Effect of Cervical Interlaminar Epidural Steroid Injection: Analysis According to the Neck Pain Patterns and MRI Findings

BACKGROUND: It is widely accepted that cervical interlaminar steroid injection (CIESI) is more effective in treating radicular pain than axial neck pain, but without direct comparison. And the differences of effect after CIESI according to MRI findings are inconsistent. In this retrospective study, we evaluated the therapeutic response of CIESI according to pain sites, durations, MRI findings, and other predictive factors altogether, unlike previous studies, which evaluated them separately. METHODS: The medical records of 128 patients who received fluoroscopy guided CIESI were analyzed. We evaluated the therapeutic response (more than a 50% reduction on the visual analog scale [VAS] by their second visit) after CIESI by (1) pain site; neck pain without radicular pain/radicular pain with or without neck pain, (2) pain duration; acute/chronic (more than 6 month), and (3) findings of MRI; herniated intervertebral disc (HIVD)/spinal stenosis, respectively and altogether. RESULTS: Eighty-eight patients (68%) responded to CIESI, and there were no significant differences in demographic data, initial VAS score, or laboratory findings. And there were no significant differences in the response rate relating to pain site, pain duration, or MRI findings, respectively. In additional analysis, acute radicular pain with HIVD patients showed significantly better response than chronic neck pain with spinal stenosis (P = 0.04). CONCLUSIONS: We cannot find any sole predictive factor of therapeutic response to the CIESI. But the patients having acute radicular pain with HIVD showed the best response, and those having other chronic neck pain showed the worst response to CIESI.

Prevalence and Geographic Distribution of Herniated Intervertebral Disc in Korean 19-Year-Old Male from 2008 to 2009: A Study Based on Korean Conscription: National and Geographic Prevalence of Herniated Intervertebral Disc in Korean 19YO Male

PURPOSE: This study was to determine the prevalence of herniated intervertebral disc (HIVD) among Korean 19-year-old male in a large national sample and to compare the prevalence across geographic regions based on the data of conscription. MATERIALS AND METHODS: We analyzed the conscription data of 615508 cases who were 19-year-old male, given an examination for conscription at nationwide Korean Military Manpower Administration from January 2008 to December 2009. Prevalence was determined by dividing the number of cases by the number of persons enrolled for 2 years. The analyses included of a cross-tabulations and nonparametric chi-square to compare the prevalence according to geographic region, disc severity, and conscription year. RESULTS: The prevalence of HIVD among 19-year-old male was 0.47%. Seoul had the highest prevalence of HIVD (total HIVD was 0.60%, and severe HIVD was 0.44%). The prevalence of HIVD was lower in Jeollabuk-do and Jeollanam-do (total HIVD was 0.25-0.27%, and severe HIVD was 0.16-0.17%). Annual prevalence of HIVD was slightly decreased in 2009, but geographic distribution annually was not different. CONCLUSION: In Korean 19-year-old male, the national prevalence of adolescent HIVD was 0.60%, but different geographic distribution was observed. It is quite possible that secondary contributing factor(s) interfere with the different geographic prevalence of HIVD.

Clinical Results about More than 5 Years Follow-up after Open Discectomy

STUDY DESIGN: Retrospective study. OBJECTIVES: We analyzed to verify clinical result and recurrence of long term follow-up after open lumbar discectomy. SUMMARY OF LITERATURE REVIEW: There are many reports concerning the clinical result of open discectomy. However, long-term result is not frequently reported. MATERIALS AND METHODS: From 1989 to 2000, 289 patients underwent open discectomies. 142 patients who was followed more than 5 years were enrolled in this study. Follow-up rate, clinical outcome were analyzed as gender, age at the operation and operated level. Re-operation rate was analyzed as gender, age at the operation, operated level divided into same level-same side, same level-contralateral side and other level and the time at reoperation. Clinical outcomes were evaluated by Kim and Kim criteria. RESULTS: More than 5 years follow-up rate was 49.1%. Average follow-up period were 99.2 months. Clinically successful result was obtained in 75.4%, and it was not related with gender, age at the operation and operated level. Reoperations were needed in 21 patients(14.8%). Reoperation rate was not related with gender, age at the operation. Same level-same side reherniation were frequent before 6 months after first surgery, but other side and different level were similar more than 2 years after first surgery. CONCLUSIONS: Our clinical result was acceptable(75.4%). Main cause of reoperations before 6 months after first surgery was recurrence at the same level and same side, but cause of reoperation more than 2 years after first surgery were herniation at the other side and different level increased with time.

