• Journal of Korean Neurosurgical Society
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• v.43 no.6
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• pp.259-264
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• 2008

Objective : Total laminectomy (TL) is an effective surgical technique for the treatment of cervical ossification of the posterior longitudinal ligament (OPLL) along multiple levels. However, kyphosis and probable neurological deterioration have been frequently reported after laminectomy. We analyzed the changes in the cervical curvature after TL and subsequent changes in neurological status. Methods : We retrospectively reviewed the records of 14 patients who underwent TL for the treatment of cervical OPLL between Jan. 1998 and Dec. 2003. TL was selected according to the previously determined criteria. The curvature of the cervical spine was visualized on a lateral cervical spine X-ray and measured using Ishihara's Curvature Index (CI) before the operation and at the last follow-up examination. Perioperative neurological status was estimated using the modified Japanese Orthopedic Association score and the Improvement Rate (IR) at the same time as the images were evaluated. Results : The mean age of the patients was 57 years, the male/female ratio was 10:4, and the mean follow-up period was 41 months. The mean number of OPLL was 4.9, and the mean number of operated levels was also 4.9. The CI decreased after TL (p=0002), which was indicative of a kyphotic change. However, this kyphotic change showed no correlation with the length of the follow-up period, number of operated levels and preoperative CI. Neurological examination at the last follow-up showed an improved neurological status in all patients (p=0.001). There was no neurological deterioration in any case during the follow-up period. Moreover, there was no correlation between IR and the degree of kyphotic change. Postoperative complications, such as C5 radiculopathy and epidural bleeding, resolved spontaneously without neurological sequelae. Conclusion : Kyphotic change was observed in all but one patient who underwent TL for the treatment of cervical OPLL. However, we did not find any contributing factors to kyphosis or evidence of postoperative neurological deterioration.

• The Korean Journal of Pain
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• v.3 no.1
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• pp.51-54
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• 1990

There are many methods for treatment of post-herpetic neuralgia (PHN) and of these, epidural steroid or intralesional steroid injection is one of the most effective treatments. But there are some problems in the use of steroids. One of which is steroid-induced hyperglycemia. In that case, the treatment of PHN is very difficult and not so effective. So we used the low level laser therapy (LLLT), He-Ne and IR, for the treatment of post-herpetic neuralgia without any changes of blood glucose level. It seemed that LLLT was a very effective method for PHN without any systemic changes.

• The Korean Journal of Pain
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• v.24 no.3
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• pp.146-153
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• 2011

Background: Morphine has been commonly used for postoperative pain control. We measured plasma concentrations of morphine and compared the efficacy and safety of continuous epidural analgesia (CEA) using morphinebupivacaine with intravenous patient controlled analgesia (IV-PCA) with morphine for 48 hrs after the end of the operation. Methods: Nineteen patients undergoing Mile's operation were assigned to receive a morphine loading dose of 5 mg followed by IV-PCA with 0.1% morphine (IV-PCA group, n = 9) or a morphine loading dose of 2 mg and 0.125% bupivacaine 10 ml, followed by CEA with 0.004% morphine and 0.075% bupivacaine at a rate of 5 ml/hr (CEA group, n = 10). The plasma concentrations of morphine were measured and visual analog scales (VAS) for pain were recorded at 1, 6, 12, 24, and 48 hr postoperatively and the effects on respiration and any other side effects were noted. Results: The mean maximal and minimal levels of plasma morphine were $40.2{\pm}21.2\;ng/ml$ and $23.4{\pm}9.7\;ng/ml$ for the IV-PCA group and $11.8{\pm}3.5\;ng/ml$ and $8.2{\pm}1.9\;ng/ml$ for the CEA group, respectively. Resting and dynamic pain scores were significantly lower in the CEA group than in the IV-PCA group. There were no significant differences for the effects on respiration and for any side effects between the two groups. Conclusions: We evaluated plasma concentrations of morphine with CEA using morphine-bupivacaine and IV-PCA using morphine for the postoperative pain control. The CEA group had better postoperative analgesia than that of the IV-PCA group and the incidence of side effects were not significantly different between the two groups.

