• Journal of Korean Neurosurgical Society
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• v.53 no.3
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• pp.167-173
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• 2013

Objective : There are many cases in which degenerative changes are prevalent in both the cervical and lumbar spine, and the relation between both spinal degenerative findings of MRI is controversial. The authors analyzed the prevalence of abnormal findings on MRI, and suggested a model to explain the relationship between cervical and lumbar disc in asymptomatic Korean subjects. Methods : We performed 3 T MRI sagittal scans on 102 asymptomatic subjects (50 men and 52 women) who visited our hospital between the ages of 14 and 82 years (mean age 46.3 years). Scores pertaining to herniation (HN), annular fissure (AF), and nucleus degeneration (ND) were analyzed. The total scores for the cervical and lumbar spine were analyzed using correlation coefficients and multiple linear regression with various predictive parameters, including weight, height, sex, age, smoking, occupation, and sedentary fashion. Results : The correlation coefficients of HN, AF, and ND were 0.44, 0.50, and 0.59, respectively. We made the best model for relationship by using multiple linear regression. Conclusion : The results of the current study showed that there was a close relationship between the cervical score (CS) and lumbar score (LS). In addition, the correlation between CS and LS, as well as the LS value itself, can be altered by other explanatory variables. Although not absolute, there was also a linear relationship between degenerative changes of the cervical and lumbar spine. Based on these results, it can be inferred that degenerative changes of the lumbar spine will be useful in predicting the degree of cervical spine degeneration in an actual clinical setting.

• Journal of Korean Neurosurgical Society
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• v.29 no.5
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• pp.599-603
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• 2000

Objectives : In lumbar spine surgery it is observed that the ligamentum flavum(LF) is bilayered, and the inner layers can be left in situ to prevent peridural adhesion in open lumbar disc surgeries. The purposes of this study are to investigate ultrastructural differences between the inner and outer layer of lumbar LF by electron microscopic examination, and to see whether these differences are, if present, more prominent in chronic degenerative lumbar spinal disorders as compared with acute lumbar disc diseases. Methods : Biopsy specimens of LF were obtained from nine patients undergoing lumbar spine surgery, five of them for degenerative spinal stenosis and four for acute disc herniation. During the surgery the outer layers of LF were carefully dissected from the inner layer, and four pieces($1{\times}1{\times}1-mm$) of biopsy samples were made from each layer. These were examined with electron microscope for the morphologies and the contents of the elastic and the collagen fibers. Results : The outer layer of LF showed elastic fiber degeneration as evidenced and decreased fiber content, while the inner layer was relatively preserved in both cases of degenerative spinal stenosis and acute disc herniation. The ultrastructural changes of the layers were more evident in the outer layer. Conclusion : With these observations the authors believe that the LF degeneration may occur mainly in the outer layer, and that this fact may aid in making the rationale for using the inner layer as physiologic barrier to prevent peridural adhesion in open lumbar disc surgeries.

• Journal of Korean Neurosurgical Society
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• v.40 no.5
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• pp.363-368
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• 2006

Objective : Little is known about the comprehensive molecular and biological mechanism on the development of the degeneration of the intervertebral disc. Many kinds of matrix metalloproteinase[MMP] initiate the degradation of the extracellular matrix including several kinds of collagens and proteoglycans. We compared molecular and immunohistochemical features of degenerated intervertebral disc and normal counterparts in order to investigate the role of MMP-1, 2, 3, 9. Methods : We have evaluated MMP-1, 2, 3, 9 expression in 30 surgically resected lumbar disc from degenerative disc disease patients and 5 normal control cases. RT-PCR[reverse transcriptase-polymerase chain reaction] and immunohistochemistry were performed. Results : By RT-PCR, normal tissue samples showed merely scant expression of MMP-1, 2, 3, 9 mRNA, but degenerated disc samples revealed more pronounced expression. mRNA amplifications were detected in 60%, 63.3%, 70%, 53.3% cases By immunohistochemistry, normal tissue samples showed minimal protein expression of MMP-1, 2, 3, 9, but degenerated disc samples revealed more pronounced expression. Protein expressions were detected in 73.3%, 63.3%, 76.7%, 63.3% cases. Both the mRNA amplification and protein overexpression rates were significantly higher in degenerated disc than in the normal tissue. Concordance between both the mRNA amplification and protein expressions of MMP-1, 3, 9 were not observed, but there is well correlation in MMP-2 expression. Conclusion : We concluded that the over-expressions of the MMP-1, 2, 3, 9 may contribute to the development of degeneration of the intervertebral disc.

• Journal of Korean Neurosurgical Society
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• v.38 no.5
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• pp.384-386
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• 2005

There have been several reports about abdominal pain due to discitis in children or thoracic disc herniation. However, none of them could verify causal relationship between disc disease and abdominal pain clearly. The authors report a patient with discogenic abdominal pain who had disc degeneration at lower lumbar level without definite protrusion or any evidence of inflammation. We could reproduce the abdominal pain by using discography. The patient was treated by percutaneous disc decompression successfully.

