• The Korean Journal of Pain
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• 제2권1호
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• pp.85-88
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• 1989

We experienced 3 cases of continuous caudal block. The first case had suffered from severe pain of the external genitalis after urethral injury from a car accident and this was controlled by continuous caudal block. The other 2 cases were a metastaric malignant tumor of the lumbar vertebra from cancer of the cervix and histiocytoma of the breast, and both had suffered from intractable pain of the lower extremity. But lumbar epidural block was impossible because of radiation fibrosis and previous operation scar of the spine. So a continuous caudal block was performed and the pain was controlled effectively. The longest duration was 50 days and there were no problems related catheter indwelling. Pain in the area of the lumbar and sacral nerve distribution can be controlled by continuous caudal block. Here in we reported 3 cases and reviewed the literature.

• Journal of Chest Surgery
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• 제32권8호
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• pp.732-738
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• 1999

배경: 비디오 기술의 발전과 내시경의 향상으로 비디오 흉강경수술은 기흉, 다한증 및 종격동 종양 같은 몇 몇 질환에서는 표준 수술로서 인정받고 있다. 이러한 비디오 흉강경수술은 전신마취하에 이중기도관에 의한 일측 폐환기가 필요하였다. 그러나 폐질환이 동반된 환자나 전신상태가 나쁜 고령의 환자와 같은 고위험군 의 경우는 일측 폐환기나 전신마취 자체에 대한 위험성이 높다. 대상 및 방법: 1997년 12월부터 1998년 7월 까지, 전신상태가 나빠서 전신마취가 위험한 8례의 환자를 대상으로(농흉 6례, 난치성 흉수 1례, 간질성 폐섬 유증 1례) 경막외마취하에 자가호흡을 유지한 상태에서 비디오 흉강경을 이용하여 흉강내 질환의 진단 및 치료를 시행하였다. 결과: 7례에서 성공적으로 비디오 흉강경수술이 시행되었다. 수술 도중 호흡기능이 저하 되어 전신마취로 전환한 경우가 1례 있었으나 개흉술로 전환한 경우는 없었다. 만성 농흉 환자 2례의 경우 에서, 1례는 재발하여 다시 비디오 흉강경 배농술을 시행하였으며 1례는 수술 후 7일째 흉곽성형술을 시행 하였다. 수술시간은 평균 31.8$\pm$15.2분이었으며 수술 후 호흡합병증이 발생한 경우는 없었다. 결론: 경막외마 취하에 비디오 흉강경을 통한 진단 및 치료는 고위험군에서 안전하게 시행될 수 있는 기법이라고 사료된다.

• 대한영상의학회지
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• 제85권1호
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• pp.36-53
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• 2024

척추 수술의 빈도 증가와 더불어 radiography, CT, MRI 등의 의료 영상 촬영 건수도 증가하고 있으며, 이와 관련된 영상 판독의 중요성이 점점 더 커지고 있다. 본 논문에서는 척추 수술 후 발생 가능한 다양한 합병증을 이해하고, 이를 정확하고 효과적으로 진단하는 영상 검사의 중요 소견에 대해 다루고자 한다. 특히, 수술 후 초기 및 중장기 합병증을 구분하여, 각 시기별 특징적인 영상 소견을 자세히 설명한다. 척추 수술 후 초기 합병증으로는 부적절한 수술 기구 배치(instrument malposition), 장액종(seroma), 혈종(hematoma), 거짓수막류(pseudomeningocele), 수술 주변 감염(infection) 등이 있으며, 중장기 합병증으로는 수술 기구 주변의 골용해(osteolysis), 융합 실패(failure of fusion), 인접 분절 질환(adjacent segment disease), 경막외 섬유화 또는 흉터 조직(epidural fibrosis or scar) 형성 등이 포함된다. 이러한 척수 수술 후 발생하는 합병증 관련 영상 평가에 대한 정확한 이해는 척추 수술 후 합병증을 적시에 정확하게 진단하여 효과적인 환자 치료에 기여할 것이다.

• Journal of Korean Neurosurgical Society
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• 제56권2호
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• pp.162-165
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• 2014

Idiopathic hypertrophic spinal pachymeningitis (IHSP) is a chronic, progressive, inflammatory disorder characterized by marked fibrosis of the spinal dura mater with unknown etiology. According to the location of the lesion, it might induce neurologic deficits by compression of spinal cord and nerve root. A 58-year old female with a 3-year history of progressive weakness in both lower extremities was referred to our institute. Spinal computed tomography (CT) scan showed an osteolytic lesion involving base of the C6 spinous process with adjacent epidural mass. Magnetic resonance imaging (MRI) revealed an epidural mass involving dorsal aspect of cervical spinal canal from C5 to C7 level, with low signal intensity on T1 and T2 weighted images and non-enhancement on T1 weighted-enhanced images. We decided to undertake surgical exploration. At the operation field, there was yellow colored, thickened fibrous tissue over the dura mater. The lesion was removed totally, and decompression of spinal cord was achieved. Symptoms improved partially after the operation. Histopathologically, fibrotic pachymeninges with scanty inflammatory cells was revealed, which was compatible with diagnosis of idiopathic hypertrophic pachymeningitis. Six months after operation, motor power grade of both lower extremities was normal on physical examination. However, the patient still complained of mild weakness in the right lower extremity. Although the nature of IHSP is generally indolent, decompressive surgery should be considered for the patient with definite or progressive neurologic symptoms in order to prevent further deterioration. In addition, IHSP can present as an osteolytic lesion. Differential diagnosis with neoplastic disease, including giant cell tumor, is important.

• Journal of Korean Neurosurgical Society
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• 제60권5호
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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.

• The Korean Journal of Pain
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• 제13권1호
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• pp.97-100
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• 2000

Thoracic outlet syndrome (TOS) is a combination of signs and symptoms caused by the compression of the vital neurovascular structure at the thoracic outlet region. It may stem from a number of abnormalities, including degenerative or bony disorders, trauma to cervical spine, fibromuscular bands, vascular abnormalities and spasm of the anterior scalene muscle. CPT (current perception threshold) is defined as the minimum amount of current applied transcutaneously that an individual consciously perceives. It enables quantification of the hyperesthesia that precedes progressive nerve impairment, as well as hypoesthetic conditions. We experienced a case of thoracic outlet syndrome caused by fibrosis of anterior scalene muscle. The patient was a 30 years old woman with a 3 years history of numbness on the ulnar side, progressive weakness and coldness of both hand, tiredness in the left arm, nocturnal pain in the left forearm, and pain in the left elbow, shoulder and neck. Conservative treatment, stellate ganglion block, cervical epidural block, anterior scalene block and previous operation, including both carpal tunnel release, provided no remarkable relief to the patient. A left scalenectomy and first rib resection were performed by transaxillary approach and left cervical root neurolysis was done. After surgery, we measured CPT using neurometer and found conditions worsening in the opposite arm. We performed the same procedure on right side, and followed by CPT measurement. This case suggests that CPT is a useful measurement of recovery and progression of TOS.