• Composites Research
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• 제25권4호
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• pp.98-104
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• 2012

본 논문에서는 척추체 간 유합용 케이지의 응력방패현상을 감소시키기 위하여 강성 차이에 대한 연구를 수행하였다. 최근 의료 임플란트 분야에서는 탄소섬유강화 폴리머를 이용하여 좋은 결과를 보여 왔다. 그러나 생체 역학적으로 이 재료에 대하여 요추체의 안정성과 골 이식재가 받는 응력에 관련한 연구는 없었다. 따라서 이전에 유효화한 요추체 (L2-L5) 비선형 유한 요소 모델을 이용하여 L4-L5 분절의 케이지의 강성 차이에 따른 효과를 알아보기 위하여 탄소섬유강화 폴리머와 티타늄 케이지를 이용한 후방 요추체 유합 모델을 만들었다. 자가골 보다 강성이 작은 탄소 섬유강화폴리머 케이지는 인접 분절의 하종판에 응력이 적게 걸리며, 골 이식재에 응력은 증가시켰다. 위의 결과로 탄소섬유강화 폴리머 케이지는 응력 방패 현상을 감소시킬 수 있을 뿐만 아니라 골 유합률을 증가시킬 수 있다.

• Journal of Korean Neurosurgical Society
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• 제67권3호
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• pp.354-363
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• 2024

Objective : This study aims to determine the optimal dose of recombinant-human bone morphogenic protein-2 (rhBMP-2) for successful bone fusion in minimally invasive lateral lumbar interbody fusion (MIS LLIF). Previous studies show that rhBMP is an effective alternative to autologous iliac crest bone graft, but the optimal dose remains uncertain. The study analyzes the fusion rates associated with different rhBMP doses to provide a recommendation for the optimal dose in MIS LLIF. Methods : Ninety-three patients underwent MIS LLIF using demineralized bone matrix (DBM) or a mixture of rhBMP-2 and DBM as fusion material. The group was divided into the following three groups according to the rhBMP-2 usage : group A, only DBM was used (n=27); group B, 1 mg of rhBMP-2 per 5 mL of DBM paste (n=41); and group C, 2 mg of rhBMP-2 per 5 mL of DBM paste (n=25). Demographic data, clinical outcomes, postoperative complication and fusion were assessed. Results : At 12 months post-surgery, the overall fusion rate was 92.3% according to Bridwell fusion grading system. Groups B and C, who received rhBMP-2, had significantly higher fusion rates than group A, who received only DBM. However, there was no significant increase in fusion rate when the rhBMP-2 dosage was increased from group B to group C. The groups B and C showed significant improvement in back pain and Oswestry disability index compared to the group A. The incidence of screw loosening was decreased in groups B and C, but there was no significant difference in the occurrence of other complications. Conclusion : Usage of rhBMP-2 in LLIF surgery leads to early and increased final fusion rates, which can result in faster pain relief and return to daily activities for patients. The benefits of using rhBMP-2 were not significantly different between the groups that received 1 mg/5 mL and 2 mg/5 mL of rhBMP-2. Therefore, it is recommended to use 1 mg of rhBMP-2 with 5 mL of DBM, taking both economic and clinical aspects into consideration.

• Journal of Korean Neurosurgical Society
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• 제29권7호
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• pp.935-939
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• 2000

