Smartcare

SPINE Global Leader in Spine Treatment

Research on Spine in Korea Spinal diseases are common, with 80% of the world’s population having them at least

once in their lives. Past

Disease of elderly people

Present

Extended to young people due to their lack of exercise, obesity, sedentary lifestyle, etc.

Statistics of Annual Spine Surgical Operations (2010-2015) (unit: persons)

0.1% increased compared

166,517 with 2010

155,229 163,518

149,770 157,385

155,450

2010 2011 2012 2013 2014 2015

Source: 2016 statistics of the National Health Insurance Service

As of 2015, there are 2,562 neurosurgeons, 432 residents, and 86 training hospitals. In

addition, about 100 doctors acquire neurosurgeon’s licenses every year.

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Korean Spinal Neurosurgery Society

It has six subsocieties and two branches, and growth has continued in each area. Moreover,

each one is competitive enough to hold at least two academic conferences every year. As

world-class research and procedures are shared, in these conferences. Doctors around the

world are visiting Korea to learn about the excellency of spine treatments in Korea.

The Korean Journal of Spine, an academic journal published by the Korean Spinal

Neurosurgery Society, is currently registered in PubMed Central (PMC)*.

* PMC is an electronic library of the biomedical and life sciences operated by the U.S. National Library of

Medicine (NLM) under the National Institutes of Health (NIH).

▲ Picture of overseas doctors during training

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Ⅱ Why Korea? World-class level of the number of surgeries for spinal diseases

Including endoscopic spine surgeries, there were more than 140,000 cases yearly from 2009 to

2011 and more than 160,000 cases yearly in 2012 and 2013 in Korea. Achieving these

numbers means that the clinical level of spine surgery practiced in the country has already

reached world-class status.

Surgical cases of Korean spine surgeons

1,800

1,400

1,000

600

200

0

■ Grneral spinal surgery ■ Endoscopic spinal surgery

2007 2008 2009 2010 2011 2012 2013

Source: Research articles published by Korean spine surgeons: Scientific progress and the increase in spine surgery

World-class level of the number of research articles presented

on spinal diseases

Among the spine-related research articles of Korean spine surgeons arranged by type, original

study articles have the most number, followed by case reports. In addition, many world-class

research articles and achievements that are related to surgical skills or basic research have

been largely presented.

Number of research articles presented by Korean spine surgeons per year

300

250

200

150

100

50

0

■ 3. Other

■ 2. Case report

■ 1. Original study 2007 2008 2009 2010

2011 2012 2013 2014

Source: Research articles published by Korean spine surgeons: Scientific progress and the increase in the

number of spine surgeries

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Yearly publications based on evidence level by Oxford

200

150

100

50

0 2007 2008 2009 2010 2011 2012 2013 2014

Source: Research articles published by Korean spine surgeons: Scientific progress and the increase in

the number of spine surgeries

Korean research on spinal diseases presented in international

journals Number of cases presented by each country at the Global Spine Society in 2017

Top 5 countries

Italy 82 India 83

USA 140 Germany

66 Korea 84

Source: http://gsc2017.org

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Treatments of Prominent Spinal Diseases in Korea

1. Spine tumor

A tumor that grows in the spine is called a spine tumor. It can be largely classified as a

primary spine tumor or a metastatic spine tumor.

Spine tumor treatment and surgery

① Primary spine tumor (a new tumor that has newly-grown in the spine)

Clinical •In many cases, abnormal sensation or paralysis of the arms and

symptoms legs progress insidiously for a few months or years, which might be accompanied by pain

Diagnosis •X-ray and Magnetic Resonance Imaging (MRI)

•A primary spinal cord tumor, particularly a benign tumor, must be Treatment completely removed while maintaining neurologic functions.

•A nervous system monitor can be used to safely remove it.

② Metastasis spine tumor Clinical

symptoms

Diagnosis

Treatment

•Pain, which can be local or neuromuscular, is reported by 95% of patients with this tumor. Such pain is continuous, and staying in a supine position

does not relieve it, which means that it occurs even when the patients are at rest or asleep.

•This tumor damages the spine, thereby inducing spine deformity or instability.

•X-ray, Computed Tomography (CT), and MRI •If an abnormal finding is observed through a diagnosis, a biopsy is performed.

•A multidisciplinary approach that combines chemotherapy, radiation therapy, and surgical treatment must be taken to remove this tumor. •If a gait disturbance occurs, the patient’s walking function can be recovered

within three days of a placebo occurrence. In addition, 90% of the patients whose strength in their lower extremities is greater than Grade IV can recover their walking function as well.

