• The Korean Journal of Health Service Management
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• v.8 no.1
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• pp.151-164
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• 2014

This study was conducted to investigate the effect of timing of surgery on outcomes of spine operated patients for lumbar herniated intervertebral disc. The research design was cohort study and based on the data of claims for the medical expenses of health insurance. 21,475 cases who had primary spine surgery between January 1, and December 31, 2003, observed to conservative treatment period in the past two years from preoperative primary diagnosis to timing of primary surgery. According to one and five year follow up monitoring, the probability of occurrence of reoperation was not statistically significant with preoperative duration of symptom. Also one year follow up, the probability of occurrence of complication, was not statistically significant with preoperative duration of symptom. But five year follow up, groups who had one to two month preoperative duration of symptom decreased complication rate than less than a month(95%CI:0.594-0.927). Thus, from the onset of symptoms of back pain before primary surgery with enough and adequate time observation is required. Also, medical consumers or providers to choose surgery in determining prudence is required.

• Journal of Korean Neurosurgical Society
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• v.44 no.5
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• pp.320-326
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• 2008

Objective : To evaluate the risk factors that may be responsible for the development of contralateral reherniations from ipsilateral ones after open lumbar microdiscectomy (OLM), and to compare surgical outcomes of revision OLM for contralateral reherniations with those for ipsilateral ones. Methods: Seventeen patients who underwent revision OLM for contralateral reherniation were enrolled into Group I, and 35 patients who underwent revision OLM for ipsilateral reherniation were enrolled into Group II. Using medical charts and imaging study results, the differences in the clinical and radiological factors were evaluated between the two groups. Clinical outcomes of each group were compared between the two groups. Results: Significant differences were found in the interval to reherniation from initial surgery (33 months for Group I and 18.6 months for Group II, p=0.009), as well as in the incidences of both protruded disc (35.3% for Group I and 8.6% for Group II, p=0.045) and mild disc degeneration (29.4% for Group I and 5.7% for Group II, p=0.031) at initial surgery. On binary multi-logistic regression analysis, significant differences were found in the interval to reherniation (p=0.027, Odds ratio=1.051) and incidence of mild disc degeneration (p=0.025, Odds ratio= 12.03) between the two groups. There were no significant differences in the improvement of clinical outcomes after revision OLM between the two groups. Conclusion: The interval to reherniation from initial surgery and the grade of disc degeneration at initial surgery were key factors that distinguished the development of contralateral reherniations from ipsilateral ones. Surgical outcomes of revision OLM were similar in both groups.

• Journal of Korean Neurosurgical Society
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• v.44 no.6
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• pp.385-388
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• 2008

We herein describe the case of a focal spontaneous spinal epidural abscess who was initially diagnosed to have a free fragment of a lumbar disc. A 71-year-old woman presented with history of low back and right leg pain. Magnetic resonance imaging suggested a peripherally enhancing free fragment extending down from S1 nerve root axilla. Preoperative laboratory investigation showed elevation of c-reactive protein (CRP), erythrocyte sedimentation rate (ESR) levels. She was taken for surgery and a fluctuating mass at the axilla of S1 nerve was found. When the mass was probed with a dissector, a dark yellow, thick pus drained out. Pus cultures were negative. Patients who present with extreme low back plus leg pain and increased leucocyte count, ESR and CRP levels should raise the suspicion of an infection of a vertebral body or spinal epidural space.

• Journal of Korean Neurosurgical Society
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• v.46 no.2
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• pp.168-171
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• 2009

Intradural lumbar disc herniation (ILDH) is rare. In this report, authors present 2 cases of ILDHs associated with severe adhesion between the dural sac and posterior longitudinal ligament. In a 40-year-old man, ILDH occurred in association with epidural adhesion due to ossification of the posterior longitudinal ligament (OPLL). In other 31-year-old man, ILDH occurred in presence of epidural adhesion due to previous spine surgery.

