• Journal of Pharmacopuncture
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• v.16 no.3
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• pp.46-51
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• 2013

Objectives: The aim of this study is to evaluate the effect of acupotomy in patients with degenerative lumbar spine stenosis. Methods: A total of 437 patients who had been diagnosed as having lumbar spine stenosis and who had been admitted to Daejeon Oriental hospital from June 1, 2008, to September 31, 2012, were included in this study. The patients underwent acupotomy once, twice or three times on the lumbar spine, according to their symptoms. Then, the patients were asked to complete the verbal numeric rating scale (VNRS) and the oswestry disability index (ODI) before and after acupotomy and underwent a global assessment. The resulting data were analyzed. Results: The gender ratio of the participants was 1:1.54, and the mean age was $65{\pm}10.0$ yr. The number of patients over the age of 65 yr was less than that of the patients under the age of 65 yr in the ratio of 1:1.3. The average disease period was $30.17{\pm}56.63$ months. The verbal numeric rating scale (VNRS) significantly decreased from 10 to an average of $7.10{\pm}2.50$ after one acupotomy, $6.30{\pm}2.60$ after two acupotomies, and $5.50{\pm}2.50$ after three acupotomies. The ODI was significantly decrease from $20.60{\pm}8.70$ to $17.80{\pm}8.60$ after once acupotomy, $17.10{\pm}8.50$ after two acupotomies, and $16.70{\pm}8.60$ after three acupotomies. High scores were also observed on the global assessment. Conclusion: These results provide evidence that acupotomy is effective to relieve pain and to improve quality of life in patients with degenerative lumbar spinal stenosis.

• Journal of Korean Neurosurgical Society
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• v.45 no.2
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• pp.81-84
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• 2009

Objective : Many biomechanical and clinical studies on adjacent segment degeneration (ASD) have addressed cranial segment. No study has been conducted on caudal segment degeneration after upper segment multiple lumbar fusions. This is a retrospective investigation of the L5-S1 segment after spinal fusion at and above L4-5, which was undertaken to analyze the rate of caudal ASD at L5-S1 after spinal fusion on and above L4-5 and to determine that factors that might have influenced it. Methods : The authors included 67 patients with L4-5, L3-5, or L2-5 posterior fusions. Among these patients, 28 underwent L4-5 fusion, 23 L3-5, and 16 L2-5 fusions. Pre- and postoperative radiographs were analyzed to assess degenerative changes at L5-S1. Also, clinical results after fusion surgery were analyzed. Results : Among the 67 patients, 3 had pseudoarthrosis, and 35 had no evidence of ASD, cranially and caudally. Thirteen patients (19.4%) showed caudal ASD, 23 (34.3%) cranial ASD, and 4 (6.0%) both cranial and caudal ASD. Correlation analysis for caudal ASD at L5-S1 showed that pre-existing L5-S1 degeneration was most strongly correlated. In addition, numbers of fusion segments and age were also found to be correlated. Clinical outcome was not correlated with caudal ASD at L5-S1. Conclusion : If caudal and cranial ASD are considered, the overall occurrence rate of ASD increases to 50%. The incidence rate of caudal ASD at L5-S1 was significantly lower than that of cranial ASD. Furthermore, the occurrence of caudal ASD was found to be significantly correlated with pre-existing disc degeneration.

• Journal of Korean Neurosurgical Society
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• v.40 no.2
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• pp.84-89
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• 2006

Objective : The purpose of this study is to compare the outcomes of two methods for stabilization and fusion : Postero-Lateral Fusion [PLF, pedicle screw fixation with bone graft] and Posterior Lumbar Interbody Fusion [PLIF, cage insertion] for spinal stenosis and recurred disc herniation except degenerative spondylolisthesis. Methods : Seventy one patients who underwent PLF [n=36] or PLIF [n=35] between 1997 and 2001 were evaluated prospectively. These two groups were compared for the change of interbody space, the range of segmental angle, the angle of lumbar motion, and clinical outcomes by Prolo scale. Results : The mean follow-up period was 32.6 months. The PLIF group showed statistically significant increase of the interbody space after surgery. However, the difference in the change of interbody space between two groups was insignificant [P value=0.05]. The range of segmental angle was better in the PLIF group, but the difference in the change of segmental angle was not statistically significant [P value=0.0l7]. Angle of lumbar motion was similar in the two groups. Changes of Prolo economic scale were not statistically significant [P value=0.193]. The PLIF group showed statistically significant improvement in Prolo functional scale [P value=0.003]. In Prolo economic and functional scale, there were statistically significant relationships between follow-up duration [P value<0.001]. change of interbody space [P value<0.001], and range of segmental angle [P value<0.001]. Conclusion : Results of this study indicate that PLIF is superior to PLF in interbody space augmentation and clinical outcomes by Prolo functional scale. Analysis of clinical outcomes showed significant relationships among various factors [fusion type, follow-up duration, change of interbody space, and range of segmental angle]. Therefore, the authors recommend instrumented PLIF to offer better clinical outcomes in patients who needed instrumented lumbar fusion for spinal stenosis and recurred disc herniation.

