• Journal of Korean Society of Spine Surgery
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• v.25 no.4
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• pp.175-179
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• 2018

Study Design: Case report. Objectives: We report 3 cases of loss of disc height after spontaneous regression of a herniated lumbar disc. Summary of Literature Review: Reports of spontaneous regression of a herniated lumbar disc were identified. Materials and Methods: We conservatively treated 3 patients who were diagnosed with a herniated lumbar disc. During outpatient follow-up, radiating pain improved in all patients, but they complained of chronic lower back pain. Magnetic resonance imaging (MRI) was performed for diagnostic purposes. Results: On MRI, spontaneous regression of the herniated lumbar discs was observed, but loss of disc height was also found. Conclusions: A herniated lumbar disc may be a risk factor for loss of disc height. It is important to recognize that a patient with a herniated lumbar disc can struggle with chronic lower back pain even if spontaneous regression of the herniated lumbar disc occurs.

• Journal of Korean Neurosurgical Society
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• v.39 no.6
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• pp.413-418
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• 2006

Objective : The objective of this study is to evaluate and compare the clinical results between classical open surgery and percutaneous endoscopic lumbar discectomy[PELD] in cases of extraforaminal lumbar disc herniation. Methods : We obtained the clinical data from 47 patients with extraforaminal lumbar disc herniations who underwent the open paramedian muscle-splitting approach or percutaneous endoscopic lumbar discectomy[PELD] between January 2001 and February 2004. This study consisted of patients with soft disc extraforaminal herniations. The patients were assessed with the visual analogue scale[VAS] and MacNab's criteria before surgery, just before discharge, and postoperative 1 year. Results : There were 25 cases in the open surgery group and 22 cases in the PELD group. The average operating time was $78{\pm}36.71\;min$ in the PELD group and $110{\pm}29.68\;min$ in the open surgery group. The mean hospital stay was $2.73{\pm}2.62$ days in the PELD group and $7.68{\pm}2.59$ days in the open surgery group. VAS decreased from $8.34{\pm}0.66$ to $1.29{\pm}2.27$ in the PELD group and from $8.40{\pm}1.40$ to $1.70{\pm}1.72$ in the open surgery group at the one-year follow-up. The success rate of PELD was 86.4%, compared with 80.0% for open surgery. However, there were no statistically significant difference between two groups for success rate and VAS. Conclusion : Although the success rates were similar in both groups, PELD is less invasive, faster, and safe procedure than open surgery for extraforaminal disc herniation in selected patients.

• Journal of Korean Neurosurgical Society
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• v.60 no.5
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• pp.485-497
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• 2017

Surgical treatment of the degenerative disc disease has evolved from traditional open spine surgery to minimally invasive spine surgery including endoscopic spine surgery. Constant improvement in the imaging modality especially with introduction of the magnetic resonance imaging, it is possible to identify culprit degenerated disc segment and again with the discography it is possible to diagnose the pain generator and pathological degenerated disc very precisely and its treatment with minimally invasive approach. With improvements in the optics, high resolution camera, light source, high speed burr, irrigation pump etc, minimally invasive spine surgeries can be performed with various endoscopic techniques for lumbar, cervical and thoracic regions. Advantages of endoscopic spine surgeries are less tissue dissection and muscle trauma, reduced blood loss, less damage to the epidural blood supply and consequent epidural fibrosis and scarring, reduced hospital stay, early functional recovery and improvement in the quality of life & better cosmesis. With precise indication, proper diagnosis and good training, the endoscopic spine surgery can give equally good result as open spine surgery. Initially, endoscopic technique was restricted to the lumbar region but now it also can be used for cervical and thoracic disc herniations. Previously endoscopy was used for disc herniations which were contained without migration but now days it is used for highly up and down migrated disc herniations as well. Use of endoscopic technique in lumbar region was restricted to disc herniations but gradually it is also used for spinal canal stenosis and endoscopic assisted fusion surgeries. Endoscopic spine surgery can play important role in the treatment of adolescent disc herniations especially for the persons who engage in the competitive sports and the athletes where less tissue trauma, cosmesis and early functional recovery is desirable. From simple chemonucleolysis to current day endoscopic procedures the history of minimally invasive spine surgery is interesting. Appropriate indications, clear imaging prior to surgery and preplanning are keys to successful outcome. In this article basic procedures of percutaneous endoscopic lumbar discectomy through transforaminal and interlaminar routes, percutaneous endoscopic cervical discectomy, percutaneous endoscopic posterior cervical foraminotomy and percutaneous endoscopic thoracic discectomy are discussed.