Spinal Nerve Root Swelling Mimicking Intervertebral Disc Herniation in Magnetic Resonance Imaging: A Case Report

A herniated intervertebral disc is the most common type of soft tissue mass lesion within the lumbar spinal canal. Magnetic resonance imaging (MRI) is a useful tool for the assessment of patients with lower back pain and radiating pain, especially intervertebral disc herniation. MRI findings of intervertebral disc herniation are typical. However, from time to time, despite an apparently classic history and typical MRI findings suggestive of disc herniation, surgical exploration fails to reveal any lesion of an intervertebral disc. Our patient underwent lumbar disc surgery with the preoperative diagnosis of lumbar disc herniation; however, nothing could be found during the surgical procedure, except a swollen nerve root.

Cervical HIVD Related to Long-Term Whole Body Vibration and Awkward Posture / 대한산업의학회지

BACKGROUND: The relationship between whole body vibration and awkward neck posture to cervical herniated intervertebral disc (HIVD) has been rarely reported. In this report, we present the case of an overhead crane operator, that had no known history of neck injury, but had long-term exposure to whole body vibration and improper neck posture, who developed cervical HIVD, which raises concerns over the possibility of occupational causation. CASE: A patient, operating an overhead crane since Dec 26th 1986, began to suffer from a neck pain and developed cervical HIVD in 1998. He had been frequently treated in an outpatient clinic, but the symptom was not improve. Eventually, he got HIVD surgery in Sep 6th 2007, and then the symptom was relieved. There were 4 groups and 3 shift system in the patient's overhead crane operation. He worked eight hours a day and 5 days a week. Actual crane work time was about 6 hours a day. The crane was located at 20 meters above the work field so that the crane operator had to look downward and the neck was bent by more than 20degrees for nearly the entire working day. Daily vibration exposure was expressed in terms of an 8-hour energy-equivalent frequency-weighted acceleration magnitude (A(8)) and vibration dose value (VDV). The daily A(8) was measured to be 0.23 m/s2 and the daily VDV was 7.4 m/s(1.75). Although these levels were below the action level recommended by the International Organization for Standardization (ISO) and European Commission (EC), it cannot be ignored that whole body vibration in addition to an awkward neck posture may be related to an increased risk for neck disease. A long-term awkward posture can adversely impact the prevalence of neck disease. In addition, occupational exposure to whole body vibration along with an awkward neck posture seems to exacerbate these effects. CONCLUSION: An overhead crane operator may have acquired cervical HIVD due to an occupational causation. Therefore, to elucidate the causal relationship of an improper neck posture and whole body vibration to neck diseases, further investigations need to be conducted for lager sample of overhead crane operators that were exposed to a long-term awkward neck posture and whole body vibration.

Effectiveness of Selective Nerve Root Block on the Need for Surgical Treatment of Lumbar Disc Herniation / 대한정형외과학회잡지

PURPOSE: The purpose of the study is to evaluate the effectiveness of selective nerve root block (SNRB) in advance to the patient who is going to undergo the operation for lumbar herniated intervertebral disc (HIVD). MATERIALS AND METHODS: 103 cases were selected from among SNRB conducted to the patients who had been diagnosed by this hospital to have lumbar HIVD from December 2004 to November 2005 and assigned for operations. The follow-up period was 10 months in average (2.5-30 months) and the average age was 35.5 years (19-72 years). Patients had been monitored by means of clinical records, interviews and telephone and features of symptoms and stage of nerve root compression were compared between the group of operated patients and that of the non-operated. RESULTS: As for stages of nerve root compression, 15 cases could be classified to belong to the 1st stage, 4 cases to the 2nd stage and 1 case to the 3rd stage. Among 42 cases for which operations were conducted because there was no improvement after SNRB. Divided by stages of nerve root compression, 13 cases belonged to the 1st stage, followed by 10 cases to the 2nd stage and 4 cases to the 3rd stage. No statistically significant difference turned out to exist the clinical results between 42 cases which underwent operations and 61 cases which experienced improvement after nerve root block. No significant difference, either, was confirmed from the statistical outcomes between SNRB group and operations. CONCLUSION: The preserving treatment using SNRB for the patients with lumbar HIVD seems to have positive clinical effects. Features of radiating pains or stages of nerve root compression, however, can't be regarded to be factors foretelling the treatment effects of SNRB.

