• Journal of Korean Neurosurgical Society
• /
• v.62 no.4
• /
• pp.442-449
• /
• 2019

Objective : Bone mineral density (BMD) is an important consideration during fusion surgery. Although dual X-ray absorptiometry is considered as the gold standard for assessing BMD, quantitative computed tomography (QCT) provides more accurate data in spine osteoporosis. However, QCT has the disadvantage of additional radiation hazard and cost. The present study was to demonstrate the utility of artificial intelligence and machine learning algorithm for assessing osteoporosis using Hounsfield units (HU) of preoperative lumbar CT coupling with data of QCT. Methods : We reviewed 70 patients undergoing both QCT and conventional lumbar CT for spine surgery. The T-scores of 198 lumbar vertebra was assessed in QCT and the HU of vertebral body at the same level were measured in conventional CT by the picture archiving and communication system (PACS) system. A multiple regression algorithm was applied to predict the T-score using three independent variables (age, sex, and HU of vertebral body on conventional CT) coupling with T-score of QCT. Next, a logistic regression algorithm was applied to predict osteoporotic or non-osteoporotic vertebra. The Tensor flow and Python were used as the machine learning tools. The Tensor flow user interface developed in our institute was used for easy code generation. Results : The predictive model with multiple regression algorithm estimated similar T-scores with data of QCT. HU demonstrates the similar results as QCT without the discordance in only one non-osteoporotic vertebra that indicated osteoporosis. From the training set, the predictive model classified the lumbar vertebra into two groups (osteoporotic vs. non-osteoporotic spine) with 88.0% accuracy. In a test set of 40 vertebrae, classification accuracy was 92.5% when the learning rate was 0.0001 (precision, 0.939; recall, 0.969; F1 score, 0.954; area under the curve, 0.900). Conclusion : This study is a simple machine learning model applicable in the spine research field. The machine learning model can predict the T-score and osteoporotic vertebrae solely by measuring the HU of conventional CT, and this would help spine surgeons not to under-estimate the osteoporotic spine preoperatively. If applied to a bigger data set, we believe the predictive accuracy of our model will further increase. We propose that machine learning is an important modality of the medical research field.

• The Korean Journal of Pain
• /
• v.27 no.1
• /
• pp.3-15
• /
• 2014

As our population ages and the rate of spine surgery continues to rise, the use epidural lysis of adhesions (LOA) has emerged as a popular treatment to treat spinal stenosis and failed back surgery syndrome. There is moderate evidence that percutaneous LOA is more effective than conventional ESI for both failed back surgery syndrome, spinal stenosis, and lumbar radiculopathy. For cervical HNP, cervical stenosis and mechanical pain not associated with nerve root involvement, the evidence is anecdotal. The benefits of LOA stem from a combination of factors to include the high volumes administered and the use of hypertonic saline. Hyaluronidase has been shown in most, but not all studies to improve treatment outcomes. Although infrequent, complications are more likely to occur after epidural LOA than after conventional epidural steroid injections.

• Journal of Korean Neurosurgical Society
• /
• v.47 no.4
• /
• pp.316-318
• /
• 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.

• The Journal of the Korean bone and joint tumor society
• /
• v.13 no.2
• /
• pp.157-161
• /
• 2007

Hibernoma is a rare, benign tumor arising from vestigial remnant of brown adipose tissue. It is usually asymptomatic and slow growing. Awareness of the MR imaging may allow possible differential diagnosis prior to surgery.

• Journal of Yeungnam Medical Science
• /
• v.7 no.2
• /
• pp.189-195
• /
• 1990

Pyogenic vertebral osteomyelitis is rare. It most commonly occurs at the lumbar area and in the fifth to seventh decades of life. Most individuals present with back pain, abdominal pain, hip pain and meningeal syndrome. We experienced three cases of unusual patterns of pyogenic osteomyelitis. The first case developed after sepsis. The second case developed after open fracture and infection of other site. The third case was misdiagnosed as metastatic cancer. We present these cases with a brief review of literatures.

• Journal of Korean Orthopaedic Sports Medicine
• /
• v.3 no.2
• /
• pp.100-106
• /
• 2004

Thigh injuries are relatively uncommon sports injuries. But the incidence is increasing as many kinds of sports activity develops. And the prompt recognition and treatment of these injuries are critical to prevent prolonged disability. Also, despite the simple anatomic structure of the thigh, this region is finely tuned muscular mechanism with both anterior and posterior muscles crossing two joints. So the contracture of thigh muscle can result in not only decreased range of motion of the knee and hip joint, but also painful lumbar spine. So we reviewed recent literatures about the type of thigh injuries, diagnosis, treatment and rehabilitation.

