• Journal of Korean Medicine Rehabilitation
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• v.26 no.3
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• pp.97-108
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• 2016

Objectives This study is planned to classify effectiveness of Korean medicine treatment on lumbar intervertebral Disc herniation patients' fear-avoidance belief. Methods We measured 84 patients with lumbar intervertebral disc herniation in Jaseng Korean Medicine Hospital. We used numeric rating scale, oswestry disability index, fear-avoidance belief questionaire for evaluating effectiveness of oriental medicine treatment on lumbar intervertebral disc herniation. And We used Magentic Resonance Imaging(MRI) for classifying the patient who has lumbar intervertebral disc or not. Results 1. There was statistical effectiveness of korean medicine treatment on lumbar intervertebral disc herniation patients' fear-avoidance belief (p<0.01). ${\Delta}NRS$ and ${\Delta}ODI$ (r=0.587) was Most statistically correlative. ${\Delta}ODI$ and ${\Delta}FABQ$ had a little of statistically correlation (r=0.313). ${\Delta}NRS$ and ${\Delta}FABQ$ has no statistically correlation (r=0.145). Conclusions This study suggests that screening for the korean medicine treatment reduces fears and negative belief of patients with the lumbar disc herniation and prevents chronic physical symptoms that come from them so that it can be a great help to controlling patients' pain clinically.

• Journal of Korean Medicine Rehabilitation
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• v.21 no.4
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• pp.119-130
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• 2011

Objectives: The purpose of this study is to find cut the characteristics of intervertebral disc changes arid relative factors of the patients with spondylolisthesis. Methods: We investigated 95 cases of patients who visited one Korean traditional medicine hospital and were diagnosed as spondylolisthesis on lumbar spine X-ray and lumbar spine magnetic resonance imaging(MRI). We selected these cases retrospectively and randomly. We analysed the relativity between number of changed discs and type of change disc and age, level of spondylolisthesis and type of spondylolisthesis. Results: 1. The number of changed discs increased with older and degenerative spondylolisthesis type(p<0.05) and was not related to the level of spondylolisthesis. 2. Bulging disc is the dominant type of disc change(74.12%). The type of changed disc was shown to be similar in lytic and degenerative spondylolisthesis. It was not relative to the level of spondylolisthesis(p>0.05). 3. The direction of nerve compression was diffuse type in about halfly of the patients(47.06%) and the symptoms of patent and dermatome did not matched in 54 cases. Conclusions: The patients who visited a Korean medicine hospital and were diagnosed as spondyolithesis have different characteristics from the established studies. Their discs changed dominantly to diffuse bulging type and the symptoms of patient were not related with the direction and level of the changed discs were spondylolisthesis existed.

• The Journal of Churna Manual Medicine for Spine and Nerves
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• v.4 no.1
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• pp.31-41
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• 2009

Objectives: The aim of this study was to evaluate the evolution of lumbar disc herniation in patients treated with oriental medicine. Methods: 14patients(15 cases) with lumbar disc herniation proved at MRI(Magnetic resonance imaging) underwent a follow-up MRI study. Follow-up MRI was performed $4{\sim}14$months(mean 7 months) after initial MRI. Results & Conclusions: 1. 13 cases(87%) had reduction of disc herniation. 1 showed no change in amount of disc herniation. 1 had an increase in disc herniation. 2. Comparison initial MRI with follow-up MRI showed that 2 of the herniations decreased between 0% and 25%, 3 decreased between 25% and 50%, 5 decreased between 50% and 75%, 3 decreased between 75% and 100%. The size of the herniation decreased on average by 49% in 14patients(15 cases). 3. On axial images, the proportion of the cross-sectional area of the spinal canal occupied by the herniated disc was 54.41% on the average on the initial scan, 29.65% on the follow-up scan.

• The Korean Journal of Pain
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• v.24 no.1
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• pp.36-43
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• 2011

Background: Nucleoplasty is a minimally invasive spinal surgery using a $Coblation^{(R)}$ technique that creates small voids within the disc. The purpose of this study was to evaluate the efficacy of cervical nucleoplasty in patients with cervical disc disorder. Methods: Between March 2008 and December 2009, 22 patients with cervical disc disorders were treated with cervical nucleoplasty after failed conservative treatment. All procedures were performed under local anesthesia, and fluoroscopic guidance and voids were created in the disc with the $Perc^{TM}$ DC Spine $Wand^{TM}$. Clinical outcomes were evaluated by the Modified Macnab criteria and VAS score at preprocedure, postprocedure 1 month, and 6 months. Results: Six patients had one, eight patients had two and eight patients had three discs treated; a total of 46 procedures was performed. Mean VAS reduced from 9.3 at preprocedure to 3.7 at postprocedure 1 month and to 3.4 at postprocedure 6 months. There was no significant complication related to the procedure within the first month. Outcomes were good or excellent in 17/22 (77.3%) cases. Postprocedure magnetic resonance imaging was acquired in two patients after two months showing morphologic evidence of volume reduction of protruded disc material in one patient but not in the other. Conclusions: Percutaneous decompression with a nucleoplasty using a $Coblation^{(R)}$ technique in the treatment of cervical disc disorder is a safe, minimally-invasive and less uncomfortable procedure, with an excellent short-term clinical outcome.

