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pISSN : 2093-4378 / eISSN : 2093-4386

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2018, Vol.25, No.3

  • 1.

    Overview of the Management of Chronic Non-Cancer Pain in Patients with Spinal Disease

    Hun Kyu Shin | Woo Dong Nam | 김동수 and 4other persons | 2018, 25(3) | pp.91~98 | number of Cited : 0
    Abstract
    Study Design: Cross-sectional, multi-center survey study. Objectives: The objective of this study was to investigate the pain status, pain management methods, and pain experience after treatment among patients suffering from chronic non-cancer pain due to spinal disease. Summary of the Literature Review: No thorough investigation of the current status of chronic non-cancer pain management in patients with spinal disease has recently been reported. Materials and Methods: We surveyed 330 patients with chronic non-cancer pain who visited spine clinics in Korea. Results: Prior to treatment, 86.7% of the patients had severe pain and 99.4% of the patients had taken oral analgesics for pain control. After treatment, the percent of patients with severe pain was reduced to 42.1%, and 52.4% of patients responded that they experienced intermittent pain. End of dose failure was experienced by 29.1% of patients, and 41.7% of patients experienced pain again 3-6 hours after taking analgesics. Furthermore, 8.2% of patients experienced breakthrough pain, and 29.1% of patients experienced pain that interfered with sleeping. Conclusions: Many patients with chronic pain reported experiencing pain due to end of dose failure after medication. As the causes of chronic pain are complex, appropriate analgesics should be considered and selected for effective pain management.
  • 2.

    Survival Rate and Risk Factor Analysis in Patients Who Experience a New Fracture after Kyphoplasty

    김정훈 | 김동혁 | 2018, 25(3) | pp.99~107 | number of Cited : 0
    Abstract
    Study Design: Retrospective study. Objectives: To evaluate the factors related to the incidence of a new fracture in an adjacent vertebra after kyphoplasty for single vertebral body fracture due to osteoporosis and to assess the impact of such factors on patients’ survival rate. Summary of Literature Review: It is controversial whether fracture of an adjacent vertebra after kyphoplasty is due to the natural course of osteoporosis or as a complication of kyphoplasty. Materials and Methods: From December 2006 to December 2016, among 490 cases of kyphoplasty for single vertebral body fracture due to osteoporosis, 153 cases were analyzed retrospectively. The survival rate was analyzed based on age, gender, body mass index (BMI), fracture level, leakage of cement, amount of cement, compression rate, recovery rate, bone density, osteoporotic medication rate and compliance, existence of a compression fracture, hypertension, diabetes, and smoking habit. The average follow-up duration was 15.1 months (range, 1 month to 8 years and 8 months) and the mean age was 74.4 years (range, 54-93 years). Results: A new fracture in an adjacent vertebral body occurred in 27 cases (17.3%). The 1-year survival rate was 82.6%, the 2-year survival rate was 72.5%, and the 6-year survival rate was 53.7%. The survival rate was significantly higher in patients younger than 75 years (p=0.0495). The survival rate was also significantly higher in patients with a preoperative vertebral bone density greater than −3.7 and hip bone density greater than −2.2 (p<0.0001, p=0.0114). The survival rate was significantly higher in patients with a BMI greater than 18.1 kg/m2 at the time of surgery (p=0.0014). Furthermore, the survival rate was significantly higher in patients with a postoperative recovery of vertebral height of 14% or less (p=0.0031). In addition, the survival rate was higher in patients without a compression fracture before surgery (p=0.0297). In multiple factor analysis, vertebral bone density (p=0.0049) and age (p=0.0408) were identified as statistically significant factors. Conclusions: The survival rate was significantly lower at 1, 2, and 6 years in patients with an adjacent vertebral fracture. The most crucial factors affecting the survival rate were age and vertebral bone density.
  • 3.

    Relationship between Lumbar Extensor Muscle Degeneration Classification and Osteoporotic Vertebral Compression Fracture

