• Journal of Korean Neurosurgical Society
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• v.60 no.6
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• pp.755-762
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• 2017

Objective : The purpose of this study is to describe the detailed surgical technique and short-term clinical and radiological outcomes of lateral lumbar interbody fusion (LLIF) and in situ lateral screw fixation using a conventional minimally invasive screw fixation system (MISF) for revision surgery to treat rostral lumbar adjacent segment disease. Methods : The medical and radiological records were retrospectively reviewed. The surgery was indicated in 10 consecutive patients with rostral adjacent segment stenosis and instability. After the insertion of the interbody cage, lateral screws were inserted into the cranial and caudal vertebra using the MISF through the same LLIF trajectory. The radiological and clinical outcomes were assessed preoperatively and at 1, 3, 6, and 12 months postoperatively. Results : The median follow-up period was 13 months (range, 3-48 months). Transient sensory changes in the left anterior thigh occurred in 3 patients, and 1 patient experienced subjective weakness; however, these symptoms normalized within 1 week. Back and leg pain were significantly improved (p<0.05). In the radiological analysis, both the segmental angle at the operated segment and anterior disc height were significantly increased. At 6 months postoperatively, solid bony fusion was confirmed in 7 patients. Subsidence and mechanical failure did not occur in any patients. Conclusion : This study demonstrates that LLIF and in situ lateral screw fixation may be an alternative surgical option for rostral lumbar adjacent segment disease.

• Journal of Korean Neurosurgical Society
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• v.62 no.2
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• pp.209-216
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• 2019

Objective : Hydatid cyst disease is caused by the parasite Echinococcus granulosus. It is rarely seen in the vertebral system, occurring at a rate of 0.2-1%. The aim of this study is to present 12 spinal hydatid cyst cases, and propose a new type of drainage of the cyst. Methods : Twelve cases of spinal hydatid cysts, surgical operations, multiple operations, chronic recurrences, and spinal hydatic cyst excision methods are discussed in the context of the literature. Patients are operated between 2005 and 2016. All the patients are kept under routine follow up. Patient demographic data and clinicopathologic characteristics are examined. Results : Six male and six female patients with a median age of 38.6 at the time of surgery were included in the study. Spinal cyst hydatid infection sites were one odontoid, one cervical, five thoracic, two lumbar, and three sacral. In all cases, surgery was performed, with the aim of total excision of the cyst, decompression of the spinal cord, and if necessary, stabilization of the spinal column. Mean follow up was 61.3 months (10-156). All the patients were prescribed Albendazole. Three patients had secondary hydatid cyst infection (one lung and two hepatic). Conclusion : The two-way drainage catheter placed inside a cyst provides post-operative chlorhexidine washing inside the cavity. Although a spinal hydatid cyst is a benign pathology and seen rarely, it is extremely difficult to achieve a real cure for patients with this disease. Treatment modalities should be aggressive and include total excision of cyst without rupture, decompression of spinal cord, flushing of the area with scolicidal drugs, and ensuring spinal stabilization. After the operation the patients should be kept under routine follow up. Radiological and clinical examinations are useful in spotting a recurrence.

• The Korean Journal of Pain
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• v.31 no.2
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• pp.87-92
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• 2018

Background: An epidural steroid injection (ESI) is a commonly administered procedure in pain clinics. An unintentional lumbar facet joint injection during interlaminar ESI was reported in a previous study, but there has not been much research on the characteristics of an unintentional lumbar facet joint injection. This study illustrated the imaging features of an unintentional lumbar facet joint injection during an interlaminar ESI and analyzed characteristics of patients who underwent this injection. Methods: From December 2015 to May 2017, we performed 662 lumbar ESIs and we identified 24 cases (21 patients) that underwent a lumbar facet joint injection. We gathered data contrast pattern, needle approach levels and directions, injected facet joint levels and directions, presence of lumbar spine disease as seen on magnetic resonance images (MRI), and histories of lumbar spine surgeries. Results: The contrast pattern in the facet joint has a sigmoid or ovoid contrast pattern confined to the vicinity of the facet joint. The incidence of unintentional lumbar facet joint injection was 3.6%. The mean age was 68.47 years. Among these 21 patients, 14 (66.7%) were injected in the facet joint ipsilaterally to the needle approach. Among the 20 patients who received MRI, all (100%) had central stenosis and 15 patients (75%) had severe stenosis. Conclusions: When the operator performs an interlaminar ESI on patients with central spinal stenosis, the contrast pattern on the fluoroscopy during interlaminar ESI should be carefully examined to distinguish between the epidural space and facet joint.