• The Korean Journal of Health Service Management
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• v.6 no.4
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• pp.73-82
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• 2012

The purpose of this study was to examine the impact of the DISC behavioral patterns of health care workers on their job satisfaction, organization Commitment and job stress in a bid to suggest an ideal behavioral pattern of Nurses and Dental hygienist. The subjects were 184 health care workers who worked in general hospitals and clinics in Busan and Ulsan for a year or more. The collected data were analyzed using ANOVA and linear regression. As a result of analyzing the relationship of their DISC behavioral patterns to job stress, organizational satisfaction and organizational commitment, there were significant differences in job stress according to their DISC behavioral patterns(p=0.015). In regard to relationship between their DISC behavioral patterns and the subfactors of job stress, there were significant gaps in role conflicts(p=.007), conflicts with subordinates(p=0.001) and conflicts over underpayment(p=0.015) according to their DISC behavioral patterns. As a result of investigating the influential factors of job stress, factors produced significant results(p<.001). The findings of the study illustrated that out of the DISC behavioral patterns, type I was most prevailing among the health care workers, which indicated that the weight of this type was highest among the behavioral styles. There were no significant gaps in job satisfaction and organizational commitment according to their DISC behavioral patterns.

• Journal of Korean Neurosurgical Society
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• v.60 no.1
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• pp.40-46
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• 2017

Objective: To assess role of some inflammatory mediators in patients with primary and recurrent lumbar disc herniation. Expression of IL-6, transforming growth factor (TGF)-1, insulin-like growth factor (IGF)-1, and Bcl-2-associated X protein (BAX) have been shown to be more intense in the primary group than the recurrent goup, but this mediators may be important aspects prognostic. Methods: 19 patients underwent primary and revision operations between June 1, 2009 and June 1, 2014, and they were included in this study. The 19 patients' intervertebral disc specimens obtained from the primary procedures and reoperations were evaluated. Expression of IL-6, TGF-1, IGF-1, and BAX were examined immunohistochemically in the 38 biopsy tissues obtained from the primary and recurrent herniated intervertebral discs during the operation. Results: For IL-6 expression in the intervertebral disc specimens, there was no difference between the groups. The immunohistochemical study showed that the intervertebral disc specimens in the primary group were stained intensely by TGF-1 compared with the recurrent group. Expression of IGF-1 in the primary group was found moderate. In contrast, in the recurrent group of patients was mild expression of IGF-1. The primary group intervertebral disc specimens were stained moderately by BAX compared with the recurrent group. Conclusion: The results of our prognostic evaluation of patients in the recurrent group who were operated due to disc herniation suggest that mediators may be important parameters.

• Journal of Korean Neurosurgical Society
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• v.60 no.5
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• pp.485-497
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• 2017

Surgical treatment of the degenerative disc disease has evolved from traditional open spine surgery to minimally invasive spine surgery including endoscopic spine surgery. Constant improvement in the imaging modality especially with introduction of the magnetic resonance imaging, it is possible to identify culprit degenerated disc segment and again with the discography it is possible to diagnose the pain generator and pathological degenerated disc very precisely and its treatment with minimally invasive approach. With improvements in the optics, high resolution camera, light source, high speed burr, irrigation pump etc, minimally invasive spine surgeries can be performed with various endoscopic techniques for lumbar, cervical and thoracic regions. Advantages of endoscopic spine surgeries are less tissue dissection and muscle trauma, reduced blood loss, less damage to the epidural blood supply and consequent epidural fibrosis and scarring, reduced hospital stay, early functional recovery and improvement in the quality of life & better cosmesis. With precise indication, proper diagnosis and good training, the endoscopic spine surgery can give equally good result as open spine surgery. Initially, endoscopic technique was restricted to the lumbar region but now it also can be used for cervical and thoracic disc herniations. Previously endoscopy was used for disc herniations which were contained without migration but now days it is used for highly up and down migrated disc herniations as well. Use of endoscopic technique in lumbar region was restricted to disc herniations but gradually it is also used for spinal canal stenosis and endoscopic assisted fusion surgeries. Endoscopic spine surgery can play important role in the treatment of adolescent disc herniations especially for the persons who engage in the competitive sports and the athletes where less tissue trauma, cosmesis and early functional recovery is desirable. From simple chemonucleolysis to current day endoscopic procedures the history of minimally invasive spine surgery is interesting. Appropriate indications, clear imaging prior to surgery and preplanning are keys to successful outcome. In this article basic procedures of percutaneous endoscopic lumbar discectomy through transforaminal and interlaminar routes, percutaneous endoscopic cervical discectomy, percutaneous endoscopic posterior cervical foraminotomy and percutaneous endoscopic thoracic discectomy are discussed.

