• Title/Summary/Keyword: Interlaminar approach

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Symptomatic Post-Discectomy Pseudocyst after Endoscopic Lumbar Discectomy

  • Kang, Suk-Hyung;Park, Seung-Won
    • Journal of Korean Neurosurgical Society
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    • v.49 no.1
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    • pp.31-36
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    • 2011
  • Objective: The objectives of this study were to determine the frequency of symptomatic postdiscectomy pseudocyst (PP) after endoscopic discectomy and to compare the results of surgical and conservative management of them. Methods: Initial study participants were 1,503 cases (1,406 patients) receiving endoscopic lumbar discectomy by 23-member board of neurosurgeons from March 2003 to October 2008. All patients' postoperative magnetic resonance imaging (MRI) scans were evaluated. On the postoperative MRI, cystic lesion of T2W high and T1W low at discectomy site was regarded as PP. Reviews of medical records and radiological findings were done. The PP patients were divided into two groups, surgical and conservative management by treatment modality after PP detection. We compared the results of the two groups using the visual analogue scale (VAS) for low back pain (LBP), VAS for leg pain (LP) and the Oswestry disability index (ODI). Results: Among 1,503 cases of all male soldiers, the MRls showed that pseudocysts formed in 15 patients, about 1.0% of the initial cases. The mean postoperative interval from surgery to PP detection was 53.7 days. Interlaminar approach was correlated with PP formation compared with transforaminal approach. (p=0.001).The mean VAS for LBP and LP in the surgical group improved from 6.5 and 4.8 to 2.0 and 2.3, respectively. The mean VAS for LBP and LP in the conservative group improved from 4.4 and 4.4 to 3.9 and 2.3, respectively. There was no difference in treatment outcome between surgical and conservative management of symptomatic PP. Conclusion: Although this study was done in limited environment, symptomatic PP was detected at two months' postoperative period in about 1% of cases. Interlaminar approach seems to be more related with PP compared with transforaminal approach.

The Difference of Success Rate between the Midline Approach and the Paramedian Approach of Spinal Anesthesia in each of Flexed Patients and Straightened Patients (한국 성인에서 정중접근법과 측면접근법에 의한 요부 척추천자시 전굴 자세에 따른 성공률의 비교)

  • Cho, Myung-Hyun;Lee, Jong-Sun
    • The Korean Journal of Pain
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    • v.9 no.1
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    • pp.126-129
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    • 1996
  • Background: Advantages of paramedian approach over midline approach include less tissue trauma and less dependence on patient's ability to assume a fetal position. When midline approach fails in patients who are difficult to take a position with lumbar spine flexed, paramedian approach to interlaminar space may succeed. Methods: Success rates of spinal anesthesia were measured for 47 flexed patients by midline approach, 48 flexed patients by paramedian approach, 23 straightened patients receiving spinal anesthesia by midline approach, and 23 straightened patients by paramedian approach. Results: Success rates in flexed patients were 100% by midline approach and 100% by paramedian approach. Success rates for straightened patients were 13.0% by midline approach and 78.3% by paramedian approach. For straightened patients there were no correlations between success fate and age, weight, Ponderal Index but there were correlations between height and midline approach of spinal anesthesia. Conclusion: Pertaining to adult Koreans, success rates of spinal anesthesia for strainghtened patients were less than those for flexed patients. Success rate of paramedian approach of spinal anesthesia among strainghtened patients were better than those of midline approach.

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Direct Numerical Simulation of Composite laminates Under low velocity Impact (저속충격을 받는 적층복합재료 평판의 직접 수치모사)

  • Ji, Kuk-Hyun;Kim, Seung-Jo
    • Composites Research
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    • v.19 no.1
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    • pp.1-8
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    • 2006
  • Prediction of damage caused by low-velocity impact in laminated composite plate is an important problem faced by designers using composites. Not only the inplane stresses but also the interlaminar normal and shear stresses playa role in estimating the damage caused. But it is well known that the conventional approach based on the homogenization has the limit in description of damage. The work reported here is an effort in getting better predictions of dynamic behavior and damage in composite plate using DNS approach. In the DNS model, we discretize the composite plates through separate modeling of fiber and matrix for the local microscopic analysis. In the view of microscopic mechanics with DNS model, interlaminar stress behaviors in the inside of composite materials are investigated and compared with the results of the homogenized model which has been used in the conventional approach to impact analysis. Also the multiscale model based on DNS concept is developed in order to enhance the effectiveness of impact analysis, and we present the results of multiscale analysis considering micro and macro structures simultaneously.

