• Journal of Korean Neurosurgical Society
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• v.64 no.4
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• pp.552-561
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• 2021

Objective : To compare the anterior cervical discectomy and fusion (ACDF) and posterior cervical fusion (PCF) with wide facetectomy in the treatment of parallel-shaped bony foraminal stenosis (FS). Methods : Thirty-six patients underwent surgery due to one-or-two levels of parallel-shaped cervical FS. ACDF was performed in 16 patients, and PCF using CPS was performed in 20 patients. All patients were followed up at 1, 3, 6, and 12 months postoperatively. Standardized outcome measures such as Numeric rating scale (NRS) score for arm/neck pain and Neck disability index (NDI) were evaluated. Cervical radiographs were used to compare the C2-7 Cobb's angle, segmental angle, and fusion rates. Results : There was an improvement in NRS scores after both approaches for radicular arm pain (mean change -6.78 vs. -8.14, p=0.012), neck pain (mean change -1.67 vs. -4.36, p=0.038), and NDI score (-19.69 vs. -18.15, p=0.794). The segmental angle improvement was greater in the ACDF group than in the posterior group (9.4°±2.7° vs. 3.3°±5.1°, p=0.004). However, there was no significant difference in C2-7 Cobb angle between groups (16.2°±7.9° vs. 14.8°±8.5°, p=0.142). As a complication, dysphagia was observed in one case of the ACDF group. Conclusion : In the treatment of parallel-shaped bony FS up to two surgical levels, segmental angle improvement was more favorable in patients who underwent ACDF. However, PCF with wide facetectomy using CPS should be considered as an alternative treatment option in cases where the anterior approach is burdensome.

• The Journal of Churna Manual Medicine for Spine and Nerves
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• v.16 no.1
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• pp.53-66
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• 2021

Objectives The purpose of this scoping review is to investigate the trends and gaps in existing research on neural mobilization in Korea and to suggest further directions for study. Methods A scoping review was sequentially conducted according to the five steps outlined by Arksey and O'Malley, and the PRISMA-ScR checklist. We searched five domestic databases (RISS, DBpia, KISS, ScienceON, and KMBASE) and identified relevant literature reported until April 15, 2021. The key search terms used were "Neural mobilization" and "Neurodynamic". Results Of the 1383 studies identified in the search, 50 were finally selected. Of these, 45 studies were in the field of medicine and pharmacy and physical therapy as the most common sub-field. Thirty-eight of the 50 studies (76%) were randomized controlled trials. Neural mobilization was most frequently used in the treatment of stroke (n = 13) and of various neuromusculoskeletal diseases such as cervical radiculopathy (n = 8) and low back pain (n = 5). The main targets of neural mobilization were the median nerve (n = 20) and sciatic nerve (n = 14). The most commonly used technique for neural mobilization was that developed by Butler and Jones in 1991 (n = 10). Conclusions This is the first scoping review of neural mobilization in Korea. We believe that further research on neural mobilization with other types of research design is necessary to investigate the utility of neural mobilization and to establish standard protocols. Our findings indicate that neural mobilization can be considered as an intervention for neuromusculoskeletal diseases in Korean medicine.

• Journal of Acupuncture Research
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• v.38 no.1
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• pp.32-40
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• 2021

Background: The aim of this study was to evaluate the efficacy of Korean medicine combination treatment on recurrent neck pain after medical procedures. Methods: This retrospective study included 158 inpatients of the Daejeon Jaseng Hospital of Korean Medicine who were diagnosed with "Cervical disc disorder with radiculopathy (M50.1)" between December 14th, 2017 and May 29th, 2019. The patients were assigned to 1 of 2 groups based on whether they received medical procedures on the cervical spine at least once. Korean medicine combination treatment was evaluated using EuroQol-5 dimensions index (EQ-5D), numeric rating scale (NRS), and neck disability index (NDI) scores. Results: Before and after treatment, the patients who received medical procedures on the cervical spine at least once before admission (Group A) showed a statistically significant difference in the NDI and NRS scores but not in the EQ-5D scores. This was similar to the patients who had not received medical procedures on the cervical spine before admission (Group B) they showed a statistically significant difference in the NDI and NRS scores but not in the EQ-5D scores. When comparing the results of Group A and Group B before and after treatment, no statistically significant differences were observed in the EQ-5D, NDI, and NRS scores. Conclusion: Korean medicine combination treatment improves the neck functional disability of patients who suffer from recurrent neck pain despite patients having undergone medical procedures.

• Journal of the Korean Orthopaedic Association
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• v.55 no.3
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• pp.261-265
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• 2020

A lumbar juxtafacet cyst is a rare disease that causes low back pain, radiculopathy and neurological claudication by compressing the nerve roots. A 34-year-old male complained of severe low back pain and radicular pain in the right lower extremity. Magnetic resonance images revealed a cyst at the lateral recess of the spinal canal between the L3-4 disc and posterior facet joint that extended to the L4 body level. Under the guidance of an image intensifier, needle aspiration of the cyst was performed, which extracted 1.5 ml of serous, yellowish colored fluid. After the aspiration, the symptoms subsided dramatically. The follow-up magnetic resonance images showed no recurrence of the cyst. To the best of the author's knowledge, there are no reports of lumbar juxtafacet cyst treated with needle aspiration in Korea. This case is reported with a review of the relevant literature.

