• Journal of Korean Neurosurgical Society
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• v.52 no.3
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• pp.215-220
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• 2012

Objective : There were previous reports of redundant nerve roots (RNRs) focused on their clinical significance and pathogenesis. In this study, we investigated the significant radiologic findings that correlate with RNRs occurrence. These relations would provide an advanced clue for clinical significance and pathogenesis of RNRs. Methods : Retrospective research was performed with data from 126 patients who underwent surgery for central lumbar spinal stenosis (LSS). Finally, 106 patients with common denominators (inter-observer accuracy : 84%) were included on this study. We divided the patients into two groups by MRI, patients with RNRs and those with no RNRs (NRNRs). Comparative analyses were performed with clinical and radiologic parameters. Results : RNRs were found in 45 patients (42%) with central LSS. There were no statistically significant differences between the two groups in severity of symptoms. On the other hand, we found statistically significant differences in duration of symptom and number of level included (p<0.05). In the maximal stenotic level, ligamentum flavum (LF) thickness, LF cross-sectional area (CSA), dural sac CSA, and segmental angulation are significantly different in RNRs group compared to NRNRs group (p<0.05). Conclusion : RNRs patients showed clinically longer duration of symptoms and multiple levels included. We also confirmed that wide segmental angulation and LF hypertrophy play a major role of the development of RNRs in central LSS. Together, our results suggest that wide motion in long period contribute to LF hypertrophy, and it might be the key factor of RNRs formation in central LSS.

• Journal of Korean Neurosurgical Society
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• v.60 no.6
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• pp.684-690
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• 2017

Objective : As increasing the size of the geriatric population, the number of elderly patients, who need the surgery for painful degenerative spinal stenosis has been increasing. The geriatric population may be relatively high complications, because of age and age-associated medical conditions. However, there is a lack of studies addressing the perioperative complications and outcomes in elderly patients with posterior lumbar inter body fusion with screw augmentation (PLIF). Methods : We retrospectively reviewed the medical records and radiographic studies of geriatric patients who had spine surgery of PLIF due to spinal stenosis for 11 years. We divided into 2 groups (A; 70-75 years, B; over then 76 years) according to the age. Surgical level of each groups, hospital day and postoperative day, co-morbidities, complications, clinical outcomes were analyzed. Operative reports, hospital and outpatient clinic charts, and radiographic studies were reviewed. Results : Group A was composed of 80 patients, their mean age was 72.21 and female dominant (n=46), and their mean surgically fused level was 1.52 level. Group B was 36 patients, their mean age was 78.83 and female dominant (n=20), and their mean surgically fused level was 1.36 level. Comparing between two groups, complications, postoperative hospital stay were slightly increase in group B and co-morbidity was statistically high in group B, however clinical outcomes were similar between two groups. Conclusion : Increasing age might be an important risk factor for complications in patients undergoing PLIF, however, we would like to recommend that if the situation of spine of extreme geriatric patients need PLIF, it should be in the surgeon's consideration after careful selection and clinical judgement.

• Journal of Acupuncture Research
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• v.17 no.3
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• pp.116-124
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• 2000

This clinical study was carried out 15 cases with lumbar spinal stenosis patients, who had been admitted and diagnosed by Computed Tomography from June, 1999 to May, 2000, in the department of acupuncture and moxibustion. Hanseo University Oriental Medical Nospital. The results obtained from this study were as follows; 1. We investigated 10 female and 5 male patients. The age distribution was from early 20's to 70's, among which 30's and 50's were most common. 2. The most common duration of symptom was less than a year(46.7%). 3. Regarding to the number of the involved levels, one was 12 cases(80%), two was 3 cases(20.0%). In the one level cases, L4~5 was the most common involved site. 4. Regarding to the clinical symptoms, low back pain was the most common, followed by lower extremity radiating pain, intermittent claudication, lower extremity paresthesia. 5. In orthopaedic examinations, positive sign in Milgram test was 80.0%, positive sign in straight leg raising test was 40.0%, and positive sign in Braggard test was 33.3%. Inneurologic examinations, sensory loss was seen in 60.0%, motor weakness and decreased deep tendon reflex were 26.7% in each. 6. According to clinical symptom scale proposed by Chae(1989), grade I1I was the most common (53.3%), followed by grade II, grade IV, grade I . 7. According to treatment outcome scale proposed by Chae(1989), Good was the most common (73.3%), followed by Excelleat, Fair and Poor.

