How Effective Is the Injection Therapy in Foot and Ankle Disorder? / 대한족부족관절학회지

Evidence-based papers on the treatment of some chronic tendinopathy or ligament lesions using an injection in foot and ankle disorders have been reported, but there are few reports on the treatment of acute ankle ligament injury. On the other hand, some papers have reported a faster return to play for injection therapy that combines RICE (Rest, Icing, Compression, and Elevation) treatment and rehabilitation. Injection therapy can be used as an additional treatment for ankle ligament injury. Rather than having narrow-minded thinking about these treatments, it is important to make efforts to verify the safety and precautions of treatment and recognize them as a category of normal treatment. Continuous analysis and monitoring of these treatments can satisfy patients whose needs are changing rapidly.

Superficial Peroneal Nerve Entrapment Syndrome (A Case Report) / 대한족부족관절학회지

Superficial peroneal nerve entrapment is an uncommon compression neuropathy, and is frequently associated with a fascial defect and a muscle hernia. The standard treatment of that was the nerve decompression by complete or limited fasciotomy. But, we experienced a case of superficial peroneal nerve entrapment had satisfactory surgical outcome by fascial repair of peroneus muscle.

Two Stage Procedure with a Temporary Antibiotic-impregnated Cement Spacer of Infected Hallux Interphalangeal Joint (A Case Report) / 대한족부족관절학회지

The interphalangeal joint (IPJ) of the hallux has received little attention compared with the first metatarsophalangeal joint. But, the hallucal IPJ has several disorders such intra-articular fractures, dorsal dislocation, alignment disorder, and inflammatory or degenerative arthritis. Among these disorders septic arthritis of the IPJ of the hallux is rare. We report a case of sepsis of the hallucal IPJ and adjacent underlying osteomyelitis without neuropathic problem and was performed through infected soft tissue and osseous debridement, temporary antibiotic-impregnated cement spacer, and delayed intercalary allogenic fibular bone graft with K-wire fixation.

Operation Fee and Insurance Charge of Hallux Valgus Surgery / 대한족부족관절학회지

PURPOSE: The purpose of this study was to figure out the appropriate and systemic insurance charge for the hallux valgus operations. MATERIALS AND METHODS: 5 Hospitals for hallux valgus operations were analyzed how they have been charging the national health insurance corporation for their operation fees and how to use the estimated guide and authoritive interpretation through the guide book of health insurance medical treatment grant expense and the guide book of Health insurance medical treatment. RESULTS: There are nothing for guiding principle of hallux valgus operations in both books but a guide of Mcbride operation which is approved 'JA-93-KA and JA-31' for operation fee. So majority of hospitals have charged operation fee depending on their own interpretations they like. According to the guide books, there was a authoritive interpretation that simultaneous operation of osteotomy and tendon transfer for cerebral palsy and flat foot can be eatimated as 'osteotomy +JA-93-NA'. CONCLUSION: Distal soft tissue procedure should be approved as 'JA-93-NAx100%+JA-31x50%' according to the the estimated guide and authoritive interpretation if transected adductor hllucis is transfered to first metatarsal head. So distal chevron osteotomy could be 'JA-30-1-RAx100%+JA-31x50%', proximal metatarsal osteotomy could be 'JA-93-NAx100%+JA-31-50%+JA-30-1-RAx50%', first metatarsocuneiform joint arthrodesis could be 'JA-93-NAx100%+ JA-31x50%+JA-73-RAx50%'.

