• 한국정밀공학회:학술대회논문집
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• 한국정밀공학회 2005년도 춘계학술대회 논문집
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• pp.907-910
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• 2005

Although several artificial disc designs have been developed for the treatment of discogenic low back pain, biomechanical change with its implantation was rarely studied. To evaluate the effect of artificial disc implantation on the biomechanics of functional spinal unit, nonlinear three-dimensional finite element model of L4-L5 was developed with 1-mm CT scan data. Two models implanted with artificial discs, SB $Charit\acute{e}$ or Prodisc, via anterior approach were also developed. The implanted model predictions were compared with that of intact model. Angular motion of vertebral body, force on spinal ligaments and facet joint, and the stress distribution of vertebral endplate for flexion-extension, lateral bending, and axial rotation with a compressive preload of 400 N were compared. The implanted model showed increased flexion-extension range of motion and increased force in the vertically oriented ligaments, such as ligamentum flavum, supraspinous ligament and interspinous ligament. The increase of facet contact force on extension were greater in implanted models. The incresed stress distribution on vertebral endplate for implanted cases indicated that additinal bone growth around vertebral body and this is matched well with clinical observation. With axial rotation moment, relatively less axial rotation were observed in SB $Charit\acute{e}$ model than in ProDisc model.

• Journal of Dental Anesthesia and Pain Medicine
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• 제21권1호
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• pp.71-80
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• 2021

Background: The options for stabilization appliance therapy for masticatory muscle pain include soft occlusal and hard stabilization appliances. A previous study suggested that hard stabilization appliance therapy was effective for patients with local myalgia who developed long facets on their occlusal appliances. The objective of this study was to identify patients in whom a soft occlusal appliance should be used to treat masticatory muscle pain by analyzing the type of muscle pain present and patient factors that influenced the effectiveness of this treatment. Methods: The study included 42 patients diagnosed with local myalgia or myofascial pain according to the Diagnostic Criteria for Temporomandibular Disorders Diagnostic Decision Tree. The analysis of patient factors included variables believed to be associated with temporomandibular disorders. First, a temporary screening appliance was used for 2 weeks to assess each patient for bruxism during sleep. Soft appliance therapy was then started. For each patient, the effectiveness of the appliance was evaluated according to the intensity of tenderness during muscle palpation and the treatment satisfaction score at one month after starting treatment. Results: Data from 37 of the 42 patients were available for analysis. Twenty-five patients reported satisfaction with the appliance. In logistic regression analysis, the odds ratio for reduction of facet length was 1.998. Nineteen patients showed at least a 30% improvement in the visual analog scale score. The odds ratio for local myalgia was 18.148. Conclusion: Soft appliance therapy may be used in patients with local myalgia. Moreover, patients who develop short facets on the appliance surface are likely to be satisfied with soft appliance therapy. Soft appliance therapy may be appropriate for patients with local myalgia who develop short facets on their occlusal appliance.

• The Korean Journal of Pain
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• 제20권2호
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• pp.111-115
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• 2007

Background: Selective diagnostic blocks of the medial branches of the dorsal primary ramus are usually performed under the guidance of fluoroscopic or computed tomography. Recently, however, ultrasound guidance has been suggested as an altemative method. In this study, the distances between the vertebral structures were measured and compared with the values measured using magnetic resonance imaging (MRI) to assess the clinical feasibility of using ultrasound-guided block in Korean patients. Methods: Five male and 15 female patients were enrolled in this study. The target point of the medial branch block in our study was the groove at the base of the superior articular process, We measured the depth from the skin to the target point at the transverse process (d-TP) and to the most superficial point of the superior articular process (d-AP). Results: The d-TP and d-AP values measured under ultrasound guidance were concordant with the values measured using MRI. Conclusions: The images of the bony landmarks obtained under ultrasound examination could be useful for ultrasound-guided lumbar medial branch block.