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Spinal tumor surgery recurrence rate, average admission period,

and average treatment cost

Surgery Japan 32%, Korea 14% recurrence (Source: Comparison of meningioma recurrence rates in Japan and Korea (Kim et al.,

rate Eur Spine J [25: 4025-4032, 2016])

Admission period

70.8 days-78.7 days per year

Average treatment

cost

USD

Metastatic spine tumor in the U.S.:

USD 12,734-15,556

Admission cost: USD 5,570 ± USD

6,150-USD, 2,117 ± USD 3,201

(base on one year of admission cost in 2006)

Korea

Primary spine tumor (USD 15,223),

primary benign and borderline

tumors (USD 6,502), and metastatic

spine tumor (USD 16,038)

(base on total yearly treatment cost per person in 2011)

Source: The Health Insurance Review and Assessment Service

▲ Before and after the spine tumor removal

The Korean Spinal Tumor Research Society, of which members are mostly

neurosurgeons who specialize in spinal tumors, has been holding at least two

academic conferences per year since 2010. About 100 spinal neurosurgeons, as well

as radiation oncologists and oncologists, have been attending the conferences every

year.

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Treatments of Prominent Spinal Diseases in Korea

2. Degenerative spinal disease

(cervical and lumbar HIVD) Degenerative spinal diseases are those in which degenerative changes progress in the

relevant structures due to of the continuous use of spinal segments (e.g., disc disease, spinal

stenosis, spine instability, etc., including spondylolisthesis)

Treatment and surgery for degenerative spinal disease

Clinical symptoms

Treatment

•Severe pain, neurological damage because of nerve compression

•Nonsurgical treatments: pharmacotherapy, injection, and exercises •Surgical treatments: microscopic spine surgery and minimally invasive

spine surgery (endoscopic surgery)

Global positioning of Korea in terms of treatment and

surgery for degenerative spinal diseases

Korea is the leading country in the area of microinvasive spine surgery, which is an advanced

type of spine surgery and treatment, through its extensive research.

Total of 39 countries contributed to the MISS research.

Total of 2051 articles were identified

USA (855/2051, 41.7%)

Germany (245/2051, 11.9%)

Korea (160/2051, 7.8%)

China (147/2051, 7.2%)

Japan (108/2051, 5.2%)

USA hed the highest total citations (12472)

Germany (2825) Korea (1401)

China (621) Japan (916)

USA had the highest average citations

Germany (11.53) Japan (11.98) ▲ The 39 countries contributed to the

Korea (8.7) China (4.14) minimally invasive spine surgery (MISS) research

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Ⅲ

▲ Before and after endoscopic spine surgery

Success rate of surgeries for degenerative spinal diseases,

reoperation rate within five years, and average admission period Lumbar herniated intervertebral disc disease: 94%

Success rate of sur- geries

Spinal stenosis: 96%

Lumbar interbody fusion: 95%

Re-operation rate Lumbar herniated intervertebral disc disease: 13.4%

within five years Spinal stenosis: 14.2%

Admission period Lumbar herniated intervertebral disc disease: 10.85 days

Source: Smart Care-Spine, 2017, KHIDI

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Treatments of Prominent Spinal Diseases in Korea

3. Myelopathy

Myelopathy is a spinal cord disease caused by changes in the spine, intervertebral disc,

and spinal segments because of aging.

Treatment and surgery of myelopathy

① Cervical spondylotic myelopathy

Clinical symptoms Diagnosis

Treatment

•Gait disturbance, impaired hand movements, impairment in delicate hand movements, abnormal sensation, and numbness in the hands

(Various manifestations can be seen based on the location and degree of spinal cord compression and number of compressed segments)

•Simple radiographic imaging •Magnetic Resonance Imaging (MRI)

•Computed Tomography (CT) scan •Neuropsychological test

•Natural course: Patients with minor symptoms

•Conservative treatment: Pharmacotherapy, injection through the vertebral foramen, wearing a cervical collar, equipping one’s car with an

airbag for driving, being cautious when walking downhill or exercising, traction, etc.

•Surgical treatment: There are anterior and posterior approaches, and the presurgical cervical curvature is an important consideration when

choosing which one to apply.

② Cervical spondylotic myelopathy

Clinical symptoms

Diagnosis

Treatment

•Many patients with the ossification of the posterior longitudinal ligament of the cervical spine initially have no symptoms at all or only

complain about minor neck pain or abnormal sensation in the hands. However, as the size of the ossification of the posterior longitudinal ligament gradually becomes larger, the spinal cord and nerve are compressed, inducing symptoms.

