• Journal of Korean Neurosurgical Society
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• v.63 no.6
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• pp.806-813
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• 2020

Objective : Lumbar disc herniation (LDH) is a common disease, and lumbar discectomy (LD) is a common neurosurgical procedure. However, there is little previous data on return to work (RTW) after LD. This study investigated the period until the RTW after LD prospectively. Clinically, the pain state at the time of RTW also checked. RTW failure rate 6 months after surgery also investigated. Methods : Patients with daily/regular jobs undergoing LD between September 2014 and December 2018 were enrolled. Pain was assessed by the Oswestri Disability Index (ODI) and the Numeric Rate Scale (NRS). Employment type was divided into self-employed, regular and contracted. Monthly telephone interviews were conducted to check RTW status and self-estimated work capability after surgery. Results : Sixty-seven patients enrolled in this study. Three patients failed to RTW, and three others resigned within 6 months after surgery. The preoperative NRS and ODI were 7.2±1.2 and 22.1±7.9, respectively. The average time to RTW was 5.1±6.0 weeks. At RTW, NRS was 1.5±1.8 and ODI was 6.3±3.9. Amongst patients that successfully returned to work were 16 self-employed workers, 42 regular employees, and three contracted workers. The time to RTW of self-employed, regular, and contracted workers were 5.9±8.8, 4.2±4.3 and 13.3±2.3 weeks, respectively (p=0.011). Thirty-six of the patients that returned to work self-reported a 22.8±15.6% reduction in work capability at 6 months. Conclusion : RTW may vary depending on the employment status. In this study, we found that while employment type may affect the length to RTW, most patients were able to RTW and >40% of patients reported no loss of work capabilities 6 months postoperatively, hopefully alleviating some patient hesitation towards LD.

• Journal of Korean Neurosurgical Society
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• v.59 no.4
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• pp.363-367
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• 2016

Objective : To compare the fusion rate of a hydroxyapatite demineralized bone matrix (DBM) with post-laminectomy acquired autograft in lumbar interbody fusion surgery and to evaluate the correlation between fusion rate and clinical outcome. Methods : From January 2013 to April 2014, 98 patients underwent lumbar interbody fusion surgery with hydroxyapatite DBM (HA-DBM group) in our institute. Of those patients, 65 received complete CT scans for 12 months postoperatively in order to evaluate fusion status. For comparison with autograft, we selected another 65 patients who underwent lumbar interbody fusion surgery with post-laminectomy acquired autograft (Autograft group) during the same period. Both fusion material groups were matched in terms of age, sex, body mass index (BMI), and bone mineral density (BMD). To evaluate the clinical outcomes, we analyzed the results of visual analogue scale (VAS), Oswestry Disability Index (ODI), and Short Form Health Survey (SF-36). Results : We reviewed the CT scans of 149 fusion levels in 130 patients (HA-DBM group, 75 levels/65 patients; Autograft group, 74 levels/65 patients). Age, sex, BMI, and BMD were not significantly different between the groups (p=0.528, p=0.848, p=0.527, and p=0.610, respectively). The HA-DBM group showed 39 of 75 fused levels (52%), and the Autograft group showed 46 of 74 fused levels (62.2%). This difference was not statistically significant (p=0.21). In the HA-DBM group, older age and low BMD were significantly associated with non-fusion (61.24 vs. 66.68, p=0.027; -1.63 vs. -2.29, p=0.015, respectively). VAS and ODI showed significant improvement after surgery when fusion was successfully achieved in both groups (p=0.004, p=0.002, HA-DBM group; p=0.012, p=0.03, Autograft group). Conclusion : The fusion rates of the hydroxyapatite DBM and Autograft groups were not significantly different. In addition, clinical outcomes were similar between the groups. However, older age and low BMD are risk factors that might induce non-union after surgery with hydroxyapatite DBM.

