• The Korean Journal of Pain
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• v.18 no.1
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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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• v.63 no.6
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• pp.730-737
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• 2020

Objective : Spinal degeneration is a progressive disease, worsening over time. Lumbar degenerative disease (LDD) is a major spinal disease in elderly patients. Surgical treatment is considered for medically intractable patients with LDD and reoperation after primary surgery is not uncommon. The surgical outcome is occasionally unpredictable because of comorbidities. In the present study, the relationship between comorbidities and the incidence of reoperation for LDD over time was determined. Methods : The claims data of the health insurance national database were used to identify a cohort of patients who underwent spinal surgery for LDD in 2009. The patients were followed up until 2016. Medical comorbidity was assessed according to the Charlson comorbidity index (CCI). Cox proportional hazard regression modeling was used to identify significant differences in sex, surgery, age, causative disease, and comorbidity. Results : The study cohort included 78241 patients; 10328 patients (13.2%) underwent reoperation during the observation period. The reoperation rate was statistically higher (p<0.01) in males, patients 55-74 years and 65-74 years of age, and patients with decompression or discectomy. Significant association was found between increasing reoperation rate and CCI score (p<0.01). Based on multivariate analysis of comorbidities, the significantly higher reoperation rates were observed in patients with peripheral vascular disease, pulmonary lung disease, peptic ulcer, diabetes, and diabetes complications (p<0.01). Conclusion : The study results indicate the reoperation rate for LDD is associated with patient comorbidities. The comorbidities identified in this study could be helpful in future LDD studies.

• Journal of Korean Neurosurgical Society
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• v.38 no.3
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• pp.206-210
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• 2005

Objective : Our aim is to evaluate the early changes of biologic markers such as white blood cell[WBC] count, erythrocyte sedimentation rate[ESR] and C-reactive protein[CRP] in early diagnosis of postoperative infection and to differentiate infection from inflammatory reaction in lumbar spine surgery. Methods : We reviewed 330patients who had undergone spinal operations between May 1999 and October 2001. For this study, the patients were classified into two groups, which include a group that underwent spinal decompressive surgery without instrumentation[SD], and the other group that underwent fusion surgery with spinal instrumentation[SI]. And each group was also subdivided into two groups respectively, one with infection and the other without infection. We retrospectively analyzed the WBC count, ESR and CRP preoperatively and postoperatively, according to their operation type and postoperative infection history. Results : Inflammatory indices were physiologically affected by instrumentation itself. But ESR and CRP elevations were more prolonged and sustained under infection. In SD patients without infection, ESR and CRP were stabilized 5 days after surgery. In SI patients without infection, CRP was stabilized about 7days after surgery, but ESR showed sustained and variously elevated. In both SD and SI groups, the stabilization of CRP was the most reliable behavior of surgery without infection. Conclusion : C-reactive protein is most sensitive parameter for postoperative spine infection. The knowledge of the inflammatory indices and their relatively uniform patterns with or without infection offers surgeons the ability to infer the state of surgical wound.

• Journal of Korean Neurosurgical Society
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• v.58 no.5
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• pp.479-482
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• 2015

We report a case of a 31-year-old woman with glioblastoma multiforme (GBM) in the pineal region with associated leptomeningeal dissemination and lumbar metastasis. The patient presented with severe headache and vomiting. Magnetic resonance imaging (MRI) of the brain showed a heterogeneously enhanced tumor in the pineal region with obstructive hydrocephalus. After an urgent ventricular-peritoneal shunt, she was treated by subtotal resection and chemotherapy concomitant with radiotherapy. Two months after surgery, MRI showed no changes in the residual tumor but leptomeningeal dissemination surrounding the brainstem. One month later, she exhibited severe lumbago and bilateral leg pain. Thoracico-lumbar MRI showed drop like metastasis in the lumbar region. Finally she died five months after the initial diagnosis. Neurosurgeons should pay attention to GBM in the pineal region, not only as an important differential diagnosis among the pineal tumors, but due to the aggressive features of leptomeningeal dissemination and spinal metastasis.

