• Journal of Korean Neurosurgical Society
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• v.63 no.5
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• pp.614-622
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• 2020

Objective : The method of approach during transforaminal endoscopic lumbar discectomy (TELD) has been the subject of repeated study. However, the ideal entry point during TELD has not been studied in detail. Therefore, this study investigated the ideal entry point for avoiding complications using computed tomography (CT) scans obtained from patients in the prone position. Methods : Using CT scans obtained from patients in the prone position, we checked for retroperitoneal or visceral violations and measured the angles of approach with five conventional approach lines drawn on axial CT scans at each disc space level (L2-3, L3-4, and L4-5). We also determined the ideal entry point distance and approach angles for avoiding retroperitoneal or visceral violations. Correlation analysis was performed to identify the patient characteristics related to the ideal entry point properties. Results : We found that the far lateral approach at the L2-3 level resulted in high rates of visceral violation. However, rates of visceral violation at the L3-4 and L4-5 levels were remarkably low or absent. The ideal angles of approach decreased moving caudally along the spine, and the ideal entry point distances increased moving caudally along the spine. Weight, body mass index (BMI), and the depth of the posterior vertebral line from the skin were positively associated with the distance of the ideal entry point from the midline. Conclusion : We reviewed the risk of the extreme lateral approach by analyzing rates of retroperitoneal and visceral violations during well-known methods of approach. We suggested an ideal entry point at each level of the lumbar spine and found a positive correlation between the distance of the entry point to the midline and patient characteristics such as BMI, weight, and the depth of the posterior vertebral line from the skin.

• Annals of Clinical Neurophysiology
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• v.1 no.1
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• pp.39-46
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• 1999

Transcranial doppler ultrasonography (TCD) is a new, non-invasive and easily applicable method to evaluate cerebral hemodynamics. Last 10 years, its use in Korea has been dramatically expanded, but the qualification of TCD laboratory has yet to be settled. Since duplex sonography is seldom used in Korea, we have to depend totally on TCD to evaluate cerebral hemodynamic changes. Thus, all of the available data from every detectabler cerebral arteries has to be obtained for accurate interpretation of TCD measurements. Moreover, flow direction and wave form should be concerned in addition to the flow velocity. In this article, I present technique to measure the anterior, meddle and posterior cerebral arteries, the internal carotid artery siphon and at cervical level, and the vertebral and the basilar artery, and normal values for these measurements which is essential for the adequate interpretation.

• Journal of Korean Neurosurgical Society
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• v.57 no.2
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• pp.131-134
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• 2015

Traumatic diaphragm hernia can occur in rare cases and generally accompanies thoracic or abdominal injuries. When suffering from ankylosing spondylitis, a small force can develop into vertebral fracture and an adjacent structural injury, and lead to diaphragm hernia without accompanying concomitant thoracoabdominal injury. A high level of suspicion may be a most reliable diagnostic tool in the detection of a diaphragm injury, and we need to keep in mind a possibility in a patient with ankylosing spondylitis and a thoracolumbar fracture, even in the case of minor trauma.

• Journal of Korean Neurosurgical Society
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• v.49 no.4
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• pp.231-233
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• 2011

Chronic spinal epidural hematoma related to Kummell's disease is extremely rare. An 82-year-old woman who had been managed conservatively for seven weeks with the diagnosis of a multi-level osteoporotic compression fracture was transferred to our institute. Lumbar spine magnetic resonance images revealed vertebral body collapse with the formation of a cavitary lesion at L1, and a chronic spinal epidural hematoma extending from L1 to L3. Because of intractable back pain, a percutaneous vertebroplasty was performed. The pain improved dramatically and follow-up magnetic resonance imaging obtained three days after the procedure showed a nearly complete resolution of the hematoma. Here, we present the rare case of a chronic spinal epidural hematoma associated with Kummell's disease and discuss the possible mechanism.

