• The Korean Journal of Pain
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• v.11 no.2
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• pp.314-316
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• 1998

Psoas compartment block has been used to provide anesthesia and analgesia of hip joint. This block is advocated for relief of pain of various origins in the thigh, leg and lumbar area. A-40-year-old women complained of pain in the left thigh and lumbar area after operation of the second lumbar vertebral compression fracture. To relieve pain, caudal block was performed. This block reduced in lumbar pain but left thigh pain persisted. So, we were performed psoas compartment block using mepivacaine and dexamethasone, which relieved the pain in the left thigh and lumbar area. We recommend psoas compartment block as useful and simple method for patients with thigh and lumbar area pain, especially when the epidural block is not feasible.

• The Journal of Korean Academy of Orthopedic Manual Physical Therapy
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• v.12 no.2
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• pp.33-41
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• 2006

This study planed to analyze durability of effect and result that the Medx and Sling exercise gets to the strength of lumbar extensors. 15 patients who had enforce the minimal invasive lumbar surgery were executed 3 times per week for 8 weeks. The purpose of this study was to identify the influence of the mixed exercises of the Medx and Sling program on lumbar trunk muscles and to present basic data for the proper exercise prescription for lumbar patients. The results were as follows: 1) Left: Patients by lumbar hernia operation of trunk muscle strength by Sling-exercise: 0, 45, 90, 135, 180 (degree) treatment periods (P<0.05). 2) Right: Patients by lumbar hernia operation of trunk muscle strength by Sling-Exercise: 0, 45, 90, 135, 180 (degree) treatment periods (P<0.05). Medx treatment, a muscle strengthening lumbar extension exercise program, was now being used at local hospitals. In addition, Sling exercise, which is designed to develop lumbar muscle by way of reducing gravity in a new way so that it can accelerate the growth of muscles and ligaments in-depth in the patients, also has begun to be introduced gradually. In this study, therefore, the new mixed program (Sling and Medx training)can used as an exercise program that can reduce pain and increase lumbar muscles, not only for disk disease patients but also for all those who have undergone surgery or who haven't undergone surgery, who have chronic pain, and it also can be utilized as basic data for the new method of exercise.

• Journal of Korean Neurosurgical Society
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• v.29 no.8
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• pp.1055-1062
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• 2000

Objectives : Burst fracture of the lower lumbar spine(L3-L5) is rare and has some different features compare to that of thoracolumbar junction. Lower lumbar spine is flexible segments located deeply, and has physiologic lordosis. All of these contribute to making surgical approach difficult. Generally, lower lumbar burst fracture is managed either anteriorly or posteriorly with various fixation and fusion methods. But there is no general guideline or consensus regarding the proper approach for such lesion. We have tried to find out the influencing factors for selecting the surgical approach through the analysis of lower lumbar burst fractures treated for last 4 years(1994.3-1998.3). Method : This study includes 15 patients(male : 10, female : 5, age range 20-59 years with mean age of 36.7 years, L3 : 8 cases, L4 : 5 cases, L5 : 2 cases). Patients were classified into anterior(AO) and posterior operated(PO) groups. We investigated clinical findings, injured column, operation methods, and changes in follow-up radiologic study (kyphotic angle) to determine the considerable factors in selecting the surgical approaches. Results : There were 5 AO and 10 PO patients. Anterior operation were performed with AIF with Kaneda or Z-plate and posterior operation were done with pedicle screw fixation with PLIF with cages or posterolateral fusion. Canal compression was 46.6% in AO and 38.8% in PO. The degree of kyphotic angle correction were 10.7 degree(AO) and 8.5 degree(PO), respectively. There was no statistical difference between anterior and posterior operation group. All patients showed good surgical outcome without complications. Conclusion : Anterior operation provided good in kyphotic angle correction and firm anterior strut graft, but it difficulty arose in accessing the lesions below L4 vertebra. While posterior approach showed less correction of kyphotic angle, it required less time and provided better results for accompanied adjacent lesion and pathology such as epidural hematoma. The level of injury, canal compression, biomechanics, multiplicity, and pathology are considered to be important factors in selection of the surgical approach.

• Journal of Korean Neurosurgical Society
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• v.41 no.3
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• pp.157-160
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• 2007

Objective : The purpose of this study was to evaluate the efficacy and safety of the surgical treatment for lumbar spinal stenosis in elderly patients. Methods : The authors reviewed the medical records of 49 patients older than 65 years of age with lumbar spinal stenosis who underwent surgical treatment from January 2002 to December 2004 in our institute. Results : Average age of patients was 70 years old [32 women, 17 men]. Twenty-four patients had chronic medical disorders. All patients were operated under the general anesthesia of these, 29 patients underwent decompressive laminectomy and decompressive laminectomy with instrumentation and fusion in 20 patients. The mean operation time was 193.5 minutes, mean estimated blood loss was 378cc and mean postoperative hospital stay length was 15.3 days. The mean follow-up duration was 11.9 months. The evaluation of outcome was assessed by Macnab classification. At first month after operation, the outcome showed excellent in 7 [14.3%]. good in 35 [71.4%], fair in 5 [10.2%], and poor in 2 [4.1%]. And at 6 months after operation, 17 patients were lost in follow-up, the outcome showed excellent in 4 [12.5%], good in 25 [78.1%], fair in 3 [9.4%], and no poor cases. There was no significant difference between outcome of laminectomy alone and that of laminectomy with fusion. Six patients [12.2%] experienced postoperative complications which included wound infection [3], nerve root injury [1], disc herniation [1], and reoperation due to insufficient decompression [1]. There were no deaths related to operation. Conclusion : We conclude that the surgical treatment for lumbar spinal stenosis in elderly patients can provide good results with acceptable morbidity when carefully selected. In addition, decision on lumbar spinal fusion should not be against solely on advanced age.

