• 대한약침학회지
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• 제11권2호
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• pp.117-124
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• 2008

Objective This study was investigated on the Scolopendrid Pharmacopuncture of Caude equina syndrome which has been described as a complex of low back pain, bilateral sciatica, saddle anesthesia and motor weakness in the lower extremity that progress to paraplegia with baldder and bowel incontinence. Methods & Results Clinical observation was done on Cauda equina syndrome in the Department of Acupuncture & Moxibustion, Woosuk jeonju Oriental Medical Hospital frome May 30 to July 13. The patient was treated with Scolopendrid Pharmacopuncture at Shinsu(B23), Gihaesu(B24), Taejangsu(B25), Gwanweonsu(b26), Dangryo(b31), Charyo(b32), Jang-gang(gv1) and Hoe-eum(cv1) with Oriental Medicine treatment. We evaluated SF-36, the bladder incontinence, bowel incontinence, sensibility by sting skin, before and after treatmeat. Conclusion 1. At the early time, gait disturbance was treated well, but discomfort of bladder incontinence, bilateral sciatica, saddle anesthesia and motor weakness was remained. 2. The symptoms of Cauada equina syndrome, especially bladder incontinence and bilateral sciatica, was recurred in short duration by scolopendrid Pharmacopuncture and oriental medicine treatment.

• Journal of Acupuncture Research
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• 제28권5호
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• pp.135-142
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• 2011

Objectives : This study was to investigate on the hominis placenta pharmacopuncture of FBSS patient who were diagnosed as the cauda equina syndrome which has been described as a complex of low back pain, bilateral sciatica, saddle anesthesia and hypoesthesia in the lower extremity with bladder and bowel incontinence. Methods : The patient was treated with hominis placenta parmacopuncture at Samchosu($BL_{22}$), Shinsu($BL_{23}$), Sangryo($BL_{31}$), Charyo($BL_{32}$), Jungryo($BL_{33}$) and Haryo($BL_{34}$) with oriental medical conservative treatment. We estimated by visual analog scale and Oswestry disability index and nerve level dermatome test for evaluate the effect of Hominis Placenta Pharmacopuncture with oriental conservative treatment. Results : After treatment, patient's visual analogue scale score, Oswestry disability index score, bilateral sciatica, saddle anesthesia and hypoesthesia in the lower extremity with bladder and bowel incontinence were generally decreased. Conclusions : The hominis placenta pharmacopuncture with oriental medical conservative treatment might be an effective method to treat the FBSS patient who were diagnosed as the cauda equina syndrome.

• The Korean Journal of Pain
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• 제23권3호
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• pp.190-197
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• 2010

Background: Conventional spinal saddle block is performed with the patient in a sitting position, keeping the patient sitting for between 3 to 10 min after injection of a drug. This amount of time, however, is long enough to cause prolonged postoperative urinary retention. The trend in this block is to lower the dose of local anesthetics, providing a selective segmental block; however, an optimal dose and method are needed for adequate anesthesia in variable situations. Therefore, in this study, we evaluated the question of whether only 1 min of sitting after drug injection would be sufficient and safe for minor anorectal surgery. Methods: Two hundred and sixteen patients undergoing minor anorectal surgery under spinal anesthesia remained sitting for 1 min after completion of subarachnoid administration of 1 ml of a 0.5% hyperbaric bupivacaine solution (5 mg). They were then placed in the jack-knife position. After surgery, analgesia levels were assessed using loss of cold sensation in the supine position. The next day, urination and 11-point numeric rating scale (NRS) for postoperative pain were assessed. Results: None of the patients required additional analgesics during surgical manipulation. Postoperative sensory levels were T10 [T8-T12] in patients, and no significant differences were observed between sex (P = 0.857), height (P = 0.065), obesity (P = 0.873), or age (P = 0.138). Urinary retention developed in only 7 patients (3.2%). In this group, NRS was $5.0{\pm}2.4$ (P = 0.014). Conclusions: The one-minute sitting position for spinal saddle block before the jack-knife position is a safe method for use with minor anorectal surgery and can reduce development of postoperative urinary retention.

• Journal of Korean Neurosurgical Society
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• 제39권1호
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• pp.40-45
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• 2006