Treatment of the Unstable Distal Radius Fracture with External Fixation and Bone Cement in Elderly Patients

PURPOSE: To evaluate the functional and radiologic results in the using of external fixation with bone cement (polymethylmethacrylate, PMMA) for unstable, osteoporotic distal radius fractures in elderly patients that have high morbidity and chronic medical problems. MATERIALS AND METHODS: We retrospectively analyzed 12 cases of 12 patients who were treated by external fixation and bone cement for unstable distal radius fractures in the aged persons with poor general condition from January 2003 to July 2004 and followed over one year. We analyzed the radiologic results, and measured the ranges of motion and grip strengths. Functional results were evaluated using the Modified Mayo Wrist Scoring System. RESULTS: Radiographically, mean volar tilt, mean radial inclination and mean radial length were 8.33o, 24.66 mm and 11.31o respectively on the last follow-up. The mean arc of range of motion was 74.4% of that the uninjured side, and the mean grip strength was 78.0% of that the contralateral side. The average Modified Mayo Wrist Score was 78.3. There were reflex sympathetic dystrophy in a case and pin tract infection in 3 cases as complications associated with external fixator. CONCLUSION: External fixation and bone cement is useful method for radial length maintenance, preventing reduction loss, restoring the articular surface, early exercise of the wrist joint without morbidity of donor site for unstable distal radius fractures requiring autogenous bone graft in the elderly patients.

The Effects of Heme Oxygenase-1 on Collagen Induced Arthritis Model / 대한해부학회지

Heme oxygenase-1 (HO-1), an inducible heme-degrading enzyme, is expressed by macrophages and endothelial cells in response to inflammatory stresses. It has been known to show strong immunosuppressive properties although its mechanisms are not completely understood. This study was designed to determine the effects of HO-1 modulation on collagen induced arthritis (CIA) model. CIA model was induced by subcutaneous injection of collagen on tail of DBA/1J mice. For evaluation of HO-1 effects, an inducer of HO-1, cobalt protoporphyrin IX (CoPPIX), or an inhibitor of HO-1, tin protoporphyrin IX (SnPPIX), were administered every other days into peritoneal cavity from day 1 to day 42 after CIA induction. The macrocopic clinical findings of CIA were evaluated and histo-pathologic findings and radiographic analysis were carried out. The expressions of TNF-alpha, IL-6, and VEGF which have important roles in pathogenesis of rheumatoid arthritis were observed by immuno-histochemical staining. Collagen on DBA/1J mice induced arthritis at knee joint and ankle joint. Administration of CoPPIX significantly aggravated the severity of arthritis while SnPPIX protected collagen induced arthritis. SnPPIX strongly suppressed inflammatory cell infiltration, swelling of synovial membrane, and erosion and destruction of bone on CIA mice. Furthermore subcutaneous injection of collagen also increased expression of TNF-alpha, IL-6, and VEGF which are important pro-inflammatory mediators in rheumatoid arthritis. SnPPIX suppressed expression of the pro-inflammatory mediators on CIA mice. Finally, we suggest that HO-1 mediates the expression of pro-inflammatory mediators and bone destruction during pathogenesis of CIA, which indicates modulation of HO-1 can be a new therapeutic target of rheumatoid arthritis.

The Modified Brostrom Procedure for Chronic Lateral Ankle Instability / 대한족부족관절학회지

PURPOSE: The purpose of this study is to evaluate the surgical results of modified Brostrom procedure for chronic lateral ankle instability and to assess whether or not associated injuries may affect postoperative satisfaction. MATERIALS AND METHODS: Twenty-four patients with chronic lateral ankle instability were evaluated retrospectively from August 1998 to March 2002. Average age was 29.3 years. All patients were performed pre & postoperative ankle anteroposterior and lateral view, stress anterior drawer and varus test using Telos device, MRI and intraoperative arthroscopic evaluations before ligament reconstruction. RESULTS: Of the 24 cases, 23 cases was improved more than average 12 points on AOFAS scales. On modified scales of Hamilton, 3 excellent, 20 good, 1 fair results. On stress view, average 2.2 mm difference was improved on anterior drawer test and average 1.7 degree on varus test. Associated injuries were 8 osteochondral defects, 4 anterior impingements, 2 loose bodies, 2 os subfibulare, 2 os submalleolare and 2 partial ruptures of peroneus brevis. 8 cases with no associated injuries rated excellent or good. CONCLUSION: The modified Brostrom procedure is believed to be an effective and successful method for chronic lateral ankle instability that didn't respond to conservative treatment. Because associated injuries in chronic lateral ankle instability may affect postoperative satisfaction, appropriate detection and treatment may need for postoperative satisfaction.

