• The Korean Journal of Pain
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• v.20 no.1
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• pp.54-59
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• 2007

Background: Selective transforaminal epidural block (STEB) has showen effectiveness as a diagnostic and therapeutic option for the management of patients with low back pain or sciatica. This study was carried out in order to determine the short-term effects and prognostic factors associated with STEB in patients with low back pain or sciatica. Methods: Ninety-seven patients were selectedfor participation in this study. Their diagnosis were based werewason the clinical symptoms and MRI findings. We performed STEB under fluoroscopic guidance and injected 3 ml of radio opaque dye in order to confirm the technical success of the procedure. We then injected 20 mg of triamcinolone mixed into 3 ml of 0.5% mepivacaine. One month later, we classified the patient outcomes as excellent, good, moderate or poor, according to the degree of reduction in VAS score from baseline. The independent variables assessed included symptom duration, block level, number of blocks, primary diagnosis, prior caudal block, anterior epidural space filling of dye, medication history, demographic data, radiating pain, back surgery and spondylolisthesis. Results: At a mean follow-up period of 1 month after STEB, excellent results were noted in the patients diagnosed with herniated lumbar disc (70%), non-specific spondylosis (54%), spinal stenosis (44%), and failed back syndrome (28%). The patients with epidural adhesion and combined spondylolisthesis were associated with poorer outcomes. Combined caudal block, symptom duration and the extent of epidural spread of the drug were not related to the effectiveness of the treatment. Conclusions: Selective transforaminal epidural block is effective in treating patients with radiculopathy, such as herniated lumbar disc, but it isrelatively ineffective in treating patients with structural deformities, such as failed back syndrome and spondylolisthesis.

• Journal of Korean Neurosurgical Society
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• v.29 no.4
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• pp.528-535
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• 2000

Objective : To investigate objectively the postoperative improvement of gait disturbance in patients with cervical myelopathy through a gait analysis. Patients and Methods : Ten patients who underwent cervical decompression and fusion for cervical myelopathy caused by spondylosis, OPLL, or concomitant hypertrophy of ligamentum flavum were studied. Preoperatively, gait disturbance was present in all patients. The patients were evaluated by gait analysis using three dimensional motion analyzer to collect data of linear and kinematic parameters before surgery, 1 week and 3 months after surgery. Statistical analysis of the related pre-and post-operative data were performed. Results : In the linear parameters, average value of cadence, walking speed, stride length, step time, width and double support were increased postoperatively compare to preoperative value. In the kinematic parameters, average value of knee flexion during initial swing phase, plantar flexion of ankle and range of motion of hip joint were increased as well. These differences were statistically significant(p<0.05). Conclusion : This study suggests that gait analysis can be used as a method of quantitative analysis of postoperative gait improvement in patients with cervical myelopathy.

• Journal of Korean Neurosurgical Society
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• v.60 no.5
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• pp.550-559
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• 2017

Objective : Subsidence is a frequent complication of anterior cervical discectomy and fusion. Postoperative segmental micromotion, thought to be a causative factor of subsidence, has been speculated to increase with uncinate process resection area (UPR). To evaluate the effect of UPR on micro-motion, we designed a method to measure UPR area based on pre- and postoperative computed tomography images and analyzed the relationship between UPR and subsidence as a proxy of micro-motion. Methods : We retrospectively collected clinical and radiological data from January 2011 to June 2016. A total of 38 patients (53 segments) were included. All procedures included bilateral UPR and anterior plate fixation. UPR area was evaluated with reformatted coronal computer tomography images. To reduce level-related bias, we converted UPR area to the proportion of UPR to the pre-operative UP area (pUPR). Results : Subsidence occurred in 18 segments (34%) and positively correlated with right-side pUPR, left-side pUPR, and the sum of bilateral pUPR (sum pUPR) (R=0.310, 301, 364; p=0.024, 0.029, 0.007, respectively). Multiple linear regression analysis revealed that subsidence could be estimated with the following formula : $subsidence=1.522+2.7{\times}sum\;pUPR$($R^2=0.133$, p=0.007). Receiver-operating characteristic analysis determined that sum $pUPR{\geq}0.38$ could serve as a threshold for significantly increased risk of subsidence (p=0.005, area under curve=0.737, sensitivity=94%, specificity=51%). This threshold was confirmed by logistic regression analysis for subsidence (p=0.009, odds ratio=8.471). Conclusion : The UPR measurement method confirmed that UPR was correlated with subsidence. Particularly when the sum of pUPR is ${\geq}38%$, the possibility of subsidence increased.