Objective : Traumatic disc lesion is a lesion with tremendous controversies. The causal relationships of this lesion are not established along with pathogenesis, diagnostic criteria, methods of treatment and the outcome. However, a significant number of patients with back pain after a trauma underwent spinal operations under the diagnosis of traumatic disc lesions. Such an ill-directed operation eventually produce a person with an iatrogenic disability. We present two illustrative cases, and tried to make a preventive method. Methods : We examined the path from mild trauma after a road traffic accident into the iatrogenic disability in two illustrative cases, who requested disability assessment and medical appraisement. We evaluated the reason and background for such an unwanted outcome and tried to find a method to reduce or prevent it by a literature review. Results : These two patients were admitted to the hospital with the diagnosis of lumbar sprain after a road traffic accidents. They eventually underwent spinal surgery under another diagnosis such as traumatic disc herniation or internal disc disruption. They stayed at the hospital for more than six months and finally lost their jobs. They became the disabled at last. Although they complained back pain, they never insisted by themselves that their symptoms were due to the traumatic disc lesion. To prevent such an iatrogenic disability, the doctors should assist them to go-back to the workplace promptly instead of a reckless extension of the treatment period. It may be necessary to evaluate the certificates to extend the treatment period with an additional diagnosis by a medical expert. To reduce the unnecessary long-term admission, a new billing system such as a partial share for the high cost of the treatment by the patients may be needed. Conclusion : It is not the patient but the doctors, who has the responsibility to avoid the unnecessary operations. All treating doctors should try to reduce or prevent such an iatrogenic complication caused by ourselves before we are forced to do so.

• 대한정형외과학회지
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• 제55권5호
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• pp.411-417
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• 2020

목적: 양방향 내시경적 감압술(unilateral biportal endoscopic decompression, UBE)의 유용성을 증명하기 위해 수술의 임상적, 영상학적 결과를 보고하고자 한다. 대상 및 방법: 요추 추간공 협착증으로 일측성 양방향 내시경적 측부 추간공 감압술(unilateral biportal endoscopic far-lateral decompression, UBEFLD)을 시행받은 20명의 환자들을 분석하였다. 임상적으로 시각통증척도(visual analogue scale, VAS), modified Macnab criteria, Oswestry Disability Index (ODI), 영상학적으로 수술 전후 단순영상을 비교하여 intervertebral angle (IVA), percentage slip, disc height index (DHI), foraminal height index (FHI)를 분석하였다. 결과: VAS는 평균적으로 술 전 6.20에서 술 후 1개월 2.05, 3개월 1.75, 1년 1.45로 호전을 보였다(p<0.001). Modified Macnab criteria는 술 후 1개월 70.0%, 3개월 80.0%, 1년 85.0%의 환자들에서 good 혹은 excellent 판정을 받았다(p=0.034). ODI는 술 전 59.8%, 1개월 35.8%, 3개월 33.2%, 1년 17.1%로 호전을 보였다(p<0.001). IVA는 술 후 평균 0.40도 증가(p=0.057), percentage slip은 술 후 0.19% 증가하였다(p=0.134). DHI는 술 전 0.49에서 술 후 0.62로 증가(p=0.359), FHI 또한 술 전 0.71에서 술 후 0.79로 증가하였다(p<0.001). 결론: UBEFLD는 임상학적 및 영상학적으로 모두 만족스러운 결과를 보였으며 종래의 척추 유합술이나 현미경 추간공 성형술의 훌륭한 대체가 될 수 있음을 의미한다.

• The Korean Journal of Pain
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• 제14권1호
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• pp.7-11
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• 2001

Background: Although several mechanisms of causalgia, which results from a partial injury to the peripheral nerve trunk, have been proposed, whether or not antidromic impulses from the injured neurons contribute to the development of the mechanical hyperalgesia has not been studied. The purpose of this experiment is was to investigate the role of antidromic impulses to the peripheral sensory receptor site on the development of mechanical hyperalgesia in a rat model of peripheral neuropathy. Methods: Rats were prepared with tight ligation of by tightly ligating the left fifth and sixth lumbar spinal nerves. The effect of bupivacaine pretreatment on the development of mechanical hyperalgesia was evaluated by injecting 0.5% bupivacaine (0.3 ml) into the plantar surface of the left hind paw before the skin incision was made. For the control group, normal saline (0.3 ml) was injected instead of bupivacaine. To measure the mechanical hyperalgesia, paw withdrawal thresholds were measured using a series of von Frey hairs. Mechanical hyperalgesia was measured a the day before, and 1, 2, 3, 4, 7, and 14 days after the surgery. Results: The control group showed decreased withdrawal thresholds from the day after the surgery (the values were $14.0{\pm}0.5$, $8.9{\pm}1.3$, $8.4{\pm}1.6$, $6.9{\pm}1.2$, $8.8{\pm}1.5$, $10.5{\pm}1.3$, and $8.6{\pm}1.3$ g; at -1, 1, 2, 3, 4, 7, and 14 days after the surgery, respectively). However, withdrawal thresholds of the bupivacaine-pretreated group showed increased withdrawal thresholds for three days after the surgery ($14.5{\pm}0.3$, $12.6{\pm}1.4$, $12.7{\pm}1.1$, $10.5{\pm}1.3$ g; at 1, 1, 2, 3 days after the surgery). Conclusions: Our result suggests that antidromic impulses to the peripheral sensory receptors are at least partly responsible for the initial development of mechanical hyperalgesia in a rat model of peripheral neuropathy.

