• Title/Summary/Keyword: chronic back pain

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Idiopathic Hypertrophic Spinal Pachymeningitis : Report of Two Cases and Review of the Literature

  • Kim, Jee-Hee;Park, Young-Mok;Chin, Dong-Kyu
    • Journal of Korean Neurosurgical Society
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    • v.50 no.4
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    • pp.392-395
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    • 2011
  • Idiopathic hypertrophic spinal pachymeningitis (IHSP) is a rare inflammatory disease characterized by hypertrophic inflammation of the dura mater and various clinical courses that are from myelopathy. Although many associated diseases have been suggested, the etiology of IHSP is not well understood. The ideal treatment is controversial. In the first case, a 55-year-old woman presented back pain, progressive paraparesis, both leg numbness, and voiding difficulty. Initial magnetic resonance imaging (MRI) demonstrated an anterior epidural mass lesion involving from C6 to mid-thoracic spine area with low signal intensity on T1 and T2 weighted images. We performed decompressive laminectomy and lesional biopsy. After operation, she was subsequently treated with steroid and could walk unaided. In the second case, a 45-year-old woman presented with fever and quadriplegia after a spine fusion operation due to lumbar spinal stenosis and degenerative herniated lumbar disc. Initial MRI showed anterior and posterior epidural mass lesion from foramen magnum to C4 level. She underwent decompressive laminectomy and durotomy followed by steroid therapy. However, her conditions deteriorated gradually and medical complications occurred. In our cases, etiology was not found despite through investigations. Initial MRI showed dural thickening with mixed signal intensity on T1- and T2-weighted images. Pathologic examination revealed chronic nonspecific inflammation in both patients. Although one patient developed several complications, the other showed slow improvement of neurological symptoms with decompressive surgery and steroid therapy. In case of chronic compressive myelopathy due to the dural hypertrophic change, decompressive surgery such as laminectomy or laminoplasty may be helpful as well as postoperative steroid therapy.

Case Report of a Lumbar Disc Herniation (LDH) Patient with Chronic Active Hepatitis B (만성 활동성 B형 간염 질환 환자의 요추간판 탈출증 치험례)

  • Jung, You-jin;Kang, Kyung-rae;Lee, Min-su;Choi, A-ryun;Kang, A-hyun;Han, Dong-kun;Song, Woo-sub;Lee, Hyung-chung
    • The Journal of Internal Korean Medicine
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    • v.37 no.2
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    • pp.374-380
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    • 2016
  • Objective: Although the incidence of chronic hepatitis B has decreased around the world due to widespread national preventative control measures, mortality from the same condition can increase if the condition leads to liver cancer or liver cirrhosis. In most cases, herbal medicine does not show any statistically significant effects related to liver damage, but preconceptions do exist that herbal medicine can be toxic and cause such liver damage. To investigate this situation, this study therefore investigated a patient with hepatitis B who had combined traditional Korean medicine therapy and the use of analgesic drugs during a hospitalization period.Method: A patient with hepatitis B was given combined traditional Korean medicine therapy and the use of analgesic drugs during a hospitalization period.Results: Within 26 days, the patient was free from liver damage during the hospitalization period. She was followed up with a liver function test and was discharged after her condition improved; she also reported decreased back pain.

The Role of Bone Cement Augmentation in the Treatment of Chronic Symptomatic Osteoporotic Compression Fracture