• Neurospine
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• v.15 no.4
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• pp.388-393
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• 2018

Objective: Computed tomography following myelography (CTM) revealed an unusual flow of contrast dye into the anterior median fissure (AMF) in a patient with cervical spondylotic myelopathy. Since then, several AMF configurations have been observed on CTM. Therefore, we evaluated morphological patterns of the AMF on CTM and investigated the significance and mechanisms of contrast dye flow into the AMF. Methods: Morphological patterns of the AMF on CTM were examined in 79 patients. Group A (24 patients) underwent surgery because of symptomatic cervical myelopathy. Group B (43 patients) had no clinical symptoms but showed spinal cord compression on CTM. Group C (12 patients), who showed neither clinical symptoms nor cord changes, underwent CTM for lumbar lesion evaluation. AMF patterns were classified into 4 types according to their configurations on CTM (reversed T, Y, V, and O types). Results: In group B, the reversed T type and Y type appeared significantly more often near the compressed portion (p<0.001). A similar tendency was seen in group A. The V and O types were most frequently observed in group C (p<0.001). Conclusion: On CTM, contrast dye tends to flow into the AMF of the cervical cord when the spinal cord is compressed. We speculate that there may be 3 possible mechanisms for this phenomenon: deformation of the epipial layer of the AMF due to cervical cord compression, AMF dilatation due to atrophy of the anterior funiculus or anterior horn, and temporary AMF dilatation when it becomes an alternative route for cerebrospinal fluid circulation.

• Journal of Korean Medicine Rehabilitation
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• v.29 no.2
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• pp.149-158
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• 2019

Objectives This study was performed to research the trends of Korean traditional medicine treatment for cervical spondylotic myelopathy (CSM). Methods Clinical studies about Korean traditional medicine of CSM were searched in 7 online databases. We extracted the characteristics of selected studies according to author, publication year, country, research design, treatment methods, evaluation tools, and adverse events. Results Nineteen studies were selected in online databases. The included studies consist of 8 uncontrolled trial, 7 case reports, 3 randomized controlled trials and 1 non-randomized controlled trials. In these studies, various Korean traditional medicine treatments were performed, and herbal medicine was the most common. The most commonly used outcomes was effective rate. Conclusions This study showed that Korean traditional medicine could be an effective treatment for CSM. It was suggested that various studies should be conducted to provide objective evidence of the therapeutic effects of Korean traditional medicine treatment for CSM.

• Journal of Korean Medicine Rehabilitation
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• v.29 no.3
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• pp.141-148
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• 2019

Cervical spondylotic myelopathy (CSM) is a severe disease that usually needs surgical treatment. We have treated two CSM patients with Korean traditonal medicine, which includes acupuncture, pharmacopuncture, herbal medicine and manual treatment (Chuna). For objective evaluation, we used Nurick's classification, JOA (Japanses Orthopedic Association) score, grip and release test and hand grasping power measurement. Post-treatment analysis has shown that grip and release test score and grasping power of two patients were both remarkably improved, along with the improvements on both Nurick's classification and JOA score. This study showed that Korean traditional medicine could be effective conservative treatment for CSM.

• Journal of Korean Neurosurgical Society
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• v.62 no.6
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• pp.671-680
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• 2019

Objective : We introduce innovative method of cervical column reconstruction and performed the reconstruction with a flanged titanium mesh cage (TMC) instead of a plate after anterior corpectomy for cervical spondylotic myelopathy (CSM) and an ossified posterior longitudinal ligament (OPLL). Methods : Fifty patients with CSM or OPLL who underwent anterior cervical reconstruction with a flanged TMC were investigated retrospectively. Odom's criteria were used to assess the clinical outcomes. The radiographic evaluation included TMC subsidence, fusion status, and interbody height. Thirty-eight patients underwent single-level and 12 patients underwent two-level corpectomy with a mean follow-up period of 16.8 months. Results : In all, 19 patients (38%) had excellent outcomes and 25 patients (50%) had good outcomes. Two patients (4%) in whom C5 palsy occurred were categorized as poor. The fusion rate at the last follow-up was 98%, and the severe subsidence rate was 34%. No differences in subsidence were observed among Odom's criteria or between the single-level and two-level corpectomy groups. Conclusion : The satisfactory outcomes in this study indicate that the flanged TMC is an effective graft for cervical reconstruction.

