• Journal of Korean Neurosurgical Society
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• v.45 no.1
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• pp.24-31
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• 2009

Objective : To investigate the effectiveness of radiographic parameters on segmental instability in the lumbar spine using Kinetic magnetic resonance imaging (MRI). Methods : Segmental motion, defined as excessive (more than 3 mm) translational motion from flexion to extension, was investigated in 309 subjects (927 segments) using Kinetic MRI. Radiographic parameters which can help indicate segmental instability include disc degeneration (DD), facet joint osteoarthritis (FJO), and ligament flavum hypertrophy (LFH). These three radiographic parameters were simultaneously evaluated, and the combinations corresponding to significant segmental instability at each level were determined. Results : The overall incidence of segmental instability was 10.5% at L3-L4, 16.5% at L4-L5, and 7.3% at L5-S1. DD and LFH at L3-L4 and FJO and LFH at L4-L5 were individually associated with segmental instability (p<0.05). At L4-L5, the following combinations had a higher incidence of segmental instability (p<0.05) when compared to other segments : (1) Grade IV DD with grade 3 FJO, (2) Grade 2 or 3 FJO with the presence of LFH, and (3) Grade IV DD with the presence of LFH. At L5-S1, the group with Grade III disc and Grade 3 FJO had a higher incidence of segmental instability than the group with Grade I or II DD and Grade 1 FJO. Conclusion : This study showed that the presences of either Grade IV DD or grade 3 FJO with LFH at L4-L5 were good indicators for segmental instability. Therefore, using these parameters simultaneously in patients with segmental instability would be useful for determining candidacy for surgical treatment.

• Journal of Korean Physical Therapy Science
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• v.16 no.3
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• pp.11-17
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• 2009

Background: The purpose of this study was designed to find out the effectiveness of reposition sense, muscle fatigue response on lumbar spine after apply lumbosacral stabilization exercise program to 4 patients with chronic low back pain and for 12 weeks. Method: In this study the reposition sense was measured in 3 angle(60, 30, 12) of the lumbar spine motion with blind by MedX test machine and the difference of instability to lumbar vertebra segments in flexion, extension test of standing position and spinal load test Mattress Test by Spinal Mouse. The stabilization exercise program was applied 2 times a week for 12 weeks in hospital and 2 times a day for 20 minutes at home. Result: The results of the present study were that the repositioning sense was appeared the most error in 12 angles of lumbar flexion and Men was appeared to decrease an error more than female in average value of 4 angles after 12 weeks. And average error of male was decrease more than female. Thus the effects of lumbosacral stabilization exercise was improved repositioning sense of prorioceptor. Fatigue response test(FRT) results, in male, was raised muscle fatigue rate during increase weight, on the other hand female appeared lower than male. Conclusion: As a results, lumbosacral stabilization exercise was aided to improvement of lumbar spine repositioning sense and vertebra segments stabilization. It was showed the rate of decrease in typically 12 degree angle point of each 3 angle(60, 36, 12). Especially, that spine instability patients will have a risk when in lifting a load or working with slight flexion posture around 12 degree during the daily of living life and it is probably to increase recurrence rate. Thus, not only lumbar extension muscle strength but also stability of vertebra segments in lumbar spine may be very important.

• Journal of Yeungnam Medical Science
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• v.19 no.2
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• pp.73-91
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• 2002

Method of management of the spine injury should be determined, based on the status of neurological injury as well as on the presence of traumatic instability. At the thoracic and lumbar spine, patterns of neurological injury are different from the cervical spine due to their neuro-anatomical characteristics. Especially, at the thoracolumbar junction, neurological injury patterns with their respective prognosis vary from the complete cord injury or conus medullaris syndrome to the cauda equina syndrome according to the injury level. The concept of Holdsworth's instability based on the posterior ligament complex theory has evolved into the current 3-column theory of Denis. Flexion-rotation injury and fracture-dislocation are well known to be unstable that surgical fixation is frequently needed for these injuries. However, there have been some controversies for the stability of burst fractures and their treatment, such as indirect or direct decompression and anterior or posterior approach. In this article, current concepts and management of traumatic instabilities at the thoracic and lumbar spine have been reviewed and summarized.

