The Usefulness of Selective Spinal Nerve Root Block / 대한척추외과학회지

PURPOSE: A retrospective study on the usefulness of selective spinal nerve root block among lumbar herniated intervertebral disc (HIVD), spinal stenosis and postoperative syndrome over 10 years. MATERIAL AND METHOD: From a total 1195 patients, whose symptoms were not improved by conservative treatment, 505 treated by selective nerve root block were divided into 3 groups; 150 (29.7%) with HIVD, 313 (62.0%) with spinal stenosis and 42 with postoperative syndrome, and were followed up from Oct. 1992 to Dec 2001. The degree of pain and activity were evaluated by a visual analogue scale method at the out-patient department or through telephone interviews. RESULTS: The end-results of selective spinal nerve root block, with more than 50% reduction in pain occurred in 380 (75.3%) of the 505 patients. The effectiveness was greater in young patients with HIVD than elderly patients with spinal stenosis. After discharge, 160 patients (31.7%) needed no other treatment: 14 (31.0%) with an extrusion type HIVD and 17 (20.0%) with spondylolisthesis. The only 98 patients (19.4%) needed a surgical procedure after selective spinal nerve root block. CONCLUSION: Selective spinal nerve root block in patients with lower back and radiating pain is a valuable conservative treatment to quickly improved symptoms and avoid surgical procedures and the continuous administration of drugs.

Long Term Results of the Selective Spinal Nerve Root Block for the Herniated Lumbar Intervertebral Disc / 대한척추외과학회지

STUDY DESIGN: A retrospective study. OBJECTIVES: To access the 5-year outcomes of patients with sciatica, not caused by spinal stenosis, spondylolysis, spondylolisthesis or congenital deformity, but by a lumbar herniated intervertebral disc (HIVD), treated by a selective nerve root block (SNRB). A review of the alternative treatments, during the follow up period, is also presented. SUMMARY OF LITERATURE REVIEW: Controversy exists about the therapeutic effects, particularly the long-term effects of a SNRB, in sciatica caused by a lumbar HIVD. MATERIALS AND METHODS: SNRB was performed on a total of 288 patients, diagnosed with a lumbar HIVD, through the clinical manifestations and physical and radiological findings, including MRI, between Jan. 1992 and Dec. 1997. Of the 288 patients, the 79 that underwent SNRB treatment only, and were minimally followed up for five years, were reviewed. The type of HIVD was based on the MRI findings, and the results of the SNRB were analyzed, with regard to the presence or absence of a relapse, the other treatments for recurrent or remnant symptoms following the SNRB, return to previous daily living and working activities and the degree of subjective symptomatic improvement, as assessed by a chart review, or an out patient department follow up or a telephone interview. RESULTS: With regard to the HIVD, there were 17 cases of bulging type (21.5%), 37 of protrusion (46.8%), 21 of extrusion (26.6%) and 4 of sequestration (5.1%) types. Medication and physical therapy was required in 13 cases (16.5%) and 35 cases (44.3%) used herbal medication and acupuncture. Thirteen of the 79 cases relapsed, and 10 were treated by microscopic discectomy. SNRBs were reperformed in 3 cases. Twenty-three cases (29.1%) required no treatment. Fifty-six cases (84.8%) returned to their previous daily living and working activities. SUMMARY: As this study did not accurately evaluate the change in the natural history of a HIVD following a SNRB, a further prospective study is still required. However, a SNRB is still a valuable non-operative treatment method for the acute radicular pain associated with a HIVD.

Clinical Analysis on the Efficacy of Stellate Ganglion Block in the Patients with Cervical Herniated Intervertebral Disc

OBJECTIVE: The purpose of this study is to evaluate the efficacy of stellate ganglion block for the patients with cervical Herniated Intervertebral Disc (HIVD). METHOD: Forty patients with cervical HIVD were selected for the study. Patients were randomly assigned to one of two groups: Group 1, stellate ganglion block of 1% lidocaine and physical modalities (n=20); Group 2, only physical modalities as a control group (n=20). Group 1 patients were treated with the stellate ganglion block of 1% lidocaine three times over two-week period. The efficacy of stellate ganglion block was assessed with Visual Analog Scale (VAS) on pre- and post-stellate ganglion blocks and with Rubin scale (success rate). RESULTS: The VAS scores of post-block were significantly lower than pre-score (p<0.05) in both groups, but there was no statistically significance between the two groups. After treatment, Rubin scale was with excellent or good in 75% in group 1 and in 50% in group 2, but there was no statistically significance. CONCLUSION: The stellate ganglion block may be effective therapeutic method for patient with cervical HIVD. But the efficacy of additional stellate ganglion block for cervical HIVD remains controversial.

