• Journal of Korean Neurosurgical Society
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• 제29권5호
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• pp.623-627
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• 2000

Objective : Spontaneous lumbar epidural hematoma is a rare entity, although the precipitating factors such as anticoagulation therapy frequently precede it. The authors report four cases of surgically confirmed spontaneous epidural hematoma mimicking lumbar disc herniation. Methods : Between 1995 and 1998, four patients with spontaneous lumbar epidural hematoma were diagnosed. The clinical findings which are identical to that of acute disc herniation are included in this study. The operative findings and radiological characteristics are also included. Results : The magnetic resonance(MR) image findings demonstrated epidural lesions of intermediate to low signal intensity equivalent to those of normal discs on $T_1$-weighted images, and epidural lesions of high signal intensity higher than these normal discs on a $T_2$-weighted image. The image findings also showed rim enhanced pattern of the gadolinium-enhanced $T_1$-weighted MR images. All of the hematomas was associated with a small concomitant disc herniation or underlying annular tear. Conclusion : The authors speculate that spontaneous lumbar epidural hematoma results from tearing of the fragile penetrating vein caused by underlying disc or annulus disruption between Batson' plexus and vertebral body.

• Journal of Korean Neurosurgical Society
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• 제39권6호
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• pp.413-418
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• 2006

Objective : The objective of this study is to evaluate and compare the clinical results between classical open surgery and percutaneous endoscopic lumbar discectomy[PELD] in cases of extraforaminal lumbar disc herniation. Methods : We obtained the clinical data from 47 patients with extraforaminal lumbar disc herniations who underwent the open paramedian muscle-splitting approach or percutaneous endoscopic lumbar discectomy[PELD] between January 2001 and February 2004. This study consisted of patients with soft disc extraforaminal herniations. The patients were assessed with the visual analogue scale[VAS] and MacNab's criteria before surgery, just before discharge, and postoperative 1 year. Results : There were 25 cases in the open surgery group and 22 cases in the PELD group. The average operating time was $78{\pm}36.71\;min$ in the PELD group and $110{\pm}29.68\;min$ in the open surgery group. The mean hospital stay was $2.73{\pm}2.62$ days in the PELD group and $7.68{\pm}2.59$ days in the open surgery group. VAS decreased from $8.34{\pm}0.66$ to $1.29{\pm}2.27$ in the PELD group and from $8.40{\pm}1.40$ to $1.70{\pm}1.72$ in the open surgery group at the one-year follow-up. The success rate of PELD was 86.4%, compared with 80.0% for open surgery. However, there were no statistically significant difference between two groups for success rate and VAS. Conclusion : Although the success rates were similar in both groups, PELD is less invasive, faster, and safe procedure than open surgery for extraforaminal disc herniation in selected patients.

• 대한물리치료과학회지
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• 제28권3호
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• pp.42-52
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• 2021

Background: The purpose of this study was to investigate the effects of the severity and direction of lumbar disc herniation (LDH) on the facet joints and paraspinal muscles. Design: Cross-sectional design. Methods: The subjects were divided according to the diagnosis for severity of unilateral herniation of L4-L5 disc. The groups consisted of disc protrusion group (n=15), disc extrusion group (n=15), and no disc herniation group (n=15). The asymmetry and angle of facet joints and the cross-sectional area of paraspinal muscles were analyzed and compared using magnetic resonance imaging (MRI). Results: The results showed that the angle of facet tropism was larger in disc extrusion group than the disc protrusion group and the difference was found to be significant difference (p<0.01). In addition, when both left and right angles of patients with unilateral disc herniation were measured, the results showed larger facet joint angle in the herniated area of the disc extrusion group than in the disc protrusion group. When paraspinal muscles were measured according to the severity of disc herniation and the degree of facet joint asymmetry, there was no difference in paraspinal muscles between the disc protrusion and disc extrusion groups. Meanwhile, the multifidus muscle was smaller in the group with facet tropism than the group without facet tropism (p<0.03), while there were no significant differences in the erector spinae and psoas muscles. Conclusion: Progression of disc herniation resulted in increased facet joint tropism, increased angle of the facet joints in the direction of disc herniation, and decreased size of the multifidus muscle.

