• The Korean Journal of Pain
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• v.21 no.3
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• pp.248-251
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• 2008

The clinical syndrome of posttraumatic syringomyelia can complicate major spinal trauma and develops many months after spinal injury. The 50-90% of patients experienced the pain and especially the component of central pain. In patients with central pain following spinal cord injury, ketamine has been shown to be an effective analgesic. We report a case of posttraumatic syringomyelia in a 30-year-old woman who complained of central pain, weakness of both legs and dysesthesia. She had not responded to pulsed radiofrequency, or lidocaine infusion therapy, but a continuous intravenous infusion of ketamine, an N-methyl-D-asparate receptor antagonist, reduced her severe central pain. In conclusion, a ketamine infusion therapy resulted in a significant reduction of central pain without decreasing of motor power and function.

• The Korean Journal of Pain
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• v.33 no.1
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• pp.3-12
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• 2020

Neuropathic pain after spinal cord injury (SCI) has a significant negative impact on the patients' quality of life. The objective of this systematic review is to examine the safety and efficacy of pregabalin (PGB) and gabapentin (GBP) in the treatment of neuropathic pain due to SCI. PubMed, the Cochrane Library, Embase, Scopus, and the Web of Science were searched up to December 2018. The reference lists of key and review studies were reviewed for additional citations. The quality of the studies was evaluated using the Cochrane Collaboration's tools for assessing the risk of bias. A meta-analysis was performed for primary and secondary outcomes. Eight studies were eligible for inclusion. Meta-analysis of PGB vs. placebo showed that PGB was effective for neuropathic pain (standardized mean difference [SMD] = -0.40; 95% confidence interval [CI]: -0.78, -0.01), anxiety (MD = -0.68; 95% CI: -0.77, -0.59), depression (mean difference [MD] = -0.99; 95% CI: -1.08, -0.89), and sleep interference (MD = -1.08; 95% CI: -1.13, -1.02). Also, GBP was more effective than a placebo for reducing pain. No significant difference was observed between the efficacy of the two drugs (MD = -0.37; 95% CI: -1.67, 0.93). There was no significant difference between the two drugs for discontinuation due to adverse events (risk ratio = 3.00; 95% CI: 0.81, 11.15). PGB and GBP were effective vs. placebos in decreasing neuropathic pain after SCI. Also, there was no significant difference between the two drugs for decreasing pain and adverse events.

• Journal of Korean Neurosurgical Society
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• v.63 no.6
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• pp.777-783
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• 2020

Objective : To compare the accuracy and breach rates of freehand (FH) versus navigated (NV) pedicle screws in the thoracic and lumbar spine in patients with metastatic spinal tumors. Methods : A retrospective review of adult patients who underwent pedicle screw fixation in the thoracic or lumbar spine for metastatic spinal tumors between 2012 and 2018 was conducted. Breaches were assessed based on the Gertzbein and Robbins classification and only screws placed >4 mm outside of the pedicle wall (lateral or medial) were considered breached. Results : A total of 62 patients received 547 pedicle screws (average 8 per patient) - 34 patients received 298 pedicle screws in the FH group and 28 patients received 249 screws in the NV group. There were 40/547 breaches, corresponding to a breach and accuracy rate of 7.3% and 92.7%, respectively. The breach rate was 9.7% in the FH group and 4.4% in the NV group (chi-squared test, p=0.017); this corresponded to an accuracy rate of 90.3% and 95.6%, respectively. Only one patient from the overall cohort (in the FH group) required revision surgery due to a medial breach abutting the spinal cord (1.6% of all patients; 2.9% of FH patients); no patient suffered organ, vessel, or neurological injury from screw breaches. Conclusion : Navigated pedicle screw placement in patients with metastatic spinal tumors has a significantly higher radiographic accuracy compared to the FH technique. However, the revision surgery was low and no patient suffered from clinically-relevant breach. Navigation also offers the advantage of real-time localization of spinal tumors and aids in targeting and resection of these lesions.

• The Korean Journal of Pain
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• v.19 no.2
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• pp.223-227
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• 2006

Complex regional pain syndrome (CRPS) is clinically characterized by pain, abnormal regulation of blood flow and sweating, edema of skin and subcutaneous tissues, sensory and motor disturbances, and trophic changes of the skin. A 21-year-old man was suffering from pain and swelling in his right hand and forearm. His arm had been in splints for 3 weeks following an extension injury of the right fingers and wrist, with the pain having developed 2 weeks after the splinting. He was treated with various nerve blocks including continuous epidural infusion, thoracic sympathetic block and peripheral nerve blocks, and squeezing his edematous region under general anesthesia as well as intravenous lidocaine and ketamine infusions. However, all of the performed treatments had no effect on the patient's pain or hand swelling. As a next line therapy, spinal cord stimulation should be considered because of intractable severe pain and swelling to almost all other modalities of therapy. We therefore performed an early intervention of spinal cord stimulation for the patient with refractory CRPS type I 5 months after the onset of pain and have got an excellent result.