  • Kim, Hyeun-Sung;Kim, Sung-Hoon;Ju, Chang-Il;Kim, Seok-Won;Lee, Sung-Myung;Shin, Ho
    • Journal of Korean Neurosurgical Society
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    • v.48 no.6
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    • pp.490-495
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    • 2010
  • Objective : Bone cement augmentation procedures such as percutaneous vertebroplasty and balloon kyphoplasty have been shown to be effective treatment for acute or subacute osteoporotic vertebral compression fractures. The purpose of this study was to determine the efficacy of bone cement augmentation procedures for long standing osteoporotic vertebral compression fracture with late vertebral collapse and persistent back pain. Methods : Among 278 single level osteoporotic vertebral compression fractures that were treated by vertebral augmentation procedures at our institute, 18 consecutive patients were included in this study. Study inclusion was limited to initially, minimal compression fractures, but showing a poor prognosis due to late vertebral collapse, intravertebral vacuum clefts and continuous back pain despite conservative treatment for more than one year. The subjects included three men and 15 women. The mean age was 70.7 with a range from 64 to 85 years of age. After postural reduction for two days, bone cement augmentation procedures following intraoperative pressure reduction were performed. Imaging and clinical findings, including the level of the vertebra involved, vertebral height restoration, injected cement volume, local kyphosis, clinical outcome and complications were analyzed. Results : The mean follow-up period after bone cement augmentation procedures was 14.3 months (range 12-27 months). The mean injected cement volume was 4.1 mL (range 2.4-5.9 mL). The unipedicular approach was possible in 15 patients. The mean pain score (visual analogue scale) prior to surgery was 7.1, which decreased to 3.1 at 7 days after the procedure. The pain relief was maintained at the final follow up. The kyphotic angle improved significantly from $21.2{\pm}4.9^{\circ}$ before surgery to $10.4{\pm}3.8^{\circ}$ after surgery. The fraction of vertebral height increased from 30% to 60% after bone cement augmentation, and the restored vertebral height was maintained at the final follow up. There were no serious complications related to cement leakage. Conclusion : In the management of even long-standing osteoporotic vertebral compression fracture for over one year, bone cement augmentation procedures following postural reduction were considered safe and effective treatment in cases of non-healing evidence.

Analysis of Readmission Patients after Lumbar Microdiscectomy (요추간판 미세 현미경 수술 후 재입원 환자의 분석)

  • Chi, Yong-Chul;Son, Byung-Gil;Choi, Eun-Seok;Lee, Si-Ou;Shin, Jong-Hyun;Cha, Young-Hoon
    • Journal of Korean Neurosurgical Society
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    • v.29 no.6
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    • pp.772-777
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    • 2000
  • Objectives : After lumbar microdiscectomy there are relatively higher incidence of readmission because of various postoperative discomfort. Analyzing these readmitted patients in our private hospital where the patients can be readmitted more easily, we expect to find out which factors are associated with improvement of the surgical outcome. Patients and Methoes : After discharge all significant patient's clinical data were registered to our computerized data bank system and periodic follow-up were performed. The authors analysed 651(97.7%) cases followed up over 2 years(average 3 years) out of 666 patients who underwent a initial lumbar microdiscectomy from May, 1994 to April, 1997. Among them, 63 patients(9.7%) were readmitted. Results : Among the patients readmitted, 29 patients(4.5%) were reoperated because of recurred disc herniation, 17 patients were myofascial pain syndrome, 4 patients were discitis, 3 patients were adhesion and one patient was epidural abscess. Treatment results of these readmitted patients showed that success rate of all readmitted patients was 68.3%, reoperation was 58.6% and myofascial pain syndrome was 82.4%. Conclusion : Treatment results of the patients readmitted because of a continuous lumbago or leg pain after microdiscectomy were acceptable through the careful analysis of the causes of the recurrent symptom. Therefore, the incidence of the chronic failed back syndrome can be reduced by efforting a more active management through readmission.

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A Comparative Review on Carthmi-Flos Pharmacopuncture Treatment - Focused on Clinical Study (홍화약침 시술에 관한 임상논문 비교연구)

  • Lee, Soo-Hwan;Yoon, Jeong-Won;Kim, Soon-Joong
    • Journal of Korean Medicine Rehabilitation
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    • v.27 no.4
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    • pp.55-65
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    • 2017
  • Objectives The purpose of this review is to analyze results of case studies and controlled studies about Carthmi-Flos pharmacopuncture. Based on the review, authors desire to suggest the study model including precise information and evident the effect of Carthmi-Flos pharmacopuncture objectively in treating clinical disorders. Methods We search 44 studies about Carthmi-Flos pharmacopuncture from 6 Korean web databases, using words 'Carthmi-Flos pharmacopuncture' in Korean alphabet. This study had been conducted throughout 1 month (July, 2017). We selected case studies and controlled trials in investigated 44 thesis, excluding experimental research and thesis not using the Carthmi-Flos pharmacopuncture for major treatment. Results We analyze 13 case reports and 7 controlled trials. As a result, Carthmi-Flos Pharmacopuncture was used mostly in musculoskeletal, neurological diseases. But this can be applied to internal diseases. Disorders reported effectively were carpal tunnel syndrome, degenerative knee joint arthritis, posterior neck pain, low back pain, radial nerve palsy, shoulder pain, lumbar compression fracture, alopecia areata, chronic daily headache, duverney fracture, oligomenorrhea, cervical disc herniation, rheumatoid arthritis and cervical headache. Conclusions As we analyzed, Carthmi-Flos pharmacopuncture is specifically effective in musculoskeletal and neurologic diseases. But there are various problems in study design. To design accurately, the study design should include much more specific information. And the result can be more precise by excluding other methods.

