• Journal of Korean Physical Therapy Science
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• v.5 no.4
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• pp.763-775
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• 1998

Some segment or segments of the body must compensate for the heel, and the higher the heel the greater the compensation. Such compensation was once generally thought to take place in the lumbar region and therefore to increase the lumbar lordosis. The purpose of this study is to analyze changes of lumbar sagittal curvature in barefoot and 6cm 12cm high-heel stance. We selected 19 subjects(11 males, 8 females} without history of lower back pain, significant spinal abnormality. And lateral view X-ray of lumbar region from T12 to S1 was taken of each individual. On each X-ray film, lumbar lordotic angle lumbosacral angle and lumbar segmental angles were measured by Cobb method. We drew the following interpretations from the analysis of measured variables of the lumbar region. 1. In comparison of barefoot 6cm heel 12cm heel stance, lumbar lordotic angle had a tendency to decrease according as the heel height was higher. The change in lumbar lordosis measured in high-heel stance was inconsistent with clinical forkelord of hyperlordosis in wearers of high-heeled. 2. Lumbar lordotic angle from T12 to L5 showed sex difference, and was more lordotic in female(p<0.05). 3. There was no sex difference in lumbosacral angle and lumbar segmental angles(p>0.05). 4. There was a significant correlation between lumbar lordotic angle and lumbosacral angle(r>0.60).

• Journal of Korean Neurosurgical Society
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• v.37 no.5
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• pp.336-339
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• 2005

Objective: The goal of this study is to establish the anatomical criteria of the normal and stenotic lumbosacral extraforaminal tunnel, and also to determine the effect of the pathologic intervertebral disc on the size of extraforaminal tunnel in the lumbosacral spine. Methods: MRI and CT scans were reviewed and classified into two groups: (1) 40 patients with normal discs at L5- S1 (Group 1) and (2) 43 patients that had undergone successful decompression surgery for extraforaminal entrapment at the lumbosacral region(Group 2). In these two groups, the following parameters were compared are compared: the distance between the disc margin and the ala (lumbosacral tunnel) on the axial MRI, and the posterior disc height at L5-S1 on the mid-sagittal MRI. Results: In the group 1, the mean distance of the lumbosacral tunnel on the axial MRI was $10.1{\pm}2.2mm$. The mean posterior disc height at L5-S1 was $7.4{\pm}1.7mm$ on the mid-sagittal MRI. In the group 2, the mean distance between the disc margin and the ala (costal process) was $1.6{\pm}1.3mm$ on the axial MRI. The average posterior disc height was $4.4{\pm}1.5mm$ on the mid-sagittal MRI. The posterior disc height and the size of the lumbosacral tunnel between the two groups were statistically different on the paired t-test (p<0.0001). However, the posterior disc height was not positively correlated with the size of the extraforaminal tunnel for group 2 (p=0.909). Conclusion: The extraforaminal stenosis was correlated to pathologic disc. However, the posterior disc height was not correlated to the size of the of the extraforaminal tunnel.

• The Korean Journal of Pain
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• v.33 no.2
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• pp.192-198
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• 2020

Background: Previous studies have shown varying results between lumbosacral transforaminal epidural steroid injections (TFESIs) performed with particulate versus non-particulate corticosteroids. The purpose of this study was to investigate the difference in pain relief and functional improvement between particulate and nonparticulate lumbosacral TFESIs in patients who had undergone both injections, sequentially. Methods: This was a self-controlled, retrospective study of 20 patients who underwent both a methylprednisolone and a dexamethasone TFESI to the same vertebral level and side. Primary outcomes included pain relief according to the visual analogue scale (VAS) and functional improvement determined by a yes/no answer to questions regarding mobility and the activities of daily living. Post-injection data was recorded at 2, 3, and 6 months. Results: A decrease in VAS scores of -3.4 ± 3.0 (mean ± standard deviation), -3.1 ± 3.1, and -2.8 ± 3.4 was seen for the methylprednisolone group at 2, 3, and 6 months, respectively. Similar decreases of -3.9 ± 3.5, -3.4 ± 2.8, and -2.3 ± 3.4 were seen in the dexamethasone group. There was no significant difference in pain relief at any point between the two medications. The percentage of subjects who reported improved function at 2, 3, and 6 months was 65%, 51%, and 41%, respectively, for the methylprednisolone group and 75%, 53%, and 42% for the dexamethasone group. Conclusions: These findings support the use of non-particulate corticosteroids for lumbosacral TFESIs in the context of documented safety concerns with particulate corticosteroids.