•Simple radiographic imaging •CT scan

•Decompression surgery (The surgical method is determined based on the patient’s age, the surgeon’s capability, the ossification degree, the shape

and type, and the lordosis or kyphosis status of the cervical spine.) ※ A surgery as a preventive measure is not recommended.

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Ⅲ

▲ Comparison of pictures before and after a multisegmental decompression surgery

(from top to bottom: before surgery and after surgery)

Success rate of surgeries for myelopathy and

the average admission period Average

admission

period

ACDF: 7-10 days Posterior: 6-7 days

Combined: About 5 days Laminoplasty: About 3 days

※ When both anterior and posterior fusions were done at the same time, the

average length of stay was prolonged.

Success rate Mortality caused by postsurgical complications: 0.3%-1%

of surgeries Morbidity: 7%-9%

Source: Smart Care-Spine, 2017, KHIDI

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Treatments of Prominent Spinal Diseases in Korea

4. Deformity Such as Scoliosis, a medical condition in which the spine bends to one side.

Surgery and treatment for scoliosis

Clinical symptoms

Diagnosis

Treatment

•Constipation caused by the compression of the internal organs because of the curvature •Back pain, shoulder pain, neck pain, and hip pain •Radiating pain in the lower extremities because of the compression of nerves that run along the lower extremities •Movement limitations •Painful menstruation secondary to pelvic tilt

•X-ray •Periodic observation •Wearing of braces

•Surgery (anterior and posterior approaches)

※ The treatment of scoliosis can vary by the degree of curvature, the possibility of spine growth, and the risk of curvature progression.

▲ Before and after corrective surgery for idiopathic scoliosis

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Success rate of scoliosis surgery, average admission period,

readmission rate within five years, and average treatment cost

Success rate of

scoliosis surgery

Average

admission period

Readmission rate

within five years

80%-90% for idiopathic scoliosis

About five days

Less than 3%

The cost of surgery for idiopathic scoliosis is about KRW 10

Average treatment cost million, including the hospital stay (when the national medical

insurance of Korea is applied. The cost for foreign patients to whom

the insurance is not applied is about KRW 30 million).

Source: Smart Care-Spine, 2017, KHIDI

Korea’s global positinging in scoliosis

The surgical method of thoracic scoliosis correction using transpedicular screws, which is

widely used in Korea, was globally recognized in 1995. In Korea, scoliosis centers are operated

in most tertiary medical institutions and spine specialized hospitals, where there are residing

surgeons who specialize in scoliosis disease. In scoliosis centers, not only surgical treatment

but also rehabilitation and pharmacotherapy are provided so that a holistic treatment is pos-

sible.

In particular, research on spine deformity has been ac-

tively performed, which has resulted in the publication of

more than 150 research articles since 2000. From 2000

to 2014, 1,982 surgery-related research articles were

published by Korean spine surgeons. The annual number

of research articles increased from 20 in 2000 to 293 in

2014. Most research articles (65.9%) were written by neu-

rosurgeons who specialized in spine surgery.

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Ⅳ Convenient Medical Service in Korea One-Stop Medical Service

Medical information and consulting reservation using the Medical

Korea Reservation Platform

•Visit Medical Korea home page: www.visitmedicalkorea.or.kr

•Medical Korea Reservation Platform: health.medicalkorea.or.kr

Pre-arrival

On Arrival

During Stay

Post-departure

Medical Visa

•Possible to request for a concierge service in advance

Upon arrival: If requested in advance, a transportation service with an ambulance and medical staff can be provided.

※ Possible to Go through immigration quickly at Incheon Airport

A customized service for patients and his/her dependents is provided.

•Medical service: Varies depending on each medical institution

•Non-medical service: Visa extension, 24/7 medical inquiry hotline, help desk, etc.

Post-departure: Management even after departure by connecting with the patients’ local hospitals

Medical tour visas are available for foreign patients, who wants to receive treatment,

as well as their spouses, accompanying family members, etc. who are their caregivers,

and it can be requested from institutions that are registered to attract international

patients.

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Medical Korea Information Center

- The Medical Korea Information Center provides information on Korean medical institu-

tions, legal assistance and other information on medical services in multiple languag-

es (English, Japanese, Chinese, Russian, and Arabic).

*Operated by the Korea Health Industry Development Institute with the support of the Ministry of

Health and Welfare of Korea

Medical consul- Assistance for Legal assistance for Illegal Broker

tation interpreter Cosmetic Surgery medical disputes Report Center matching services Tax Refund and complaints

and medical

visa issuance information service.

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