• Journal of Korean Neurosurgical Society
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• 제60권3호
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• pp.371-374
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• 2017

Ganglioneuroma (GN) is a rare benign tumor of neural crest origin usually found in the abdomen, but may occasionally present at uncommon sites including the cervical, lumbar, or sacral spine. However, GNs of thoracic spine are extremely rare. In this report, we describe a 12-year-old girl with giant GN in the thoracic spine, who underwent successful resection (T1-4 level) of the tumor. Histopathological examination confirmed the diagnosis. GN should be considered in the differential diagnosis of any paraspinal mass. A high index of suspicion and correlation of clinico-radiological findings is necessary in differentiating a large benign tumor from a malignant growth. Complete surgical excision is the treatment of choice; however tumor size and location need to be considered for the surgical approach (one-step or multiple surgeries). Close follow-up after surgery is mandatory.

• Journal of Korean Neurosurgical Society
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• 제47권4호
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• pp.316-318
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• 2010

We report a rare case of intracranial hypotension that was complicated by a subdural hematoma following spine surgery. Intraoperatively, we did not notice any breach of the dura. However, the patient continued to have fluid leakage from the inferior edge of the lumbar incision. During revision surgery, a small dural tear was identified and repaired. It is likely that a small dural tear was overlooked or the dura was weakened during the initial operation and caused a subdural hematoma associated with intracranial hypotension.

• Journal of Korean Neurosurgical Society
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• 제53권3호
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• pp.174-179
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• 2013

Objective : Many studies have investigated paraspinal muscle changes after posterior lumbar surgery, including lumbar fusion. However, no study has been performed to investigate back muscle changes after pedicle based dynamic stabilization in patients with degenerative lumbar spinal diseases. In this study, the authors compared back muscle cross sectional area (MCSA) changes after non-fusion pedicle based dynamic stabilization. Methods : Thirty-two consecutive patients who underwent non-fusion pedicle based dynamic stabilization (PDS) at the L4-L5 level between February 2005 and January 2008 were included in this retrospective study. In addition, 11 patients who underwent traditional lumbar fusion (LF) during the same period were enrolled for comparative purposes. Preoperative and postoperative MCSAs of the paraspinal (multifidus+longissimus), psoas, and multifidus muscles were measured using computed tomographic axial sections taken at the L4 lower vertebral body level, which best visualize the paraspinal and psoas muscles. Measurements were made preoperatively and at more than 6 months after surgery. Results : Overall, back muscles showed decreases in MCSAs in the PDS and LF groups, and the multifidus was most affected in both groups, but more so in the LF group. The PDS group showed better back muscle preservation than the LF group for all measured muscles. The multifidus MCSA was significantly more preserved when the PDS-paraspinal-Wiltse approach was used. Conclusion : Pedicle based dynamic stabilization shows better preservation of paraspinal muscles than posterior lumbar fusion. Furthermore, the minimally invasive paraspinal Wiltse approach was found to preserve multifidus muscles better than the conventional posterior midline approach in PDS group.

• Asian Spine Journal
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• 제12권6호
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• pp.1037-1042
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• 2018

Study Design: Retrospective study. Purpose: This study aimed to investigate whether segmental lumbar hyperlordosis of the affected vertebra in patients with spondylolysis occurs only at L5 or also occurs at L4. Overview of Literature: To the best of our knowledge, increase in segmental lordosis of the spondylolytic vertebrae has only been investigated in bilateral L5 spondylolysis; it has not been examined at different levels of bilateral spondylolysis. According to the characteristics of segmental lordosis in bilateral L5 spondylolysis, patients with bilateral L4 spondylolysis may also have increased segmental lordosis of the L4 vertebra. Methods: Patients with bilateral spondylolysis of the L5 or L4 vertebra in 2013-2015 were retrospectively identified from the hospital database. Standing lateral lumbar radiographs were assessed for the angle of segmental lordosis of the L5 and L4 vertebra, sacral slope, and lumbar lordosis. The differences in segmental lordosis of the L5 and L4 vertebra, sacral slope, and lumbar lordosis were determined using non-paired Student t-test. Results: Overall, 15 cases of bilateral L4 spondylolysis and 41 cases of bilateral L5 spondylolysis satisfied the inclusion and exclusion criteria. Lordosis of the L4 vertebra was significantly greater in the bilateral L4 spondylolysis group ($24.2^{\circ}{\pm}7.0^{\circ}$) than that in the L5 spondylolysis group ($20.3^{\circ}{\pm}6.1^{\circ}$, p=0.047). Lordosis of the L5 vertebra was significantly lower in the L4 spondylolysis group ($27.7^{\circ}{\pm}8.2^{\circ}$) than that in the L5 spondylolysis group ($32.5^{\circ}{\pm}7.3^{\circ}$, p=0.040). The sacral slope and lumbar lordosis did not significantly differ between the groups. Conclusions: Adolescent patients with bilateral spondylolysis have segmental hyperlordosis of the affected vertebra not only at the L5 level but also at the L4 level.

• Journal of Korean Neurosurgical Society
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• 제44권1호
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• pp.47-51
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• 2008

Ligamentum flavum hematoma is a rare condition. Twenty cases including present case have been reported in English-language literature. Among them, only one case reported in pure thoracic spine. A 72-year-old man presented with thoracic myelopathy without precedent cause. Magnetic resonance images revealed a posterior semicircular mass which was located in T7 and T8 level compressing the spinal cord dorsally. T7-8 total laminectomy and extirpation of the mass was performed. One month later following surgery, the patient fully recovered to normal state. Pathologic result was confirmed as ligamentum flavum hematoma. Ligamentum flavum hematoma of rigid thoracic spine is a very rare disease entity. Most reported cases were confined to mobile cervical and lumbar spine. Surgeons should be aware that there seems to be another different pathogenesis other than previously reported cases of mobile cervical and lumbar spine.