Analysis of Homepages Relating to Lumbar Disc Surgery in Orthopaedic and Neurosurgical Hospitals / 대한정형외과학회잡지

PURPOSE: This study evaluated the operability for disease of lumbar intervertebral disc (LID) of practitioners and pay doctors of orthopedic surgeons and neurosurgeons by examining their websites. MATERIALS AND METHODS: From March 2006 to April 2006, we searched the internet using the key words orthopedic surgery and neurosurgery, with NAVER as the portal site. There were 68 homepages of orthopedic hospitals and physician's offices (OHP) and 27 homepages of neurosurgical hospitals and physician's offices (NHP). Each homepage was visited in order to survey the operability for disease of an intervertebral disc and the number of board of orthopedists and neurosurgeons. Statistical analysis was carried out using a chi-square test. RESULTS: In 45.6% (31/68) of OHP and 85.2% (23/27) of NHP, the operation for LID was performed and there was significant difference (p<0.001). In 16.2% (11/68) of OHP, neurosurgeons employed by OHP performed the operation for spinal disorders. In 29.4% of OHP, the orthopedic surgeon performed the operation for LID. Orthopedists were employed in 51.9% of NHP. NHP were significantly higher than OHP in the cases in whom the orthopedists and neurosurgeons worked together in a single hospital (p<0.001). CONCLUSION: In 70% of OHP, surgery for LID was not performed. A survey about reasons for not performing operation for LID and improvement of that reasons should be carried out by the medical association.

Peripheral Neuropathy in a Patient with Churg-Strauss Syndrome: A case report / 대한통증학회지

Although Churg-Strauss syndrome (CSS) is a rare disease that is generally associated with vasculitis, nerve involvement is also common in cases of CSS. A 48-year old man was diagnosed with a herniated disc at L4-5 and an annular tear at L5-S1 after complaining of pain and numbness in the left lower leg. Peripheral edema was observed during physical examination and the patient was diagnosed with CSS after a biopsy was conducted. In addition, electromyography and nerve conduction velocity revealed the presence of multiplex mononeuropathy, which indicated the pain and numbness was due to peripheral neuropathy caused by CSS. The symptoms were relieved after oral administration of prednisolone. This case indicates that when symptoms of peripheral neuropathy do not match the radiographic evidence other causes, such as CSS, must be considered.

Evaluation of Quality of Website Information about Lumbar Herniated Intervertebral Disc / 대한정형외과학회잡지

PURPOSE: This study evaluated the information quality of websites that provide information about herniated intervertebral discs (HIVD) and examined the correlation between the information quality score (IQS) and the rank of popularity. MATERIALS AND METHODS: From April 1 to May 31, 2005, of 308 homepages that had been searched on three search engines using the key words (vertebra, disc, lumbago, HIVD), 150 homepages with information about HIVD were surveyed. The informational quality score of each homepage was examined according to the existence or nonexistence of 25 criteria and compared the IQS according to the discipline and operating scale. The homepages were rated according to the rank of popularity and the correlations between their point of popularity and informational quality were assessed. RESULTS: The mean IQS of the 150 homepages were 8.5 (+/-6.4) points, IQS of 94 (62.6%) homepages were <10 points. There were no significant differences between the IQS of orthopedic surgery and neurosurgery (p=0.985). However, the IQS of oriental medicine were significantly lower than orthopaedic surgery (p<0.001) and neurosurgery (p<0.001). There was no significant correlation between the popularity and IQS (p=0.256). CONCLUSION: Proper guidelines and certification of the homepage that provide information about HIVD by the medical association are needed.

Iliopsoas Pyomyositis Overlaping the Herniated Intervertebral Lumbar Disc Symptom: A case report / 대한통증학회지

The diagnosis of pyomyositis in the pelvic region is difficult, as its incidence is relatively, with symptoms that mimic those of discogenic pain. Sciatica is a common presentation of a prolapsed lumbar disc. Less common causes, such as spinal stenosis, pelvic tumors or even primary nerve tumors can also cause these symptoms. Magnetic resonance imaging (MRI) is a useful diagnostic tool. Herein, the case of a patient with an acute pyogenic infection in the iliopsoas muscle, presenting with sciatica, is reported. This is a rare infective disease, which if promptly treated with intravenous antibiotics, can be completely resolved; otherwise, it can result in deep abscess formation, sepsis and death.