• Journal of Chest Surgery
• /
• v.31 no.2
• /
• pp.203-207
• /
• 1998

We have experienced 2 patients who underwent retroperitoneal endoscopic lumbar sympathectomy(RELS) for bilateral plantar hyperhidrosis. They had underwent thoracic sympathectomy by thoracoscopy 20 months and 1 month ago, respectively. The first patient had to be converted to the open procedure due to pneumoperitonium and she was reoperated due to continous sweating by the incomplete sympathectomy on right side. At follow-up after 70 and 30 days postoperatively, RELS results were graded as excellent, good, fair, or poor. The first patient was very satisfied as "Excellent" and the second was slightly less satisfied as "Good" with compensatory hyperhidrosis at perianal area. This RELS is a feasible procedure to plantar hyperhydrosis patients with less pain, minimal scar, short period of convalescence, and short hospital stay.short hospital stay.

• Korean Journal of Acupuncture
• /
• v.38 no.3
• /
• pp.189-195
• /
• 2021

Foot drop due to lumbar disc herniation is perceived to be an indication for surgery. A 44-year-old male presented with motor deficit in left ankle dorsiflexion along with radiating pain and paraesthesia. Motion Style Acupuncture Therapy (MSAT) was administered on the left side every other day. Acupuncture and Chuna were performed daily. Herbal medicine was taken 3 times a day. His symptoms rapidly improved throughout treatment, verified by decreased Numeric Rating Scale (NRS), Oswestry Disability Index (ODI), increased 5-level EuroQol-5 Dimension (EQ-5D-5L) scores, and improved motor grades. We suggest that a combination of MSAT with traditional Korean medicine could be a favorable option for foot drop in LDH patients in terms of rapid pain reduction and the improvement of quality of life.

• Journal of Korean Neurosurgical Society
• /
• v.30 no.12
• /
• pp.1394-1398
• /
• 2001

Objective : The purpose of this non-randomized prospective study was to evaluate the safety and efficacy of continuous intravenous nalbuphine-ketorolac-droperidol(CIA) versus continuous infusion of epidural morphine-bupivacaine(CEA) for pain control after lumbar spinal surgery. Methods : Twenty-one patients who underwent spine surgery including laminectomy, fusion with fixation were assigned to receive an intravenous bolus of nalbuphine 5mg and ketorolac 15mg, followed by a continuous infusion of nalbuphine 25mg, ketorolac 105mg, and droperidol 5mg mixed with normal saline 98cc(2cc/hr). Twenty patients received a bolus infusion of morphine 2mg and 0.125% bupivacaine 8cc followed by a continuous intravenous infusion of 100cc 0.125% bupivacaine and morphine sulfate 8.0mg(2cc/hr). Pain score was measured on a visual analogue scale(VAS). It's safety and efficacies were compared with the results of continuous infusion of epidural morphine-bupivacaine, which was reported previously by same authors. A continuous infuser was used to give epidural morphine-bupivacaine and intravenous nalbuphine-ketorolac-droperidol. Results : In general, mild pain, pain less than 3 VAS scores, was observed postoperatively from 30minutes to 72hours in CEA group, and from 6 hours to 72 hours in CIA group. The early postoperative pain was controlled easily in 6 hours in CEA group, compared to CIA group(p<0.05). However, there was no statistical significance in 72 hours on pain scores between CEA and CIA groups after 6-12hours of pain managements. Pruritus, nausea and vomiting, and urinary retention were more frequent in CEA group. Conclusion : CIA and CEA are considered effective methods in postoperative pain managements. However, adequate doses in early intravenous infusion and continuous intravenous analgesia with nalbuphine-ketorolac-droperidol will be needed for better control in early postoperative pain with less side effects.

• Annals of Hepato-Biliary-Pancreatic Surgery
• /
• v.28 no.1
• /
• pp.109-113
• /
• 2024

Cholangiocarcinoma is a heterogeneous group of aggressive tumors that correspond to the second most common primary liver tumor. They can be classified according to their anatomical position concerning the biliary tree, and each subtype demonstrates different behavior and treatment. A 38-year-old male patient presenting solely right lumbar pain was diagnosed with a 7 cm hepatic tumor involving segments I, Iva, and VIII associated with involvement of the hepatic veins. He underwent a bloc resection of hepatic segments I, II, III, IV, partial V, partial VII, and VIII; right, middle, and left hepatic veins; and inferior vena cava segment, with perfusion of the remaining liver in situ with a preservation solution. As the patient had a large accessory inferior right hepatic vein draining the remaining liver, no reimplantation of hepatic veins was necessary. He remained clinically stable in outpatient follow-up, with excellent performance status-current survival of 2 years 6 months after surgical treatment.