• Journal of Korean Neurosurgical Society
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• 제50권1호
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• pp.54-56
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• 2011

Ankylosing spondylitis (AS) is frequently associated with inflammatory lesions of the spine and continuous fatigue stress fractures; however, an association with an intraspinal synovial cyst has not been previously reported. A 55-year-old man with a five year history of AS who presented with back pain and a right radiculopathy was admitted to the hospital. Five years previously, he underwent a percutaneous vertebroplasty for an osteoporotic L1 compression fracture, and was diagnosed with AS at that time. Plain radiographs showed aggravated kyphosis and a stress fracture through the ossified posterior element, below the prior vertebroplasty. Magnetic resonance images revealed a right foraminal cystic lesion at the L2-L3 level with effacement of the nerve root. A 1.6 cm cystic lesion that appeared to arise from the L2-L3 facet joint without direct communication was excised from the L2-L3 foramen. Pathological examination confirmed synovial cyst. The patient's symptoms resolved immediately after surgery except for a mild dysesthesia of the right leg. We report herein a rare case of foraminal synovial cyst associated with AS accompanying posterior element fracture with a review of literature.

• 대한한의학회지
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• 제34권3호
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• pp.126-142
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• 2013

Objectives: Previous reports have shown that Bogijetong-Tang (BJT) is effective in peripheral neuropathy induced by taxol and crush injury. In this study, we researched the effects of BJT on diabetic neuropathy induced by STZ in the mouse. Methods: We performed both in vitro and in vivo experiments to verify the effects of BJT on diabetic neuropathy induced by STZ in mice. Changes in axonal recovery were observed with immunofluorescence staining using NF-200, Hoechst33258, $S100{\beta}$, caspase 3 and anti-cdc2. Proliferation and degeneration of Schwann cells were investigated by immunofluorescence staining and western blot analyses. Results: BJT showed considerable effects on neurite outgrowth and axonal regeneration in diabetic neuropathy. BJT contributed to the creation of NF-200, GAP-43, Cdc2, phospho-vimentin, ${\beta}1$, active ${\beta}1$, ${\beta}3$ integrin, phospho-Erk1/2 protein. Conclusions: Through this study, we found that BJT is effective for enhanced axonal regeneration via dynamic regulation of regeneration-associated proteins. Therefore, BJT had a pharmaceutical property enhancing recovery of peripheral nerves induced by diabetic neuropathy and could be a candidate for drug development after more research.

• 동의생리병리학회지
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• 제32권1호
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• pp.30-34
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• 2018

This research was practiced to comparative investigate the distribution of sensory and motor neuron linkaged with Yangji(TE4) by using neural-tracer technology. A total 16 S-D rats were used in the present research. After anesthesia, the rats received micro-injection of $6{\mu}{\ell}$ of cholera toxin B subunit(CTB) into the relation positions of the Yangji(TE4), in the human body for observing the distribution of the linkaged sensory neurons in dorsal root ganglia(DRGs) and motor neurons in the spinal cord(C3~T4) and sympathetic ganglia. 3 days after the micro injection, the rats were anesthetized and transcardially perfused saline and 4% paraformaldehyde, followed by routine section of the DRGs, sympathetic chain ganglia(SCGs) and spinal cord. Marked neurons and nerve fibers were detected by immunohistochemical method and observed by light microscope. The marked neurons were recorded and counted. From this study the distribution of primary sensory and motor neurons linkaged with Yangji(TE4) were concluded as follows. Yangji(TE4) dominated by spinal segments of C5~T1, C6~T4, individually.

• Journal of Korean Neurosurgical Society
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• 제39권5호
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• pp.366-369
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• 2006

Objective : There are various surgical approaches to far-lateral lesions in the L5-S1 intervertebral space. Of these is the validity of a paramedian tangential approach is being investigated in this study. Methods : A retrospective study was conducted on 25 patients who had been diagnosed as having a far-lateral L5-S1 disc herniations, osteophyte, costal process hypertrophy, and had undergone a paramedian tangential approach from November 1999 through December 2003. The degree of symptoms and improvement were compared via the visual analog pain scale, before and after surgery. Results : This study included 4 males and 21 females with a mean age of $62{\pm}11.8$ years old. The average follow-up period after surgery was $8.2{\pm}2.7$ months. The visual analog pain scale taken before surgery was $6.7{\pm}1.1$ points, while the post-surgical scale was $2.4{\pm}0.9$ points showing a significant degrease [p < 005]. There were no complications that developed during surgery. Conclusion : A paramedian tangential approach is less invasive in the soft tissue than that of the median approach. This approach may effectively reduce nerve root compression and expand intervertebral foramens, and is devoid of the risk of spinal instability after surgery. The authors suppose that a paramedian tangential approach is quite an effective technique to relive compression in the far-lateral L5-S1 intervertebral space.

