• Journal of Acupuncture Research
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• v.33 no.1
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• pp.103-116
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• 2016

Objectives : This study was performed to assess the effectiveness of conservative Korean traditional medical treatment on lumbar intervertebral disc herniation in 12 adolescents. Methods : Data were collected from adolescent patients diagnosed with lumbar intervertebral herniation by MRI, hospitalized at Jaseng Korean Medicine Hospital from January 1, 2014 to December 31, 2015. A total of 12 patients were included in the study. Patients were treated by acupuncture, pharmacopuncture, electroacupuncture, herbal medicine, chuna manual therapy, physical therapy during hospitalization period. To measure treatment outcomes, a verbal numerical rating scale (VNRS), Oswestry disability index (ODI), range of motion (ROM), Straight leg raising test (SLR), and EQ-5D were used. Results : The average age of the participants was $16.05{\pm}1.62$. The average of duration of symptom was $19.25{\pm}26.83(weeks)$ and the average length of hospitalization was $23.8{\pm}16.4(days)$. 2 patients (17 %) suffered from only lumbar pain, while 10 patients (83 %) suffered from lumbar and leg pain. No participant suffered from only leg pain. 8 patients (67 %) were diagnosed with disc herniation in one segment, and 4 patients (33 %) were diagnosed with disc herniation in multiple segments. A total of 17 disc segments (28 %) were herniated. The most herniated lumbar level was L4-5. 3 segments were diagnosed with bulging (17 %), 6 with protrusion (35 %), and 8 with extrusion (47 %). Extrusion was the most frequent herniated type. After treatment, the average VNRS of lumbar pain significantly decreased from $5.58{\pm}1.62$ to $2.91{\pm}1.56$ (p<0.001) and the average VNRS of leg pain significantly decreased from $5.16{\pm}2.51$ to $3.08{\pm}1.8$ (p<0.001). ODI significantly decreased from $48.87{\pm}18.72$ to $28.57{\pm}15.05$ (p<0.05), and EQ-5D significantly increased $0.58{\pm}0.31$ to $0.80{\pm}0.12$ (p<0.05). Range of flexion significantly improved from $61.25{\pm}32.62$ to $68.33{\pm}26.22$ (p<0.05). Conclusion : Conservative Korean Traditional Medical Treatment may be effective in the treatment of lumbar intervertebral disc herniation in adolescence. However, more case reports and clinical research are needed.

• Journal of Korean Medicine Rehabilitation
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• v.26 no.1
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• pp.87-93
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• 2016

Objectives To analyze the resorption of herniated lumbar intervertebral disc on MRI in patients who were treated with Korean Medicine. Methods 78 patients with lumbar disc herniation were included, 47 males and 32 females. Patients' diagnosis was based on magnetic resonance imaging (MRI). All of the patients were only treated with Korean Medicine for 6 months treatment, and underwent MRI examination twice, pre-treatment and post-treatment. MR images were assessed by reduction in diameter of T2-weighted image between pre-treatment and post-treatment, and analyzed by differences in sex, age and disc type. Results 91.2% (71 people) of total patients had extrusion type. Korean medicine treatment reduced lumbar disc herniation diameter of all the patients from 7.11 mm to 3.67 mm on average (p<0.001). The reduction of diameter in the male group was 3.52 mm on average. The reduction of diameter in the female group was 3.32 mm on average. The reduction of diameter was 3.28 mm in the group below age 29, 3.88 mm in the 30~39 age group, 3.39 mm in the 40~49 age group, and 2.71 mm in the above 50 age group on average. Conclusions The MRI results suggest that lumbar herniated disc can resorb with Korean Medicine treatment. The likelihood of lumbar disc resorption was higher at extrusion type. but there was not a significant difference between the sexes and between ages.

• Journal of Korean Neurosurgical Society
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• v.30 no.sup2
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• pp.254-258
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• 2001

Objective : The terminology of degenerative disc disease lacks official standardization. Lacks of such standardization may provoke some clinical and litigation problems. The authors investigated interobserver and intraobserver variability in interpretation of lumbar disc abnormality. Methods : Magnetic resonance imaging studies of the lumbar spine performed prospectively in 50 patients, were read blindly by three doctors dealing spinal disorders, using two nomenclature. Nomenclature I was normal, bulging, protrusion, extrusion. Nomenclature II was normal, bulging, herniation without neural compression, with neural compression. Intraobserver and interobserver variation were measured statistically. Results : Interobserver agreement was 70.4-80.8% for nomenclature I, 76.2-80.2% for nomenclature II. Intraobserver agreement was 84.0-88.0% for nomenclature I, 79.2-86.8% for nomenclature II. Interobserver Kappa statistic was 0.53-0.56 for nomenclature I, 0.54-0.57 for nomenclature II. Intraobserver Kappa statistic was 0.60-0.85 for nomenclature I, 0.53-0.72 for nomenclature II. Conclusion : Experienced doctors showed only moderate interobserver agreement when interpreting disc status on lumbar magnetic resonance imaging. Intraobserver agreement was superior to interbserver. The standardization of nomenclatures for lumbar disc extension beyond interspace are needed.

