• Journal of Korean Neurosurgical Society
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• v.56 no.3
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• pp.206-210
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• 2014

Objective : Lumbar spinal stenosis is a common degenerative spine disease that requires surgical intervention. Currently, there is interest in minimally invasive surgery and various technical modifications of decompressive lumbar laminectomy without fusion. The purpose of this study was to present the author's surgical technique and results for decompression of spinal stenosis. Methods : The author performed surgery in 57 patients with lumbar spinal stenosis between 2006 and 2010. Data were gathered retrospectively via outpatient interviews and telephone questionnaires. The operation used in this study was named central decompressive laminoplasty (CDL), which allows thorough decompression of the lumbar spinal canal and proximal two foraminal nerve roots by undercutting the lamina and facet joint. Kyphotic prone positioning on elevated curvature of the frame or occasional use of an interlaminar spreader enables sufficient interlaminar working space. Pain was measured with a visual analogue scale (VAS). Surgical outcome was analyzed with the Oswestry Disability Index (ODI). Data were analyzed preoperatively and six months postoperatively. Results : The interlaminar window provided by this technique allowed for unhindered access to the central canal, lateral recess, and upper/lower foraminal zone, with near-total sparing of the facet joint. The VAS scores and ODI were significantly improved at six-month follow-up compared to preoperative levels (p<0.001, respectively). Excellent pain relief (>75% of initial VAS score) of back/buttock and leg was observed in 75.0% and 76.2% of patients, respectively. Conclusion : CDL is easily applied, allows good field visualization and decompression, maintains stability by sparing ligament and bony structures, and shows excellent early surgical results.

• Journal of Korean Neurosurgical Society
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• v.29 no.11
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• pp.1533-1537
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• 2000

Granulocytic sarcomas are solid tumors resulting from the localized proliferation of myelogenous leukions cells. Epidural involvement of granulocytic sarcoma is very rare in acute myelogenous leukemia(AML). We report a patient with a thoracic epidural granulocytic sarcoma whose presentation with acute paraparesis led to the diagnosis of relapsing of alleged AML. Early recognition of the etiology of the paraparesis and treatment with emergency decompressive, laminectomy, radiation therapy and chemotherapy resulted in an excellent neurological and hematological outcome.

• Journal of Korean Neurosurgical Society
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• v.40 no.1
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• pp.54-57
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• 2006

Central nervous system[CNS] involvement of acute lymphoblastic leukemia may occur. However, CNS involvement as a first manifestation of leukemia is very rare. An 8-year-old girl complained of a backache after playing in the water. Neurological examination detected progressing paraparesis. Magnetic resonance imaging[MRI] of the thoracolumbar spine showed a well-circumscribed homogeneous posterior extradural mass lesion extending from T7 to T9. MRI of the brain showed diffused fatty marrow replacement of the calvarium and the skull base. We report a patient with epidural Burkitt's lymphoma of the thoracic and lumbar vertebra causing compression of the spinal cord after pathologic evaluation. The tumor consisted mainly of lymphoblastic cells, which were identical to those originally seen in the bone marrow aspiration and biopsy. After decompressive laminectomy she began consolidation chemotherapy.

• Journal of Korean Neurosurgical Society
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• v.47 no.5
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• pp.381-384
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• 2010

Spinal epidural hematoma (SEH) causing acute myelopathy is rare. The usual clinical presentation of a SEH is sudden severe neck or back pain that progresses toward paraparesis or quadriparesis, depending on the level of the lesion. Recent studies have shown that early decompressive surgery is very important for patient's recovery. We experienced five patients of cervico-thoracic epidural hematomas associated with neurologic deficits that were treated successfully with surgical intervention.

• The Korean Journal of Pain
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• v.22 no.3
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• pp.249-252
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• 2009

Spinal epidural lipomatosis (SEL) is a rare condition of pathological overgrowth of fat tissue in the vertebral canal. SEL leads to back pain, radiculopathy or paraparesis. Glucocorticoids seem to play a major role in the development of SEL. SEL is best diagnosed by magnetic resonance imaging. The treatment of SEL is directed at reducing the body weight and decreasing the excess glucocorticoid. In severe cases, decompressive laminectomy with removal of the excess epidural fat might become necessary to alleviate the neurological symptoms caused by spinal cord compression.

• Journal of Korean Neurosurgical Society
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• v.37 no.1
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• pp.76-78
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• 2005

We report a rare case of cauda equina syndrome due to bilateral lumbar facet cyst. A 62-year-old woman has developed both legs sciatica 3 months prior to her visit, but recently motor weakness and voiding difficulty occurred. Lumbar magnetic resonance image showed bilateral lumbar facet cyst compressing and surrounding both L5 nerve root and accompanying spinal stenosis. Urgent decompressive laminectomy and cyst removal was performed. Although sciatica was relieved and motor weakness was recovered usefully. Voiding difficulty and dysesthesia were not improved.

