• The Korean Journal of Pain
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• 제10권2호
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• pp.262-265
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• 1997

We experienced a case of osteoid osteoma in thoracic vertebra accompanied with herniated nucleus pulposus during the management of back pain. A 32 year old male patient with herniated nucleus pulposus complained of back pain and radiation to right leg. Lumbar epidural block with 1% mepivacaine 5 ml was performed for pain control and it relieved the radiating pain. However patient continued to experience severe exacerated back pain at night which responded to aspirin. Therefore we performed further examination for existence of disease of the spine and diagnosed osteoid osteoma in the right pedicle of T12 vertebra. In conclusion, we recommend physicians when evaluating patients with back pain to be congnizant of possible existence of neoplastic disease of the spine and incorporate it in differential diagnosis.

• The Korean Journal of Pain
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• 제4권1호
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• pp.51-55
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• 1991

There is a variety of therapeutic modality for herniated nucleus pulposus. Recently the low level laser has come into use for treatment for it. We treated two patients suffered from herniated nucleus pulposus of the central type of $L_{3,4}$ level, with He-Ne, $CO_2$ and Ga Al As laser simultaneously daily under hospitalization. In order to determine the efficacy of treatment, we used the "visual analogue scale" and its improvement rate. The results were as follows; Case I complained of gait disturbance, and hypoesthesia on the lateral side of the left lower leg, as and as low back pain. At the 15th day after treatment, VAS improvement rate was 40%, and the gait disturbance and hypoesthesia were markedly improved. 35th days after tratement, VAS improvement rate was 80%. Case II complained only of low back pain. At the 15th day after treatment, the VAS improvement rate was 68%, and at 20 days after treatment it was 84%. We sugsest that, using the low level laser for treatment of herniated nucleus pulposus increased the cartilage entrophism, and inhibitory effects of the inflammatory materials such as acid glycosaminoglycan by its anti-inflammatory and analgesic effects.

• The Journal of Korean Physical Therapy
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• 제24권3호
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• pp.208-215
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• 2012

Purpose: We attempt to assess the differences in the degree of lumbar lordosis in patients with lower back pain caused by the herniation of the nucleus pulposus and in normal people (divided into male and female groups). Methods: This study was conducted with 14 patients (7 males, 7 females) diagnosed with, and being treated for, lumbar herniated nucleus pulposus and 14 normal people (7 males, 7 females). In order to examine the degree of lumbar lordosis in these subjects, hip flexor lengthening tests were conducted and the lumbar curves were measured in three postures (supine, sitting, and prone) and the results were compared. Results: The measured values of the curves for the standing and prone postures showed statistically significant differences between the normal group and the patient group, between the normal male group and the male patient group, and between the normal female group and the female patient group (p<0.05). Conclusion: The measurement method that uses flexible curve rulers in the standing or prone postures can be usefully utilized in assessing the lumbar lordosis of patients with lumbar herniation of the nucleus pulposus.

• The Journal of Korean Physical Therapy
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• 제20권3호
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• pp.69-74
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• 2008

Purpose: The majority of patients with radiculopathy caused by a herniated nucleus pulposus (HNP) heal spontaneously without surgery. The aim of this report is to describe the spontaneous regression of lumbar disc herniation and the results of clinical follow-up. Methods: Three patients with radiating low back pain presented with an extruded intervertebral disc on magnetic resonance imaging (MRI). We performed follow-up with conservative treatment (epidural injection, medication, physical therapy, exercise) and clinical assessments on the 6th, 10th and 22nd months. Results: The extruded intervertebral disc almost complete regressed, and correlated with clinical improvement and follow-up MRI. Conclusion: Conservative treatment can be an effective approach for a herniated lumbar discs if no neurological deficits are present.

• The Korean Journal of Pain
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• 제19권2호
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• pp.207-212
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• 2006

Background: The epidural injection technique is a commonly used intervention in the management of chronic spinal pain, which has the advantage of delivering various drugs, such as local anesthetics or steroids, in higher concentrations to the inflamed nerve root. A guidewire-reinforced epidural catheter was introduced through a Tuohy needle during the caudal epidural procedure, with a catheter threaded into the affected nerve roots and the spread-pattern of contrast agents observed under fluoroscopy. Methods: Sixty-seven patients with low back pain, who showed evidence of a herniated nucleus pulposus on magnetic resonance imaging, were included. All patients received fluoroscopically guided caudal epidural injections, with the guidewire-reinforced epidural catheter introduced through a Tuohy needle and threaded either to the right or left side toward the target nerve roots. After confirming the catheter tip position at the affected nerve root, 2 ml increments of contrast agents (up to 6 ml) were injected, and their corresponding AP fluoroscopic views were obtained. Three radiologists reviewed all the radiographic findings and measured the proportion of the area of contrast spread at the side of target nerve roots. Results: Greater proportion of the area of contrast spread was observed at the side of the target nerve roots (P < 0.0001). At each level of contrast injection (2-⁣, 4- ⁣ and 6 ml), more than 70% of the spread of contrast dye was observed at the side of the target nerve roots in 85%, 70%, and 55% of cases, respectively. Conclusions: The combination of a caudal epidural injection and use of a guidewire-reinforced epidural catheter significantly enhances the target specificity, as revealed by the selective spread of contrast dye at the side of target nerves.

