• 대한정형도수물리치료학회지
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• 제10권2호
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• pp.45-56
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• 2004

OBJECTIVE: The objective of this study was to know the effects of the postoperative lumbar extensor strengthening exercise program on back muscles strength and volume, pain, and the time of return to work. METHODS: A prospective controlled trial of lumbar extensor exercise program in patients who underwent microdiscectomy or percutaneous endoscopic discectomy for prolapsed lumbar intervertebral disc. Seventy-five patients were randomized into exercise group (20 male, 15 female) and non-exercise group (18 male, 22 female). Six weeks after surgery, patients in exercise group undertook a 12-week lumbar extension exercise (MedX) program. Assessment of spinal function was performed in all patients on postoperative 6 weeks, 18 weeks. The assessment included measures of lumbar extensor power, muscle mass of erector spinalis. All patients completed the visual analog scale (VAS) for evaluation of pain, and return to work. RESULTS: In muscle power, there were statistically significant improvements between pre and post test on muscle power in exercise group. But there were not statistically significant difference on muscle power in non-exercise group. In muscle mass, there were statistically significant difference between pre and post test on muscle mass in exercise group. But there were not statistically significant difference on muscle mass in non-exercise group. In the pain, there were statistically significant decrease between pre and post test on both group. But there were not statistically significant difference on fatty tissue and obesity in non-exercise group. The percentages of return to work in postoperative 4 months were significantly greater in the exercise group than in the non -exercise group. CONCLUSIONS: Postoperative lumbar extensor strengthening exercise program appears to be more beneficial to the patients who underwent operation for prolapsed lumbar intervertbral disc.

• The Korean Journal of Pain
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• 제25권2호
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• pp.81-88
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• 2012

Background: In discography performed during percutaneous endoscopic lumbar discectomy (PELD) via the posterolateral approach, it is difficult to create a fluoroscopic tunnel view because a long needle is required for discography and the guide-wire used for consecutive PELD interrupts rotation of fluoroscope. A stereotactic system was designed to facilitate the determination of the needle entry point, and the feasibility of this system was evaluated during interventional spine procedures. Methods: A newly designed stereotactic guidance system underwent a field test application for PELD. Sixty patients who underwent single-level PELD at L4-L5 were randomly divided into conventional or stereotactic groups. PELD was performed via the posterolateral approach using the entry point on the skin determined by premeasured distance from the midline and angles according to preoperative magnetic resonance imaging (MRI) findings. Needle entry accuracy provided by the two groups was determined by comparing the distance and angle measured by postoperative computed tomography with those measured by preoperative MRI. The duration and radiation exposure for determining the entry point were measured in the groups. Results: The new stereotactic guidance system and the conventional method provided similarly accurate entry points for discography and consecutive PELD. However, the new stereotactic guidance system lowered the duration and radiation exposure for determining the entry point. Conclusions: The new stereotactic guidance system under fluoroscopy provided a reliable needle entry point for discography and consecutive PELD. Furthermore, it reduced the duration and radiation exposure associated with determining needle entry.

• Journal of Korean Neurosurgical Society
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• 제45권2호
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• pp.67-73
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• 2009

Objective : Although endoscopic procedures for lumbar disc diseases have improved greatly, the postoperative outcomes for high grade inferior migrated discs are not satisfactory. Because of anatomic limitations, a rigid endoscope cannot reach all lesions effectively. The purpose of this study was to determine the feasibility of endoscopic transforaminal suprapedicular approach to high grade inferior-migrated lumbar disc herniations. Methods : Between May 2006 and March 2008, a suprapedicular approach was performed in 53 patients with high grade inferior-migrated lumbar disc herniations using a rigid endoscope and a semi-rigid flexible curved probe. One-to-four hours after surgery, the presence of remnant discs was checked with MRI. The outcomes were evaluated with the visual analogue scale (VAS) score and the Oswestry Disability Index (ODI) one week after surgery. Results : The L2-3 level was involved in 2 patients and the L3-4 level was involved in 14 patients, while the L4-5 level was involved in 39 patients. There were single piece-type in 34 cases and a multiple piece-type in 19 cases. Satisfactory results were obtained in all cases. The mean preoperative VAS for leg pain was $9.32{\pm}0.43$ points (range, 7-10 points), whereas the mean ODI was $79.82{\pm}4.53$ points (range, 68-92 points). At the last follow-up examination, the mean postoperative VAS for leg pain was $1.78{\pm}0.71$ points and the mean postoperative ODI improved to $15.27{\pm}3.82$ points. Conclusion : A high grade inferior migrated lumbar disc is difficult to remove sufficiently by posterolateral endoscopic lumbar dscectomy using a rigid endoscope. However, a satisfactory result can be obtained by applying a transforaminal suprapedicular approach with a flexible semi-rigid curved probe.

