to April, 2017. RESULTS: Data from 60 women were analyzed. They were 28.2±5.5 years old, had resided in Korea for 40.6±31.1 months, and had 1.5±0.6 children on average. In total, 51.7% had previous injury prevention education, 68.2% had experienced child safety injuries, and 95.0% wanted to receive education on how to prevent child safety injuries. The mean total score of child injury prevention behaviors was 27.33±17.79, and that variable was associated with a longer duration of formal education (t=2.41, p=.021) and with women's experiences of child safety injury (t=5.97, p<.001). CONCLUSION: Immigrant Vietnamese women experienced a higher frequency of child safety injuries and needed educational opportunities to prevent these injuries. Further research is necessary to develop the essential content and effective methods for education on child safety injury prevention among this unique multicultural population.

Radiographic Assessment on Magnetic Resonance Imaging after Percutaneous Endoscopic Lumbar Foraminotomy.

Percutaneous endoscopic lumbar foraminotomy (ELF) is a novel minimally invasive technique used to treat lumbar foraminal stenosis. However, the validity of foraminal decompression based on quantitative assessment using magnetic resonance imaging (MRI) has not yet been established. The objective of this study was to investigate the radiographic efficiency of ELF using MRI. Radiographic changes of neuroforamen were measured based on pre- and postoperative MRI findings. Images were blindly analyzed by two observers for foraminal stenosis grade and foraminal dimensions. The intraclass correlation coefficient (ICC) and k statistic were calculated to determine interobserver agreement. Thirty-five patients with 40 neuroforamen were evaluated. The mean visual analog scale (VAS) score improved from 8.4 to 2.1, and the mean Oswestry disability index (ODI) improved from 65.9 to 19.2. Overall, 91.4% of the patients achieved good or excellent outcomes. The mean grade of foraminal stenosis significantly improved from 2.63 to 0.68. There were significant increases in the mean foraminal area (FA) from 50.05 to 92.03 mm2, in mean foraminal height (FH) from 11.36 to 13.47 mm, in mean superior foraminal width (SFW) from 6.43 to 9.27 mm, and in mean middle foraminal width (MFW) from 1.47 to 78 mm (P < 0.001). Interobserver agreements for preoperative and postoperative measurements were good to excellent with the exception of SFW. In conclusion, foraminal dimensions and grades of foraminal stenosis significantly improved after ELF. These findings may enhance the clinical relevance of endoscopic lumbar foraminal decompression.

Disrupted Control Network Connectivity in Abstinent Patients with Alcohol Dependence.

OBJECTIVE: Alcohol causes damage to the brain and is associated with various functional impairments. However, much of the brain damage can be reversed by abstaining for enough time. This study aims to investigate the patterns and degrees of brain function in abstinent patients with alcohol dependence by using resting-state functional connectivity. METHODS: 26 male patients with alcohol dependence (alcohol group) and 28 age-matched male healthy volunteers (control group) were recruited from a mental hospital and the community, respectively. Using 3T MRI scan data, the resting-state functional connectivity of the task-negative and task-positive networks was determined and compared between the groups. RESULTS: There were no significant group differences in the resting-state functional connectivity in the default mode or in the salience and sensorimotor networks. Compared with the control group, the alcohol group showed significantly lower functional connectivity in the executive control network, especially in the cingulo-opercular network and, in some regions of interest, the dorsal attention network. CONCLUSION: This finding suggests that some brain networks do not normalize their functions after abstinence from drinking, and these results may be helpful in future research to investigate the mechanisms for craving alcohol and alcohol relapse prevention.

Application of corona discharge-generated air ions for filtration of aerosolized virus and inactivation of filtered virus.