• The Korean Journal of Pain
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• v.21 no.2
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• pp.136-142
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• 2008

Background: A transforaminal epidural steroid injection (TFESI) is one of the methods for the conservative treatment of the lumbar spinal stenosis. As efforts to prolong the therapeutic duration and to predict the outcome of TFESI are very important, we analyzed factors considered to be associated with the therapeutic duration of a TFESI. Methods: Between August 2006 and March 2007, 69 patients (Group A: patients with no pain relief, Group B: patients with pain relief of less than 6 months, Group C: patients with pain relief of more than 6 months) who failed to the medical treatment were included to undertake a fluoroscopic-guided TFESI. Prior to treatment, the VAS (visual analogue scale), ODI (Oswestry disability index), BDI (Beck depression inventory), and BAI (Beck anxiety inventory) scores were determined to evaluate the degree of pain, disability, and psychological status. The VAS and ODI scores were used to assess the degree of pain relief. To identify the total duration of pain relief, regular outpatient visits for six months were conducted, and for the patients who were not able to visit the outpatient clinic regularly, outcome was assessed by telephone interviews after six months. Results: The dural sac cross-sectional area (DSCSA), ODI, pain duration, BDI, BAI, and age showed similar distribution for patients in the A, B, and C groups. Conclusions: The DSCSA, ODI, pain duration, BDI, BAI, and age were not associated with the therapeutic duration of TFESI in lumbar spinal stenosis patients.

• Journal of Korean Medicine Rehabilitation
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• v.31 no.2
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• pp.99-108
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• 2021

The study reports the clinical case of a patient with lower extremity weakness and gait disturbance treated with Korean medicine treatments including Chuna therapy. The patient suffered lower extremity weakness and gait disturbance with diagnosis of lumbar disk herniation and spinal stenosis. As a treatment, the doctor applied Chuna therapy, herbal medicine, acupuncture, pharmacopuncture, cupping and moxa. The effect of treatment was evaluated by numeral rating scale (NRS), self-walkable distance, functional independence measure (FIM), Oswestry disability index (ODI) and manual muscle test (MMT). NRS decreased from 6 to 4 at the leg. Self-walkable distance increased from 0 m to 10 m, FIM increased 85 to 96 points while ODI decreased 64% to 54%. MMT of hip flex and knee extension improved from grade 3+, grade 3 to grade 4, respectively. Korean medicine treatment can be effective for patients who suffer lower extremity weakness and gait disturbance due to lumbar disk herniation and spinal stenosis. Further clinical studies are required to verify these findings.

• Journal of Pharmacopuncture
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• v.16 no.3
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• pp.46-51
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• 2013

Objectives: The aim of this study is to evaluate the effect of acupotomy in patients with degenerative lumbar spine stenosis. Methods: A total of 437 patients who had been diagnosed as having lumbar spine stenosis and who had been admitted to Daejeon Oriental hospital from June 1, 2008, to September 31, 2012, were included in this study. The patients underwent acupotomy once, twice or three times on the lumbar spine, according to their symptoms. Then, the patients were asked to complete the verbal numeric rating scale (VNRS) and the oswestry disability index (ODI) before and after acupotomy and underwent a global assessment. The resulting data were analyzed. Results: The gender ratio of the participants was 1:1.54, and the mean age was $65{\pm}10.0$ yr. The number of patients over the age of 65 yr was less than that of the patients under the age of 65 yr in the ratio of 1:1.3. The average disease period was $30.17{\pm}56.63$ months. The verbal numeric rating scale (VNRS) significantly decreased from 10 to an average of $7.10{\pm}2.50$ after one acupotomy, $6.30{\pm}2.60$ after two acupotomies, and $5.50{\pm}2.50$ after three acupotomies. The ODI was significantly decrease from $20.60{\pm}8.70$ to $17.80{\pm}8.60$ after once acupotomy, $17.10{\pm}8.50$ after two acupotomies, and $16.70{\pm}8.60$ after three acupotomies. High scores were also observed on the global assessment. Conclusion: These results provide evidence that acupotomy is effective to relieve pain and to improve quality of life in patients with degenerative lumbar spinal stenosis.

