• Journal of Acupuncture Research
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• v.23 no.6
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• pp.199-205
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• 2006

Objectives : The present study was conducted to evaluate the analgesic effects of automatically controlled heating acupuncture(ACHA) using 2 different pain models(acute pain and neuropathic pain) and 2 different stimulation conditions (heating $41.5^{\cdot}C$ and heating $44.5^{\cdot}C$) in Sprague-Dawley rats. Methods : Tail flick latency(TFL) to a noxious radiant heat stimulus in lightly anesthetized rats was measured before and after ACHA stimulation for 5-min at the Zusanli(ST36) acupoint. For the neuropathic surgery, the right superior caudal trunk was resected at the level between S1 and S2 spinal nerves innervating the tail. Two weeks after the nerve injury, ACHA stimulation($41.5^{\cdot}C$ or $44.5^{\cdot}C$) was delivered to Zusanli(ST36) for 5 min. The behavioral signs of warm allodynia were evaluated by the tail immersion test (i.e. immersing the tail in warm $water(40^{\cdot}C)$ and measuring the latency to an abrupt tail movement) before and after the ACHA stimulation. Results : In the TFL test, ACHA stimulations under both the conditions above produced more potent analgesic effects than plain acupuncture(PA, acupuncture needle insertion only) and control(no treatment). In the tail immersion test, ACHA stimulations under all of the conditions had markedly relieved the warm allodynia signs. Conclusion : Automatically controlled heating acupul1cture produced analgesic effecs in acute and neuropathic pains.

• Journal of Korean Neurosurgical Society
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• v.52 no.5
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• pp.491-494
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• 2012

We report a rare complication of iatrogenic spinal intradural following minimally invasive extradural endoscopic procedues in the lumbo-sacral spines. To our knowledge, intradural cyst following epiduroscopy has not been reported in the literature. A 65-year-old woman with back pain related with previous lumbar disc surgery underwent endoscopic epidural neuroplasty and nerve block, but her back pain much aggravated after this procedure. Postoperative magnetic resonance imaging revealed a large intradural cyst from S1-2 to L2-3 displacing the nerve roots anteriorly. On T1 and T2-weighted image, the signal within the cyst had the same intensity as cerebrospinal fluid. The patient underwent partial laminectomy of L5 and intradural exploration, and fenestration of the cystic wall was accomplished. During operation, the communication between the cyst and subarachnoid space was not identified, and the content of the cyst was the same as that of cerebrospinal fluid. Postoperatively, the pain attenuated immediately. Incidental durotomy which occurred during advancing the endoscope through epidural space may be the cause of formation of the intradural cyst. Intrdural cyst should be considered, if a patient complains of new symptoms such as aggravation of back pain after epiduroscopy. Surgical treatment, simple fenestration of the cyst may lead to improved outcome. All the procedures using epiduroscopy should be performed with caution.

• Journal of Haehwa Medicine
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• v.9 no.1
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• pp.661-689
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• 2000

We came to the conculsion after considering all of information from many kinds of books on the cause, pathogenesis and treatment of Flaccidity-syndrome. The results were as follows : 1. Flaccidity-syndrome means limb-relaxation due to muscle atony that isn't able to constraction. It's begun as mild degree from extremities, in some cases ended to quadriplegia or expire. 2. Cause factor and pathogenesis of Flaccidity-syndrome is various. After Lung fluid consuption caused by heat-evil was refered in The Yellow Emperor's Canon of Internal Medicine. They were refered as cause factor that Main channel asthenia, excess of sexual intercourse, wetness-evil, heat-evil gets into the interior, asthenia of the spleen and stomach. Since Ming Dynasty, It's classified to wetness-heat evil, wetness-phlegm, deficiency of vital energy, deficiency of blood, deficiency of yin, blood stasis and indygestion, etc. 3. In the view of treatment of Flaccidity-syndrome, Yangming was selected in The Yellow Emperor's Canon of Internal Medicine, and it's been mean to clear away wetness-heat evil located at Yangming. In the method of acupuncture it was same on the base, and many skills have been used that electronic acupuncture, point-injection theraphy, acupuncture point block, catgut implantaion at acupuncture point, cutaneous acupuncture, auriculo-acupuncture and head acupuncture by the through post generation. 4. Flaccidity-syndrome was defined to weak, disuse and non-pain. Beacause it was non-pain, so medicine to expel wind-evil was prevented to use. But through post generation Flaccidity-syndrome has been treated that is able to cause pain or numness as arthralgia-syndrome. Therefore there is tendency that medicine to expel wind-evil is capable within pathological basement of Flaccidity-syndrome in recent. 5. In the view of west-medicine, Flaccidity-syndrome is diplegia or quadriplegia with sensory disorder, muscle atropy in some cases. And there are spinal disease, peripheral nerve disease, muscular disease, nerve-muscle copula disease. The symptoms are able to amyotomia, numness, sensory disorder, pain.

