• Journal of Acupuncture Research
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• v.38 no.1
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• pp.32-40
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• 2021

Background: The aim of this study was to evaluate the efficacy of Korean medicine combination treatment on recurrent neck pain after medical procedures. Methods: This retrospective study included 158 inpatients of the Daejeon Jaseng Hospital of Korean Medicine who were diagnosed with "Cervical disc disorder with radiculopathy (M50.1)" between December 14th, 2017 and May 29th, 2019. The patients were assigned to 1 of 2 groups based on whether they received medical procedures on the cervical spine at least once. Korean medicine combination treatment was evaluated using EuroQol-5 dimensions index (EQ-5D), numeric rating scale (NRS), and neck disability index (NDI) scores. Results: Before and after treatment, the patients who received medical procedures on the cervical spine at least once before admission (Group A) showed a statistically significant difference in the NDI and NRS scores but not in the EQ-5D scores. This was similar to the patients who had not received medical procedures on the cervical spine before admission (Group B) they showed a statistically significant difference in the NDI and NRS scores but not in the EQ-5D scores. When comparing the results of Group A and Group B before and after treatment, no statistically significant differences were observed in the EQ-5D, NDI, and NRS scores. Conclusion: Korean medicine combination treatment improves the neck functional disability of patients who suffer from recurrent neck pain despite patients having undergone medical procedures.

• Journal of Yeungnam Medical Science
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• v.36 no.2
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• pp.109-114
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• 2019

Background: Transforaminal epidural block (TFEB) is an effective treatment option for radicular pain. To reduce complications from intravascular injection during TFEB, use of imaging modalities such as real-time fluoroscopy (RTF) or digital subtraction angiography (DSA) has been recommended. In this study, we investigated whether DSA improved the detection of intravascular injection during TFEB at the whole spine level compared to RTF. Methods: We prospectively examined 316 patients who underwent TFEB. After confirmation of final needle position using biplanar fluoroscopy, 2 mL of nonionic contrast medium was injected at a rate of 0.5 mL/s under RTF; 30 s later, 2 mL of nonionic contrast medium was injected at a rate of 0.5 mL/s under DSA. Results: Thirty-six intravascular injections were detected for an overall rate of 11.4% using RTF, with 45 detected for a rate of 14.2% using DSA. The detection rate using DSA was statistically different from that using RTF (p=0.004). DSA detected a significantly higher proportion of intravascular injections at the cervical level than at the thoracic (p=0.009) and lumbar (p=0.011) levels. Conclusion: During TFEB at the whole spine level, DSA was better than RTF for the detection of intravascular injection. Special attention is advised for cervical TFEB, because of a significantly higher intravascular injection rate at this level than at other levels.

• Journal of Korean Neurosurgical Society
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• v.42 no.4
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• pp.311-316
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• 2007

Objective : The objective of this study is to investigate the safety, surgical efficacy, and advantages of a polyaxial screw-rod system for posterior occipitocervicothoracic arthrodesis. Methods : Charts and radiographs of 32 patients who underwent posterior cervical fixation between October 2004 and February 2006 were retrospectively reviewed. Posterior cervical polyaxial screw-rod fixation was applied on the cervical spine and/or upper thoracic spine. The surgical indication was fracture or dislocation in 18, C1-2 ligamentous injury with trauma in 5, atlantoaxial instability by rheumatoid arthritis (RA) or diffuse idiopathic skeletal hyperostosis (DISH) in 4, cervical spondylosis with myelopathy in 4, and spinal metastatic tumor in 1. The patients were followed up and evaluated based on their clinical status and radiographs at 1, 3, 6 months and 1 year after surgery. Results : A total of 189 screws were implanted in 32 patients. Fixation was carried out over an average of 3.3 spinal segment (range, 2 to 7). The mean follow-up interval was 20.2 months. This system allowed for screw placement in the occiput, C1 lateral mass, C2 pars, C3-7 lateral masses, as well as the lower cervical and upper thoracic pedicles. Satisfactory bony fusion and reduction were achieved and confirmed in postoperative flexion-extension lateral radiographs and computed tomography (CT) scans in all cases. Revision surgery was required in two cases due to deep wound infection. One case needed a skin graft due to necrotic change. There was one case of kyphotic change due to adjacent segmental degeneration. There were no other complications, such as cord or vertebral artery injury, cerebrospinal fluid leak, screw malposition or back-out, or implant failure, and there were no cases of postoperative radiculopathy due to foraminal stenosis. Conclusion : Posterior cervical stabilization with a polyaxial screw-rod system is a safe and reliable technique that appears to offer several advantages over existing methods. Further biomechanical testings and clinical experiences are needed in order to determine the true benefits of this procedure.