• 대한한방부인과학회지
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• 제34권1호
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• pp.93-103
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• 2021

Objectives: The purpose of this study was to report a case of a pregnant woman diagnosed with lumbar disc herniation that improved in lumbar pain and radiating leg pain through combined korean medical treatment including pharmacopuncture at lumbar facet joints in situations surgical and pharmacological treatment is limited due to pregnancy. Methods: A combination of treatment including pharmacopuncture at lumbar facet joints, acupuncture, cupping, and herbal medicine was provided for 1 month to a woman at 21 weeks pregnant who was diagnosed with lumbar disc herniation. Her progress was assessed with Numeric Rating Scale (NRS), Oswestry Disability Index (ODI), EuroQol-5Dimension (EQ-5D) before and after treatment. Results: After the treatment, the pain decreased and the quality of life was enhanced. No adverse events were observed. Conclusions: The findings indicate that combined korean medical treatment including pharmacopuncture at lumbar facet joints can be safe and effective alternative to treat lumbar disc herniation during pregnancy.

• 한방재활의학과학회지
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• 제19권3호
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• pp.81-90
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• 2009

Objectives : To analyze the therapeutic outcomes of back pain modalities in patients with disc herniation according to the change of Magnetic Resonanse Imaging(MRI) whom were treated with herbal medicine, chuna, acupuncture, bee-venom acupuncture. Methods : Clinical outcomes of 35 patients diagnosed with lumbar disc herniation by MRI examination, treated conservatively, were analyzed according to MRI follow-up change. Patients underwent MRI examaintion at baseline and after 24th week of treatment. Patients are divided into three groups ; improved, unchanged, worsened. 35 patients with lumbar disc herniation were treated with chuna therapy, acupuncture, bee-venom acupuncture once a week and took herbal medicine after a meal two times daily. The patients' clinical outcomes were assessed at baseline, 12th week, 24th week by Visual analogue scale(VAS), Oswestry disability index(ODI). Results : 1. MRI follow-up exams on regression of disc herniation resulted on 42.86% of cases by conservative treatment. 2. VAS(low back pain and sciatica) and ODI of disability of daily activities showed significant decrease in "improved" and "unchanged" groups compared to "worsened" group(P<0.05). 3. VAS(low back pain and sciatica) and ODI change after treatment did not show any relationship with MRI follow-up change(P<0.05). Conclusions : This study suggests that "improved" and "unchanged" groups compared to "worsened" group on MRI follow-up in patients with lumbar disc herniation were more effective when treated with herbal medicine, chuna therapy, acupuncture, bee-venom acupuncture. MRI follow-up change does not affect clinical changes in patients with lumbar disc herniation.

• Journal of Korean Neurosurgical Society
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• 제62권6호
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• pp.691-699
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• 2019

Objective : Lumbar discectomy is an effective treatment for lumbar disc herniation (LDH); however, up to 2-18% of patients with LDH have experienced recurrent disc herniation. The purpose of this study was to evaluate the efficacy of a novel annular closure device (ACD) for preventing LDH recurrence and re-operation compared with that of conventional lumbar discectomy (CLD). Methods : In this prospective randomized controlled trial, we compared CLD with discectomy utilizing the $Barricaid^{(R)}$ (Intrinsic Therapeutics, Inc., Woburn, MA, USA) ACD. Primary radiologic outcomes included disc height, percentage of preoperative disc height maintained, and re-herniation rates. Additional clinical outcomes included visual analog scale (VAS) scores for back and leg pain, Oswestry Disability Index (ODI) scores, and 12-item short-form health survey (SF-12) quality of life scores. Outcomes were measured at preoperation and at 1 week, 1, 3, 6, 12, and 24 months postoperation. Results : Sixty patients (30 CLD, 30 ACD) were enrolled in this study. At 24-month follow-up, the disc height in the ACD group was significantly greater than that in the CLD group ($11.4{\pm}1.5$ vs. $10.2{\pm}1.2mm$, p=0.006). Re-herniation occurred in one patient in the ACD group versus six patients in the CLD group (${\chi}^2=4.04$, p=0.044). Back and leg VAS scores, ODI scores, and SF-12 scores improved significantly in both groups compared with preoperative scores in the first 7 days following surgery and remained at significantly improved levels at a 24-month follow-up. However, no statistical difference was found between the two groups. Conclusion : Lumbar discectomy with the $Barricaid^{(R)}$ (Intrinsic Therapeutics, Inc.) ACD is more effective at maintaining disc height and preventing re-herniation compared with conventional discectomy. Our results suggest that adoption of ACD in lumbar discectomy can help improve the treatment outcome.