    허주영 | 박지훈 | 김민욱 and 4other persons | 2018, 25(3) | pp.108~114 | number of Cited : 0
    Abstract
    Study Design: Retrospective study. Objectives: To investigate the reliability of the lumbar extensor muscle degeneration classification as an indicator of potential risk for osteoporotic vertebral compression fractures (OVCF). Summary of Literature Review: Fatty degeneration of lumbar extensor muscles has attracted increased interest in the literature as a risk factor for OVCF. Materials and Methods: Ninety-one patients with OVCF (group 1) and 60 patients without OVCF (group 2) were investigated. Magnetic resonance imaging was used to measure and to analyze the muscle mass and fatty degeneration of the lumbar extensor muscle. The degree of fatty degeneration of the lumbar extensor muscle was classified into 4 stages: less than 10%, 10%-25%, 25%-50%, and more than 50%. Results: Fatty degeneration of the lumbar extensor muscle and the bone mineral density T-score were 29.66%±12.28% and −3.56±1.13 in group 1 and 24.04%±13.29% and −2.27±1.46 in group 2, which were statistically significant differences (p<0.05). Logistic regression analysis revealed that as the fatty degeneration of the lumbar extensor muscle increased, the risk of OVCF increased (odds ratio [OR]=1.21; p=0.01). The risk of OVCF increased as the lumbar extensor muscle degeneration classification scores increased (OR=13.53; p=0.02). Furthermore, as the muscle mass of the multifidus decreased, lumbar lordosis and sacral inclination decreased (β=0.33; p=0.01 and β =0.25; p=0.04, respectively). However, no factor affected thoracic kyphosis. Conclusions: Fatty degeneration of the lumbar extensor muscle was correlated with OVCF. A lumbar extensor muscle degeneration classification higher than stage 3 should be considered a risk factor of OVCF.
  • 4.

    Risk Factors for Wound Infection in Spinal Surgery: A Focus on Diabetes Mellitus

    정화재 | Hun Kyu Shin | 박종근 and 4other persons | 2018, 25(3) | pp.115~121 | number of Cited : 0
    Abstract
    Study Design: Retrospective study. Objectives: To identify risk factors for infection after spinal surgery. Summary of the Literature Review: Infection after spinal surgery is relatively uncommon. However, such infections cause serious consequences and increased costs and sequelae. Risk factors for infection after spinal surgery include a posterior approach, instrumentation, the use of an allogenic bone graft, transfusion, and a long operating time. Patient-related factors include diabetes and obesity. Materials and Methods: From January 2009 to December 2013, 350 patients who underwent surgery at our hospital due to spinal disease, including 10 patients with a postoperative spinal infection, were evaluated. We investigated patients’ age, gender, morbidity due to diabetes mellitus, body mass index, level of surgery, approach, location, instrumentation, and operation type. Results: Ten of the 350 patients developed a spinal infection after surgery. The proportion of diabetic patients among the infected patients was higher than among the non-infected patients, although the difference was not statistically significant. Additionally, the proportion of diabetic patients with hemoglobin A1c levels greater than 7.0% was higher among the infected patients. Operating time, the surgical approach, drain tube insertion, transfusion, and the use of an allogenic bone graft were not significantly different between the infected and non-infected patient groups. Conclusions: Uncontrolled diabetes is the most important risk factor for the development of spinal infection after surgery. Therefore, in order to prevent infection after surgery, blood glucose should be controlled before surgery.
  • 5.

    Comparison of Postoperative Pain Control Methods in Patients with Spinal Stenosis after Posterior Spinal Decompression

    송우석 | Young-Sang Lee | 박병학 and 2other persons | 2018, 25(3) | pp.122~127 | number of Cited : 0
    Abstract
    Study Design: Prospective study. Objectives: This study compared the early postoperative analgesic effects and the postoperative nausea and vomiting (PONV) associated with 3 methods of pain control after posterior spinal decompression. Summary of Literature Review: Spinal surgery causes severe postoperative pain. Efficient and safe methods for postoperative analgesia after spinal surgery are necessary. Materials and Methods: To determine the clinical symptoms and to assess improvements in postoperative pain, 52 patients in whom single-level posterior lumbar decompression was planned were randomly assigned to 3 groups. For postoperative pain control, 18 patients received a preoperative single-shot epidural injection (SEI), 16 patients received a postoperative continuous epidural injection (CEI), and 18 patients received only postoperative intravenous patient-controlled analgesia (IV-PCA). Patient ratings of pain intensity (visual analog scale score from 0 [no pain] to 10 [most severe pain]), nausea (from 0 [no nausea] to 5 [severe nausea]), and vomiting (from 0 [no vomiting] to 5 [severe vomiting]) were recorded immediately after the operation and at 4 hours, 12 hours, 1 day, and 2 days postoperatively. Results: The CEI group showed significantly enhanced analgesic effects, followed by the SEI group and the IV PCA group (p<0.05). PONV due to postoperative pain control was more severe in the IV PCA group than in the other 2 groups (p<0.05). Conclusions: Continuous epidural injection (CEI) is effective for postoperative pain control and minimizes the occurrence of PONV after posterior spinal decompression.
  • 6.