• Journal of Yeungnam Medical Science
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• 제15권1호
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• pp.75-96
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• 1998

복강내장을 지배하는 감각신경세포체 및 신경섬유의 표지부위를 관찰하기 위하여 복강내장을 부위별(위, 십이지장, 공장, 회장, 맹장, 오름결장, 내림결장)로 나누어 2.5% WGA-HRP $30{\mu}l$와 0.5% CTB $20{\mu}l$를 장막과 근육층 사이의 4부위에 나누어 주입하였다. 그 후 48-96시간의 생존시간이 경과한 후 뇌줄기, 척수신경절과 미주신경절에서의 감각신경섬유와 신경세포체의 표지부위를 면역조직화학 염색법과 HRP 조직화학 기법으로 관찰한 결과는 다음과 같다. 1. WGA-HRP에 표지된 감각신경섬유는 위와 맹장에서만 관찰되었으며, CTB에 표지된 감각신경섬유는 복강내장의 모든 장기에서 관찰되었다. 2. 복강내장을 지배하는 감각신경섬유는 뇌줄기내 좌우 고립로핵의 교질부, 교질부의 등쪽내측부, 교차연결부, 내측부, 넷째뇌실벽, 맨아래구역의 앞쪽경계 및 중심관의 등쪽 정중선인 교차연결부에 국소적으로 강하게 표지되었다. 3. 척수신경절에서 위 (stomach)에 분포하는 감각신경세포체는 좌우 관계없이 $T_2$에서 $L_1$까지 여러 신경절에 표지되었으며 이 중 좌우 $T_{8-9}$부위에 가장 많이 표지되었다. 4. 십이지장에서의 척수신경절에 표지된 감각 신경세포체는 좌우 $T_6-L_2$부위에 표지되었으나 다른 장기에 비하여 표지된 감각신경세포체의 수는 적었다. 5. 공장에서의 척수신경절에 표지된 감각신경세포체는 좌우 $T_6-L_2$부위에 표지되었다. 가장 많이 표지된 부위는 좌측 $T_{12}$ 부위였으며, 우측은 $T_{13}$ 부위에 표지되었다. 6. 회장에서의 척수신경절에 표지된 감각신경세포체는 좌우 $T_6-L_2$부위였다. 가장 많이 표지된 부위는 좌측에서 $T_{11}$부위였고, 우측에서 $L_1$부위였다. 7. 맹장에서의 척수신경절에 표지된 감각신경 세포체는 좌측은 $T_7-L_2$부위였으며 우측은 $T_6-L_1$부위였다. 가장 많이 표지된 부위는 좌측은 $T_{11}$이었으며, 우측은 $T_{11-12}$에 표지되었다. 8. 오름결장에서 척수신경절에 표지된 감각신경세포체는 좌측은 $T_7-L_2$부위에 표지되었고 우측은 $T_9-L_4$부위에 표지되어 좌우측 표지부위의 차이를 보였다. 가장 많이 표지된 부위는 좌측은 $T_9$이었으며, 우측은 $T_{11}$에 표지되었다. 9. 내림결장에서 척수신경절에 표지된 감각신경 세포체는 좌측은 $T_9-L_2$부위에 표지되었고 우측은 $T_6-L_2$부위에 표지되었다. 가장 많이 표지된 부위는 좌측은 $T_{13}$이었으며, 우측은 $L_1$에 표지되었다. 10. 복강내장을 지배하는 좌우 미주신경절에 표지된 감각신경세포체는 위에서 가장 많이 표지되었으며 위를 제외한 나머지 장기에서는 표지된 감각신경세포체의 수는 위에 표지된 수보다 적었다. 이상의 결과로 흰쥐의 복강내장을 지배하는 감각신경섬유의 뇌줄기내 표지영역은 좌우 고립로 핵의 교질부, 교질부의 등쪽내측부, 교차연결부, 내측부, 넷째뇌실벽, 맨아래구역의 앞쪽경계 및 중심관의 등쪽 정중선인 교차연결부였으며, 감각신경세포체의 표지영역은 미주신경절과 척수신경절 $T_2-L_4$ 부위였음을 알 수 있었다. 위를 제외한 나머지 장기들에서는 $T_6-L_4$부위에 표지되었으나 소장에서 대장으로 갈수록 가장 많이 표지된 부위는 원위부 가슴신경절에서 근위부 허리신경절쪽으로 이동하는 경향을 보였다.