• Journal of Korean Society of Spine Surgery
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• v.25 no.4
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• pp.180-184
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• 2018

Study Design: Case report Objectives: To document fistula formation between the disc and dura by an unrecognized dural tear after percutaneous endoscopic lumbar discectomy (PELD). Summary of Literature Review: The risk of durotomy is relatively low with PELD, but cases of unrecognized durotomies have been reported. An effective diagnostic tool for such situations has not yet been identified. Materials and Methods: A patient twice underwent transforaminal PELD under the diagnosis of a herniated lumbar disc at L4-5. She still complained of intractable pain and motor weakness around the left lower extremity at 6 months postoperatively. Magnetic resonance imaging showed no specific findings suggestive of violation of the nerve root. However, L5 and S1 nerve root injury was noted on electromyography. An exploratory operation was planned to characterize damage to the neural structures. Results: In the exploration, a dural tear was found at the previous operative site, along with a fistula between the disc and dura was also found at the dural tear site. The durotomy site was located on the ventrolateral side of the dura and measured approximately 5 mm. The durotomy site was repaired with Nylon 5-0 and adhesive sealants. The patient's preoperative symptoms diminished considerably. Conclusions: Fistula formation between the disc and dura can be caused by an unrecognized dural tear after PELD. Discography is a reliable diagnostic tool for fistulas formed by an unrecognized durotomy.

• Journal of Yeungnam Medical Science
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• v.15 no.1
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• pp.164-172
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• 1998

The Graf stabilization has been introduced in treating lumbar spinal disorder associated with posterior instability. This study reviewed some problems of the Graf instrumentation as a soft stabilizer. The purpose of this study is to analyse the problems of the soft stabilization in spinal instability. We reviewed 145 cases which were operative treatment using the Graf instrument for lumbar spinal disorder associated with posterior instability at our department from May, 1991 to Dec, 1995. The mean follow up periods was 29 months ranging from 24 months to 6 years 8 months. Of the 145 cases, 22 cases were showed the problem. The diagnostic method were simple x-ray, flexion-extension lateral stress view and CT scan. Results were as follows: Adjacent segmental instability was 10 cases(6.9%), disc space narrowing was 8 cases(5.5%), screw loosening was 3 cases(2.1%) and breakage of the Graf band was 1 case(0.6%). The problems of the soft stabilization were adjacent segmental instability, disc space narrowing, screw loosening, and breakage of the Graf band. But the rate of adjacent segmental instability and disc space narrowing was lower than other lumbar spinal instrumentation.

• Journal of Korean Neurosurgical Society
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• v.56 no.4
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• pp.315-322
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• 2014

Objective : Posterior accessed lumbar interbody fusion (PALIF) has a clear objective to restore disc height and spinal alignment but surgeons may occasionally face the converse situation and lose lumbar lordosis. We analyzed retrospective data for factors contributing to a postoperative flat back. Methods : A total of 105 patients who underwent PALIF for spondylolisthesis and stenosis were enrolled. The patients were divided according to surgical type [posterior lumbar inter body fusion (PLIF) vs. unilateral transforaminal lumbar interbody fusion (TLIF)], number of levels (single vs. multiple), and diagnosis (spondylolisthesis vs. stenosis). We measured perioperative index level lordosis, lumbar lordosis, pelvic tilt, sacral slope, pelvic incidence, and disc height in standing lateral radiographs. The change and variance in each parameter and comparative group were analyzed with the paired and Student t-test (p<0.05), correlation coefficient, and regression analysis. Results : A significant perioperative reduction was observed in index-level lordosis following TLIF at the single level and in patients with spondylolisthesis (p=0.002, p=0.005). Pelvic tilt and sacral slope were significantly restored following PLIF multilevel surgery (p=0.009, p=0.003). Sacral slope variance was highly sensitive to perioperative variance of index level lordosis in high sacral sloped pelvis. Perioperative variance of index level lordosis was positively correlated with disc height variance ($R^2=0.286$, p=0.0005). Conclusion : Unilateral TLIF has the potential to cause postoperative flat back. PLIF is more reliable than unilateral TLIF to restore spinopelvic parameters following multilevel surgery and spondylolisthesis. A high sacral sloped pelvis is more vulnerable to PALIF in terms of a postoperative flat back.