• Journal of Korean Neurosurgical Society
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• 제63권1호
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• pp.108-118
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• 2020

Objective : This study aimed to determine the incidence and analyze trends of the herniated lumbar disc (HLD) based on a national database in the Republic of Korea (ROK) from January 2008 to December 2016. Methods : This study was a retrospective analysis of data obtained from the national health-claim database provided by the National Health Insurance Service for 2008-2016 using the International Classification of Diseases. The crude incidence and age-standardized incidence of HLD were calculated, and additional analysis was conducted according to age and sex. Changes in trends in treatment methods and some treatments were analyzed using the Korean Classification of Diseases procedure codes. Results : The number of patients diagnosed with HLD was 472245 in 2008 and increased to 537577 in 2012; however, it decreased to 478697 in 2016. The pattern of crude incidence and the standardized incidence were also similar. Overall, the incidence of HLD increased annually for the 30s, 40s, 50s, and 70s until 2012 and then decreased. However, the incidence of HLD for the 80s continued to increase. The crude incidence of HLD in female patients exceeded that of male patients in their middle age (30s or 40s) and was 1.5-1.6 times higher than in male patients in their 60s. The total number of open discectomy (OD) increased from 71598 in 2008 to 93942 in 2012 and then decreased to 85846 in 2016. The rate of younger patients (the 20s, 30s, and 40s) who underwent OD was decreased, and the rate of younger patients who underwent percutaneous endoscopic lumbar discectomy was increased. However, the rate of older patients (the 70s and 80s) who underwent OD was continuously increased. Conclusion : This nationwide data on HLD from 2008 to 2016 in the ROK demonstrated that the crude incidence and the standardized incidence increased until 2012 and then decreased. The annual crude incidence was different according to age and sex. These findings may be considered when deciding future health policy, especially in countries with a similar national health insurance system (or with plans to adopt).

• Journal of Korean Neurosurgical Society
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• 제29권12호
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• pp.1612-1619
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• 2000

Objective : To retrospectively analyse the surgical outcome and efficacy of the lumbar spinal surgery in sixty to older patients who failed to conservative treatments. Methods : Between July 1990 and November 1996, the authors retrospectively investigated the medical records of 46 patients who over 60 years of age at the time of surgery. The clinical severity was assessed with Prolo's grade(economic and functional). Questionnaire was sent to each patient regarding long-term effect, satisfaction, and side effects. Results : In 46 patients, 2 patients(1 case died of lung cancer, 1 case lost in follow-up) were lost. Among 44 patients (28 men, 16 women ; mean age 64 years), 22 patients underwent partial or total laminectomy, 17 spinal fusion with instruments, 2 chemonucleolysis, 2 adhesiolysis for failed back surgery syndrome, and 1 automated percutaneous lumbar discectomy. Although postoperative complications were observed in 5 patients, they were successfully managed. No deaths were documented in the perioperative periods. The average Prolo's economic and functional grade improved from 2.98 to 3.48 and 2.81 to 3.75, respectively. Conclusion : In overall, the favorable surgical outcome was obtained. This results indicated that with appropriate preoperative selections and indications, careful intraoperative monitoring, and attentive postoperative care, the surgical treatment of eldery patients for the lumbar spinal disorders, significant improvement with acceptable levels of morbidity and mortality can be achived.