• 대한물리치료과학회지
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• 제14권1_4호
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• pp.11-23
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• 2007

This study was performed to evaluate the effects of low-intensity ultrasound application to the peripheral nerve injury animal model on enhancement of nerve regeneration and functional recovery. Using aseptic microsurgical techniques, the sciatic nerve of adult male Sprague-Dawley rats was crushed at the outside of right mid-thigh for 30 seconds with fine forceps. Beginning just after surgery, various continuous-wave ultrasound treatments with intensities of 0.2 W/$cm^2$, 0.5 W /$cm^2$ and 1.0 W /$cm^2$ operated at 1 MHz or sham treatment were applied to the opposite inside of the crush site for 1 minute every other day with a transducer moving speed of 2cm/sec. For evaluation of the progress of sciatic nerve regeneration, c-Fos expression in the lumbar spinal cord (L4-5) dorsal horn was investigated. c-fos expression was markedly increased at 1hour after sciatic nerve crush injury, then gradually decreased thereafter. The c-fos expressions were significantly decreased (p<0.05) in all the experimental groups in comparison with the control group until 3days post-crush, and the degrees of decrease were higher in 0.5 W/$cm^2$ and 1 W/$cm^2$ intensity ultrasound application groups. It is suggested that low-intensity ultrasound application to an animal model of sciatic crush injury may suppress pain transmission and promote nerve regeneration, and which may result in delayed progress of muscle atrophy and accelerated progress of muscle recovery and eventually may result in accelerated and improved foot function recovery.

• Journal of Acupuncture Research
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• 제27권4호
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• pp.9-18
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• 2010

Objectives : This study will broaden understanding of acupotomy therapy through comparison of side effects and complication which can be caused by the mechanism of treatment, surgical methods, and procedure by acupotomy therapy and epidural neuroplasty. Moreover, through an in-depth analysis of headache affected by two procedures, this research is supposed to find prospective cures for headache after acupotomy therapy. Methods : To compare acupotomy therapy with epidural neuroplasty this research was done using a comparative analysis eight theses about acupotomy therapy since 1995, as well as eleven theses about epidural neuroplasty since 2000. Other theses and data were used as references in the process of comparative analysis. Results : Acupotomy therapy and epidural neuroplasty, new treatments of damaged discs in the spine and stenosis made in 1990s, have the mechanism of treatment in common in that adhesion, a node or scar caused by the soft tissue damage is removed by putting catheter or acupuncture into the lesions. Epidural neuroplasty has additional injection into the lesions, which is different from acupotomy therapy in the process of surgical procedure. There are various reports of positive effects about curative effect in these two treatments. The two procedures may cause various complications. Headache may be a complication after surgery. The headache after acupotomy therapy is characterized as being an ache in the body, which is similar to that of post-dural puncture headache in the outbreaks and symptom. Headache after percutaneous epidural neuroplasty appears in general, which is similar to a headache as a result of the increased pressure of the brain spinal cord regardless of posture. Conclusions : Although they are alike in the mechanism of treatment, surgical methods and side effects, and complication after they are carried out as a result of analyzing theses related to acupotomy therapy and percutaneous epidural neuroplasty, there is a difference in aspects and mechanism of headaches experienced after the procedure.