The Effect of Work Department, Income and Job Status on the Workplace Injury Rates in One Car Manufacturing Factory / 한국역학회지

PURPOSE: There has been little research into socio-economic factors and work condition s as risk factors for workplace injuries in Korea. Separating work from social class is difficult as the social division of labour is at the origin of social class (1). The objective of this study is to investigate the relationship of working conditions and socio-economic factors with workplace injury rates. METHODS: Three year-follow up data sets for workplace injury data analysis for retrospective cohort study were obtained linking the total workforce and workplace injuries between 1995 and 1997. The Proportional Hazards Model (Cox regression) is used to estimate the hazard ratios for workplace injury by different possible risk factors: work department, income, job status, age and tenure. RESULTS: The press, body and engine departments have higher hazard rates for severe injuries; the press, engine, and supporting departments for lower-back pain; and the assembly line (with wider confidence interval) and supporting departments for Herniated Intervertebral Discs. Lower waged workers have higher rates of workplace injuries, especially for lower-back pain. Workers with low job status have higher rates than foremen or supervisors. Thus, socio-economic factors and work department contribute independently to workplace injury rates. CONCLUSIONS: Even though this study could not fully investigate the relationship between socio-economic factors and working conditions, the working conditions as well as socioeconomic factors need to be considered as risk factors of workplace injuries in the workplace.

Lumbar HIVD Associated with Spondylolysis / 대한척추외과학회지

STUDY DESIGN: This is a retrospective study determining the surgical result of lumbar HIVD associated with spondylolysis. OBJECTIVES: To analyze the incidence of lumbar HIVD associated with spondylolysis and to compare the results of open discectomy for lumbar HIVD associated with spondylolysis to simple lumbar HIVD. SUMMARY OF LITERATURE REVIEW: Lumbar HIVD associated with spondylolysis need be treated by spinal fusion. MATERIALS AND METHODS: Nine patients(5 males and 4 females) who had lumbar HIVD with spondylolysis, no instability, fol-low-up period of 1yr were identified out of 273 patients with lumbar HIVD, treated by open discectomy from March 1989 to Feb. 1999. The type of HIVD and level of spondylolysis were evaluated, the clinical symptoms and signs including SLR, motor deficit, sensory deficit, change of DTR and severity of radiating pain were periodically followed up on the predesigned protocol. RESULTS: The incidence of lumbar HIVD associated with spondylolysis is 3.7%. The recovery of back pain was 2.1 to 2.1 by visu-al analogue scale, radiating pain was 7.6 to 0.8. The recovery rate of SLR was 100%, motor deficit; 100%, sensory deficit; 85%, change of DTR; 40%. The clinical evaluation was excellent(2), good(6), fair(1). CONCLUSIONS: According to the recovery rate of the clinical symptoms, the results of open discectomy for lumbar HIVD associ-ated with spondylolysis without spinal instability and simple HIVD was not different. Therefore, we conclude that lumbar HIVD associated with spondylolysis need not be treated by spinal fusion.

Cauda Equina Syndrome after Laminectomy of Lumbar Spine with Application of Autogenous Free Fat Graft: A Case Report / 대한정형외과학회잡지

Although epidural fibrosis after laminectomy is considered to be the cause of pain in a number of patients, the exact relationship of postoperative scar tissue and symptoms remains controversial. However it is generally accepted that epidural fibrosis after surgical decompression of neural tissue has to be avoided. To diminish the likelihooa that such a scar will form, fat grafts have been used to create an interpositional membrane. Compression of a nerve after the use of a fat graft is rare; postoperative cauda equina syndrome, resulting from compression by a grafted fat. We report the case of a patient who had this complication.