The effect of corona discharge-generated air ions on the filtration of aerosolized bacteriophage MS2 was studied. A carbon-fiber ionizer was installed upstream of a medium-efficiency air filter to generate air ions, which were used to charge the virus aerosols and increase their filtration efficiency. After the virus aerosols were captured by the filter for a certain time interval, they were exposed to a newly incoming air ion flow. Captured virus particles were detached from the filter by sonication, and their antiviral efficiency due to air ions was calculated by counting the plaque-forming units. The antiviral efficiency increased with ion exposure time and ion concentration. When the concentration of positive air ions was 107 ions/cm3, the antiviral efficiencies were 46.1, 78.8, and 83.7% with exposure times of 15, 30, and 45 min, respectively. When the ionizer was operated in a bipolar mode, the number concentrations of positive and negative ions were 6.6×106 and 3.4×106 ions/cm3, respectively, and the antiviral efficiencies were 64.3, 89.1, and 97.4% with exposure times of 15, 30, and 45 min, respectively. As a quantitative parameter for the performance evaluation of air ions, the susceptibility constant of bacteriophage MS2 to positive, negative, bipolar air ions was calculated as 5.5×10-3, 5.4×10-3 and 9.5×10-3, respectively. These susceptibility constants showed bipolar ion treatment was more effective about 1.7 times than unipolar ion treatment.

Volume of hippocampal subfields in patients with alcohol dependence.

Alcohol-induced hippocampal atrophy has been well documented in many studies and is known to affect various subfields. Given the functional heterogeneity of these subfields, we investigated the precise effects of alcohol-induced damage in these areas. Twenty-six male patients with alcohol dependence (alcohol group) and twenty-six age-matched male healthy social drinkers were recruited from a mental health hospital and the community respectively, with the aim of comparing the hippocampal subfields between groups. Each participant underwent a 3T MRI scan. Hippocampal subfield volumes were estimated using an automated procedure and drinking history recorded using Lifetime Drinking History, Alcohol Use Disorder Identification Test, and the Brief Michigan Alcoholism Screening Test. The alcohol group showed a lower total hippocampus volume, specifically in the left presubiculum, fimbria, and bilateral subiculum. Regression analysis assessing the influence of age and group showed that group was a more significant factor than age in most subfields. Our findings suggest that alcohol dependence alters hippocampal subfield volumes. Further longitudinal studies on the interaction of structural and neurocognitive changes would improve our understanding of brain structural changes resulting from long-term alcohol consumption.

Surface-Based Parameters of Brain Imaging in Male Patients with Alcohol Use Disorder.

OBJECTIVE: The structural alteration of brain shown in patients with alcohol use disorder (AUD) can originate from both alcohol effects and genetic or developmental processes. We compared surface-based parameters of patients with AUD with healthy controls to prove the applicability of surface-based morphometry with head size correction and to determine the areas that were sensitive to brain alteration related to AUD. METHODS: Twenty-six abstinent male patients with AUD (alcohol group, mean abstinence=13.2 months) and twenty-eight age-matched healthy participants (control group) were recruited from an inpatient mental hospital and community. All participants underwent a 3T MRI scan. Surface-based parameters were determined by using FreeSurfer. RESULTS: Every surface-based parameter of the alcohol group was lower than the corresponding control group parameter. There were large group differences in the whole brain, grey and white matter volume, and the differences were more prominent after head size correction. Significant group differences were shown in cortical thicknesses in entire brain regions, especially in parietal, temporal and frontal areas. There were no significant group differences in surface areas, but group difference trends in surface areas of the frontal and parietal cortices were shown after head size correction. CONCLUSION: Most of the surface-based parameters in alcohol group were altered because of incomplete recovery from chronic alcohol exposure and possibly genetic or developmental factors underlying the risk of AUD. Surface-based morphometry with controlling for head size is useful in comparing the volumetric parameters and the surface area to a lesser extent in alcohol-related brain alteration.

Early Vertebroplasty versus Delayed Vertebroplasty for Acute Osteoporotic Compression Fracture : Are the Results of the Two Surgical Strategies the Same?