The Usefulness of Selective Spinal Nerve Root Block / 대한척추외과학회지

PURPOSE: A retrospective study on the usefulness of selective spinal nerve root block among lumbar herniated intervertebral disc (HIVD), spinal stenosis and postoperative syndrome over 10 years. MATERIAL AND METHOD: From a total 1195 patients, whose symptoms were not improved by conservative treatment, 505 treated by selective nerve root block were divided into 3 groups; 150 (29.7%) with HIVD, 313 (62.0%) with spinal stenosis and 42 with postoperative syndrome, and were followed up from Oct. 1992 to Dec 2001. The degree of pain and activity were evaluated by a visual analogue scale method at the out-patient department or through telephone interviews. RESULTS: The end-results of selective spinal nerve root block, with more than 50% reduction in pain occurred in 380 (75.3%) of the 505 patients. The effectiveness was greater in young patients with HIVD than elderly patients with spinal stenosis. After discharge, 160 patients (31.7%) needed no other treatment: 14 (31.0%) with an extrusion type HIVD and 17 (20.0%) with spondylolisthesis. The only 98 patients (19.4%) needed a surgical procedure after selective spinal nerve root block. CONCLUSION: Selective spinal nerve root block in patients with lower back and radiating pain is a valuable conservative treatment to quickly improved symptoms and avoid surgical procedures and the continuous administration of drugs.

Total Knee Arthroplasty Using Bone Graft in Neuropathic Knee: Preliminary Report

INTRODUCTION: Recently, total knee arthroplasty is being considered as an alternative to the arthrodesis for neuropathic knee. This study was performed to prove the results of the total knee arthroplasty using autograft or femoral head allograft. SUBJECTS AND METHOD: In 8 patients, total knee arthroplasty was performed from July 1992 to January 2002. PCL substituting type with extension rods, constrained condylar knee prostheses were used. In all cases, auto or allo-grafts were used. The follow-up period was an average 3 years and 6 months. HSS knee score and radiographic findings were analysed. RESULT: The preoperative HSS score was an average 42 points and follow up was a 89 points, which was more than good. The average range of motion was increased from 110 degrees to 122 degrees, femorotibial alignment was corrected to 6.1 degrees valgus. There was a no radiolucent line over 2mm and loosening of implant. But, one case had a partial absorption of medial tibial bone graft site, and complained the subluxation after 6 years and 5 months. So the meniscal bearing was exchanged from 12.5mm to 17.5mm. CONCLUSION: If the proper choice of prostheses and bone grafts are accompanied, the total knee arthroplasty can be used to treat the neuropathic joint concurrently with arthrodesis.

Hip and Pelvis Diseases on Lumbar AP Radiographs Including Both Hip Joints

PURPOSE: To determine the frequency of diseases of the hip and pelvis, as seen of plain radiography of the lumbar spine in patients with suspicious lumbar disease, and to evaluate the methods used for lumbar spine radiography in Korea. MATERIALS AND METHDOS: Sixty university and training hospitals were randomly selected and asked to describe the projections, film size and radiographic techniques employed for routine radiography in patients with suspected disease of the lumbar spine. Plain radiographs of 1252 patients, taken using 14"x17"film and depicting both hip joints and the lumbar region, were analysed between March 1999 and February 2000. RESULTS: In 15 patients (1.2%), the radiographs revealed hip or pelvic lesions, confirmed as follows: avascular necrosis of the femoral head (n=11, with bilateral lesions in four cases); sustained ankylosing spondylitis (n=2); acetabular dysplasia (n=1); and insufficiency fracture of the pubic rami secondary to osteoporosis (n=1). In 11 of the 20 hospitals which responded, 14"x17"film was being used for lumbar radiography, while in the other nine, film size was smaller. CONCLUSION: Plain radiography of the lumbar spine including both hip joints, may be a useful way to simultaneously evaluate lesions not only of the lumbar spine but also of the hip and/or pelvis.