• The Korean Journal of Pain
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• v.34 no.1
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• pp.47-57
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• 2021

Background: Lumbar disc herniation (LDH) is a common cause of radicular pain, but the mechanism is not clear. In this study, we investigated the engagement of toll-like receptor 4 (TLR4) and the nuclear factor-kappa B (NF-κB) in radicular pain and its possible mechanisms. Methods: An LDH model was induced by autologous nucleus pulposus (NP) implantation, which was obtained from coccygeal vertebra, then relocated in the lumbar 4/5 spinal nerve roots of rats. Mechanical and thermal pain behaviors were assessed by using von Frey filaments and hotplate test respectively. The protein level of TLR4 and phosphorylated-p65 (p-p65) was evaluated by western blotting analysis and immunofluorescence staining. Spinal microglia activation was evaluated by immunofluorescence staining of specific relevant markers. The expression of proand anti-inflammatory cytokines in the spinal dorsal horn was measured by enzyme linked immunosorbent assay. Results: Spinal expression of TLR4 and p-NF-κB (p-p65) was significantly increased after NP implantation, lasting up to 14 days. TLR4 was mainly expressed in spinal microglia, but not astrocytes or neurons. TLR4 antagonist TAK242 decreased spinal expression of p-p65. TAK242 or NF-κB inhibitor pyrrolidinedithiocarbamic acid alleviated mechanical and thermal pain behaviors, inhibited spinal microglia activation, moderated spinal inflammatory response manifested by decreasing interleukin (IL)-1β, IL-6, tumor necrosis factor-α expression and increasing IL-10 expression in the spinal dorsal horn. Conclusions: The study revealed that TLR4/NF-κB pathway participated in radicular pain by encouraging spinal microglia activation and inflammatory response.

• Journal of Korean Neurosurgical Society
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• v.61 no.2
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• pp.167-179
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• 2018

The prevalence of patients with adult spinal deformity (ASD) has been reported as high as 68%. ASD often leads to significant pain and disability. Recent emphasis has been placed on sagittal plane balance and restoring normal sagittal alignment with regards to the three dimensional deformity of ASD. Optimal sagittal alignment has been known to increase spinal biomechanical efficiency, reduce energy expenditure by maintaining a stable posture with improved load absorption, influence better bony union, and help to decelerate adjacent segment deterioration. Increasingly positive sagittal imbalance has been shown to correlate with poor functional outcome and poor self-image along with poor psychological function. Compensatory mechanisms attempt to maintain sagittal balance through pelvic rotation, alterations in lumbar lordosis as well as knee and ankle flexion at the cost of increased energy expenditure. Restoring normal spinopelvic alignment is paramount to the treatment of complex spinal deformity with sagittal imbalance. Posterior osteotomies including posterior column osteotomies, pedicle subtraction osteotomies, and posterior vertebral column resection, as well anterior column support are well known to improve sagittal alignment. Understanding of whole spinal alignment and dynamics of spinopelvic alignment is essential to restore sagittal balance while minimizing the risk of developing sagittal decompensation after surgical intervention.

• Journal of Korean Medicine Rehabilitation
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• v.29 no.4
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• pp.89-100
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• 2019

Objectives We are going to analyze patient's medical and Korean medicine use trends after lumbar surgery, and examine the percentage of use of Korean medicine after surgery and its relevance to the medical care outcome after lumbar surgery. Methods Using 3% patients' sample data of the Health Insurance Review and Assessment Service, two groups were compared the treatment progress of the Korean Medicine treatment group and the untreated group after lumbar surgery by hierarchical logistic regression analysis. After hierarchical logistic regression analysis(including propensity scores), two groups were compared after lumbar surgery, the Korean Medicine treatment group within 50days and untreated group within 50days. Results Lumbar surgery was performed in 2750 patients in 2015. It was 3.72 that the risk(odds ratio) of finished treatment of patients treated without Korean Medicine, compared to patients with Korean Medicine. It was 0.12 that the risk of continuing treatment(odds ratio) of patients treated with Korean Medicine within 50 days, compared to patients treatment more than 50 days. Conclusions The ratio of Korean Medicine treatment after lumbar surgery was 14.8%. The group that did not have Korean Medicine showed a higher possibility of treatment termination than the group who did not. Among the groups treated with Korean Medicine, the early treatment group was more likely to end treatment than the late treatment group. Considering various situations in the medical environment, further studies such as prospective studies and long-term data analysis are considered to be necessary.