• Journal of Korean Neurosurgical Society
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• v.59 no.3
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• pp.276-281
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• 2016

Objective : Although trunk muscles in the lumbar spine preserve spinal stability and motility, little is known about the relationship between trunk muscles and spinal fusion rate. The aim of the present study is to evaluate the correlation between trunk muscles cross sectional area (MCSA) and fusion rate after posterior lumbar interbody fusion (PLIF) using stand-alone cages. Methods : A total of 89 adult patients with degenerative lumbar disease who were performed PLIF using stand-alone cages at L4-5 were included in this study. The cross-sectional area of the psoas major (PS), erector spinae (ES), and multifidus (MF) muscles were quantitatively evaluated by preoperative lumbar magnetic resonance imaging at the L3-4, L4-5, and L5-S1 segments, and bone union was evaluated by dynamic lumbar X-rays. Results : Of the 89 patients, 68 had bone union and 21 did not. The MCSAs at all segments in both groups were significantly different (p<0.05) for the PS muscle, those at L3-4 and L4-5 segments between groups were significantly different (p=0.048, 0.021) for the ES and MF muscles. In the multivariate analysis, differences in the PS MCSA at the L4-5 and L5-S1 segments remained significant (p=0.048, 0.043 and odds ratio=1.098, 1.169). In comparison analysis between male and female patients, most MCSAs of male patients were larger than female's. Fusion rates of male patients (80.7%) were higher than female's (68.8%), too. Conclusion : For PLIF surgery, PS muscle function appears to be an important factor for bone union and preventing back muscle injury is essential for better fusion rate.

• Journal of Biomedical Engineering Research
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• v.44 no.2
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• pp.139-146
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• 2023

Osteoporosis is a disease in which the risk of bone fractures increases due to a decrease in bone density caused by aging. Osteoporosis is diagnosed by measuring bone density in the total hip, femoral neck, and lumbar spine. To accurately measure bone density in the lumbar spine, the vertebral region must be segmented from the lumbar X-ray image. Deep learning-based automatic spinal segmentation methods can provide fast and precise information about the vertebral region. In this study, we used 695 lumbar spine images as training and test datasets for a deep learning segmentation model. We proposed a lumbar automatic segmentation model, CM-Net, which combines the center point of the spine and the modified U-Net network. As a result, the average Dice Similarity Coefficient(DSC) was 0.974, precision was 0.916, recall was 0.906, accuracy was 0.998, and Area under the Precision-Recall Curve (AUPRC) was 0.912. This study demonstrates a high-performance automatic segmentation model for lumbar X-ray images, which overcomes noise such as spinal fractures and implants. Furthermore, we can perform accurate measurement of bone density on lumbar X-ray images using an automatic segmentation methodology for the spine, which can prevent the risk of compression fractures at an early stage and improve the accuracy and efficiency of osteoporosis diagnosis.

• Journal of radiological science and technology
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• v.29 no.3
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• pp.157-165
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• 2006

In order to analyze clinical characteristics like sex- and age-based onset frequency and onset region from vertebral disease cases, this study investigated total 1,291 cases of vertebral disease that were diagnosed via magnetic resonance imaging(MRI) from January to December 2004 at B University Hospital in metropolitan area. For higher diagnostic accuracy in cases of spinal disorder diagnosed, this study analyzed findings from data reading conducted by veteran specialists in diagnostic radiology. But this study excluded uncertain lesion cases, the cases requiring differential diagnosis from other disorders and so on from subjects under analysis. This study employed superconductive 1.5 Tesla SIGNA MR/i for MRI test and basically received resulting images via FSE(fast spin echo). In particular, this study obtained T1 and T2 myelogram with regard to regional characteristics(such as cervical vertebrae, thoracic vertebrae and lumbar vertebra) and imaging characteristics for sagittal and transverse section. As a result, this study came to the following conclusions : 1. In terms of general characteristics of subjects under analysis, male group comprised 53.5% and female 46.5% out of total 1,291 subjects. 2. The regional onset frequency of spinal disorders was converged primarily on lumbar vertebra(65.5%), which was followed by cervical vertebrae(27.3%) and thoracic vertebrae(7.0%) respectively. 3. Top 10 cases with high onset frequency of spinal disorders can be listed as follows : 1) posterior bulging disc 65.8% 2) narrowing of neural foramen 23.8% 3) herniated intervertebral disc (HIVD) 22.4% 4) spinal stenosis 16.7% 5) osteochondrosis 6.4% 6) compression fracture 6.4% 7) facet joint arthropathy 6.2% 8) spondylolisthesis 6.0% 9) spinal cord tumor 3.5% 10) inter body fusion 2.6%

• Journal of Korean Neurosurgical Society
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• v.54 no.6
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• pp.521-524
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• 2013

Ependymoma can spread via cerebrospinal fluid, but late spinal recurrences of intracranial tumor are very rare. We describe a case of a 33-year-old male who presented with multiple, delayed, recurrent lesions in the spinal cord from an intracranial ependymoma. The patient underwent gross total resection and postoperative radiation therapy 14 years prior to visit for a low grade ependymoma in the 4th ventricle. The large thoraco-lumbar intradural-extramedullary spinal cord tumor was surgically removed and the pathologic diagnosis was an anaplastic ependymoma. An adjuvant whole-spine radiation therapy for residual spine lesions was performed. After completion of radiation therapy, a MRI showed a near complete response and the disease was stable for three years.