• Journal of Korean Neurosurgical Society
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• v.62 no.6
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• pp.681-690
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• 2019

Objective : To determine whether the outcomes of percutaneous epidural neuroplasty (PEN) are influenced by the type of lumbar disc herniation (LDH) and evaluate the effectiveness of PEN in patients with single-level LDH. Methods : This study included 430 consecutive patients with single-level LDH who underwent PEN. Before treatment, the LDH type was categorized as bulging, protrusion, extrusion, and sequestration, while Pfirrmann grades were assigned according to imaging findings. Visual analog scale (VAS) scores for back and leg pain and success rates (Odom's criteria) were assessed at 1, 3, 6, and 12 months after treatment. Results : The mean preoperative VAS scores for back and leg pain were 6.90 and 4.23, respectively; these decreased after PEN as follows : 2.25 and 1.45, respectively, at 1 month; 2.61 and 1.68, respectively, at 3 months; 2.28 and 1.48, respectively, at 6 months; and 2.88 and 1.48, respectively, at 12 months (p<0.001). The decrease in VAS scores for leg pain was significantly greater in the extrusion and sequestration groups than in the other two groups (p<0.05); there were no other significant differences among groups. More than 70% patients exhibited good or excellent 12-month outcomes according to Odom's criteria. Subsequent surgery was required for 59 patients (13.7%), with a significantly higher rate in the extrusion (25.0%) and sequestration (30.0%) groups than in the bulging (7.3%) and protrusion (13.8%) groups (p<0.05). Nevertheless, subsequent surgery was not required for >70% patients with extrusion or sequestration. Patients with Pfirrmann grades 1-3 (14.0-21.5%) showed a significantly higher rate of subsequent surgery than those with Pfirrmann grade 0 (4.9%; p<0.05). Conclusion : Our findings suggest that PEN is an effective treatment for back and leg pain caused by single-level LDH, with the outcomes remaining unaffected by the LDH type.

• The Journal of Churna Manual Medicine for Spine and Nerves
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• v.2 no.1
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• pp.11-21
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• 2007

The object of this study is to report a clinical effect regarding the conservative treatment of the patients who were diagnosed as the herniated intervertebral lumbar disc(HIVD). The patients were treated by the oriental medical conservative treatment including acupunture, Bee venom therapy and Chu-na therapy. We estimated by visual analogue scale and pain rating score subjectively. And we examined the patients with SLR test and valsalva test. Oriental medical conservative treatment improved HIVD subjuctively and objectively.

• Journal of Korean Neurosurgical Society
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• v.38 no.5
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• pp.399-402
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• 2005

Direct anterior approach for lesions located anterior to the thecal sac is definitely superior to lateral or posterior approach in many respects. However, various anatomical obstacles and technical difficulties often hinder direct anterior approach. Thanks to ripe experience of retroperitoneal approach to the lumbar spine for anterior lumbar interbody fusion and total disc replacement, the authors could perform lumbar corpectomy and reconstruction by using midline retroperitoneal approach recently. During this approach, we repaired anterior longitudinal ligament also to reduce the risk of graft extrusion and to prevent erosion of vascular wall due to direct contact between metallic hardware, which was used for reconstruction of vertebral body, and major vessels.

• Journal of Trauma and Injury
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• v.31 no.1
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• pp.38-42
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• 2018

A case of surgically treated intervertebral disc extrusion with intraoperatively confirmed intradiscal hematoma in a 30-year-old physical trainer is presented. Preoperative magnetic resonance imaging revealed downward migrating disc herniation, without definite suggestive findings of intradiscal hematoma. Intervertebral disc herniation with concomitant intradiscal hematoma is extremely rare, but could occur in patients who have excessive axial stress to the spine occupationally. In our case, the patient was an occupational physical trainer who had repetitive minor trauma to the lumbar spine. Although the patient did not have any clear history of major trauma to the spine, the intraoperative findings revealed intradiscal hematoma, which is very rare. The presence of intradiscal hematoma is to be suspected even when preoperative imaging studies shows indefinite findings of hematoma, considering the change in signal intensity of hematoma by time.

• Journal of Acupuncture Research
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• v.24 no.5
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• pp.197-205
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• 2007

Objectives : Herniation of Nucleus Pulposus(HNP) of Lumbar is the most important that causes low back pain. The aim of this study is to compare several therapies about Lumbar spine Hearniated Nucleus Pulposus in oriental Medecine which are Bee-venom Acpuncture and Ouhyul Herbal Acpuncture. Methods: Subjects of this research were 60 inpatients complaining Herniation of Nucleus Pulposus, and who were diagnosed as bulging disc, disc protrusion or extrusion with CT & MRI. 20 patients in each, 3 groups; Acpuncture therapy only, Bee-venom Acpuncture, and Ouhyul Herbal Acpuncture, were divided and the conclusions for treatment are as follows. Results : 1. Regarding alleviation of pain by VAS, Ouhyul Herbal Acpuncture Group III showed significant decrease of VAS in the early period of admission(5days), while Bee-venom Acpuncture Group II showed higher score of VAS compared to Acpuncture therapy only Group I. 2. On contrary, in the latter period of admission($5{\sim}9days$), Bee-venom Acpuncture Group II showed significantly higher rate of improvement than the other groups. 3. On the 9th admission day, Bee-venom Acpuncture Group II and Ouhyul Herbal Acpuncture Group III showed higher improvement than Acpuncture therapy only Group I. Between group II and III, Group II showed higher improvement rate. Conclusions : In this study, there were different effects among three groups according to period of treatment. Further study on various traatment for Herniation of Nucleus Pulposus required.