• Journal of Korean Neurosurgical Society
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• v.29 no.2
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• pp.240-248
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• 2000

Objective : Spontaneous intracranial hypotension is a rarely reported syndrome of spontaneous postural headache associated with low CSF pressure and has rarely been demonstrated radiographically or surgically. But recently, it is being recognized with increasing frequency. The purpose of this study was to characterize clinical and imaging features, etiologic factors, and outcome in the spontaneous intracranial hypotension. Patients and Methods : We reviewed our experience with documented cases of spontaneous intracranial hypotension in 5 consecutive patients with orthostatic headaches from April 1998 to April 1999. Results : The mean age was 41 years(from 35 to 49 years). All patients had postural headaches, which were completely alleviated by recumbency position. Nausea, neck pain, horizontal diplopia, photophobia, and blurred vision were noted in some of the patients. Brain MRI showed diffuse pachymeningeal gadolinium enhancement, subdural collections of fluid, and descent of the brain. The opening pressure from lumbar puncture was $4cmH_2O$ or less in three of five patients whereas the opening pressure was within normal range in two patients. All patients underwent radioisotope cisternography and computerized tomographic myelography. On radioisotope cisternography, CSF leakage was suspected at the level of cervical area(1 patient), upper thoracic area(2 patients), mid-thoracic area(1 patient). Computed tomography myelography revealed extraarachnoid accumulation of contrast media(compatible finding with CSF leakage) at the level of cervical or thoracic area. In all patients, the symptoms resolved in response to supportive measures or epidural blood patch(1 patient). Conclusion : Spontaneous spinal CSF leakage is increasingly recognized as a cause of spinal postural headache. Most CSF leaks are located at the cervicothoracic junction or in the thoracic spine and can be demonstrated by variable diagnostic method. The condition is usually self-limiting and its prognosis is typically good.

• Journal of Korean Neurosurgical Society
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• v.52 no.4
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• pp.359-364
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• 2012

Objective : Transpedicular screw fixation has some disadvantages such as postoperative back pain through wide muscle dissection, long operative time, and cephalad adjacent segmental degeneration (ASD). The purposes of this study are investigation and comparison of radiological and clinical results between interspinous fusion device (IFD) and pedicle screw. Methods : From Jan. 2008 to Aug. 2009, 40 patients underwent spinal fusion with IFD combined with posterior lumbar interbody fusion (PLIF). In same study period, 36 patients underwent spinal fusion with pedicle screw fixation as control group. Dynamic lateral radiographs, visual analogue scale (VAS), and Korean version of the Oswestry disability index (K-ODI) scores were evaluated in both groups. Results : The lumbar spine diseases in the IFD group were as followings; spinal stenosis in 26, degenerative spondylolisthesis in 12, and intervertebral disc herniation in 2. The mean follow up period was 14.24 months (range; 12 to 22 months) in the IFD group and 18.3 months (range; 12 to 28 months) in pedicle screw group. The mean VAS scores was preoperatively $7.16{\pm}2.1$ and $8.03{\pm}2.3$ in the IFD and pedicle screw groups, respectively, and improved postoperatively to $1.3{\pm}2.9$ and $1.2{\pm}3.2$ in 1-year follow ups (p<0.05). The K-ODI was decreased significantly in an equal amount in both groups one year postoperatively (p<0.05). The statistics revealed a higher incidence of ASD in pedicle screw group than the IFD group (p=0.029) Conclusion : Posterior IFD has several advantages over the pedicle screw fixation in terms of skin incision, muscle dissection and short operative time and less intraoperative estimated blood loss. The IFD with PLIF may be a favorable technique to replace the pedicle screw fixation in selective case.