• The Korean Journal of Pain
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• v.25 no.4
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• pp.254-257
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• 2012

Background: Elderly patients visiting pain clinic may be at greater risk of misunderstanding the explanation because of age-related cognitive decline. Video instruction may provide a consistent from of teaching in a visual and realistic manner. We evaluated the effect of educational video on the patient understanding and satisfaction in a group of geriatric patients visiting pain clinic. Methods: Ninety two patients aged more than 60 years old who were scheduled for transforaminal epidural block were recruited. After exposure to either video or paper instruction process, each patient was asked 5-item comprehension questions, overall satisfaction and preference question. During follow-up period, number of outpatient referral-line call for further explanation was counted. Results: We observed significantly better comprehension in the video education compared with paper instruction (P < 0.001). Patient satisfaction was also higher in the video group (P = 0.015), and patients visiting pain clinic were more preferred video instruction (P < 0.001). Proportion of referral-line call for further explanation were similar (P = 0.302). Conclusions: Video approach to instruction process before consent improves treatment comprehension in geriatric patient visiting pain clinic.

• Journal of Korean Neurosurgical Society
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• v.29 no.9
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• pp.1179-1183
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• 2000

Objective : The treatment of malignant posttraumatic brain swelling remains a frustrating endeavor for neurosurgeon. Mortality and morbidity rates remain high depite advances in medical treatment of increased intracranial pressure. If conventional therapy fails in patients suffering from intracranial hypertension, there is only small number of second-tier option left including decompressive craniectomy. The role of decompressive craniectomy in posttraumatic brain swelling remains controversial. We assessed the efficacy and indications of decompressive craniectomy. Methods : The authors performed decompressive bifrontotemporal craniectomy in 22 patients with malignant posttraumatic brain swelling. Epidural pressure monotoring was performed in all patients. The clnical data and surgical outcomes were reviewed retrospectively. Result : The favorable outcome(GOS score 4-5) was 59%(13 of 22 patients), whereas the mortality rate was 32% (7 of 22 patients). Two patients(9%) remained in severely disabled state. Increased rate of favorable outcome was seen in the patients who had 8 or more of GCS score at admission and exhibited B wave in ICP monitoring and who showed steady state or slow deterioration in clinical course. Conclusion : If conservative therapy fails, decompressive bifrontotemporal craniectomy should be considered in the management of malignant posttraumatic brain swelling before irreversible ischemic brain damage occur.

• Journal of Korean Neurosurgical Society
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• v.29 no.6
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• pp.772-777
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• 2000

Objectives : After lumbar microdiscectomy there are relatively higher incidence of readmission because of various postoperative discomfort. Analyzing these readmitted patients in our private hospital where the patients can be readmitted more easily, we expect to find out which factors are associated with improvement of the surgical outcome. Patients and Methoes : After discharge all significant patient's clinical data were registered to our computerized data bank system and periodic follow-up were performed. The authors analysed 651(97.7%) cases followed up over 2 years(average 3 years) out of 666 patients who underwent a initial lumbar microdiscectomy from May, 1994 to April, 1997. Among them, 63 patients(9.7%) were readmitted. Results : Among the patients readmitted, 29 patients(4.5%) were reoperated because of recurred disc herniation, 17 patients were myofascial pain syndrome, 4 patients were discitis, 3 patients were adhesion and one patient was epidural abscess. Treatment results of these readmitted patients showed that success rate of all readmitted patients was 68.3%, reoperation was 58.6% and myofascial pain syndrome was 82.4%. Conclusion : Treatment results of the patients readmitted because of a continuous lumbago or leg pain after microdiscectomy were acceptable through the careful analysis of the causes of the recurrent symptom. Therefore, the incidence of the chronic failed back syndrome can be reduced by efforting a more active management through readmission.

• Journal of Korean Neurosurgical Society
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• v.52 no.2
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• pp.133-137
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• 2012

Objective : Twist-drill craniostomy (TDC) with closed-system drainage and burr-hole drainage (BHD) with a closed system are effective treatment options for chronic subdural hematoma (CSDH). The aim of this study was to analyze clinical data and surgical results from symptomatic CSDH patients who underwent TDC with closed-system drainage at the pre-coronal point (PCP). Methods : We analyzed data for 134 symptomatic CSDH patients who underwent TDC at the PCP with closed-system drainage. We defined the PCP for TDC to be 1 cm anterior to the coronal suture at the level of superior temporal line. TDC at the PCP with closed-system drainage was selected in patients with CSDH that extended beyond the coronal suture, confirmed by preoperative CT scans. Medical records, radiological findings, and clinical performance were reviewed retrospectively. Results : Of the 134 CSDH patients, 114 (85.1%) showed improved clinical performance and imaging findings after surgery. Catheter failures were seen in two cases (1.4%); the catheters were inserted in the epidural space. Recurrent cases were seen in eight patients (5.6%), and they were improved with a second BHD with a closed-system operation. Conclusion : TDC at the PCP with closed-system drainage is safe and effective for patients with symptomatic CSDH whose hematomas extend beyond the coronal suture.