• 대한척추외과학회지
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• 제25권4호
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• pp.180-184
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• 2018

연구 계획: 증례 보고 목적: 경피적 내시경하 요추 추간판 절제술 후 인식하지 못한 경막 손상에 의해 생긴 추간판과 경막 사이의 누공에 대해 보고하고자 한다. 선행 연구문헌의 요약: 경피적 내시경하 요추 추간판 절제술시 경막 손상의 위험은 낮은 것으로 알려져 있으며, 인지하지 못한 경막 손상이 보고 되고 있으나, 이를 정확히 진단할 수 있는 도구는 아직 알려지지 않고 있다. 대상 및 방법: 50세 여자 환자는 제 4-5요추 추간판 탈출증에 대해 두 차례 경피적 내시경하 요추 추간판 절제술을 시행 받았다. 하지만, 환자는 술 후 6개월에도 지속적으로 좌측 하지에 참을 수 없는 동통과 운동 신경 마비를 호소하였다. 이에 신경 조직 손상을 찾기 위해 수술을 계획하였다. 결과: 이전 수술 부위에서 경막 손상이 발견되었으며, 또한 경막 손상 부위에서 추간판과 경막 사이에 누공이 형성된 것을 발견 하였다. 경막 손상 부위는 경막 전측부에 위치 하였으며, 크기는 5 mm 정도 였다. 5~0 나일론과 접착 봉합제로 경막 손상 부위를 봉합하였다. 술 후 환자의 술 전 증상은 호전되었다. 결론: 경피적 내시경하 요추 추간판 절제술 후 인지하지 못한 경막 손상은 추간판과 경막 사이의 누공 형성의 원인이 될 수 있다. 추간판 조영술은 인지하지 못한 경막 손상에 의해 생성된 누공에 대한 신뢰할 수 있는 진단 도구이다.

• 대한근전도전기진단의학회지
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• 제20권2호
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• pp.84-90
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• 2018

Objective: To assess the correlation between surface electromyography (SEMG) and conventional EMG in patients with facial nerve palsy. Additionally, compare the discomfort and the time required by the patients in two methods. Method: 36 patients with facial palsy were given nerve conduction studies (NCS) via conventional EMG. Then, the peak root mean square (RMS) values were obtained from the SEMG. We also recorded visual analogue scale (VAS), House-Brackmann scale, and the time required for the examination. Results: Pearson's correlation coefficient between the amplitude loss ratio of the RMS values obtained by SEMG compared to the unaffected side (RSEMG) and the amplitude loss ratio of CMAP amplitudes compared to the unaffected side (RCMAP) was 0.567 at the frontalis, 0.456 at the orbicularis oculi, 0.393 at the nasalis, and 0.437 at the orbicularis oris. An increase in RSEMG is positively correlated with an increase in RCMAP. The mean VAS score with conventional EMG was $3.55{\pm}1.42$, whereas that experienced when using SEMG was $0.11{\pm}0.52$ and the mean time required for conventional EMG was $610{\pm}103.84$ seconds, while that required for SEMG was $420{\pm}86.32$ seconds. Conclusion: This study demonstrated a significant positive correlation between facial muscle activities as measured by SEMG and conventional EMG in patients with facial nerve palsy. SEMG has the benefits of being more comfortable and faster when diagnosing facial palsy.

• Journal of Oral Medicine and Pain
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• 제25권2호
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• pp.235-240
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• 2000

This study was carried out among 34 patients who visited Yonsei Dental Hospital from 1996. 1. to 1999. 5 for trigeminal neuralgia. By studying the patient's treatment prior to visiting our hospital, features of trigeminal neuralgia, treatment process of trigeminal neuralgia, prognosis of treatment, consultation with other professions and involvement of surgery, etc., the results are as follows: 1. 67.7% of onset age range from 40s to 60s, and average age is 50.2. 2. Ratio of right to left involvement is 1:2.1, male to female ratio is 1:1.9. 3. Occurrence rate of each branch is V3(44.1%), V2(11.8%), V1+V2+V3(11.8), V1+V2(8.8%). 4. Treatments prior to admission to our hospital are extraction(5.9%), endodontic treatment(5.9%), medication(11.8%), Oriental Medicine treatment(5.9%). 5. Routes of admittance to our hospital are by their preference(55.9%), local clinic referral(32.4%), E.N.T referral(5.9%), Neurology referral(5.9%). 6. 70.6% of patients treated at our hospital who were relieved of symptoms, were referred to Neurology(66.7%) and Pain Clinic(33.3%) for the reason of relapse, side effects of the drug itself, incomplete relief of pain. 7. 2 patients who were referred to medical part showed brain vessels contacting trigeminal nerve root on Brain MRangiography. But pain is being controlled by medication and no specific surgical procedure was carried out. The results show that 17.7% of patients admitted received inappropriate early treatment. In order to relieve tooth loss and patient's psychologic stress due to inappropriate treatment, precise differential diagnosis must be made among local teeth disease and idiopathic facial pain. Medication may show side effects of the drug itself, incomplete relief of pain or relapse of symptoms. Therefore, to treat trigeminal neuralgia appropriately by drug injection, surgery or radiation therapy, consultations among dentists, neurologists and anesthesiologists are required.

