• 한방재활의학과학회지
• /
• 제28권4호
• /
• pp.43-50
• /
• 2018

Objectives Upper lumbar disc herniation (LDH) (L1/2, L2/3) has specific anatomical characteristics and different outcome after conventional treatment compared to lower LDH (L3/4, L4/5, L5/S1). The purpose of this study was to compare the clinical features and effects of korean medical treatment of upper LDH between lower LDH. Methods We retrospectively reviewed the clinical data collected from 121 patients who was had admitted at the Haeundae Jaseng Hospital of Korean Medicine from June 1st, 2014 to August 31th, 2018. The patients who had treated at L1/2, L2/3 level LDH were grouped and compared with those treated at the L3/4, L4/5, L5/S1 level. We reviewed the patient characteristics such as age, the positive rate of Straight Leg Raise Test (SLR test), the presence or absence of previous lumbar surgery. Numeric Rating Scale (NRS) and Oswestry Disability Index (ODI) were evaluated at adimission and discharge. Results Mean age was significantly higher at upper LDH group and positive rate of SLR test was higher at lower LDH group. There was no significant difference of gender and previous lumbar surgery between two groups. Each group had a significant improvement of NRS, ODI scores. But between two groups, there was no significant difference of NRS, ODI scores. Conclusions Upper LDH group was older than lower LDH group. SLR test was useful tool to exclude upper LDH. Korean medical treatment was significantly effective to both upper and lower LDH groups. Further well designed prospective comparative studies are needed.

• Journal of Korean Neurosurgical Society
• /
• 제65권6호
• /
• pp.825-833
• /
• 2022

Objective : ABM/P-15 (anorganic bone matrix/15-amino acid peptide fragment) is a commercially available synthetically manufactured P-15 collagen peptide fragment, that is adsorbed on ABM. This study was done to investigate the efficacy of ABM/P-15 in achieving fusion in the lumbar spine and comparing it with that of recombinant bone morphogenic protein-2 (rhBMP-2) and demineralized bone matrix (DBM). Methods : A retrospective observational study of prospectively collected data of 140 patients who underwent lumbar spinal fusion surgeries in a single specialty spine hospital between 2016 and 2020, with a minimum 6-month follow-up was conducted. Based on the material used for the augmentation of the bone graft at the fusion site, the patients were divided into three categories namely ABM/P-15, rhBMP-2, and DBM group. Results : ABM/P-15, rhBMP-2, and DBM were used in 46, 44, and 50 patients, respectively. Patient characteristics like age, gender, bone mineral density, smoking history, and presence of diabetes mellitus were comparable amongst the three groups. Average follow-up was 16.0±5.2, 17.9±9.8, and 26.2±14.9 months, respectively in ABM/P-15, rhBMP-2, and DBM groups. The fusion was achieved in 97.9%, 93.2%, and 98% patients while the average time-to-union was 4.05±2.01, 10±4.28, and 9.44±3.49 months (p<0.001), respectively for ABM/P-15, rhBMP-2, and DBM groups. The average pre-operative Visual analogue scale score was 6.93±2.42, 7.14±1.97, 7.01±2.14 (p=0.900) for ABM/P-15, rhBMP-2 and DBM groups, respectively, which reduced to 1.02±0.80, 1.21±0.96, and 0.54±0.70 (p=0.112), respectively at the last follow up. Pre-operative Oswestry disability index scores were 52.7±18.02, 55.4±16.8, and 53.56±19.6 (p=0.751) in ABM/P-15, rhBMP-2, and DBM groups, which post-operatively reduced to 33.77±15.52, 39.42±16.47, and 38.3±15.89 (p=0.412) and further to 15.74±8.3, 17.41±10.45, and 16.76±9.81 (p=0.603), respectively at the last follow-up. Conclusion : ABM/P-15 appears to achieve union significantly earlier than rhBMP-2 and DBM in lumbar spinal fusion cases while maintaining a comparable clinical and complication profile.