• Journal of Korean Neurosurgical Society
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• v.46 no.4
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• pp.322-327
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• 2009

Objective : Posterior lumbar interbody fusion (PLIF) is considered to have the best theoretical potential in promoting bony fusion of unstable vertebral segments by way of a load sharing effect of the anterior column. This study was undertaken to investigate the efficacy of PLIF with cages in chronic degenerative disc disease with Modic degeneration (changes of vertebral end plate). Methods : A total of 597 patients underwent a PLIF with threaded fusion cages (TFC) from 1993 to 2000. Three-hundred-fifty-one patients, who could be followed for more than 3 years, were enrolled in this study. Patients were grouped into 4 categories according to Modic classification (no degeneration : 259, type 1 : 26, type 2 : 55, type 3 : 11). Clinical and radiographic data were evaluated retrospectively. Results : The clinical success rate according to the Prolo's functional and economic outcome scale was 86% in patients without degeneration and 83% in patients with Modic degeneration. The clinical outcomes in each group were 88% in type 1, 84% in type 2, and 73% in type 3. The bony fusion rate was 97% in patients without degeneration and 83% in patients with Modic degeneration. The bony fusion rate in each group was 81% in type 1, 84% in type 2, and 55% in type 3. The clinical success and fusion rates were significantly lower in patients with type 3 degeneration. Conclusion : The PLIF with TFC has been found to be an effective procedure for lumbar spine fusion. But, the clinical outcome and bony fusion rates were significantly low in the patients with Modic type 3. The authors suggest that PLIF combined with pedicle screw fixation would be the better for them.

• Journal of Acupuncture Research
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• v.27 no.4
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• pp.19-28
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• 2010

Objectives : To demonstrate the need for differential diagnosis between discogenic pain and lumbar sprain and strain in acute low-back pain patients. Methods : Outpatients who made their first visits during May 1, 2009 to Oct. 30, 2009(n=53) were examined by history taking, physical examination, X-rays, and CT imaging. Disorders found on lumbosacral spine X-ray cuts and those on lumbosacral spine CT images were separately recorded. The relationship between treatment period, disc space narrowing and disc degeneration on X-rays, and HIVD on CT images was examined. Results : 1. Correlation between disc space narrowing on X-rays and HIVD found on CT images was analyzed. 21(72.41%) out of 29 patients having disc space narrowing on X-rays and HIVD on CT at the same level required treatment for over 8 weeks. 2. 2(50%) out of 4 Lawrence classification grade I patients, 8(66.67%) out of 12 grade II patients, and 14(70%) out of 20 grade III patients needed treatment for over 8 weeks. Conclusions : Disc space narrowing on X-ray and HIVD on CT at the same level, or disc space narrowing and disc degeneration on X-ray image alone indicate a tendency for treatment periods over 8 weeks, which is longer than the conventional treatment period for lumbar strain and sprain.

• The Korean Journal of Pain
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• v.22 no.1
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• pp.99-103
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• 2009

We studied the historical changes of intervertebral disc displacement using magnetic resonance imaging. The phenomenon of the spontaneous regression of herniated discs is well known. The case of a 40-years-old male presenting with a large disc herniation at L5-S1, experiencing severe sciatic pain, and having the straight leg raising test positive at 25 degrees is presented. The extruded disc was documented by clinical examination. He was treated conservatively with epidural steroid injection (ESI), medication, physical therapy and self-exercise and reevaluated in 10 weeks later, 30 and 1 year. Large extruded disc can be treated successfully by physical therapy with ESI. However, the degeneration and the dehydration of disc result in decrease of disc height. Consequently, the regression of extruded disc might have been due to the resorption and the dehydration.

• Proceedings of the KSMRM Conference
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• 1999.11a
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• pp.102-102
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• 1999

• Journal of Korean Neurosurgical Society
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• v.59 no.2
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• pp.129-136
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• 2016

Objective : The purpose of this study was to figure out the radiologic findings and risk factors related to adjacent segment degeneration (ASD) after anterior cervical discectomy and fusion (ACDF) using 3-year follow-up radiography, computed tomography (CT), and magnetic resonance image (MRI). Methods : A retrospective matched comparative study was performed for 64 patients who underwent single-level ACDF with a cage and plate. Radiologic parameters, including upper segment range of motion (USROM), lower segment range of motion (LSROM), upper segment disc height (UDH), and lower segment disc height (LDH), clinical outcomes assessed with neck and arm visual analogue scale (VAS), and risk factors were analyzed. Results : Patients were categorized into the ASD (32 patients) and non-ASD (32 patients) group. The decrease of UDH was significantly greater in the ASD group at each follow-up visit. At 36 months postoperatively, the difference for USROM value from the preoperative one significantly increased in the ASD group than non-ASD group. Preoperative other segment degeneration was significantly associated with the increased incidence of ASD at 36 months. However, pain intensity for the neck and arm was not significantly different between groups at any post-operative follow-up visit. Conclusion : The main factor affecting ASD is preoperative other segment degeneration out of the adjacent segment. In addition, patients over the age of 50 are at higher risk of developing ASD. Although there was definite radiologic degeneration in the ASD group, no significant difference was observed between the ASD and non-ASD groups in terms of the incidence of symptomatic disease.

• Journal of Korean Neurosurgical Society
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• v.29 no.4
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• pp.543-549
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• 2000

Objective : In contrary to ganglion cyst that commonly develops in connective tissue of peripheral joint or tendon, spinal ganglion cysts have been rarely reported. The authors report five cases of spinal ganglion cysts which originated from posterior longitudinal ligament of the lumbar spine. Methods : The authors retrospectively analyzed clinical, radiological, and surgical findings of five cases of spinal ganglion cysts and speculated the pathogenesis of spinal ganglion cyst. Result : Cysts were excised totally and symptoms improved without complications in all cases. Intraoperative findings revealed cysts that were tightly adherent to posterior longitudinal ligament. Conclusion : Five cases of ganglion cyst which caused similar symptoms and signs those of lumbar disc herniations were excised successfully. MRI and operative findings suggested spinal ganglion cyst of posterior longitudinal ligament were closely associated with disc degeneration which imply disc degeneration or herniation may play an important role in the pathogenesis of ganglion cyst.