• Journal of Korean Neurosurgical Society
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• 제62권4호
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• pp.414-421
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• 2019

Objective : To evaluate 3-dimensional magnetic resonance imaging (MRI) of Kambin's safe zone to calculate maximum cannula diameter permissible for safe percutaneous endoscopic lumbar discectomy. Methods : Fifty 3D MRIs of 19 males and 31 females (mean, 47 years) were analysed. Oblique, axial and sagittal views were used for image analysis. Three authors calculated the inscribed circle (cannula diameter) individually, within the neural (original) and bony Kambin's triangle in oblique views, disc heights on sagittal views and root to facet distances at upper and lower end plate levels on axial views and their averages were taken. Results : The mean root to facet distances at upper end plate level measured on axial sections increased from $3.42{\pm}3.01mm$ at L12 level to $4.57{\pm}2.49mm$ at L5S1 level. The mean root to facet distances at lower end plate level measured on axial sections also increased from $6.07{\pm}1.13mm$ at L12 level to $12.9{\pm}2.83mm$ at L5S1 level. Mean maximum cannula diameter permissible through the neural Kambin's triangle increased from $5.67{\pm}1.38mm$ at L12 level to $9.7{\pm}3.82mm$ at L5S1 level. The mean maximum cannula diameter permissible through the bony Kambin's triangle also increased from $4.03{\pm}1.08mm$ at L12 level to $6.11{\pm}1mm$ at L5S1 level. Only 2% of the 427 bony Kambin's triangles could accommodate a cannula diameter of 8mm. The base of the bony Kambin's triangle taken in oblique view (3D MRI) was significantly higher than the root to facet distance at lower end plate level taken in axial view. Conclusion : The largest mean diameter of endoscopic cannula passable through "bony" Kambin's triangle was distinctively smaller than the largest mean diameter of endoscopic cannula passable through "neural" Kambin's triangle at all levels. Although proximity of exiting root to the facet joint is always taken into consideration before PELD procedure, our 3D MRI based anatomical study is the first to provide actual maximum cannula dimensions permissible in this region.

• Journal of Korean Neurosurgical Society
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• 제63권5호
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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.

• The Korean Journal of Pain
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• 제29권2호
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• pp.129-135
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• 2016

Although discal cysts are a rare cause of low back pain and radiculopathy. Currently, surgical excision is usually the first-line treatment for discal cysts. However, alternative treatment methods have been suggested, as in some cases symptoms have improved with interventional therapies. A 27-year-old man presented with an acute onset of severe pain, and was found to have a discal cyst after an open discectomy. The patient underwent cyst aspiration and steroid injection through the facet joint under C-arm guidance. After the procedure, the patient's pain improved to NRS 0-1. On outpatient physical examination 1 week, and 1 and 3 months later, no abnormal neurological symptoms were present, and pain did not persist; thus, follow-up observation was terminated. When a discal cyst is diagnosed, it is more appropriate to consider interventional management instead of surgery as a first-line treatment, while planning for surgical resection if the symptoms do not improve or accompanying neurologic deficits progress.

• The Korean Journal of Pain
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• 제26권1호
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• pp.27-31
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• 2013

Background: Neuroplasty using a Racz catheter or epiduroscope and percutaneous endoscopic laser discectomy are performed as treatment for chronic refractory low back and/or lower extremity pain, but they are limited in that they cannot completely remove the causing pathology. Lately, epiduroscopic laser neural decompression (ELND) has been receiving attention as an alternative treatment, but there are insufficient reports of results. Hence we aimed to investigate and report the data in our hospital. Methods: Seventy-seven patients were selected who had received ELND via the anterior and posterior epidural approach through the pain clinic in our hospital from March 2011 to July 2012. Their medical records including age, diagnosis, epiduroscopic findings and degree of symptom relief were investigated. The degree of symptom relief following the procedure was categorized into 5 stages of very good (5), good (4), no change (3), bad (2), and very bad (1) at 2 weeks and 1 month after the procedure. Results: The subjects were 30 males and 47 females. Mean age was 54.6 for males and 59.6 for females, so the overall mean age was 58.1 years old, with the youngest being 23 and the oldest 88 years old. In epiduroscopic images of all patients, more than one situation of herniated disc, fibrous tissue and adhesion, or inflammation was observed. Sixty-seven patients (87.0%) showed symptom relief 2 weeks after the procedure and 63 patients (81.8%) showed relief after 1 month. Conclusions: ELND is considered to be an effective treatment alternative for chronic refractory low back and/or lower extremity pain, including lumbar disc herniation, lumbar spinal stenosis, and failed back surgery syndrome which cannot be alleviated with existing non-invasive conservative treatment.