• Journal of Korean Neurosurgical Society
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• 제38권2호
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• pp.111-115
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• 2005

Objective : Upper lumbar disc herniation is rare disease, compared with lower. The lamina of this high level lumbar vertebra is narrower than that of low level, and this have taken surgeon into important consideration for surgical methods because partial removal of lamina for discectomy weakens the base of the articular process and may result in fracture. The authors an accurate preoperative diagnosis that enables the surgeon to operative approach for preserving the facet joint. Methods : Thirteen patients with upper lumbar disc herniation have underone surgical procedure by midline approach for removal of ruptured disc fragment and paraspinal approach for removal of residual disc materials simultaneously without instrumentation. All patients who underwent surgery were analyzed and long-term follow-up was conducted. Results : At a mean follow-up of 24months, there were complete resolution of presenting radiating leg pain in 85% of the patients, 7.5% were left with minimal residual discomfort, and 7.5% derived little or no benefit from surgery. The follow-up radiologic findings of all patients shows that lamina and facet joint have preserved safely and no instability. Conclusion : Simultaneously, paraspinal with midline approach provides highly satisfactory operating methods by simplifying exposure and greatly limiting the risk of complications. This provides the basis for a planned surgical approach in which destruction of the facet joint can be avoided.

• Journal of Korean Neurosurgical Society
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• 제47권4호
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• pp.282-286
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• 2010

Objective : The aim of the present study was to assess the effect of lumbar disc herniation surgery for low back pain on the erectile functioning. Methods : Thirty-eight patients, with age ranging from 22 to 56 years, who had presented with pain due to herniated lumbar discs were included in the study. International Index of Erectile Function (IIEF) Short Form questionnaire was used to evaluate the erectile functioning. Patient visits on the 1st week,1st month and 3rd month postoperatively were analyzed. Pain scores were also noted together with side effects and the complications of the surgery. Results : Of the 38 patients, 18 patients had reported erectile dysfunction; 10 patients mild and 8 patients moderate erectile dysfunction. Twenty patients did not report erectile problems. The herniation levels mostly were L5-S1 in 12 (31.6%). Overall, erectile dysfunction rates have improved in 31.7% of those previously with erectile dysfunction in a 3 month period after the surgery. Best results were obtained in those patients with mild erectile dysfunction preoperatively. Conclusion : Mild erectile dysfunction together with radiculopathy tends to improve after lumbosacral disc surgery. Moderate and severe erectile dysfunction may be related to a more severe nerve injury or to vascular and/or psychiatric factors. An evaluation of erectile functioning should routinely be performed in patients with lumbosacral disc disease both for data accumulation and for medico legal causes since the documentation of the correlation between erectile dysfunction and lumbosacral disc disease is still lacking.

• 동의생리병리학회지
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• 제27권1호
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• pp.124-129
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• 2013

Embedding Therapy keep the stimulation to acupoint. Recently, Embedding Therapy is used for various disease and also studied in many different fields especially in China. In Korea, Embedding Therapy is studied and used for dermatology, face-lift, obesity, facial palsy most frequently. Chinese studies shows us Embedding Therapy could help musculoskeletal system disorder, lumbar herniated intervertebral disc, sprain, spinal canal stenosis. In Korea study concerning lumbar herniated intervertebral disc treatment used Embedding Therapy is few. This study's purpose is to ensure effect of Embedding Therapy at lumbar herniated intervertebral disc treatment. Four lumbar disc herniation patients had been treated with Embedding Therapy were described in this article. The patients(n=4) had been suffering from chronic lower back and leg pain that continued for more than 6 months. All patients had been diagnosed as lumbar disc herniation by MRI or CT, and treated with Embedding Therapy at least 2 times(7 days interval). 2 patients had been treated with concurrent treatment of acupuncture therapy, and the other 2 patients with concurrent treatment of acupuncture and herbal therapy. We observed 4 patients for more than 2 weeks, and their symptoms and quality of daily life had been improved. This suggests that lumbar disc herniation can be successfully recovered with Concurrent Embedding Therapy under conventional Korean Medical Treatment without side effects.