Objective : To determine the relationship between the clinical outcome and the extent of surgical laminectomy for adequate decompression on the cases of cauda equina syndrome, the authors review and analyze their cases and compared with those of literatures. Methods : The authors reviewed 655 patients retrospectively who had underwent surgery on the cases of lumbar disc herniation from January 2000 to December 2004. There were 19 patients [2.9%] who presented for clinical cauda equina syndrome. Among them, we selected and analyzed 15 patients who were treated by unilateral partial hemilaminectomy with discectomy or bilateral partial laminectomy with discectomy, and they had been followed from 5 weeks to 47 months postoperatively [mean, 13.47 months]. The levels of the disc herniations were L4-5 in 8 patients, following L5-S1 in 4 patients and 2 levels [L4-5 and L5-S1] in 3 patients. Motor and sensory recoveries were recorded. Postoperative urinary function recovery Was defined according to Gleave and Macfarlane. Results : In 12 months postoperatively, the bladder function was obtained in 14 of 15 patients[93%] with regaining urinary continence. Thirteen of 15 patients[86%] with preoperative motor weakness of lower extremities were recovered. Sensory deficit of lower extremities, perianal and saddle anesthesia were all recovered. Patients had recovered on lumbosciatic pain and saddle hypesthesia, in turn, motor function and urinary incontinence. Conclusion : In treating cauda equina syndrome, the authors did less extensive surgery, such as unilateral partial hemilaminectomy with discectomy or bilateral partial laminectomy with discectomy for adequate decompression. The outcome is satisfactory and comparable with those of subtotal or total laminectomy.

• Journal of Acupuncture Research
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• 제19권6호
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• pp.205-213
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• 2002

Objective : This study was to investigate on the Korean Bee-Venon acupuncture of Cauda equina syndrome which has been described as complex of low back pain, bilateral sciatica, saddle anesthesia and motor weakness in the lower extremity that progress to paraplegia with bladder and bowel incontinence. Methods : Clinical observation was done on Cauda equina syndrome in the Department of Acupuncture & Moxibustion, Kyungwon Inchon Oriental Medical Hospital from may 25 to June 24. The patients was treated with Korean Bee-Venon acupuncture at Samchosu(B22), Shinsu(B23), Taejangsu(B25), Pang-gwangsu(B28) and Yo-yang-gwan(Gv3) with oriental medicine treatment. We evaluated the bladder incontinence, duration of urination and area of anesthesia before and after treatment. Conclusions : 1. At the early time, gait disturbance was treated well, but discomfort bladder incontinence was remained. 2. The symptoms of Cauda equina syndrome especially bladder incontinence was recurred in short duration by Korean Bee-Venon acupuncture and oriental medicine treatment. 3. There was no significant changes in GOT/GPT before and after treatment.

• Korean Journal of Acupuncture
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• 제22권1호
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• pp.33-41
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• 2005

갑작스러운 요통과 양측하지통, 하지의 근력 감소, 대소변 장애 및 운동, 감각장애로 양방병원에서 마미증후군으로 진단받고 추궁판 절제술과 감압술을 시행 후 임상적인 호전을 보이지 않은 환자 1례에 대해 홍화자(紅花子) 약침요법(藥鍼療法)을 중심으로 복합적인 한방치료를 시행한 결과 요통에 대한 VAS와 요통점수표, ODI 항목에서는 각 항목 모두에서 현저한 호전 양상을 나타내었다. 운동기능 및 보행에 있어서 입원 당시에 보행기에 의지하여 보행하였는데 치료 후에는 안독으로 보행이 가능하고 일상적인 가벼운 생활도 가능해지게 되었다. 배뇨기능에 있어서도 자발적인 배뇨가 가능할 정도로 완전회복 되었다. 하지만 배변의 상태는 입원 당시와 치료 후에는 변의가 느껴지는 것 이외에 자발적인 배변은 이루어지지 않았다. 감각 기능의 회복에 있어서도 온통각, 압촉각과 하지 냉감은 호전 양상을 보였으나 안장 감각과 괄약근의 기능은 거의 회복되지 않았다. 본 연구를 기초로 하여 향후 수술이나 양방적인 치료 후에 발생할 수 있는 후유증의 관리에 있어서 홍화자(紅花子) 약침(藥鍼)에 대한 더욱 심도있는 후속 연구가 이루어져야 할 것이다.

• The Korean Journal of Pain
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• 제7권2호
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• pp.287-291
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• 1994

좌측 제 11번 늑간 신경통과 요통을 주소로 입원한 49세 남자 환자에게 흉부 신경근 열 응고술을 시행한 후 3일간에 걸쳐 척수 압박 증상이 급속히 진행되었다. 흉 요추의 단순 X-선과 자기 공명 영상 촬영으로 밝힌 그 원인은 제 11 및 12 흉추의 척추 종양이었다.