• 대한핵의학회지
• /
• 제38권6호
• /
• pp.522-527
• /
• 2004

목적 : 본 연구는 골다공증에 의한 척추 골절 환자를 대상으로 골SPECT를 시행하고 골 섭취 증가 병변의 형태와 분포를 분석하여, 척추 골절에서 골SPECT의 유용성을 알아보고자 하였다. 대상 및 방법: 골다공증에 의한 척추 골절이 있었던 32명의 환자를 대상으로 하였다. 평균 연령은 $67{\pm}8$세였으며, 남자 5명, 여자 27명이었다. 79개의 척추골절이 발견되었으며, 병소는 흉부 및 흉요추부 척추가 38개, 요추부 척추가 41개였다. 척추체의 골절 형태는 압박 형태에 따라 쐐기형, 양요형, 압박형으로 분류하였고, SPECT 상 척추체의 골 섭취 증가 병변은 국소성 혹은 미만성, 대칭성 혹은 비대칭성으로 분류하였다. 척추 후방부의 SPECT 소견은 척추경, 척추 후관절, 관절간부, 극상 돌기의 골섭취 증가 병변 유무로 분류하였다. 척추체 골절 형태와 골절 척추의 위치에 따른 골 SPECT소견에 차이가 있는지를 분석하였다. 결과: 79개의 척추제 압박 골절 중 쐐기형 병소가 47개, 양요형 병소가 20개, 압박형 병소가 12개이었다. 골 SPECT에서는 척추체의 섭취 증가가 모든 예에서 관찰되었으며, 골절의 형태와 관계없이 국소형 보다는 미만형이, 대칭성 보다는 비대칭성 골 섭취 증가가 많았다. 척추 후방부에 병소가 발견된 경우는 69개(87.3%) 였으며, 쐐기형이 40개(85.1%), 양요형 17개(85.0%), 압축형 12개(100%)에서 관찰되었다. 흉부 및 흉요추부 척추에서는 쐐기형 골절이 많은 반면, 요추부 척추에서는 골절형태 분포가 비교적 균일한 것으로 나타났다(p=0.04). 극상돌기의 골섭취는 흉부 및 흉요추부 골절의 5예(13.2%)에서 있었던 반면 요추부 척추 골절에서는 16개(39.0%)에서 발견되어 분포의 차이가 있었다(p=0.009). 요추부 척추에서 발생한 양요형 골절에서 척추 후관절에 골 섭취 증가를 보인 경우가 12개(92.3%)인데 반해 흉부 및 흉요추부 척추에 발생한 경우 4개(57.1%) 에서만 골섭취 증가 병변이 있었다. 극상돌기의 골섭취에도 차이가 있어서 요추가 8개(38.5%)인데 비해 흉부 및 흉요추부 척추에서는 1개(14.3%)에서만 골섭취가 있었다(p=0.043). 결론: 골SPECT는 골다공증에 의한 척추 골절 진단에 유용하며, 특히 척추 후방부의 골 섭취 증가 병변의 평가에 유용하였다.

• Journal of Korean Neurosurgical Society
• /
• 제29권11호
• /
• pp.1484-1490
• /
• 2000

Objectives : In spinal metastasis and myeloma, percutaneous vertebroplasty could be an effective treatment method to provide spinal stabilization and to relief pain for early rehabilitation. The authors report twenty-five cases the clinical results of percutaneous vertebroplasty for twenty-five cases of spinal metastasis and myeloma. Materials and Methods : From September 1998 to December 1999, seventy percutaneous vertebroplasties(PVP) were performed for spinal metastases and myeloma in 25 patients, sixteen women and nine men ranging in age from 34 to 74. The primary malignancies were 6 multiple myelomas, and in metastatic tumore from various origin. All patients complained of severe pain and had osteolytic vertebral body destructions without spinal cord compression. To evaluate clinical improvement, suObjective verbal analogue pain score(VAS) and Karnofsky performance scale(KPS) were used. Thin sliced(2mm-thickness) sectional computed tomography(CT) was performed before and after PVP. Plain X-ray film was followed up every 1 month to assess the vertebral column stability. Results : In 25 patients, a total of seventy PVPS were performed successfully : 6 cervical, 33 thoracic and 31 lumbar vertebrae. Most patients had clear improvement of pain after PVP ; mean as score was 8.1 and 2.9 before and after PVP, respectively. Improvement was maintained in most patients. No further collapse of treated vertebrae was observed(mean follow-up, 7 months). Leakage of PMMA was notod in the spinal canal(13 levels), neural foramen (2 levels), adjacent disk(15 levels), paravertebral soft tissue(14 levels) and vein(8 levels). Pulmonary embolism was detected in three patients after the procedure, but was not associated with clinical symptoms. Conclusion : These results indicate that percutaneous vertebroplasty can be valuable treatment method in osteolytic spinal metastasis and myeloma, providing immediate pain relief and spinal stabilization and contributing to early rehabilitation.

