• Journal of Korean Neurosurgical Society
• /
• v.51 no.4
• /
• pp.208-214
• /
• 2012

Objective : Discal cyst is rare and causes indistinguishable symptoms from lumbar disc herniation. The clinical manifestations and pathological features of discal cyst have not yet been completely known. Discal cyst has been treated with surgery or with direct intervention such as computed tomography (CT) guided aspiration and steroid injection. The purpose of this study is to evaluate the safety and efficacy of the percutaneous endoscopic surgery for lumbar discal cyst over at least 6 months follow-up. Methods: All 8 cases of discal cyst with radiculopathy were treated by percutaneous endoscopic surgery by transforaminal approach. The involved levels include L5-S1 in 1 patient, L3-4 in 2, and L4-5 in 5. The preoperative magnetic resonance imaging and 3-dimensional CT with discogram images in all cases showed a connection between the cyst and the involved intervertebral disc. Over a 6-months period, self-reported measures were assessed using an outcome questionaire that incorporated total back-related medical resource utilization and improvement of leg pain [visual analogue scale (VAS) and Macnab's criteria]. Results : All 8 patients underwent endoscopic excision of the cyst with additional partial discectomy. Seven patients obtained immediate relief of symptoms after removal of the cyst by endoscopic approach. There were no recurrent lesions during follow-up period. The mean preoperative VAS for leg pain was $8.25{\pm}0.5$. At the last examination followed longer than 6 month, the mean VAS for leg pain was $2.25{\pm}2.21$. According to MacNab' criteria, 4 patients (50%) had excellent results, 3 patients (37.5%) had good results; thus, satisfactory results were achieved in 7 patients (87.5%). However, one case had unsatisfactory result with persistent leg pain and another paresthesia. Conclusion : The radicular symptoms were remarkably improved in most patients immediately after percutaneous endoscopic cystectomy by transforaminal approach.

• Journal of Korean Neurosurgical Society
• /
• v.48 no.6
• /
• pp.547-550
• /
• 2010

Spinal cysticercosis is a very uncommon manifestation of neurocysticercosis which is caused by the larvae of Taenia solium. However, it can develop as a primary infection through blood stream or direct larval migration. It can result in high recurrence and severe neurologic morbidity if not treated appropriately. We report the case of a 43-year-old woman who presented with severe lower back pain and left leg radiating pain in recent 2 weeks. Magnetic resonance image (MRI) of lumbar spine demonstrated extruded disc at the L5-S1 level combined with intradural extramedullary cystic lesion. We performed the open lumbar microdiscectomy (OLM) at L5-S1 on the left with total excision of cystic mass. After surgery, the patient showed an improvement of previous symptoms. Diagnosis was confirmed by histopathological examination as intradural extramedullary cysticercosis. We discuss clinical features, diagnostic screening, and treatment options of spinal cysticercosis.

• Journal of Korean Neurosurgical Society
• /
• v.48 no.6
• /
• pp.501-505
• /
• 2010

Objective : This study was undertaken to compare the diagnostic performances of magnetic resonance imaging (MRI), MR myelography (MRM) and myelography in young soldiers with a herniated lumbar disc (HLD). Methods : Sixty-five male soldiers with HLD comprised the study cohort. A visual analogue scale for low back pain (VAS-LBP), VAS for leg radiating pain (VAS-LP), and Oswestry disability index (ODI) were applied. Lumbar MR, MRM, and myelographic findings were checked and evaluated by four independent radiologists, respectively. Each radiologist was asked to score (1 to 5) the degree of disc protrusion and nerve root compression using modified grading systems devised by the North American Spine Society and Pfirrmann and the physical examination rules for conscription in the Republic of Korea. Correlated coefficients between clinical and radiological factors were calculated. Interpretational reproducibility between MRI and myelography by four bases were calculated and compared. Results : Mean patient age was $20.5{\pm}1.1$. Mean VAS-LBP and VAS-LP were $6.7{\pm}1.6$ and $7.4{\pm}1.7$, respectively. Mean ODI was $48.0{\pm}16.2%$. Mean MRI, MRM, and myelography scores were $3.3{\pm}0.9$, $3.5{\pm}1.0$, and $3.9{\pm}1.1$, respectively. All scores of diagnostic performances were significantly correlated (p < 0.05). However, none of these scores reflected the severity of patients' symptoms. There was no statistical difference of interpretational reproducibility between MRI and myelography. Conclusion : Although MRI and myelography are based on different principles, they produce similar interpretational reproducibility in young soldiers with a HLD. However, these modalities do not reflect the severity of symptoms.

