• Journal of Korean Neurosurgical Society
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• v.46 no.6
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• pp.581-583
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• 2009

Abducens nerve palsy associated with spinal surgery is extremely rare. We report an extremely rare case of abducens nerve palsy after lumbar spinal fusion surgery with inadvertent dural tearing, which resolved spontaneously and completely. A 61-year-old previous healthy man presented with chronic lower back pain of 6 weeks duration and 2 weeks history of bilateral leg pain. He was diagnosed as having isthmic spondylolisthesis at L4-5 and L5-S1, and posterior lumbar interbody fusion was conducted on L4-5 and L5-S1. During the operation, inadvertent dural tearing occurred, which was repaired with a watertight dural closure. The patient recovered uneventfully from general anesthesia and his visual analogue pain scores decreased from 9 pre-op to 3 immediately after his operation. However, on day 2 he developed headache and nausea, which were severe when he was upright, but alleviated when supine. This led us to consider the possibility of cerebrospinal fluid leakage, and thus, he was restricted to bed. After an interval of bed rest, the severe headache disappeared, but four days after surgery he experienced diplopia during right gaze, which was caused by right-side palsy of the abducens nerve. Under conservative treatment, the diplopia gradually disappeared and was completely resolved at 5 weeks post-op.

• The Journal of Korean Academy of Orthopedic Manual Physical Therapy
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• v.20 no.1
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• pp.47-52
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• 2014

Background: This case study is to describe the manual therapy for the patient with posttraumatic stress (PTSD), sleep disturbance, and pain such as chronic low back pain (CLBP). Methods: The patient who participated in this study was a 60 year-old male PTSD patient with CLBP. His CLBP is not from any genetic or family history but a sequelae of torture that he had gone through about 30 years ago. Prior to the intervention, it was assessed that the PDS-K score was 16, PQSI-K was 12, SLR-90-R was low, VAS score was 10, and KODI socre was 25. The intervention was conducted through manual therapy (myofascial release, muscle energy technique, lumbar stabilization) twice a week for eight weeks in total. Results: After eight week-intervention, the PDS-K, SLR-90-R, VAS, and KODI score were improved whereas PQSI-K was not sufficiently fast improved. Conclusions: The manual therapy is substantially effective in dealing with PTSD and CLBP.

• Journal of Acupuncture Research
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• v.23 no.5
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• pp.39-54
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• 2006

Objectives : Herniation of Nucleus Pulpous (HNP) of Lumbar is one of the most common causes of low back pain. The aim of this study is to investigate the effectiveness of acupuncture, bee venom acupuncture (BVA), and bee venom Pharmacopuncture (BVP) therapy for HNP. Methods : We separated 35 patients with HNP of L-spine into three groups; Acupuncture treated group, BVA treated group, and BVP treated group, and monitored for 30 days. 4 grades of recovery degree, score of Visual Analog Scale (VAS), and Oswestry Disability Index (ODI) were examined for comparison. Results : 1. Visual Analogue Scale of low back pain and radiating pain showed significant decrease in BVA and BVP groups compared to the Acupuncture group at VAS0_2, VAS0_3 evaluations. 2. ODI of disability of daily activities showed significant decrease in BVA and BVP groups compared to the Acupuncture group at VAS0_1, VAS0_2, and VAS0_3 evaluations. 3. Compared to the Acupuncture group, BVA and BVP groups were improved in S.L.R.T and R.O.M of L-spine as confirmed by the physical examination. 4. Treatment efficacy was more apparent in acute cases as ODI was significantly lower than chronic cases. Conclusion : BVA and BVP therapies can be used in addition to the acupuncture therapy for highly effective treatment of HNP. Further clinical studies are required to verify these findings.