Effects of the Strengthening Exercise on Back Muscles after Lumbar Discectomy / 대한척추외과학회지

STUDY DESIGN: A retrospective study about lumbar strengthening exercise after lumbar discectomy. OBJECTIVES: To evaluate the effect of lumbar strengthening exercise on muscle power and pain, to analyze the problem of rehabilitation program after lumbar discectomy. SUMMARY OF LITERATURE REVIEW: The effectiveness of Lumbar strengthening exercise is still controversy and we can not found the similar article for this kind problem. MATERIALS AND METHODS: Three-hundred twenty eight patients of microscopic lumbar discectomy from 1998 to 1999, were divided into 2 groups; exercise group was 72 cases among 119 patients, and non-exercise group was 58 cases among 208 patients. degree of pain and functional activity were evaluated by visual analog scale and API test, respectively, at postoperative 3 months, 6 months, 1 year. the reason for not exercising was surveyed in non-exercise group. RESULTS: Exercise group 119 patients(36%). The most common cause of Non-Exercise was a deficiency of importance for lumbar strengthening exercise and exercise was done better in civil peoples than inrural peoples. There was a significant good result in exercise group by visual analog scale for pain at 3 months and 6 months postoperatively, but no difference between two groups after 1 year. exercise group had better results in flexion/extension test and fatigue endurance test. Lumbar strengthening exercise was a good method for relieving the pain in short term, but it was not effective in long term follow up. CONCLUSIONS: These results suggest that good results after lumbar discectomy in exercise group result from the secondary effects of increasing muscle power rather than relieving pain.

Clinical Characteristics of Contralateral Recurrent Lumbar Disc Herniation at the Same Level: A Retrospective Controlled Study / 대한척추외과학회지

STUDY DESIGN: A retrospective study of patients with contralateral recurrent lumbar disc herniation at the same level. OBJECTIVES: To analyze the risk factors of recurrence, clinical result and reoperative efficiency of contralateral recurrent lumbar disc herniation at the same level after primary discectomy compared with those after discectomy in primary lumbar disc herniation. SUMMARY OF LITERATURE REVIEW: There have been many studies on recurrent disc herniation, but little investigation of risk factors and clinical result of contralateral recurrent lumbar disc herniation at the same level. MATERIALS AND METHODS: Ten cases who can investigate for 2 years among the patients who underwent reoperation for contralateral recurrent lumbar disc herniation at the same level after primary discectomy were selected as study group (group I) and thirty cases who underwent discectomy during the same study period were selected as control group (group II). Age, gender, etiology and symptom of disc herniation, clinical improvement rate and amount of remove disc were recorded. Overall patient satisfaction, pain severity, functional outcome and work status were evaluated. Risk factors of recurrence were analyzed. RESULTS: Etiology was no different between both groups but showed the abrupt onset symptom in study group. Recurrence was more common in the case herniated posterolaterally and had severe degeneration change in lumbar disc before primary discectomy. The amount of bulging disc removed were average 1.5 cc in study group and 2.5 cc in control group. Recurrence was more in the cases removed smaller amount of bulging disc and remained the symptom of pain after primary discectomy. Clinical result show the same between both group after 2 years (p>0.05). CONCLUSIONS: Contralateral recurrent disc herniation at the same level mainly has abrupt symptom and more in the cases degenerated discs. Recurrence was more common in the cases removed smaller amount of bulging disc and remained the symptom after primary discectomy.

