• Journal of Korean Neurosurgical Society
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• 제65권4호
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• pp.539-548
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• 2022

Objective : Although full-endoscopic lumbar interbody fusion (Endo-LIF) has been tried as the latest alternative technique to minimally invasive transforaminal lumbar interobody fusion (MIS-TLIF) since mid-2010, the evidence is still lacking. We compared the clinical outcome and safety of Endo-LIF to MIS-TLIF for lumbar degenerative disease. Methods : We systematically searched electronic databases, including PubMed, EMBASE, and Cochrane Library to find literature comparing Endo-LIF to MIS-TLIF. The results retrieved were last updated on December 11, 2020. The perioperative outcome included the operation time, blood loss, complication, and hospital stay. The clinical outcomes included Visual analog scale (VAS) of low back pain and leg pain and Oswestry disability index (ODI), and the radiological outcome included pseudoarthosis rate with 12-month minimum follow-up. Results : Four retrospective observational studies and one prospective observational study comprising 423 patients (183 Endo-LIF and 241 MIS-TLIF) were included, and the pooled data analysis revealed low heterogeneity between studies in our review. Baseline characteristics including age and sex were not different between the two groups. Operation time was significantly longer in Endo-LIF (mean difference [MD], 23.220 minutes; 95% confidence interval [CI], 10.669-35.771; p=0.001). However, Endo-LIF resulted in less perioperative blood loss (MD, -144.710 mL; 95% CI, 247.941-41.478; p=0.023). Although VAS back pain at final (MD, -0.120; p=0.586), leg pain within 2 weeks (MD, 0.005; p=0.293), VAS leg pain at final (MD, 0.099; p=0.099), ODI at final (MD, 0.141; p=0.093) were not different, VAS back pain within 2 weeks was more favorable in the Endo-LIF (MD, -1.538; 95% CI, -2.044 to -1.032; p<0.001). On the other hand, no statistically significant group difference in complication rate (relative risk [RR], 0.709; p=0.774), hospital stay (MD, -2.399; p=0.151), and pseudoarthrosis rate (RR, 1.284; p=0.736) were found. Conclusion : Relative to MIS-TLIF, immediate outcomes were favorable in Endo-LIF in terms of blood loss and immediate VAS back pain, although complication rate, mid-term clinical outcomes, and fusion rate were not different. However, the challenges for Endo-LIF include longer operation time which means a difficult learning curve and limited surgical indication which means patient selection bias. Larger-scale, well-designed study with long-term follow-up and randomized controlled trials are needed to confirm and update the results of this systematic review.

• Journal of Korean Neurosurgical Society
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• 제65권1호
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• pp.84-95
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• 2022

Objective : To investigate the clinical efficacy and safety of the controlled distraction-compression technique using an expandable titanium cage (ETC) in posttraumatic kyphosis (PTK). Methods : We retrospectively studied and collected data on 20 patients with PTK. From January 2014 to December 2017, the controlled distraction-compression technique using ETC was consecutively performed in 20 patients with PTK of the thoracolumbar zone (range, 36-82 years). Among them, nine were males and 11 were females and the mean age was 61.5 years. The patients were followed regularly at 1, 3, 6, and 12 months, and the last follow-up was more than 2 years after surgery. Results : The mean follow-up period was 27.3±7.3 months (range, 14-48). The average operation time was 286.8±33.1 minutes (range, 225-365). The preoperative regional kyphotic angle (RKA) ranged from 35.6° to 70.6° with an average of 47.5°±8.1°. The immediate postoperative mean RKA was 5.9°±3.8° (86.2% correction rate, p=0.000), and at the last follow-up more than 2 years later, the mean RKA was 9.2°±4.9° (80.2% correction rate, p=0.000). The preoperative mean thoracolumbar kyphosis was 49.1°±9.2° and was corrected to an average of 8.8°±5.3° immediately after surgery (p=0.000). At the last follow-up, a correction of 11.9°±6.3° was obtained (p=0.000). The preoperative mean back visual analog scale (VAS) score was 7.9±0.8 and at the last follow-up, the VAS score was improved to a mean of 2.3±1.0 with a 70.9% correction rate (p=0.000). The preoperative mean Oswestry disability index (ODI) score was 32.3±6.9 (64.6%) and the last follow-up ODI score was improved to a mean of 6.85±2.9 (3.7%) with a 78.8% correction rate (p=0.000). The overall complication was 15%, with two of distal junctional fractures and one of proximal junctional kyphosis and screw loosening. However, there were no complications directly related to the operation. Conclusion : Posterior vertebral column resection through the controlled distraction-compression technique using ETC showed safe and good results in terms of complications, and clinical and radiologic outcomes in PTK. However, to further evaluate the efficacy of this surgical procedure, more patients need long-term follow-up and there is a need to apply it to other diseases.