• Journal of the Korea Academia-Industrial cooperation Society
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• v.11 no.11
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• pp.4382-4394
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• 2010

The objective of this survey was to understand the effect of the subjective degree and pain of urinary incontinence on the quality of life of the middle-aged women with the subjective symptom of urinary incontinence. A questionnaire was carried out to investigate the quality of life in relation to urinary incontinence for 114 patients of chronic musculoskeletal system from Feb. to May in 2010. Overall, the subjects responded that their quality of life was medium(($61.36{\pm}13.2$score) and the pain related to urinary incontinence was low back pain. The degree of pain was between the moderate and a little severe in the VAS (Visual Analogue Scale) range of 4 to 7. It was also shown that the action of the subjects was affected by urinary incontinence in forms of avoidance limitation and psycosocial effect. Since the survey showed that the urinary incontinence and pain substantially affect the quality of life of the middle-aged women, the result may provide basic information in developing a practical intervention program.

• Maxillofacial Plastic and Reconstructive Surgery
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• v.23 no.1
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• pp.95-102
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• 2001

Temporomandibular ankylosis is defined as a situation in which the condyle is fused to the fossa by bone or fibrous tissue. Conditons such as trauma, infection, or systemic disease may predispose to various types of ankylosis, bringing about different levels of limitation in mandibular movement. Most patients with temporomandibular ankylosis are associated with limitation of maximal mouth opening, deviation of the chin toward the affected side, impaired occlusion, chronic pain, compromised oral hygiene, severe facial asymmetry & impeded mandibular molar eruption occurring in childhood. Several techniques to release ankylosis have been described in the literature, showing variable and often unsatisfactory results. The most frequently used operations are gap arthroplasty, interpositional arthroplasty, and exicision and joint reconstruction with autogenous or alloplastic materials. We have managed the two patients of TMJ ankylosis. They had previously TMJ surgery and we treated with gap arthroplasty & active physial therapy. We have obtained favorable results and report these cases with literatures review.

• The Korean Journal of Pain
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• v.33 no.4
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• pp.305-317
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• 2020

Not all sciatica-like manifestations are of lumbar spine origin. Some of them are caused at points along the extra-spinal course of the sciatic nerve, making diagnosis difficult for the treating physician and delaying adequate treatment. While evaluating a patient with sciatica, straightforward diagnostic conclusions are impossible without first excluding sciatica mimics. Examples of benign extra-spinal sciatica are: piriformis syndrome, walletosis, quadratus lumborum myofascial pain syndrome, cluneal nerve disorder, and osteitis condensans ilii. In some cases, extra-spinal sciatica may have a catastrophic course when the sciatic nerve is involved in cyclical sciatica, or the piriformis muscle in piriformis pyomyositis. In addition to cases of sciatica with clear spinal or extra-spinal origin, some cases can be a product of both origins; the same could be true for pseudo-sciatica or sciatica mimics, we simply don't know how prevalent extra-spinal sciatica is among total sciatica cases. As treatment regimens differ for spinal, extra-spinal sciatica, and sciatica-mimics, their precise diagnosis will help physicians to make a targeted treatment plan. As published works regarding extra-spinal sciatica and sciatica mimics include only a few case reports and case series, and systematic reviews addressing them are hardly feasible at this stage, a scoping review in the field can be an eye-opener for the scientific community to do larger-scale prospective research.

• Journal of Korean Neurosurgical Society
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• v.52 no.3
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• pp.228-233
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• 2012

Objective : Chronic neck or back pain can be managed with various procedures. Although these procedures are usually well-tolerated, a variety of side effects have been reported. In this study we reviewed cases of unexpected temporary adverse events after blocks and suggest possible causes. Methods : We reviewed the records of patients treated with spinal pain blocks between December 2009 and January 2011. The types of blocks performed were medial branch blocks, interlaminar epidural blocks and transforaminal epidural blocks. During the first eight months of the study period (Group A), 2% mepivacaine HCL and triamcinolone was used, and during the last six months of the study period (Group B), mepivacaine was diluted to 1% with normal saline. Results : There were 704 procedures in 613 patients. Ten patients had 12 transient neurologic events. Nine patients were in Group A and one was in Group B. Transient complications occurred in four patients after cervical block and in eight patients after lumbar block. Side effects of lumbar spine blocks were associated with the concentration of mepivacaine (p<0.05). The likely causes were a high concentration of mepivacaine in five patients, inadvertent vascular injection in three patients, intrathecal leak of local anesthetics in one, and underlying conversion disorder in one. Conclusion : Spinal pain blocks are a good option for relieving pain, but clinicians should always keep in mind the potential for development of inevitable complications. Careful history-taking, appropriate selection of the anesthetics, and using real-time fluoroscopy could help reduce the occurrence of adverse events.