Correlation between Epidurographic Contrast Flow Patterns and Clinical Effectiveness in Chronic Lumbar Discogenic Radicular Pain Treated with Epidural Steroid Injections Via Different Approaches

  • Gupta, Ruchi;Singh, Saru;Kaur, Sukhdeep;Singh, Kulvinder;Aujla, Kuljeet
    • The Korean Journal of Pain
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    • v.27 no.4
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    • pp.353-359
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    • 2014
  • Background: Epidural steroid injections are an accepted procedure for the conservative management of chronic backache caused by lumbar disc pathology. The purpose of this study was to evaluate the epidurographic findings for the midline, transforaminal and parasagittal approaches in lumbar epidural steroid injections, and correlating them with the clinical improvement. Methods: Sixty chronic lower back pain patients with unilateral radiculitis from a herniated/degenerated disc were enrolled. After screening the patients according to the exclusion criteria and randomly allocating them to 3 groups of 20 patients, fluoroscopic contrast enhanced epidural steroids were injected via midline (group 1), transforaminal (group 2) and parasagittal interlaminar (group 3) approaches at the level of the pathology. The fluoroscopic patterns of the three groups were studied and correlated with the clinical improvement measured by the VAS over the next 3 months; any incidences of complications were recorded. Results: The transforaminal group presented better results in terms of VAS reduction than the midline and parasagittal approach groups (P < 0.05). The epidurography showed a better ventral spread for both the transforaminal (P < 0.001) and the paramedian approaches (P < 0.05), as compared to the midline approach. The nerve root filling was greater in the transforaminal group (P < 0.001) than in the other two groups. The ventral spread of the contrast agent was associated with improvement in the VAS score and this difference was statistically significant in group 1 (P < 0.05), and highly significant in groups 2 and 3 (P < 0.001). In all the groups, any complications observed were transient and minor. Conclusions: The midline and paramedian approaches are technically easier and statistically comparable, but clinically less efficacious than the transforaminal approach. The incidence of ventral spread and nerve root delineation show a definite correlation with clinical improvement. However, an longer follow-up period is advisable for a better evaluation of the actual outcom.

Delamination behavior of multidirectional laminates under the mode I loading (모드 I 하중조건하에 있는 다방향 적층 복합재료의 층간파괴거동)

  • Choi, Nak-Sam;Kinloch, A.J.
    • Transactions of the Korean Society of Mechanical Engineers A
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    • v.22 no.3
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    • pp.611-623
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    • 1998
  • The delamination fracture of multidirectional carbon-fiber/epoxy laminates under the Mode I condition has been studied using the modified beam analysis for a fracture mechanics approach. It was found that the variation of fracture energy $G_IC$ with increasing length of the propagating crack exhibited a minimum for the pure interlaminar fracture and a maximum for the intraply fracture,i.e. a rising "R-curve", which was strongly affected by the degree of fiber bridging and crack-tip splitting arising in the global delamination. The maximum $G_IC$ value was significantly dependent on such types of delamination as no crack jumping, crack jumping into the adjacent ply and edge-delamination. It was shown also that the value of "effective flexural modulus" estimated from the modified beam analysis increased much with the development of fiber bridging behind the crack tip.ehind the crack tip.