• Journal of Korean Neurosurgical Society
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• v.51 no.1
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• pp.20-23
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• 2012

Objective : To compare radiographic analysis on the sagittal lumbar curve when standing, sitting on a chair, and sitting on the floor. Methods : Thirty asymptomatic volunteers without a history of spinal pathology were recruited. The study population comprised 11 women and 19 men with a mean age of 29.8 years. An independent observer assessed whole lumbar lordosis (WL) and segmental lordosis (SL) between L1 and S1 using the Cobb's angle on lateral radiographs of the lumbar spine obtained from normal individuals when standing, sitting on a chair, and sitting on the floor. WL and SL at each segment were compared for each position. Results : WL when sitting on the floor was reduced by 72.9% than the average of that in the standing position. Of the total decrease in WL, 78% occurred between L4 to S1. There were significant decreases in SL at all lumbar spinal levels, except L1-2, when sitting on the floor as compared to when standing and sitting on a chair. Changes in WL between the positions when sitting on a chair and when sitting on the floor were mostly contributed by the loss of SL at the L4-5 and L5-S1 levels. Conclusion : When sitting on the floor, WL is relatively low; this is mostly because of decreasing lordosis at the L4-5 and L5-S1 levels. In the case of lower lumbar fusion, hyperflexion is expected at the adjacent segment when sitting on the floor. To avoid this, sitting with a lordotic lumbar curve is important. Surgeons should remember to create sufficient lordosis when performing lower lumbar fusion surgery in patients with an oriental life style.

• Journal of Korean Neurosurgical Society
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• v.42 no.3
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• pp.195-199
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• 2007

Objective : Bilateral laminotomy and unilateral laminotomy for bilateral decompression are becoming the minimally invasive procedures for lumbar spinal stenosis (LSS). With the aim of less invasiveness and better preservation of spinal stability. these techniques have been developed. But there are no large randomized studies to show the surgical results between these two techniques. The objective of this study was to examine the safety and efficacy of these two minimally invasive techniques. Methods : A total of 80 patients were included in this study (Group I : bilateral laminotomy, Group II : Unilateral laminotomy for bilateral decompression). Perioperative parameters and complications were analyzed. Symptoms and scores such as visual analog scale (VAS) scores, Oswestry Disability Index (ODI) scores, and SF-36 scores of prospectively accrued patients were assessed preoperatively and at 1 month and 12 months after surgery. Paired-t test, two-sample student-t tests, and non parametric tests were used to determine cross-sectional differences between two groups. Results : No major complications such as spinal instability or deaths occurred during follow-up periods. VAS, ODI scores and SF-36 body pain and physical function scores showed statistically significant improvements in both groups (p<0.001). The significant widening of the spinal canal diameter was also noted in both groups. But, in Group II. there were minor postoperative complications such as dural tear (2 cases 5.0%), fracture of ipsilateral inferior facet (1 case 2.5%), and 5 cases of transient leg symptoms of contralateral side. Conclusion : Both bilateral laminotomy and unilateral laminotomy for bilateral decompression allow achievement of adequate and long-lasting operative results in patients with LSS. But postoperative complications are more frequent in Group II (unilateral laminotomy and bilateral decompression). These results indicate that bilateral laminotomy is the preferred minimally invasive technique to treat symptomatic LSS.

• The Journal of the Korean bone and joint tumor society
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• v.17 no.2
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• pp.106-110
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• 2011

In the patient who has intradural mass associated with spinal stenosis, if the operation for spinal stenosis is performed alone, the symptom may remain. We report with literature review that we achieved the successful outcome after simultaneous decompression of spinal stenosis and space occupying mass removal in the case of intradural and extradural compression. A 71-year-old female patient suffering from low back pain and radiating pain of both lower extremities admitted. In magnetic resonance imaging, spinal stenosis on L4-5 and spondylolisthesis on L5-S1 compressed dural sac and intradural space occupying mass on L4 level compressed. By posterior approach, decompression and interbody fusion were carried out. Then mass was removed with median durotomy. Pathologic diagnosis was schwannoma and the symptom was improved remarkably.