Descriptive Patterns of Radiating Pain for Lumbar Herniated Intervertebral Disc / 대한척추외과학회지

STUDY DESIGN AND OBJECTIVE: To evaluate the descriptive patterns of radiating leg pain due to lumbar herniated intervertebral disc, and the correlation between the patterns and various factors such as age, gender, occupation, education, duration of symptom, straight leg raising test, and degree of disc herniation on magnetic resonance imaging. MATERIALS AND METHODS: One hundred and three patients who had lower back pain and radiating leg pain were diagnosed with lumbar herniated intervertebral disc. We investigated the descriptions of their radiating leg pain, and standardized and classified 44 adjective words to 11 groups by the Korean McGill pain questionnaire. We analyzed the frequencies of each word and the correlation between the frequencies and the various factors. RESULTS: The pattern of pain descriptions tended to exhibit certain characteristic traits. The word 'flashing' was the most common (72.8%), followed by the word 'jerking'(62.1%). Descriptions of most patients included either the word 'flashing' or 'jerking'(92.2%). However, there was no significant relation between the frequencies of each word and any factors (p>0.05, chisquare). CONCLUSIONS: The pattern of patients' descriptions for radiating pain of lumbar herniated intervertebral disc is either the word 'flashing'or 'jerking'. This is a useful description to diagnosis and plan for the treatment of lumbar herniated intervertebral disc.

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 Role of Nitric Oxide in Neuropathic Changes Induced by the Autograft of Nucleus Pulposus to the Sciatic Nerve in Rats

OBJECTIVE: To investigate the neuropathic changes induced by nucleus pulposus and possible role of nitric oxide (NO) in the pathogenesis of painful radiculopathy. METHOD: Autologous nucleus pulposus was harvested from the rat coccygeal intervertebral disc and grafted to the sciatic nerve. Pain behavior, neurophysiologic and pathologic changes were compared between autografted and sham operated group during 14-day-period. Western immunoblotting and immunohistochemistry with anti-nitrotyrosine mouse monoclonal antibody were used to compare the NO production and nerve damage in autografted and sham operated nerve tissues. RESULTS: Mechanical allodynia and thermal hyperalgesia were observed 2 days after autograft of nucleus pulposus and persisted during 14-day-period (p<0.05). Motor nerve conduction latency was delayed and compound muscle action potential amplitude was decreased 5 days after autograft (p<0.05). Histologically, nucleus pulposus induced severe inflammatory reaction with fibroblast proliferation and foamy macrophage infiltration, which were persisted during 14-day- period. More nitrated proteins were detected consistently in nerve tissues with autograft of nucleus pulposus and immunohistochemical staining of nitrotyrosine was prominent around foamy macrophages. CONCLUSION: These data suggest that nucleus pulposus induce mechanical allodynia, thermal hyperalgesia and nerve dysfunction through inflammatory reaction with macrophage infiltration. NO and NO related tissue injury may play an important role in the pathogenesis of painful radiculopathy.

The Cervical Herniated Intervertebral Disc Presenting with False Localizing Thoracic Sensory Levels

Symptoms of compressive cervical myelopathy classically include spasticity and weakness, predominantly involving the lower extremities. Sensory abnormalities are reportedly common in the upper extremities, but are often vague or misleading. The sensory findings are usually localized 2-3 spinal segments below the actual spinal cord compression. In our current series, 3 patients presented with progressive symptoms of weakness and hyperreflexia involving the lower extremities without upper extremity symptoms and with a distant thoracic sensory level ranging from T10 to T12. All 3 patients were eventually found to have a cervical herniated intervertebral disc. The direct physical effects of compression and vascular compromise in the central cervical cord compression may be responsible for the reported abnormality at a distinct thoracic sensory level. Failure to diagnose cervical myelopathy because of the presence of a thoracic sensory level can delay appropriate treatment or lead to incorrect therapy.

