• Journal of Korean Neurosurgical Society
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• v.29 no.10
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• pp.1340-1344
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• 2000

Objective : A prospective biochemical assay of prostaglandin $E_2$ content in symptomatic lumbar disc materials was done in order to clarify the pathogenesis of lumbar radiculopathy. Patients and Methods : Forty-eight disc specimens were purified by a standard solid-phase extraction procedure and analyzed by an enzymelinked immunosorbent assay for prostaglandin $E_2$. Clinical and anatomic correlations were evaluated with analysis of variance and t-test. Results : Acute herniated lumbar disc diseases tended to be associated with a higher prostaglandin $E_2$ content than degenerative lumbar disc disease. Sequestered discs tended to be associated with a higher prostaglandin $E_2$ content than extruded discs, which also showed higher prostaglandin $E_2$ content than protruded ones. A sciatica and positive straight leg raising test appeared to be associated with a higher prostaglandin $E_2$ content than a negative test. Conclusion : This result suggests that the level of prostaglandin $E_2$ would be correlated with clinical symptom and sign in the inflammatory process of lumbar disc herniation.

• Journal of Acupuncture Research
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• v.34 no.4
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• pp.185-189
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• 2017

Background: The aim of this study was to assess the change in radiating leg pain after traffic accidents in patients with and without herniated intervertebral disc (HIVD) and improvement of radiating leg pain after traffic accidents. Methods: This was an retrospective study of 188 patients. Patients who had been admitted to the Hospital of Korean Medicine with the complaint of radiating leg pain after traffic accidents, and who had undergone lumbar spine magnetic resonance imaging to determine the presence or absence of HIVD were observed from April to June 2016. We analyzed sex, age, length of admission, direction (to a single leg or to both legs) and locations, (medial, anterior, lateral or posterior side of the lower limb) of radiating leg pain, presence or absence of HIVD, and number, grade and position of HIVD. The Numeric Rating Scale (NRS) and Oswestry Disability Index (ODI) were used to evaluate the impact of radiating leg pain on patients. Results: Radiating leg pain NRS score decreased significantly in both the HIVD group (from $6.12{\pm}2.39$ to $4.31{\pm}1.87$, p < 0.001) and the no HIVD group (from $5.76{\pm}1.64$ to $3.85{\pm}1.41$, p < 0.001). ODI score also decreased significantly in both groups (HIVD, from $44.67{\pm}17.38$ to $26.83{\pm}13.18$; no HIVD, from $39.24{\pm}15.58$ to $19.69{\pm}12$.; both p < 0.001). Conclusion: There was no significant change in radiating leg pain after traffic accidents in patients with and without HIVD and improvement of radiating leg pain after traffic accidents.

• Journal of Korean Neurosurgical Society
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• v.54 no.3
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• pp.183-188
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• 2013

Objective : The aim of this study is to assess outcomes during first one year for patients with severe motor weakness caused by lumbar disc herniation that underwent surgical or nonsurgical treatment. Methods : The 46 patients with motor weakness because of lumbar disc herniation who were treated at neurosurgical department and rehabilitation in our hospital from 2006 to 2010, retrospectively. Each group had 26 surgical treatments and 20 conservative treatments. We followed up 1, 3, 6 months and 12 month and monitored a Visual Analogue rating Scale (VAS) of back and leg pain, Oswestry Disability Index (ODI) and degree of motor weakness. We analyzed the differences between surgical and nonsurgical groups using Mann-Whitney U test and repeat measure ANOVA in each follow-up periods. Results : In the recovery of motor weakness, surgical treatment uncovered a rapid functional recovery in the early periods (p=0.003) and no difference between groups at the end of follow-up period was found (p>0.05). In VAS of back and leg, the interaction between time and group was not found (p>0.05) and there was no difference between groups (p>0.05). In ODI, the interaction between time and group was not found (p>0.05) and there was no difference between groups (p>0.05). Conclusion : Surgical treatment for motor weakness caused by herniated intervertebral disc resulted in a rapid recovery in the short-term period, especially 1 month. We think early and proper surgical treatment in a case of motor weakness from disc herniation could be a good way for providing a chance for rapid alleviation.