• Journal of Korean Neurosurgical Society
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• 제62권6호
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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.

• 대한정형외과스포츠의학회지
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• 제11권1호
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• pp.66-68
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• 2012

청소년에서 요추 추간판 탈출증은 드물게 발생하고, 임상적 증상이 성인과 달리 다양하게 나타난다. 또한, 청소년 환자의 주관적인 증상 호소를 분석하는 것이 어려워서 진단 및 치료가 늦어지는 경우가 많고, 성인에서와 달리 보존적 치료에 잘 반응하지 않는다. 슬괵근 강직 및 요추부 측만 변형등 청소년 요추 추간판 탈출증에서 특징적인 증상들은 수술로 잘 치료 되었고, 청소년의 추간판 부분절제술 수술 후의 중장기 추적검사에서 재수술 빈도는 15%로 성인과 큰 차이가 없었다. 그러므로, 보존적 치료에 잘 반응하지 않는 청소년 요추 추간판 탈출증은 수술적 치료를 적극적으로 고려해야 한다고 알려져 있다. 저자들은 축구를 하던 도중에 수상한 슬관절 손상으로 오인되어 수상 후 2년이 지나도록 진단이 지연되면서 슬괵근 강직과 보행 장애가 있었던 16세 청소년 요추 추간판 탈출증을 수술을 통해 치료하여 좋은 결과를 경험하였기에 문헌 고찰과 함께 보고하고자 한다.

• 한방재활의학과학회지
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• 제23권4호
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• pp.159-167
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• 2013

Objectives In this study, we wanted to find out the characteristics - gender, SLR test, valsalva test, duration, ESR, CRP and night pain - of lumbar disc herniation being classified as blood stasis and phlegm-retained fluid. Methods We surveyed 42 patients suffering from lumbar disc herniation using the diagnosis blood stasis syndrome, water retention syndrome of the comprehensive diagnosis of QI blood water. Blood stasis and phlegm-retained fluid are identical with blood stasis syndrome, water retention syndrome. Then we analyzed the characteristics - gender, SLR test, valsalva test, duration, ESR, CRP and night pain - of the patients suffering from lumbar disc herniation who were diagnosed as blood stasis and phlegm-retained fluid. Results Patients were sorted into two groups: 18 blood stasis patients and 30 phlegm-retained fluid patients. Gender (Woman), acute phase and night pain are related to blood stasis. Acute phase, positive of SLR test is related to phlegm-retained fluid. There was no correlation between blood stasis and SLR test, valsalva test, duration, ESR, CRP. Also no correlation between phlegm-fluid and gender, valsalva test, duration, ESR, CRP and night pain. Conclusions By Considering the characteristics - gender, SLR test, valsalva test, duration, ESR, CRP and night pain - of lumbar disc herniation patients, it can help to analyze the pattern of its symptoms.

• 척추신경추나의학회지
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• 제6권2호
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• pp.33-44
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• 2011

양혈풍탕(養血風湯)을 처방하여 경추 추간판 탈출증으로 인한 극심한 통증 및 두통이 호전된 2례를 통하여 신경학적 결손이 없는 요추 방출성 골절에 대해 양혈풍탕(養血風湯)이 환자의 자각적인 증세 및 NRS, NDI 상으로 유효한 효과가 있었음을 확인하였다. 이에 저자는 두통이 동반된 경추 추간판 탈출증으로 입원하여 양혈풍탕(養血風湯)을 복용한 후 호전된 2케이스를 보고하는 바이다.