• Annals of Clinical Neurophysiology
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• 제12권1호
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• pp.3-6
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• 2010

The British guideline for early management of persistent low back pain, published in 2009, indicated that physicians should offer exercise or medication, rather than radiological interventions or injections, as first choice of treatment in the patients with chronic low back pain (CLBP). However, there had been great controversies regarding the effectiveness of interventional treatment of patients with CLBP. Both somatic (discogenic, instability, etc) and psychosocial factors contribute to the pathophysiology of chronic low back pain (CLBP). Although it can be difficult in many occasions, thorough interview with the patients and specific diagnostic approaches can help us to identify which is the main etiology in individual patient. With the recent progress in medical radiology and development of new therapeutic modalities, some subgroups of patients of CLBP caused by somatic factors appear to be good candidates of interventional therapy. Interventional therapy can be considered in patients with CLBP caused by annulus rupture, facet joint degeneration, disc degeneration, and vertebral column instability. Among other subgroups of CLBP, carefully selected patients with disc degeneration show the most favorable result by interventional therapy. In this regard, discogenic pain, either as a form of CLBP or acute discogenic radiculopathy, seems to be a good indication of interventional therapy. Because many spine specialists generally consider those with radiculopathy are easier to be treated, patients with CLBP tend to be subjects of conventional conservative therapy. For these reasons, clinicians should make their best effort to identify every possible somatic cause in patients with CLBP before regarding them as hypochondriacs. In this review, some of the recent evidence on the role of interventional treatment in patients with CLBP will be discussed, and some of our cases who showed favorable results by interventional therapy will be presented.

• 대한물리의학회지
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• 제1권1호
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• pp.125-137
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• 2006

Purpose : The purpose of the study was to examine lumbar pain through literature reviews about herniated intervertebral disc (HIVD). Methods : Diagnosis was made by patient's history, physical examination, simple radiography, myelography, spinal computerized tomography, electromyography, somatosensory evoked potential, etc. Results : There are two treatment modalities, one is conservative and the other is operative. About 90% of patients with HIVD have been recovered only by conservative treatment and therapeutic exercise was the most effective one among these conservative treatments. Conclusion : We consider HIVD can be treated with therapeutic exercise which can correct muscular imbalance and facet joint problems and make the degenerative process of intervertebral disc slower.

• Journal of Yeungnam Medical Science
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• 제8권2호
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• pp.222-226
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• 1991

In advant of high-resolutional CT and MRI, it is not so difficult to detect the lumbar synovial cyst, however the unusual disease should be included in the differential diagnosis of cauda equina compression syndromes. The case of a 55-year-old man who had a low back pain and severe radiating pain on both legs showed a retrolisthesis at L3-4 and L4-5 and epidural enhansing mass just around L4-5 facet joint on MRI. Microscopically a lining of synovial tissue was demonstrated. After surgery of the total resection of synovial cyst and stabilization, the patient's presenting symptoms were improved.

• The Journal of Korean Physical Therapy
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• 제10권2호
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• pp.149-159
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• 1998

요추가 제기능을 다하려면 추체와 디스크 및 후관절을 구성하고 있는 주위 연부조직이 정상적 위치에 있어야한다. 또한 체중을 지탱하는 역학적 관계로 볼 때 척주(vertebral column)의 운동범위가 가장 큰 부위가 요천추관절이므로 항상 구조적 변화가 잘 일어난다. 이러한 사실로 볼 때 요통 발생은 요추부의 해부학적 구조 중 후관절, 추체, 추간판의 역학적 관계를 고찰을 통해서 본 결과 어느 특정한 한 부위에서 발생한 것 보다는 추체, 추간판, 후관절의 변화에 따른 주위 연부조직의 변화도 함께 동반 손상이 된다는 결론을 얻을 수 있다. 요통이란 용어는 포괄적인 개념에서 다양한 원인과 증상을 동반하는 매우 광범위한 질병 중 대표적이라 할 수 있다. 요통의 해부학적 고찰을 통해서 미비하나마, 요통은 디스크의 문제라는 일반적인 개념에서 탈피해서 여러 가지 복잡 다양한 원인과 증상을 알아보았다. 요통의 치료는 그 원인에 따라 치료가 이루어져야 하기 때문에 좀더 정확한 원인을 규명하는 것이 필수적이라 생각된다.

