• Journal of Korean Neurosurgical Society
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• v.30 no.2
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• pp.144-149
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• 2001

Objective : Spinal nerve root compression occurs commonly in conditions, such as herniated nucleus pulposus, spinal stenosis, intervertebral foraminal stenosis, and trauma. However, the pathophysiolosy of the symptoms and signs related to spinal nerve root compression is poorly understood. The purpose of the present study was to assess and compare the changes of various pressures of intervertebral foraminal pressure before and after decompression. Method : After laminetomy without foraminotomy was performed, pressure sensor tip of Camino parenchymal type was located at the middle-central portion of the intervertebral foramen and anterior portion of nerve root for the foraminal pressure before decompression of the intervertebral foramen. After laminectomy with foraminotomy, the same method was used for the foraminal pressure after decompression. The authors studied 40 consecutive patients (57 disc spaces) with severe constant root pain to the lower leg, pain unrelived by bed rest, and minimal tension signs, diagnosed by MRI. Results : In patients with intervertebral foraminal stenosis, the intraforaminal pressure was decreased from $86{\pm}2.23mmHg$ to $17.1{\pm}1.51mmHg$ and in patients without stenosis, from $55.9{\pm}1.08mmHg$ to $11.9{\pm}1.25mmHg$. All patients below 20mmHg after decompression showed good outcome, but 4 cases who showed poor outcome had foraminal stenosis, posterolateral type of the herniated disc, and above 30mmHg of foraminal pressure after decompression. Conclusion : These findings suggest that if the foraminal pressure falls below 20mmHg after decompression, good outcome can be anticipated. Central type of the herniated disc shows better outcome compared to the posterolateral type.

• Journal of Acupuncture Research
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• v.34 no.4
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• pp.172-179
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• 2017

Background: This study was designed to evaluate the clinical effectiveness of traditional Korean medicine treatment for lumbar spinal stenosis as assessed by radiological criteria. Methods: This was an observational study of 122 patients who were diagnosed with lumbar spinal stenosis and admitted to Jaseng Hospital between January 2016 and June 2017. They were analyzed according to sex, age, cause of disease, disease stage, length of admission, type of stenosis, morphological grade, and dural sac cross-sectional area. All patients were treated with traditional Korean medicine. Patients were assessed with the Numeric Rating Scale (NRS), Oswestry Disability Index (ODI) and EQ-5D before and after treatment. Results: Regarding the distribution of the factors analyzed, these were of note: more females than males (1:3.52); and highest proportions were age more than 70 years (37.70%), cause of lumbar spinal stenosis unknown (67.21%), and subacute stage (42.62%). Comparing before and after treatment, the NRS score for low back and pelvic pain decreased from $6.14{\pm}1.71$ to $4.28{\pm}1.91$ (p < 0.001), and the NRS score for radiating pain and numbness decreased from $6.27{\pm}1.61$ to $2.02{\pm}1.54$ (p < 0.001). ODI decreased from $46.86{\pm}19.40$ to $33.63{\pm}18.66$ (p < 0.001), and gait-related ODI decreased from $3.34{\pm}1.23$ to $2.80{\pm}1.11$ (p < 0.001). There were no statistically significant differences in improvement of the NRS, ODI, gait-related ODI, and EQ-5D for morphological grade and dural sac cross-sectional area. Conclusion: Traditional Korean medicine is effective treatment for patients with lumbar spinal stenosis. Even in patients with severe radiological findings, it is possible to reduce pain and improve quality of life.

• Journal of Korean Neurosurgical Society
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• v.49 no.4
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• pp.234-236
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• 2011

Lumbar spinal stenosis (LSS) is a common spinal disease in the elderly. The cardinal symptom of LSS is neurogenic claudication, but not all patients present with such typical symptom. The clinical symptoms are often confused with symptoms of peripheral neuropathy, musculo-skeletal disease and other medical conditions in elderly patients. In particular, LSS presenting with rapid progression of leg weakness must be distinguished from other combined diseases. We report a case of rapid progressive leg weakness in a patient with LSS and iatrogenic adrenal insufficiency that was induced by obscure health supplement.

• The Korean Journal of Pain
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• v.14 no.2
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• pp.245-248
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• 2001

Lysis of epidural adhesion has been done in patients with refractory lumbar radiculopathies. Cauda equina syndrome is a rare complication of epidural block. We report on a case of cauda equina syndrome following epidural adhesiolysis in a patient with spinal stenosis. The patient complained of numbness of the perineum, weakness of the left leg, an inability to void and fecal incontinence. She was treated with medication, bladder training and physical therapy, and finally recovered 1 month after the procedure without any sequelae. We suggest that the causative factors are osmotic damage produced by the subarachnoid injection of large doses of hypertonic saline and temporary neural compression due to spinal stenosis.

• The Korean Journal of Pain
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• v.19 no.2
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• pp.168-174
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• 2006

Background: Several biochemical mediators, such as substance P, calcitonin gene-related peptide (CGRP) and prostaglandin $E_2$, have been demonstrated to be involved in herniated or degenerated disc-induced radiculopathy. The authors tested the hypothesis that these mediators would existed in the epidural space of humans. Methods: Thirty nine patients were divided into two groups; 27 patients, who were diagnosed with spinal stenosis (stenosis group), and 12 scheduled for epidural anesthesia, without a history of back pain (control group). Under fluoroscopic guidance, an epidural catheter was introduced through the caudal space and placed into the anterior and posterior spaces, up to and around the epidural adhesive area, in the stenosis group. In the control group, the catheter was placed into the posterior epidural space through the L3⁣-4 or L4⁣-5 intervertebral space. Epidural irrigation was performed with 10 ml of saline, via an epidural catheter. Aspirated lavage fluid was collected, and the concentrations of biochemical mediators (substance P, CGRP and prostaglandin $E_2$) measured using an enzyme immunoassay kit. Results: Substance P, CGRP and prostaglandin $E_2$ were detected in all the epidural lavage fluids from both groups. The concentrations of substance P and prostaglandin $E_2$ in the stenosis group were higher than those of the control (P < 0.05). However, there was no difference in the CGRP levels between the two groups. In the stenosis group, the concentrations of these three mediators in the anterior epidural space were no different to those in the posterior space. Conclusions: These results suggest that biochemical mediators, such as substance P and prostaglandin $E_2$, in the epidural space might be partly involved in pain mechanism associated with spinal stenosis.