• 대한척추외과학회지
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• 제25권4호
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• pp.147-153
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• 2018

연구 계획: 후향적 사례분석 목적: 보존적 치료에 반응하지 않는 증후성 쉬모를 결절에서 신경절 이후 신경차단술의 임상 결과를 후향적으로 평가하고자 하였다. 선행 연구문헌의 요약: 쉬모를 결절은 대부분 우연히 발견되는 무증상의 추체내 병변으로 알려져 있으나, 때로 중증의 축성요통의 원인이며, 삶의 질에 상당한 영향을 미친다고 보고되고 있다. 증후성 쉬모를 결절에 대한 치료법에 대해서 아직까지 명확한 합의는 없다. 대상 및 방법: 2015년 10월부터 2017년 10월까지 4주간 약물치료, 침상안정 및 물리치료 등의 보존적 치료에 반응하지 않으면서, 자기공명영상 검사 상증후성 쉬모를 결절로 진단된 총 21명의 환자를 대상으로 신경절 이후 신경차단술을 시행하였다. 시술 후 4시간, 4주, 8주, 3개월 및 6개월에 시각 통증 척도(VAS)와 Oswestry disability index (ODI)를 통해 효과적인 통증 완화(시술 전 대비 50% 이상의 요통 호전) 및 기능 척도의 호전을 평가하였다. 결과: 증후성 쉬모를 결절은 제 2-3요추 부위에서 호발 하였으며, 상부 종판에 비해 하부 종판의 침범이 많이 관찰되었다. 총 21명의 환자 중 18명의 환자에서(85.7%) 효과적인 통증 완화를 보였으며, 추시 기간 내 재 악화 소견은 관찰되지 않았다. 전체 추시 기간 동안 시술 전 대비 VAS는 유의하게 호전되었다(p<0.05). 전례에서 시술 후 합병증은 보고되지 않았다. 결론: 보존적 치료에 반응하지 않는 증후성 쉬모를 소결절에서 신경절 이후 신경차단술은 통증 호전을 위한 좋은 비침습적 치료법 중 하나이다.

• 한방재활의학과학회지
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• 제24권4호
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• pp.41-48
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• 2014

Objectives The present study examines the domestic trend of Failed Back Surgery Syndrome (FBSS) in Korea. Methods The studies on FBSS were investigated via searching Korean web databases. As a result, 41 research papers were found and they were analyzed according to the year of publishment, the titles of journals which have the papers, the types of study, the definition of FBSS, employed treatment trials, and the instruments for assessment. Results The number of the research papers on FBSS published was increased since 2005. The studies on FBSS were mainly published in the Korean Journal of Pain. The most popular type of the studies were the case report and the most studies defined FBSS as persistent or recurring low back pain with or without sciatica after receiving spine surgeries. Various surgical and conservative treatments were employed in the studies and Visual Analogue Scale (VAS), Numeric Rating Scale (NRS), Oswestry Disability Index (ODI) were used as primary means of assessments. Conclusions Reviewing the domestic trends of studies on FBSS and examining the definition of FBSS is essential for the future studies because there is no clear criteria for making diagnosis of FBSS. Therefore, the further studies on FBSS need to be more elaborate with the definition of FBSS, and it is also necessary to apply more assessment tools for the better understanding of FBSS from various aspects. Ultimately, this review is anticipated to benefit the future in-depth study on FBSS.

• Journal of Acupuncture Research
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• 제33권3호
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• pp.197-205
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• 2016

Objectives : To report the clinical application and safety of Traditional Korean Medical treatment for patients with low back pain during pregnancy. Methods : Three patients who suffered from low back pain during pregnancy were treated with acupuncture, pharmacopuncture, moxibustion, and herbal medicine for 12 to 21 days. Numeric rating scale (NRS) of low back pain and Oswestry Disability Index (ODI) were checked to measure the outcome. A liver function and renal function test was carried out to identify any drug-induced liver or renal injury, and any adverse events were monitored thoroughly until delivery. Results : Low back pain reduced on NRS in all cases, and no serious adverse effects were found in the patients or infants. Conclusion : This study suggests that Traditional Korean Medical treatment is a candidate therapy for relieving low back pain during pregnancy, and also is safe for both patients and infants.