• 대한물리치료사협회지
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• 통권3호
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• pp.11-18
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• 1981

A Clinical Study of physical Therapy on the Low Back Conditions J. B. Rhee, S. K. fang, D. J, Han Low back pain usually is due primarily to a faulty mechanics, ,dis'c disease and other contributing factors .Conservative treatment of low back pain is considered to be useful with applicationes physical therapeutic measures including elimination of gravity, but surgical treatment is alternative to conservative .This study 1s conducted to analyse and evaluate efficiency of physical therapy on the low back pain on 452 cases who were treated at the Korea University Hospital, from January 1, 1978 to December 31. 1978.The results obtained in this study are summarized as follows :1. Sex distribution of total rationㄷs surveyed showed that 5l.3% in male and 487% in female.2 . In the age distrbution. the mest Liedominant age group was 25-54 years with7O.8 % .3 . The most proportion of the cases by occupation was housewife 27.7%, clerical and office workers 2l.7% , students 12.8% and labours 12.2 % respectively .4 . The most common causes of low back conditions classified, the Strain or Trau-rla revealed the highest frequency with 58.4% and thc Herniated Nucleus Pulpe-sus with 29.2 % of the total.5 . The modalities of physical therapy suitable to each cases were applied : 94.0%of all cases were treated with deep thermotherapy, 91.4 % hydrocollator steampack, 86.7% strengthening exercise of the weak muscles, pelvic traction 34.1%.6 . In regard to the duration required for the physical therapy. Herniated Nucleus Pulposus were approximately 4 weeks and strain or trauma were 2 weeks.7 . The improvement by physical therapy on lcw back conditions was classified in-to 41grades and showed following reaulits , excellent 42.5%, good 37.8%, fair 13.7% and poor 6.0% respectively.

• 대한추나의학회지
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• 제1권1호
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• pp.55-65
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• 2000

The present study retrospectively investigated clinical outcome at patients with low back pain or sciatica during Chuna treatment (flexion-distraction technique). The study population consisted of 29 patients. Discogenic group consisted of 21 patients who were already diagnosed as HNP of lumbar spine with serial MRIs(magnetic resonance imaging) or CTs(computerized tomography). Simple LBP group consisted of 8 patients with low back pain & sciatica who were non-specific disorder on radiologic examination. All patients were treated with flexion-distraction technique, one of Chuna technique, under analysis of Moire Topography. And the evaluation of clinical outcome was done twice during this study by Moire Topography Analytic Point and Low Back Pain Assesment, Visual Analogue Scale. The results were summarized as follows; Total improvement rate of Moire Topography was $25.8{\pm}17.8%$, and the rate of Low Back Pain Assesment was $56.5{\pm}23.0%$, Visual Analogue Scale of post-treatment was $32.6{\pm}22.5$ Between Improvement rate of Moire Topography and improvement rate of Low Back Pain Assesment, significant correlation was proved(Person's coefficient was 0.381, p<0.05). After all, it is certain improvement of Moire Topography represents symptom's improvement.

• The Korean Journal of Pain
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• 제21권3호
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• pp.217-223
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• 2008

Background: Lumbar transforaminal epidural injections (LTEIs) have been utilized in the treatment of radicular pain, and LTEIs have the advantage of target-specificity. However, there have not been enough studies on the contrast patterns in LTEIs with using fluoroscopy. The purpose of this study was to evaluate the spreading epidural contrast patterns that are seen during real-time fluoroscopic guided LTEIs. Methods: A total of 131 patients who underwent fluoroscopic guided LTEIs were studied. The inclusion criteria were those patients with low back pain and/or lower extremity pain that was caused by a herniated nucleus pulposus, lumbar spinal stenosis, failed back surgery syndrome, and herpes zoster-associated pain. We classified the contrast patterns in regard to the contrast flow spreading to the nerve root and/or the unilateral, bilateral or cylinderic type of epidural spreading on the AP view of the fluoroscopy and the ventral or dorsal epidural filling on the lateral view. In addition to the pattern analysis, we evaluated the range of contrast spreading from the cranial to the caudal epidural filling and the incidence of an intravascular flow pattern. Results: Epidural spreading was seen in 126 cases (96.2%) of the total patients through the nerve root. Ventral spreading occurred in 120 cases (95.2%). On the AP view, a nerve root with unilateral, bilateral and cylinderic epidural filling was noted for 108 (85.7%), 9 (7.1%) and 9 (7.1%) cases, respectively. The contrast spreading to vertebral segments was smaller for the patients with lumbar spinal stenosis and failed back surgery syndrome than for the other groups (P < 0.0083). The incidence of intravascular injection was 11.1% (14/126). Conclusions: LTEIs using fluoroscopic visualization provided excellent assessment of the ventral epidural filling as well as nerve root filling. However, unilateral epidural spreading was prominent for the LTEIs.

• The Korean Journal of Pain
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• 제14권2호
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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.

• 대한물리치료과학회지
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• 제9권2호
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• pp.37-48
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• 2002

The purpose of this study is to improve the effect of Lumbar extensor exercise program and develop the Lumbar extensor exercise program which will be suitable to the patients characteristics. In this study the experimental group was made up of 38 subjects. They are the patients with low back pain using the Lumbar extension exercise program in C hospital. The lumbar extension exercise program was given two times a week for 8 weeks. The results were estimated by Lumbar extensor strength by diagnosis agent. The results were measured three times, one time pre-treatment and two times post-treatment at 4weeks and 8weeks by lumbar extensor curve angle(0, 12, 24, 36, 48, 60, 72). The results were compared at pre-test 4weeks and 8weeks. The muscle strength measured at both 4weeks and 8weeks with the greater strength was shown at 4weeks. The muscle strength of patients with M.strain, Laminectomy and HNP was increased at all angles except for patients with stenosis. The results of this study indicated that diagnosis influenced the muscle strength in Lumbar extensor exercise program.