• Journal of Korean Neurosurgical Society
• /
• v.51 no.3
• /
• pp.182-186
• /
• 2012

In conventional percutaneous disc surgery, introducing instruments into disc space starts by inserting a guide needle into the triangular working zone. However, landing the guide needle tip on the annular window is a challenging step in endoscopic discectomy. Surgeons tend to repeat the needling procedure to reach an optimal position on the annular target. Obturator guiding technique is a modification of standard endoscopic lumbar discectomy, in which, obturator is used to access triangular working zone instead of a guide needle. Obturator guiding technique provides more vivid feedback and easy manipulation. This technique decreases the steps of inserting instruments and takes safer route from the peritoneum.

• Journal of Korean Neurosurgical Society
• /
• v.53 no.1
• /
• pp.52-56
• /
• 2013

Four patients underwent lumbar surgery. In all four patients, the dura was minimally torn during the operation. However, none exhibited signs of postoperative cerebrospinal fluid leakage. In each case, a few days after the operation, the patient suddenly experienced severe recurring pain in the leg. Repeat magnetic resonance imaging showed transdural nerve rootlets entrapped in the intervertebral disc space. On exploration, ventral dural tears and transdural nerve rootlet entrapment were confirmed. Midline durotomy, herniated rootlet repositioning, and ventral dural tear repair were performed, and patients' symptoms improved after rootlet repositioning. Even with minimal dural tearing, nerve rootlets may become entrapped, resulting in severe recurring symptoms. Therefore, the dural tear must be identified and repaired during the first operation.

• Journal of Korean Neurosurgical Society
• /
• v.59 no.2
• /
• pp.172-181
• /
• 2016

To describe the details of the foraminoplastic superior vertebral notch approach (FSVNA) with reamers in percutaneous endoscopic lumbar discectomy (PELD) and to demonstrate the clinical outcomes in limited indications of PELD. Retrospective data were collected from 64 patients who underwent PELD with FSVNA from August 2012 to April 2014. Inclusion criteria were high grade migrated disc, high canal compromised disc, and disc protrusion combined with foraminal stenosis. The clinical outcomes were assessed using by the visual analogue scale (VAS), Oswestry Disability Index (ODI) and modified MacNab criteria. Complications related to the surgery were reviewed. The procedure used a unique approach, using the superior vertebral notch as the target and performing foraminoplasty with only reamers under C-arm control. The mean age of the 55 female and 32 male patients was 52.73 years. The mean F/U period was $12.2{\pm}4.2$ months. Preoperative VAS ($8.24{\pm}1.25$) and ODI ($67.8{\pm}15.4$) score improved significantly at the last follow-up (VAS, $1.93{\pm}1.78$; ODI, $17.14{\pm}15.7$). Based on the modified MacNab criteria, excellent or good results were obtained in 95.3% of the patients. Postoperative transient dysthesia (n=2) and reoperation (n=1) due to recurred disc were reported. PELD with FSVNA could be a good method for treating lumbar disc herniation. This procedure may offer safe and efficacious results, especially in the relatively limited indications for PELD.

• Journal of Korean Neurosurgical Society
• /
• v.39 no.1
• /
• pp.40-45
• /
• 2006

Objective : To determine the relationship between the clinical outcome and the extent of surgical laminectomy for adequate decompression on the cases of cauda equina syndrome, the authors review and analyze their cases and compared with those of literatures. Methods : The authors reviewed 655 patients retrospectively who had underwent surgery on the cases of lumbar disc herniation from January 2000 to December 2004. There were 19 patients [2.9%] who presented for clinical cauda equina syndrome. Among them, we selected and analyzed 15 patients who were treated by unilateral partial hemilaminectomy with discectomy or bilateral partial laminectomy with discectomy, and they had been followed from 5 weeks to 47 months postoperatively [mean, 13.47 months]. The levels of the disc herniations were L4-5 in 8 patients, following L5-S1 in 4 patients and 2 levels [L4-5 and L5-S1] in 3 patients. Motor and sensory recoveries were recorded. Postoperative urinary function recovery Was defined according to Gleave and Macfarlane. Results : In 12 months postoperatively, the bladder function was obtained in 14 of 15 patients[93%] with regaining urinary continence. Thirteen of 15 patients[86%] with preoperative motor weakness of lower extremities were recovered. Sensory deficit of lower extremities, perianal and saddle anesthesia were all recovered. Patients had recovered on lumbosciatic pain and saddle hypesthesia, in turn, motor function and urinary incontinence. Conclusion : In treating cauda equina syndrome, the authors did less extensive surgery, such as unilateral partial hemilaminectomy with discectomy or bilateral partial laminectomy with discectomy for adequate decompression. The outcome is satisfactory and comparable with those of subtotal or total laminectomy.