• The Journal of Korean Medicine
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• v.16 no.1 s.29
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• pp.132-140
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• 1995

Object : This study is designed to evaluate the correlation between the data of DITI(Digital Infrared Thermographic Imaging)examination and the changes of clinical symptom after the therapy of acupuncture in the patients with herniated cervical intervertebral disc. Content : The conservative therapy with acupuncture was performed during $4{\sim}5$ weeks, The acupuncture points of SI3, B62, TE3, G34, LI4, S36, GV26, G21, SII5 were used. In the pre- and post therapy, DITI examinations were performed in patients who had HIVD and were treated by acupuncture simultaneously, and then tried to correlate the results of clinical symptoms with the difference of thermographic findings at pre-acupuncture and post-acupuncture. Setting : The standard routine thermoghaphic examinations were performed with thermography(DITI) in the 15 patients with lumbar disc herniations at pre- and post acupuncture. Patient : Thermographic imaging of 15 cases were analyzed. They has disc herniations in X-ray, CT scan and MRI and they were treated by acupuncture theraphy in our hospital from March, 1994 to January, 1995. Result : 1) The causes were trauma(60%), retention of phlegm and fluid(8.7%) and cold & moisture(33.3%) 2) Levels of herniated cervical disc are C2/3(1 case). C3/4(2 cases), C5/6 & C6/7 (2 cases), C6/7(4 cases), Normal(6 cases). 3) Classifications of thermographic pattern are radiculopathy(80%), spot(13.3%), and nonspecific(6.7%) in order. 4) In evaluation Results of clinical symptom are Excellent(80%), Good(6.7%), and Poor(6.7%). Data of DITI are Excellent(80%), Good(6.7%), Fair(6.7%), and Poor(6.7%). Conclusion ; Acupuncture showed good results over 86.7% in clinical evaluation and 86.7% in DITI. Thermographic examination was valuable in the evaluation of therapeutic effect of acupuncture treatment.

• Journal of Korean Neurosurgical Society
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• v.38 no.2
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• pp.102-106
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• 2005

Objective : The purposes of this study are to evaluate the efficacy of en bloc open-door laminoplasty and to investigate the validity of various factors as prognotic indicators in patients with multisegmental spondylotic myelopathy and ossification of posterior longitudinal ligament[OPLL]. Methods : The authors reviewed 43 cases in whom laminoplasty were performed for cervical myelopathy between January 2000 and December 2002. Clinical symptoms and results were evaluated using the Japanese Orthopaedic Association[JOA] scale. The recovery rate was calculated and then assessed for prognostic factors such as preoperative JOA scores, ages, history of previous trauma, duration of symptoms and signal change in cord on T2-weighted magnetic resonance Image. Results : In cervical stenosis, canal widening of antero-posterior diameter and dimension after laminoplasty is 4.16mm, $87.43mm^2$ and in OPLL is 6.20mm, $117.61mm^2$. In all cases there wasn't neurologic deterioration, mild postoperative complications developed in seven cases. Four patient had a limitation of range of neck motion and the other one showed kyphotic change and another two showed C5 radiculopathy. The recovery rate of JOA score in cervical stenosis and OPLL was 62% and 68% respectively. Duration of symptoms, the severity[preoperative JOA score], and signal change in cord on T2-weighted magnetic resonance image had close relationship to the clinical outcomes. Conclusion : Unilateral en bloc laminoplasty is simultaneous expansile and decompressive method. And preoperative JOA score, symptom duration and high signal intensity on T2-weighted magnetic resonance image can be used to predict prognosis.

• Clinical Pain
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• v.19 no.2
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• pp.116-119
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• 2020

Cervical transforaminal epidural steroid injection (TFESI) is commonly performed to provide relief of pain caused by radiculopathy. Intra-arterial injection of particulate steroid or direct needle injury can lead to spinal artery embolism or thrombosis. Also there is a possibility of vascular spasm. To our knowledge, this is the first reported case of spinal cord infarction that occurred after TFESI with non-particulate steroid in Korea. A 47-year-old female patient underwent C7 TFESI at local pain clinic. Injected materials were dexamethasone and mepivacaine. Right after the intervention, she felt muscle weakness and decreased sensation. On physical examination, she had decreased sensation from C4 to T2 dermatome in light touch and pin-prick test. Proprioception and vibration were intact. The motor grades of upper extremities were grade 1. Cervical and thoracic spine MRI was checked. Diffusion-weighted image and apparent diffusion coefficient image showed long extension of spinal cord infarction from C2 to T1 level.

• Biomolecules & Therapeutics
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• v.27 no.4
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• pp.342-348
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• 2019

Ossification of the posterior longitudinal ligament (OPLL) can be defined as an ectopic ossification in the tissues of spinal ligament showing a hyperostotic condition. OPLL is developed mostly in the cervical spine and clinical presentations of OPLL are majorly myelopathy and/or radiculopathy, with serious neurological pathology resulting in paralysis of extremities and disturbances of motility lowering the quality of life. OPLL is known to be an idiopathic and multifactorial disease, which genetic factors and non-genetic factors including diet, obesity, physical strain on the posterior longitudinal ligament, age, and diabetes mellitus, are involved into the pathogenesis. Up to now, surgical management by decompressing the spinal cord is regarded as standard treatment for OPLL, although there might be the risk of development of reprogression of ossification. The molecular pathogenesis and efficient therapeutic strategy, especially pharmacotherapy and/or preventive intervention, of OPLL has not been clearly elucidated and suggested. Therefore, in this review, we tried to give an overview to the present research results on OPLL, in order to shed light on the potential pharmacotherapy based on molecular pathophysiologic aspect of OPLL, especially on the genetic/genomic factors involved into the etiology of OPLL.

