• Journal of Korean Neurosurgical Society
• /
• 제46권6호
• /
• pp.515-521
• /
• 2009

Objective : The purpose of this study was to compare clinical and radiological outcomes of percutaneous endoscopic lumbar discectomy (PELD) and open lumbar microdiscectomy (OLM) for recurrent disc herniation. Methods : Fifty-four patients, who underwent surgery, either PELD (25 patients) or repeated OLM (29 patients), due to recurrent disc herniation at L4-5 level, were divided into two groups according to the surgical methods. Excluded were patients with sequestrated disc, calcified disc, severe neurological deficit, or instability. Clinical outcomes were assessed using Visual Analogue Scale (VAS) score and Oswestry Disability Index (ODI). Radiological variables were assessed using plain radiography and/or magnetic resonance imaging. Results : Mean operating time and hospital stay were significantly shorter in PELD group (45.8 minutes and 0.9 day, respectively) than OLM group (73.8 minutes and 3.8 days, respectively) (p < 0.001). Complications occurred in 4% in PELD group and 10.3% in OLM group in the perioperative period. At a mean follow-up duration of 34.2 months, the mean improvements of back pain, leg pain, and functional improvement were 4.0, 5.5, and 40.9% for PELD group and 2.3, 5.1, and 45.0% for OLM group, respectively. Second recurrence occurred in 4% after PELD and 10.3% after OLM. Disc height did not change after PELD, but significantly decreased after OLM (p = 0.0001). Neither sagittal rotation angle nor volume of multifidus muscle changed significantly in both groups. Conclusion : Both PELD and repeated OLM showed favorable outcomes for recurrent disc herniation, but PELD had advantages in terms of shorter operating time, hospital stay, and disc height preservation.

• Journal of Chest Surgery
• /
• 제42권1호
• /
• pp.115-118
• /
• 2009

중부 식도암에서 개흉적 식도절제술을 시행 받은 65세 남자가 식도열공 직상부의 좌측 종격 흉막이 찢어진 곳을 통해 횡행결장의 흉강내 탈장이 발생하였다. 단순흉부촬영상 좌측 하폐야에 공기음영의 누적이 발견되었고 이는 점차 진행하여 좌측 폐를 완전히 허탈시키고 혈역학적 불안정을 야기하였다. 식도절제술 후 생명을 위협하는 흉강내로의 탈장은 응급 개복술을 통하여 교정되었다. 식도절제술 후 식도열공을 통한 흉강내 탈장은 장의 폐색이나 꼬임의 위험 때문에 생명을 위협할 가능성이 있어 증상이 있는 환자에서 응급으로 복부절개를 통한 탈장의 수술적 복원을 시행하여야 한다. 하지만 식도절제술시 이러한 합병증의 예방을 위한 신중이 최우선일 것이다.

• Journal of Korean Neurosurgical Society
• /
• 제58권5호
• /
• pp.454-461
• /
• 2015

Objective : In this study, we aimed to investigate the underlying ethiological factors in chiari malformation (CM) type-I (CMI) via performing volumetric and morphometric length-angle measurements. Methods : A total of 66 individuals [33 patients (20-65 years) with CMI and 33 control subjects] were included in this study. In sagittal MR images, tonsillar herniation length and concurrent anomalies were evaluated. Supratentorial, infratentorial, and total intracranial volumes were measured using Cavalieri method. Various cranial distances and angles were used to evaluate the platybasia and posterior cranial fossa (PCF) development. Results : Tonsillar herniation length was measured $9.09{\pm}3.39mm$ below foramen magnum in CM group. Tonsillar herniation/concurrent syringomyelia, concavity/defect of clivus, herniation of bulbus and fourth ventricle, basilar invagination and craniovertebral junction abnormality rates were 30.3, 27, 18, 2, 3, and 3 percent, respectively. Absence of cisterna magna was encountered in 87.9% of the patients. Total, IT and ST volumes and distance between Chamberlain line and tip of dens axis, Klaus index, clivus length, distance between internal occipital protuberance and opisthion were significantly decreased in patient group. Also in patient group, it was found that Welcher basal angle/Boogard angle increased and tentorial slope angle decreased. Conclusion : Mean cranial volume and length-angle measurement values significantly decreased and there was a congenital abnormality association in nearly 81.5 percent of the CM cases. As a result, it was concluded that CM ethiology can be attributed to multifactorial causes. Moreover, congenital defects can also give rise to this condition.