• Korean Journal of Computational Design and Engineering
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• v.13 no.1
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• pp.58-66
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• 2008

The artificial discs have recently used to preserve the motion of the treated segment in lumbar spine surgery. However, there have been lack of biomechanical information of the artificial discs to explain current clinical controversies such as long-term results of implant wear and excessive facet contact forces. In this study, we investigated the biomechanical effects of three artificial implants on the lumbar spinal segments by finite element analysis. The finite element model of intact lumbar spine(L1-S) was developed and the three implants were inserted in L4-L5 segment of the spine model. 5 Nm of flexion and extension moments were applied on the superior plate of L1 with 400 N of compressive load. Excessive motions and high facet contact forces at the surgical level were generated in the all three implanted models. In the flexion, the peak von-Mises stresses in the semi-constrained type implant was higher than those in the un-constrained type implant which would cause wear on the polyethylene core. The results of the study would provide a biomechanical guideline for selecting optimal surgical approach or evaluating the current design of the implants, or developing a new implant.

• The Journal of Churna Manual Medicine for Spine and Nerves
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• v.13 no.2
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• pp.65-73
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• 2018

Objectives : To verify Korean Medicinal Combination Treatments for patients who have Failed Back Surgery Syndrome along with scoliosis Methods : We used Acupuncture, Chuna manual therapy, Pharmacoacupuncture, Herbal medication. We measured Numeral Rating Sacle(NRS), Pain-Free walking distance(PFWD) and Oswestry Disability Index(ODI) score to evaluate the treatment effects. Results : Patients' LBP & Rt.leg pain NRS, PFWD and ODI score were improved. Conclusions : Traditional Korean medicine can be effective for FBSS patients along with scoliosis.

• Asian Spine Journal
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• v.12 no.6
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• pp.981-986
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• 2018

Study Design: Retrospective case series. Purpose: Cauda equina syndrome (CES) is associated with etiologies such as lumbar disc herniation (LDH) and lumbar canal stenosis (LCS). CES has a prevalence of 2% among patients with LDH and exhibits variable outcomes, even with early surgery. Few studies have explored the factors influencing the prognosis in terms of bladder function. Therefore, we aimed to assess the factors contributing to bladder recovery and propose a simplified bladder recovery classification. Overview of Literature: Few reports have described the prognostic clinical factors for bladder recovery following CES. Moreover, limited data are available regarding a meaningful bladder recovery status classification useful in clinical settings. Methods: A single-center retrospective study was conducted (April 2012 to April 2015). Patients with CES secondary to LDH or LCS were included. The retrieved data were evaluated for variables such as demographics, symptom duration, neurological symptoms, bladder symptoms, and surgery duration. The variable bladder function outcome during discharge and at follow-up was recorded. All subjects were followed up for at least 2 years. A simplified bladder recovery classification was proposed. Statistical analyses were performed to study the correlation between patient variables and bladder function outcome. Results: Overall, 39 patients were included in the study. Majority of the subjects were males (79.8%) with an average age of 44.4 years. CES secondary to LDH was most commonly seen (89.7%). Perianal sensation (PAS) showed a significant correlation with neurological recovery. In the absence of PAS, bladder function did not recover. Voluntary anal contraction (VAC) was affected in all study subjects. Conclusions: Intactness of PAS was the only significant prognostic variable. Decreased or absent VAC was the most sensitive diagnostic marker of CES. We also proposed a simplified bladder recovery classification for recovery prognosis.