• Journal of Korean Neurosurgical Society
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• v.29 no.11
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• pp.1505-1513
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• 2000

Objectives : Many surgical procedures have been introduced to a symptomatic lumbar stenosis. Most of these procedures still have been regarded as an extensive surgical intervention with respect to normal aging process of the lumbar spine. We adopted a microsurgical decompression procedure via unilateral exposure as a minimally invasive intervention for symptomatic lumbar stenosis without instability. Materials and Methods : Fifty-seven patients with symptomatic lumbar stenosis underwent microsurgical decompression via unilateral laminotomy between March 1998 and December 1999. The conceptual modification and technical refinements were added to the previously reported microsurgical decompression procedure. Bilateral decompression through a unilateral laminotomy hole was performed in 11 patients. These patients profile also included 9 cases of degenerative spondylolisthesis(Grade I) without instability. Results : Preoperative neurogenic intermittent claudication(NIC) was more notably improved than low back pain, 60% to 82% during the follow-up period. Overall clinical results were excellent in 20(35%), good in 29(51%), fair in 6(11%) and poor in 2(3%). Conclusions : Microsurgical decompression for lumbar stenosis with stable spine provided a satisfactory symptomatic improvement without extensive destruction of the weight-bearing structures and functional mobile segments, even bilateral symptoms existed.

• Physical Therapy Rehabilitation Science
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• v.10 no.2
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• pp.90-97
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• 2021

Objective: The purpose of this study was to find out how the back instability during clam exercise (CE) causes changes in pelvic rotation and hip joint abductor muscle activity, and to find out the effects with different methods of application of pressure biofeedback. Design: Comparative study using repeated measures. Methods: Each subjects performed the clam exercise (CE) without pressure biofeedback, the clam exercise with pressure biofeedback applied to the back (CE-PBU to back), and the clam exercise with pressure biofeedback applied to the side (CE-PBU to side). The amount of pelvic rotation was measured using myomotion. And the muscle activity of the muscle gluteus medius and the tensor fasciae latae was measured using EMG device. One-way repeated measures ANOVA followed by the Bonferroni post test were used to compare the EMG activity in each muscle and pelvic rotation angle during the CE, CE-PBU to back, CE-PBU to side. Results: The amounts of pelvic rotation was the lowest in CE-PBU to back (p< 0.05) and the ratio of muscle activity of the muscle gluteus / tensor fasciae latae was the highest in CE-PBU to back (p< 0.05). Conclusions: It is thought that, in order to stabilize the waist-pelvis and increase hip joint muscle strength in subjects with back instability, applying clam exercise with pressure biofeedback applied to the lower back is effective in improving waist-pelvic movements and selectively strengthening the muscle gluteus medius.

• Journal of the Korean Society of Physical Medicine
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• v.14 no.3
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• pp.73-80
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• 2019

PURPOSE: This study examined the correlation between the visual analog scale (VAS) and the rate of change in the respiration patterns according to the result of Lumbar Instability Tests (LITs) in young people with chronic low back pain (CLBP) METHODS: Thirty-six adults, aged 20-40 years with CLBP, participated in this study. The general characteristics and VAS of the participants were recorded by the subjects themselves and seven structure and functional LITs were conducted. According to the positive response number, the positive group was divided into four groups (group 1: n=8, group 2: n=9, group 3: n=10, group 4: n=9). The breathing pattern change tests were performed in three states: during forced breathing exercise and motor control tests. A total of 13 positive lists were set, each of which was scored by 1 or 2 points according to the severity. After the positive lists were scored, the breathing pattern changing rate (BPCR) and VAS were compared according to the positive response number of LITs, and the correlation between them was analyzed. RESULTS: A strong correlation was observed between the number of positive of LITs and BPCR (r= .863, p= .000) and a moderate correlation between the positive number of LITs and VAS (r= .508, p= .002). In addition, there was a poor correlation between the BPCR and VAS (r= .434, p= .008). CONCLUSION: In young CLBP people, when the structural and functional instability are both present, the changes in the respiratory pattern of the whole body can be varied and broader, and the pain scale also increases.