• The Korean Journal of Pain
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• 제21권3호
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• pp.229-232
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• 2008

Insufficiency fractures of the sacrum are relatively common and cause severe low back and buttock pain. Percutaneous vertebroplasty is effective for treating vertebral compression fractures. We present a case of percutaneous sacroplasty for the treatment of low back and buttock pain in a sacral insufficiency fracture. A 79-year-old male with non-small lung cancer presented with severe low back and buttock pain after series of radiation treatments. Preoperative MRI showed both a sacral ala and S2 metastatic insufficiency fracture. An epidural port was inserted for continuous morphine infusion and sacral nerve root blocks were performed. However, his pain did not diminish and we attempted percutaneous sacroplasty. Both sides of the sacroplasty were done with a fluoroscopy-guided technique with 1.7 ml and 2.3 ml of bone cement injected into the right and left sacral ala. Pain relief was significant and the patient was able to sit down 1 day after the procedure.

• Journal of Korean Neurosurgical Society
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• 제41권3호
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• pp.157-160
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• 2007

Objective : The purpose of this study was to evaluate the efficacy and safety of the surgical treatment for lumbar spinal stenosis in elderly patients. Methods : The authors reviewed the medical records of 49 patients older than 65 years of age with lumbar spinal stenosis who underwent surgical treatment from January 2002 to December 2004 in our institute. Results : Average age of patients was 70 years old [32 women, 17 men]. Twenty-four patients had chronic medical disorders. All patients were operated under the general anesthesia of these, 29 patients underwent decompressive laminectomy and decompressive laminectomy with instrumentation and fusion in 20 patients. The mean operation time was 193.5 minutes, mean estimated blood loss was 378cc and mean postoperative hospital stay length was 15.3 days. The mean follow-up duration was 11.9 months. The evaluation of outcome was assessed by Macnab classification. At first month after operation, the outcome showed excellent in 7 [14.3%]. good in 35 [71.4%], fair in 5 [10.2%], and poor in 2 [4.1%]. And at 6 months after operation, 17 patients were lost in follow-up, the outcome showed excellent in 4 [12.5%], good in 25 [78.1%], fair in 3 [9.4%], and no poor cases. There was no significant difference between outcome of laminectomy alone and that of laminectomy with fusion. Six patients [12.2%] experienced postoperative complications which included wound infection [3], nerve root injury [1], disc herniation [1], and reoperation due to insufficient decompression [1]. There were no deaths related to operation. Conclusion : We conclude that the surgical treatment for lumbar spinal stenosis in elderly patients can provide good results with acceptable morbidity when carefully selected. In addition, decision on lumbar spinal fusion should not be against solely on advanced age.

• The Korean Journal of Pain
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• 제37권1호
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• pp.3-12
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• 2024

One of the most common sources of spinal pain syndromes is the facet joints. Cervical, thoracic, and lumbar facet joint pain syndromes comprise 55%, 42%, and 31% of chronic spinal pain syndromes, respectively. Common facet joint disorders are degenerative disorders, such as osteoarthritis, hypertrophied superior articular process, and facet joint cysts; septic arthritis; systemic and metabolic disorders, such as ankylosing spondylitis or gout; and traumatic dislocations. The facet pain syndrome from osteoarthritis is suspected from a patient's history (referred pain pattern) and physical examination (tenderness). Other facet joint disorders may cause radicular pain if mass effect from a facet joint cyst, hypertrophied superior articular process, or tumors compress the dorsal root ganglion. However, a high degree of morphological change does not always provoke pain. The superiority of innervating nerve block or direct joint injection for diagnosis and treatment is still a controversy. Treatment includes facet joint injection in facet joint osteoarthritis or whiplash injury provoking referred pain or decompression in mass effect in cases of hypertrophied superior articular process or facet joint cyst eliciting radicular pain. In addition, septic arthritis is treated using a proper antibiotic, based on infected tissue or blood culture. This review describes the diagnosis and treatment of common facet joint disorders.