• Clinical Pain
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• v.19 no.2
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• pp.116-119
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• 2020

Cervical transforaminal epidural steroid injection (TFESI) is commonly performed to provide relief of pain caused by radiculopathy. Intra-arterial injection of particulate steroid or direct needle injury can lead to spinal artery embolism or thrombosis. Also there is a possibility of vascular spasm. To our knowledge, this is the first reported case of spinal cord infarction that occurred after TFESI with non-particulate steroid in Korea. A 47-year-old female patient underwent C7 TFESI at local pain clinic. Injected materials were dexamethasone and mepivacaine. Right after the intervention, she felt muscle weakness and decreased sensation. On physical examination, she had decreased sensation from C4 to T2 dermatome in light touch and pin-prick test. Proprioception and vibration were intact. The motor grades of upper extremities were grade 1. Cervical and thoracic spine MRI was checked. Diffusion-weighted image and apparent diffusion coefficient image showed long extension of spinal cord infarction from C2 to T1 level.

• Journal of Trauma and Injury
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• v.35 no.1
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• pp.34-42
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• 2022

Purpose: Percutaneous iliosacral (IS) screw fixation for pelvic ring injuries is a minimally invasive technique that reduces the amount of blood loss and shortens the procedure time. Moreover, two unilateral IS S1 screws exhibit superior stability to a single IS screw and are also safer for neurological injuries than an S2 screw. Therefore, this study aimed to evaluate fixation using percutaneous two unilateral IS S1 screws for pelvic ring injuries and its subsequent clinical outcomes. Methods: We retrospectively reviewed 38 patients who underwent percutaneous two unilateral IS S1 screw fixation for pelvic ring injuries. The procedure time, blood loss, achievement of bone union, radiological outcomes (Matta and Tornetta grade), and postoperative complications were evaluated. Results: The mean procedure time, hemoglobin loss, bone union rate, and time to union were 40.1 minutes (range, 18-102 minutes), 0.6 g/dL (range, 0.3-1.0 g/dL), 100%, and 153.2 days (range, 61-327 days), respectively. The Matta and Tornetta grades were excellent, good, and fair in 24 (63.1%), 11 (28.9%), and three patients (7.9%), respectively, and the postoperative complications were S1 screw loosening, widening of the symphysis pubis (2.3 and 2.5 mm), lumbosacral plexopathy, and S1 radiculopathy in one (2.6%), two (5.3%), one (2.6%), and one patient (2.6%), respectively. However, all neurological complications recovered spontaneously. Conclusions: Percutaneous two unilateral IS S1 screw fixation was useful for treating pelvic ring injuries. In particular, it involved a short procedure time with little blood loss and also led to 100% bone union and good radiological outcomes.

• Journal of Korean Neurosurgical Society
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• v.66 no.4
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• pp.426-437
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• 2023

Objective : To investigate the efficacy and safety of the posterior endoscopic cervical foraminotomy (PECF) using ultrasonic osteotome for the treatment of cervical osseous foraminal stenosis, focusing on introduction of the advantages of ultrasonic osteotome in partial pediculectomy and ventral osteophyte resection in PECF. Methods : Nineteen patients with cervical osseous foraminal stenosis who underwent PECF using ultrasonic osteotome in our institution between April 2018 and April 2021 were enrolled in this study. All the patients were followed up more than 12 months. The patients' medical data, as well as pre- and postoperative radiologic findings were thoroughly investigated. The visual analogue score (VAS), Japanese Orthopaedic Association (JOA) score, cervical dysfunction index (Neck disability index, NDI), and modified MacNab criteria were used to assess the surgical efficacy. Results : All the patients were successfully treated with PECF using ultrasonic osteotome. The pre- and postoperative VAS, NDI, and JOA scores were significantly improved (p<0.05). According to the modified MacNab criteria, 17 patients were assessed as "excellent", two patients were assessed as "good" at the last follow-up. There was no dura tear, nerve root damage, incision infection, neck deformity, or other complications. Conclusion : Adequate nerve root decompression can be accomplished successfully with the help of ultrasonic osteotome in PECF, which has the advantage of reducing the probability of damage to the nerve root and dura mater, in addition to the original merits of endoscopic surgery.