• Journal of Korean Neurosurgical Society
• /
• 제58권6호
• /
• pp.539-546
• /
• 2015

Objective : To report the learning curve of percutaneous endoscopic lumbar discectomy (PELD) for a surgeon who had not been previously exposed to this procedure based on the period and detailed technique with a retrospective matched comparative design. Methods : Of 213 patients with lumbar disc herniation encountered during the reference period, 35 patients who were followed up for 1 year after PELD were enrolled in this study. The patients were categorized by the period and technique of operation : group A, the first 15 cases, who underwent by the 'in-and-out' technique; group B, the next 20 cases, who underwent by the 'in-and-out-and-in' technique. The operation time, failure rate, blood loss, complication rate, re-herniation rate, the Visual Analogue Scale (VAS) for back and leg were checked. The alteration of dural sac cross-sectional area (DSCSA) between the preoperative and the postoperative MRI was checked. Results : Operative time was rapidly reduced in the early phase, and then tapered to a steady state for the 35 cases receiving the PELD. After surgery, VAS scores for the back and leg were decreased significantly in both groups. Complications occurred in 2 patients in group A and 2 patients in group B. Between the two groups, there were significant differences in operative time, improvement of leg VAS, and expansion of DSCSA. Conclusion : PELD learning curve seems to be acceptable with sufficient preparation. However, because of their high tendency to delayed operation time, operation failure, and re-herniation, caution should be exercised at the early phase of the procedure.

• 대한한방내과학회지
• /
• 제41권2호
• /
• pp.283-292
• /
• 2020

Background: This case study suggests the potential use of Korean medicine treatments as a conservative management for low back pain and decreased living function due to herniation of intervertebral discs in the lumbar spine. Case Summary: The patient suffered low back pain and decreased living function due to herniation of intervertebral discs of the lumbar spine. Korean medicine treatments, including herbal medicine, acupuncture performed on BL23, BL40, SP6, and GB39, and pharmacupuncture containing Sinbaro, were applied for eight days. The numeric rating scale (NRS) results for low back pain decreased from 6 to 2 and the Oswestry Disability Index (ODI) low back pain scores decreased from 75.56 to 31.11. Walking time also increased from less than one minute to 20 minutes, with an increase in range of motion (ROM) from "Uncheckable" to about normal motion range. Conclusion: Korean medicine treatment can be considered to be an effective conservative management option for pain and decreased living function in patients with herniation of intervertebral discs in the lumbar spine.

• 동의생리병리학회지
• /
• 제30권1호
• /
• pp.66-72
• /
• 2016

This retrospective observational study was aimed to assess that Shinchubogun-tang (Shenzhuibujian-tang ; SBT) improves the symptoms related to lumbar disc herniation. We analyzed the medical records of 36 patients, who were satisfied with inclusion and exclusion criteria. The patients were diagnosed with lumbar disc herniation and prescribed with SBT in addition to Korean medical common treatments at Dunsan Korean Medicine Hospital of Daejeon University from January 1st, 2013 to November 30th, 2015. The effects of SBT was evaluated by comparing before and after taking SBT through 0-10 visual analogue scale(VAS) of the symptoms including lower back pain, radiating pain, and lower extremity numbness. The average period of common Korean medicine treatment before SBT prescription was 9.78 days and then the patients received SBT along with common Korean medicine treatment for 13.17 days on average. SBT plus common korean medicine treatment group significantly decreased VAS score of lower back pain from 5.40±1.62 to 3.28±1.70 (p<0.01), radiating pain from 5.60±1.42 to 2.35±1.79 (p<0.01), lower extremity numbness from 5.77±1.52 to 2.55±1.85(p<0.01). These results demonstrated that SBT might have a potential on improvement of lumbar disc herniation by reducing the symptoms of lower back pain, radiating pain, and lower extremity numbness.

• Journal of Korean Neurosurgical Society
• /
• 제60권2호
• /
• pp.220-224
• /
• 2017

