Korea Health Industry Development Institute187, Osongsaengmyeong 2-ro, Osong-eup, Heungdeok-gu, Cheongju-si, Chungcheongbuk-do, Republic of Korea Tel : 043)713-8000~5 www.khidi.or.kr

SPINESmartcare

Global Leader in Spine Treatment

Spinal diseases are common, with 80% of the world’s population having them at least

once in their lives.

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

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

Ⅰ Research on Spine in Korea

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

Source: 2016 statistics of the National Health Insurance Service

2010

155,229

2011

149,770

2012

166,517

2013

163,518

2014

157,385

2015

155,450

0.1% increased compared with 2010

Past Disease of elderly people

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

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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 Neurosur-

gery 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.

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.

Surgical cases of Korean spine surgeons

0

200

600

1,000

1,400

1,800

2007 2008 2009 2010 2011 2012 2013

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

■ Grneral spinal surgery

■ Endoscopic spinal surgery

Number of research articles presented by Korean spine surgeons per year

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

50

100

150

200

250

300

02007 2008 2009 2010 2011 2012 2013 2014

■ 3. Other■ 2. Case report■ 1. Original study

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

Top 5 countries

USA 140 Germany 66 Italy 82

India 83 Korea 84

0

50

100

150

200

2007

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

Yearly publications based on evidence level by Oxford

2008 2009 2010 2011 2012 2013 2014

Korean research on spinal diseases presented in international journals

Source: http://gsc2017.org

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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)

• In many cases, abnormal sensation or paralysis of the arms and legs progress insidiously for a few months or years, which might be accompanied by pain

Clinical symptoms

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

• A primary spinal cord tumor, particularly a benign tumor, must be completely removed while maintaining neurologic functions. •A nervous system monitor can be used to safely remove it.

Treatment

② Metastasis spine tumor

• 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.

Clinicalsymptoms

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

performed.Diagnosis

• 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.

Treatment

ⅢTreatments of Prominent Spinal Diseases in Korea

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Spinal tumor surgery recurrence rate, average admission period, and average treatment cost

Surgery recurrence

rate

Japan 32%, Korea 14%(Source: Comparison of meningioma recurrence rates in Japan and Korea (Kim et al., Eur Spine J [25: 4025–4032, 2016])

Admission period 70.8 days–78.7 days per year

Average treatment

cost

USDMetastatic 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)

KoreaPrimary 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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•Severe pain, neurological damage because of nerve compression Clinicalsymptoms

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

spine surgery (endoscopic surgery)Treatment

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 identifiedUSA (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 citationsGermany (11.53) Japan (11.98)

Korea (8.7) China (4.14)

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

▲ The 39 countries contributed to the minimally invasive spine surgery (MISS) research

ⅢTreatments of Prominent Spinal Diseases in Korea

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Success rate of surgeries for degenerative spinal diseases, reoperation rate within five years, and average admission period

Success rate of sur-geries

Lumbar herniated intervertebral disc disease: 94%Spinal stenosis: 96%Lumbar interbody fusion: 95%

Re-operation rate within five years

Lumbar herniated intervertebral disc disease: 13.4% 

Spinal stenosis: 14.2%

Admission period Lumbar herniated intervertebral disc disease: 10.85 days

Source: Smart Care-Spine, 2017, KHIDI

▲ Before and after endoscopic spine surgery

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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• 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)

Clinicalsymptoms

•Simple radiographic imaging•Computed Tomography (CT) scan

•Magnetic Resonance Imaging (MRI)•Neuropsychological testDiagnosis

•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.

Treatment

② Cervical spondylotic myelopathy

• 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.

Clinicalsymptoms

•Simple radiographic imaging •CT scanDiagnosis

• 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.

Treatment

ⅢTreatments of Prominent Spinal Diseases in Korea

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Success rate of surgeries for myelopathy and the average admission period

Average

admission

period

ACDF: 7–10 days Posterior: 6–7 daysCombined: 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

of surgeriesMortality caused by postsurgical complications: 0.3%–1%Morbidity: 7%–9%

Source: Smart Care-Spine, 2017, KHIDI

▲ Comparison of pictures before and after a multisegmental decompression surgery (from top to bottom: before surgery and after surgery)

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ⅢTreatments 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

• 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

Clinicalsymptoms

•X-rayDiagnosis

•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.

Treatment

▲ 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 80%–90% for idiopathic scoliosis

Averageadmission period About five days

Readmission rate within five years Less than 3%

Average treatment cost

The cost of surgery for idiopathic scoliosis is about KRW 10 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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One-Stop Medical Service

ⅣMedical 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•Possible to request for a concierge service in advance

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.During Stay

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

Post-departure

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

On Arrival

Pre-arrival

Medical VisaMedical 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.

Convenient Medical Service in Korea

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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

For foreigners free consultations in English, Chinese, Japanese, Russian, Arabic

1577-7129

Medical Korea Information Center

Medical consul-tation interpreter matching services

and medical visa issuance

information service.

Assistance for Cosmetic Surgery

Tax Refund

Legal assistance for medical disputes and complaints

Illegal Broker Report Center

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