• Journal of Korean Neurosurgical Society
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• v.54 no.5
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• pp.379-383
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• 2013

Objective : There are differences in the clinical characteristics and surgical results between upper (L1-2 and L2-3) and lower (L3-4, L4-5, and L5-S1) lumbar disc herniations. We conducted this study to compare the clinical features and surgical outcomes between the two types of lumbar disc herniations. Methods : We retrospectively reviewed the clinical features of patients who underwent microdiscectomies from 2008 to 2012. We evaluated the clinical characteristics such as age, preoperative autonomic dysfunction, the presence or absence of previous lumbar surgery and fusion required during surgery. Visual Analogue Scale (VAS) scores about back pain and leg pain were evaluated preoperatively and at the final follow-up. Results : Upper lumbar group (n=15) was significantly older than lower lumbar group (n=148). The incidence of autonomic dysfunction was significantly higher in upper lumbar group. The number of patients with a previous lumbar surgery was significantly greater in upper lumbar group. There was no statistical significance for fusion required during surgery between two groups. Both groups showed a significant decrease in the VAS scores of leg pain. VAS scores of back pain were significantly decreased in lower lumbar group. But this was not seen in upper lumbar group. Both groups showed significant improvement of Oswestry Disability Index score. Conclusion : Upper lumbar group had different clinical characteristics from those of lower lumbar group and these include older age, a higher incidence of autonomic dysfunctions and a higher incidence of patients with previous lumbar surgery. There were no significant differences in surgical outcomes, except for back pain, between two groups.

• Journal of Korean Neurosurgical Society
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• v.38 no.2
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• pp.144-146
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• 2005

Herein, a case of missed upper lumbar disc herniation, diagnosed by thorough neurological examination, digital infrared thermographic imaging[DITI], and repeated magnetic resonance[MR] image study, is reported. A 36-year-old female presented with intractable leg pain on left anterior thigh. Although she underwent lumbar MR image at other hospital, she was misdiagnosed as acute sprain. Neurological examination suggested the possibility of upper lumbar disc herniation, which was confirmed by DITI, MRI, and selective root block. After operation, her leg pain was significantly improved. It should be considered that upper lumbar disc herniation might be misdiagnosed as an acute sprain, as in our case. A high index of suspicion based on thorough neurological examination is most important in such cases. Then, multi-access such as DITI, MR image, and selective block, base on thorough neurological examination, are warranted.

• Physical Therapy Korea
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• v.28 no.2
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• pp.117-122
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• 2021

Background: Flat-back posture refers to a posture in which the pelvis is tilted backward, the lumbar spine is bent, the upper thoracic spine is increasingly bent, and the lower thoracic spine is straight. Given that most of the day is spent sitting, we need to develop exercise programs and devices that are suitable for people who spend less time exercising than sitting. Objects: This study investigated the effects of resistance footrest exercise on spine posture angles in visual display terminal (VDT) workers with flat back. Methods: We measured the upper lumbar angle (ULA) and lower lumbar angle (LLA) using a flexible ruler for the ULA and LLA. Then, after 1 week of resistance footrest exercise designed to strengthen the lumbar spine musculature, we measured these angles again. We measured each angle three times and then compared measurements from before and after exercise. Results: There were no significant differences in the ULA following the strengthening exercise, but significant differences were observed in LLA. Conclusion: The resistance footrest exercise strengthened the muscles affecting the pelvic and lumbar lordotic angles, and increases in the LLA were changed. This suggests that the role of the lower lumbar spine in the lumbar lordotic curve is greater than that of the upper lumbar spine. In addition, considering the contemporary tendency to lead fairly sedentary lives, these results indicate that exercising while seated can be effective.

• Journal of Korean Neurosurgical Society
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• v.38 no.2
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• pp.111-115
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• 2005

Objective : Upper lumbar disc herniation is rare disease, compared with lower. The lamina of this high level lumbar vertebra is narrower than that of low level, and this have taken surgeon into important consideration for surgical methods because partial removal of lamina for discectomy weakens the base of the articular process and may result in fracture. The authors an accurate preoperative diagnosis that enables the surgeon to operative approach for preserving the facet joint. Methods : Thirteen patients with upper lumbar disc herniation have underone surgical procedure by midline approach for removal of ruptured disc fragment and paraspinal approach for removal of residual disc materials simultaneously without instrumentation. All patients who underwent surgery were analyzed and long-term follow-up was conducted. Results : At a mean follow-up of 24months, there were complete resolution of presenting radiating leg pain in 85% of the patients, 7.5% were left with minimal residual discomfort, and 7.5% derived little or no benefit from surgery. The follow-up radiologic findings of all patients shows that lamina and facet joint have preserved safely and no instability. Conclusion : Simultaneously, paraspinal with midline approach provides highly satisfactory operating methods by simplifying exposure and greatly limiting the risk of complications. This provides the basis for a planned surgical approach in which destruction of the facet joint can be avoided.