• The Korean Journal of Pain
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• 제21권3호
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• pp.173-178
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• 2008

Background: The intrathecal (IT) $GABA_A$ receptor antagonist, bicuculline (BIC), results in tactile allodynia (TA) through disinhibition in the spinal cord. Such disinhibition is considered to be an important mechanism for neuropathic pain. Agmatine, an endogenous polyamine, has a neuro-protective effect in the central nervous system. We investigated the analgesic effects and mechanisms of agmatine action on BIC-induced TA. Methods: Male Sprague-Dawley rats, weighting 250-300 g, were subjected to implantations of PE-10 into the lumbar subarachnoid space for IT drug injection. Five days after surgery, either $10{\mu}l$ of normal saline (NS) or agmatine ($30{\mu}g$ or $10{\mu}g$) in $10{\mu}l$ NS were injected 10 min prior to BIC ($10{\mu}g$) or NMDA ($5{\mu}g$). We assessed the degree of TA (graded 0: no response, 1: mild response, 2: moderate response, 3: strong response) every 5 min for 30 min. Areas under curves and degree of TA were expressed as mean ${\pm}$ SEM. Results were analyzed using one-way ANOVA followed by a Tukey test for multiple comparisons. P < 0.05 was considered significant. Results: IT BIC-induced strong TA reached its peak and plateaued between 10 to 15 min. IT NS-NMDA induced mild transient TA for up to 15 min. Preemptive IT AG attenuated IT BIC-induced TA dose dependently and preemptive IT AG10 completely abolished the IT NMDA-induced TA. Conclusions: Preemptive IT AG attenuated the IT BIC-induced TA through inhibitory actions on postsynaptic NMDA receptor activation. AG might be a viable therapeutic option in the treatment of neuropathic pain.

• Journal of Korean Neurosurgical Society
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• 제55권6호
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• pp.370-374
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• 2014

To present a case of cauda equina syndrome (CES) caused by chronic inflammatory demyelinating polyneuropathy (CIDP) which seemed clinically similar to Charcot-Marie-Tooth disease type1 (CMT1). CIDP is an immune-mediated polyneuropathy, either progressive or relapsing-remitting. It is a non-hereditary disorder characterized by symmetrical motor and sensory deficits. Rarely, spinal nerve roots can be involved, leading to CES by hypertrophic cauda equina. A 34-year-old man presented with low back pain, radicular pain, bilateral lower-extremity weakness, urinary incontinence, and constipation. He had had musculoskeletal deformities, such as hammertoes and pes cavus, since age 10. Lumbar spine magnetic resonance imaging showed diffuse thickening of the cauda equina. Electrophysiological testing showed increased distal latency, conduction blocks, temporal dispersion, and severe nerve conduction velocity slowing (3 m/s). We were not able to find genetic mutations at the PMP 22, MPZ, PRX, and EGR2 genes. The pathologic findings of the sural nerve biopsy revealed thinly myelinated nerve fibers with Schwann cells proliferation. We performed a decompressive laminectomy, intravenous IgG (IV-IgG) and oral steroid. At 1 week after surgery, most of his symptoms showed marked improvements except foot deformities. There was no relapse or aggravation of disease for 3 years. We diagnosed the case as an early-onset CIDP with cauda equine syndrome, whose initial clinical findings were similar to those of CMT1, and successfully managed with decompressive laminectomy, IV-IgG and oral steroid.