• Therapeutic Science for Rehabilitation
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• v.7 no.1
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• pp.63-77
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• 2018

Objective : The purpose of this study was to investigate the effects of task-oriented training with functional electrical stimulation on hand function in incomplete cervical cord injury. Method : The subjects of the study were 3 adults diagnosed as incomplete cervical cord injury. The design of this study was ABA single-subject research design to compare dominant hand function of before and after intervention and detect individual effects. The experiment consisted of 30sessions, in which baseline process A1 and A2 were implemented 5 sessions each for 10sessions. Intervention B was implemented 20 sessions. The dependent variable was converted to the change of hand function every session, and Canadian Occupational Performance Measure (COPM), Jebsen-Taylor Hand Function Test(JTHFT), Wolf Motor Function Test(WMFT) were selected for outcome measurements. Result analysis was suggested through visual analysis using a graph and comparison of pre, post and follow-up intervention measurements. Results : As a result, the quality and quantity of dominant hand function increased during intervention B compared to the baseline A1 for all subjects. Baseline A2 was also maintained without training. Additionally, JTHFT, WMFT and COPM scores demonstrated improvement and maintain. The follow up JTHFT and WMFT showed increased required time on all subjects and decrease or maintain task performance and satisfaction in COPM. Conclusion : The task-oriented training with function electrical stimulation in this study has been positive effects on hand function and task performance and satisfaction.

• Journal of Korean Academy of Nursing
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• v.24 no.1
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• pp.129-142
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• 1994

The purpose of this study determine and compare spinal cord injured(SCI) patients’ and nurses’ perceptions of SCI patients’ learning needs about altered elimination and then provide nursing data for more effective SCI patients’ learning process. Data collection was done from September 3 to October 2, 1993. For this study, 36 SCI Patients(12 paraplegia, 24 quadriplegia) and 20 nurses who were working neurosurgery or rehabilitation unit in 3 general hospitals in C and I city were selected. Data collection was accomplished by Questionnaire method and the instrument developed by the investigator, elicited information about learning needs about altered elimination of SCI patients from SCI patient, nurse, rehabilitation doctor, nursing professor, nursing graduate students. The questionnaire composed altered urinary elimination part with 10 categories and altered bowel elimination part with 10 categories. The results of this study were as follows : 1. There was no significant difference in learning needs about altered urinary elimination of the paraplegic SCI patients’ perceptions and nurses’ perceptions of the paraplegic SCI patients. But there was significant difference in learning needs about altered urinary elimination of the quadriplegic SCI patients and nurses’ perceptions of the quadriplegic patients(t=2.48, p=.017). 2. There was no significant difference in learning needs about altered bowel elimination of the paraplegic SCI patients’ perceptions and nurses’ perceptions of the paraplegic SCI patients. But there was significant difference in learning needs about altered bowel elimination of the quadriplegic SCI patients and nurses’ perceptions of the quadriplegic patients(t=-3.00. p=.005). 3. Degree of paraplegic SCI patients’ perceived learning needs about altered urinary elimination was 2.4083 and quadriplegic SCI patients’ perceptions were 2.0750. Degree of paraplegic SCI patients’ perceived learning needs about altered bowel elimination was 2.3972 and quadriplegic SCI patients' perceptions were 2.181.

• Journal of Korean Neurosurgical Society
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• v.29 no.6
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• pp.763-771
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• 2000

Objectives : Thoracolumbar burst fractures(TBLF) result in not only compressive deformity of vertebral body but also spinal cord compression by bony fragments. Many thoracolumbar burst fractures demand both anterior decompression and intervertebral fusion. Most of spinal surgeons use anterior instrumentation for anteior intervertebral bony fusion. The use of Z-plate has been increased recently, however there has been only a few reports regarding its clinical long-term strength. We studied nineteen patients with TBLF to find out the long-term stability of Z-plate. Methods : We have operated 19 patients from March 1996 to August 1998. They were treated with anterior decompression through either a transthoracic, retroperitoneal extrapleural or retroperitoneal approach. Retropulsed bony fragments were removed completely by corpectomy. Iliac bone graft was used for interbody fusion in all of the cases. They were evaluated by plain X-ray films including flexion and extention lateral films. Cobbs angle was used to evaluate kyphotic and lateral wedging deformity. Results : Burst fractured sites were T11 in two, three T12, nine L1, and five L2. Mean follow-up duration was fifteen months. Preoperative average kyphotic angle was 23.7 degree. Immediate postoperative kyphotic angle was 10.2 degree. Follow-up resluts of average kyphotic angles revealed 14 degrees. Four patients(21%), including two spinal 3-column injury, showed increasement of kyphotic angle more than 5 degree or breakage of intrumentation. Two patients showed the difference of kyphotic angle more than 3 degree. Five patients(26%) revealed lateral wedging deformity more than 3 degrees. Postoperative complications were two meralgia parestheticas, one pulmonary atelectasis and two donor site infections. Four of the eight patients, who initially showed incomplete spinal cord deficits, were nerologically improved by Frankel's grade. Conclusion : Z-plate fixation and iliac bone graft after anterior decompression in thoracolumbar burst fractures is a safe and easy method. Immediate postoperative results revealed excellent correction of posttraumatic kyphosis, but long-term follow-up evalution showed insufficient strength. Therefore we believe that use of Z-plate should be carefully decided, especially in the case of large lumbar fracture or 3-column injury.