The Urodynamic Study in Vertebral Disorders with Nerve Root Compression / 대한비뇨기과학회지

PURPOSE: Nerve root compression from spinal stenosis or herniated intervertebral disc(HIVD) may affect bladder function by the disease itself, operation or inappropriate general postoperative care. Preoperative urodynamic study seems to be needed for differential diagnosis of postoperative bladder dysfunction. MATERIALS AND METHODS: Thirty three patients diagnosed as nerve root compression were analysed for urodynamic features prospectively and classified into type I(hyporeflexic, hyposensitive, normal sphincter and hypocontractile, high compliance), type II(hyperreflexic, hypersensitive, normal sphincter and hypocontractile, low compliance), type III(hyperreflexic, hypersensitive, normal sphincter and hypercontractile, low compliance) and normal. Correlation with voiding symptoms, duration of the disease and urodynamic findings was evaluated. RESULTS: The mean age of patients was 56.2 years(29-80 years old), including 21 men and 12 women. Among thirty three patients, 21 had spinal stenosis and twelve patients were diagnosed as HIVD. Urodynamically, there were 16 cases(48.5%) showing type II, 6 cases(18.2%) for type I and 2 cases(6%) for type III. Normal finding was shown in 9 cases(27.3%). No significant difference was shown in mean duration of disease and in urodynamic findings. Patients with voiding symptoms or abnormal urodynamic finding were 20 cases(60.6%) and 24 cases(72.7%), respectively. Among thirteen patients without voiding symptoms, eight patients(61.5%) had abnormal urodynamic findings. CONCLUSIONS: Voiding symptoms and urodynamic findings in patients with nerve root compression were various. Because there is no consistent pattern of dysfunction with any type of nerve root compression disease, preoperative urodynamic study seems to the cornerstone for rational therapy and gives the exact information of bladder function to orthopedic operator.

Correlation of Magnetic Resonance Imaging of Lumbar Herniated Intervertebral Disc with Operative Findings

Magnetic resonance imaging(MRI) is clearly more reliable than computer tomography and myelography in radiological diagnosis of lumbar herniated intervertebral disc. Moreover, MRI can also detect degenerative changes of intervertebral discs. The purpose of this study was to determine the utility and accuracy of MRI in conjuntion with the diagnosis of lumbar herniated intervertebral disc and to compare findings with operative findings. Comparisons of operative findings and MRI were done in 133 cases. Each patients had been diagnosed by MRI as having lumbar herniated intervertebral disc. MRI findings included those of spin echo T1-weighted images and T2-weighted images, gradient echo T1-weighted images and T2-weighted images, and gadolinium-DTPA enhancement when needed. In 32 protrusion disc cases diagnosed by MRI, 28 cases were confirmed by operation and four were actually extrusion disc. In 77 cases diagnosed by MRI as extrusion disc, 72 cases were confirmed by operative findings, while 5 cases were found to be protrusion disc. 4 cases of sequestration disc diagnosed by MRI were confirmed by operative findings. Specific dimensions of MRI use yielded the following results: protrusion disc indicated 84.8% in sensitivity, 95% specificity, 87.5% in accuracy; extrusion disc showed 94.7%, 86.5%, 93.5%, respectively; and sequestration disc revealed 100% in all categories. In this study, the average accuracy of lumbar herniated intervertebral disc diagnosed by MRI was 93.6% on average. Accordingly, MRI has shown itself to be a good diagnostic tool for determining anatomical and biological change in lumbar herniated intervertebral disc.

Herniated Intervertebral Disc of Lumbar Spine in the Teenager / 대한정형외과학회잡지

The incidence of herniated lumbar disc under the age of 19 years is increasing due to increased sports activity of teenager and development of diagnostic methods. 33 cases of herniated lumbar disc of the teenager was analyzed at Department of Orthopaedic Surgery, Dong-A College of Medicine from March 1990 to May 1994. The results were obtained as follows: 1) Among 413 patients, 33 patients(7.9%) were teenagers and the sex ratio was 2.3:1 in male to female. 2) Average intervals between the onset of clinical symptoms and the admission were 13.2 months. 3) 20 cases(60.6%) had a definite trauma history, and among these cases, 14 cases(70.0%) were associated with sports activity. 4) The most common level of herniation was L4-5 in 29 cases(64.4%), straight leg raising test was positive in 32 cases(97.0%), sensory change in 13 cases(39.4%), motor weakness in 10 cases(30.3%). 5) Among positive MRI findings(32 cases), 17 cases(53.1%) were the protruded type. 6) Among 23 operative cases, 21 cases had excellent or good results.