• Physical Therapy Rehabilitation Science
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• v.12 no.2
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• pp.92-104
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• 2023

Objective: The purpose of this study was to investigate the effect of spinal mobilization with leg movement (SMWLM) and neural mobilization (NM) in patients with lumbar disc herniation (LDH) accompanied by radiating pain. Design: Three-group pre-test-post-test control group design. Methods: We enrolled 48 participants, whom we randomly assigned to three groups. The SMWLM group (n=16) underwent 20 min of conventional physical therapy (CT) and 20 min of SMWLM. The NM group (n=16) underwent 20 min of CT and 20 min of NM. The control group (n=16) underwent 20 min of CT. These interventions in all the groups were performed three times a week for 4 weeks. Numeric pain rating score (NPRS), body grid chart score (BGCS), passive straight leg raise (PSLR), active lumbar flexion range of motion (ALFROM), korean version oswestry disability index (KODI), and korean version fear avoidance beliefs questionnaire (KFABQ) were measured pre- and post-intervention. Results: In all three groups, the NPRS, PSLR, KODI, and KFABQ scores were significantly different pre- and post-intervention (p<0.05). Significant differences were observed in BGCS and ALFROM in the SMWLM and NM groups pre- and post-intervention (p<0.05). The SMWLM group showed more improvement in the NPRS of leg pain, ALFROM, and KFABQ score than that exhibited by the NM and control groups (p<0.05). Conclusions: Both SMWLM and NM were effective for improving back and leg pain, centralization of symptoms, mechanical sensitivity, lumbar mobility, lumbar functional disability, and psychosocial functioning in patients with LDH with radiating pain.

• Clinical Pain
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• v.18 no.2
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• pp.70-75
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• 2019

Objective: The purpose of this study is to evaluate the usefulness of infrared thermography in patients with carpal tunnel syndrome by comparing with electrodiagnostic and ultrasonographic findings. Method: From January 2014 to October 2017, electrodiagnosis, ultrasound, and digital infrared thermal image (DITI) of unilateral carpal tunnel syndrome diagnosed in a single hospital were retrospectively analyzed. The subjects with bilateral symptoms of carpal tunnel syndrome, peripheral vascular disease, diabetes, thyroid disease, fibromyalgia, rheumatic disease, systemic infection, inflammation, malignant tumor, and other musculoskeletal disorders such as finger osteoarthritis, peripheral neuropathy, cervical radiculopathy, and the previous history of surgery were excluded. Results: Of 53 patients diagnosed with carpal tunnel syndrome, 11 were male and 42 were female. The visual analogue scale was 4.9 ± 1.9, and the duration of symptom was 11.8 ± 12.5 months. There was no statistically significant difference in the body surface temperature between the unaffected and affected sides. The severity of symptoms, electrodiagnostic findings, and cross-sectional area of the median nerve significantly correlates to each other. The temperature difference between the second fingers of the affected and unaffected sides showed a weak correlation with the amplitude of sensory nerve action potential and onset latency of compound muscle action potential, when there was no significant correlation with the other parameters. Conclusion: The difference in temperature on the surface of the body, which can be confirmed by DITI, is little diagnostic value when DITI is performed in unilateral carpal tunnel syndrome patients, especially when compared with ultrasonography.

• Journal of Korean Neurosurgical Society
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• v.30 no.1
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• pp.47-53
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• 2001

Objective : This study was undertaken to evaluate operative results and prognosis according to preoperative clinical status and histopathological finding of spinal cord tumor. Methods : We analyzed of clinical feature, tumor location, histopathologic finding, operative results and prognosis in 55 patients with spinal cord tumor during last 10 years. Results : 1) The incidence of spinal cord tumors varies with the age of affected patients who are 2 to 75 years of age. Peak incidences were in the 5th & 7th decade of life, and the ratio of male to female was 1.2:1. 2) The most common histopathologic type was neurinoma(41.9%). 3) The tumors were located most frequently in the thoracic area(22 cases, 40.0%) and in the intradural extramedullary space(30 cases, 54.5%). 4) The most common initial clinical feature was pain in 20 cases(36.4%). For neurologic status on admission, 30 cases(54.5%) showed motor disturbance. 5) In radiologic studies, there were abnormal finding in 21 cases from plain X-rays among 37 cases. The entire 20 cases in when myelography was done showed subarachnoid blockade, either complete or incomplete. The magnetic resonance imaging, regard as the most accurate diagnostic method, revealed the exact location of the tumor and the relationship of the tumor with the adjacent anatomical structure. 6) The total removal was possible in 36 cases(65.5%), subtotal removal in 17 cases(30.9%) and biopsy in 2 cases (3.6%). Nineteen cases(90.5%) among 21 cases with preoperative radiculopathy group showed recovery or improvement, where as only 11 cases(36.7%) among 30 cases with preoperative motor weakness group showed recovery or improvement, with statistically significant difference(p<0.01). Pathologically, 26 cases(83.9%) among 31 cases of neurinoma and meningioma showed postoperative recovery or improved, but only 1 case(6.3%) among 16 cases of metastatic tumor, astrocytoma and ependymoma recovered. Postoperative complication noted in 5 cases(9.1%), and were noted postoperative hematoma, pneumonia, pulmonary edema and spinal cord infarction. Conclusion : Preoperative neurologic status and histopathologic finding are considered important factors of Postoperative outcome in patients with spinal cord tumor.