• Journal of Korean Neurosurgical Society
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• v.29 no.11
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• pp.1505-1513
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• 2000

Objectives : Many surgical procedures have been introduced to a symptomatic lumbar stenosis. Most of these procedures still have been regarded as an extensive surgical intervention with respect to normal aging process of the lumbar spine. We adopted a microsurgical decompression procedure via unilateral exposure as a minimally invasive intervention for symptomatic lumbar stenosis without instability. Materials and Methods : Fifty-seven patients with symptomatic lumbar stenosis underwent microsurgical decompression via unilateral laminotomy between March 1998 and December 1999. The conceptual modification and technical refinements were added to the previously reported microsurgical decompression procedure. Bilateral decompression through a unilateral laminotomy hole was performed in 11 patients. These patients profile also included 9 cases of degenerative spondylolisthesis(Grade I) without instability. Results : Preoperative neurogenic intermittent claudication(NIC) was more notably improved than low back pain, 60% to 82% during the follow-up period. Overall clinical results were excellent in 20(35%), good in 29(51%), fair in 6(11%) and poor in 2(3%). Conclusions : Microsurgical decompression for lumbar stenosis with stable spine provided a satisfactory symptomatic improvement without extensive destruction of the weight-bearing structures and functional mobile segments, even bilateral symptoms existed.

• Journal of Korean Medicine Rehabilitation
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• v.19 no.1
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• pp.135-143
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• 2009

Objectives : Low back pain(LBP) is a common disabling disease in clinical practice and loss of working hours due to this condition is huge. The aim of this study was to determine if there was an association between fat deposit of paraspinal muscles as observed on MRI scans in patients presenting with unilateral LBP. Methods : 24 patients who visiting our hospital with a clinical presentation of unilateral LBP were recruited to the study. Patients were between 20 and 30 years and had a history of unilateral LBP within 12 months. After MRI scaning, the images were saved in DICOM file format for Picture Archiving and Communication System(PACS). The percentage of fat infiltrated area was measured using a pseudocoloring technique. Data were analyzed comparing the fat deposits of the muscles on the symptomatic and asymptomatic sides. Paired t-test was used to find the difference between the measurements of fat tissue in individual patients. Results : The amount of fat in the symptomatic side was $7.6{\pm}4.51%$, asymptomatic side was $6.7{\pm}4.29%$. There were increases, statistically significant, in the fat changes of the paraspinal muscles at the L4-5 disc level(P <0.05). Also, men were likely than women to have more fat deposit in symptomatic side(men $8.5{\pm}5.1%$, women $6.5{\pm}3.6%$). Conclusions : The amount of fat in the symptomatic side shows significantly increased than asymptomatic side in the paraspinal muscles at the L4-5 disc level. It suggested that fat infiltration in the muscles associated with LBP. Further studies will be needed to confirm the relationship between the muscle fatty changes and LBP in the large sample size. In addition, the correlation of pain severity with fat infiltration needs to be addressed.

• Journal of Korean Physical Therapy Science
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• v.7 no.2
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• pp.579-595
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• 2000

The purposes of this study were to compare pelvic tilt before and after manipulation of sacroiliac joint in 31 low back pain patients (11 males, 20 females) with sacroiliac joint dysfunction. The sacroiliac joint of patients was manipulated on the side of anterior pelvic tilt, using the technique described by Stoddard (1962) and Greenmann (1996). I used this technique because it usually eliminated sacroiliac joint dysfunction in one treatment session. SPSS for window computer system was used to analyze the data. Also t-test was performed for comparison of pelvic tilt angle before and after manipulation, and Pearson product-moment correlation analysis was performed for intratester reliability for measurements of pelvic tilt angle before and after manipulation. The result were as follows: 1. Intratester reliability was good for measures of pelvic tilt (r=.98). 2. The pelvic tilt after manipulation was significantly decreased (mean=$3.40^{\circ}$) compared with the pelvic tilt before manipulation (p=.001). All subjects showed asymmetrical right versus left pelvic tilt before manipulation. 40% of subjects showed decreased asymmetrical right versus left pelvic tilt after manipulation, and 60% of subjects showed symmetrical right versus left pelvic tilt after manipulation. I think that pelvic tilt asymmetry with hypomobility due to loss of joint play could be symmetrized by manipulation or mobilization, but pelvic tilt asymmetry with unilateral pelvic muscle shortening could not be symmetrized by manipulation or mobilization without relaxation and stretching of shortened muscles.