• The Korean Journal of Pain
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• v.33 no.3
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• pp.275-283
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• 2020

Background: Previous studies showed neurography and tractography of the greater occipital nerve (GON). The purpose of this study was determining diffusion tensor imaging (DTI) parameters of bilateral GONs and dorsal root ganglia (DRG) in unilateral cervicogenic headache as well as the grading value of DTI for severe headache. The correlation between DTI parameters and clinical characteristics was evaluated. Methods: The fractional anisotropy (FA) and apparent diffusion coefficient (ADC) values in bilateral GONs and cervical DRG (C2 and C3) were measured. Grading values for headache severity was calculated using a receiver operating characteristics curve. The correlation was analyzed with Pearson's coefficient. Results: The FA values of the symptomatic side of GON and cervical DRG (C2 and C3) were significantly lower than that of the asymptomatic side (all the P < 0.001), while the ADC values were significantly higher (P = 0.003, P < 0.001, and P = 0.003, respectively). The FA value of 0.205 in C2 DRG was considered the grading parameter for headache severity with sensitivity of 0.743 and specificity of 0.999 (P < 0.001). A negative correlation and a positive correlation between the FA and ADC value of the GON and headache index (HI; r = -0.420, P = 0.037 and r = 0.531, P = 0.006, respectively) was found. Conclusions: DTI parameters in the symptomatic side of the C2 and C3 DRG and GON were significantly changed. The FA value of the C2 DRG can grade headache severity. DTI parameters of the GON significantly correlated with HI.

• Asian Spine Journal
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• v.12 no.6
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• pp.1100-1105
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• 2018

Study Design: Prospective observational study. Purpose: To determine the incidence of postoperative urinary retention (POUR) in patients undergoing elective posterior lumbar spine surgery and identify the risk factors associated with the development of POUR. Overview of Literature: POUR following surgery can lead to detrusor dysfunction, urinary tract infections, prolonged hospital stay, and a higher treatment cost; however, the risk factors for POUR in spine surgery remain unclear. Methods: A prospective, consecutive analysis was conducted on patients undergoing elective posterior lumbar surgery in the form of lumbar discectomy, lumbar decompression, and single-level lumbar fusions during a 6-month period. Patients with spine trauma, preoperative neurological deficit, previous urinary disturbance/symptoms, multiple-level fusion, and preoperative catheterization were excluded from the study. Potential patient- and surgery-dependent risk factors for the development of POUR were assessed. Univariate analysis and a multiple logistical regression analysis were performed. Results: A total of 687 patients underwent posterior lumbar spine surgery during the study period; among these, 370 patients were included in the final analysis. Sixty-one patients developed POUR, with an incidence of 16.48%. Significant risk factors for POUR were older age, higher body mass index (BMI), surgery duration, intraoperative fluid administration, lumbar fusion versus discectomy/decompression, and higher postoperative pain scores (p<0.05 for all). Sex, diabetes, and the type of inhalational agent used during anesthesia were not significantly associated with POUR. Multiple logistical regression analysis, including age, BMI, surgery duration, intraoperative fluid administration, fusion surgery, and postoperative pain scores demonstrated a predictive value of 92% for the study population and 97% for the POUR group. Conclusions: POUR was associated with older age, higher BMI, longer surgery duration, a larger volume of intraoperative fluid administration, and higher postoperative pain scores. The contribution of postoperative pain scores in the multiple regression analysis was a significant predictor of POUR.

• The Korean Journal of Pain
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• v.32 no.3
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• pp.178-186
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• 2019