• Journal of Korean Physical Therapy Science
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• v.10 no.2
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• pp.96-103
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• 2003

The purpose of this study was to assess the effect of applied pressure to abdomen on lumbar and abdominal muscle activation during upper limb exercise. The experimental group consisted of twenty-seven healthy male subjects (mean age=$22.40{\pm}2.19years$, mean height=$175.30{\pm}2.19cm$, mean weight= $67.67{\pm}7.44kg$, RM=$8.43{\pm}2.76kg$). In each different pressure condition (OmmHg, 30mmHg, 70mmHg, 100mmHg), upper limb exercise was performed in total of 10 trials with 10 RM dumb-bell exercise. Lumbar and abdominal muscle activity was measured using surface bipolar electrode electromyography(EMG). EMG activity was measured from upper rectus abdominis, external oblique abdominis, internal oblique abdominis, and elector spinae. The raw EMG signal was processed into the root mean square(RMS). All RMS EMG data were normalized and express as a percentage of the EMG(%EMG). Collected data were statistically analyzed by SPSS/PC Ver 10.0 using two-way analysis of variance for repeated measures($4{\pm}3$) and Bonferroni post hoc, test. Lumbar and abdominal muscle activation was significantly increased when 100 mmHg was applied(p<.05). Upper rectus abdominis activation was significantly increased compared as other muscles activation(p<.05). However, there were no interaction between pressure and muscles(p>.05). The findings of this study can be used as a fundamental data when lumbar orthosis is applied and external pressure can be used as a therapeutic tool.

• Journal of Korean Neurosurgical Society
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• v.53 no.3
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• pp.145-149
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• 2013

Objective : We analyzed the clinical and radiologic features of posterior apophyseal ring separation (PARS) with lumbar disc herniation and suggest the proper management options according to the PARS characteristics. Methods : We reviewed case series of patients with PARS who underwent surgery of lumbar disc herniation. Preoperative symptoms, neurologic status, Body Mass Index, preoperative and postoperative Visual Analogue Scale (VAS) and Korean-Oswestry Disability Index (K-ODI) scores, operation types were obtained. PARS size, locations, the degree of resection were assessed. Results : PARS was diagnosed in 109 (7.5%) patients among 1448 patients given surgical treatment for single level lumbar disc herniation. There were 55 (50.5%) small PARS and 54 (49.5%) large PARS. Among the large PARS group, 15 (27.8%) had lower endplate PARS of upper vertebra at the level of disc herniation. Thirty-nine (72.2%) were upper endplate PARS of lower vertebra. Among the group with upper endplate PARS of lower vertebra, unresected PARS was diagnosed in 12 (30.8%) cases and resected PARS was diagnosed in 27 (69.2%) cases. VAS and K-ODI scores changes were $3.6{\pm}2.9$ and $5.4{\pm}6.4$ in the unresected PARS group, $5.8{\pm}2.1$ and $11.3{\pm}7.1$ in the resected PARS group. The group with upper endplate PARS of lower vertebra showed significant difference of VAS (p=0.01) and K-ODI (p=0.013) score changes between unresected and resected PARS groups. Conclusion : The large PARS of upper endplate in lower vertebra should be removed during the surgery of lumbar disc herniation. High level or bilateral side of PARS should be widely decompressed and arthrodesis procedures are necessary if there is a possibility of secondary instability.