    Diagnosis of C2 Spondylotic Radiculopathy by Physical Examination and Imaging Studies and Treatment by Microscopic Posterior Foraminotomy - A Case Report -

    정유훈 | 이영상 | Dong-Chan Eun and 1other persons | 2018, 25(3) | pp.128~132 | number of Cited : 0
    Abstract
    Study Design: Case report. Objectives: We report the case of a patient with C2 spondylotic radiculopathy who was treated by microscopic posterior foraminotomy. Summary of Literature Review: C2 spondylotic radiculopathy is rare, but it can occur due to spondylosis, compression by a venous plexus or vertebral artery, or hypertrophy of the atlantoepistrophic ligament. Materials and Methods: A 64-year-old woman was hospitalized with severe occipital pain radiating toward the left cervical area and posterior to the left ear. It started 3 years previously, and became aggravated 3 months previously. Foraminal stenosis of C1-2 was observed on magnetic resonance imaging (MRI) and degenerative changes of the facet joint of C1-2 and osteophytes originating from the left atlantoaxial joint were shown on computed tomography (CT). Dynamic rotational CT showed narrowing of the left C1-2 neural foramen when it was rotated to the left. Selective C2 root block was done, but the pain was aggravated. Thus, we decompressed the C2 nerve root by microscopic posterior laminotomy of the C1 vertebra. After surgery, the patient’s occipitocervical pain mostly resolved. By the 6-month follow up, pain had not recurred, and instability was not observed on plain radiographs. Results: C2 Spondylotic radiculopathy was diagnosed by physical examination and imaging studies and it was treated by a surgical approach. Conclusions: C2 spondylotic radiculopathy should be considered when a patient complains of occipitocervical pain triggered by cervical rotation and C1-2 foraminal stenosis is observed on MRI and CT.
  • 7.

    Acute Lumbar Paraspinal Compartment Syndrome after Weightlifting - A Case Report -

    Ki-Won Kim | 하지윤 | Jun Seok Lee and 1other persons | 2018, 25(3) | pp.133~139 | number of Cited : 0
    Abstract
    Study Design: Case report. Objectives: To report 2 cases of acute lumbar paraspinal compartment syndrome due to weightlifting. Summary of Literature Review: Acute lumbar paraspinal compartment syndrome is very rare, but it causes muscle necrosis and acute renal failure. Therefore, it should be treated immediately. Materials and Methods: A 31-year-old male patient and a 30-year-old male patient visited the emergency room due to severe back pain. The left paraspinal compartment pressure of the 31-year-old patient was measured as 35 mm Hg using the Whitesides technique. The paraspinal compartment pressure of the 30-year-old patient was measured as 22 mm Hg on the left side and 30 mm Hg on the right side. We diagnosed acute lumbar paraspinal compartment syndrome and performed a fasciotomy. This study received Institutional Review Board approval (ID: SC18ZESE0032). Results: Lab findings improved after fasciotomy. The operative wounds healed after fasciocutaneous flap placement. Conclusions: Acute lumbar paraspinal compartment syndrome is very rare, but should be considered in patients with severe back pain.
  • 8.

    Spinal Subarachnoid Hematoma after Spinal Anesthesia - A Case Report -

    신원식 | 이정수 | 안동기 and 2other persons | 2018, 25(3) | pp.140~144 | number of Cited : 0
    Abstract
    Study Design: Case report. Objectives: We report a case of spinal subarachnoid hematoma that developed after spinal anesthesia in a female patient who had no risk factors. Summary of Literature Review: Few case reports of spinal subarachnoid hematoma (SSH) after spinal anesthesia have been published. The incidence of SSH is much less than that of epidural hematoma. Materials and Methods: A 56-year-old female patient underwent arthroscopic surgery on her right knee under spinal anesthesia. Automated patient-controlled analgesia (PCA) was applied after surgery. On day 2, the patient complained of lower back pain, headache, nausea, and vomiting, but there were no neurological signs in the lower extremity. At day 5, she had a moderate fever (38.4°) and continuous nausea and vomiting. Magnetic resonance imaging (MRI) was conducted on day 5 and a large subarachnoid hematoma was found. We immediately performed surgical hematoma evacuation. Her low back and buttock pain improved immediately, and all symptoms disappeared in a week without any neurological sequelae. Results: The unusual and vague symptoms in this case made the diagnosis difficult, but spinal MRI confirmed SSH. Immediate surgical hematoma evacuation improved all symptoms and left no neurologic sequelae. Conclusions: SSH after spinal anesthesia may have cerebral symptoms that mimic the side effects of PCA. Early diagnosis by MRI and surgical evacuation of the SSH are a reasonable approach for this complication.