Radiologic Result of Displacement according to Position and Measurement Methods in Spondylolisthesis / 대한척추외과학회지

STUDY DESIGN: Prospective analysis was based on radiographic appearance in 80 cases of spondylolisthesis taken in positional change. PURPOSE: The aim of the study was to investigate the flexion-extension lateral radiographs about the difference between decubitus and upright position and the measurement method of displacement in spondylolisthesis. SUMMARY OF LITERATURE REVIEW: Although the flexion-extension lateral radiographs of spine were known the most preferable diagnostic method for spine instability, there are some debates about the difference of displacement according to the patient position and measurement methods. MATERIALS AND METHODS: The radiographs of 80 patients with spondylolisthesis were taken in the decubitus and upright position. Extent of the displacement were measured by Taillard, DuPuis, modified Qunnell & Stockdale method and Ferguson angle, slip angle, lordosis angle and vertebral centroid measurement of lumbar lordosis(CLL) were measured, according to position. RESULTS: Significant difference between the positions was shown on the CLL and lordosis angle. Differences between positions analyzed from Taillard, DuPuis, modified Qunnell & Stockdale method, Ferguson angle and slip angle had no statistical significance. Differences between positions analyzed from the pathologic movement of translation(>4 mm) had a clinically significance in the upright position rather than the decubitus. CONCLUSION: The lateral flexion-extension radiographs on upright position rather than decubitus position are considered as the more useful diagnostic method.

The Selective Spinal Nerve Root Block as Predictors of Outcome of Operative Treatment in the Lumbar Spine / 대한척추외과학회지

PURPOSE: The selective spinal nerve root block is one of the preoperative diagnostic tool to identify and confirm the lesion site of primary cause of pain. The purpose of this study was to ascertain the correlation between diagnostic selective spinal nerve root blocks and outcome following surgical treatment of selected levels of both lumbar herniated intervertebral disc (HIVD) and spinal stenosis. MATERIAL AND METHOD: In a total 341 selective nerve root blocks in 169 patients who were diagnosed as lumbar HIVD and spinal stenosis from Jan. 1993 to Jun. 1997 with performed in a retrospective study, two groups of patients were chosen for this study. The result of pain change of selective nerve root block were judged by Denis' pain scale, the end-result selective spinal nerve root and operative treatment used by Kim's criteria. RESULT : 1. The end-results of selective spinal nerve root block, excellent and good results were 64 cases (67.3%) in lumbar HIVD group and 50 cases (67.5%) in spinal stenosis group. The end-results of selective spine surgery, at last follow up, excellent and good results were 82 cases (86.2%) in lumbar HIVD group and 56 cases (75.7%) in spinal stenosis group. RESULT: 2. The predictive value of selective spinal nerve root block was 68.4% in lumbar HIVD group and 74.3% in spinal stenosis group. In addition, statistical analysis with regression analysis, to show any significant correlation between the selective spinal nerve root block results and the outcome of operative treatment, especially in spinal stenosis group. CONCLUSION: The selective spinal nerve root block is one of the valuable procedure that helpful and predictors of outcome selective operative treatment of lumbar spinal stenosis.

Neural Injury and Recovery of the Thoracolumbar Spine Fractures / 대한척추외과학회지

1. Evaluation of the Neural Injury For evaluation of neural injury from the thoracolumbar spine fracture, we should know the type and extent of injury. In case of the complete Spinal Cord Injury( SCI - Frankel classification A), they will not only lose the spinal cord function permanently distal to the injury site, but also show the probability 0~9% from Frankel A to D or E. But in case of the incomplete SCI, they will show sacral sparing and some kind of function will be recovered. The anticipation of recovery from the SCI depend on the results of neurologic examination after the spinal shock. If they have motor sparing, 86% of patients show the recovery of motor function during the first 6 month. The factor that influence to neurologic recovery are the initial kyphosis angle and canal compromising pattern, and do not influenced by treatmet methods. 2. The Factor of the Neural Injury Recovery 1) Conservative treatment in acute stage The inital pathophysiology of SCI is the mechanical injury, but secondary injury will be occur by impairment of blood supply and biochemical alteration, formation of free radial, release of glutamic acid, calcium influx, lipid peroxidation. Immediate methylprednisolone could minimize the spinal cord inury during the first 8 hours, and other GM-1 ganglioside, naloxone, TRH, spinal cord cooling, hyperbaric theraphy will be helpful. 2) Surgical treatment The factor influence the recovery of SCI (1) time interval injury to operation, (2)decompression of neural element, (3) reduction of fractured fragment. 3) Management of the Residual chronic stage Most common cause of death in SCI is urinary complication. We always should consider the improvement bladder function in SCI and the maintenance of low bladder pressure and feel free a bladder symptom.

