• The Korean Journal of Pain
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• v.9 no.2
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• pp.407-411
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• 1996

Stereotactic radiofrequency dorsal root ganglionotomy can be very useful procedures for the treatment of pain emanating from the lumbar segmental nerves. This procedure is reserved for patients who have failed conservative interventional treatments and in whom open surgical intervention is not an option. The advantages of the radiofrequency lesion method are presented, excellent control of the lesion process using temperature monitoring to quantify the lesion size, prevent boiling, and to produce differential destruction of neural tissue. The afferent fibers in the ventral root which are spared by dorsal rhizotomy but nerve fibers with their cells in the ganglion from either dorsal or ventral root can be destructed with stereotactic radiofrequency ganglionotomy. This technique is performed using a 100 mm cannula with a 5 mm active tip. Repeated lateral fluoroscopic view should be taken to make sure that cannlua still resides within the superior, dorsal quadrant or the foramen. With the cannula in this position, electrostimulation is performed and good paresthesia on the leg should be noted with 0.3 and 0.5 volt at 50 Hz stimulation. At 2Hz stimulation distinct dissociation between motor and sensory should be shown. Percutaneous lumbar ganglionotomy have carried out under local anesthesia on inpatient basis in 6 patients. A series of 5 patients with metastatic cancer pain and a patient with compression fracture have been relieved of pain without serious complications.

• Journal of Korean Foot and Ankle Society
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• v.12 no.1
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• pp.66-73
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• 2008

Purpose: To report the clinical results of tibio-talo-calcaneal arthrodesis fixed with multiple cannulated screws for the cases of painful ankle and hindfoot arthropathy regardless of any deformity or instability. Materials and Methods: A retrospective analysis was performed upon 10 patients that underwent tibio-talo-calcaneal arthrodesis from October 1999 to May 2006. There were 4 males and 6 females, with an average age of 63 years (43-70). The etioloty of arthrodesis included 5 osteoarthritis, 2 Charcot joints, 1 rheumatoid arthritis, 1 Tbc arthritis and 1 residual poliomyelitis. Chief complaints were pain in 9 cases and instability in 1 case. Three patients had combined severe varus deformity. Tibio-talo-calcaneal arthrodesis using multiple cannulated screws was performed by transfibular approach for all cases and short leg cast was applied for 12 weeks postoperatively. Results: The average follow-up period was 16.5 months (12-26 months). VAS pain score was average 8.2 (7-10) and modified AOFAS score was average 25 (8-40, total 86) preoperatively. At final follow-up, VAS score was average 1.0 (0-3) and AOFAS score improved to average 66 (58-75). There were 4 complications: 2 nonunion, 1 tibia stress fracture and 1 malunion. Seven of 8 patients were satisfied with the results at final follow-up. Conclusion: Fixation with multiple cannulated screws for tibio-talo-calcaneal arthrodesis through transfibular approach is a recommendable surgical option.

• The Korean Journal of Pain
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• v.21 no.3
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• pp.202-205
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• 2008

Background: Lumbar radicular pain is a frequent and often debilitating event. Although many treatment methods have been described in several studies, the available evidences regarding efficacy is not sufficient enough to draw definitive conclusions on an optimal therapy regime. Pulsed radiofrequency (RF) treatment was found to exert a beneficial effect on intractable radicular pain in individuals. The purpose of this study was to assess the efficacy of pulsed RF of the dorsal root ganglion for chronic lumbar radicular pain. Methods: Twenty five patients with chronic lumbar radicular pain that was refractory to selective nerve root blockage met the inclusion criteria of our study and received pulsed RF treatment. The average numeric rating scale (NRS) for leg pain during usual activities and the Oswestry disability index (ODI) were measured at 1 and 3 months after the procedure. Results: Of the 25 patients accepted for pulsed RF treatment, one dropped out due to a vertebral compression fracture during this study. ODI and NRS showed a positive trend in favor of the pulsed RF treatment. No significant complications were observed during the study period. Conclusions: It appears that pulsed RF treatment of the lumbar spinal dorsal root ganglion may be an effective treatment method for patients suffering from lumbar radicular pain, and who were not responsive to selective nerve root blockage.

• Journal of Korean Neurosurgical Society
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• v.42 no.3
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• pp.195-199
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• 2007