• The Korean Journal of Pain
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• v.19 no.1
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• pp.22-32
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• 2006

Background: This study was conducted to investigate the roles of the spinal and peripheral ${\gamma}$-aminobutyric acid (GABA)- ergic systems for the mechanical hypersensitivity produced by chronic compression of the dorsal root ganglion (CCD). Methods: CCD was performed at the left 5th lumbar dorsal root ganglion. The paw withdrawal threshold (PWT) to von Frey stimuli was measured. The mechanical responsiveness of the lumbar dorsal horn neurons was examined. GABAergic drugs were delivered with intrathecal (i.t.) or intraplantar (i.pl.) injection or by topical application onto the spinal cord. Results: CCD produced mechanical hypersensitivity, which was evidenced by the decrease of the PWT, and it lasting for 10 weeks. For the rats showing mechanical hypersensitivity, the mechanical responsiveness of the lumbar dorsal horn neurons was enhanced. A similar increase was observed with the normal lumbar dorsal horn neurons when the GABA-A receptor antagonist bicuculline was topically applied. An i.t. injection of GABA-A or GABA-B receptor agonist, muscimol or baclofen, alleviated the CCD-induced hypersensitivity. Topical application of same drugs attenuated the CCD-induced enhanced mechanical responsiveness of the lumbar dorsal horn neurons. CCD-induced hypersensitivity was also improved by low-dose muscimol applied (i.pl.) into the affected hind paw, whereas no effects could be observed with high-dose muscimol or baclofen. Conclusions: The results suggest that the neuropathic pain associated with compression of the dorsal root ganglion is caused by hyperexcitability of the dorsal horn neurons due to a loss of spinal GABAergic inhibition. Peripheral application of low-dose GABA-A receptor agonist can be useful to treat this pain.

• The Korean Journal of Pain
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• v.11 no.1
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• pp.165-168
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• 1998

Although the incidence of epidural abscess is low, patient requiring continuous epidural analgesia for control of acute and chronic pain is increasing rapidly. Therefore we anticipate more frequent encounters with epidural abscess patients in future. Once epidural abscess formation begins, early diagnosis and treatment is very important to prevent permanent neurologic damage. The authors encountered a case of epidural abscess after continuous epidural analgesia for control of perineal pain due to rectal cancer. Forty-eight hours after the block, patient began to suffer severe low back pain, local tenderness, and fever. So the catheter was removed and culture sensitivity test was done with blood and local drainage. The test results identified methicillin susceptible staphylococcus aureus. Antibiotics were administered. Ten days after the block, left ankle jerk disappeared, and force of dorsiflexion of great toe decreased, but numbness or anesthesia appeared at $L_5$ dermatome. Laminectomy was performed, and abscess and necrotic fat material was removed from left $L_5$ nerve root. The patient was discharged 12 days after operation without any neurologic sequalae.

• Journal of Industrial Convergence
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• v.20 no.10
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• pp.209-218
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• 2022

Individuals often report significant relief from pain and stress even after a single session of massage therapy; however, no previous studies have provided objective evidence supporting the effectiveness of a solitary massage therapy session. In the present study, we aimed to investigate the effectiveness of one-time treatment with a spinal thermal massage device reported to exert the same therapeutic effects as massage therapy in terms of pain reduction and stress relief. A man with chronic low back pain (LBP) underwent two rounds of experiments involving spinal massage treatment and bed rest, respectively. Pain was assessed using a visual analog scale, and heart rate variability (HRV) was measured in real-time to examine autonomic nervous system (ANS) activity. Blood samples were obtained at five points during each round of the experiment to examine changes in cortisol, epinephrine, and norepinephrine. Spinal massage significantly reduced pain and enhanced parasympathetic activity when compared with the bed rest condition. In addition, both epinephrine and norepinephrine levels were lower following spinal massage than following bed rest. These results are consistent with the reported effects of conventional massage therapy and support the effectiveness of one-time treatment using a spinal thermal massage device.