• The Journal of Churna Manual Medicine for Spine and Nerves
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• v.16 no.1
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• pp.25-34
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• 2021

Objectives This review was conducted to evaluate the effectiveness and clinical significance of Chuna manual therapy (CMT) in the treatment of pediatric cough. Methods Ten electronic databases (PubMed, EMBASE, Cochrane, CNKI [CAJ], KMBASE, KISS, KISTI, NDSL, RISS, and Oasis) were searched. Only randomized controlled trials (RCTs) using CMT for pediatric cough treatment were included. The methodological quality of each RCT was evaluated using the Cochrane risk-of-bias tool (v1.0). Results Nine RCTs met the inclusion criteria. The meta-analysis revealed positive effects of CMT in the treatment of pediatric cough. Both CMT alone and CMT combined with Chinese medication or Chinese medicine acupoint application (CMAA) were effective in treating pediatric cough. Conclusions This systematic review shows the reliability, effectiveness, and clinical significance of CMT in the treatment of pediatric cough. However, the evidence is limited due to the defective design of the included RCTs. More well-designed RCTs are required to provide clearer evidence for this claim.

• The Journal of Churna Manual Medicine for Spine and Nerves
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• v.16 no.1
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• pp.35-42
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• 2021

Objectives The objective of this study was to evaluate the effect of chuna manual therapy for rhinitis. Methods We performed a literature search using ten electronic databases (PubMed, Embase, Cochrane Library, Chinese Academic Journals(CAJ), Research Information Sharing Service(RISS), Dbpia, National Digital Science Library(NDSL), Koreanstudies Information Service System(KISS), Korean Medical database(KMbase), and Oriental Medicine Advanced Searching Integrated System(OASIS)) and two academic journals up to the end of April 2021. We included randomized controlled trials (RCTs) which appraised the effect of chuna manual therapy (CMT) in the treatment of rhinitis. The risk of bias was evaluated from the Cochrane Risk of Bias tool. Results 4 appropriate RCTs were included and analyzed. The efficacy rate of the CMT group was statistically higher compared to the control group treated with medicine[RR 1.14 (95%CI 1.06 1.22), P<0.01]. Conclusions Based on results, CMT could be effective in rhinitis. However, evidence were limited due to small number of studies, lack of well-designed RCT and regional bias. Further well-designed research should be required to obtain stronger evidence.

• The Journal of Churna Manual Medicine for Spine and Nerves
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• v.15 no.2
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• pp.9-18
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• 2020

Objectives This study verified the clinical effectiveness of Qigong exercise therapy for individuals with hypertension. Methods Ten electronic databases were used for information retrieval. Only randomized controlled trials (RCTs) using Qigong exercise therapy as a treatment for hypertension were included in this study. Cochrane risk of bias tool was used to assess the methodological quality of each RCT. Results After a thorough review, six RCTs were deemed eligible. These studies were divided into two groups: Qigong vs. no intervention and Qigong plus anti-hypertensive drug vs. anti-hypertensive drug alone. Among the six RCTs, four studies were Qigong vs. no intervention, and two studies were Qigong plus anti-hypertensive drug vs. anti-hypertensive drug alone. The meta-analysis demonstrated that adding Qigong exercise to anti-hypertensive drug treatment lowers diastolic blood pressure more than the anti-hypertensive drug alone. Conclusions Although Qigong exercise is not widely used in the Korean medical field, the results of this study demonstrated the necessity of exercise while controlling hypertension. However, the number of included studies was small, with their high risk of bias. In conclusion, although it is difficult to determine whether Qigong exercise lowers blood pressure in hypertensive patients, exercise including Qigong must be parallel with the intake of anti-hypertensive drugs.

