2019, Vol.26, No.3

Caudal Epidural Injection with a Catheter in Patients with Failure of Conventional Epidural Blocks

, TAEKEUN AHN

and 2 other persons | 2019, 26(3) | pp.69~75 | number of Cited : 0

Study Design: Retrospective study. Objectives: The purpose of this study was to analyze and report the results of caudal epidural injections using a catheter in patients in whom conventional epidural block had failed. Summary of Literature Review: Epidural nerve block is often used to treat chronic back pain and radicular pain in degenerative lumbar disease, and percutaneous epidural neuroplasty or surgery may be an alternative if it fails. Material and Methods: In total, 146 patients who were treated with caudal epidural block using a catheter were recruited for this study from January 1, 2015 to June 30, 2019. Forty-five patients who had not undergone any epidural block in the past were excluded from the study. Among patients who did not have a fracture and were followed up for at least 1 month, the medical records of 61 patients with degenerative disc herniation, spondylosis, and stenosis were reviewed retrospectively. Visual analogue scale (VAS) scores were evaluated before and after the procedure. Results: Of the 61 patients who had undergone epidural block through a transforaminal caudal approach with no pain control effect, there were 18 males and 43 females. Their mean age was 66.3 years and the average follow-up period was 2.64 months. There were 46 cases of spinal stenosis, 33 cases of spondylosis, 2 cases of spondylolisthesis, 9 cases of disc herniation and 1 case of ankylosing spondylitis. The mean number of epidural blocks was 5.85 (times) before the procedure. The mean initial VAS score was 5.34 and the final follow-up VAS score was 2.70. There was a significant difference between before and after the procedure (p<0.05). The mean duration of effect after the procedure was 1.84 months and the mean number of procedures was 2.30. After the procedure, there were 4 cases of surgical treatment, 2 cases of neuroplasty, and 3 cases of epidural block using other methods over more than 1 year of followup. Conclusions: The result of this clinical study suggests that caudal epidural injections using a catheter may be effective for patients with low back pain who have not responded to previous epidural blocks before surgical treatment. Key words: Back pain, Catheter, Epidural block, Caudal block

The Effects of Sagittal Spino-Pelvic Alignment on the Clinical Symptoms of Thoracolumbar Kyphosis in Osteoporotic Patients

송대건

, Whoan Jeang Kim

, Jae Won Lee and 4 other persons | 2019, 26(3) | pp.76~83 | number of Cited : 1

Study Design: Retrospective study. Objectives: The purpose of this study was to gassess gln-llgnmnnlnl mm-the effect of saittaspiopevic aignmetothe ciicasyptosof thoracolumbar kyphosis (TLK; T10-L2 Cobb’s angle >20°) inosteoporotic patients. Summary of Literature Review: Few studies have investigated the clinicalsymptoms and radiologicalfeatures of TLK caused by degenerative changes. There is also controversy over whether clinicalsymptoms willdeteriorate inpatients with TLK or which treatment should be chosenaccordingto the degree of TLK. Materials and Methods: FromMay 2005 to May 2016, we reviewed 75 patients who were diagnosed with TLK (T10-L2 Cobb’s angle >20°) and osteoporosis. Patients were excluded fromthe study if they had neurologicalsymptoms, underlyingspinaldisorders, or unstable vertebralfractures. Fifty patients with TLK due to anosteoporotic vertebralcompressionfracture (group F) and 25 patients with senile TLK (group S) were assessed by clinicalsymptoms and radiologicalparameters. Thoracolumbar kyphosis angle and sagittalverticalaxis (SVA) were also analyzed. Clinicalsymptoms were assessed usinga visualanalogue scale (VAS) and the Oswestry Disability Index (ODI). Results: There were no significant differences inclinicalsymptoms (VAS, ODI) and radiologicalparameters betweengroups F and S, or accordingto the degree of -33-44lnl mmgnnlmn ngl ml-TLK (20°-30°, 0°-40°, >0°). Ciicasyptoswere significatyore severe ipatiets with saittaibaance (SVA >5 cm) thaninthose with sagittalbalance. Conclusions: Sagittalimbalance is a more important factor affectingclinicalsymptoms thanthe cause or the degree of TLK. Therefore, sagittalimbalance should be considered inthe management of TLK inosteoporotic patients. Key Words: Thoracolumbar kyphosis, Osteoporosis, Sagittalspino-pelvic alignment, Sagittalimbalance

Surgical Extent of Metastatic Spine Tumor Excision and Its Effects on Postoperative Ambulatory Function: Comparison of Extensive Wide versus Palliative Excision Surgery

Kim Young Hoon

, Kim Sang-il

, Kee-Yong Ha

and 4 other persons | 2019, 26(3) | pp.84~93 | number of Cited : 0

Study Design: Retrospective study. Objectives: To compare surgical outcomes such as the ambulatory period and survival according to different surgical excision tactics for metastatic spine tumors (MSTs). Summary of Literature Review: Surgical outcomes, such as pain relief and survival, in patients with MSTs have been reported in several studies, but the effects of differences in surgical extent on the ambulatory period have rarely been reported. Materials and Methods: Ninety-six patients with MSTs who underwent palliative (n=60) or extensive wide excision (n=36) were included. Palliative excision was defined as partial removal of the tumor as an intralesional piecemeal procedure for decompression. Extensive wide excision was defined as a surgical attempt to remove the whole tumor at the index level as completely as possible. The primary outcome was the ambulatory period following surgery. Other demographic and radiographic parameters were analyzed to identify the risk factors for loss of ambulatory ability and survival. Perioperative complications were also assessed. Results: The mean postoperative ambulatory period was longer in the extensive wide excision group (average 14.8 months) than in the palliative excision group (average 11.7 months) (p=0.021). The survival rates were not significantly different between the two surgical excision groups (p=0.680). However, postoperative ambulatory status and major complications within 30 days postoperatively were significant prognostic factors for survival (p=0.003 and p=0.032, respectively). Conclusions: The extent of surgical excision affected the ambulatory period, and the complication rates were similar, regardless of surgical excision tactics. A proper surgical strategy to achieve postoperative ambulatory ability and to reduce perioperative complications would have a favorable effect on survival. Key Words: Metastatic spine tumor, Surgical extent, Palliative, Wide, Ambulation

Acute and Delayed Epidural Hematoma After Total Spondylectomy for a Metastatic Spinal Tumor -A Case Report -

Young Kyu Kim

, 김정훈

| 2019, 26(3) | pp.94~99 | number of Cited : 0

A Rare Extradural Spinal Meningioma with Nocturnal Chest Pain - A Case Report -

Yougun Won

, Sang Bum Kim

, Min Gu Jang and 4 other persons | 2019, 26(3) | pp.100~104 | number of Cited : 0

Delayed-Onset Leg Weakness Caused by Posterior Migration of a Herniated Disc to the Thecal Sac Mimicking Epidural Hematoma in a Flexion-Distraction Injury of the Lumbar Spine - A Case Report -

Han-Dong Lee

, 전창훈

, Chung， Nam-Su