• Journal of Korean Neurosurgical Society
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• v.64 no.1
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• pp.69-77
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• 2021

Objective : Classification systems for cervical ossification of the posterior longitudinal ligament (OPLL) have traditionally focused on the morphological characteristics of ossification. Although the classification describes many clinical features associated with the shape of the ossification, including the concept of spondylosis seems necessary because of the similarity in age distribution. Methods : Patients diagnosed with OPLL who presented with increase signal intensity (ISI) on magnetic resonance imaging were surgically treated in our department. The patients were divided into two groups (pure versus degenerative) according to the presence of disc degeneration. Results : Of 141 patients enrolled in this study, more than half (61%) were classified into the degenerative group. The pure group showed a profound male predominance, early presentation of myelopathy, and a different predilection for ISI compared to the degenerative group. The mean canal compromise ratio (CC) of the ISI was 47% in the degenerative group versus 61% in the pure group (p<0.0000). On the contrary, the global and segment motions were significantly larger in the degenerative group (p<0.0000 and p=0.003, respectively). The canal diameters and global angles did not differ between groups. Conclusion : Classifying cervical OPLL based on the presence of combined disc degeneration is beneficial for understanding the disorder's behavior. CC appears to be the main factor in the development of myelopathy in the pure group, whereas additional dynamic factors appear to affect its development in the degenerative group.

• Journal of the Korean Society of Physical Medicine
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• v.16 no.3
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• pp.1-14
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• 2021

PURPOSE: This study aims to reveal the prevalence, therapeutic efficacy and undesirable side effects of cupping therapy all over the world from past to present. METHODS: This meta-analysis is based on the data obtained by scanning the keyword "cupping therapy" from the Pub-Med system, which is an international database. The date range has been set as 1950-2019. Local databases were not included. Cupping therapy studies combined with other complementary therapies such as acupuncture, moxa and hirudotherapy are also included in the meta-analysis. RESULTS: A total of 381 scientific studies were found on cupping therapy. Of these studies 127 wererandomized controlled trials (RCSs). Cupping treatment has been found effective in studies of painful conditions such as herpes zoster pain, fibromyalgia, back pain, neck pain, headache and acute injury pain. In addition, the effectiveness of cupping therapy was found to be high in studies related to bone / muscular system diseases such as osteoarthritis, rheumatoid arthritis, ankylosing spondylitis, gout, carpal tunnel syndrome, cervical spondylosis. In addition, cupping treatment is also promising in studies on skin diseases, neurological diseases, respiratory system diseases and cardiovascular system diseases. CONCLUSION: Recently, there has been an increase in the number of RCSs related to cupping therapy. The vast majority of this increase has been made in European and American countries rather than in Far Eastern countries. Studies on cupping therapy, which have been and will be carried out in the future, will provide evidence-based indication of whether cupping therapy is effective. and it will allow more patients to benefit from this treatment, which has a very low rate of side effects and complications.

• Journal of Veterinary Clinics
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• v.39 no.5
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• pp.235-239
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• 2022

A 10-year-old neutered male Siberian Husky presented with paraparesis and severe lethargy. On physical examination, the patient was unable to weight-bear and walk and exhibited significant muscle mass loss in both hindlimbs and generalized truncal alopecia with a dull coat of hair. On neurological examination, cranial lumbar vertebral pain, hind limb cross-extensor reflex, delayed hindlimb postural reaction, upper motor neuron bladder dysfunction, and total absence of cutaneous trunci reflex were identified. Computed tomography revealed diffuse idiopathic skeletal hyperostosis and spondylosis deformans of the cervical and thoracolumbar vertebrae. In addition, a generalized decrease in bone mineral density of the vertebrae was identified. Magnetic resonance imaging showed hyperplasia of the epidural fat compressing the spinal cord in the thoracolumbar region and concurrent mild multiple intervertebral disc herniations. No specific findings were observed in cerebrospinal fluid analysis. Blood analysis of thyroid function revealed decreased total T4 and free T4 levels, and increased TSH levels. The patient was tentatively diagnosed with spinal epidural lipomatosis (SEL) secondary to hypothyroidism. The patient was treated with levothyroxine, firocoxib, and gabapentin. Clinical signs gradually improved, and the patient showed normal ambulation 40 days after treatment initiation. SEL is extremely rare in dogs. To the best of our knowledge, this is the first case report of SEL secondary to hypothyroidism that was treated conservatively. Secondary SEL can be sufficiently managed by treating the underlying cause, if possible.