• 한방재활의학과학회지
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• 제23권2호
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• pp.139-149
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• 2013

Objectives : The aim of this study was to investigate the characteristic of low back pain(LBP) and lumbosacral-pelvic alignments, and the relationship between them, depending on the presence and the duration of LBP. Methods : Ninety six patients were classified into the no LBP group(n=31), the acute LBP group(n=33) and the chronic LBP group(n=32), based on the presence and duration of LBP. In each group, lumbosacral-pelvic indicators were measured. The data were analysed by one way analysis of variance(ANOVA) and pearson correlation. Results : 1. The chronic LBP group showed the lower mean value in Ferguson angle, Lumbar lordosis angle, Pelvic Incidence and difference between left and right iliac height, being compared to acute LBP group. 2. There was not significant correlation between lumbosacral-pelvic alignments and LBP in every group. 3. A positive correlation was found among period of LBP and visual analogue scale(VAS), Oswestry disability index(ODI). Conclusions : For presence and duration of LBP, there were different characteristic values in descriptive statistics. And period of LBP is the most important factor for the degree of LBP. These results show that the lumbosacral-pelvic alignments and LBP have distinctive relationships depending on the duration of LBP.

• Journal of Acupuncture Research
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• 제31권1호
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• pp.61-73
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• 2014

Objectives : The purpose of this study is to estimate the test-retest reliability and the intratest repeatability in measuring the lumbar range of motion of healthy volunteers with wireless microelectromechanical system inertial measurement unit(MEMS-IMU) system and to discuss the feasibility of this system in the clinical setting to evaluate the lumbar spine movement. Methods : 19 healthy male volunteers were participated, who got under 21 points at oswestry disability index(ODI) were adopted. Their lumbar motion were measured with IMU twice in consecutive an hour for the test-retest reliability study. Intratest repeatability was calculated in the two tests separately. The calculated intraclass correlation coefficients(ICC) were discussed and compared with the those of the previous studies. Results : Lumbar range of motion of flexion $41.45^{\circ}$, extension $16.34^{\circ}$, right lateral bending $16.41^{\circ}$ left lateral bending $13.63^{\circ}$ right rotation $-2.47^{\circ}$, left rotation $-0.61^{\circ}$. ICCs were 0.96~1.00(intratest repeatability) and 0.61~0.92(test-retest reliability). Conclusion : This study shows that MEMS-IMU system demonstrates a high test-retest reliability and intratest repeatability by calculated intraclass correlation coefficients. The results of this study represents that wireless inertial sensor measurement system has portable and economical efficiency. By MEMS-IMU system, we can measures lumbar range of motion and analyze lumbar motion effectively.

• Journal of Korean Neurosurgical Society
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• 제65권5호
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• pp.719-729
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• 2022

Objective : The ossification of the ligamentum flavum (OLF) is one of the major causes of thoracic myelopathy. Surgical decompression with or without instrumented fusion is the mainstay of treatment. However, few studies have reported on the added effect of instrumented fusion. The objective of this study was to compare clinical and radiological outcomes between surgical decompression without instrumented fusion (D-group) and that with instrumented fusion (F-group). Methods : A retrospective review was performed on 28 patients (D-group, n=17; F-group, n=11) with thoracic myelopathy due to OLF. The clinical parameters compared included scores of the Japanese Orthopedic Association (JOA), the Visual analogue scale of the back and leg (VAS-B and VAS-L), and the Korean version of the Oswestry disability index (K-ODI). Radiological parameters included the sagittal vertical axis (SVA), the pelvic tilt (PT), the sacral slope (SS), the thoracic kyphosis angle (TKA), the segmental kyphosis angle (SKA) at the operated level, and the lumbar lordosis angle (LLA; a negative value implying lordosis). These parameters were measured preoperatively, 1 year postoperatively, and 2 years postoperatively, and were compared with a linear mixed model. Results : After surgery, all clinical parameters were significantly improved in both groups, while VAS-L was more improved in the F-group than in the D-group (-3.4±2.5 vs. -1.3±2.2, p=0.008). Radiological outcomes were significantly different in terms of changes in TKA, SKA, and LLA. Changes in TKA, SKA, and LLA were 2.3°±4.7°, -0.1°±1.4°, and -1.3°±5.6° in the F-group, which were significantly lower than 6.8°±6.1°, 3.0°±2.8°, and 2.2°±5.3° in the D-group, respectively (p=0.013, p<0.0001, and p=0.037). Symptomatic recurrence of OLF occurred in one patient of the D-group at postoperative 24 months. Conclusion : Clinical improvement was achieved after decompression surgery for OLF regardless of whether instrumented fusion was added. However, adding instrumented fusion resulted in better outcomes in terms of lessening the progression of local and regional kyphosis and improving leg pain. Decompression with instrumented fusion may be a better surgical option for thoracic OLF.