• 대한한방내과학회지
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• 제40권1호
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• pp.126-135
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• 2019

Background: Because of fear of reoperation and low efficiency, some patients with failed back surgery syndrome (FBSS) opt for Korean medicine treatment. Gold standard treatment is not present for FBSS, therefore both surgical and non-surgical treatment are possible. Studies of Korean conservative medicine for FBSS had a short duration of treatment and mainly pre- and post-treatment comparisons. And case of female patients who have worsened after childbirth is rare. The purpose of this study was to report long-term follow-up and rare cases of FBSS. Case summary: A 33-year-old female patient diagnosed with lumbar disc herniation complained with low back pain and radicular pain in the left leg after surgery in 2011. Acupuncture and decoction (Cheongpa-jeon, GCSB-5) were administered to her twice a day for about 6 years and 6 months. The patient's complaints improved with each hospitalization, and Magnetic Resonance Imaging (MRI) showed a slight decrease in the size of the recurrent disc (L4/5) and a newly developed disc (L5/S1) that had deteriorated after delivery. Conclusion: Korean medicine could be used to manage the pain of lumbar spine FBSS patients for 6-7 years and to alleviate lumbago after delivery.

• 보건의료산업학회지
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• 제8권1호
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• pp.151-164
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• 2014

This study was conducted to investigate the effect of timing of surgery on outcomes of spine operated patients for lumbar herniated intervertebral disc. The research design was cohort study and based on the data of claims for the medical expenses of health insurance. 21,475 cases who had primary spine surgery between January 1, and December 31, 2003, observed to conservative treatment period in the past two years from preoperative primary diagnosis to timing of primary surgery. According to one and five year follow up monitoring, the probability of occurrence of reoperation was not statistically significant with preoperative duration of symptom. Also one year follow up, the probability of occurrence of complication, was not statistically significant with preoperative duration of symptom. But five year follow up, groups who had one to two month preoperative duration of symptom decreased complication rate than less than a month(95%CI:0.594-0.927). Thus, from the onset of symptoms of back pain before primary surgery with enough and adequate time observation is required. Also, medical consumers or providers to choose surgery in determining prudence is required.

• 대한기계학회:학술대회논문집
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• 대한기계학회 2008년도 추계학술대회A
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• pp.664-667
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• 2008

Since the advent of pedicle screw fixation system, posterior spinal fusion has markedly increased This intemal fixation system has been reported to enhance the fusion rates, thereby becoming very popular procedure in posterior spinal arthrodesis. Although some previous studies have shown the complications of spinal instruments removal, i.e. loss of correction and spinal collapse in scoliosis or long spine fusion patients, there has been no study describing the benefit or complications in lumbar spinal fusion surgery of one or two level. In order to clarify the effect of removal of instruments on mechanical motion profile, we simulated a finite element model of instrumented posterolateral fused lumbar spine model, and investigated the change of mechanical motion profiles after the removal of instrumentation.

• Investigative Magnetic Resonance Imaging
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• 제19권4호
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• pp.224-230
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• 2015

Purpose: To determine whether we should recommend ultrasonography (US) for an incidental thyroid nodule identified by additional cervicothoracic sagittal T2-weighted image (C-T sag T2WI) of lumbar spine magnetic resonance imaging (MRI). Materials and Methods: A retrospective study of 61 patients who underwent both lumbar spine MRI and thyroid US between December 2011 and April 2015 was conducted. For all US-found thyroid nodules > 1 cm, investigators evaluated whether there was any correlation between thyroid nodule detectability by C-T sag T2WI and US features such as echogenicity, composition, or suspicion of malignancy. Results: Solid hypoechoic (2/4; 50%) or mixed echoic nodules (4/8; 50%) appeared to be found relatively more easily by C-T sag T2WI than more benign-looking solid isoechoic (1/4; 25%) or spongiform nodules (0/6; 0%). Among six nodules with ultrasonographic suspicion for malignancy, only one nodule was detected by C-T sag T2WI. Conclusion: If an incidental thyroid nodule is seen by C-T sag T2WI, it would be better to recommend thyroid US for identifying malignancy.

• Journal of Korean Neurosurgical Society
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• 제38권3호
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• pp.206-210
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• 2005

Objective : Our aim is to evaluate the early changes of biologic markers such as white blood cell[WBC] count, erythrocyte sedimentation rate[ESR] and C-reactive protein[CRP] in early diagnosis of postoperative infection and to differentiate infection from inflammatory reaction in lumbar spine surgery. Methods : We reviewed 330patients who had undergone spinal operations between May 1999 and October 2001. For this study, the patients were classified into two groups, which include a group that underwent spinal decompressive surgery without instrumentation[SD], and the other group that underwent fusion surgery with spinal instrumentation[SI]. And each group was also subdivided into two groups respectively, one with infection and the other without infection. We retrospectively analyzed the WBC count, ESR and CRP preoperatively and postoperatively, according to their operation type and postoperative infection history. Results : Inflammatory indices were physiologically affected by instrumentation itself. But ESR and CRP elevations were more prolonged and sustained under infection. In SD patients without infection, ESR and CRP were stabilized 5 days after surgery. In SI patients without infection, CRP was stabilized about 7days after surgery, but ESR showed sustained and variously elevated. In both SD and SI groups, the stabilization of CRP was the most reliable behavior of surgery without infection. Conclusion : C-reactive protein is most sensitive parameter for postoperative spine infection. The knowledge of the inflammatory indices and their relatively uniform patterns with or without infection offers surgeons the ability to infer the state of surgical wound.