Comparison of clinical efficacy in epidural steroid injections through transforaminal or parasagittal approaches

  • Hong, Ji Hee;Park, Eun Kyul;Park, Ki Bum;Park, Ji Hoon;Jung, Sung Won
    • The Korean Journal of Pain
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    • v.30 no.3
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    • pp.220-228
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    • 2017
  • Background: The transforaminal (TF) epidural steroid injection (ESI) is suggested as more effective than the interlaminar (IL) route due to higher delivery of medication at the anterior epidural space. However, serious complications such as spinal cord injury and permanent neural injury have been reported. The purpose of this study is to evaluate and compare the clinical effectiveness, technical ease, and safety of the TF and parasagittal IL (PIL) ESI. Methods: A total of 72 patients were randomized to either the PIL group (n = 41) or the TF group (n = 31) under fluoroscopic guidance. Patients were evaluated for effective pain relief by the numerical rating scale (NRS) and Oswestry Disability Index (ODI) (%) before and 2 weeks after the ESI. The presence of concordant paresthesia, anterior epidural spread, total procedure time, and exposed radiation dose were also evaluated. Results: Both the PIL and TF approach produced similar clinically significant improvements in pain and level of disability. Among the 72 patients, 27 PIL (66%) and 20 TF (64%) patients showed concordant paresthesia while 14 (34%) and 11 (36%) patients in the same respective order showed disconcordant or no paresthesia. Radiation dose and total procedure time required were compared; the PIL group showed a significantly lower radiation dose ($30.2{\pm}12$ vs. $80.8{\pm}26.8$ [$Cgy/cm^2$]) and shorter procedure time ($96.2{\pm}31$ vs. $141.6{\pm}30$ seconds). Conclusions: ESI under fluoroscopic guidance with PIL or TF approach were effective in reducing the NRS and ODI. PIL ESI was a technically easier and simple method compared to TF ESI.

CT Guided Cervical Transforaminal Steroid Injection: 2 Months Follow-up (CT 유도하 경추부위 경추간공 경막외 스테로이드주입술: 2개월 경과관찰)

  • Kim, Hoondo;Lee, Sang Ho;Kim, Myung-Ho
    • The Korean Journal of Pain
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    • v.19 no.1
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    • pp.51-55
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    • 2006
  • Background: A cervical transforaminal steroid injection is an effective therapeutic modality for radiculopathy of a herniated cervical disc or a cervical foraminal stenosis. However, there is some debate regarding the safety of the transforaminal approach under C-arm guidance compared with the posterior interlaminar approach. We report a new technique for cervical transforaminal steroid injection guided by MDCT. Methods: Patients presenting with radiating pain on their shoulder or arm were diagnosed using CT or MRI of a cervical herniated disc or a foraminal stenosis. Each patient whose symptoms were compatible with the image scan was enrolled in this study. They received a cervical transforaminal steroid injection under CT guidance, and the effectiveness and complications of this technique were evaluated over a 2-month period. Results: According to the CT scan, none of the participants had an internal jugular vein or a carotid artery invasion during the procedure. No vertebral artery injection was noted, and no patient developed a hematoma after the injection. The VAS score had improved significantly by 2, 4 and 8 weeks after the injection. Conclusions: While a conventional C-arm guided cervical transforaminal steroid injection does not appear to differentiate between the major vessels and structures in images, a CT guided approach is a more useful and safer technique for the precise placement of a needle.

Comparison of treatment outcomes in lumbar central stenosis patients treated with epidural steroid injections: interlaminar versus bilateral transforaminal approach

