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.

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.

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.