• Title/Summary/Keyword: spinal pain

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An Unusual Case of Post-Operative Spondylitis Caused by $Mycobacterium$ $Intracellulare$ in an Immunosuppressed Patient

  • Kim, Sung-Hoon;Son, Dong-Wuk;Lee, Sang-Weon;Song, Geun-Sung
    • Journal of Korean Neurosurgical Society
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    • v.50 no.5
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    • pp.460-463
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    • 2011
  • There are few reported cases of post-operative spondylitis caused by $Mycobacterium$ $Intracellulare$. A 75-year-old female presented to our hospital with low back pain and paraparesis after a fall. The radiologic examination revealed compression fractures of L1, L3 and L4 and an epidural hematoma compressing the spinal cord. The dark-red epidural hematoma was urgently evacuated. Four weeks post-operatively, neurologic deficits recurred with fever. On magnetic resonance image, an epidural abscess and osteomyelitis were detected in the previous operative site. Five weeks post-operatively, revision was performed with multiple biopsies. The specimen were positive for acid-fast bacilli and traditional anti-tuberculous medications were started. Because the Polymerase Chain Reaction for non-tuberculous mycobacterium (NTM) was positive, the anti-tuberculous medications were changed to anti-NTM drugs. However, the neurologic deficits did not improve and persistent elevation of erythrocyte sedimentation rate and C-reactive protein were noted. Eight weeks after the revision, $Mycobacterium$ $Intracellulare$ was detected in the specimen cultures. Despite supportive care with medication, the patient died due to multiple organ failure.

Candida Parapsilosis Spondylodiscitis after Lumbar Discectomy

  • Cho, Kyun-Gil;Lee, Sun-Ho;Kim, Eun-Sang;Eoh, Whan
    • Journal of Korean Neurosurgical Society
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    • v.47 no.4
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    • pp.295-297
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    • 2010
  • Candida is a relatively rare cause of spinal infections that commonly affects immunocompromised patients. A 70-year-old woman, who underwent a lumbar discectomy on L5-S1 two months earlier, was admitted to our department complaining of persistent back and leg pain. Magnetic resonance imaging showed irregular enhancing mass lesion in L5-S1 intervertebral space, suggest of pyogenic discitis with epidural abscess. The surgery was performed via retroperitoneal approach and the infected material at L5-S1 intervertebral space was removed. The histological examination of the specimen revealed chronic inflammation involving the bone and soft tissue, and a culture of the excised material was positive for Candida parapsilosis. The patient received intravenous fluconazole for 4 weeks after surgery and oral fluconazole 400 mg/day for 3 months after surgery. The patient made a full recovery with no symptoms 6 months after surgery. We present a rare case of spondylodiscitis after a lumbar discectomy due to Candida parapsilosis and discuss treatment option with a review of the literatures.

Acute Myelopathy Caused by a Cervical Synovial Cyst

  • Kim, Dong Shin;Yang, Jin Seo;Cho, Yong Jun;Kang, Suk Hyung
    • Journal of Korean Neurosurgical Society
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    • v.56 no.1
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    • pp.55-57
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    • 2014
  • Synovial cysts of the cervical spine, although they occur infrequently, may cause acute radiculopathy or myelopathy. Here, we report a case of a cervical synovial cyst presenting as acute myelopathy after manual stretching. A 68-year-old man presented with gait disturbance, decreased touch senses, and increased sensitivity to pain below T12 level. These symptoms developed after manual stretching 3 days prior. Computed tomography scanning and magnetic resonance imaging revealed a 1-cm, small multilocular cystic lesion in the spinal canal with cord compression at the C7-T1 level. We performed a left partial laminectomy of C7 and T1 using a posterior approach and completely removed the cystic mass. Histological examination of the resected mass revealed fibrous tissue fragments with amorphous materials and granulation tissue compatible with a synovial cyst. The patient's symptoms resolved after surgery. We describe a case of acute myelopathy caused by a cervical synovial cyst that was treated by surgical excision. Although cervical synovial cysts are often associated with degenerative facet joints, clinicians should be aware of the possibility that these cysts can cause acute neurologic symptoms.

The Effect of Heel Height on Lumbar Sagittal Curvature at Standing Posture (기립자세에서 신발 굽의 높이가 요추부 시상만곡각에 미치는 영향)

  • Yoon, Bum-Chul;Lee, Myung-Hwa
    • Journal of Korean Physical Therapy Science
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    • v.5 no.4
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    • pp.763-775
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    • 1998
  • Some segment or segments of the body must compensate for the heel, and the higher the heel the greater the compensation. Such compensation was once generally thought to take place in the lumbar region and therefore to increase the lumbar lordosis. The purpose of this study is to analyze changes of lumbar sagittal curvature in barefoot and 6cm 12cm high-heel stance. We selected 19 subjects(11 males, 8 females} without history of lower back pain, significant spinal abnormality. And lateral view X-ray of lumbar region from T12 to S1 was taken of each individual. On each X-ray film, lumbar lordotic angle lumbosacral angle and lumbar segmental angles were measured by Cobb method. We drew the following interpretations from the analysis of measured variables of the lumbar region. 1. In comparison of barefoot 6cm heel 12cm heel stance, lumbar lordotic angle had a tendency to decrease according as the heel height was higher. The change in lumbar lordosis measured in high-heel stance was inconsistent with clinical forkelord of hyperlordosis in wearers of high-heeled. 2. Lumbar lordotic angle from T12 to L5 showed sex difference, and was more lordotic in female(p<0.05). 3. There was no sex difference in lumbosacral angle and lumbar segmental angles(p>0.05). 4. There was a significant correlation between lumbar lordotic angle and lumbosacral angle(r>0.60).