• Journal of Korean Neurosurgical Society
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• 제61권1호
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• pp.89-96
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• 2018

Objective : Morphometric data for the lumbar posterior longitudinal ligament (PLL) was investigated to identify whether there is a difference in the morphometry of the PLL of the lumbar spine at each level with respect to the pattern of intervertebral disc displacement. Methods : In 14 formalin-fixed adult cadavers (12 males and 2 females), from L1 to L5, the authors measured the width and height of the PLL and compared them with other landmarks such as the disc and the pedicle. Results : Horizontally, at the upper margin of the disc, the central portion of the superficial PLL covered 17.8-36.9% of the disc width and the fan-like portion of the PLL covered 63.9-76.7% of the disc width. At the level of the median portion of the disc, the PLL covered 69.1-74.5% of the disc width. Vertically, at the level of the medial margin of the pedicle, the fan-like portion of the PLL covered 23.5-29.9% of the disc height. In general, a significant difference in length was not found in the right-left and male-female comparisons. Conclusion : This study presents the morphometric data on the pattern of intervertebral disc displacement and helps to improve the knowledge of the surgical anatomy of the lumbar PLL.

• The Korean Journal of Pain
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• 제21권2호
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• pp.143-149
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• 2008

Background: Traction has often been utilized to treat patients with a herniated lumbar disc. Currently, the most advanced type of traction therapy is non-surgical spinal decompression. Therefore, this study was conducted to evaluate the effectiveness of decompression therapy in patients with a herniated lumbar disc based on clinical findings and symptoms. Methods: Sixty patients with herniated lumbar discs were included in this study. The patients were randomly divided into two groups, a decompression group (n = 30) and a traction group (n = 30). To evaluate the impact of decompression and traction therapy on the herniated disc, the clinical symptoms for each group were evaluated prior to and after treatment using the visual analogue scale (VAS), straight leg raising (SLR), the herniation index, and the disc height. Results: The VAS score was significantly lower in the decompression group ($2.0{\pm}0.2$) than the traction group ($3.9{\pm}0.2$) following treatment. In addition, the SLR angle was significantly higher in the decompression group ($79{\pm}1.5$) than the traction group ($63.3{\pm}1.9$). The herniation index was significantly lower in the decompression group ($217.6{\pm}19.1$) than the traction group ($259.5{\pm}16.4$). Finally, the disc height was not significant differences between pre-treatment and follow-up in two groups. Conclusions: The results of this study suggest that decompression therapy for the treatment of patients suffering from a herniated lumbar disc has an effect on the pain, SLR, and herniation indices, not disc heights.

• The Korean Journal of Pain
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• 제18권1호
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• pp.34-38
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• 2005

Background: Over the years, disc surgery has progressively evolved in the direction of decreasing trauma and its invasiveness. Conventional open surgery has many complications, such as scarring, instability, bleeding and a relative high mortality rate. Minimally invasive spinal surgery is now an alternative to a traditional discectomy. Herein, we present an operative technique, and the early results, for a percutaneous endoscopic lumbar discectomy in herniated lumbar disc disease. Methods: 43 patients, including 27 men and 16 women, with ages ranging from 18 to 66 years, were enrolled in this study. All the patients showed a protruded or extruded soft disc herniation at the lumbar level on magnetic resonance imaging and computed tomography. A percutaneous endoscopic lumbar discectomy was applied to the patients, and clinical responses evaluated using MacNab's criteria. Results: 40 patients were regarded as showing successful responses (93.1%), and there were no severe complications, such as a hematoma, nerve injury, postoperative dysesthesia or death. One patient underwent fusion surgery for remnant back pain six month later. Conclusions: We conclude that, in properly selected patients, a percutaneous endoscopic lumbar discectomy is a safe, noninvasive and effective treatment modality for herniated lumbar intervertebral disc disease.

• Journal of Korean Neurosurgical Society
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• 제29권5호
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• pp.599-603
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• 2000

Objectives : In lumbar spine surgery it is observed that the ligamentum flavum(LF) is bilayered, and the inner layers can be left in situ to prevent peridural adhesion in open lumbar disc surgeries. The purposes of this study are to investigate ultrastructural differences between the inner and outer layer of lumbar LF by electron microscopic examination, and to see whether these differences are, if present, more prominent in chronic degenerative lumbar spinal disorders as compared with acute lumbar disc diseases. Methods : Biopsy specimens of LF were obtained from nine patients undergoing lumbar spine surgery, five of them for degenerative spinal stenosis and four for acute disc herniation. During the surgery the outer layers of LF were carefully dissected from the inner layer, and four pieces($1{\times}1{\times}1-mm$) of biopsy samples were made from each layer. These were examined with electron microscope for the morphologies and the contents of the elastic and the collagen fibers. Results : The outer layer of LF showed elastic fiber degeneration as evidenced and decreased fiber content, while the inner layer was relatively preserved in both cases of degenerative spinal stenosis and acute disc herniation. The ultrastructural changes of the layers were more evident in the outer layer. Conclusion : With these observations the authors believe that the LF degeneration may occur mainly in the outer layer, and that this fact may aid in making the rationale for using the inner layer as physiologic barrier to prevent peridural adhesion in open lumbar disc surgeries.