• Korean Journal of Acupuncture
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• v.35 no.3
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• pp.130-138
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• 2018

Objectives : The purpose of this study is to explore patients' perceptions that deserve attention when designing core questions for a clinical practice guideline of Korean medicine(KM) for degenerative lumbar spinal stenosis (LSS). Methods : Patients who had been admitted to Pusan National Korean Medicine Hospital from November 1, 2015 to October 31, 2016 were invited to the survey. Patients were eligible if they were both clinically and radiologically confirmed as degenerative LSS. The structured questionnaire was distributed by mail and outpatient visits. Questions included types of experienced Korean/Western medical interventions for LSS, their perceived effectiveness on symptoms, the necessity for studies of KM for degenerative LSS, the types of KM interventions to be investigated and the types of outcome measures after treatments. Data were descriptively analysed. Results : Twenty of thirty-one invited participants responded to the questionnaire. Acupuncture and herbal medicine were the most frequently used KM interventions. Eighteen respondents reported that KM treatments were helpful for their improvement. Sixteen patients who mentioned that research on KM is needed chose acupuncture as the top priority(88%) among KM interventions. The most important outcomes in the view of nineteen respondents included functional recovery (68%) and pain relief (53%). Thirteen respondents (65%) replied that both short-term and long-term outcome were important for them. Conclusions : Our findings may have limited validity due to the small number of respondents and the potential selection and information bias. Further qualitative studies and large-scale surveys to comprehensively identify patients' views are warranted.

• Journal of Ginseng Research
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• v.23 no.4
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• pp.239-246
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• 1999

The analgesic effect of ginsenosides or morphine was determined following intrathecal (i.t.) administration in rat tail-flick test. The effects of intrathecal co-administration of ginsenosides with morphine on the development of opioid tolerance and dependence were also examined using rat tail-flick test and naloxone-pre-cipitated withdrawal, respectively. Administration of ginsenosides (i.t.) produced a weak antinociception in a dose-dependent manner. Administration of morphine (i.t.) also produced antinociception in a dose-dependent manner. The $ED_50$ was $1.20\;{\mu}g\;(1.14\~1.29\;{\mu}g)$. However, the acute co-administration of $200{\mu}g$ ginsenosides with 0.1-1.0${\mu}g$ morphine did not show additive effect on morphine induced analgesia in rat tail-flick test. I.t. co-administration of 200 ${\mu}g$ ginsenosides with 10 ${\mu}g$ morphine for 7 days inhibited development of tolerance induced by 10 ${\mu}g$ morphine in rat tail-flick test, although i.t. co-administration of 50 or 100 ${\mu}g$ ginsenosides with morphine was without effect. I.t. co-administration of 200 ${\mu}g$ ginsenosides for 7 days also partially attenuated the development of morphine dependence as assessed by naloxone-precipitated withdrawal. In conclusion, these results suggest that i.t. administered ginsenosides produce a weak antinociception in rat tail-flick test and also prevent opioid tolerance and attenuate opioid dependence in chronic treatment with morphine at the spinal sites.

• Korean Journal of Acupuncture
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• v.26 no.4
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• pp.195-209
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• 2009

Objectives : Transient inflammation has been demonstrated to alter visceral sensory function in animal models and acute mucosal inflammation may precede the manifestation of visceral hyperalgesia. Thus in this study we compared effects of herbal acupuncture of Nidus Vespae (NV) applied to the different acupoints in the acute colitis induced by trinitrobenzenesulphonic acid (TNBS) intracolonic injection in rats. Methods : In Male Sprague-Dawley rats, weighing 250 ~ 400 g, TNBS (5 mg/kg) was infused intrarectally through a silicon rubber catheter into the anus under isoflurane anaesthesia. Under general anesthesia, acupoints of LI4 (Hapkok), SI25 (Cheonchu), ST36 (Joksamni), BL25 (Daejangsu) were intramuscularly injected by NV. Expressions of cFos protein in the periaqueductal gray (PAG), locus coeruleus (LC), nucleus of solitary tract (Sol), and the 6th lumbar spinal cord (L6 s.c.) were observed at 24 hrs after TNBS induced colitis by immunohistochemistry. Results : The expression of c-Fos protein in L6 s.c., Sol, LC and PAG increased 24 hrs after TNBS injection into colorectum as compared to normal group. NV herbal acupuncture also inhibited the expression of c-Fos protein in Sol but not L6 s.c., LC, and PAG. NV to ST36 inhibited significantly the c-Fos expression in Sol and PAG. NV to ST25 inhibited the c-Fos protein expression all over the observation area. NV to BL25 showed the inhibitory effects in the areas except LC. Whether or not a role of endogenous opioids, intrathecal injection of naltrexone (30 ug / 30 ul) was applied before the 2nd herbal acupuncture treatment 24 hrs after TNBS-induced colitis in rat. Naltrexone reversed the inhibition of c-Fos protein expression in the spinal cord and brainstem under different conditions such as type of herbal acupuncture compound and choice of acupoint. Conclusions : In summary, these data show that herbal acupuncture of NV inhibits signal pathways such as spinal cord and brain stem ascending hypersensitivity of colorectum after TNBS induced colitis. This effect may be mediated by acupoints through the endogenous opioid system involving the pain modulation.