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Connective Tissue Massage (Bindegewebs massage) (결합조직 맛사지)

  • Kim, Jong-Soon;Ryoo, Jae-Kwan
    • Journal of Korean Physical Therapy Science
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    • v.4 no.3
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    • pp.475-489
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    • 1997
  • Connective tissue massage(CTM, Bindegewebs massage) are developed and named by Mrs. Elizabeth Dicke, a German physical therapist. The CTM is used primarily for internal disorder such as myocarditis, coronary insufficiency, high blood pressure, functional stomach and intestinal disorders, inflamma-tion of the gallbladder, and hepatitis, arterial circulatory problems, venous disorders, headache, particularly trauma to the head, and some gynecologic disorder, etc. Which is performed with special stroking technique of the subcutaneous tissue of the trunk, extremities, and face. The mechanism of effectiveness of CTM is based on a viscerocutaneous reflex. The stroking stimulates the nerve end-ings of the autonomic nervous system. The impulses activated by stroking travel to the sympathetic trunk and the spinal cord and brain, which causes a change in reaction susceptibility. The most important for apply CTM is necessary to know the reflex zone (Head's zone, Mackenzie's zone and Dicke's connective tissue zone). Dicke's connective tissue zones are only found by the special dia-gnostic stroking. Because the connective tissue zones no discomfort when unmanipulated, and thus the patient is unaware of them. It is characterized by diagnostic stroking that causes a sharp pain in the tissue. As a general rule, all treatment are preceded by the basic stroke from the level of the coccyx to the first lumbar vertebra and each stroke is done three times. The right side is done first, then the left side.

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Scapulothoracic Arthrodesis for Refractory Shoulder Dysfunction: A Retrospective Study of Indications and Functional Outcome

  • Chung, Soo-Tai;Warner, Jon J.P.
    • The Academic Congress of Korean Shoulder and Elbow Society
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    • 2009.03a
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    • pp.208-208
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    • 2009
  • Eleven shoulders (9 patients) with refractory scapulothoracic dysfunction were treated with scapulothoracic arthrodesis between 2000 and 2006. Refractory shoulder dysfunction included facioscapulohumeral muscular dystrophy in five shoulders (3 patients), refractory scapular winging with long thoracic nerve palsy in one shoulder, scapular winging caused by serratus anterior palsy with trapezius dysfunction in one shoulder, post-surgical thoracic outlet syndrome due to medial clavicle resection in two shoulders, refractory scapular winging with spinal accessory nerve injury in one shoulder, and chronic trapezius rupture caused by cervical spine surgery in one shoulder. The mean active flexion was improved from 82 degrees preoperatively to 112 degrees postoperatively. The mean Constant score was improved from 27.2 points to 68.0 points. Two shoulders (1 patient) that had facioscapulohumeral muscular dystrophy had broken wires due to nonunion, and one patient had a reactive pulmonary effusion. In ten of the eleven shoulders, the patients were satisfied with their results. The scapulothoracic arthrodesis can cause significant pain relief and functional improvement in refractory scapulothoracic and/or shoulder dysfunction. By selecting patients that present with appropriate indications, and using experienced surgical technique through complete preoperative evaluation, we can diminish the complication rate and make good clinical outcomes.

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The Study on Clinical relations of Mamok and Abnormal sensations (마목(麻木)과 이상감각(異常感覺)과의 연관성에 관한 연구(1))

  • Ko, Seong-Kyu
    • The Journal of Korean Medicine
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    • v.18 no.1
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    • pp.251-266
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    • 1997
  • The results are as follows. 1. Oriental medical terms which express abnormal sensations are Bulin, Mamok, Mamokbulin. 2. Bulin, Oriental medical terminology, was used from Naegyeong's era to the Song Dynasty era and expressed as one of the symptoms in Jungpung(Stroke), Bi syndrome(Obstruction syndrom of Gi and Hyeol), Wi syndrome(Flaccid paralysis of the limbs), Hyeolbi(One of the Bi syndroms). But since the Keum Dynasty era, Mamok or Mamokbulin were more used than Bulin and that was refered as seperated disease. 3. Ma is paresthesia or dysthesia on the skin and the limbs, and the symtoms are not itchy, patients are felt like insect's crawling or bite. Mok is a stubborn symptom , the patients are felt like tree, which don't know pain and itching sensation. And therefore Ma is similar to positive phenomena and Mok is similar to negative phenomena in clinical aspect. 4. Mamok is GiHyeol(Gi is functional activities, Hyeol is blood) and Gyeonglak(Meridian system)'s disease. It's main causes are Giheo(Deficiency of Gi) and Hyeolhel(dificiency of Blood) and inducing tactors are Pung-Han-Seub(pathogenic wind-cold-dump) and Damtak(Phlegm-turbity), Eohyeol(Stagnated blood). 5. Mamok is induced from mononeuritis, multiple mononeuritis, polyneuropathy in the peripheral nervous lesions and also induced from cervical spondylosis, spinal tumour, multiple sclerosis, cerebrospinal vascular disease in central nervous systems.