• Journal of Korean Medicine Rehabilitation
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• v.19 no.4
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• pp.165-173
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• 2009

Objectives : The purpose of this study was to report effectiveness of oriental medical treatments to symptoms and quality of life in the patients with herniated lumbar disc being suggested operation. Methods : Eighteen patients diagnosed with herniated lumbar disc by MRI in hospital were treated by oriental medical treatments. Symptoms of the patients were assessed by visual analogue scale(VAS) and SF-36. Results : After the treatments, the VAS of symptoms of herniated lumbar disc and the score of role-physical scale in SF-36 were improved but the other scores of scales were not significantly different. Conclusions : It could be suggested that oriental medical treatments were effective for the patients with herniated lumbar disc being suggested operation. Further study of the effect of oriental medical treatments on herniated lumbar disc is needed.

• The Journal of Korean Academy of Orthopedic Manual Physical Therapy
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• v.10 no.2
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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.

• Journal of Korean Neurosurgical Society
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• v.38 no.2
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• pp.144-146
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• 2005

Herein, a case of missed upper lumbar disc herniation, diagnosed by thorough neurological examination, digital infrared thermographic imaging[DITI], and repeated magnetic resonance[MR] image study, is reported. A 36-year-old female presented with intractable leg pain on left anterior thigh. Although she underwent lumbar MR image at other hospital, she was misdiagnosed as acute sprain. Neurological examination suggested the possibility of upper lumbar disc herniation, which was confirmed by DITI, MRI, and selective root block. After operation, her leg pain was significantly improved. It should be considered that upper lumbar disc herniation might be misdiagnosed as an acute sprain, as in our case. A high index of suspicion based on thorough neurological examination is most important in such cases. Then, multi-access such as DITI, MR image, and selective block, base on thorough neurological examination, are warranted.

• The Korean Journal of Pain
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• v.6 no.2
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• pp.258-260
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• 1993

We experienced a rare case of erection failure which developed after unilateral lumbar sympathetic block. A 43 year old male patient suffering from reflex sympathetic dystrophy, which had developed after multiple communitted fracture of the right ankle, underwent right lumbar sympathetic block with 99.9% alcohol. The effectiveness of the lumbar sympathetic block was evaluated by monitoring the clinical symptoms, signs and temperature changes by digital infrared thermographic imaging. Postoperatively, the temperature of the affected side limb rose about $2^{\circ}C$, but the patient's conditions gradually returned to normal. Ten days after the operation the patient complainted of difficulty in achieving an erection. The patient was examined by a urologst without much results. The patient gradually recovered his ability to achieve an erection approximately 5 weeks after the lumbar sympathetic block.

• The Journal of Korean Academy of Orthopedic Manual Physical Therapy
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• v.11 no.2
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• pp.83-95
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• 2005

The purpose of this study is to analyze, durability of motor effort after finishing rehabilitation program and the influence from the isotonic lumbar region extension exercise after an operation according to the different operation way in invasive degrees. We selected randomly 80 patients who have no complication and musculoskeletal system diseases with finishing the 12 weeks' rehabilitation program after getting laser discectomy, but fail to conservative treatment, about Lumbar HNP, and divided into minimal invasive groups 38 and invasive groups 42 for study. As the results, in minimal invasive group, after finishing cure and 6 months later, the degree of hold muscle of women is much better than that of men. but in Invasive group, that of men is better than that of women, in case of women, the $0^{\circ}$ and $72^{\circ}$ in lumbar flexion angle have weaken or no improvement than before beginning exercise. and muscle force in $72^{\circ}$ in lumbar flexion angle increased to all men and women than before beginning exercise in Minimal invasive group. but in invasive group. it decreased. When analyze the lapsed time in Minimal invasive group, the groups who start the exercise within 3 months are better than the groups who start the exercise above 3 months after an operation the hold muscle degree all angles after finishing cure and 6 months later. Meanwhile, in invasive group, the groups who start the exercise within 3 months are better than the groups who start the exercise above 3 months after an operation about the hold muscle degree in 36-72 of lumbar flexion angle but 0-36 are not good after finishing cure and 6 months later. When analyze BMI in Minimal invasive group, the normal groups are better than the overweight groups about hold muscle degree in all angles after finishing cure and 6 months later.

• Journal of Korean Neurosurgical Society
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• v.58 no.6
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• pp.539-546
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• 2015

Objective : To report the learning curve of percutaneous endoscopic lumbar discectomy (PELD) for a surgeon who had not been previously exposed to this procedure based on the period and detailed technique with a retrospective matched comparative design. Methods : Of 213 patients with lumbar disc herniation encountered during the reference period, 35 patients who were followed up for 1 year after PELD were enrolled in this study. The patients were categorized by the period and technique of operation : group A, the first 15 cases, who underwent by the 'in-and-out' technique; group B, the next 20 cases, who underwent by the 'in-and-out-and-in' technique. The operation time, failure rate, blood loss, complication rate, re-herniation rate, the Visual Analogue Scale (VAS) for back and leg were checked. The alteration of dural sac cross-sectional area (DSCSA) between the preoperative and the postoperative MRI was checked. Results : Operative time was rapidly reduced in the early phase, and then tapered to a steady state for the 35 cases receiving the PELD. After surgery, VAS scores for the back and leg were decreased significantly in both groups. Complications occurred in 2 patients in group A and 2 patients in group B. Between the two groups, there were significant differences in operative time, improvement of leg VAS, and expansion of DSCSA. Conclusion : PELD learning curve seems to be acceptable with sufficient preparation. However, because of their high tendency to delayed operation time, operation failure, and re-herniation, caution should be exercised at the early phase of the procedure.