• Journal of Korean Neurosurgical Society
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• v.62 no.6
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• pp.691-699
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• 2019

Objective : Lumbar discectomy is an effective treatment for lumbar disc herniation (LDH); however, up to 2-18% of patients with LDH have experienced recurrent disc herniation. The purpose of this study was to evaluate the efficacy of a novel annular closure device (ACD) for preventing LDH recurrence and re-operation compared with that of conventional lumbar discectomy (CLD). Methods : In this prospective randomized controlled trial, we compared CLD with discectomy utilizing the $Barricaid^{(R)}$ (Intrinsic Therapeutics, Inc., Woburn, MA, USA) ACD. Primary radiologic outcomes included disc height, percentage of preoperative disc height maintained, and re-herniation rates. Additional clinical outcomes included visual analog scale (VAS) scores for back and leg pain, Oswestry Disability Index (ODI) scores, and 12-item short-form health survey (SF-12) quality of life scores. Outcomes were measured at preoperation and at 1 week, 1, 3, 6, 12, and 24 months postoperation. Results : Sixty patients (30 CLD, 30 ACD) were enrolled in this study. At 24-month follow-up, the disc height in the ACD group was significantly greater than that in the CLD group ($11.4{\pm}1.5$ vs. $10.2{\pm}1.2mm$, p=0.006). Re-herniation occurred in one patient in the ACD group versus six patients in the CLD group (${\chi}^2=4.04$, p=0.044). Back and leg VAS scores, ODI scores, and SF-12 scores improved significantly in both groups compared with preoperative scores in the first 7 days following surgery and remained at significantly improved levels at a 24-month follow-up. However, no statistical difference was found between the two groups. Conclusion : Lumbar discectomy with the $Barricaid^{(R)}$ (Intrinsic Therapeutics, Inc.) ACD is more effective at maintaining disc height and preventing re-herniation compared with conventional discectomy. Our results suggest that adoption of ACD in lumbar discectomy can help improve the treatment outcome.

• Geomechanics and Engineering
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• v.34 no.1
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• pp.103-113
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• 2023

This study focused on understanding the relationship between the design of a tunnel boring machine disc cutter ring and its rock-breaking efficiency, as well as the applicable conditions of different cutter ring types. The discrete element method was used to establish a numerical model of the rock-breaking process using disc cutters with different ring types to reveal the development of rock damage cracks and variation in cutter penetration load. The calculation results indicate that a sharp-edged (V-shaped) disc cutter penetrates a rock mass to a given depth with the lowest load, resulting in more intermediate cracks and few lateral cracks, which leads to difficulty in crack combination. Furthermore, the poor wear resistance of a conventional V-shaped cutter can lead to an exponential increase in the penetration load after cutter ring wear. In contrast, constant-cross-section (CCS) disc cutters have the highest quantity of crack extensions after penetrating rock, but also require the highest penetration loads. An arch-edged (U-shaped) disc cutter is more moderate than the aforementioned types with sufficient intermediate and lateral crack propagation after cutting into rock under a suitable penetration load. Additionally, we found that the cutter ring wedge angle and edge width heavily influence cutter rock-breaking efficiency and that a disc cutter with a 16 to 22 mm edge width and 20° to 30° wedge angle exhibits high performance. Compared to V-shaped and U-shaped cutters, the CCS cutter is more suitable for soft or medium-strength rocks, where the penetration load is relatively small. Additionally, two typical case studies were selected to verify that replacing a CCS cutter with a U-shaped or optimized V-shaped disc cutter can increase cutting efficiency when encountering hard rocks.

• Anatomy and Cell Biology
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• v.56 no.3
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• pp.382-393
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• 2023

Cell clusters are a histological hallmark feature of intervertebral disc degeneration. Clusters arise from cell proliferation, are associated with replicative senescence, and remain metabolically, but their precise role in various stages of disc degeneration remain obscure. The aim of this study was therefore to investigate small, medium, and large size cell-clusters. For this purpose, human disc samples were collected from 55 subjects, aged 37-72 years, 21 patients had disc herniation, 10 had degenerated non-herniated discs, and 9 had degenerative scoliosis with spinal curvature <45°. 15 non-degenerated control discs were from cadavers. Clusters and matrix changes were investigated with histology, immunohistochemistry, and Sodium dodecyl sulphate polyacrylamide gel electrophoresis (SDS-PAGE). Data obtained were analyzed with spearman rank correlation and ANOVA. Results revealed, small and medium-sized clusters were positive for cell proliferation markers Ki-67 and proliferating cell nuclear antigen (PCNA) in control and slightly degenerated human discs, while large cell clusters were typically more abundant in severely degenerated and herniated discs. Large clusters associated with matrix fissures, proteoglycan loss, matrix metalloproteinase-1 (MMP-1), and Caspase-3. Spatial association findings were reconfirmed with SDS-PAGE that showed presence to these target markers based on its molecular weight. Controls, slightly degenerated discs showed smaller clusters, less proteoglycan loss, MMP-1, and Caspase-3. In conclusion, cell clusters in the early stages of degeneration could be indicative of repair, however sustained loading increases large cell clusters especially around microscopic fissures that accelerates inflammatory catabolism and alters cellular metabolism, thus attempted repair process initiated by cell clusters fails and is aborted at least in part via apoptosis.