• Journal of Korean Neurosurgical Society
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• v.60 no.6
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• pp.684-690
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• 2017

Objective : As increasing the size of the geriatric population, the number of elderly patients, who need the surgery for painful degenerative spinal stenosis has been increasing. The geriatric population may be relatively high complications, because of age and age-associated medical conditions. However, there is a lack of studies addressing the perioperative complications and outcomes in elderly patients with posterior lumbar inter body fusion with screw augmentation (PLIF). Methods : We retrospectively reviewed the medical records and radiographic studies of geriatric patients who had spine surgery of PLIF due to spinal stenosis for 11 years. We divided into 2 groups (A; 70-75 years, B; over then 76 years) according to the age. Surgical level of each groups, hospital day and postoperative day, co-morbidities, complications, clinical outcomes were analyzed. Operative reports, hospital and outpatient clinic charts, and radiographic studies were reviewed. Results : Group A was composed of 80 patients, their mean age was 72.21 and female dominant (n=46), and their mean surgically fused level was 1.52 level. Group B was 36 patients, their mean age was 78.83 and female dominant (n=20), and their mean surgically fused level was 1.36 level. Comparing between two groups, complications, postoperative hospital stay were slightly increase in group B and co-morbidity was statistically high in group B, however clinical outcomes were similar between two groups. Conclusion : Increasing age might be an important risk factor for complications in patients undergoing PLIF, however, we would like to recommend that if the situation of spine of extreme geriatric patients need PLIF, it should be in the surgeon's consideration after careful selection and clinical judgement.

• Journal of Korean Neurosurgical Society
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• v.63 no.6
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• pp.747-756
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• 2020

Objective : To evaluate the effectiveness and long-term outcome predictors of percutaneous sacroplasty (PSP). Methods : This single-center study assessed 40 patients with sacral insufficiency fractures using the short-axis technique under C-arm flat-panel detector computed tomography (CT). Two radiologists reviewed the patients' magnetic resonance and CT images to obtain imaging findings before PSP and determine technical success, respectively. The short-term outcomes were visual analog scale score changes and opioid usage reductions. Long-term outcomes were determined using telephone interviews and the North American Spine Society (NASS) patient-satisfaction index at least one year after PSP. Results : Technical success was achieved without any significant complications in 39 patients (97.5%). Telephone interviews were possible with 12 patients and failed in 10 patients; death was confirmed in 18 patients. Fifteen patients (50%) re-visited the hospital and received conservative treatment, including spinal injections. Nine patients reported positive satisfaction (NASS patient-satisfaction index 1 or 2), while the negative satisfaction group (NASS patient-satisfaction index 3 or 4, n=3) showed a higher incidence of compression fractures at the thoracolumbar spine level (66.7% vs. 22.2%) and previous spinal injection history (66.7% vs. 33.3%). The poor response group also showed higher incidences of facet joint arthrosis (100% vs. 55.6%), central canal stenosis (100% vs. 22.2%), neural foraminal stenosis (33.3% vs. 22.2%), scoliosis (100% vs. 33.3%), and sagittal malalignment (100% vs. 44.4%). Conclusion : PSP was effective for sacral insufficiency fractures and showed good long-term outcomes. Combined compression fractures in the thoracolumbar spine and degenerative lumbar pathologies could be possible poor outcome predictors.

• The Korean Journal of Pain
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• v.34 no.4
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• pp.471-478
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• 2021

Background: The effect of lumbar spinal stenosis (LSS) and peripheral vascular disease (PVD), which occurs with similar degenerative conditions, when seen together, has not been studied. The aim of this study is to examine and compare the relationship between pain, balance, disability, fear of falling, and kinesiophobia in LSS patients with intermittent vascular claudication (IVC). Methods: Seventy-two patients diagnosed with LSS using magnetic resonance imaging participated in this study. Thirty-five patients with IVC symptoms and showing vascular lesions by lower extremity venous and arterial Doppler ultrasonography imaging were included in the IVC-LSS group. The pain, static balance, dynamic balance, disability, fear of falling, and kinesiophobia were evaluated using the numeric rating scale, single leg stance test, Time Up and Go (TUG), the Oswestry Disability Index (ODI), Fall Efficacy Scale-International (FES-I), and Tampa Scale for Kinesiophobia (TSK), respectively. Results: Age and female sex were found to be higher in the IVC-LSS group (P = 0.024; P = 0.012). The IVC-LSS group had a shorter single leg stance time and TUG test duration, pain intensity, ODI, FES-I, and TSK scores were higher than patients with LSS (P = 0.001). Pain, fear of falling, and kinesiophobia were moderately correlated with disability in the IVC-LSS group. No relationship was found between pain and dynamic balance. Also, the pain was not related to kinesiophobia. Conclusions: The findings indicated that IVC causes loss of balance and an increase in pain, disability, fear of falling, and kinesophobia in patients with LSS.