• Journal of Korean Neurosurgical Society
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• v.54 no.5
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• pp.379-383
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• 2013

Objective : There are differences in the clinical characteristics and surgical results between upper (L1-2 and L2-3) and lower (L3-4, L4-5, and L5-S1) lumbar disc herniations. We conducted this study to compare the clinical features and surgical outcomes between the two types of lumbar disc herniations. Methods : We retrospectively reviewed the clinical features of patients who underwent microdiscectomies from 2008 to 2012. We evaluated the clinical characteristics such as age, preoperative autonomic dysfunction, the presence or absence of previous lumbar surgery and fusion required during surgery. Visual Analogue Scale (VAS) scores about back pain and leg pain were evaluated preoperatively and at the final follow-up. Results : Upper lumbar group (n=15) was significantly older than lower lumbar group (n=148). The incidence of autonomic dysfunction was significantly higher in upper lumbar group. The number of patients with a previous lumbar surgery was significantly greater in upper lumbar group. There was no statistical significance for fusion required during surgery between two groups. Both groups showed a significant decrease in the VAS scores of leg pain. VAS scores of back pain were significantly decreased in lower lumbar group. But this was not seen in upper lumbar group. Both groups showed significant improvement of Oswestry Disability Index score. Conclusion : Upper lumbar group had different clinical characteristics from those of lower lumbar group and these include older age, a higher incidence of autonomic dysfunctions and a higher incidence of patients with previous lumbar surgery. There were no significant differences in surgical outcomes, except for back pain, between two groups.

• The Journal of Korean Physical Therapy
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• v.21 no.3
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• pp.95-102
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• 2009

Purpose: This study evaluates MCP-1 expression in the dorsal horn of a rat model of lumbar disc herniation by an autograft of the nucleus pulposus to the spinal nerve. Methods: After a coccygeal nucleus pulposus graft to the left $5^{th}$ lumbar spinal nerve, proximal to dorsal root ganglion, mechanical allodynia and thermal hyperalgesia were assessed 1 day before surgery, and 1, 10, 20, 30 days after surgery. The mRNA of MCP-1 in the dorsal horn was assessed by real time PCR to compare the temporal pattern of neuropathic pain of the lumbar disc herniation model. Results: In the ipsilateral side of the lumbar disc herniation models, mechanical allodynia and thermal hyperalgesia reached a maximum at 10 days after surgery with significant difference from the control group. Pain was also provoked in the contralateral side of the lumbar disc herniation models with less intensity than the ipsilateral side. The level of MCP-1 mRNA expression in the dorsal horn reached a peak at 20 days after surgery. Conclusion: Mechanical allodynia and thermal hyperalgesia was induced by nucleus pulposus in a rat lumbar disc herniation model, similar to a previously reported peripheral nerve injury model. The level of MCP-1 expression was higher in the dorsal horn of the ipsilateral and contralateral sides. These results suggest that MCP-1 might play a role in the maintenance of neuropathic pain.

• Journal of Korean Neurosurgical Society
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• v.46 no.3
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• pp.261-264
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• 2009

Vascular injury during lumbar disc surgery is a rare but potentially life-threatening complication. It has been managed by open vascular surgical repair. With recent technologic advance, endovascular treatment became one of effective treatment modalities. We present a case of a 32-year-old woman who suffered with common iliac artery injury during lumbar disc surgery that was treated successfully by endovascular repair with temporary balloon occlusion and subsequent insertion of a covered stent. Temporary balloon occlusion for 1.5 hours could stop bleeding, but growing pseudoaneurysm was identified at the injury site during the following 13 days. It seems that the temporary balloon occlusion can stall bleeding from arterial injury for considerable time duration, but cannot be a single treatment modality and requires subsequent insertion of a covered stent.