• Journal of Genetic Medicine
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• v.7 no.2
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• pp.145-150
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• 2010

Acrodysostosis is an extremely rare disorder characterized by short fingers and toes with peripheral dysostosis, nasal hypoplasia, and mental retardation. We report a 16-year-old Korean boy with acrodysostosis who had characteristic clinical features and cervical spine stenosis manifested by neurologic symptoms. On presentation, he complained of difficulty in raising his arms, and suffered from intermittent pain and weakness in both upper extremities. He had short stature and dysmorphic facial features, including a broad, depressed nasal bridge, small, upturned nose, bilateral epicanthal folds, and mild hypertelorism. Moderate mental retardation and sensorineural hearing loss in both ears were also present. Radiological findings included broad, short metacarpals and phalanges with cone-shaped epiphyses, bilateral Madelung deformities, hypertrophied first metatarsals, and thickening of the calvarium. Magnetic resonance imaging findings included stenosis of the cervical spine, platybasia with compression into the cervicomedullary junction, and downward displacement of the cerebellar tonsils. Here, we report a case of acrodysostosis with symptoms and signs of cervical spinal stenosis first in Korea. If it is diagnosed in the early stages, possible life-threatening complications, including spinal canal stenosis, can be managed properly and permanent neurologic sequelae might be avoided. Therefore, it is important to consider acrodysostosis in the differential diagnosis of peripheral dysostosis.

• The Journal of Churna Manual Medicine for Spine and Nerves
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• v.13 no.2
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• pp.47-63
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• 2018

Objectives : The purpose of this study was to analyze the effects of lumbar spinal herniated intervertebral Disc on MRI accompanying or not High-intensive zone(HIZ) by Korean Medical Combination Treatment Methods : 324 patients who received inpatient treatment from January 2017 to September 2017 in the Daejeon-Jaseng of Korean Medicine Hospital were divided into 2 groups by High-intensive zone(HIZ) confirmed with a Lumbar spine magnetic resonance imaging. All patients received a combination of treatment including acupunture, chuna manual therapy, pharmacopunture, herbal medication. They were compared and analyzed on the basis of improvement between measuring Numeric Rating Scale (NRS), Oswestry Disability Index (ODI), EuroQol-5 Dimension Index (EQ5D Index), physical examination as they were hospitalized and as they were discharged. The statistically significance was evaluated by SPSS 18.0 for windows. Results : After treatment, Numeric Rating Scale (NRS), Oswestry Disability Index (ODI), EuroQol-5 Dimension Index (EQ5D Index), physical examination was improved respectively. But there was no statistically significance between 2 group's improvement after treatment. Conclusions : After inpatient treatment by Korean Medical Combination Treatment, Most patient's pain, disability and Health Related Quality of Life was improved significantly. But there was no statistically difference between accompanying or not High-intensive zone(HIZ). So We think that future research of higher quality and correct statistics shall be necessary.

• Journal of Korean Neurosurgical Society
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• v.65 no.4
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• pp.549-557
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• 2022