• The Korean Journal of Pain
• /
• 제23권4호
• /
• pp.247-253
• /
• 2010

Background: Epidural anesthesia is widely used to provide pain relief, whether for surgical anesthesia, postoperative analgesia, treatment of chronic pain, or to facilitate painless childbirth. In many cases, however, the epidural catheter is inserted blindly and the indwelling catheter position is almost always uncertain. Methods: In this study, the loss-of-resistance technique was used and an imaging agent was injected through the indwelling epidural anesthesia catheter to confirm the position of its tip and examine the migration rate. Study subjects were patients scheduled to undergo surgery using general anesthesia combined with epidural anesthesia. Placement of the epidural catheter was confirmed postoperatively by injection of an imaging agent and X-ray imaging. Results: The indwelling epidural catheter was placed between upper thoracic vertebrae (n = 83; incorrect placement, n = 5), lower thoracic vertebrae (n = 123; incorrect placement, n = 5), and lower thoracic vertebra-lumbar vertebra (n = 46; incorrect placement, n = 7). In this study, a relatively high frequency of incorrectly placed epidural catheters using the loss-of-resistance technique was observed, and it was found that incorrect catheter placement resulted in inadequate analgesia during surgery. Conclusions: Although the loss-of-resistance technique is easy and convenient as a method for epidural catheter placement, it frequently results in inadequate placement of epidural catheters. Care should be taken when performing this procedure.

• Journal of Korean Neurosurgical Society
• /
• 제64권6호
• /
• pp.922-932
• /
• 2021

Objective : It is challenging to make solid fusion by posterior screw fixation and laminectomy with posterolateral fusion (PLF) in thoracic and thoracolumbar (TL) diseases. In this study, we report our experience and follow-up results with a new surgical technique entitled posterior thoracic cage interbody fusion (PTCIF) for thoracic and TL spine in comparison with conventional PLF. Methods : After institutional review board approval, a total of 57 patients who underwent PTCIF (n=30) and conventional PLF (n=27) for decompression and fusion in thoracic and TL spine between 2004 and 2019 were analyzed. Clinical outcomes and radiological parameters, including bone fusion, regional Cobb angle, and proximal junctional Cobb angle, were evaluated. Results : In PTCIF and conventional PLF, the mean age was 61.2 and 58.2 years (p=0.46), and the numbers of levels fused were 2.8 and 3.1 (p=0.46), respectively. Every patient showed functional improvement except one case of PTCIF. Postoperative hematoma as a perioperative complication occurred in one and three cases, respectively. The mean difference in the regional Cobb angle immediately after surgery compared with that of the last follow-up was 1.4° in PTCIF and 7.6° in conventional PLF (p=0.003), respectively. The mean durations of postoperative follow-up were 35.6 months in PTCIF and 37.3 months in conventional PLF (p=0.86). Conclusion : PTCIF is an effective fusion method in decompression and fixation surgery with good clinical outcomes for various spinal diseases in the thoracic and TL spine. It provides more stable bone fusion than conventional PLF by anterior column support.

