• 한방재활의학과학회지
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• 제19권1호
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• pp.135-143
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• 2009

목적 : 요통은 임상에서 가장 흔하게 접할 수 있는 질환이며, 동시에 통증으로 인한 근무 결손도나 생활 불편감이 높은 질병이다. 그래서, 많은 연구들이 요통을 일으키는 원인 혹은 악화시키는 유발 인자를 밝혀내려는데 초점이 맞추어져 있다. 이번 연구의 목적은 편측 요통을 호소하는 환자에 있어서 MRI에서 조사된 척추 주위 근육의 지방량과 통증과의 관계에 대해서 알아보는데 있다. 방법 : 2007년 11월부터 2008년 4월까지 본원에 요통으로 내원한 환자를 대상으로, 편측 요통을 호소하며, 체질량 지수가 $25kg/m^2$ 이하이며, 만 20세이상 40세미만인 환자 24명을 대상으로 연구를 진행하였다. MRI에서 조사되어진 L4-5 디스크 레벨의 척추 주위 근육의 지방량을 객관적인 pseudocoloring technique을 이용해 측정하고, paired t-test로 결과를 분석하여 요통이 유발된 측과 지방량의 관계에 대해서 연구하였다. 결과 : 요통이 있는 측의 지방량과 요통이 없는 측의 지방량을 측정하여 데이터를 분석하였다. 양측의 지방량과 통증의 유무에 대한 관계는 통계적으로 유의한 수치를 나타냈다(P <0.05). 요통이 있는 측과 없는 측과의 성별, 나이, BMI의 통계적인 차이는 없었으며, 지방량 측정시 남자들이 여자들에 비해 지방량이 더 높게 측정되었다(남자 $8.5{\pm}5.1%$, 여자 $6.5{\pm}3.6%$). 결론 : 이 연구를 통해 척추 주위 근육의 지방량과 요통에 대한 상관성의 증거를 제시하였다. 잘 선별되어진 환자의 MRI를 통해 객관적인 방법으로 지방량을 체크를 하였으며, 추후 더 많은 개체수를 이용해 보다 더 정확한 관련성을 파악하고, 나아가 지방량에 따른 통증 강도의 상관성에 대해서 연구가 필요하리라 생각된다.

• 한국전문물리치료학회지
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• 제11권4호
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• pp.19-29
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• 2004

Many muscles of the trunk and hip are capable of contributing to the stabilization and protection of the lumbar spine. To have optimal effectiveness, a training program should include dynamic back/stomach/hip exercises. This study was designed to assess the L5 level paraspinal, external abdominal oblique, and gluteus maximus muscle activities during various low back stabilization exercises. Participants were 26 healthy adults (13 males, 13 Females), aged 21 to 28 years. The surface electromyography (EMG) was recorded from the L5 level paraspinal, external abdominal oblique, and gluteus maximus muscles. The recorded signal was averaged and normalized to the maximal electromyographic amplitude obtained during the maximal voluntary contraction. The measurements were taken during 3 low back stabilization exercises. One-way analysis of variance with repeated measures was used to examine the difference, and a post hoc test was performed with least significant difference. A level of significance was set at p<.05. The significance of difference between men and women, and between the electromyographic recording sites was evaluated by an independent t-test. The EMG activity for the externus oblique and gluteus maximus muscles had significant differences among 3 exercises (p<.05). In males, the EMG activity for the external abdominal oblique muscle had significantly increased differences during exercises 1 and exercise 2 (p<.05). The gluteus maximus muscle had significantly increased differences during exercise 2 and exercise 3 (p<.05). In females, the multifidus muscle had significantly increased difference during exercise 3 (p<.05), the external abdominal oblique muscle had significantly increased difference during exercise 1 (p<.05). and the gluteus maximus muscle had significantly decreased difference during exercise 3 (p<.05). The results were that the external abdominal oblique muscle was apparently activated during the curl-up exercise in females and males, and the multifidus muscle was apparently activated during the bridging exercise in females and during the sling exercise in males and females.1)In comparison of the %MVC between males and females, exercise 2 and exercise 3 apparently activated of the multifidus and gluteus maximus muscles in both males and females (p<.05). The EMG activity of the gluteus maximus muscle of the males significantly increased during exercise 2 and exercise 3 (p<.05). The EMG activity the multifidus muscle of the females was significantly increased during exercise 2 and exercise 3 (p<.05). More research is needed to understand the nature of motor control problems in the deep muscles in patients with low back pain.

