• Journal of Chest Surgery
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• 제38권3호
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• pp.229-232
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• 2005

요부 교감 신경 절제술은 족부 다한증, 하지 혈관 질환 및 신경계 질환의 치료를 목적으로 시행되는 수술로 흉부교감 신경 절제술에 비해 수술 빈도는 많이 떨어지나, 최근의 수술 경향인 최소 침습 수술의 발달과 복강경을 이용한 요부 교감 신경 절제술이 소개되면서 관심이 증가되었다 대상 및 방법: 2003년 7월부터 2004년 12월까지 18명의 환자에서 종격동경을 이용한 요부 교감 신경 절제술을 시행하였는데 환자의 남녀비는 12:6으로 남자가 많았고 평균 연령은 24.3세였으며, 수술 부위는 12명의 족부 다한증 환자에서는 양측을 수술하였고 나머지 6명의 환자에서는 좌측 4예, 우측 2예의 수술을 시행하여 총 30예의 요부 교감 신경 절제술을 시행하였다. 결과: 평균 수술 시간은 37.2$\pm$12.5 분이었으며 수술 후 평균 재원일은 3.1$\pm$2.2일이였다. 결론: 종격동경을 이용한 요부 교감 신경 절제술은 간단하고 효과적인 수술 방법으로, 미용적인 측면과 수술 후 동통의 감소 및 수술 후 재원 기간의 단축 등의 장점이 있는 수술이라고 생각되며, 향후 더 많은 수의 환자에서 결과를 분석하여 더 나은 결과를 가져올 수 있다고 예상된다.

• 대한정형외과스포츠의학회지
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• 제11권1호
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• pp.66-68
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• 2012

청소년에서 요추 추간판 탈출증은 드물게 발생하고, 임상적 증상이 성인과 달리 다양하게 나타난다. 또한, 청소년 환자의 주관적인 증상 호소를 분석하는 것이 어려워서 진단 및 치료가 늦어지는 경우가 많고, 성인에서와 달리 보존적 치료에 잘 반응하지 않는다. 슬괵근 강직 및 요추부 측만 변형등 청소년 요추 추간판 탈출증에서 특징적인 증상들은 수술로 잘 치료 되었고, 청소년의 추간판 부분절제술 수술 후의 중장기 추적검사에서 재수술 빈도는 15%로 성인과 큰 차이가 없었다. 그러므로, 보존적 치료에 잘 반응하지 않는 청소년 요추 추간판 탈출증은 수술적 치료를 적극적으로 고려해야 한다고 알려져 있다. 저자들은 축구를 하던 도중에 수상한 슬관절 손상으로 오인되어 수상 후 2년이 지나도록 진단이 지연되면서 슬괵근 강직과 보행 장애가 있었던 16세 청소년 요추 추간판 탈출증을 수술을 통해 치료하여 좋은 결과를 경험하였기에 문헌 고찰과 함께 보고하고자 한다.

• Journal of Korean Neurosurgical Society
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• 제40권1호
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• pp.22-27
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• 2006

Objective : The purpose of this study is to investigate the clinical results of anterior and posterior stabilization by one stage posterolateral approach for the unstable fracture of thoracolumbar and lumbar spine. Methods : By posterolateral approach with curved skin incision, unilateral facet and pedicle were removed. Through this route, corpectomy was performed, and then this space was replaced with mesh cage filled up with autologous bone graft. Both side pedicle screw fixation was followed to upper and lower levels. Results : Six of seven patients of this study showed neurological improvement. The other one patient showed no neurological change. One patient had postoperative infection, another patient had postoperative kyphosis. The other patient had epidural hematoma on operation site after surgery. And all patinets on this study made to have spinal stability except one patient happened postoperative kyphosis. Conclusion : In the unstable fracture of thoracolumbar and lumbar spine, one stage anterior and posterior stabilization and fusion by posterolateral approach seems to be an effective procedure, if we have more care and supplementation.