Objective : Bilateral laminotomy and unilateral laminotomy for bilateral decompression are becoming the minimally invasive procedures for lumbar spinal stenosis (LSS). With the aim of less invasiveness and better preservation of spinal stability. these techniques have been developed. But there are no large randomized studies to show the surgical results between these two techniques. The objective of this study was to examine the safety and efficacy of these two minimally invasive techniques. Methods : A total of 80 patients were included in this study (Group I : bilateral laminotomy, Group II : Unilateral laminotomy for bilateral decompression). Perioperative parameters and complications were analyzed. Symptoms and scores such as visual analog scale (VAS) scores, Oswestry Disability Index (ODI) scores, and SF-36 scores of prospectively accrued patients were assessed preoperatively and at 1 month and 12 months after surgery. Paired-t test, two-sample student-t tests, and non parametric tests were used to determine cross-sectional differences between two groups. Results : No major complications such as spinal instability or deaths occurred during follow-up periods. VAS, ODI scores and SF-36 body pain and physical function scores showed statistically significant improvements in both groups (p<0.001). The significant widening of the spinal canal diameter was also noted in both groups. But, in Group II. there were minor postoperative complications such as dural tear (2 cases 5.0%), fracture of ipsilateral inferior facet (1 case 2.5%), and 5 cases of transient leg symptoms of contralateral side. Conclusion : Both bilateral laminotomy and unilateral laminotomy for bilateral decompression allow achievement of adequate and long-lasting operative results in patients with LSS. But postoperative complications are more frequent in Group II (unilateral laminotomy and bilateral decompression). These results indicate that bilateral laminotomy is the preferred minimally invasive technique to treat symptomatic LSS.

• Journal of Korean Neurosurgical Society
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• v.54 no.2
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• pp.128-131
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• 2013

Transforaminal lumbar interbody fusion (TLIF) is commonly used procedure for spinal fusion. However, there are no reports describing anterior cage dislodgement after surgery. This report is a rare case of anterior dislodgement of fusion cage after TLIF for the treatment of isthmic spondylolisthesis with lumbosacral transitional vertebra (LSTV). A 51-year-old man underwent TLIF at L4-5 with posterior instrumentation for the treatment of grade 1 isthmic spondylolisthesis with LSTV. At 7 weeks postoperatively, imaging studies demonstrated that banana-shaped cage migrated anteriorly and anterolisthesis recurred at the index level with pseudoarthrosis. The cage was removed and exchanged by new cage through anterior approach, and screws were replaced with larger size ones and cement augmentation was added. At postoperative 2 days of revision surgery, computed tomography (CT) showed fracture on lateral pedicle and body wall of L5 vertebra. He underwent surgery again for paraspinal decompression at L4-5 and extension of instrumentation to S1 vertebra. His back and leg pains improved significantly after final revision surgery and symptom relief was maintained during follow-up period. At 6 months follow-up, CT images showed solid fusion at L4-5 level. Careful cage selection for TLIF must be done for treatment of spondylolisthesis accompanied with deformed LSTV, especially when reduction will be attempted. Banana-shaped cage should be positioned anteriorly, but anterior dislodgement of cage and reduction failure may occur in case of a highly unstable spine. Revision surgery for the treatment of an anteriorly dislodged cage may be effectively performed using an anterior approach.

• Archives of Reconstructive Microsurgery
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• v.8 no.2
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• pp.130-138
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• 1999

The lower extremity injuries are extremely increasing with the development of industrial & transportational technology. For the lower extremity injuries that result from high-energy forces, particularly those in which soft tissue and large segments of bone have been destroyed and there is some degree of vascular compromise, the problems in reconstruction are major and more complex. In such cases local muscle coverage is probably unsuccessful, because adjacent muscles are destroyed much more than one can initially expect. Reconstruction of the lower extremity has been planned by dividing the lower leg into three parts traditionally The flaps available in each of the three parts are gastrocnemius flap for proximal one third, soleus flap for middle one third and free flap transfer for lower one third. Microvascular surgery can provide the necessary soft tissue coverage from the remote donnor area by free flap transfer into the defect. Correct selection of the appropriate recipient vessels is difficult and remains the most important factor in successful free flap transfer. Vascular anastomosis to recipient vessels distal to the zone of injury has been advocated and retrograde flow flaps are well established in island flaps. Retrograde flow anastomosis could not interrupt the major blood vessels which were essential for survival of the distal limb, the compromise of fracture or wound healing might be prevented. During 5 years, from March 1993 to Feb. 1998, we have done 68 free flap transfers in 61 patients to reconstruct the lower extremity. From analysis of the cases, we concluded that for the reconstruction of the lower extremity, free flap transfer yields a more esthetic and functional results.

• Steel and Composite Structures
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• v.39 no.4
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• pp.383-399
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• 2021

In the study, three 1:3-scale unequal span steel-concrete composite substructures with top-seat angle and double web angle connection were designed and identified as specimens GTSDWA-0.6, GTSDWA-1.0, and GTSDWA-1.4. Pseudo-static tests and refined numerical model analysis were conducted to examine the anti-progressive collapse performance of a semi-rigid steel-concrete composite substructure. The results indicated that the failure modes of the three specimens revealed that the fracture occurred in the root of the long leg of the top/seat angle in tension at the connection. With increases in the span ratio of the left and right composite beams, the bearing capacities of the composite substructures decreased, and the corresponding displacement increased. With respect to GTSDWA-0.6 and GTSDWA-1.4, the resistance due to the short composite beam corresponded to 62% and 60%, respectively, and the total resistance provided by the short composite beam exceeded that of the long composite beam. With respect to GTSDWA-1.0, the resistance due to the left and right composite beams was similar. All three specimens underwent the flexure mechanism and flexure-axial mixed mechanism stages. They resisted the external load mainly via the flexure mechanism. Moreover, the addition of stiffeners on both sides of the top and seat angles is advantageous in terms of improving the collapse resistance and ductility of unequal span composite substructures.