• The Journal of Korean Physical Therapy
• /
• v.22 no.3
• /
• pp.93-98
• /
• 2010

Purpose: To investigate temporal changes in IL-1${\beta}$ mRNA expression in spinal dorsal horn (DH) and dorsal root ganglion (DRG) in a rat lumbar disc herniation (LDH) model. Methods: Autologous nucleus pulposus, harvested from the tail disc between the second and third coccygeal vertebrae (Co2-3), was implanted next to the left L5 nerve root just proximal to the DRG after partial laminectomy. IL-1${\beta}$ mRNA expression was investigated in DRG and DH in our LDH model. Real-time PCR assays were done using a 7500 Real Time PCR system (Applied Biosystems, USA). Results: Expression of IL-1${\beta}$ in DRG and DH was observed for 30 days postoperatively. Expression of IL-1${\beta}$ mRNA in the ipsilateral DRG of the LDH group gradually increased from 5 to 30 days after surgery. The amount of IL-1${\beta}$ in the contralateral DRG peaked 10 days after surgery and then gradually decreased. However, there was no difference in IL-1${\beta}$ mRNA expression in spinal DH between the LDH group and the sham-operated group. Conclusion: Long-term expression of IL-1${\beta}$ in the LDH model may worsen the chronic pain state. Future studies on inhibition of IL-1${\beta}$ expression in the LDH model will be needed to develop selective treatment strategies for patients with LDH.

• Journal of Acupuncture Research
• /
• v.28 no.2
• /
• pp.173-181
• /
• 2011

Objectives : The purpose of this study is to report clinical effect of oriental meical for a not improved foot drop patient after herniated intervertebral lumbar disc surgery. Methods : The patient was treated using acupuncture, electroacupuncture, phamacopuncture treatment, herbal medication, moxibustion and physical treatment. And we measured of VAS, ROM of ankle and MMT. Results : After treatment, VAS, ROM of ankle and MMT were improved in case. Conclusions : Oriental medical treatment showed significant effect on patient that not improved foot drop after herniated intervertebral lumbar disc surgery.

• Asian Spine Journal
• /
• v.12 no.6
• /
• pp.973-980
• /
• 2018

Study Design: Retrospective review. Purpose: To identify the trends in stimulator use, pair those trends with various grafting materials, and determine the influence of stimulators on the risk of revision surgery. Overview of Literature: A large number of studies has reported beneficial effects of electromagnetic energy in healing long bone fractures. However, there are few clinical studies regarding the use of electrical stimulators in spinal fusion. Methods: We used insurance billing codes to identify patients with lumbar disc degeneration who underwent anterior lumbar interbody fusion (ALIF). Comparisons between patients who did and did not receive electrical stimulators following surgery were performed using logistic regression analysis, chi-square test, and odds ratio (OR) analysis. Results: Approximately 19% of the patients (495/2,613) received external stimulators following ALIF surgery. There was a slight increase in stimulator use from 2008 to 2014 (multi-level $R^2=0.08$, single-level $R^2=0.05$). Patients who underwent multi-level procedures were more likely to receive stimulators than patients who underwent single-level procedures (p<0.05; OR, 3.72; 95% confidence interval, 3.02-4.57). Grafting options associated with most frequent stimulator use were bone marrow aspirates (BMA) plus autograft or allograft for single-level and allograft alone for multi-level procedures. In both cohorts, patients treated with bone morphogenetic proteins were least likely to receive electrical stimulators (p<0.05). Patients who received stimulation generally had higher reimbursements. Concurrent posterior lumbar fusion (PLF) (ALIF+PLF) increased the likelihood of receiving stimulators (p<0.05). Patients who received electrical stimulators had similar revision rates as those who did not receive stimulation (p>0.05), except those in the multilevel ALIF+PLF cohort, wherein the patients who underwent stimulation had higher rates of revision surgery. Conclusions: Concurrent PLF or multi-level procedures increased patients' likelihood of receiving stimulators, however, the presence of comorbidities did not. Patients who received BMA plus autograft or allograft were more likely to receive stimulation. Patients with and without bone stimulators had similar rates of revision surgery.