• Clinical Pain
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• v.19 no.2
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• pp.90-96
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• 2020

Objective: To investigate the diagnostic accuracy of two physical examinations (straight leg raise [SLR] and Bragard test) and electromyography (EMG) in patients with lumbosacral monoradiculopathy in acute and chronic state on confirmation of different diagnostic criteria (MRI vs MRI and diagnostic selective nerve root block [DSNRB]). Method: We identified 297 participants retrospectively from the departmental database. MRI evidence of L5 or S1 nerve root compression and a positive result in diagnostic SNRB served as reference standards. They were divided into two groups by the symptom duration: lasting more than 12 weeks in the chronic group and less than 12 weeks in the acute group. The diagnostic value of clinical tests and EMG were compared. Results: The clinical tests (SLR and Bragard test) done in acute stage on detection by MRI and DSNRB had the highest sensitivity (68%) compared to the chronic stage (63%), but sensitivity was low (57%) on confirmation of MRI alone. However, there was no significant difference on sensitivity and specificity of EMG regardless of reference standards and symptom duration. Electromyography was a significant predictor of neuropathic abnormalities on both acute (OR, 6.3; 95% CI, 2.4 to 16.7; p<0.01) and chronic (OR, 6.8; 95% CI, 2.9 to 16.3; p<0.01). Conclusion: In general, individual physical tests are easy to do and a combination of those tests could be a sensitive indicator of L5 or S1 radiculopathy. Furthermore, the use of provocation tests could provide useful information, especially in proceeding therapeutic selective nerve root block.

• Journal of Korean Neurosurgical Society
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• v.58 no.6
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• pp.566-570
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• 2015

Intramuscular myxoma (IM) is a benign neoplasm of mesenchymal origin. We report a rare case of IM which was located in the lumbosacral paraspinal muscles. A 62-year-old female patient presented with progressive low back pain for 2 months, and the radiologic findings showed a large mass ($4.0{\times}3.5{\times}6.5cm$) in the right lumbosacral paraspinal area. Total resection of the tumor was performed and the symptom was nearly resolved after surgery. Although the immuno-histopathological analysis was consistent with IM, there were some different findings from typical pathological characteristics of IM in this case. Firstly, the symptomatic change of the mass took relatively short time (less than 3 months), and this change was accompanied by partial calcification inside the mass. Moreover, iatrogenic interruption of paravertebral muscle by the other previous operation might be the promoting factor of the fibrous dysplasia, which can explain the pathogenesis of IM. To our knowledge, this is the eighth case of the lumbar paraspinal myxoma reported in the literatures and the first case in Asian population.

• Journal of Korean Physical Therapy Science
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• v.5 no.4
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• pp.763-775
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• 1998

Some segment or segments of the body must compensate for the heel, and the higher the heel the greater the compensation. Such compensation was once generally thought to take place in the lumbar region and therefore to increase the lumbar lordosis. The purpose of this study is to analyze changes of lumbar sagittal curvature in barefoot and 6cm 12cm high-heel stance. We selected 19 subjects(11 males, 8 females} without history of lower back pain, significant spinal abnormality. And lateral view X-ray of lumbar region from T12 to S1 was taken of each individual. On each X-ray film, lumbar lordotic angle lumbosacral angle and lumbar segmental angles were measured by Cobb method. We drew the following interpretations from the analysis of measured variables of the lumbar region. 1. In comparison of barefoot 6cm heel 12cm heel stance, lumbar lordotic angle had a tendency to decrease according as the heel height was higher. The change in lumbar lordosis measured in high-heel stance was inconsistent with clinical forkelord of hyperlordosis in wearers of high-heeled. 2. Lumbar lordotic angle from T12 to L5 showed sex difference, and was more lordotic in female(p<0.05). 3. There was no sex difference in lumbosacral angle and lumbar segmental angles(p>0.05). 4. There was a significant correlation between lumbar lordotic angle and lumbosacral angle(r>0.60).