• Journal of Korean Neurosurgical Society
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• v.30 no.1
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• pp.114-117
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• 2001

Generally, the posterolateral approach had been recommended in case of extraforaminal disc herniation or lateral stenosis but it has been speculated that this procedure may be feasible to posterolateral disc herniation at the high lumbar levels of the L1-L2 interspace. Topographically, a posterolateral approach should be able to access anteromedial side of the spinal canal without the risk of the bony instability and damage to the neural structures. During the past one year period, three patients with high lumbar discs at the L1-L2 level were treated by the modified posterolateral approach. This article describeds the details of this approach with pertinent literature review.

• Journal of Korean Neurosurgical Society
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• v.48 no.3
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• pp.288-290
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• 2010

The common etiologies of pneumocephalus, presence of air in the intracranial cavity, are trauma and cranial surgery. Pneumocephalus after spinal surgery is an unusual postoperative complication. We report the case of a male 59-year-old man who developed a pneumacephalus after posterior lumbar surgery for spinal stenosis. Intraoperatively, a cerebrospinal fluid leak following a dural tear was noted and immediately repaired. The next day, the patient complained of headache and dizziness. Head and lumbar computed tomography scans revealed significant air in the frontal region, several cisterns, intraventricle, and extra-dural area in the spine canal. Symptoms were spontaneously resolved within 2 weeks with conservative management.

• Journal of Pharmacopuncture
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• v.22 no.3
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• pp.184-191
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• 2019

Objectives: Recently several Korean medical doctors have begun practicing applied kinesiology (AK). Although the efficacy of combining traditional acupuncture (TA) and pharmacopuncture (PP) on lumbar diseases such as lumbar spinal stenosis (LSS) and lumbar herniation of intervertebral disk (LHID) has been examined, the possible benefits of combining TA, PP and AK approaches have not been examined. Therefore the aim of this study was to develop effective treatment for lumbar disorders by combining TA, PP, and AK treatments. Methods: Twenty-four patients hospitalized at Samse Korean Traditional Medicine Hospital between March and September 2018 with L5 or S1 root radiculopathy associated with LSS and LHID were included in this study. They were treated for 10 days with TA, PP and AK approaches that included category block, manipulation and strain/counterstrain treatments. The primary outcomes were mainly assessed using Japanese Orthopedic Association lumbar scores (JOALS). JOALS were determined before the start of treatment as well as five and 10 days after treatment started. Results: The treatments improved the lumbar condition of the patients based on JOA pain score. Conclusion: The combined TA, PP and AK treatments were effective in treating spinal diseases of resident patients. Prospective, controlled, and relevant protocols using multimodal strategies to define the role of TA, PP and AK are needed.

• The Korean Journal of Pain
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• v.34 no.4
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• pp.394-404
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• 2021

Background: We aimed to investigate the effect of epidural polydeoxyribonucleotide (PDRN) on mechanical allodynia and motor dysfunction in a rat model of lumbar foraminal stenosis (LFS). Methods: This study was conducted in two stages, using male Sprague-Dawley rats. The rats were randomly divided into eight groups. In the first stage, the groups were as follows: vehicle (V), sham (S), and epidural PDRN at 5 (P5), 8 (P8), and 10 (P10) mg/kg; and in the second stage, they were as follows: intraperitoneal PDRN 8 mg/kg, epidural 3,7-dimethyl-1-propargilxanthine (DMPX) (0.1 mg/kg), and DMPX (0.1 mg/kg). The LFS model was established, except for the S group. After an epidural injection of the test solutions, von Frey and treadmill tests were conducted for 3 weeks. Subsequently, histopathologic examinations were conducted in the V, S, P5, and P10 groups. Results: A total of 65 rats were included. The P8 and P10 groups showed significant recovery from mechanical allodynia and motor dysfunction at all time points after drug administration compared to the V group. These effects were abolished by concomitant administration of DMPX. On histopathological examination, no epineurial inflammation or fibrosis was observed in the epidural PDRN groups. Conclusions: Epidural injection of PDRN significantly improves mechanical allodynia and motor dysfunction in a rat model of LFS, which is mediated by the spinal adenosine A_2A receptor. The present data support the need for further research to determine the role of epidural PDRN in spinal stenosis treatment.