• The Korean Journal of Pain
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• 제2권1호
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• pp.21-25
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• 1989

For the simple operations of the perineal region, caudal, epidural and saddle blocks of analgesia are preferable anesthesia techniques in men. But, if the operations shoud be delayed or the physicians are willing to observe and manipulate the patients for a couple of days, as in the ureteral stone manipulation, continuous epidural analgesia will be a reliable method. The authors have observed 36 male patients of ureteral calculi with continuous lumbar epidural analgesia for the purpose of elimination of an undesirable pain sensation which was associated with the transurethral cystoscopic manipulation. The results were as follows: 1) In most cases, the anesthetics used were 1% lidocaine 20 ml through the $L_{3-4}$ and $L_{4-5}$ interspace with 4~6cm of catheter tip advancement mainly to cephalad. 2) There was no motor weakness or paralysis in the lower extremities except some numbness and paresthesia on the perineal area. 3) Besides the various minor complications, there were no problems in respiration with small doses of morphine extradurally. 4) Among them, four cases of ureteral calculi dropped into the bladder spontaneously due to the epidural technique during transportation of the patients from the pain clinic to the urology out-clinic. One case of calculi was dropped by the aid of instrumentation at the ward, and twelve cases of calculi were removed directly by Dormia stone basket in the scopic room. For the remaining patients, we deduced that their calculi was be evacuated out because there were no complaints were notified after discharge.

• Journal of Yeungnam Medical Science
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• 제24권2호
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• pp.206-215
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• 2007

복와위는 신체 후부 노출이 필요한 척추 수술을 위해 주로 사용되고 있으며 수술부위로의 접근이 용이하고 수술 도중에 척추를 안정적으로 유지해주는 장점이 있다. 하지만 전신마취하에 있는 환자를 앙와위에서 복와위로의 전환은 여러 가지 부작용을 동반하며 특히 순환기계의 변화를 초래할 수 있다. 이를 줄이기 위해 다양한 복와위 전용 수술대들이 연구 개발되어 임상에 사용되고 있다. 이에 저자들은 앙와위에서 복와위로의 체위 변환 시에 Jackson spinal surgery table의 이용이 체위에 의한 압박 때문에 생기는 환자의 순환기계 변화를 얼마나 효과적으로 줄여줄 수 있는지 알아보고자 하였다. 본 연구는 추간판탈출증, 퇴행성척추전방전위증, 척추협착증의 진단 하에 본원 정형외과와 신경외과에서 수술을 받기로 예정된 환자 중 미국 마취과학회 신체등급 분류 1급 또는 2급에 해당하는 성인 환자 30명을 대상으로 하였다. 연구 대상 환자의 성별은 남자가 15명, 여자가 15명이었고, 심혈관계나 호흡기계 질환이 있는 환자는 연구 대상에서 제외하였다. 모든 환자는 마취전투약으로 수술 시작 1시간 전에 glycopyrrolate 0.2 mg, fentanyl $1{\mu}g/kg$을 근주하였으며 수술실에 도착한 후 비침습적 자동 혈압 측정기, 심전도 및 맥박산소 계측기를 거치하였다. Thiopental sodium과 vecuronium으로 마취를 유도하였으며 환자의 의식소실과 충분한 근이완을 확인한 후 기관내 삽관을 시행하였다. Enflurane 1.5-2.0 vol%와 $O_2$, $N_2O$ 각각 2 L/min을 사용하여 마취유지를 하였으며 급격한 활력 징후의 변동으로 마취유지가 용의치 않은 경우는 연구 대상에서 제외시켰다. 환자의 활력 징후 안정 후 요골 동맥에 카테터를 거치하여 지속적으로 동맥압을 측정하였고, 우측 쇄골하 정맥에 중심정맥 카테터를 거치하여 중심정맥압을 측정하였다. 부분재호흡 심박출량 감시기 ($NICO^{(R)}$, Novametrix Medical Systems INC., USA)를 통해 비침습적으로 환자의 심박출량을 측정하였다. 앙와위에서 복와위로 체위변경 직전에 심박출 계수, 심박출량, 평균동맥압, 심박수, 중심정맥압을 측정하여 앙와위의 값으로 삼았으며, 척추 수술 전용 수술대인 Jackson spinal surgery table을 사용하여 복와위를 취하였다. 복와위로 체위 변경 뒤 심박출 계수, 심박출량, 평균동맥압, 심박수, 중심정맥압을 측정하여 복와위의 값으로 기록하였다. 본 연구 결과 앙와위와 복와위의 혈역학적 지수의 비교시 심박수와 평균동맥압은 별다른 차이가 없었다. 중심정맥압은 유의한 정도는 아니지만 감소 소견을 보여 수술시 출혈의 위험성을 감소시킬 것으로 생각된다. 심박출량과 심박출 계수도 유의한 감소 소견을 보였으나 convex saddle table을 이용한 경우와 kneechest position을 취한 경우보다 적은 변화를 보여 Jackson spinal surgery table의 사용은 유용할 것으로 사료된다. 그러나 Jackson spinal surgery table을 사용하여 복부와 흉부에 과도한 압력이 가해지지 않더라도 유의한 심박출량 감소가 있을 수 있음을 유념해야 할 것이다. 특히 심폐여력이 부족한 환자들에 있어서는 심박출량의 감소는 위험한 결과를 초래할 수 있으므로 복와위에 의한 생리적 변화에 관한 충분한 이해와 함께 마취 시 보다 적극적인 감시와 관리가 요구된다고 여겨진다.