• Asian Spine Journal
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• v.12 no.6
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• pp.1043-1052
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• 2018

Study Design: Level III retrospective cross-sectional study. Purpose: To define and characterize the presentation, symptom duration, and patient/surgical risk factors associated with 'post-decompressive neuropathy (PDN).' Overview of Literature: PDN is characterized by lower extremity radicular pain that is 'different' from pre-surgical radiculopathy or claudication pain. Although it is a common constellation of postoperative symptoms, PDN is incompletely characterized and poorly understood. We hypothesize that PDN is caused by an intraoperative neuropraxic event and may develop early (within 30 days following the procedure) or late (after 30 days following the procedure) within the postoperative period. Methods: Patients who consented to undergo lumbar laminectomy with or without an instrumented fusion for degenerative lumbar spine disease were followed up prospectively from July 2013 to December 2014. Relevant data were extracted from the charts of the eligible patients. Patient demographics and surgical factors were identified. Patients completed postoperative questionnaires 3 weeks, 3 months, 6 months, and 1 year postoperatively. Questions were designed to characterize the postoperative pain that differed from preoperative pain. A diagnosis of PDN was established if the patient exhibited the following characteristics: pain different from preoperative pain, leg pain worse than back pain, a non-dermatomal pain pattern, and nocturnal pain that often disrupted sleep. A Visual Analog Scale was used to monitor the pain, and patients documented the effectiveness of the prescribed pain management modalities. Patients for whom more than one follow-up survey was missed were excluded from analysis. Results: Of the 164 eligible patients, 118 (72.0%) completed at least one follow-up survey at each time interval. Of these eligible patients, 91 (77.1%) described symptoms consistent with PDN. Additionally, 75 patients (82.4%) described early-onset symptoms, whereas 16 reported symptoms consistent with late-onset PDN. Significantly more female patients reported PDN symptoms (87% vs. 69%, p=0.03). Patients with both early and late development of PDN described their leg pain as an intermittent, constant, burning, sharp/stabbing, or dull ache. Early PDN was categorized more commonly as a dull ache than late-onset PDN (60% vs. 31%, p=0.052); however, the difference did not reach statistical significance. Opioids were significantly more effective for patients with early-onset PDN than for those with late-onset PDN (85% vs. 44%, p=0.001). Gabapentin was most commonly prescribed to patients who cited no resolution of symptoms (70% vs. 31%, p=0.003). Time to symptom resolution ranged from within 1 month to 1 year. Patients' symptoms were considered unresolved if symptoms persisted for more than 1 year postoperatively. In total, 81% of the patients with early-onset PDN reported complete symptom resolution 1 year postoperatively compared with 63% of patients with late-onset PDN (p=0.11). Conclusions: PDN is a discrete postoperative pain phenomenon that occurred in 77% of the patients who underwent lumbar laminectomy with or without instrumented fusion. Attention must be paid to the constellation and natural history of symptoms unique to PDN to effectively manage a self-limiting postoperative issue.

• Journal of Korean Neurosurgical Society
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• v.37 no.6
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• pp.410-415
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• 2005

Objective: The aim of our study is to evaluate the effectiveness of unilateral hemilaminectomy for bilateral decompression in elderly patients with degenerative spinal stenosis. For this purpose, we studied the co-morbid condition and clinical outcome of patients who underwent decompressive surgery using the unilateral approach technique. Methods: Thirty-four patients over 65years of age who underwent unilateral partial laminectomy for bilateral decompression from January 2000 to October 2003 were analyzed. These patients were studied for preoperative co-morbid condition and physical status according to the American Society of Anesthesiologists(ASA) classification, postoperative morphometrical change, and clinical outcomes, including visual analogue scale(VAS) score. The mean follow-up was 23months (range 6 - 48months). Results: A patient's physical status was recorded as class I, II, or III by ASA classification, which correlated to 41.2%, 44.1%, and 14.7% of patients, respectively. The cross-sectional area of the pre- and postoperative dural sac at the level of the stenosis was $52.5{\pm}19.9mm^2$ and $110.6{\pm}18.2mm^2$, respectively. The outcome was excellent in 8.8%, good in 58.8%, fair in 23.6%, and poor in 8.8% of the patients. The VAS was changed postoperatively to $3.1{\pm}1.2$. There was no operation-related transfusion yet there was no evidence of postoperative instability at the follow-up examination. Conclusion: Unilateral laminectomy for bilateral decompression, in spite of the limited exposure, can result in satisfactory decompression of the lumbar spinal stenosis and tolerable clinical outcome. This approach is thought to be appropriate for elderly patients who have a greater surgical burden.

• Journal of Korean Neurosurgical Society
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• v.39 no.1
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• pp.75-77
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• 2006

The authors experience a rare case of the cervical radiculomyelopathy due to calcification of ligamentum flavum at the level of C4-6 and report it with review of the literature. A 60-year-old woman was admitted, complaining progressive quariparesis, gait disturbance and neck pain. She had been treated with diabetes mellitus and hypertension for several years. On radiologic study, calcification of ligamentum flavum[CLF] at the C4-6 level was demonstrated on cervical spine CT and MR scan. Decompressive laminectomy of the C 4-6 and removal of CLF were performed. During operation, thecal sac was severely compressed by hypertrophic ligamentum flavum and there were tight adhesion between calcified ligamentum flavum and dura. After the operation, her motor function and neck pain improved and she could walk with an assistant.

• Journal of Korean Neurosurgical Society
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• v.40 no.5
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• pp.381-383
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• 2006

Spinal extradural arachnoid cyst is uncommon and rarely cause neural compression. We report a rare case of severe cord compression due to septated spinal extradural arachnoid cyst. A 35-year-old woman has developed back pain 3 months prior to her visit, but recently motor weakness and urinary incontinence occurred. Magnetic resonance images showed an extradural cyst posterior to the cord, which was flattened and displaced from T12 to L2. Urgent decompressive laminectomy and cyst removal was performed. Histopathological examination confirmed that cyst wall was formed by nonspecific fibrous connective tissue without a single-cell layer of inner arachnoid lining. Motor weakness and voiding difficulty were recovered completely after operation.