• Korean Journal of Acupuncture
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• v.27 no.4
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• pp.5-13
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• 2010

Objectives : Herniated lumbar intervertebral disc is common reason causing back pain. Lumbar stabilization exercise prevent back pain recurrence by strengthening lumbar muscles. Sling Exercise Therapy(SET) is a system for spinal muscle stabilization and strengthening using fixed string and mobile band. The purpose of this study is to investigate and measure the effectiveness of SET and oriental medicine for Herniated lumbar intervertebral disc. Methods : The subjects for this study are 40 patients suffering from Herniated lumbar intervertebral disc in our clinic. They were measured and compared by Visual Analogue Scale(VAS), 4 grades of recovery degree and sex, age, period of disease, disc herniation type, times of exercise. Results : In the above index, the score(VAS, 4 grades of recovery degree) improved after treatments. But they make no difference between sex, age, period of disease, disc herniation type and times of exercise. Conclusions : These results suggest that SET may be used for Herniated lumbar intervertebral disc for pain management and muscle strengthening as an essential treatment regardless of sex, age, period of disease and disc herniation type.

• Journal of Pharmacopuncture
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• v.7 no.2
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• pp.109-119
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• 2004

Objective : To broaden our understanding on occupational disease of market workers and to evaluate the effect of TKM treatment focusing on acupuncture and herb medicine and to promote base studies and clinical trials on occupational disease. Materials and Methods : Analysis was done on 33 Ga-Rak market workers' chart which had been selected through investigation of 1508 outpatient's chart of Kyung Won University Hospital from Jun. 1st, 2002 to May. 31th, 2003. Results : 1. Out of 33 patients, Men had more occupational diseases than women had and Most people were in their forties. 2. Major cause of the disease include repetitve bending, heavy weight lifting and overwork. 3. Past History of patients mostly include frequent lumbar sprain, periarthritis of shoulder, lumbar HNP 4. The patients with occupational disease were diagnosed as lumbar sprain, periarthritis of shoulder, lumbar HNP, degenerative spondylosis, spinal stenosis and their chief complaints were low back pain, omalgia, back pain with radicular pain. 5. The duration of treatment was mostly within a week. 6. Acupuncture, Bee Venom Acupuncture, moxibustion, Herb-medicine, extract, taping therapy, physical therapy were used as treatment methods. 7. Applied herb medicine were composed of 8 kinds of prescriptions and extract were made up of 6 prescriptions 8. Applied acupoints belonged mainly to 14 meridians 9. The treatment of herb medicine combined with acupuncture proved effective in treating the ocupational disease. Conclusion : The occupational disease of patients working in Ga-Rak market were closely related with overwork, especially with repetitive bending and heavy weight lifting and TKM treatment focusing on acupuncture combined with herb medicine was effective in treating occupational disease.

• Journal of Biomedical Engineering Research
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• v.32 no.3
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• pp.230-236
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• 2011

The aim of this study was to investigate the alteration of lumbar spine and trunk postures on different load-carrying types and amounts under static loading. Two load-carrying types(unilateral carrying: UC vs. bilateral carrying: BC) and four different loads(0, 5, 10, and 15 kg) were randomly tested in this study. Carrying a heavy bag would affect human body posture, specifically lumbar spine curvature, which is considered as one of sources of back problems. Previous studies have not paid attention to the approach of the multisegment model of the lumbar spine and trunk. This study separated two compartments of trunk segment(the lumbar and thorax) in the analysis. The multisegment model of the lumbar spine in addition to Helen-Hayes marker set was used. Eight motion analysis cameras and a force plate were utilized. Ten male subjects(mean mass, $70.6{\pm}3.97$ kg; mean height, $178{\pm}4.18$ m) having no musculoskeletal disease participated in this study. We analyzed trunk angles in three anatomical planes and the spinal curvature in sagittal and frontal planes. Increased loading in both UC and BC significantly resulted in increases in trunk forward lean but only UC induced increases in trunk lateral lean. In addition, increased loading in BC produced flatten lumbar curvature in sagittal plane. As far as coupling motion, subjects tended to use axial rotation of the lumbar spine in transverse plane in response to increased UC loading. Finally, it is concluded that the increased static loading in UC rather than in BC tends to causes combined alterations of the spinal postures(sagittal and transverse planes together), which would be vulnerable to improper mechanical stresses on the spine.