• 한국임상수의학회지
• /
• 제39권5호
• /
• pp.235-239
• /
• 2022

A 10-year-old neutered male Siberian Husky presented with paraparesis and severe lethargy. On physical examination, the patient was unable to weight-bear and walk and exhibited significant muscle mass loss in both hindlimbs and generalized truncal alopecia with a dull coat of hair. On neurological examination, cranial lumbar vertebral pain, hind limb cross-extensor reflex, delayed hindlimb postural reaction, upper motor neuron bladder dysfunction, and total absence of cutaneous trunci reflex were identified. Computed tomography revealed diffuse idiopathic skeletal hyperostosis and spondylosis deformans of the cervical and thoracolumbar vertebrae. In addition, a generalized decrease in bone mineral density of the vertebrae was identified. Magnetic resonance imaging showed hyperplasia of the epidural fat compressing the spinal cord in the thoracolumbar region and concurrent mild multiple intervertebral disc herniations. No specific findings were observed in cerebrospinal fluid analysis. Blood analysis of thyroid function revealed decreased total T4 and free T4 levels, and increased TSH levels. The patient was tentatively diagnosed with spinal epidural lipomatosis (SEL) secondary to hypothyroidism. The patient was treated with levothyroxine, firocoxib, and gabapentin. Clinical signs gradually improved, and the patient showed normal ambulation 40 days after treatment initiation. SEL is extremely rare in dogs. To the best of our knowledge, this is the first case report of SEL secondary to hypothyroidism that was treated conservatively. Secondary SEL can be sufficiently managed by treating the underlying cause, if possible.

• 대한핵의학회지
• /
• 제26권2호
• /
• pp.318-326
• /
• 1992

Ga-67 citrate scan has been requested for detection or follow-up of inflammatory or neoplastic disease. Visualization of Ga-67 citrate in the kidneys at 48 and 72 hr post injection is usually interpreted as evidence of renal pathology. But precise mechanisms of abnormal Ga-67 uptake in kidneys were unknown. We undertook a study to determine the clinical value of Ga-67 citrate imaging of the kidneys in 68 patients with primary or secondary nephropathy confirmed by renal biopsy and 66 control patients without renal disease. Renal uptake in 48 to 72 hr images was graded as follows: Grade 0=back-ground activity:1=faint uptake greater than background;2=definite uptake, but less than lumbar vertebrae; 3=same uptake as lumbar vertebrae, but less than liver; 4=same or higher uptake than liver. The results were as follows. 1) 42 of 65 (62%) patients with noninfectious nephritis showed grade 2 or higher Ga-67 renal uptake but only 10 percent of control patients showed similar uptake. 2) In 14 patients with systemic lupus erythematosus, 8 of 9 (89%) patients with lupus nephritis exhibited marked renal uptake 3) 36 of 41 patients (88%) with combined nephrotic syndrome showed Grade 2 or higher renal uptake. 4) Renal Ga-67 uptake was correlated with clinical severity of nephrotic syndrome determined by serum albumin level, 24 hr urine protein excretion and serum lipid levels. 5) After complete remission of nephrotic syndrome, renal uptake in all 8 patients who were initially Grade 3 or 4, decreased to Grade 1 or 0. In conclusion, we think that the mechanism of renal Ga-67 uptake in nephrotic syndrome might be related to the pathogenesis of nephrotic syndrome. In systemic lupus erythematosus, Ga-67 citrate scan is useful in predicting renal involvement.