• Journal of the Korea Convergence Society
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• v.7 no.2
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• pp.101-107
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• 2016

The purpose of this study was to determined the converge effects of weight-bearing exercise on lumbar, femur neck BMD and body compositions in intellectual disabilities and normal men. Nineteen men were participated for this study, they are divided into two groups(intellectual disabilities, n=9, and normal men, n=10). All subjects are accomplished on weight-bearing exercise (music rope-jumping) program for 60 minutes a day, 3 days a week throughout 12 weeks. Two-way ANOVA with repeated measures was used to determine differences between and within the intellectual and normal groups for dependent variables. The statistically significant level was set at 0.05. In this study, there were a significant differences on the bone mineral density of lumbar and femur neck level after exercise training in both groups (respectively p<.01, p<.001). Also, I found that there were effectively decreased on body weight, percent of body fat, and BMI levels after exercise training for 12 weeks in both groups (respectively p<.001). Therefore, music rope-jump exercise program may suggested to be one of the ideal training methods for enhancing and the convergence positive effect of bone mineral density and body compositions in intellectual and normal person.

• The Journal of Korean Physical Therapy
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• v.23 no.1
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• pp.21-28
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• 2011

Purpose: The aim of this study was to investigate correlations between the Functional Movement Screen (FMS), pain, and performance ability in professional fencing players. Methods: Fifty-six athletes participated in this study. The pain group included those who had a score on a pain-related Visual Analogue Scale (VAS) of ${\geq}$20 and an Oswestry Disability Index (ODI) score ${\geq}$10). In the non-pain group, these scores were: VAS(<20), ODI(<10). The VAS and ODI were used to measure pain throughout the study. Performance ability included motor function of the lower extremities (as assessed by a Modified Functional Index Questionnaire, MFIQ), dynamic balance (Balance system, BS and Posture med, PM), flexor and extensor muscle strength of the lumbar region was recorded as maximal isometric strength. Results: Among athletes who had pain, 5 of 15(33.33%) showed impaired functional movement. Conversely, only 2 of 41(4.88%) of those who had no pain showed such impairment (FMS ${\leq}$14score). The athletes who had pain and who had an FMS score above 14 (10/56; 17.86%) showed a significantly higher score for extensor muscle strength of the lumbar compared with those with pain and an FMS score below 14 (5/56; 8.93%) were significant correlations between the FMS and pain (r=-0.40 to -0.42, p<0.01), the MFIQ (r=-0.33, p<0.05), dynamic balance (r=-0.27 to -0.40, p<0.05-0.01), muscle strength of the lumbar (r=0.27 to 0.29, p<0.05). Stepwise multiple regression analysis showed that the dynamic balance score (${\beta}{\beta}$=-0.41) had slightly more power in predicting FMS score than pain, motor function of lower extremity, or muscle strength. Conclusion: The FMS was significantly associated with values of pain, motor function of the lower extremities, dynamic balance, and muscle strength of the lumbar. However the FMS appears to lack relevance and reasonable evidence to suggest that it is an acceptable measurement tool for functional movement analysis.

• Journal of Korean Neurosurgical Society
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• v.62 no.4
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• pp.422-431
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• 2019