• Journal of Korean Neurosurgical Society
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• v.52 no.2
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• pp.161-163
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• 2012

Spinal angiolipomas are rare lesions usually found in the epidural space of the thoracic spine. The infiltrating type of spinal angiolipomas is extremely rare. This report presents the case and reviews the related literature. A 58-year-old man was presented with a 7-month history of progressive weakness and sensory change of lower extremities. Magnetic resonance images showed a well-enhanced mass infiltrating the vertebral foramen at the T4-5 level. Resection of the tumor was performed. Histological study revealed the tumor as an angiolipoma. The patient was relieved from symptoms after tumor resection.

• Journal of Korean Neurosurgical Society
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• v.47 no.3
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• pp.224-227
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• 2010

Small bowel injury resulting from unforeseen penetration of the anterior annulus fibrosus and longitudinal ligament is a rare complication of lumbar microdiscectomy. The patient complained of abdominal tenderness and distention immediately after microdiscectomy for L4-5 and L5-S1 disc herniation. Using abdominal computed tomography, we found several foci of air overlying the anterior aspect of the vertebral body at the L5-S1 level. Segmental resection of the small bowel including small tears and primary anastomosis of the jejunum were performed. Here, we present a case of intestinal perforation after lumbar microdiscectomy and discuss technical methods to prevent this complication with a review of literature.

• Journal of Trauma and Injury
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• v.30 no.4
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• pp.212-215
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• 2017

The choice of the most appropriate treatment for thoracolumbar or lumbar spine burst fracture remains controversial from conservative treatment to fusion through a posterior or anterior approach. There are many cases where ligamentotaxis is used to reduce the burst fracture. However, indirect reduction using ligamentotaxis is often limited in the magnitude of the reduction that it can achieve. In our patient with severe burst fracture, we were able to restore an almost normal level of vertebral height and secure spinal canal widening by using only ligamentotaxis by posterior instrumentation. Before the operation, the patient had more than 95% encroachment of the spinal canal. This was reduced to less than 10% after treatment.

• Journal of Korean Neurosurgical Society
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• v.52 no.6
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• pp.564-566
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• 2012

Non-Hodgkin's lymphoma rarely originates from bone, and even more infrequently from a vertebral body. Lymphoblastic lymphoma is a rare type of non-Hodgkin's lymphoma, and results from an abnormality in adaptive immune cells. A 27-year-old man presented with a two-month history of night sweats, weight loss, and severe back pain. Radiological studies demonstrated an osteolytic lesion compressing the subarachnoid space at the T11 level. Posterolateral fusion with decompression was performed and a pathologic examination confirmed lymphoblastic lymphoma of the B-cell precursor type. To our knowledge, this is the first report of solitary lymphoblastic lymphoma from B-cell precursors in of the thoracic spine. Herein, we discuss the presenting symptoms and the management of this rare case of lymphoblastic lymphoma.

• Journal of Korean Neurosurgical Society
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• v.47 no.2
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• pp.134-136
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• 2010

Bow hunter's stroke is a rare symptomatic vertebrobasilar insufficiency in which vertebral artery (VA) is mechanically occluded during head rotation. Various pathologic conditions have been reported as causes of bow hunter's stroke. However, bow hunter's stroke caused by facet hypertrophy of C1-2 has not been reported. A 71-year-old woman presented with symptoms of vertebrobasilar insufficiency. Spine computed tomography showed massive facet hypertrophy on the left side of C1-2 level. A VA angiogram with her head rotated to the right revealed significant stenosis of left VA. C1-2 posterior fixation and fusion was performed to prevent serious neurologic deficit from vertebrobasilar stroke.

• The Korean Journal of Pain
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• v.4 no.1
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• pp.42-46
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• 1991

Splanchnic nerve block with neurolytics has been used to control the upper abdominal cancer pain. This gastric cancer case with severe chronic obstructive pulmonary disease complained of upper abdominal pain, severe dyspnea and orthopnea. He maintained a sitting position most of the time with nasal oxygen inhalation because he could not remain in a supine or prone position. We performed the unilateral splanchnic nerve alcohol block under right lateral position at the T12 and L1 vertebral level. For a short time after the block, he required oxygen inhalation therapy. Three months after unilateral alcohol block, he is still alive without severe abdominal pain and severe dyspnea.