• Journal of Korean Neurosurgical Society
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• v.56 no.6
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• pp.517-520
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• 2014

Cauda equina syndrome (CES) associated with dural ectasia is a rare neurologic complication in patients with longstanding ankylosing spondylitis (AS). We report a 68-year-old male with a 30-year history of AS who presented a typical symptom and signs of progressive CES, urinary incontinence and neuropathic pain of the lumbosacral radiculopathy. Computed tomography (CT) and magnetic resonance imaging (MRI) findings showed the unique appearances of dural ectasia, multiple dural diverticula, erosion of posterior element of the lumbar spine, tethering of the conus medullaris and adhesion of the lumbosacral nerve roots to the posterior aspect of the dural ectasia. Considering the progressive worsening of the clinical signs, detethering of the conus medullaris through resection of the filum terminale was performed through a limited laminectomy. However, the urinary incontinence did not improve and there was a partial relief of the neuropathic leg pain only. The possible pathogenetic mechanism of CES-AS and the dural ectasia in this patient with longstanding AS are discussed with a literature review.

• The Korean Journal of Pain
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• v.2 no.1
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• pp.78-84
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• 1989

Steroid and local anesthetics were injected into the epidural space through the posterior sacral foramen or lumbar approach in 4 patients for the purposes of relieving severe low back pain and radiculopathy. These patients were referred from other sections dealing with low back pain and radiculopathy, because one could not tolerate the surgical stress due to a heart problem, another two did not want the operation and the last had post-laminectomy status. All patients were satisfied with the results subjectively.

• The Korean Journal of Pain
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• v.26 no.4
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• pp.368-373
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• 2013

Background: Bertolotti's syndrome (BS), a form of lumbago in lumbosacral transitional vertebrae, is an important cause of low back pain in young patients. The purpose of this study was to assess the etiology of low back pain and the efficacy of treatment offered to patients with BS. Methods: All patients of BS Castellvi type1a during a period of 6 months were enrolled in the study. The patients underwent interventional pain procedures for diagnosis and pain relief. Response to the therapy was assessed based on VAS and ODI scores. A 50% decrease in VAS score or a VAS score less than 3 would be considered adequate pain relief. Results: All 20 patients diagnosed with BS during the 6-month observation period had scoliosis. Common causes of back pain were the ipsilateral L5-S1 facet joint, neoarticulation, the SI joint, and disc degeneration. Responses to various interventions for pain relief were different and inconsistent from patient to patient. In particular, responses to interventions for neoarticular pain were generally poor. Conclusions: Pain in patients with BS does not usually respond to interventional pain treatment. A very dynamic treatment approach must be pursued while managing BS patients, and the treatment plan must be individualized at various stages in order to obtain satisfactory pain relief.

• The Journal of Korean Physical Therapy
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• v.16 no.3
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• pp.86-96
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• 2004

A clinical study about painful manifestation on lumbar with regard to movement change of trunk The purpose of this study is to present the basis of low back pain therapy which is close examined of back muscle that is the main reason for that case of back pain when trunk rotation, flexion and extension. Therefore this study, which is based on literature review and clinical experience, has tried to figure out that back pain which is considered to be significant for the most increasing time, posture, motion, painful area, involved muscle have any influence on trunk rotation, flexion and extension This study has done with the patients in oriental rehabilitation clinic, K-oriental hospital, from Jan, 2003 to Dec, 2003. Total cases were 145(male:$39\%$-52 patients, female:$64.1\%$-93 patients) those who complained lumbosacral pain with radiating that makes patient unable to bending or extending the trunk. And they were surveyed retrospect way, checking the medical record and that of therapist. Results are as followings. 1. For sprain patient, $34.5\%$ complained pain on extension, and among them, the most remarkably, patients who did right rotation extension pattern were $20\%$. Herniated disc patient shows greater limit on flexion when trunk moves bending route, but right rotation with extension pattern shows the most limitation on flexion-extension according to the rotation of trunk 2. Cases of morning back pain($60.5\%$) showed high value on right rotation extension pattern($18.6\%$), right rotation flexion pattern($16.3\%$) but did not show big difference on left flexion and extension pattern 3. Patients those who complain pain on sitting position showed highest value each left, right $14.6\%$ of left and right rotation extension pattern 4. Among extension painful patient, there showed highest value of each $32.5\%$ on right rotation extension pattern, and $20.0\%$ on right rotation flexion pattern. 5. Tenderness distribution of quadratus lumborum showed $34.5\%$ on right rotation extension pattern, $20.7\%$ on left rotation extension pattern, and that of iliopsoas muscle at right rotation flexion pattern showed right muscle $20.0\%$, left $50.0\%$ Derived from the results of survey above, for sprain and HIVD patient showed greatest pain on right rotation pattern, for pain plus patient on right rotation extension among those who has extreme pain on sitting in the morning described tenderness on right quadratus lumborum, and those who complain pain on left rotation extension described tenderness on left lumborum the most Decisively, it is possible to figure out the problem muscle that involved when I found the time, position, motion that aggravating and painful area. Therefore this study would be expected to be able to be a useful clinical materials on diagnosis and therapy of low back pain.