• Journal of the Korean Data and Information Science Society
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• v.20 no.2
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• pp.339-348
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• 2009

This study is to examine effects of motorized flexion-distraction treatment on the pain, lumbosacral angle, lumbar lordosis angle, and lumbar 5 (L5) intervertebral disc angle in patients with chronic low back pain. We selected 30 cases of chronic low back pain, which were evenly divided into two groups: experimental group and control group. We applied the same hot pack, interferential current therapy, and ultrasound therapy to both groups. The experimental group had additional treatment of motrized flexion-distraction therapy and control group had additional of stretching exercise. For each subject, the pain, lumbosacral angle, lumbar lordosis angle, and lumbar 5 (L5) intervertebral disc angle were measured before and after treatment, While experimental groups showed significant improvements after treatment, more significant effects were found in the experimental group.

• The Korean Journal of Pain
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• v.34 no.3
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• pp.339-345
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• 2021

Background: Ultrasound-guided caudal epidural injection (CEI) is limited in that it cannot confirm drug distribution at the target site without fluoroscopy. We hypothesized that visualization of solution flow through the inter-laminar space of the lumbosacral spine using color Doppler ultrasound alone would allow for confirmation of drug distribution. Therefore, we aimed to prospectively evaluate the usefulness of this method by comparing the color Doppler image in the paramedian sagittal oblique view of the lumbosacral spine (LS-PSOV) with the distribution of the contrast medium observed during fluoroscopy. Methods: Sixty-five patients received a 10-mL CEI of solution containing contrast medium under ultrasound guidance. During injection, flow was observed in the LSPSOV using color Doppler ultrasonography, following which it was confirmed using fluoroscopy. The presence of contrast image at L5-S1 on fluoroscopy was defined as "successful CEI." We then calculated prediction accuracy for successful CEI using color Doppler ultrasonography in the LS-PSOV. We also investigated the correlation between the distribution levels measured via color Doppler and fluoroscopy. Results: Prediction accuracy with color Doppler ultrasonography was 96.9%. The sensitivity, specificity, positive predictive value, and negative predictive value were 96.7%, 100%, 100%, and 60.0%, respectively. In 52 of 65 patients (80%), the highest level at which contrast image was observed was the same for both color Doppler ultrasonography and fluoroscopy. Conclusions: Our findings demonstrate that color Doppler ultrasonography in the LS-PSOV is a new method for determining whether a drug solution reaches the lumbosacral region (i.e., the main target level) without the need for fluoroscopy.

• The Korean Journal of Pain
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• v.26 no.2
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• pp.203-206
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• 2013

There have been reports of abnormalities in the lumbosacral region involving a lower-than-normal termination of the dural sac, which is caused by disease or anatomical variation. Inadvertent dural puncture or other unexpected complications can occur during caudal epidural block or adhesiolysis in patients with these variations, but only a small number of case reports have described this issue. We report a case of dural puncture by the introducer needle before attempting caudal epidural adhesiolysis, which occurred even though the needle was not advanced upward after penetrating the sacrococcygeal ligament. Dural puncture was caused by a morphological abnormality in the lumbosacral region, with no pathological condition; the dural sac terminal was located more distally than normal. However, dural puncture could have been prevented if we had checked for such an abnormality in the magnetic resonance imaging (MRI) taken before the procedure.

• The Korean Journal of Pain
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• v.13 no.1
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• pp.111-114
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• 2000

Pain around the posterior iliac crest area is usually attributed to disorders of the lower lumbar or lumbosacral spine. However, low back pain arising from the thoracolumbar region is common and it is very similar to low back pain of lumbosacral origin. Low back pain of thoracolumbar origin is clinically distinguished from other nonspecific low back pain syndrome. It is characterized by symptoms localized at one posterior iliac crest innervated by posterior branch of $T_{12}$ spinal nerve. Patients never complain of spontaneous pain at the thoracolumbar junction. Only localized tenderness over involved segments of thoracolumbar junction can be noted. We report two cases of posterior iliac crest pain of thoracolumbar origin which was relieved by the treatment on the thoracolumbar junction.