Objective : This study aimed to unravel the putative mechanism underlying the neurologic deficits contralateral to the side with lumbar disc herniation (LDH) and to elucidate the treatment for this condition. Methods : From January 2009 to June 2015, 8 patients with LDH with predominantly contralateral neurologic deficits underwent surgical treatment on the side with LDH with or without decompressing the symptomatic side. A retrospective review of charts and radiological records of these 8 patients was performed. The putative mechanisms underlying the associated contralateral neurological deficits, magnetic resonance imaging (MRI), electromyography (EMG), and the adequate surgical approach are discussed here. Results : MRI revealed a similar laterally skewed paramedian disc herniation, with the apex deviated from the symptomatic side rather than directly compressing the nerve root; this condition may generate a contralateral traction force. EMG revealed radiculopathies in both sides of 6 patients and in the herniated side of 2 patients. Based on EMG findings and the existence of suspicious lateral recess stenosis of the symptomatic side, 6 patients underwent bilateral decompression of nerve roots and 2 were subjected to a microscopic discectomy to treat the asymptomatic disc herniation. No specific conditions such as venous congestion, nerve root anomaly or epidural lipomatosis were observed, which may be considered the putative pathomechanism causing the contralateral neurological deficits. The symptoms resolved significantly after surgery. Conclusion : The traction force generated on the contralateral side and lateral recess stenosis, rather than direct compression, may cause the contralateral neurologic deficits observed in LDH.

• 동의생리병리학회지
• /
• 제31권4호
• /
• pp.238-245
• /
• 2017

This retrospective observational study was aimed to evaluate that Daoyin Exercise therapy improves the symptoms related to lumbar disc herniation. We analyzed the medical records of 7 patients, who satisfied with inclusion and exclusion criteria. The subjects of the study were the patients who were prescribed Daoyin Exercise Therapy and Korean medical treatments for lumbar intervertebral disc herniation at Dunsan Korean Medicine Hospital of Daejeon University from July 25th, 2016 to March 31th, 2017. The effects of Daoyin Exercise Therapy was evaluated by comparing before and after taking Daoyin Exercise Therapy through 0-10 Numeric Rating Scale(NRS), Roland & Morris Disability Questionnaire(RMDQ), Trunk Extension Flexion(TEF) Program, EuroQol five Demension Questionnaire(EQ-5D, EQVAS) of the symptoms including lower back pain. The Daoyin Exercise Therapy combined with Korean medicine treatment reduced NRS($3.357{\pm}3.038$) and RMDQ($9.50{\pm}6.364$), and improved Muscle endurance($44.429{\pm}45.136$), EQ-5D($0.09{\pm}0.12$) and EQVAS($6.571{\pm}19.260$) of the 7 patients without side effects. These results implied that Daoyin Exercise Therapy might helps to improve symptoms of patients with lumbar disc herniation by reducing the symptoms of lower back pain and improving muscle endurance, quality of life, strength enhancement and core muscles.

• 한국임상수의학회지
• /
• 제26권6호
• /
• pp.632-636
• /
• 2009

회음부 팽대 병력을 보이는 세 마리 개가 건국대학교 부속 동물병원과 한강 동물병원에 내원하였다. 회음부 팽대 외에 다른 증상이 없었으며 신체 검사에서 두 마리는 환납성 한 마리는 비 환납성임을 확인 하였다. 일반 방사선 사진에서 골반강 또는 복강 내 장기가 탈장 낭 내에 없음을 확인하였다. 회음 탈장의 교정을 위해 내폐쇄근 변위 탈장 봉합술 실시 하였다. 한 마리에서 수술 후 지방을 함유하고 있는 대측 탈장이 확인되었다. 수술 후 정기 점진은 수의사의 신체 검사 혹은 보호자와의 전화 통화를 통해 실시 되었으며 세 마리 모두에서 수술과 관련한 좌골 신경 손상, 직장 탈출, 수술 부위 열개, 회음 탈장 재발과 같은 합병 증상이 없음을 확인하였다.

• Journal of the Korean Data and Information Science Society
• /
• 제21권6호
• /
• pp.1101-1108
• /
• 2010

본 연구는 요추 추간판 탈출증 환자 30명을 대상으로 전신냉기치료와 감압치료를 병행한 그룹과 감압치료를 적용한 그룹으로 나누어 2주간 실시한 후 통증과 요추 굴곡 관절가동범위, 그리고 전반적 인지효과에 미치는 효과에 대해 알아보기 위해 실시하였다. 본 연구의 측정은 시각적 상사 척도 검사와 수정판 쇼버 검사, 그리고 전반적 인지효과척도를 검사하였다. 대응표본 T검사에서 두 그룹 모두 효과적이었다. 그러나 독립표본 T검정과 공분산분석 결과 전신냉기치료와 감압치료를 병행한 그룹에서 더욱 효과적이었다. 요추 추간판 탈출증의 통증과 관절가동범위, 그리고 전반적 인지효과를 개선시키기 위해 전신냉기치료와 감압치료 병용 시 효과적이란 것을 검증하였다.