• The Journal of Korean Obstetrics and Gynecology
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• v.19 no.3
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• pp.203-213
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• 2006

Purpose : This study was carried out to evaluate correlation between Bone Mineral Density(BMD) and degenerative lumbar disease in postmenopausal low back pain patients. Methods : 69 postmenopausal patients with low back pain were examined. Magnetic resonance imaging was performed to evaluate degenerative lumbar disease and bone mineral density of lumbar spine was measured by Dual energy X-ray absorptiometry. Data were analyzed by Pearson's Linear Correlation Coefficient. Results : In postmenopausal patients with low back pain, BMD(T-score, Z-score) had negative correlation with the grade of intervertebral disc herniation and positive correlation with weight. Other lumbar diseases including Spinal stenosis, Spondylolisthesis and Facet joint arthrosis didn't have significant correlation with BMD. Conclusion : In postmenopausal patients with low back pain, BMD(T-score, Z-score) had inverse relationship with the grade of intervertebral disc herniation.

• Clinics in Orthopedic Surgery
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• v.10 no.4
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• pp.433-438
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• 2018

Background: Cervical foraminal stenosis (CFS) is one of the degenerative changes of the cervical spine; however, correlations between the severity of stenosis and that of symptoms are not consistent in the literature. Studies to date on the prevalence of stenosis are based on images obtained from the departments treating cervical lesions, and thus patient selection bias may have occurred. The purpose of this study was to investigate the prevalence of CFS according to the site, extent, and morphology of stenosis using cervical computed tomography (CT) images obtained from patients who were visiting not because of symptoms related to the cervical spine, cervical pain, or upper limb pain. Methods: Among patients who underwent CT from January 2016 to March 2016 for reasons other than cervical spine symptoms, a total of 438 subjects were enrolled, and 2,628 cervical disc images (C4-5, C5-6, and C6-7; left and right sides) were examined. Three orthopedic surgeons performed two measurements each at 4-week intervals. Values were used for analysis if matched by more than two surgeons; if no match was found, the median values were used for analysis. The left and right sides on the same axial image were independently classified. Results: Left C5-6 stenosis was most common (24.66%) among patients. At the left C6-7, there were 20 focal types and 33 diffuse types. At bilateral C4-5 and right C6-7, the focal type was more common, whereas at bilateral C5-6 and left C6-7, the diffuse type was more common. Age and the severity of stenosis showed statistically significant correlation at all cervical levels. Conclusions: The prevalence of CFS was highest at the C5-6 level (19.06%). Compared to other levels, focal stenosis was more frequent at C4-5 and diffuse stenosis was more common at C5-6. At C6-7, the incidence of focal stenosis was higher on the right side and that of diffuse stenosis was higher on the left side.

• The Korean Journal of Pain
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• v.18 no.2
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• pp.246-250
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• 2005

Facet joint synovial cysts are uncommon intraspinal abnormalities, which appear to be secondary to degenerative changes of the joints. They can cause chronic back pain and radiculopathy, as shown in spinal stenosis. When symptomatic cysts fail to respond to conservative measurements, surgical decompression is known as the standard treatment. Percutaneous steroid injections, and distension of the cysts under fluoroscopic guidance, may be a minimally invasive treatment option. Here, the case of a patient with a symptomatic L5-S1 facet joint synovial cyst and left S1 radiculopathy, who responded satisfactorily to percutaneous treatment, is presented.

• The Korean Journal of Pain
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• v.23 no.2
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• pp.147-150
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• 2010

Background: Chronic low back pain can be a manifestation of lumbar degenerative disease, herniation of intervertebral discs, arthritis, or lumbar stenosis. When nerve roots are compromised, low back pain, with or without lower extremity involvement, may occur. Local inflammatory processes play an important role in patients with acute lumbosciatic pain. The purpose of this study was to assess the value of erythrocyte sedimentation rate (ESR) and high sensitivity C-reactive protein (hsCRP) measurements in patients with chronic low back pain or radiculopathy. Methods: ESR and hsCRP were measured in 273 blood samples from male and female subjects with low back pain and/or radiculopathy due to herniated lumbar disc, spinal stenosis, facet syndrome, and other diseases. The hsCRP and ESR were measured prior to lumbar epidural steroid injection. Results: The mean ESR was 18.8 mm/h and mean hsCRP was 1.1 mg/L. ESR had a correlation with age. Conclusions: A significant systemic inflammatory reaction did not appear to arise in patients with chronic low back pain.