• Physical Therapy Rehabilitation Science
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• v.5 no.2
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• pp.84-88
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• 2016

Objective: Generally, it is known that there is a correlation between excessive calcaneus eversion and a patient with low back pain and it also affects pelvic alignment. However, there are not enough studies that show calcaneal eversion having an effect on the alignment of the trunk. Design: Cross-sectional study. Methods: A 3-dimensional motion analysis system was used to assess the lower limbs, pelvic alignment, and trunk alignment with increased unilateral and bilateral calcaneal eversion in twenty-one subjects. All subjects were asked to maintain a static posture for seven seconds on a wedge three times per posture for measurement and analysis purposes. The wedge used in the process was a lateral wedge with a 10-degree tilt to the lateral direction. To unify all of the subjects' foot position, the front and inner side of the wedge were marked. The height of the tilted wedge's inner side and flat wedge were balanced equally in order to be able to maintain the lateral part of the foot to the same height when producing an increased calcaneal eversion. Results: Comparing the changes in trunk and pelvic alignment in accordance to calcaneal eversion for each posture, there was a significant different in the X and Y-axis for each posture, but not in the Z-axis (p<0.05). Thus, it can be confirmed that calcaneal eversion in the sagittal plane and frontal plane may have and effect on the pelvis and the trunk. Conclusions: Postures with increased bilateral and unilateral calcaneal eversion has an effect on pelvic alignment, but does not cause any changes in trunk alignment.

• Journal of Chest Surgery
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• v.29 no.2
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• pp.177-184
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• 1996

Between 1987 and 1994, 21 patients were treated surgically for aortic aneurysm involving the thoracoabdominal aorta. There were 11 males and 10 females, and their age ranged from 20 to 67 years old and mean age was 41.5 years. Many complained of back pain, chest pain or discomfort, and flank pain, but three patients were asymptomatic. 15 patients had chronic dissection (71.4%) and 6 had nondissecting fusiform or saccular aneurysm(28.5%), and of those 15 patients with chronic dissection, 6(28.5%) had atherosclerosis assniated with hypertension, 5 (23.8%) were Martian syndrome, and 2 (9.5%) were associated with pregnancy. The diameter of an aneurysm ranged from 6cm to 12cm, and their extent was classified as type I in 7(33.3%), type II in 8(38.1%), type III in 3(14.3%), and type IV in 3(14.3%) patients based on Crawford classification for TAA . Diseased aorta was replaced with artificial vascular graft in all but one patient. In whom the aortic tear site due to pseudoaneurysm was closed by primary suture. For the spinal cord protection during the operation, we used partial cardiopulmonary bypass (FV-FA or PA-FA bypass) in 12 patients (57.1%), Biopump (LA-FA bypass) in 4(19.0%), total circulartory arrest and CPB in 2 (9.5%), Gott's heparinized shunt in 1(4.7%), and simple aortic cross clamping in 2 (9.5%). The most common complication after the operation was hoarseness due to unilateral vocal cord palsy which onured in 5 patients (23.8%), and the next common complication was wound infection in 4 patients(19.0%), paraplegia in 2 patients (9.5%), chylothorax in 1 patient(4.7%). The hospital mortality rate was 9.5% (2deaths), and there was no late death. Our experience shows that the graft replacement of TAAA had reasonable rate of mortality, low rate of serious complication, and provided good post operative state of the pati nts, and since the thoracoabdominal aortic operation is not a high risky procedure anymore, we recommend a radical operation for the indicated patients.