OBJECTIVE: In Korea, early vertebroplasty (EVP) or delayed vertebroplasty (DVP, which is performed at least 2 weeks after diagnosis) were performed for the treatment of acute osteoporotic compression fracture (OCF) of the spine. The present study compared the outcomes of two surgical strategies for the treatment of single-level acute OCF in the thoracolumbar junction (T12-L2). METHODS: From 2004 to 2010, 23 patients were allocated to the EVP group (EVPG) and 27 patients to the DVP group (DVPG). Overall mean age was 68.3±7.9 and minimum follow-up period was 1.0 year. Retrospective study of clinical and radiological results was conducted. RESULTS: No significant differences in baseline characteristics were observed between the two groups. As expected, mean duration from onset to vertebroplasty and mean duration of hospital stay were significantly longer in the DVPG (17.1±2.1 and 17.5±4.2) than in the EVPG (3.8±3.3 and 10.8±5.1, p=0.001). Final clinical outcome including visual analogue scale (VAS), Oswestry Disability Index, and Odom's criteria did not differ between the two groups. However, immediate improvement of the VAS after vertebroplasty was greater in the EVPG (5.1±1.3) than in the DVPG (4.0±1.0, p=0.002). The proportion of cement leakage was lower in the EVPG (30.4%) than in the DVPG (59.3%, p=0.039). In addition, semiquantitative grade of cement interdigitation was significantly more favorable in the EVPG than in the DVPG (p=0.003). Final vertebral body collapse and segmental kyphosis did not differ significantly between the two groups. CONCLUSION: Our findings suggest that EVP achieves a better immediate surgical effect with more favorable cost-effectiveness.

Influence of Compression Ratio Differences between Magnetic Resonance Images and Simple Radiographs on Osteoporotic Vertebral Compression Fracture Prognosis after Vertebroplasty.

OBJECTIVE: The extent of collapse progression after vertebroplasty in osteoporotic vertebral compression fractures (OVCF) has known to be various. In this study, we investigated that how much difference of compression ratio between standing simple radiograph and supine magnetic resonance imaging (MRI) affects the collapse progression after vertebroplasty. METHODS: This retrospective cohort study was carried out based on 27 patients with 31 OVCFs undergone vertebrplastyin the thoracolumbar junction (T12-L2), from January to December 2009. The OVCFs were divided to two groups, the smaller group A and larger group B, by mean compression ratio difference (8.1%) between standing simple radiograph and supine MRI. RESULTS: There were no significant differences in the baseline characteristics of the two groups except age. There were also no significant differences between the periodic compression ratio, back pain, Cobb's angle during follow-up period. However, Group B seemed to show improvements from the initial state to the point just after the operation, but eventually took a much worse course than group A. In the end, judging from the compression ratios of the two groups at the last follow up, group A showed less progression. CONCLUSION: Although the clinical outcome was not different significantly, a greater compression ratio difference in the initial study resulted in a greater collapse progression at last follow-up. Therefore, we suggest that it is important to check the initial standing simple radiograph, as well as supine MRI, for predicting collapse progression after vertebroplasty.

Malignant solitary fibrous tumor of tandem lesions in the skull and spine.

A Solitary Fibrous Tumor (Sft) Is A Rare Neoplasm Originated From The Pleura, But They Can Occur In A Variety Of Extrathoracic Regions. Although Many Cases Of Primary Sft Have Been Reported, There Are Extremely Rare Repots To Date Of A Malignant Sft In The Spine Or Skull. A 54-year-woman Visited Our Hospital Due To Low Back Pain And Both Leg Radiating Pain. Several Imaging Studies Including Magnetic Resonance Imaging And Computed Tomography Revealed Expansive Enhanced Lesions In The Occipital Bone, T8, S1-2, And Ilium, With Neural Tissue Compression. We Performed Surgical Resection Of The Tumor In Each Site, And Postoperative Radiosurgery And Chemotherapy Were Performed. However, After Six Months, Tumors Were Recurred And Metastasized In Multiple Regions Including Whole Spine And Lung. The Authors Report Here The First Case Of Patient With Malignant Sft Of Tandem Lesions In The Various Bony Structures, Including Skull, Thoracic Spine, And Sacral Spine, With A Rapid Recurrence And Metastasis. Although Malignant Sft Is Extremely Rare, It Should Be Considered In The Differential Diagnosis And Carful Follow-up Is Needed.