Comparison of Automated Percutaneous Lumbar Discetomy (APLD ) and Chemonucleolysis in the Treatment of Herniated Lumbar intervertebral Discs / 대한정형외과학회잡지

Automated percutaneous lumbar discectomy (APLD) and chemonucleolysis represent two major modalities of recently popularized minimally invasive surgical procedures for the treatment of herniated lumbar discs. However, the controversies concerning the safety and efficacy of the procedures are yet to be settled. The purpose of retrospective study was to determine the efficacy of these percutanous procedures and hence to establish a rational guideline for the treatment of lumbar disc herniations. Clinical review of 615 patients treated by percutaneous procedures revealed 81% success rate following chemonucleolysis and 83% following APLD, with a mean follow-up of 38 months (range 24- 60 months) and 30 months (range 24-38 months) respectively. APLD required less time for resolution of back pain, and resulted in less disc space narrowing than chemonulceolysis. Clinical failures of the procedures were associated with extruded or calcified discs, combined spinal stenosis and discitis. Reduction of herniation size in postoperative CT had no significant correlation to the clinical results. In conclusion, both procedures were effective in contained disc without calcification or associated spinal stenosis. This study suggests some advantages of APLD over chemonucleolysis in the aspect of rapidity of symptom relief, disc space narrowing and possible complications. Reduction in herniation size was not imperative for clinical success. Both procedures appear to be good alternatives to open discectomy in well selected patients, and may be good bridges for the wide gap between conservative treatment and open surgery.

Radiologic Changes after Lumbar Discectomy / 대한정형외과학회잡지

Open discectomy is one of usual treatment for herniated intervertebral disc. We may expect the reduction of height of intervertebral disc due to decreased volume by partial resection of herniated disc. But the effect of decreased height of intervertebral disc space to posterior joint and spinal canal has not been identified, and the correlation between the amount of reduced height and the changes of range of motion has been undetermined. Thus, we analyzed radiologic changes of disc height and segmental motion by the flexion-extension view in 20 patients who had undergone discetomy for prolapsed intervertebral disc from June 1989 to January 1991 who could be followed up for 3 years or more. As a result, lumbar discetomy associates with 1) significant decrement of disc height (average 14%), 2) decreased disc motion of involved segment without hypermobility (average 34%), 3) hypermobility of adjacent segment, 4) and posterior facet overriding consistent with recurred low back pain.

Herniated Intervertebral Disc of Lumbar Spine in the Teenager / 대한정형외과학회잡지

Herniated intervertebral disc(HIVD) of the lumbar spine has been known to be relatively uncommon in the teenager and frequently be associated with trauma. However, with the changing life style and increasing sports activities, and most of all, with the advent of new imaging modalities, the incidence seems to be increasing gradually. In order to define the characteristic pattern of HIVD of teenager in the era of MRI, and to clarify the associated lesions, such as apophyseal ring fractures, authors performed this retrospective study in 55 teenager patients with HIVD(77 discs), in which MRI was used as main diagnostic modality. The following results were obtained 1) The incidence of the HIVD in teenager was 9.6%(55 patients) of total HIVD patients(575 patients) for 4 years from December 1989 to December 1993. 2) According to MRI findings, HIVD of the teenager could be classified into 3 distinct patterns; simple HIVD, lumbar apophyseal ring fracture(LARF), and vertebral rim lesion. 3) In simple HIVD, as for the MRI classification, protruded type was most frequent type and there was no sequestered type 4) In LARF, the incidence was 14.4% of teenager's HIVD and posterocephalad margin of L5 was the most common site of involvement. 5) Exophytic bony protrusion from the posterior margin of vertebral body, which we called vertebral rim lesion, could be defined on MR sagittal view in 6 cases.

Comparative study between myelograpic and operative finding on 150 cases of lumbar H.I.V.D / 대한정형외과학회잡지

During January 1975 to December 1979, myelographic studies followed by operation was carried out on 150 cases of lumbar H.I.V.D. at Chung Nam National University Hospital. As to the myelographic findings, mode, level of indentation, and positive and negative finding were analyzed in comparison with operative findings. The followings results were obtained: 1. Plain radiography has a Iittle value In diagnosis of Iumbar H.I.V.D. about one third of 150 cases show significant sign in plain film study. 2. The major discrepancies between myelographic and operative findings were found in 11.3%, while the minor discrepancies were 4%, so giving an accuracy of 84.7%. 3. Positive myelographic finding(120 cases) consisted of smooth round defect in 83 cases (48.8%), unilateral wedge defect In 45 cases (26.4%), block defect In 18 cases (10.5%), bilateral wedge defect in 13 cases (7.6%), and hourglassdefect In 11 cases (6.4%), respectively. 4. Operative findings revealed the protruded disc: 74.5%, bulging: 11.1%, extruded: 22%, and mlgrated: 1.7%. 5. The myelographic finding of bulging type disc usually showed smooth round filling defect and those of protruded were smooth round filling defect, wedge shape and block filling defect, while the extruded type revealed smooth round filling defect In the most cases. 6. The myelography can be a valuable aid in the determination of the level and degree of H.I.V.D. and very helpful ln differential diagnosis.