• The Korean Journal of Pain
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• 제27권1호
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• pp.63-67
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• 2014

Background: Epiduroscopic laser neural decompression (ELND) has been performed as a treatment tool for chronic refractory low back pain and/or radicular pain. There are some studies about the usefulness of epiduroscopy for post lumbar surgery syndrome, however, few studies about the effectiveness of epiduroscopy for patients without back surgery. We compared the satisfaction of patients who underwent ELND for chronic low back pain and/or radicular pain after back surgery and for the same symptoms without surgery. Methods: We compared the degree of satisfaction of patients after ELND between who had underwent the lumbar spine surgery and who had not retrospectively by chart reviewing. We divided 39 patients who had received ELND into two groups, one is the group of patients who got the lumbar surgery (group 1), and the other is the group of patients who did not (group 2). Their medical records including age, sex, previous treatment, duration of illness, degree of symptom relief were investigated. We compared each items between two groups. Results: The number of patients in group 1 was 17, and group 2 was 22. In group 1, 16 patients (94.1%) showed more than 'Acceptable', and 19 patients (86.4%) showed more than 'Acceptable' in group 2. There is no significant differences statistically in percentage of patients who showed more than 'Acceptable' in the satisfaction after ELND between two groups. Conclusions: ELND provided satisfaction (more than 85%) for patients with chronic low back pain and/or leg pain regardless of previous back surgery history.

• Journal of Korean Neurosurgical Society
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• 제57권2호
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• pp.100-107
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• 2015

Objective : To report a minimally invasive treatment option using percutaneous pedicle screw fixation with adjuvant treatment for metastatic thoraco-lumbar and lumbar spinal tumors. Methods : This is a retrospective study of charts of patients with spinal metastases. All were older than 18 years of age and were considered to have more than 3 months of life expectancy. The patients had single or two level lesions, and compression fracture or impending fracture. Exclusion criterion was metastasis showing severe epidural compression with definite neurological symptoms. Usually spinal segments from one level above to below pathology were stabilized. Visual analog scale (VAS) score for pain assessment and Frankel scale for neurological deficit were used, while pre- and post-operative performance status was evaluated using the Eastern Cooperative Oncology Group (ECOG). Results : Twelve patients (nine men, three women; median age 54.29 years) underwent surgery. All patients presented with back pain with/without radicular pain. There were no early complications and perioperative mortalities. Following surgery, a significant difference between average pre- and post-operative VAS scores was found (p=0.003). Overall, 91.8% of patients (11/12) experienced improvement in their ECOG score post-operatively. The mean ambulation time was 196.9 days [95% confidence interval (CI), 86.2-307.6 days; median, 97 days]. During follow-up, nine patients died and the mean overall survival time in enrolled twelve patients was 249.9 days (95% CI, 145.3-354.4 days; median, 176 days). Conclusion : Minimally invasive treatment using percutaneous pedicle screw fixation with adjuvant treatment is a good alternative treatment option for potential instability of the thoraco-lumbar and lumbar spinal metastasis.

• 대한약침학회지
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• 제27권2호
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• pp.123-130
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• 2024

Objectives: Post-operative urinary retention (POUR) is a frequent complication following surgical procedures, characterized by an acute inability to void, leading to additional complications and extended hospitalization. Acupuncture has been shown to be effective in facilitating spontaneous urination and alleviating anxiety in patients experiencing poor urination. The present study aims to evaluate the effectiveness of electroacupuncture in the management of POUR in patients who have undergone lumbar spine surgery. Methods: This retrospective study conducted at the National Hospital of Acupuncture in Vietnam and reviewed the medical records of patients over 18 years old who underwent lumbar spine surgery and were diagnosed with POUR between January to December 2019. Electroacupuncture was administered at five specific acupuncture points: Qugu (CV2), Zhongji (CV3), Zhibian (BL54), Pangguanshu (BL28), and Kunlun (BL60). This study monitored key parameters related to the effectiveness of the acupuncture treatment, including the number of acupuncture treatment sessions required until a patient was successfully treated was recorded, with a maximum of three acupuncture treatment sessions per patient, the time elapsed until urination following the treatment (minutes), and urinary bladder volume before and after treatment (mL). Results: The study demonstrated a 93.3% success rate in treating POUR with electroacupuncture. A significant reduction in post-void residual volume was noted, and patients could void within 30 minutes post-treatment. No significant differences in treatment effectiveness were observed across difference genders and age groups. Conclusion: Electroacupuncture proved to be a highly effective treatment for POUR in patients post-lumbar spine surgery, with a rapid response time and substantial reduction in PVR. However, the retrospective nature of the study and single-center focus limit its generalizability. Future research incorporating randomized controlled trials or multi-center observational studies are recommended to validate these findings and explore the potential of acupuncture in POUR management on a broader scale.