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A Case of Lumbar Metastasis of Choriocarcinoma Masquerading as an Extraosseous Extension of Vertebral Hemangioma

  • Lee, Ji-Hoon;Park, Chan-Woo;Chung, Dong-Hae;Kim, Woo-Kyung
    • Journal of Korean Neurosurgical Society
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    • v.47 no.2
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    • pp.143-147
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    • 2010
  • We report here on an uncommon case of metastatic choriocarcinoma to the lung, brain and lumbar spine. A 33-year-old woman was admitted to the pulmonary department with headache, dyspnea and hemoptysis. There was a history of cesarean section due to intrauterine fetal death at 37-weeks gestation and this occurred 2 weeks before admission to the pulmonary department. The radiological studies revealed a nodular lung mass with hypervascularity in the left upper lobe and also a brain parenchymal lesion in the parietal lobe with marginal bleeding and surrounding edema. She underwent embolization for the lung lesion, which was suspected to be an arteriovenous malformation according to the pulmonary arteriogram. Approximately 10 days after discharge from the pulmonary department, she was readmitted due to back pain and progressive paraparesis. The neuroradiological studies revealed a hypervascular tumor occupying the entire L3 vertebral body and pedicle, and the tumor extended to the epidural area. She underwent embolization of the hypervascular lesion of the lumbar spine, and after which injection of polymethylmethacrylate in the L3 vertebral body, total laminectomy of L3, subtotal removal of the epidural mass and screw fixation of L2 and L4 were performed. The result of biopsy was a choriocarcinoma.

An experimental studies on the LFT, RFT of patients in Bee-venom Acupunture (봉독약침이 장기환자의 LFT와 RFT에 미치는 영향)

  • Lee, Byung-Chol;Cheon, Mi-Na;Yang, Myung-Bok
    • Journal of Acupuncture Research
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    • v.17 no.2
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    • pp.11-18
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    • 2000
  • Bee-venom Acupucture has good effect on pain control but We may be anxious about the problem of Liver and Kidneys on many times treated patients. Therefore, In order to analysis the clinical form, We have observed the LFT, RFT of 37 patients who visited Won-Kwang University Kunpo Oriental Medical Hospital and treated Bee Venom therapy over 20 times from March 1999 to February 2000. The results were summarized as follows 1. The distribution of sex was 25 females, 12 males, and the average of patients age was 42.3 years 2. The distribution of disease was degenerative arthritis, HIVD of L-spine, HIVD of C-spine, spinal stenosis, RA, etc. 3. The total treated times is 1464 and the average of treated times is 39.6 times 4. The results of the LFT(AST, ALT) of 37 patients showed that normal impression is occupied 91.9% and abnormal impression is occupied 8.1%. 5. The results of the RFT(BLTN, Creatinine) of 37 patients showed that normal impression is occupied 100%. 6. The results of treatment using BV-acupunture showed that 81.1% achieved above excelent recovery 13.5% achieved above good recovery, 5.4% achieved fair recovery.

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Calcium Ions are Involved in Modulation of Melittin-induced Nociception in Rat: II. Effect of Calcium Chelator

  • Shin, Hong-Kee;Lee, Kyung-Hee;Cho, Chul-Hyun
    • The Korean Journal of Physiology and Pharmacology
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    • v.10 no.6
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    • pp.297-302
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    • 2006
  • Melittin, a major component of bee venom, produces a sustained decrease in mechanical threshold, and an increase in spontaneous flinchings and paw thickness, which are characteristics similar to those induced by whole bee venom. Melittin-induced nociception has been known to be modulated by the changes in the activity of excitatory amino acid receptors, voltage-dependent calcium channels, cyclooxygenase and serotonin receptors. The present study was undertaken to investigate the role of calcium chelators (TMB-8 & Quin 2) in melittin-induced nociceptive responses. Changes of mechanical threshold and spontaneous flinching behaviors were measured at a given time point following intraplantar injection of melittin ($30{\mu}g/paw$). Intrathecal or intraplantar pre-administration and intrathecal posttreatment of TMB-8 and Quin 2 significantly prevented the melittin-induced reduction of mechanical threshold, and intraplantar or intrathecal pre-treatment of TMB-8 and Quin 2 suppressed melittininduced flinching behaviors. These results indicate that calcium ion in the spinal dorsal horn neurons and peripheral nerves plays an important role in the production and maintenance of mechanical allodynia and spontaneous pain by melittin.