• Journal of Korean Neurosurgical Society
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• v.58 no.4
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• pp.357-362
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• 2015

Objective : To investigate risk factors for S1 screw loosening after lumbosacral fusion, including spinopelvic parameters and paraspinal muscles. Methods : We studied with 156 patients with degenerative lumbar disease who underwent lumbosacral interbody fusion and pedicle screw fixation including the level of L5-S1 between 2005 and 2012. The patients were divided into loosening and non-loosening groups. Screw loosening was defined as a halo sign larger than 1 mm around a screw. We checked cross sectional area of paraspinal muscles, mean signal intensity of the muscles on T2 weight MRI as a degree of fatty degeneration, spinopelvic parameters, bone mineral density, number of fusion level, and the characteristic of S1 screw. Results : Twenty seven patients showed S1 screw loosening, which is 24.4% of total. The mean duration for S1 screw loosening was $7.3{\pm}4.1$ months after surgery. Statistically significant risk factors were increased age, poor BMD, 3 or more fusion levels (p<0.05). Among spinopelvic parameters, a high pelvic incidence (p<0.01), a greater difference between pelvic incidence and lumbar lordotic angle preoperatively (p<0.01) and postoperatively (p<0.05). Smaller cross-sectional area and high T2 signal intensity in both multifidus and erector spinae muscles were also significant muscular risk factors (p<0.05). Small converging angle (p<0.001) and short intraosseous length (p<0.05) of S1 screw were significant screw related risk factors (p<0.05). Conclusion : In addition to well known risk factors, spinopelvic parameters and the degeneration of paraspinal muscles also showed significant effects on the S1 screw loosening.

• The Journal of Korean Physical Therapy
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• v.13 no.1
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• pp.127-137
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• 2001

Low back pain is significant problem in today's society, with lifetime incidence rate reported between 50% and 90%. Many factors associated with LBP are reported. The purpose of this studies were to be evaluated static standing posture aberrations in chronic LBP in comparison with healthy individuals. The samples including 80 subjects recruited to the following two groups:patients and control(normal) Questionnaires were completed by 40 LBP patients and 40 controls at the department of Physical Therapy, Saejong neurosurgical clinic in Taegu city from October 1, 1999 to March 30, 2000. The angle of lumbar lordosis was measured on lateral x-ray films with standing position. In LBP groups. the mean degree of lumbar lordosis, sacral inclination, and lumbosacral joint angle were 29.9 ${\pm}$ 9.3, 34.8 ${\pm}$ 8.2, and 12.7 ${\pm}$ 5.7 respectively. Control groups, the mean degree of lumbar lordosis, sacral inclination and lumbosacral joint angle were 35.3 ${\pm}$ 7.8, 34.9 ${\pm}$ 6.4 and 12.5 ${\pm}$ 4.3 respectively. there were significantly decreaseds in lumbar lordosis in Low back pain group. lumbar lordosis on the working posture had significant differences among groups(sitting position patients 31.4 ${\pm}$ 9.3, standing position patients 29.4 ${\pm}$ 9.3, sitting position control 35.0 ${\pm}$ 6.4, standing position control 35.5 ${\pm}$ 8.8, respectively) (p=0.034). sacral inclination on the working posture had differences among groups(sitting position patients 35.9 ${\pm}$ 8.7.standing position patients 33.6 ${\pm}$ 7.6, sitting position control 33.9 ${\pm}$ 5.9. standing position control 35.6 ${\pm}$ 6.8, respectively). lumbersacral joint angle on the working Posture had differences among groups(sitting position patients 12.0 ${\pm}$ 5.6, standing position patients 13.4 ${\pm}$ 5.9, sitting position control 11.2 ${\pm}$ 3.0. standing position control 13.4$^{\circ}$, respectively).

• The Korean Journal of Pain
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• v.32 no.3
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• pp.147-159
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• 2019

Lumbar foraminal pathology causing entrapment of neurovascular contents and radicular symptoms are commonly associated with foraminal stenosis. Foraminal neuropathy can also be derived from inflammation of the neighboring lateral recess or extraforaminal spaces. Conservative and interventional therapies have been used for the treatment of foraminal inflammation, fibrotic adhesion, and pain. This update reviews the anatomy, pathophysiology, clinical presentation, diagnosis, and current treatment options of foraminal neuropathy.