• The Journal of Churna Manual Medicine for Spine and Nerves
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• v.16 no.2
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• pp.9-19
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• 2021

Objectives This systematic review aimed to provide evidence for the effectiveness and safety of Chuna manual therapy (CMT) for carpal tunnel syndrome (CTS). Methods We searched 12 electronic databases (PubMed, Ovid-MEDLINE, EMBASE, The Cochrane Library, CNKI, CiNii, ScienceON, KMbase, KISS, OASIS, KMTANK, and RISS) up to the end of October 2021. We only included randomized controlled trials (RCTs) investigating CMT for the treatment of CTS. The methodological quality of the included RCTs was evaluated using the Cochrane Risk of Bias Tool 1.0. Results Six RCTs were eligible for inclusion in our study. A meta-analysis of four studies demonstrated positive results for the use of CMT when used in conjunction with Korean medicine treatment compared to those for Western conservative treatment for CTS. Conjunction treatment significantly improved the total efficacy rate compared to conservative treatment alone (P=0.0007, n=4). Conclusions There is reliable evidence for the use of CMT in treating CTS based on a published meta-analysis. To measure only the effect of Chuna, an experimental group should be designed with Chuna alone to evaluate its effectiveness. However, it should be noted that the studies included in this systematic review were heterogeneous and of low quality, thus warranting further investigation using well-designed RCTs.

• The Journal of Churna Manual Medicine for Spine and Nerves
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• v.17 no.1
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• pp.11-19
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• 2022

Objectives This systematic review aimed to provide evidence of the effectiveness and safety of manual therapy for asthma in children and adolescents. Methods We queried eight electronic databases (PubMed, Ovid-MEDLINE, EMBASE, The Cochrane Library, CNKI, ScienceON, KISS, and RISS) up to the end of April 2022. We included only randomized controlled trials (RCTs) investigating manual therapy for the treatment of asthma in children and adolescents. The methodological quality of the included RCTs was evaluated using the Cochrane risk-of-bias tool 1.0. Results Four RCTs were eligible for inclusion. Meta-analysis could not be performed due to the heterogeneity of the studies. One study showed the statistical significance of SMD 0.41 (95% CI: 0.06, 0.76, p<0.05) in the comparison with the osteopathic therapy group and the sham control group before and after treatment on the same day of peak expiratory flow. Conclusions This possibility was observed in a non-pharmacological approach to manual therapy. Manual therapy can be considered as an adjunct therapy for asthma treatment in children and adolescents who have difficulty with drug therapy.

• The Journal of Korean Medicine
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• v.42 no.2
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• pp.90-97
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• 2021

Bone mineral density (BMD) is a major diagnostic marker for bone health. A 44-year-old male had BMD of 0.81 g/cm² (Z-score: -3.1) in lumbar spine scan and 0.54 g/cm² (Z-score: -2.7) for femoral neck from regular medical checkup in Apr 2020. He had no other specific medical conditions except hyperlipidemia and alcohol was a single risk factor for fracture according to Fracture Risk Assessment Tool. After he was diagnosed with liver-kidney deficiency and treated for 20 weeks with Jeopgol-tang originally patented for promoting fracture recovery, lumbar spine BMD increased by 13.6 % (0.92 g/cm², Z-score: -2.1) and femoral neck BMD by 22.2% (0.66 g/cm², Z-score: -1.8) compared with those of Mar 2020. Herbal medicine treatment for tonifying liver and kidney to improve BMD warrants further investigation.

• Journal of Korean Society of Spine Surgery
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• v.25 no.4
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• pp.180-184
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• 2018