• The Journal of Churna Manual Medicine for Spine and Nerves
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• v.2 no.2
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• pp.89-104
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• 2007

Objectives : The purpose of this study is to report the image changes of four cases of Lumbar intervertebral disc Herniation after Oriental medicine Treatment Methods : We examined 4 patients with Lumbar intervertebral disc Herniation (HIVD of L-spine) who showed changes on MRI images before/after the treatment among HIVD of L-spine patients who visited Jaseng Hospital of Oriental Medicine from Jan. 2006 to Apr. 2007. Results & Conclusions : In this study, the first MRI examination of HIVD of L-spine patients was performed at the first visit and re-examination of MRI was done after the treatment. We assessed clinical symptoms by using Numerical rating scales(NRS). In each case, the size of the disc herniation was considerably reduced in MRI image. NRS was also reduced significantly.

• Journal of Korean Neurosurgical Society
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• v.60 no.1
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• pp.40-46
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• 2017

Objective: To assess role of some inflammatory mediators in patients with primary and recurrent lumbar disc herniation. Expression of IL-6, transforming growth factor (TGF)-1, insulin-like growth factor (IGF)-1, and Bcl-2-associated X protein (BAX) have been shown to be more intense in the primary group than the recurrent goup, but this mediators may be important aspects prognostic. Methods: 19 patients underwent primary and revision operations between June 1, 2009 and June 1, 2014, and they were included in this study. The 19 patients' intervertebral disc specimens obtained from the primary procedures and reoperations were evaluated. Expression of IL-6, TGF-1, IGF-1, and BAX were examined immunohistochemically in the 38 biopsy tissues obtained from the primary and recurrent herniated intervertebral discs during the operation. Results: For IL-6 expression in the intervertebral disc specimens, there was no difference between the groups. The immunohistochemical study showed that the intervertebral disc specimens in the primary group were stained intensely by TGF-1 compared with the recurrent group. Expression of IGF-1 in the primary group was found moderate. In contrast, in the recurrent group of patients was mild expression of IGF-1. The primary group intervertebral disc specimens were stained moderately by BAX compared with the recurrent group. Conclusion: The results of our prognostic evaluation of patients in the recurrent group who were operated due to disc herniation suggest that mediators may be important parameters.

• Journal of Acupuncture Research
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• v.36 no.4
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• pp.230-237
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• 2019

Background: The purpose of this study was to investigate the clinical efficacy of Korean medicine combination treatments for recurring back pain after medical procedures. Methods: This was a retrospective study performed on 311 patients admitted to Daejoen Jaseng hospital who were diagnosed with lumbar spine herniated intervertebral discs. The patients were divided into 2 groups according to whether or not they had undergone at least one medical procedure on the lumbar spine. They were assessed with Numeric Rating Scale (NRS), Oswestry Disability Index (ODI) and EuroQol-5 Dimensions Index (EQ-5D) before and after treatment. Results: Patients who experienced a medical procedure on the lumbar spine in the prehospital phase (Group A), statistically significantly improved EQ-5D and ODI scores. The NRS scores also decreased however it was not statistically significant. Patients who had not undergone a medical procedure on the lumbar spine in the prehospital phase (Group B) had statistically significantly improved ODI and NRS scores. The average EQ-5D score decreased however, there was no statistically significant difference before and after scores in Group B. There was no statistically significant difference in variation in EQ-5D, ODI, and NRS scores before and after treatment between the groups. Conclusion: The results of this study indicated that even after a bilateral procedure and surgery, when pain in patients with lumbar spine herniated intervertebral disc did not decrease, (as in failed back surgery syndrome), Korean medicine combination treatment of postoperative pain was helpful and there was improvement in daily life.