• Journal of the Korean Orthopaedic Association
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• v.55 no.1
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• pp.78-84
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• 2020

Purpose: This paper compares the clinical outcomes of patients who were treated with a cervical nerve block by ultrasound and C-arm and reports the complication. Materials and Methods: A total of 97 patients were treated with an ultrasound-guided nerve root block from May 1, 2015 to February 8, 2018. On the other hand, 94 patients were treated with a C-arm guided nerve root block. The consequences of the cervical pain and the radiating pain before and after the procedures were reviewed using the verbal numeric rating scale (VNRS). In addition, the complications related to the procedures from the daily notes from the chart were inspected. Results: Sixty-six cases out of 97 cases of ultrasound-guided nerve root block were enrolled in the study. The average age of the patients was 57 years, including 41 males and 25 females. Seventy seven out of 94 cases by a C-arm guided root block were included in the study. The average age of the patients was 55 years, including 40 males and 37 females. Before the nerve root block, the mean numeric rating pain scale (NRS) of the cervical pain in ultrasound-guided block decreased from 5.4 points to 2.7 points at three weeks and 1.4 points at six weeks (p=0.0023, p<0.001), and 3.1 points in the C-arm (p<0.001, p<0.001) at three weeks and 1.5 points at six weeks (p<0.001, p<0.001). In the case of radiating pain, the mean NRS in the ultrasound-guided nerve root block group improved from 6.3 points after the procedure to 2.8 points at three weeks and 1.5 points at six weeks (p<0.001, p<0.001). In the C-arm guided nerve root block group, the NRS improved from 7.4 points after the procedure to 3.3 points at three weeks and 1.9 points at six weeks. In the case of complications, Horner's syndrome and propriospinal myoclonus were observed in one case of C-arm guided block group. Conclusion: The clinical results of the patients who underwent ultrasound-guided cervical nerve root block were not significantly different from those who underwent a C-arm guided cervical nerve root block.

• Journal of Acupuncture Research
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• v.19 no.6
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• pp.264-279
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• 2002

Objective : Ossification of the posterior longitudinal ligament(OPLL) is considered kind of degenerative disease usually found in the cervical vertebrae. Most of cases of OPLL have radiculopathy, myelopathy or both of them such as neck pain, numbness, myatonia. These symptoms seems to be similar with those of HIVD(Herniated intervertebral disc), sprain, spondylosis of C-spine. Lost of patients who have those symptoms are visiting oriental medicine hospital, clinic so we thought that making differential diagnosis, treating and prognosing might be needed with acupuncture, Herb medication. Methods : We examined the 3 patients of OPLL who visited Dong-in-dang Oriental Medicine Hospital from 1st November 1999 to 1st February 2002. We treated patients of OPLL with Oriental Medicine care (Acupuncture, Herb medication, Negative treatment) based on oriental diagnosis of neck pain(項强痛), numbness(痺證), myatonia. Results : clinical grade of 3 cases was all Gr III. After treated with oriental medical care, 2 cases were evaluated poor, I cases were evaluated fair and resulted in Clinical grade II. Conclusions : Treating OPLL with oriental medical carte was very difficult to palliate symptoms, to stop progress of OPLL. We might need to reconsider oriental medical care as conservative treatment for OPLL.

• The Journal of Korean Physical Therapy
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• v.16 no.4
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• pp.168-178
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• 2004

The purposes of this paper were to investigate the effect of active treatment compared with a conservative treatment and to provide the information for physical therapy in patients suffering from chronic neck pain. Forty female subjects who were diagnosed with cervical radiculopathy participated in this study and were divided into the conservative and active treatment groups. The active treatment group consisted of 20 patients who were treated with therapeutic modalities and active neck exercise program during the admission (15 days) and one month after discharge. The conservative treatment group consisted of 20 patients who were not received with active neck exercise program. The assessment tools were made using visual analogue scale(VAS), neck disability index(NDI) and modified Zung depression scale(MZDS). All subjects were measured three times: before the admission, at discharge, and at one month after discharge. Data were compared by groups using independent t-test. VAS, NDI and MZDS scores measured at admission and discharge were not significantly different between the groups. On the assessment performed one month after discharge, VAS and NDI scores were significantly lower for the active treatment group compared with those of the conservative treatment group(p<0.05), but MZDS score was not significantly different between the groups. In the comparison of two treatment methods for chronic neck pain, active treatment was more effective than conservative treatment. The findings of the study indicate that active treatment in chronic neck pain has a positive effect in relieving pain and restoring neck function.