A Clinical Study of Lumbar Disc Sequestration / 대한정형외과학회잡지

Sequestration of disc herniation is important cause of failure of chemonucleolysis. It is important to recongnize this particular variety of disc herniation before considering enzymatic discetomy. Disc herniation were classified into three-anatomical categories. type I: Subligamentous Herniation type II: Extra-ligamentous Herniation type III: Free-extraligamentous Herniation, Sequestratid disc. one-hundred and eight-six cases of herniatid intervertebral disc were evaluated in Department of Orthopedic Surgery, Wonju College of Medicine, Yonsei University and in Department of Orthopedic Surgery, Inchon Christian Hospital from March 1982 to March 1988. The results of study are as follows; l. Among 186 patients, type III sequestrated disc patients were 32 cases(17.2%). 2. The ratio between male and female was about 2:l. 3. The duration of symptoms in type II,III were longer than type I. 4. On examination, the physical changes were more common in type III than in other types. Positive well leg rasing test was prominant finding especially in type III. 5. The myelographic findings, in type III, were irregularity of dural sac at the level of vertebra body both on obligue and lateral view. 6. The C-T findings, in type III, were irregular protruded disc, or caudal or cephalsd migrated disc materials.

The Diagnostic Value of Computed Tomography in Herniated Intervertebral Disc / 대한정형외과학회잡지

The Computed Tomography is the most exact method to find out some diesase, soft tissue or musculoskeletal system. It is searching examination distinguishing normal structure and abnormal states in the spine and spinal canal. This is almost an absolute diagnostic method for spinal stenosis, and it has a special forte becasue it can distinguish the soft tissue around the spine. Thus we can distinguish metastatic cancer, herniated intervertebral disc, hypertrophy of the yellow ligament, and spine tumor very easily. Thirty-two cases of herniated intervertebral disc in lumbar spine were treated for 18 months from Jan. 1981 to Jun. 1982. Of thirty two cases, 18 cases were underwent CT scanning and 9 cases were underwent CT scanning and myelography. We obtained following results: 1. In the 18 cases taking a CT scan we found 6 cases of bulging annulus, 7 cases of herniated disc, one case each of facet syndrome, lateral recess syndrome, and three cases had normal finding. 2. In 9 cases taking CT scan, myelography and operation, 7 cases showed the same positive findings, but one case showed the positive CT scan and myelography, negative surgical exploration, and another case showed positive myelography, negative CT scan surgical exploration. 3. In 9 cases who took only a CT scan, there were 6 cases in which myelography was impossible or refused. Among these 6 cases 4 patients took operation and showed positive findings. 4. The diagnosis of herniated intervertebral disc by means of the CT scan has been made more accurately by the supplementary use of metrizamide and improvement of interpretation. a. When the patient refuses myelography. b. For discrimination of other diseases than herniated intervertebral disc. c. When the patient is allergic to iodine dyes used in myelography. As mention above, not only herniated intervertebral disc, but also many other diseases in spine can be diagnosed and we can decide that the herniated intervertebral disc surgery would by desirable with only the CT scan as nonivasive diagnostic test.

Analysis of Operative Treatment and the Outcome of the Lumbar Disc Surgery in Lumbar Disc Herniation / 대한정형외과학회잡지

A herniated lumbar intervertebral disc has been the most common cause of low back pain and sciatica since Mixter and Barr reported it in 1934. Our methods of treatment were the conservative treatment and the excision of the herniated disc for a limited number of carefully selected cases. The results of disc surgery relate to a number of factors, unquestionably the most important being patient selectivity. We emplopyed Finneson's lumbar disc surgery predictive score card to determine the relationship between patient selection and the outcome of lumbar disc surgery in operative cases. This report is to give a clinical review of 46 cases of the herniated disc upon which surgical removal were performed at Eul-Ji General Hospital from March 1981 to July 1982. The results were obtained as follows: 1. The most common age group were 21 to 40 year old. 2. In 46 surgically treated cases, 34 cases were male (74%) and 12 cases were female (26%). 3. The bulging of disc was found in 25 cases and the ruptured disc was found in 14 cases. The most common site of the lesion was L4-5 intervertebral disc with 30 cases (65%) and the next L5-Sl intervertebral disc with 10 cases (22%). 4. The outcomes of lumbar disc surgery were evaluated at follow-up as good in 77 per cent, fair in 11 per cent, marginal in 7 per cent and poor in 5 per cent of the patients. 5. The predictive scores of each result category were averaged and were as follows; Good: 77.1, Fair: 67.3, Marginal: 58.0, Poor: 40.0 6. The average predictive scores of each result category fell within the anticipated parameters of the score card. 7. The score card may be utilized as reliable system for presurgical patient selection.