• Journal of Korean Neurosurgical Society
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• v.40 no.2
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• pp.79-83
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• 2006

Objective : The purpose of this study was to describe a surgical technique of axillary approach of percutaneous endoscopic interlaminar discectomy for L5-S1 disc herniation and its preliminary results. Methods : From July 2002 to September 2003, 101 patients with lumbar radiculopathy due to L5-S1 disc herniation, who were treated by percutaneous interlaminar endoscopic discectomy, were retrospectively reviewed. There were 57 males and 44 females with a mean age of 44.8 years [range, 18 to 62 years]. The surgery consisted of needle insertion into the epidural space via the interlaminar space, sequential dilatation, and endoscopic discectomy through the axillary area of the S1 root. Results : The mean follow-up period was 14.5 months and the average surgical time was 41 min. According to the modified Macnab criteria, 44 patients [43.6%] had excellent outcomes, 49 [48.5%] had good results and only 8 [78%] had fair or poor outcomes. Four patients had a revision microdiscectomy due to incomplete removal of disc fragment. There were no major complications related to this surgical approach. Conclusion : Axillary approach of percutaneous endoscopic interlaminar discectomy is safe and effective procedure for the treatment of L5-Sl disc herniation. It combines the advantages of MED and conventional percutaneous endoscopic discectomy.

• Journal of Korean Neurosurgical Society
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• v.37 no.4
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• pp.282-286
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• 2005

Objective: Symptomatic chronic subdural hematoma(CSDH) is a well-known neurosurgical entity and most of the lesion is managed by surgical treatment. The authors analyze the surgical indication and the treatment results of twist drill craniostomy with closed-system drainage(TDD) for the symptomatic CSDH. Methods: From March 2001 through December 2003, 31 patients who were treated with TDD for the symptomatic CSDH and followed more than 6months were included. The radiologic criteria of TDD in this study were 1) homogeneous density of hematoma on computed tomography(CT), 2) no septation of hematoma on magnetic resonance imaging(MRI), and 3) thicker hematoma more than twice thickness of skull. Surgical procedures were performed on the maximum thickness of hematoma on CT/MRI. Short and long Steinman pins were used to penetrate the skull and hematoma membrane. As the 5L catheter was inserted through the drill hole, it was kept for 1 - 7days for the drainage of CSDH. The patients of CSDH were followed with clinical symptoms and CT studies. Results: Most of all the 31 patients were improved. However, one patient was suffered from postoperative epidural hematoma and the other patients have received the secondary operation because of the recurrence of CSDH on 3 months after initial surgery. Conclusion: TDD is safe procedure for the symptomatic CSDH if the patients are selected appropriately.

• Journal of Korean Neurosurgical Society
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• v.41 no.5
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• pp.291-294
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• 2007

Objective : The purpose of this retrospective clinical study was to describe a treatment for osteoporotic burst fracture in the setting of severe fractures involving fragmentation of the posterior wall and neural compromise with symptoms of cord compression. Methods : Indication for microscopic decompression and open kyphoplasty were intractable pain at the level of a known osteoporotic burst fractures involving neural compression or posterior wall fragmentation. A total of 18 patients [mean age, 74.6 years] with osteoporotic thoracolumbar burst fractures [3 males, 15 females] were included in this study. In all cases, microscopic decompressive laminectomy was followed by open kyphoplasty. Clinical outcome using VAS score and modified MacNab's grade was assessed on last clinical follow up [mean 6.7 months]. Radiological analysis of sagittal alignment was assessed preoperatively, immediately postoperatively, and at final follow up. Results : One level augmentation and 1.8 level microscopic decompression were performed. Mean blood loss was less than 100 ml and there were no major complications. The mean pain score before operation and at final follow up was 7.2 and 1.9, respectively. Fourteen of 18 patients were graded as excellent and good according to the modified MacNab's criteria. Overall, 6.0 degrees of sagittal correction was obtained at final follow-up. Conclusion : The combined thoracolumbar microscopic decompression and open kyphoplasty for severe osteoporotic fractures involving fragmentation of posterior wall and neural compromise provide direct visualization of neural elements, allowing safe cement augmentation of burst fractures. Decompressive surgery is possible and risk of epidural cement leakage is controlled intraoperatively.