• Journal of Korean Neurosurgical Society
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• 제63권6호
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• pp.673-680
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• 2020

The demineralized bone matrix (DBM) as the bone graft material to increase the fusion rate was widely used in spinal fusion. The current study aimed to compare the fusion rate of DBM to the fusion rate of autograft in lumbar spine fusion via meta-analysis of published literature. After systematic search, comparative studies were selected according to eligibility criteria. Checklist (risk of bias assessment tool for non-randomized study) was used to evaluate the risk of bias of the included nonrandomized controlled studies. The corresponding 95% confidence interval (95% CI) were calculated. We also used subgroup analysis to analyze the fusion rate of posterolateral lumbar fusion and lumbar interbody fusion. Eight studies were finally included in this meta-analysis. These eight studies included 581 patients. Among them, 337 patients underwent spinal fusion surgery using DBM (DBM group) and 204 patients underwent spinal fusion surgery with mainly autologous bone and without using DBM (control group). There was no significant differences of fusion rate between the two groups in posterolateral fusion analysis (risk ratio [RR], 1.03; 95% CI, 0.90-1.17; p=0.66) and interbody fusion analysis (RR, 1.13; 95% CI, 0.91-1.39; p=0.27). Based on the available evidence, the use of DBM with autograft in posterolateral lumbar spine fusion and lumbar interbody fusion showed a slightly higher fusion rate than that of autograft alone; however, there was no statistically different between two groups.

• Asian Spine Journal
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• 제12권6호
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• pp.981-986
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• 2018

Study Design: Retrospective case series. Purpose: Cauda equina syndrome (CES) is associated with etiologies such as lumbar disc herniation (LDH) and lumbar canal stenosis (LCS). CES has a prevalence of 2% among patients with LDH and exhibits variable outcomes, even with early surgery. Few studies have explored the factors influencing the prognosis in terms of bladder function. Therefore, we aimed to assess the factors contributing to bladder recovery and propose a simplified bladder recovery classification. Overview of Literature: Few reports have described the prognostic clinical factors for bladder recovery following CES. Moreover, limited data are available regarding a meaningful bladder recovery status classification useful in clinical settings. Methods: A single-center retrospective study was conducted (April 2012 to April 2015). Patients with CES secondary to LDH or LCS were included. The retrieved data were evaluated for variables such as demographics, symptom duration, neurological symptoms, bladder symptoms, and surgery duration. The variable bladder function outcome during discharge and at follow-up was recorded. All subjects were followed up for at least 2 years. A simplified bladder recovery classification was proposed. Statistical analyses were performed to study the correlation between patient variables and bladder function outcome. Results: Overall, 39 patients were included in the study. Majority of the subjects were males (79.8%) with an average age of 44.4 years. CES secondary to LDH was most commonly seen (89.7%). Perianal sensation (PAS) showed a significant correlation with neurological recovery. In the absence of PAS, bladder function did not recover. Voluntary anal contraction (VAC) was affected in all study subjects. Conclusions: Intactness of PAS was the only significant prognostic variable. Decreased or absent VAC was the most sensitive diagnostic marker of CES. We also proposed a simplified bladder recovery classification for recovery prognosis.

• Asian Spine Journal
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• 제12권6호
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• pp.973-980
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• 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.

• 대한정형외과학회지
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• 제56권2호
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• pp.178-182
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• 2021

척추의 혈종은 응급 치료를 요하는 상태로 대부분 경막외에 발생한다. 경막하 혈종은 흔히 경막외 혈종으로 오진되어 보다 급격한 신경학적 증상의 진행을 유발할 수 있으므로 정확한 진단과 치료에 대한 이해가 없으면 심각한 합병증을 유발할 수 있다. 저자들은 흔히 시행하는 경막외 신경차단술 후 기저 질환 없이 전 요추에 심한 경막하 혈종이 발생하여 진행하는 신경증상을 보였고 수술적으로 치료하여 그 증례를 보고하고자 한다.