• The Korean Journal of Pain
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• 제28권1호
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• pp.11-21
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• 2015

Background: Epidural injections are performed utilizing 3 approaches in the lumbar spine: caudal, interlaminar, and transforaminal. The literature on the efficacy of epidural injections has been sporadic. There are few high-quality randomized trials performed under fluoroscopy in managing disc herniation that have a long-term follow-up and appropriate outcome parameters. There is also a lack of literature comparing the efficacy of these 3 approaches. Methods: This manuscript analyzes data from 3 randomized controlled trials that assessed a total of 360 patients with lumbar disc herniation. There were 120 patients per trial either receiving local anesthetic alone (60 patients) or local anesthetic with steroids (60 patients). Results: Analysis showed similar efficacy for caudal, interlaminar, and transforaminal approaches in managing chronic pain and disability from disc herniation. The analysis of caudal epidural injections showed the potential superiority of steroids compared with local anesthetic alone a 2-year follow-up, based on the average relief per procedure. In the interlaminar group, results were somewhat superior for pain relief in the steroid group at 6 months and functional status at 12 months. Interlaminar epidurals provided improvement in a significantly higher proportion of patients. The proportion of patients nonresponsive to initial injections was also lower in the group for local anesthetic with steroid in the interlaminar trial. Conclusions: The results of this assessment show significant improvement in patients suffering from chronic lumbar disc herniation with 3 lumbar epidural approaches with local anesthetic alone, or using steroids with long-term follow-up of up to 2 years, in a contemporary interventional pain management setting.

• 한방재활의학과학회지
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• 제21권2호
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• pp.253-263
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• 2011

Objectives : To analyze the therapeutic outcomes of back pain modalities in patients with disc herniation according to the change of magnetic imaging(MRI) at one year after conservative treatment. Methods : Clinical outcomes of 35 patients diagnosed with lumbar disc herniation by MRI examination, treated conservatively, were analyzed according to MRI follow-up change; improved, unchanged, worsened. Patients underwent MRI examination at baseline and after 24 week of treatment. After 1 year, we followed up 30 patients. The patients' clinical outcomes were assessed at baseline, 24 week, 1 year by visual analogue scale(VAS), oswestry disability index (ODI), and analyzed by each of it's correlation. Results : 1. VAS of sciatica and ODI of disability of daily activities showed significant decrease in patients after 1 year follow up(p<0.05). 2. VAS(low back pain and sciatica) and ODI of disability of daily activities showed significant decrease in "improved" group and VAS(sciatica) and ODI showed significant decrease in "unchanged" group. "worsened" group showed no statistic significance(p<0.05). 3. The 1 year follow-up of VAS(low back pain and sciatica) and ODI change showed relationship with MRI follow-up change(p<0.05). Conclusions : This study suggests that "improved" groups compared to "unchanged" and "worsened" group on MRI follow-up in patients with lumbar disc herniation were more effective at 1 year after conservative treatment. MRI follow-up change affect clinical changes in patients with lumbar disc herniation after 1 year.

• 한방재활의학과학회지
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• 제18권4호
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• pp.135-145
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• 2008

Objectives : To investigate therapeutic outcomes of back pain modalities in patients with disc herniation according to the duration by treated with herbal medicine, chuna, acupuncture, bee-venom acupuncture. Methods : We separated 36 patients with disc herniation into three group according to duration; acute patients within 4 week, subacute patients within 5-12 week, and chronic group within 13-24 week. 36 patients with lumbar disc herniation were treated with chuna therapy, acupuncture, bee-venom acupuncture one times a week and took herbal medicine after a meal two times daily. The patients' symptoms were assessed 1 week, 2 week, 4 week, 8 week by Visual analogue scale(VAS), Oswestry disability index(ODI), 36-Item short-form health survey(SF-36). Results : 1. ODI of disability of daily activities showed significantly decreased in acute stage group compared to subacute and chronic stage groups(P<0.05). 2. Physical functioning(PF), bodily pain(BP), social functioning(SF) score of SF-36 showed significantly increased in acute stage group compared to subacute and chronic stage groups(P<0.05). Conclusions : This study suggests that acute stage group compared to subacute and chronic stage groups in patients with lumbar disc herniation is the more effective to improve symptoms treated with herbal medicine, chuna therapy, acupuncture, bee-venom acupuncture.