Background: Epidural steroid injections (ESIs) have been widely used in managing spinal pain. Dexamethasone has recently emerged as a useful drug in this setting, relative to particulate steroids, although the associated systemic effects have not been fully elucidated. This study aimed to investigate the incidences and types of systemic effects after fluoroscopically guided ESI with dexamethasone. Methods: This retrospective study included 888 ESIs with dexamethasone (fluoroscopically guided at the cervical and lumbosacral levels) performed on 825 patients during January to June 2017. Data regarding systemic effects were collected via telephone interviews using a standardized questionnaire at 2 weeks after the procedure. Data on patient demographic, clinical, and procedural characteristics were collected and analyzed to identify factors that were associated with systemic effects. All statistical analyses were performed using the chi-squared test. Results: Among the 825 patients, 40 patients (4.8%) experienced systemic effects during the 2-week follow-up period. The most common systemic effect was facial flushing (12 patients, 1.5%), which was followed by urticaria (7 patients, 0.8%) and insomnia (7 patients, 0.8%). A history of spine surgery was significantly associated with the occurrence of systemic effects (P = 0.036). Systemic effects were significantly more common for injections at the cervical level than at the lumbar level (P = 0.019). Conclusions: Approximately 4.8% of the patients who underwent ESI with dexamethasone experienced minor and transient systemic effects. These effects were more common in patients who had undergone a previous spine surgery or received a cervical ESI.

• The Korean Journal of Pain
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• v.35 no.3
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• pp.336-344
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• 2022

Background: The U.S. Food and Drug Administration has prohibited epidural steroid injection (ESI) with particulate steroids. Thus, this study aimed to compare the efficacy and safety of ESI with two nonparticulate steroids, dexamethasone and betamethasone. Methods: The eligible patients (n = 600) who received ESI (0 week) with dexamethasone (ESI-dexa) or betamethasone (ESI-beta) had follow-up visits at 2, 4, and 8 weeks with a phone interview at 12 weeks. The primary endpoint was the proportion of effective responders without pain or who were much improved at 2 weeks. The secondary endpoints were the proportion of crossover injections at 2 weeks; changes in the visual analog scale (VAS) and disability index scores at 2, 4, and 8 weeks; the number of additional ESIs in 12 weeks; the number of participants having spinal surgery, as well as the incidence of adverse events over the 12 weeks. Results: The proportion of effective responders at 2 weeks was not different between ESI-beta (72/216, 33.3%) and ESI-dexa (63/200, 31.5%; P = 0.670). Adverse events were more common with ESI-dexa (40/200, 20.0%) than with ESI-beta (24/216, 11.1%; P = 0.012). VAS scores decreased more with ESI-beta than with ESI-dexa at 2 weeks (difference, 0.35; P = 0.023) and 4 weeks (difference, 0.42; P = 0.011). The disability score improved significantly more with ESI-beta compared with ESI-dexa at 2 weeks (difference, 3.37; P = 0.009), 4 weeks (difference, 4.01; P = 0.002), and 8 weeks (difference, 3.54; P = 0.007). Conclusions: Betamethasone would be more appropriate for ESI.

• Therapeutic Science for Rehabilitation
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• v.7 no.4
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• pp.19-30
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• 2018

Objective: The purpose of this study was to suggest predictors of participation restriction in community-dwelling Spinal Cord Injury (SCI) based on environmental, functional, injury-related, psychosocial, and sociodemographic factors. Methods: The participants were 82 community-dwelling SCI adults over the age of 18. They were all included in the American Spinal Injury Association's (ASIA) Levels A, B, and C. This study surveyed participants' participation using the CHART-K-SF, environmental factors using the CHIEF-25 Korean version, and functional factors using the SCIM III. Further, pain and distress were surveyed using Zung's Self-rating Pain and the PAD, self-esteem was assessed using the RSES, and self-efficacy using the GSS. Finally, information concerning injury levels, post-injury period, causes of injury-related factors, and sociodemographic factors such as gender, age, marriage, education level, and residence information were collected. The collected data were analyzed using SPSS Version 21.0 Results: Participants' risk factors were environmental and functional. The Nagelkerke's $R^2$ was.737. The OddsRatio(OR) of environmental factors(referent,0-1) was 40.346. Moreover, the OR of the $1^{st}$ quartile functional factor(referent,4thquartile) was 236. 621, and that of the$2^{nd}$ quartile was 21.174. In addition, the occupational predictors included the "policies" subscales in the CHART-K-SF, "physical/structural" in the CHIEF-25, and "mobility" in the SCIM III. Further, the predictors of "physical independence" were "services/assistance" in CHIEF-25, and "respiration and sphincter management' on the SCIM III. Additionally, "mobility" was predicted by "physical/structural" on the CHIEF-25 and "mobility" on the SCIM III. Conclusions: This study multidimensionally confirmed predictors of participation restriction. Through these facts, we investigated occupational therapists' roles in community setting. Therefore, this study's results will provide useful information for occupational therapy services, for which the goal is SCI participation improvement within the community.