Solitary ruptured aneurysm of the spinal artery of adamkiewicz with subarachnoid hemorrhage.

Spinal subarachnoid hemorrhage (SAH) due to solitary spinal aneurysm is extremely rare. A 45-year-old female patient visited the emergency department with severe headache and back pain. Imaging studies showed cerebral SAH in parietal lobe and spinal SAH in thoracolumbar level. Spinal angiography revealed a small pearl and string-like aneurysm of the Adamkiewicz artery at the T12 level. One month after onset, her back pain aggravated, and follow-up imaging study showed arachnoiditis. Two months after onset, her symptoms improved, and follow-up imaging study showed resolution of SAH. The present case of spinal SAH due to rupture of dissecting aneurysm of the Adamkiewicz artery underwent subsequent spontaneous resolution, indicating that the wait-and-see strategy may provide adequate treatment option.

Postoperative Cervical Cord Compression Induced by Hydrogel Dural Sealant (DuraSeal®).

Cerebrospinal fluid (CSF) leakage is a potential complication of cranial and spinal surgery. Postoperative CSF leakage can induce delayed healing, wound infection and meningitis. DuraSeal® (Covidien, Waltham, MA, USA) is a synthetic product which has been increasingly used to facilitate watertight repair of dural defects after cranial and spinal surgery. Despite some advantages of Duraseal®, the authors report a patient who developed cord compression following the use of DuraSeal® in cervical spine surgery in which the expansion of the DuraSeal® was believed to be the causative factor.

Traumatic Atlanto-occipital Dislocation (AOD).

OBJECTIVE: Traumatic atlanto-occipital dislocation (AOD) results from high energy trauma and is an uncommon and usually fatal injury due to an injury to the cervicomedullary junction. Recently, improved prehospital management, early diagnosis and effective treatment led to increasing reports of survival. This study of patients with AOD initial imaging modalities recognizes the clinical features and diagnostic considerations for a quick diagnosis. METHODS: In this article, five survived adult patients with traumatic AOD are presented and retrospectively reviewed. Diagnosis was made by lateral cervical spine x-ray, cervical computed tomography (CT), or magnetic resonance imaging(MRI). Treatment consisted of early immobilization, respiratory support, and subsequent occipitocervical fusion. RESULTS: Four patients were male and the other one was female. Three were diagnosed early and the others were delayed in confirmations. One was type I AOD and four were type II AOD. All patients were applied occipitocervical fusion. Two cases were worse; neurological states and the other three that showed no change. Lateral X-ray film of all patients in the prevertebral soft tissue swelling at the C2 level was noted. The mean thickness of prevertebral soft tissue C2 level was 17.88 mm(15.18 to 20.17mm). Two were in the normal range of dens-basion index(DBI), three showed abnormalities, and Power's ratio was abnormal in 3 patients. CONCLUSION: As for damages caused by a strong external force in patients with severe prevertebral soft tissue swelling at C2 level abnormaly, the doctor determines whether more should be carefully AOD and considers 3D CT or MRI to confirm AOD in these patients.

Korean guideline development for the evaluation of permanent impairment of the spine: proposal by the Korean Academy of Medical Sciences Committee.

The criteria for the evaluation of spinal impairment are diverse, complex, and have no standardized form. This makes it difficult and somewhat troublesome to accurately evaluate spinal impairment patients. A standardized guideline was studied for the evaluation of spinal impairment, based on the American Medical Association (AMA) Guides and the McBride method. This guideline proposal was developed by specialty medical societies under the Korean Academy of Medical Sciences. In this study, the grades of impairment were assessed by dividing patients into three different categories: spinal cord impairment, spinal injury impairment and spinal disorder impairment. The affected regions of the spine are divided into three: the cervical region, the thoracic region, and the lumbosacral region. The grade of impairment was differentially evaluated according to the affected region. The restricted range of motion was excluded in the evaluation spinal impairment because of low objectivity. Even though the new Korean guideline for the evaluation of spinal impairment has been proposed, it should be continuously supplemented and revised.