• Journal of Korea Entertainment Industry Association
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• v.14 no.8
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• pp.245-253
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• 2020

This study has conducted to investigate the changes in the mobility of the three thoraco-abdominal lines(TAMs) during breathing and in the thoracic and lumbar spine mobility(TSM, LSM) during trunk forward flexion, after breathing pattern correction. The 30 subjects with lumbar instability(LI) have divided into the breathing pattern correction exercise(BPC) group of 15 subjects and the lumbar stabilization exercise(LSE) group of 15 subjects and performed each exercise for 40 minutes at one session, and a total of 18 sessions were applied for 6 weeks. As a result, The BPC group during breathing showed a significant increase in all TAMs(p<.001) and in the TSM(p<.001) than the LSE group. Besides, had a more decrease in the LSM than the LSE group(p<.001). The BPC showed high positive correlations with TAMs(rest: r=.868, forced: r=.870) and the TSM(r=.672) and had a negative correlation with the LSM(r=-.420). Based on this result of the study, the authors believe that the BPC in LI people could decrease the lumbar flexion mobility when they have motion of trunk forward flexion with promotions in the thoracic spine and rib joint mobility by improvements in relative mobility of thoraco-abdominal lines.

• Journal of Korean Neurosurgical Society
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• v.54 no.4
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• pp.366-369
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• 2013

Lumbar microdiscectomy (MD) is the gold standard for treatment of lumbar disc herniation. Generally, the surgeon attempts to protect the facet joint in hopes of avoiding postoperative pain/instability and secondary degenerative arthropathy. We believe that preserving the facet joint is especially important in young patients, owing to their life expectancy and activity. However, preserving the facet joint is not easy during lumbar MD. We propose several technical tips (superolateral extension of conventional laminotomy, oblique drilling for laminotomy, and additional foraminotomy) for facet joint preservation during lumbar MD.

• Journal of Korean Neurosurgical Society
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• v.57 no.2
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• pp.100-107
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• 2015

Objective : To report a minimally invasive treatment option using percutaneous pedicle screw fixation with adjuvant treatment for metastatic thoraco-lumbar and lumbar spinal tumors. Methods : This is a retrospective study of charts of patients with spinal metastases. All were older than 18 years of age and were considered to have more than 3 months of life expectancy. The patients had single or two level lesions, and compression fracture or impending fracture. Exclusion criterion was metastasis showing severe epidural compression with definite neurological symptoms. Usually spinal segments from one level above to below pathology were stabilized. Visual analog scale (VAS) score for pain assessment and Frankel scale for neurological deficit were used, while pre- and post-operative performance status was evaluated using the Eastern Cooperative Oncology Group (ECOG). Results : Twelve patients (nine men, three women; median age 54.29 years) underwent surgery. All patients presented with back pain with/without radicular pain. There were no early complications and perioperative mortalities. Following surgery, a significant difference between average pre- and post-operative VAS scores was found (p=0.003). Overall, 91.8% of patients (11/12) experienced improvement in their ECOG score post-operatively. The mean ambulation time was 196.9 days [95% confidence interval (CI), 86.2-307.6 days; median, 97 days]. During follow-up, nine patients died and the mean overall survival time in enrolled twelve patients was 249.9 days (95% CI, 145.3-354.4 days; median, 176 days). Conclusion : Minimally invasive treatment using percutaneous pedicle screw fixation with adjuvant treatment is a good alternative treatment option for potential instability of the thoraco-lumbar and lumbar spinal metastasis.

• Journal of Korean Neurosurgical Society
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• v.30 no.sup2
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• pp.235-241
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• 2001

Objective : Controversy exists which surgical treatment better in lumbar grade I spondylolisthesis, decompressive laminectomy with or without lumbar instrumentation. Methods : Out of Sixty-four patients with lumbar spondylolisthesis underwent surgery, 18 patients operated with decompressive laminectomy alone and 44 patients with decompession and lumbar instrument, during recent 5-years between January, 1994 and December, 1998. The author studied a long term follow-up in the above two groups to analyzing the overall clinical outcomes in each group and to determining the incidence of pos-toperative radiologic instability. Results : 1) Overall postoperative symptoms improvement were not so different in both groups. 2) Postoperative progressive subluxation is more common after decompressive laminectomy without instrumentation than with instrumentation group. 3) Overall clinical outcomes were slightly better in decompressive laminectomy without instrumentation than with instrumentation group but there was no significant difference. 4) Postoperative radiologic changes did not seem to influence the patient-reported clinical outcomes. 5) Postoperative complications is more common in decompressive laminectomy with instrumentation group than without instrumentation group. Conclusion : In the surgical management of grade I spondylolisthesis, the efficiency and superiority of surgical treatments requires the cost effectiveness and risk/benefit analysis of decompressive laminectomy with or without instrumentation. Therefore, Further detailed studies of long term follow up in a large number of patients in each group are needed for choice of best treatment.