Study Design: Case report Objectives: To document fistula formation between the disc and dura by an unrecognized dural tear after percutaneous endoscopic lumbar discectomy (PELD). Summary of Literature Review: The risk of durotomy is relatively low with PELD, but cases of unrecognized durotomies have been reported. An effective diagnostic tool for such situations has not yet been identified. Materials and Methods: A patient twice underwent transforaminal PELD under the diagnosis of a herniated lumbar disc at L4-5. She still complained of intractable pain and motor weakness around the left lower extremity at 6 months postoperatively. Magnetic resonance imaging showed no specific findings suggestive of violation of the nerve root. However, L5 and S1 nerve root injury was noted on electromyography. An exploratory operation was planned to characterize damage to the neural structures. Results: In the exploration, a dural tear was found at the previous operative site, along with a fistula between the disc and dura was also found at the dural tear site. The durotomy site was located on the ventrolateral side of the dura and measured approximately 5 mm. The durotomy site was repaired with Nylon 5-0 and adhesive sealants. The patient's preoperative symptoms diminished considerably. Conclusions: Fistula formation between the disc and dura can be caused by an unrecognized dural tear after PELD. Discography is a reliable diagnostic tool for fistulas formed by an unrecognized durotomy.

• Journal of Korean Neurosurgical Society
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• v.63 no.5
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• pp.649-656
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• 2020

Objective : Unclear mental state is one of the major factors contributing to diagnostic failure of occult skeletal trauma in patients with traumatic brain injury (TBI). The aim of this study was to evaluate the overlooked co-occurring skeletal trauma through whole body bone scan (WBBS) in TBI. Methods : A retrospective study of 547 TBI patients admitted between 2015 and 2017 was performed to investigate their cooccurring skeletal injuries detected by WBBS. The patients were divided into three groups based on the timing of suspecting skeletal trauma confirmed : 1) before WBBS (pre-WBBS); 2) after the routine WBBS (post-WBBS) with good mental state and no initial musculoskeletal complaints; and 3) after the routine WBBS with poor mental state (poor MS). The skeletal trauma detected by WBBS was classified into six skeletal categories : spine, upper and lower extremities, pelvis, chest wall, and clavicles. The skeletal injuries identified by WBBS were confirmed to be simple contusion or fractures by other imaging modalities such as X-ray or computed tomography (CT) scans. Of the six categorizations of skeletal trauma detected as hot uptake lesions in WBBS, the lesions of spine, upper and lower extremities were further statistically analyzed to calculate the incidence rates of actual fractures (AF) and actual surgery (AS) cases over the total number of hot uptake lesions in WBBS. Results : Of 547 patients with TBI, 112 patients (20.4 %) were presented with TBI alone. Four hundred and thirty-five patients with TBI had co-occurring skeletal injuries confirmed by WBBS. The incidences were as follows : chest wall (27.4%), spine (22.9%), lower extremities (20.2%), upper extremities (13.5%), pelvis (9.4%), and clavicles (6.3%). It is notable that relatively larger number of positive hot uptakes were observed in the groups of post-WBBS and poor MS. The percentage of post-WBBS group over the total hot uptake lesions in upper and lower extremities, and spines were 51.0%, 43.8%, and 41.7%, respectively, while their percentages of AS were 2.73%, 1.1%, and 0%, respectively. The percentages of poor MS group in the upper and lower extremities, and spines were 10.4%, 17.4%, and 7.8%, respectively, while their percentages of AS were 26.7%, 14.2%, and 11.1%, respectively. There was a statistical difference in the percentage of AS between the groups of post-WBBS and poor MS (p=0.000). Conclusion : WBBS is a potential diagnostic tool in understanding the skeletal conditions of patients with head injuries which may be undetected during the initial assessment.

• Journal of Trauma and Injury
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• v.22 no.1
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• pp.37-43
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• 2009