Objective : In an aging society, the number of patients with symptomatic degenerative spondylolisthesis (DS) is increasing and there is an emerging need for fusion surgery. However, few studies have compared transforaminal lumbar interbody fusion (TLIF) and lateral lumbar interbody fusion (LLIF) for the treatment of patients with DS. The purpose of this study was to investigate the clinical and radiological outcomes between TLIF and LLIF in DS. Methods : We enrolled patients with symptomatic DS at L4-5 who underwent TLIF with open pedicle screw fixation (TLIF group, n=41) or minimally invasive LLIF with percutaneous pedicle screw fixation (LLIF group, n=39) and were followed-up for more than one year. Clinical (visual analog scale and Oswestry disability index) and radiological outcomes (spondylolisthesis rate, segmental sagittal angle [SSA], mean disc height [MDH], intervertebral foramen height [FH], cage subsidence, and fusion rate) were assessed. And we assessed the changes in radiological parameters between the postoperative and the last follow-up periods. Results : Preoperative radiological parameters were not significantly different between the two groups. LLIF was significantly superior to TLIF in immediate postoperative radiological results, including reduction of spondylolisthesis rate (3.8% and 7.2%), increase in MDH (13.9 mm and 10.3 mm) and FH (21.9 mm and 19.4 mm), and correction of SSA ($18.9^{\circ}$ and $15.6^{\circ}$) (p<0.01), and the changes were more stable from the postoperative period to the last follow-up (p<0.01). Cage subsidence was observed significantly less in LLIF (n=6) than TLIF (n=21). Fusion rate was not different between the two groups. The clinical outcomes did not differ significantly at any time point between the two groups. Complications were not statistically significant. However, TLIF showed chronic mechanical problems with screw loosening in four patients and LLIF showed temporary symptoms associated with the surgical approach, such as psoas and ileus muscle symptoms in three and two cases, respectively. Conclusion : LLIF was more effective than TLIF for spondylolisthesis reduction, likely due to the higher profile cage and ligamentotactic effect. In addition, LLIF showed mechanical stability of the reduction level by using a cage with a larger footprint. Therefore, LLIF should be considered a surgical option before TLIF for patients with unstable DS.

• The Journal of Churna Manual Medicine for Spine and Nerves
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• v.16 no.2
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• pp.79-86
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• 2021

Objectives This study aimed to assess the role of complex Korean medicinal treatment with Chuna manual therapy in two patients with chronic pain after posterior lumbar fusion surgery. Methods A retrospective analysis was performed on 2 patients postoperatively based on their medical records. The surgery regions were verified using T2-weighted axial magnetic resonance imaging. Patients with chronic pain after spondylolisthesis posterior lumbar fusion surgery received complex Korean medicinal treatment with Chuna manual therapy during hospitalization. Numeric rating scale (NRS) in the degree of 0-10 and Oswestry disability index (ODI) were measured before and after treatment. Results Case 1 had an improved NRS score from 7 to 4, and Case 2 had an improved NRS score from 7 to 5. In addition, ODI score improved in both cases. Conclusions Complex Korean medicinal treatment with Chuna manual therapy is effective for relief from chronic pain after posterior lumbar fusion surgery.

• Journal of Korean Physical Therapy Science
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• v.18 no.2
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• pp.1-8
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• 2011

Background: The purpose of this study was to systematic review the effect of exercise programs for chronic low back pain patients. We needs systematic development of low back pain exercise program to reduce economic cost further doing great service to public health promotion. Methods: We searched to the effects of exercise programs for chronic low back pain patients by Dankook University electronic library databases of DBPIA, KSI KISS, CINAHL, MEDLINE and PEDro combined with a hand search of papers published in relevant journals. Any type of study relevant to the topic published during time period from 1970 to 2007 was included. Results: The literature search identified 30 studies. 1.Performing the flexion exercise increased abdominal muscle activity but acute herniated intervertebral disc should be avoided. 2.The general lumbar extension exercise used lumbar extension machine and the muscle power increases, significant probability the change. 3.The spinal segments exercise for the patients offered significant efficacy and appeared to be a reasonable therapeutic option. 4.Spinal stabilization exercises appear to improve trunk endurance and balance to patients with chronic low back pain. This exercise programs had effective decrease pain and disability. Conclusion: The review suggests that although the exercise programs for chronic low back pain patients, and we expected the efficacy of the exercise programs for chronic low back pain patients used in this study should be further investigated in a long period study and objective outcomes.

• Journal of Acupuncture Research
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• v.26 no.1
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• pp.59-66
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• 2009

Objectives : This study was designed to evaluate clinical effects of Hua-Tuo-Jia-Ji-Xue acupuncture to the patients with herniation of nucleus pulposus(HNP) of lumbar. Methods : Total of 40 patients with HNP of lumbar were participated in this study. We divided them into two group; A group using conventional acupuncture and B group using conventional acupuncture and Hua-Tuo-Jia-Ji-Xue acupuncture at the same time. All the subjects were asked to complete the VAS(visual analogue scale) and ODI(Oswestry disability index) before and after treatment. Results : Both A and B group represented effective improvement in VAS and ODI. And, B group is more effective than A group statistically. Conclusions : A comparision of VAS and ODI results of the two groups show that Hua-Tuo-Jia-Ji-Xue acupuncture trement can give be more effective method on lumbago patients, if it is added conventional acupuncture. Further clinical studies are needed to verify these findings.