• Physical Therapy Korea
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• v.29 no.1
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• pp.48-53
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• 2022

Background: The gastrocnemius tightness can easily occur. Gastrocnemius tightness results in gait disturbance. Thus, various interventions have been used to release a tight gastrocnemius muscle and improve gait performance. Moreover, focal muscle vibration (FMV) has recently been extensively researched in terms of tight muscle release and muscle performance. However, no study has investigated the effects of FMV application on medial gastrocnemius architectural changes. Objects: In this study, we aimed to investigate the effects of FMV on medial gastrocnemius architecture in persons with limited ankle dorsiflexion. Methods: Thirty one persons with <10° of passive ankle dorsiflexion participated in this study. We excluded persons with acute ankle injury within six months prior to study onset, a history of ankle fracture, leg length discrepancy greater than 2 cm, no history of neurological dysfunction, or trauma affecting the lower limb. The specifications of the FMV motor were as follows: a fixed frequency (fast wave: 150 Hz) and low amplitude (0.3-0.5 mm peak to peak) of vibration; the motor was used to release the medial gastrocnemius for 15 minutes. Each participant completed three trials for 10 days; a 30-second rest period was provided between each trial. Medial gastrocnemius architectural parameters [muscle thickness (MT), fiber bundle length (FBL), and pennation angle (PA)] were measured via ultrasonography. Results: MT significantly decreased after FMV application (p < 0.05). FBL significantly increased from its baseline value after FMV application (p < 0.05). PA significantly decreased from its baseline value after FMV application (p < 0.05). Conclusion: FMV application may be advantageous in reducing medial gastrocnemius excitability following a decrease in the amount of contractile tissue. Furthermore, FMV application can be used as a stretching method to alter medial gastrocnemius architecture.

• Journal of Trauma and Injury
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• v.35 no.1
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• pp.56-60
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• 2022

The most common cause of foot drop is lumbar degenerative disc herniation, particularly at L4/5. We present a rare case of spinal cord injury accompanied by a thoracolumbar lesion that presented with bilateral foot drop. A 69-year-old male patient presented with sudden-onset severe bilateral leg pain and bilateral foot drop. Radiologic findings revealed T12 spondylitis compressing the conus medullaris. He had undergone vertebroplasty for a T12 compression fracture after a fall 6 months before. A physical examination showed bilateral foot drop, paresthesia of both L5 dermatomes, increased deep tendon reflex, and a positive Babinski sign. An acute bilateral L5 root lesion and a conus medullaris lesion were suspected based on electromyography. A surgical procedure was done for decompression and reconstruction. After the operation, bilateral lower extremity muscle strength recovered to a good grade from the trace grade, and the patient could walk without a cane. The current case is a very rare report of bilateral foot drop associated with T12 infectious spondylitis after vertebroplasty. It is essential to keep in mind that lesions of the thoracolumbar junction can cause atypical neurological symptoms. Furthermore, understanding the conus medullaris and nerve root anatomy at the T12-L1 level will be helpful for treating patients with atypical neurological symptoms.

• Journal of the Korean Orthopaedic Association
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• v.54 no.3
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• pp.244-253
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• 2019

Purpose: Total hip arthroplasty was performed using a direct anterior approach (DAA) on an ordinary operation table and a short femoral stem. The clinical radiographic results were evaluated by a comparison with those performed using the modified hardinge (anterolateral approach, ALA) method. Materials and Methods: From January 2013 to November 2015, 102 patients who underwent total hip arthroplasty using DAA (DAA group) and the same number of patients using ALA (ALA group), both performed by a single surgeon, were compared and analyzed retrospectively. The operation time and amounts of bleeding were compared, and the improvement in post-operative pain, ambulatory capacity and functional recovery of the hip joint were checked. The location of insertion of the acetabular cup and femoral stem were evaluated radiologically, and the complications that occurred in the two groups were investigated. Results: The amount of bleeding was significantly smaller in the DAA group (p=0.018). Up to 3 weeks postoperatively, recovery of hip muscle strength was significantly higher in the DAA group (flexion/extension strength p=0.023, abduction strength p=0.031). The Harris hip score was significantly better in the DAA group for up to 3 months (p<0.001) and the Koval score showed significantly better results in the DAA group up to 6 weeks (p≤0.001). The visual analogue scale score improvement was significantly higher in the DAA group by day 7 (p=0.035). The inclination angle (p<0.001) and anteversion angle (p<0.001) of the acetabular cup were located in the safe zone of the DAA group more than in the ALA group, and there was no statistically significant difference in the position of the femur stem and leg length difference. During surgery, two cases of greater trochanter fracture occurred in the DAA group (p=0.155). Conclusion: The DAA performed in the ordinary operation table using a short femoral stem showed post-operative early functional recovery. Because a simple to use fluoroscope was used during surgery with an anatomical position familiar to the surgeon, it is considered to be useful for the insertion of implants into the desired position and for an approach that is useful for the prevention of leg length differences.