• Physical Therapy Korea
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• v.20 no.1
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• pp.10-17
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• 2013

The purpose of this study was to assess the influence of the duration of smartphone usage on cervical and lumbar spine flexion angles and reposition error in the cervical spine. The study included 18 healthy smartphone users (7 males and 11 females). We measured the kinematics of the upper and lower cervical and lumbar spine flexion angles and the reposition error of the upper and lower cervical spine after 3 s and 300 s smartphone use in sitting. A paired t-test was used to compare the effects of the duration of smartphone usage on the kinematics of cervical and lumbar spine flexion angles and reposition error. The flexion angles of the lower cervical and lumbar spine and the reposition error in the upper and lower cervical spine were significantly increased after 300 s smartphone of use (p<.05). However, the flexion angle of the upper cervical spine was not significantly different between the 3 s and 300 s smartphone of use (p>.05). These findings suggest that prolonged use of smartphones can induce changes in cervical and lumbar spine posture and proprioception in the cervical spine.

• The Journal of the Korea Contents Association
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• v.11 no.12
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• pp.800-806
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• 2011

The objective of this study was to identify the effect of lumbar lordotic curve adjustment on head and neck posture in older adults. Methods Twenty healthy older participants (mean age 71.32) were photographed while watching monitor in sitting with or without lumbar roll support(length 28cm, diameter 10cm). The upper cervical angle and lower cervical angle were measured using the NIH ImageJ 1.32. Comparisons between upper and lower cervical angle with or without lumbar roll support were made using paired-t test analysis. Results Subjects demonstrated a significant difference in the mean upper and lower cervical angle. Mean difference of the upper cervical angle was about $2.83^{\circ}$ with and without lumbar roll support(p<0.005). Mean difference of the lower cervical angle was about $4.44^{\circ}$ with and without lumbar roll support(p<0.0001). Conclusions This study showed that healthy older adults demonstrated more ability to maintain an upright posture of cervical spine during lumbar lordotic curve maintenance with lumbar roll support than without lumbar roll support. When the clinicians consider improvement of the head and neck posture in older adults, they must incorporate adjustment in the lumbar region.

• Journal of International Academy of Physical Therapy Research
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• v.10 no.2
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• pp.1785-1790
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• 2019

Background: Lumbar disc herniation (LDH) causes neurological symptoms by compression of the dura mater and nerve roots. Due to the changed in proprioception inputs that can result in abnormal postural pattern, delayed reaction time, and changed in deep tendon reflex. Objective: To investigate the effects of lumbar stabilization exercises on motor neuron excitability and neurological symptoms in patients with LDH. Design: Randomized Controlled Trial (single blind) Methods: Thirty patients with LDH were recruited; they were randomly divided into the balance center stabilization resistance exercise group (n=15) and the Nordic walking group (n=15). Each group underwent their corresponding 20-minute intervention once a day, four times a week, for four weeks. Participants' motor neuron excitability and low back pain were assessed before and after the four-week intervention. Results: There were significant differences in all variables within each group (p<.05). There were significant differences between the experimental and control groups in the changes of upper motor neuron excitability and pain (p<.05), but not in the changes of lower motor neuron excitability and Korean Oswestry Disability Index. Conclusion: Lumbar stabilization exercises utilizing concurrent contraction of deep and superficial muscles improved low back function in patients with LDH by lowering upper motor neuron excitability than compared to exercises actively moving the limbs. Lumbar stabilization exercises without pain have a positive impact on improving motor neuron excitability.

• Journal of the Korean Society of Physical Medicine
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• v.8 no.3
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• pp.443-448
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• 2013

PURPOSE: In recent years, senior friendly device is growing rapidly because of population aging The study was designed to investigate the effects of table height of electronic bed on upper extremity and trunk EMG in elderly. METHODS: Thirty right-handed elderly without history of neurological and musculoskeletal dysfunction were participated in this study. Three heights of the table (3/3 height, 2/3 height, and 1/3 height between top of the shoulder and olecranon) were provided. During the eating performance, surface electromyography (EMG) was used to measure muscle activity, and electrodes were attached to the deltoid middle fiber, serratus anterior, suprapinatus, upper trapezius, rhomboideus, cervical part of longissimus, thoracic part of longissimus, lumbar part of longissimus on right. One way ANOVA was conducted for the statistical analysis. RESULTS: There were significant differences in deltoid middle fiber, suprapinatus, upper trapezius, rhomboideus, lumbar part of longissimus in the 3 different height of table (p<.05). The deltoid middle fiber, suprapinatus, upper trapezius, and lumbar part of longissimus were significantly increased in higher table than lower table(p<.05). And the rhomboideus was significantly decreased in higher table than lower table(p<.05). CONCLUSION: This study demonstrates that different height of table affect upper extremity and trunk muscle activity. The table height of olecranon is the best for elderly.