• Journal of Korean Neurosurgical Society
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• v.59 no.6
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• pp.610-614
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• 2016

Objective : The purpose of this study was to present the outcome of the microsurgical foraminotomy via Wiltse paraspinal approach for foraminal or extraforaminal (FEF) stenosis at L5-S1 level. We investigated risk factors associated with poor outcome of microsurgical foraminotomy at L5-S1 level. Methods : We analyzed 21 patients who underwent the microsurgical foraminotomy for FEF stenosis at L5-S1 level. To investigate risk factors associated with poor outcome, patients were classified into two groups (success and failure in foraminotomy). Clinical outcomes were assessed by the visual analogue scale (VAS) scores of back and leg pain and Oswestry disability index (ODI). Radiographic parameters including existence of spondylolisthesis, existence and degree of coronal wedging, disc height, foramen height, segmental lordotic angle (SLA) on neutral and dynamic view, segmental range of motion, and global lumbar lordotic angle were investigated. Results : Postoperative VAS score and ODI improved after foraminotomy. However, there were 7 patients (33%) who had persistent or recurrent leg pain. SLA on neutral and extension radiographic films were significantly associated with the failure in foraminotomy (p<0.05). Receiver-operating characteristics curve analysis revealed the optimal cut-off values of SLA on neutral and extension radiographic films for predicting failure in foraminotomy were $17.3^{\circ}$ and $24^{\circ}s$, respectively. Conclusion : Microsurgical foraminotomy for FEF stenosis at L5-S1 level can provide good clinical outcomes in selected patients. Poor outcomes were associated with large SLA on preoperative neutral (>$17.3^{\circ}$) and extension radiographic films (>$24^{\circ}$).

• Journal of Korean Neurosurgical Society
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• v.42 no.1
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• pp.6-10
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• 2007

Objective : The purpose of this study was to determine the effect of bone cement augmentation of pedicular screwing in severe osteoporotic spondylolisthetic patients. Methods : Twenty patients with spondylolisthesis (8 : spondylolytic spondylolisthesis 12 : degenerative spondylolisthesis) who had undergone pedicular screwing and interbody fusion for osteoporotic lumbar spine (T-score on bone mineral density<-3.0) from 2002 to 2005 were reviewed. Mean age was 62.3 years with 3 male and 17 female patients. Average follow-up period was 14 months. Average T-score on bone mineral density (BMD) was -3.62. After decompression of neural elements, about 6cc of polymethylmethacrylate (PMMA) was injected into the each vertebral body through transpedicular route. All patients underwent one level interbody fusion and pedicular screw fixation. Clinical outcome was assessed using Oswestry Disability Index (ODI) on the last clinical follow-up. In addition, a modified MacNab's grading criteria was used to objectively assess patient's outcome postoperatively. Radiographic analysis of sagittal contour was assessed preoperatively, immediately postoperatively, and at final follow-up including fusion rate. Results : Eighteen of 20 patients were graded as excellent or good according to the modified MacNab's criteria. An significant improvement of ODI was achieved in both groups. Mean sagittal angle at the preoperative state, postoperative state and at the last follow-up state was $11.0^{\circ},\;20.1^{\circ}$ and $18.3^{\circ}$, respectively, with mean sagittal angle correction gain $7.3^{\circ}$. Firm fusion was achieved in all patients. There were one compression fracture above the fused segment after 6 months follow-up and one case of seroma. But there were no postoperative complications related to bone cement leakage and pedicular screwings such as screw pullout or screw cut-up. Conclusion : Bone cement augmentation of pedicular screwing can be an effective procedure for osteoporotic lumbar spine in spondylolisthetic patients.