  • Sencan, Savas;Edipoglu, Ipek Saadet;Celenlioglu, Alp Eren;Yolcu, Gunay;Gunduz, Osman Hakan
    • The Korean Journal of Pain
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    • v.33 no.3
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    • pp.226-233
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    • 2020
  • Background: We aimed to compare interlaminar epidural steroid injections (ILESI) and bilateral transforaminal epidural steroid injections (TFESI) on pain intensity, functional status, depression, walking distance, and the neuropathic component in patients with lumbar central spinal stenosis (LCSS). Methods: The patients were divided into either the ILESI or the bilateral TFESI groups. Prime outcome measures include the numerical rating scale (NRS), Oswestry disability index (ODI), Beck depression inventory (BDI), and pain-free walking distance. The douleur neuropathique en 4 questions score was used as a secondary outcome measure. Results: A total of 72 patients were finally included. NRS, ODI, and BDI scores showed a significant decline in both groups in all follow-ups. Third-month NRS scores were significantly lower in the ILESI group (P = 0.047). The percentages of decrease in the ODI and BDI scores between the baseline and the third week and third month were significantly higher in the ILESI group (P = 0.017, P = 0.001 and P = 0.048, P = 0.030, respectively). Pain-free walking distance percentages from the baseline to the third week and third month were significantly higher in the ILESI group (P = 0.036, P < 0.001). The proportion of patients with neuropathic pain in the bilateral TFESI group significantly decreased in the third week compared to the baseline (P = 0.020). Conclusions: Both ILESI and TFESI are reliable treatment options for LCSS. ILESI might be preferred because of easier application and more effectiveness. However, TFESI might be a better option in patients with more prominent neuropathic pain.

Acupuncture in Patients with a Vertebral Compression Fracture: A Protocol for a Randomized, Controlled, Pilot Clinical Trial

  • Lee, Hyun-Jong;Seo, Jung-Chul;Park, Sung-Hoon;Kwak, Min-Ah;Shin, Im Hee;Min, Bo-Mi;Cho, Min-Su;Roh, Woon-Seok;Jung, Jin-Yong
    • Journal of Pharmacopuncture
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    • v.18 no.1
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    • pp.79-85
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    • 2015
  • Objectives: A vertebral compression fracture (VCF) is characterized by back pain and fracture of a vertebral body on spinal radiography. VCFs of the thoraco lumbar spine are common in the elderly. In general, appropriate analgesics should be prescribed to reduce pain and, thus, promote early mobilization. The ideal treatment approach for VCFs has not been determined. In Korea, acupuncture and herbal medication have been used to treat VCFs for many years. There is empirical evidence that acupuncture might benefit patients with a VCF. However, no randomized, controlled, clinical trials evaluating the efficacy and the safety of acupuncture for treating a VCF have been published. Therefore, we designed a randomized, controlled, pilot, clinical trial to obtain information for the design of a further full scale trial. Methods: A five week protocol for a randomized, controlled, pilot, clinical trial is presented. Fourteen patients will be recruited and randomly allocated to two groups: a control group receiving interlaminar epidural steroid injections once a week for three weeks, and an experimental group receiving interlaminar epidural steroid injections plus acupuncture treatment (three acupuncture sessions per week for three weeks, nine sessions in total). The primary outcomes will be the pain intensity (visual analogue scale and PainVision$^{TM}$ system). The secondary outcome measurements will be the answers on the short form McGill pain questionnaire and the oswestry disability index. Assessments will be made at baseline and at one, three, and five weeks. The last assessment (week five) will take place two weeks after treatment cessation. This study will provide both an indication of feasibility and a clinical foundation for a future large scale trial. The outcomes will provide additional resources for incorporating acupuncture into existing treatments, such as nonsteroidal anti-inflammatory medications, narcotics and vertebral augmentation. This article describes the protocol.

Three-dimensional stress analysis of composite laminates patches under extension load (인장하중 하에서 복합재 적층 패치의 3 차원 응력 해석)

  • Lee, Jae-Hun;Cho, Maeng-Hyo;Kim, Heung-Soo;Grediac, Michel
    • Proceedings of the KSME Conference
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    • 2008.11a
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    • pp.652-657
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    • 2008
  • A stress distribution of composite laminates patches is obtained by using the Kantorovich method when the substrate is under uniaxial load. The analysis is based on the stress function approach and uses the complementary virtual work principle. The three-dimensional stresses satisfy the traction free conditions at the free edges and the top surfaces of the patch. The stress of the bottom surfaces of the patch is obtained from equilibrium equation of patch and substrate. To demonstrate the efficiency and validity of the proposed analysis, numerical examples for cross-ply and quasi-isotropic laminates are included. The present method provides accurate stresses in the interior and near the free edges of composite laminate patches.

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