• Journal of Chest Surgery
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• v.15 no.4
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• pp.414-421
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• 1982

200 patients admitted to the Chest Surgery Department of Jeonbug National University Hospital from January, 1974 to December, 1981 were analyzed clinically. The ratio of male to female was 7: 1, which showed male predominance. Distribution of patients according to age disclosed that over half [62%] of the patients was social age between 20 and 49 years. The most common cause of chest trauma was traffic accident [39%], and the next were stab wound, fall down [17.5%], and hit [8.5%] in decreasing order. Common lesions due to chest trauma were as follows; rib fracture [51%], hemopneumothorax, hemothorax, and pneumothorax in decreasing number. The most common cause of rib fracture was traffic accident [50%] and the associated organ injuries were long bone fracture, head injury, spine and pelvic bone fracture, spleen rupture, and liver laceration. Hemothorax, pneumothorax, and hemopneumothorax were treated with insertion of thoracic catheter in 90 cases, pure thoracentesis in 11 cases, and emergency thoracotomy in 11 cases. In flail chest, 6 patients were treated by intramedullary insertion of Kirschner`s wire and the results were good. The incidence of complication was 17%, including atelectasis [11 cases], pyothorax, fibrothorax, pneumonia, and acute respiratory failure. Four patients were died [2%], and the causes were acute respiratory failure in 2 cases, spinal cord injury in one case and head injury in one case.

• The Journal of Internal Korean Medicine
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• v.22 no.2
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• pp.263-269
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• 2001

Monoplegia is the paralysis of either the upper or lower limb. Monoplegia is commonly caused by an injury to the cerebral cortex; it is rarely caused by an injury to the internal capsule, brain stem, or spinal cord. Most cerebral cortex is derived from the occlusion of a brain cortex blood vessel due to thrombus or embolus. According to motor homunculus, lower limb monoplegia occurs from limited damage to the most upper part of the primary motor area(Brodmann's area 4, located in precentral gyrus). Clinically, lower limb monoplegia due to brain cortical infarction is commonly misunderstood as monoplegia due to spinal injury because the lesion is situated at the most upper part of precentral gyrus. We had many difficulties in finding lesion on brain CT, but we diagnosed two patients correctly by using an MRI, who have lower limb monoplegia due to brain cortical infarction oriental treatment.

• Journal of Trauma and Injury
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• v.33 no.4
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• pp.207-218
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• 2020

The following recommendations are presented herein: All trauma patients admitted to the resuscitation room should be constantly (or periodically) monitored for parameters such as blood pressure, heart rate, respiratory rate, oxygen saturation, body temperature, electrocardiography, Glasgow Coma Scale, and pupil reflex (1C). Chest AP and pelvic AP should be performed as the standard initial trauma series for severe trauma patients (1B). In patients with severe hemodynamically unstable trauma, it is recommended to perform extended focused assessment with sonography for trauma (eFAST) as an initial examination (1B). In hemodynamically stable trauma patients, eFAST can be considered as the initial examination (2B). For the diagnosis of suspected head trauma patients, brain computed tomography (CT) should be performed as an initial examination (1B). Cervical spine CT should be performed as an initial imaging test for patients with suspected cervical spine injury (1C). It is not necessary to perform chest CT as an initial examination in all patients with suspected chest injury, but in cases of suspected vascular injury in patients with thoracic or high-energy damage due to the mechanism of injury, chest CT can be considered for patients in a hemodynamically stable condition (2B). CT of the abdomen is recommended for patients suspected of abdominal trauma with stable vital signs (1B). CT of the abdomen should be considered for suspected pelvic trauma patients with stable vital signs (2B). Whole-body CT can be considered in patients with suspicion of severe trauma with stable vital signs (2B). Magnetic resonance imaging can be considered in hemodynamically stable trauma patients with suspected spinal cord injuries (2B).