Purpose: A missed fracture is a very common occurrence in the Emergency Department (ED) and can have serious results because of delays in treatment, resulting in long-term disability. It is also one of the most common causes leading to medical legal issues. We analyzed the causes of missed fractures by using a bone scan which is known to be an effective tool for diagnosing bony lesions. Methods: We reviewed the medical records of trauma patients who underwent a bone scan after being discharged the ED from September 2006 to March 2008. Cases of missed fractures were identified by using electronic medical records to review each diagnosis. Definition of missed fracture was read after bone scan by radiologist. We decided that there was no fracture if we read 'trauma-related lesion' or 'cannot rule out fracture' on a bone scan read by a radiologist. Enrolled patients were analyzed by age, sex, time until bone scan and Injury Severity Score (ISS). Patients were divided into two groups, alert mentality and not-alert mentality, so there were split between a diagnosis group and a missed fracture group. ISS was also used in determining the severity of the patient's injury upon discharge from the ED. Results: A total of 532 patients were enrolled in this study. Of those, 487 patients were in the diagnosis group, and 45 patients (8.4%) were discovered to have had a fracture. Of the 45 missed fracture patients, 34 patients (6.4%) had one-site fractures, 8 patients (1.5%) had two-site fractures, and 3 patients (0.6%) had three-site fractures. The most commonly missed fracture was multiple rib fractures (18 patients, 30.5%), followed by lumbosacral (LS) spine fractures (10 patients, 16.9%), thoracic spine fractures (8 patients, 13.6%), and clavicle fractures (6 patients, 10.2%). Mean age was $50.12{\pm}18.54$ years in the diagnosis group and $57.38{\pm}16.88$ years in the missed fracture group. For the diagnosis group, the mean ISS was $9.03{\pm}8.26$, but in the missed fracture group it was $17.53{\pm}9.69$. Missed fractures were much more frequent in the not-alert mentality (p<0.01) and in the high (ISS$ ISS{\geq}16$) group (p<0.01). Conclusion: Missed fractures occur most frequent in patients of old age, not-alert mentality, and high ISS. Multiple rib and spine fractures were found to be the most frequent missed fractures, regardless of trauma severity. This study also shows a high possibility of clavicle and scapula fractures in patients with severe trauma.

• Journal of Korean Neurosurgical Society
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• v.64 no.6
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• pp.995-1003
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• 2021

Objective : People are living longer and the elderly population continues to increase. The incidence of degenerative spinal diseases (DSDs) in the elderly population is quite high. Therefore, we are facing more cases of DSD and offering more surgical solutions in geriatric patients. Understanding the significance and association of frailty and central sarcopenia as risk factors for spinal surgery in elderly patients will be helpful in improving surgical outcomes. We conducted a retrospective cohort analysis of prospectively collected data to assess the impact of preoperative central sarcopenia, frailty, and comorbidity on surgical outcome in elderly patients with DSD. Methods : We conducted a retrospective analysis of patients who underwent elective spinal surgery performed from January 1, 2019 to September 30, 2020 at our hospital. We included patients aged 65 and over who underwent surgery on the thoracic or lumbar spine and were diagnosed as DSD. Central sarcopenia was measured by the 50th percentile of psoas : L4 vertebral index (PLVI) using the cross-sectional area of the psoas muscle. We used the Korean version of the fatigue, resistance, ambulation, illnesses, and loss of weight (K-FRAIL) scale to measure frailty. Comorbidity was confirmed and scored using the Charlson Comorbidity Index (CCI). As a tool for measuring surgical outcome, we used the Clavien-Dindo (CD) classification for postoperative complications and the length of stay (LOS). Results : This study included 85 patients (35 males and 50 females). The mean age was 74.05±6.47 years. Using the K-FRAIL scale, four patients were scored as robust, 44 patients were pre-frail and 37 patients were frail. The mean PLVI was 0.61±0.19. According to the CD classification, 50 patients were classified as grade 1, 19 as grade 2, and four as grade 4. The mean LOS was 12.35±8.17 days. Multivariate stepwise regression analysis showed that postoperative complication was significantly associated with surgical invasiveness and K-FRAIL scale. LOS was significantly associated with surgical invasiveness and CCI. K-FRAIL scale showed a significant correlation with CCI and PLVI. Conclusion : The present study demonstrates that frailty, comorbidity, and surgical invasiveness are important risk factors for postoperative complications and LOS in elderly patients with DSD. Preoperative recognition of these factors may be useful for perioperative optimization, risk stratification, and patient counseling.