• 한국정밀공학회지
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• 제28권1호
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• pp.115-122
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• 2011

Recently, we have proposed a hypothesis that spinal structures have a stress sensor driving feedback mechanism, In the human spine, spinal structure could react to modify muscular action in such a way so as to equalize stress at the disc, therefore reduce the risk of injury, In this analysis, abdominal muscle and abdominal pressure, which were not included in the previous study, were added to identify those effects in spine stability during upright stance posture for the case where the intervertebral disc plays the role of mechanoreceptor, The musculoskeletal FE model was consisted with detailed whole lumbar spine, pelvis, sacrum, coccyx and simplified trunk model. Muscle architecture with 46 local muscles containing paraspinal muscle and 6 rectus abdominal muscles were assigned according to the acting directions. The magnitude of 4kPa was considered for abdominal pressure. Minimization of the nucleus pressure deviation and annulus fiber average tension stress deviation was chosen for cost function. Developed model provide nice coincidence with in-vivo measurement (nucleus pressure). Analysis was conducted according to existence of co-activation of abdominal muscle and abdominal pressure. Antagonistic activity of abdominal muscle produced stability of spinal column with relatively small amount of total muscle force. In contrast to the abdominal muscle, effect of abdominal pressure was not clear that was partly depending on the assumption of constant abdominal pressure.

• Journal of Korean Neurosurgical Society
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• 제59권6호
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• pp.610-614
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• 2016

Objective : The purpose of this study was to present the outcome of the microsurgical foraminotomy via Wiltse paraspinal approach for foraminal or extraforaminal (FEF) stenosis at L5-S1 level. We investigated risk factors associated with poor outcome of microsurgical foraminotomy at L5-S1 level. Methods : We analyzed 21 patients who underwent the microsurgical foraminotomy for FEF stenosis at L5-S1 level. To investigate risk factors associated with poor outcome, patients were classified into two groups (success and failure in foraminotomy). Clinical outcomes were assessed by the visual analogue scale (VAS) scores of back and leg pain and Oswestry disability index (ODI). Radiographic parameters including existence of spondylolisthesis, existence and degree of coronal wedging, disc height, foramen height, segmental lordotic angle (SLA) on neutral and dynamic view, segmental range of motion, and global lumbar lordotic angle were investigated. Results : Postoperative VAS score and ODI improved after foraminotomy. However, there were 7 patients (33%) who had persistent or recurrent leg pain. SLA on neutral and extension radiographic films were significantly associated with the failure in foraminotomy (p<0.05). Receiver-operating characteristics curve analysis revealed the optimal cut-off values of SLA on neutral and extension radiographic films for predicting failure in foraminotomy were $17.3^{\circ}$ and $24^{\circ}s$, respectively. Conclusion : Microsurgical foraminotomy for FEF stenosis at L5-S1 level can provide good clinical outcomes in selected patients. Poor outcomes were associated with large SLA on preoperative neutral (>$17.3^{\circ}$) and extension radiographic films (>$24^{\circ}$).

• 대한물리의학회지
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• 제13권3호
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• pp.1-9
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• 2018

PURPOSE: The purpose of this study was to determine the effect of exercise therapy on low back pain (LBP), the function of paraspinal and abdominis muscles, and the sacrohorizontal angle as seen on the radiographs of the lumbar spine in a young female golf player with LBP. METHODS: This case report describes an 11-year-old female golfer who presented with LBP. The exercise therapy program comprised lumbar joint mobilization, lumbar spine flexion distraction, abdominal bridge, plank, side plank, and single-leg extensions from a 4-point kneeling position for 40 min/day; this was done twice a week for 8-weeks. LBP [visual analog scale (VAS) and Oswestry disability index (ODI)] and function of paraspinal and abdominis muscles [Ito test, curl-up test, $90^{\circ}$ stop test, squat test, opened eye one leg stance test (OEOL), and closed eye one leg stance test (CEOL)] were measured before and after 4 and 8 weeks of exercise therapy. The radiographs were analyzed for the lumbar Cobb's angle and sacrohorizontal angle before and after 8 weeks of exercise therapy. RESULTS: After 4 and/or 8 weeks of exercise therapy, VAS and ODI scores decreased; results for the Ito test, curl-up test, $90^{\circ}$ stop test, squat test, and OEOL and CEOL of muscle function improved; and the lumbar Cobb's angle and sacrohorizontal angle improved. CONCLUSION: These results suggest that exercise therapy improves LBP, muscle function, and radiographic parameters associated with LBP in young golf players. These findings have clinical implications for exercise therapy in young female golf players who have LBP.