Objective : This study analyzed the risk factors in patients who developed distal junctional kyphosis (DJK) after posterior cervical fusion. Methods : We retrospectively analyzed the clinical and radiographic outcomes of 64 patients, aged ≥18 years (51 and 13 male and female patients, respectively), who underwent single-staged multilevel (3-6 levels) posterior cervical fusion surgery due to multiple cervical spondylotic myelopathy. The surgeries were performed by a single spinal surgeon between January 2012 and December 2017. Demographic data, clinical outcomes, and radiological results were collected. We divided the patients into a DJK group and a non-DJK group according to the presence of DJK and investigated the risk factors by comparing the differences between the two groups. Results : Of the 64 patients, 13 developed DJK. No significant differences in clinical results were observed between the two groups before and immediately after the surgery. At the final follow-up, a higher visual analog score for neck pain was observed in the DJK group compared to the non-DJK group (p<0.01). The DJK group had a significantly lower T1 slope and a significantly higher C2-7 sagittal vertical axis (SVA) before surgery compared to the non-DJK group (p=0.03 and p<0.01, respectively). Immediately after surgery, the difference between the two groups decreased and no significant difference was observed. However, at the last follow-up, a significantly higher C2-7 SVA was observed in the DJK group (p<0.01). At the last follow up, there is no discrepancy in T1S-CL. In multiple logistic regression analysis, preoperative higher C2-7 SVA and preoperative lower T1 slope were identified as independent risk factors (p=0.03 and p<0.01, respectively). As a result, it was confirmed that DJK occurred along the process of returning to preoperative values. Conclusion : DJK can be considered to be caused by cervical misalignment due to excessive change in the surgical site in patients with low T1 slope and high C2-7 SVA before surgery. This also affects the clinical outcome after surgery. It is recommended to refrain from excessive segmental lordosis changes during multilevel cervical post fusion surgery, especially in patients with a small preoperative T1 slope and a large SVA value.

• International Journal of Oral Biology
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• v.34 no.4
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• pp.191-197
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• 2009

Somatostatin (SST) is a known neuromodulator of the central nervous system. The substantia gelatinosa (SG) of the trigeminal subnucleus caudalis (Vc) receives many thinmyelinated $A{\delta}$-fiber and unmyelinated C primary afferent fibers and is involved in nociceptive processing. Many studies have demonstrated that SST plays a pivotal role in pain modulation in the spinal cord. However, little is yet known about the direct effects of SST on the SG neurons of the Vc in adult mice. In our present study, we investigated the direct membrane effects of SST and a type 2 SST receptor agonist, seglitide (SEG), on the SG neurons of the Vc using a gramicidin-perforated current clamp in adult mice. The majority (53%, n = 27/51) of the adult SG neurons were hyperpolarized by SST (300 nM) but no differences were found in the hyperpolarization response rate between males and females. When SST was applied successively, the second response was smaller ($76{\pm}9.5%$, n=19), suggesting that SST receptors are desensitized by repeated application. SST-induced hyperpolarization was also maintained under conditions where presynaptic events were blocked ($75{\pm}1.0%$, n=5), suggesting that this neuromodulator exerts direct effects upon postsynaptic SG neurons. SEG was further found to induce membrane hyperpolarization of the SG neurons of the Vc. These results collectively demonstrate that SST inhibits the SG neuronal activities of the Vc in adult mice with no gender bias, and that these effects are mediated via a type 2 SST receptor, suggesting that this is a potential target for orofacial pain modulation.

• Annals of Clinical Neurophysiology
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• v.10 no.2
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• pp.83-97
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• 2008

Cervical and thoracic radiculopathies are among the most common causes of neck pain. The most common causes are cervical disc herniation and cervical spondylosis in patients with cervical radiculopathy, and diabetes mellitus and thoracic disc herniation in thoracic radiculopathy. A thorough history, physical examination, and testing that includes electrodiagnostic examination and imaging studies may distinguish radiculopathy from other pain sources. Although various electrodiagnostic examinations may help evaluate radiculopathy, needle electromyography is the most important, sensitive, and specific method. Outcome studies of conservative treatments have shown varying results and have not been well controlled or systematic. When legitimate incapacitating symptoms continue despite conservative treatment attempts, more invasive spinal procedures and intradiscal treatment may be appropriate. Surgery has been shown to have excellent clinical outcomes in patients with disc extrusion and neurological deficits. However, patients with minimal disc herniation have fair or poor surgical outcomes. In addition, conventional open disc surgery entails various inadvertent surgical related risks. Although there has not yet been a non-surgical interventional procedure developed with the therapeutic efficacy of open surgery, conservative procedures can offer substantial benefits, are less invasive, and avoid surgical complications. While more invasive procedures may be appropriate when conservative treatment fails, prospective studies evaluating cervical and thoracic radiculopathies treatment options would help guide practitioners toward optimally cost-effective patient evaluation and care.