• The Korean Journal of Pain
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• v.2 no.1
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• pp.61-65
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• 1989

Chloroma is a localized myeloblastic tumor which may develop during the course of myelogenous leukemia or as a presenting sign of the disease. A 47-year-old female diagnosed as chronic myelogenous leukemia in her hematologic remission period complained of left lower leg pain. The lumbar-spine series showed multiple osteolytic changes in the left lateral border of the lumbar spine. An inhomogenous soft tissue mass involving left lateral aspects of lumbar vertebrae was identified by CT-scanning. At the first pain attack, lumbar epidural steroid and local anesthetic injection could abolish her pain and the patient could go a few days without pain. The following radiation therapy could also improve the symptom and retain the pain free interval. One month later, a second pain attack occurred and lumbar and caudal epidural steroid and local anesthetic injections could result only in an incidental relief of pain. Radiation and chemotherapy were started but failed to relieve pain. A neurolytic block was considered but the patient's general condition was aggravated and even verbal communication with her became impossible.

• Journal of Korean Neurosurgical Society
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• v.52 no.3
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• pp.254-256
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• 2012

Intracranial hypotension syndrome typically occurs spontaneously or iatrogenically. It can be associated with headache, drowsy mentality and intracranial heamorrhage, Iatrogenic intracranial hypotension can occur due to dural pucture, trauma and spine surgery. Treatment may include conservative therapy and operation. We report a case of a 54-year-old man who was successfully treated with epidural blood patches for intracranial hypotension due to cerebrospinal fluid (CSF) leakage into the lumbosacral area after spine surgery.

• The Journal of Korean Physical Therapy
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• v.14 no.1
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• pp.169-176
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• 2002

The purpose of this study were to measured peak torque of lumbar extensor at various degrees and to compare with the choronic low back pain patients and healthy subjects back extensor peak torque. Research subject are fifty choronic low back pain patients and fifty healthy subjects are Dong-a university hospital visited to 2000, January since 1999, august none lumbosacral traumal past history and neurologic disorder that is twenty generation, thirty generation, forty generation, fifty generation, sixty generation in healthy subjects and twenty generation, thirty generation, forty generation, fifty generation, sixty generation in cause choronic low back pain patients. The result were as follows. 1. There were each generation choronic low back pain patients and healthy subjects back extensor peak torque are consideration (p<.05). 2. Twenty generation was all degree of angle in lumbar extention peak torque in choronic low back pain patients back extensor are lower than healthy subjects(p<.05). 3. Thirty generation was all degree of angle in lumbar extention peak torque in choronic low back pain patients back extensor are lower than healthy subjects(p<.05). 4. Forty generation was all degree of angle in lumbar extention peak torque in choronic low back pain patients back extensor are lower than healthy subjects(p<;.05). 5. Fifty generation was all degree of angle in lumbar extention peak torque in choronic low back pain patients back extensor are lower than healthy subjects(p<.05). 6. Sixty generation was all degree of angle in lumbar extention peak torque in choronic low back pain patients back extensor are lower than healthy subjects(p<.05).