• Journal of Trauma and Injury
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• 제18권1호
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• pp.17-25
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• 2005

Background: Traumatic rupture of the aorta is a life-threatening injury that must be diagnosed as rapidly as possible and treated immediately. The chest X-ray is a valuable tool for screening traumatic rupture of the aorta in blunt chest trauma. And various chest radiologic parameters are being used as diagnostic tools for aortic injury. The purpose of this study is to identify chest radiographic parameters that may assist in the detection of traumatic rupture of the aorta and to compare these findings with those of other reports. Methods: This study involved 30 adult patients with traumatic rupture of the aorta seen at the emergency department of the Asan Medical Center from 1997 to 2004. The control subjects were 30 healthy patients with neither lung nor cardiovascular disease. We retrospectively assessed over 14 parameters on chest X-rays. Results: In 11 of the 14 parameters, there were significant differences between the study group and the control group. There was no significant difference in the M/C ratio (mediastinumto-chest width ratio) between the two groups, and neither the left nor the right paraspinal interface was statistically significant (p value>0.05). Our study indicates that new criteria for the MC ratio and for the paraspinal interfaces are needed for screening traumatic aorta injury. The other radiographic parameters for traumatic rupture of the aorta need to be further assessed through a prospective study.

• 한국정밀공학회지
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• 제27권2호
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• pp.130-136
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• 2010

For stability analysis of the lumbar spine, the hypothesis presented is that the disc has stress sensors driving feedback mechanism, which could react to the imposed loads by adjusting the contraction of the muscles. Fusion in the motion segment of the lumbar spinal column is believed to alter the stability of the spinal column. To identify this effect finite element (FE) models combined with optimization technique was applied and quantify the role of each muscle and reaction forces in the spinal column with respect to the fusion level. The musculoskeletal FE model was consisted with detailed whole lumbar spine, pelvis, sacrum, coccyx and simplified trunk model. Vertebral body and pelvis were modeled as a rigid body and the rib cage was constructed with rigid truss element for the computational efficiency. Spinal fusion model was applied to L3-L4, L4-L5, L5-S1 (single level) and L3-L5 (two levels) segments. Muscle architecture with 46 local muscles was used as acting directions. Minimization of the nucleus pressure deviation and annulus fiber average axial stress deviation was selected for cost function. As a result, spinal fusion produced reaction changes at each motion segment as well as contribution of each muscle. Longissimus thoracis and psoas major muscle showed dramatic changes for the cases of L5-S1 and L3-L5 level fusion. Muscle force change at each muscle also generated relatively high nucleus pressure not only at the adjacent level but at another level, which can explain disc degeneration pattern observed in clinical study.

• 대한물리의학회지
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• 제5권2호
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• pp.223-231
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• 2010

Purpose : The Purpose of this study was to compare muscle activation and foot pressure on baby carrier and sling for baby care. Methods : Thirty one women subjects (mean age 23.2 years) participated in four static conditions : unloaded quite standing, carrying an anterior baby carrier, carrying a posterior baby carrier, and sling. The baby carrier and sling were loaded with baby model that filled 7.6kg loads. Surface electromyography was used to measure activity in the internal oblique, T4, L3, L5 paraspinal muscle, vastus medialis, biceps femoris, tibialis anterior, and gastrocnemius for four conditions. And foot pressure was measured by using MatScan system(Tekscan, USA). Results : The activation of Biceps femoris, T4, L3, and L5 paraspinal muscle were significant differences(p<.05), but other muscles were no significant differences in four conditions(p>.05). Right foot contact area and peak pressure of right mid foot area were significant differences in four conditions(p<.05). Conclusion : The results of this study indicate that the use of baby carrier of sling for baby care were influenced postural responses of young women. Further work is recommended to find out the influences of various assistive devices for baby care.

• Journal of Korean Neurosurgical Society
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• 제51권5호
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• pp.316-319
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• 2012

A 24-year-old man presented with mental change, fever, abdominal pain, tenderness and palpable mass on the lower abdomen. He was a non-Korean engineer and did not accompany a legal guardian, so medical history taking was difficult due to his mental status. Brain magnetic resonance imaging showed multiple rim-enhanced lesions of the brain, and abdominal computed tomography showed huge paraspinal abscess. Chest X-ray and computed tomography showed poorly defined nodular opacities. We initially thought that this patient was infected with toxoplasmosis with typical cerebral image finding and immunoglobulin laboratory finding of cerebrospinal fluid and serum study. The abdominal abscess was confirmed as tuberculosis through the pathologic finding of caseous necrosis. We used anti-tuberculosis medication and anti-toxoplasmosis medication for almost 4 months, and then his clinical state and radiological findings were considerably improved.

• The Korean Journal of Pain
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• 제14권2호
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• pp.257-260
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• 2001

It is well known that bronchogenic carcinoma frequently metastasize to bony skeleton, although it is unusual for it to metastasize to soft tissue in the form of a musculoskeletal abscess. We report a bronchogenic cancer patient presenting with back pain after undergoing a celiac plexus block. Magnetic resonance imaging (MRI) demonstrated inflammation with an abscess of the paraspinal muscle from T12 to L5; however, it was subsequently diagnosed as a metastatic pleomorphic carcinoma by histopathological study.