Korean Medicinal In-patient Treatments for Chronic Renal Disease : 2 cases report (만성신질환 환자의 한의 입원치료 치험 2례)

  • Oh, Jeong Min;Jung, Eun Sun;Choi, Koh Eun;Heo, Jong Won;Kim, Hyun Tae;Ryu, Ju Young;Lee, Kang Wook;Cha, Ji Yun;Seol, In Chan;Cho, Hyun Kyoung;Yoo, Ho Ryong;Cho, Min Kyoung;Kim, Yoon Sik
    • Journal of Physiology & Pathology in Korean Medicine
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    • v.30 no.4
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    • pp.289-299
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    • 2016
  • This study is aimed to report two cases of chronic kidney disease treated with Korean traditional medicine. We treated the patients with traditional herbal medicine and other treatments including acupuncture. We measured serum creatinine, estimated glomerular filtration rate(eGFR), blood urea nitrogen(BUN), albumin, red blood cell count(RBC), hemoglobin for several times during admission. Case 1 patient was diagnosed with right medulla infarction, bladder stone, chronic kidney disease. The symptoms were quadriplegia, right side dysesthesia, drowsiness and edema. Case 2 patient was diagnosed with acute cerebral infarction, hypertension, chronic kidney disease. The symptoms were right side weakness, delusion, anorexia, low back pain. Case 1 patient was hospitalized for 80 days, and case 2 patient was for 31 days. Korean traditional medicine decreased serum creatinine and BUN level, improved eGFR, increased RBC and hemoglobin. The symptoms of chronic kidney disease such as edema, general body weakness and anorexia were also improved. These cases suggest that Korean traditional medicine can be effective and safe for patients with chronic kidney disease.

Development of a Discogenic Pain Animal Model: Preliminary Study (추간판성통증 동물모델의 개발: 초기 연구)

  • Kim, Byung-Jo;Lee, Min;Lim, Eun-Jeong;Yu, Sung-Wook;Hong, Sung-Ha;Hong, Seok-Joo;Na, Heung-Sik
    • Annals of Clinical Neurophysiology
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    • v.11 no.2
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    • pp.41-47
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    • 2009
  • Background: Discogenic pain can develop into chronic low back pain that is very difficult to treat effectively, because the pathogenesis of the disease still remains controversial. To clarify the pathogenesis, numerous animal models of intervertebral disc degeneration have been proposed in the literature, each with attendant advantages and disadvantages. The aim of this study was to determine the most efficacious method and dose of complete Freund's adjuvant (CFA) injection into intervertebral disc to develop a discogenic pain in a rat. Methods: CFA was injected into the L5-L6 or L4-L5 disc of male Sprague-Dawley rats in various conditions including a dose of CFA (10, 20, or 50 uL), drilling, injection site sealing using cyanoacrylate, and injection velocity. Sham animals were subjected to the same procedure, except for the CFA injection. Mechanical and heat allodynia were serially measured at both hindpaws until 8 weeks post-operatively. Serial MRI analyses were performed to observe degenerative changes of the discs. In addition, CGRP & Substance P-immunoreactivities (ir) in the superficial dorsal horn were evaluated at 4 weeks using immunohistochemistry. Results: Each condition provoked various problems such as development of hindpaw paralysis, CFA leakage, and no pain development. Mid-sagittal T2 MRI revealed no significant degenerative changes in the CFA injected disc. The CGRP-ir of the bilateral superficial dorsal horns at the level of L5-L6 was significantly increased in the CFA group. Conclusions: A total of 10 uL CFA injection into L5-L6 disc for a period of 10 minutes using a 26-gauge needle without drilling was the most efficacious way to develop discogenic pain animal model.