• Journal of radiological science and technology
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• v.28 no.4
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• pp.327-332
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• 2005

The purpose of this Study was to investigate the prevalence rate of idiopathic scoliosis to the students from the elementary to the university in S city of Chung-Nam using 100 mm Mirror Camera radiation indirect examination units, with on age range of between eight and thirteen (1.526 subjects), fourteen and sixteen (462 subjects), seventeen and eighteen (291 subjects), nineteen and twenty four(508 subjects) and total of 2,787 participants with the 590 male subjects and 2,197 female subjects. The results of this study can be summarized and compared the primary examination with the secondary test of greater than $10^{\circ}$of Cobb's Angle were obtained as follows; 1. Indirect Examination were conducted to find idiopathic scoliosis amomg total 2.787 subjects, 257 subjects (9.2%) who showed positive sign greater than $10^{\circ}$in the Cobb's Angle ; below age of thirteen (132 subjects), between fourteen and sixteen (52 subjects), seventeen and eighteen (35 subjects), nineteen and twenty four (38 subjects). The $x^2-test$ analysis of Indirect Examination showed no statistical significant difference association between the age range and $10^{\circ}$Cobb's Angle of spinal curve(P>0.059). 2. The numbers of idiopathic scoliosis of greater than $10^{\circ}$Cobb's Angle of spinal curve in the primary examination were observed in 147 subjects (57.2%) at the Thoracolumbar region, 81subjects (31.5%) at the Thoracic region, 20 subjects (7.8%) at the Cervicothoracic region, 7 subjects (2.7%) at the Lumbar region, 2 subjects (0.8%) at the Cervical region. So, the large numbers were Thoracolumbar region, 183 participants (71.2%) showed the right side curve of scoliosis and 74 participant (28.8%) showed the left side curve of scoliosis. 3. The main region of the pain in one's own self more than $10^{\circ}$ Cobb's angle of spinal curve were no pain 219 subjects (85.2%), 18 subjects (7.0%) at the Lumbar region, 9 subjects (3.5%) at the Cervical region, 7 subjects (2.7%) at the Thoracic region, 2 subjects (0.7%) at the shoulder girdle region, 1 subjects (0.39%) at the pelvis and whole body region. There was statistical significant difference association between the Cobb's Angle of spinal curve and the main pain region of one's (P<0.006). This study may be significant to an early stage investigate of the prevalence rate of idiopathic scoliosis in the juveniles using 100 mm Mirror Camera radiation indirect examination units. The results of this study help that the students in a stage on growth the basis of data early discovery and therapy of idiopathic scoliosis.

• Journal of Korean Neurosurgical Society
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• v.48 no.2
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• pp.119-124
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• 2010

Objective : Disc herniations at the L1-L2 and L2-L3 levels are different from those at lower levels of the lumbar spine with regard to clinical characteristics and surgical outcome. Spinal canals are narrower than those of lower levels, which may compromise multiple spinal nerve roots or conus medullaris. The aim of this study was to evaluate the clinical features and surgical outcomes of upper lumbar disc herniations. Methods : We retrospectively reviewed the clinical features of 41 patients who had undergone surgery for single disc herniations at the L1-L2 and L2-3 levels from 1998 to 2007. The affected levels were L1-L2 in 14 patients and L2-L3 in 27 patients. Presenting symptoms and signs, patient characteristics, radiologic findings, operative methods, and surgical outcomes were investigated. Results : The mean age of patients with upper lumbar disc was 55.5 years (ranged 31 to 78). The mean follow-up period was 16.6 months. Most patients complained of back and buttock pain (38 patients, 92%), and radiating pain in areas such as the anterior or anterolateral aspect of the thigh (32 patients, 78%). Weakness of lower extremities was observed in 16 patients (39%) and sensory disturbance was presented in 19 patients (46%). Only 6 patients (14%) had undergone previous lumbar disc surgery. Discectomy was performed using three methods : unilateral laminectomy in 27 cases, bilateral laminectomy in 3 cases, and the transdural approach in 11 cases, which were performed through total laminectomy in 10 cases and unilateral laminectomy in 1 case. With regard to surgical outcomes, preoperative symptoms improved significantly in 33 patients (80.5%), partially in 7 patients (17%), and were aggravated in 1 patient (2.5%). Conclusion : Clinical features of disc herniations at the L1-L2 and L2-L3 levels were variable, and localized sensory change or pain was rarely demonstrated. In most cases, the discectomy was performed successfully by conventional posterior laminectomy. On the other hand, in large central broad based disc herniation, when the neural elements are severely compromised, the posterior transdural approach could be an alternative.