• Journal of Korean Neurosurgical Society
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• v.37 no.6
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• pp.410-415
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• 2005

Objective: The aim of our study is to evaluate the effectiveness of unilateral hemilaminectomy for bilateral decompression in elderly patients with degenerative spinal stenosis. For this purpose, we studied the co-morbid condition and clinical outcome of patients who underwent decompressive surgery using the unilateral approach technique. Methods: Thirty-four patients over 65years of age who underwent unilateral partial laminectomy for bilateral decompression from January 2000 to October 2003 were analyzed. These patients were studied for preoperative co-morbid condition and physical status according to the American Society of Anesthesiologists(ASA) classification, postoperative morphometrical change, and clinical outcomes, including visual analogue scale(VAS) score. The mean follow-up was 23months (range 6 - 48months). Results: A patient's physical status was recorded as class I, II, or III by ASA classification, which correlated to 41.2%, 44.1%, and 14.7% of patients, respectively. The cross-sectional area of the pre- and postoperative dural sac at the level of the stenosis was $52.5{\pm}19.9mm^2$ and $110.6{\pm}18.2mm^2$, respectively. The outcome was excellent in 8.8%, good in 58.8%, fair in 23.6%, and poor in 8.8% of the patients. The VAS was changed postoperatively to $3.1{\pm}1.2$. There was no operation-related transfusion yet there was no evidence of postoperative instability at the follow-up examination. Conclusion: Unilateral laminectomy for bilateral decompression, in spite of the limited exposure, can result in satisfactory decompression of the lumbar spinal stenosis and tolerable clinical outcome. This approach is thought to be appropriate for elderly patients who have a greater surgical burden.

• Proceedings of the Korean Society of Precision Engineering Conference
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• 2005.06a
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• pp.1963-1966
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• 2005

Degenerative lumbar spinal stenosis(DLSS) is a disease inducing low back pain, leg pain, convulsion, numbness, and neurogenic claudication from compression of nerve root. Intervertebra fixation was reported to increase the degenerative of neighbor region after treatment. Recently, a new surgical technique of inserting a fixator between interspinous processes has been introduced. The purpose of this study is to design of the interspinous process fixator with flexibility to complement the trouble of using fixator in DLSS. This study evaluated the existing fixator through the mechanical test and modified fixators using the finite element analysis(FEA). Displacement, stiffness and Von-Mises stress were found to have similar values to those obtained from the mechanical test and the FEA in the biomechanical loading condition. Effects of variation in length and thickness were investigated to design an optimal fixator.

• Journal of Korean Biological Nursing Science
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• v.13 no.2
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• pp.156-163
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• 2011

Purpose: The purpose of this study was to examine the effects of a bergamot essential oil-inhalation on chronic pain after surgery for lumbar spinal stenosis. Methods: Fifty-two subjects were randomly assigned to the experimental (bergamot essential oil-inhalation) and control (almond oil-inhalation) group. All patients understood the purpose of this study and a written informed consent for the study was obtained. Results: Bergamot essential oil-inhalation was conducted during twenty minutes. Visual analog scale, blood pressure, heart rate, and respiratory rate were measured before and after treatment in the two groups. The visual analog scale score, heart rate, and respiratory rate in bergamot essential oil-inhalation group were significantly lower than those in almond oil-inhalation group. However, there was no significant difference in systolic and diastolic blood pressure between the two groups. Conclusion: Therefore, bergamot essential oil-inhalation is effective in alleviating pain, heart rate, and respiratory rate. These results suggest that bergamot essential oil-inhalation can be a useful method for the relief of chronic pain during the treatment after spinal surgery.

• Journal of Acupuncture Research
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• v.38 no.4
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• pp.320-324
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• 2021

Lumbar spinal stenosis (LSS) is a common degenerative spinal condition that can have unpredictable improvement and worsening of symptoms which include low back pain, radiating pain, claudication, and degenerative lumbar scoliosis affecting quality of life. In this study, thread embedding acupuncture (TEA) was used as a conservative treatment for LSS in combination with complex Korean medicine treatments (acupuncture, herbal medicines, and physical therapy). The treatment was evaluated using the numerical rating scale, walking distance and duration, and inclination of radiological lumbar scoliosis according to antalgic posture. TEA was performed 27 times between June 8, 2020, and March 16, 2021. The patient showed improvement in numerical rating scale score from 7 to 2, pain-free walking distance from 10 m to 900 m, and scoliosis inclination following treatment. The findings of this study suggest that TEA may be helpful in the treatment of LSS.

• Journal of the Korean Orthopaedic Association
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• v.54 no.3
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• pp.219-226
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• 2019

Lumbar decompressive surgery is a standard surgery for lumbar spinal stenosis. Many surgical techniques have been introduced, ranging from open surgery to percutaneous procedures. Minimally invasive techniques are preferred because of the less postoperative pain and shorter hospital stay. Uniportal percutaneous endoscopic decompression has technical difficulties due to the narrow field. Biportal percutaneous endoscopic decompression is a satisfactory technique that can compensate for the shortcomings and provide sufficient decompression.