• The Korean Journal of Pain
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• v.18 no.1
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• pp.34-38
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• 2005

Background: Over the years, disc surgery has progressively evolved in the direction of decreasing trauma and its invasiveness. Conventional open surgery has many complications, such as scarring, instability, bleeding and a relative high mortality rate. Minimally invasive spinal surgery is now an alternative to a traditional discectomy. Herein, we present an operative technique, and the early results, for a percutaneous endoscopic lumbar discectomy in herniated lumbar disc disease. Methods: 43 patients, including 27 men and 16 women, with ages ranging from 18 to 66 years, were enrolled in this study. All the patients showed a protruded or extruded soft disc herniation at the lumbar level on magnetic resonance imaging and computed tomography. A percutaneous endoscopic lumbar discectomy was applied to the patients, and clinical responses evaluated using MacNab's criteria. Results: 40 patients were regarded as showing successful responses (93.1%), and there were no severe complications, such as a hematoma, nerve injury, postoperative dysesthesia or death. One patient underwent fusion surgery for remnant back pain six month later. Conclusions: We conclude that, in properly selected patients, a percutaneous endoscopic lumbar discectomy is a safe, noninvasive and effective treatment modality for herniated lumbar intervertebral disc disease.

• Journal of Chest Surgery
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• v.17 no.2
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• pp.315-320
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• 1984

A vascular complication caused by lumbar disc surgery is not infrequent till recently after the report by Linton and White in 1945. Thereafter, many reports about the accidental injuries to the great vessels anterior to the lumbar area had been reported. In June, 1982, we experienced one case of arteriovenous fistula between right common lilac artery and inferior vena cava which was corrected surgically. The arteriovenous fistula caused by lumbar disc surgery and its review of the literature and presented.

• Journal of Korean Neurosurgical Society
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• v.30 no.sup2
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• pp.242-246
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• 2001

Objective : The short hospitalization or outpatient care for patients undergoing laminectomy is not popular practice in Korea. We evaluated the clinical and economical significance of short hospitalization for patients undergoing microdiscectomy for their lumbar disc herniation. Material and Methods : From March 1999 to December 2000, patients were hospitalized for intended short period hospitalization for lumbar disc surgery. Their radiological and clinical data were analyzed for their clinical and economical results. We compared these data with 20 patients who hospitalized conventionally. Results : Total of 64 patients were evaluated. Three were lost to follow-up. Mean postoperative hospitalization period is 2.0 days(excluding one patient). Excellent to good outcome was achieved in 90.6 % of the patients. They payed about half expenses for hospitalization compared with conventional group. Their mean number of outpatient visit was 3.0. Conclusion : Short hospitalization for lumbar disc surgery is an acceptable option in Korea. It is also economically beneficial while achieving acceptable clinical results.

• Journal of Korean Orthopaedic Sports Medicine
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• v.11 no.1
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• pp.66-68
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• 2012

Lumbar disc herniation in the adolescent is rare. The clinical features of adolescent lumbar disc herniation are typically different from those of adults. Many adolescent with that disease may be misdiagnosed as minor trauma, muscle sprain, tight hamstrings or scoliosis. Published series reiterate that adolescents, as opposed to adults, do not respond well to conservative treatment. In adolescent lumbar disc herniation with hamstring tightness, the neurologic defects are improved shortly after, discectomy, but the hamstring tightness continue and remain even after 1 year. Earlier discectomy and adjunct postsurgical conservative measures can provide a greater opportunity for correction and stabilization of scoliotic posture. We here report on a case of adolescent lumbar disc herniation that was misdiagnosed by knee injury during 2 years. After posterior partial discectomy, the hamstring tightness and scoliosis was disappeared without complication.