• Journal of the Korean Society of Physical Medicine
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• v.5 no.3
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• pp.363-373
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• 2010

Purpose : The purpose of this study was to compare differences in thoracolumbar ranges of motions by comparing ratios among 4 type diagnosis for patient with chronic low back pain. Methods : The subjects were 58 chronic low back pain patients. A motion analysis program (Global Postural System) was used after photography for posture measurement. To analyze differences in mobility percentages and ratios of thoracolumbar ranges of motion, one-way ANOVA was used. Results : Regional difference spinal posture and movement were found to diagnosis patients with chronic low back pain. Comparison of thoracolumbar ranges of motion revealed significant differences in the thoracic region during forward-bending of the trunk (p<.05). In the upper thoracic region, the herniated intervertebral lumbar disc (HILD) group was significantly larger than the spinal stenosis/herniated intervertebral lumbar disc (SS/HILD) group (p<.05). In the lower thoracic region, chronic sprains (CS) were significantly greater than in the spinal stenosis (SS) group and in the (SS/HJLD) group (p<.05). Comparative analysis of thoracic/lumbar mobility ratio showed the CS group's ratio during forward bending was largest: 1.66, while the HILD group's ratio was smallest: 84 a significant difference between the two groups (p<.01). Diagnosis was not associated with difference in thoracolumbar backward-bending range of motion (p>.05). Conclusion : Theses results indicate the clinical efficacy of diagnosing for chronic low back pain by evaluating spinal mobility.

• 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.

• The Journal of Internal Korean Medicine
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• v.40 no.1
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• pp.126-135
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• 2019

Background: Because of fear of reoperation and low efficiency, some patients with failed back surgery syndrome (FBSS) opt for Korean medicine treatment. Gold standard treatment is not present for FBSS, therefore both surgical and non-surgical treatment are possible. Studies of Korean conservative medicine for FBSS had a short duration of treatment and mainly pre- and post-treatment comparisons. And case of female patients who have worsened after childbirth is rare. The purpose of this study was to report long-term follow-up and rare cases of FBSS. Case summary: A 33-year-old female patient diagnosed with lumbar disc herniation complained with low back pain and radicular pain in the left leg after surgery in 2011. Acupuncture and decoction (Cheongpa-jeon, GCSB-5) were administered to her twice a day for about 6 years and 6 months. The patient's complaints improved with each hospitalization, and Magnetic Resonance Imaging (MRI) showed a slight decrease in the size of the recurrent disc (L4/5) and a newly developed disc (L5/S1) that had deteriorated after delivery. Conclusion: Korean medicine could be used to manage the pain of lumbar spine FBSS patients for 6-7 years and to alleviate lumbago after delivery.

• The Korean Journal of Pain
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• v.14 no.2
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• pp.234-238
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• 2001

Percutaneous laser discectomy has potential advantages over conservative therapy and classical open surgery as a minimally invasive procedure, although clinical experiences are limited. We experienced a patient treated with herniated lumbar discs using Nd：YAG laser. A 55-year-old woman complained of severe back pain with sciatica on L4/5 and L5/S1 dermatome for several months. The MRI finding showed bulging discs at L4/5 and L5/S1. Epidural, transsacral and root block treatments were attempted without effect. Under fluoroscopic guidance, a 14 G biopsy needle was inserted into the L4/5 and L5/S1 disc spaces to the margin of the nucleus pulposus. Laser irradiation for vaporization of tissue was performed at 20 W/second to 1200 J. A laser fiber ($600{\mu}m$) was advanced 1 cm from the tip of the needle. At the end of the procedure, the patient began to feel relief of pain (VAS changed from 9 to 4) and was discharged the same day after staying 2 hours in the recovery room. Antibiotics were administered for prevention of discitis. She had no complaints of pain until the 1-month follow up visit. Percutaneous laser discetomy technique has the disadvantages of expensive equipment, high temperature and amount of vaporing disc tissue is empirical. However, this technique, as one of the therapeutic modalities for disc herniation, provides faster relief from acute attack than conservative management techniques in carefully selected patients with sciatica due to disc prolapse.