• 대한족부족관절학회지
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• 제21권4호
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• pp.144-150
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• 2017

Purpose: To assess the clinical and radiographic results and complications of arthroscopy-assisted reduction and percutaneous fixation for patients with tongue-type Sanders type II calcaneal fractures. Materials and Methods: Between August 2014 and December 2015, 10 patients who underwent surgery using subtalar arthroscopic assisted reduction and percutaneous fixation for tongue-type Sanders type II calcaneal fractures were reviewed. The mean age was 50.8 years (36~62 years), and the mean follow-up period was 24 months (12~40 months). The clinical results were evaluated using the visual analogue scale (VAS) and American Orthopaedic Foot and Ankle Society (AOFAS) ankle-hindfoot score at the regular follow-ups, and the foot function index (FFI) at the last follow-up. The subtalar range of motion (ROM) was evaluated and compared with the uninjured limb at the last follow-up. The radiographic results were assessed using the Bohler's angle from the plain radiographs and the reduction of the posterior calcaneal facet using computed tomography (CT). The postoperative complications were assessed by a chart review. Results: The VAS and AOFAS ankle-hindfoot score improved until 12 months after surgery. The FFI was 15 (1.8~25.9) and subtalar ROM was 75.5% (60%~100%) compared to the uninjured limb at the last follow-up. The $B{\ddot{o}}hler^{\prime}s$ angle was increased significantly from $2^{\circ}$ ($-14^{\circ}{\sim}18^{\circ}$) preoperatively to $21.8^{\circ}$ ($20^{\circ}{\sim}28^{\circ}$) at the last follow-up. The reduction of the posterior facet was graded as excellent in five feet (50.0%) and good in five (50.0%) on CT obtained at 12 months after surgery. One foot (10.0%) had subfibular pain due to a prominent screw head. One foot (10.0%) had pain due to a longitudinal tear of the peroneal tendon that occurred during screw insertion. Conclusion: Subtalar arthroscopic-assisted reduction of the posterior calcaneal facet of the subtalar joint and percutaneous fixation is a useful surgical method for tongue-type Sanders type II calcaneal fractures.

• 대한족부족관절학회지
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• 제16권2호
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• pp.116-122
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• 2012

Purpose: Subtalar arthrodesis has been the gold standard for the painful subtalar joint disorders. Successful subtalar arthrodesis requires fusion of the 3 facet joints. The purpose of the study is to compare the clinical outcome of the posterior fixation (P2) and anterior-posterior (A1P1) fixation technique for subtalar arthrodesis which enhance anterior and middle facet fixation. Materials and Methods: The study is based on the 20 feet (19 patients) of the subtalar arthrodesis utilizing cannulated screws from September 2006 to September 2009 with at least 1-year follow-up. Two fixation techniques were utilized for the subtalar arthrodesis: 1) posterior fixation only (P2, 7 feet, 35%) and 2) anterior-posterior (A1P1) fixation method (13 feet, 65%). Visual Analog Scale Pain (VAS) score, American Orthopaedic Foot and Ankle Society (AOFAS) ankle-hindfoot score (maximum: 94 points), the time for returning to daily living and the patient satisfaction were also evaluated. Results: Average follow-up period were 13.2 months (12-3 mo). The AOFAS score improved from preoperative average 45 (0-68) to 81.6 (62-94), while VAS score was decreased from average 8.0 (3-10) to 1.8 (0-5) at final follow-up. Ninety-five percent of the patients were satisfied with surgery. All the patients returned to daily living at average 7.2 months (2-15 mo) post-surgery. Radiographically, 2 techniques both showed 100% fusion of the posterior compartment of the subtalar joint. Postoperative complications were 1 case of low grade infection and 1 case of sural nerve neuralgia. Conclusion: The subtalar arthrodesis using A1P1 fixation technique showed better fusion rate of the anterior compartment of the subtalar joint compared to P2 fixation technique although the 2 techniques both showed similar favorable clinical outcome. Therefore the A1P1 fixation technique is found to be a viable option to address chronic painful subtalar joint disorders to enhance the anterior compartment fixation.

• 대한정형외과학회지
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• 제56권4호
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• pp.351-356
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• 2021

부고환 결핵으로 부고환 절제술 및 항결핵제제를 복용중인 67세 남자 환자가 급성 요통 및 방사통을 주소로 내원하였다. 환자는 통풍의 과거력은 없었으나 혈액 검사상 고요산혈증 소견을 보였으며, 요추 후관절 및 후궁 부위의 골 파괴 병변이 관찰되었다. 요추 후관절 부위의 컴퓨터 단층촬영 유도하 바늘 생검을 실시하여 조직학적 검사를 시행한 결과 통풍성 척추관절병증 및 결핵성 척추염이 진단되었다. 환자는 통풍성 관절염에 대한 보존적 치료를 통해 증상은 호전되었다. 항결핵제제 복용 등 고요산혈증 위험을 가진 환자가 급성 요통을 호소하는 경우 통풍성 척추관절병증을 감별진단해야 하겠다.