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Clinical Application of Focused Ultrasound in Korean Medicine (집속초음파 치료의 한의 임상 활용에 대한 고찰)

  • Yoomin Choi;Maeum Lee;Nayeon Hur;Eunhee Lee;Hyugyong Choi;Hyung-Sik Seo;Eui-Hyoung Hwang;Insoo Jang
    • Korean Journal of Acupuncture
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    • v.40 no.3
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    • pp.79-89
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    • 2023
  • Objectives : The purpose of this study is to investigate various application methods of focused ultrasound and apply them to clinical use in Korean medicine. Methods : Search was performed using the search engines of electronic databases, including PubMed, ScienceDirect, Cumulative Index to Nursing and Allied Health Literature (CINAHL), ScienceON, Oriental Medicine Advanced Searching Integrated System (OASIS), China National Knowledge Infrastructure (CNKI), Wanfang Data, Japan Science Technology Information Aggregator, Electronic (J-STAGE) and Citation Information by NII (CiNii), from inception to July 2023 without language limitation. Inclusion criteria were clinical studies including randomized controlled trials (RCTs), and animal experimental studies related with focused ultrasound treatments for acupoints or meridian sinews. Results : Total 17 papers, 7 for RCT, 6 for in vivo animal studies, and other experimental studies, were finally selected. Indications used in studies were shoulder pain, back pain, chronic back pain, and degenerative knee arthritis. In experimental studies, studies on animal models of hypoxic ischemic brain damage and hyperlipidemia were also conducted. As for the acupoints, LR3, LI4, and ST36 were used in clinical studies and, in animal experimental studies, GV20, KI1, and ST36 were used. As for the dose, 4 studies below 3 W/cm2 and 3 studies in the range of 0.625 to 5 W/cm2 in clinical studies, and all studies did not exceed 5 W/cm2. In animal experimental studies, 0.5 W/cm2, 2 W/cm2, 7.5 WW/cm2, 15 W/cm2, 10~20 W/cm2 were used. In all three studies describing the penetration depth during irradiation, it was less than 1 cm. Conclusions : We suggest that focused ultrasound is an appropriate treatment tool for stimulating the acupoints to transfer heat energy. Future studies with rigorous and well-designed RCTs for various diseases will be required to ascertain the focused ultrasound stimulate acupoints or meridian sinews.

INFLUNCE OF ELECTRO-MYOSCOPE(ACUSCOPE) ON INJURED QUADRICEPS FEMORIS WITH USING ELECTRO_MYOGRAPHIC ANALYSIS BUILT INTO THE ELCETROMYOSCOPE

  • Song, Byung-Ho
    • Journal of Korean Physical Therapy Science
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    • v.7 no.2
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    • pp.697-709
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    • 2000
  • The purpose of this study was to evaluate the effectiveness of ElectroMyoscope(Electro_Acuscope and Myopulse) in tissue repairing on fatigue quadriceps femoris(rectus femoris, vastus lateralis, vastus intermedius, and vastus medialis). Subjects were female adult volunteers with (n=13) and without (n=5) chronic fatigue muscle pain. We needed to fatigue the rectus femoris by overusing of a Cybex machine exercise. We turned the Electro-Myoscope to treatment mode and treated with treatment probe on the fatigue muscle, then turned instrument back to EMG and took the reading. The results indicated that the reading after the treatment was lower than before the treatment. A two-tailed t-test and Chi square indicated significant results(P<.03). It appears that the Electro-Myoscope is effective in treatment on the fatigue muscle.

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Candida Parapsilosis Spondylodiscitis after Lumbar Discectomy

  • Cho, Kyun-Gil;Lee, Sun-Ho;Kim, Eun-Sang;Eoh, Whan
    • Journal of Korean Neurosurgical Society
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    • v.47 no.4
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    • pp.295-297
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    • 2010
  • Candida is a relatively rare cause of spinal infections that commonly affects immunocompromised patients. A 70-year-old woman, who underwent a lumbar discectomy on L5-S1 two months earlier, was admitted to our department complaining of persistent back and leg pain. Magnetic resonance imaging showed irregular enhancing mass lesion in L5-S1 intervertebral space, suggest of pyogenic discitis with epidural abscess. The surgery was performed via retroperitoneal approach and the infected material at L5-S1 intervertebral space was removed. The histological examination of the specimen revealed chronic inflammation involving the bone and soft tissue, and a culture of the excised material was positive for Candida parapsilosis. The patient received intravenous fluconazole for 4 weeks after surgery and oral fluconazole 400 mg/day for 3 months after surgery. The patient made a full recovery with no symptoms 6 months after surgery. We present a rare case of spondylodiscitis after a lumbar discectomy due to Candida parapsilosis and discuss treatment option with a review of the literatures.