• 한국콘텐츠학회논문지
• /
• 제9권6호
• /
• pp.207-215
• /
• 2009

만성 요통 환자들에 대한 다양한 치료적 중재 방법이 있다. 그러나 대부분의 치료들이 통증에 대한 치료들이다. 만성 요통 환자들은 요추관절들의 구조적 고착들을 가지고 있다, 이러한 구조적 고착들은 관절가동범위을 저하시키고 나아가 동적 균형능력의 저하를 발생시킨다. 동적 균형능력의 저하는 손상을 가중시키고 위험상황에서의 대처능력을 감소시킨다. 따라서 본 연구에서는 만성요통환자들에 대한 즉각적인 동적 균형능력의 회복을 위하여 메이트란드의 도수치료의 방법들을 이용하였다. 만성 요통 환자 64명을 대상으로 메이트란드의 도수치료를 적용한 실험군 32명, 이학적 도구(온열팩, 저주파치료기, 초음파)를 사용한 대조군 32명을 대상으로 하였다. 각 군의 치료 전, 후의 동적 균형능력을 비교하기위하여 신뢰도가 높은 스타 익스커션 밸런스 테스트(0.81-0.96)를 이용하였다. 실험군에서 치료 후 동적 균형능력이 전방, 오른쪽, 왼쪽, 후방모두에서 증가하였고 대조군에서는 변화가 없었다. 따라서 메이트란드의 도수치료가 만성요통환자들의 요추 관절을 유연하게 해서 즉각적인 동적 균형능력을 증가시키는데 영향을 주었다고 생각된다.

• Journal of Acupuncture Research
• /
• 제17권4호
• /
• pp.139-148
• /
• 2000

Objectives : Hua-Tuo-Jia-Ji-Xue(華佗夾脊穴) is the Jing-Wai-Qi-Xue(經外奇穴) that is widely used in clinic and effective in Acupuncture and Moxibustion. But the location, number, acupuncture method, clinical application of Hua-Tuo-Jia-Ji-Xue have not been explained clearly and consistently; moreover, studies or clinical reports about this are insufficient. The purpose of this study is to investigate the location, number, acupuncture method, clinical apptication of Hua-Tuo-Jia-Ji-Xue. Methods : We investigated Hua-Tuo-Jia-Ji-Xue through survey of 11 books and 26 relevant journals published in China Results : 1. Hua-Tuo-Jia-Ji-Xue is located in about 0.5 Cun(寸) at both sides of spinous process of each vertebra. 2. There is differ as the number of Hua-Tuo-Jia-Ji-Xue is 34, 48, 56, 58 in each documents. Hua-Tuo-Jia-Ji-Xue located in first, second cervical vertebra and first sacrum is low in application frequency, Hua-Tuo-Jia-Ji-Xue located from third cervical vertebra to fourth lumbar vertebra is high in apptication frequency. Therefore, all of the acupoints located in about 0.5 Cun(寸) both sides of spinous process of cervical, thoracic, lumbar and sacral vertebrae are regarded as Hua-Tuo-Jia-Ji-Xue in wide meaning. 3. There are Kou-Ci-Fa(叩刺法), Qian-Ci-Fa(淺刺法), Yan-Pi-Ci-Fa(沿皮刺法), Shen-Ci-Fa(深刺法) in acupuncture method of Hua-Tuo-Jia-Ji-Xue. Acupuncturing depths, directions is differ in each location(cervical, thoracic, lumbar vertebra, sacrum) and have something to do with therapeutic effect of Hua-Tuo-Jia-Ji-Xue. The feeling that patient receive after acupuncture is the key to the treatment of disease. 4. The clinical application of each Hua-Tuo-Jia-Ji-Xue is mainly selected by distribution of meridians, nerve roots, vertebral segments which are attacked with a disease. The musculoskeletal diseases in treatment of disease by Hua-Tuo-Jia-Ji-Xue are the most common as 12 cases. Second, there are many reports about nervous system diseases. In addition, good therapeutic results by application of Hua-Tuo-Jia-Ji-Xue are reported in some diseases, for instance, diseases of five viscera and six entrails, organ, tissue Conclusions : Hua-Tuo-Jia-Ji-Xue is located in about 0.5 Cun(寸) at both sides of spinous process of each cervical, thoracic lumbar and sacral vertebra. Therapeutic effect of Hua-Tuo-Jia-Ji-Xue has something to do with acupuncturing depths, directions and feelings. Hua-Tuo-Jia-Ji-Xue is mainly selected by distribution of meridians, nerve roots, vertebral segments which are attacked with a disease and is mainly applied musculoskeletal diseases, nervous system diseases.