The Role of NMDA and non-NMDA Receptors for cFos Protein Expression on the Spinal Cord in Formalin Pain Model / 대한정형외과연구학회지

The purpose of this study was to evaluate effect of NMDA and non-NMDA receptor antagonists on pain-related behavioral change and cFos-like protein expression on the spinal dorsal horn neurons following subcutaneous injection of diluted formalin into one paw. Depending on the drug pretreatment paradigm, animals were divided into four groups; the saline treated, the MK801 treated, CNQX treated, and both MK801 and CNQX treated. Each group was consisted of fifteen rats. After single injection of formalin, all animals exhibited signs of phasic pain(first pain) within 15 minutes, which was followed by a long lasting tonic pain(second pain), thereafter. MK801 pretreatment significantly reduced only the tonic pain. On the other hand, the intrathecal administration of CNQX significantly inhibited only the first phasic pain behavior. An injection of formalin into one hindpaw elicited cFos-like protein expression on the ipsilateral dorsal horn neurons from T12 to S1 spinal cord. The cFos-like protein expression was especially strong in the L3-5 segments and sustained more than 8 hours after the formalin injection. The cFos-like protein expression was peaked two after the formalin injection in superficial layer (laminar III-VII). The MK801 pretreatment reduced the number of cFos-like protein positive neurons significantly one hour after the formalin injection in the superficial dorsal horn. The reduction was observed in the superficial as well as deep layers four hours after the injection. The pretreatment of MK801+CNQX reduced significantly cFos-like protein expression on the both superficial and deep layers of the ipsilateral dorsal horn throughout the experimental session. However, CNQX application did not produce any significant reduction of cFos-like protein expression on the dorsal horn neurons. These results suggest that NMDA receptor may play an more important role in cFos-like protein expression of ipsilateral dorsal horn neurons on the formalin evoked pain model of the rat.

Autogenous Bone Graft with Perpendicular Screw Fixation of the Medial Tibial Bone Defect in Total Knee Arthroplasty / 대한정형외과학회잡지

PURPOSE: We modified the Scuderi bone graft method for severely varus deformed patients, and then analyzed the clinical and radiological results and the changes of BMD at bone graft site. MATERIALS AND METHODS: Twenty-three total knee arthroplasties were performed in severely deformed varus knees. The proximal tibia was resected less than 10 mm thickness. In anteroposterior and tibial plateau view, defects was converted into a trapezoidal wedge shape for the self locking, and preserved anterior and posterior cortex. The defect was filled with an autogenous bone graft and fixed with two screws perpendicularly for early ambulation. RESULTS: The graft was completely united in 21 cases (90%) and the average of the union was 4 months postoperatively. The results were classified as excellent in 16 knees (70%) , good in 6 knees (26%) , and fair 1 knee (4%) using HSS knee rating scale. The average arc of motion was 115. and the tibio-femoral angle was 6.3. valgus. The BMD of bone graft site was checked 1.03 +/- 0.033 g/cm2 postoperatively and converted to 0.82 +/- 0.075 g/cm2 at follow-up 1 year. CONCLUSION: Modified autogenous bone graft could be preserved the subchondral bone essential for optimal thickness of cement and fixation of the tibial component.

Results of microscopic discectomy in lumbar disc herniation: A 5-years follow up / 대한척추외과학회지

PURPOSE: This study was performed in an attempt to determine if there was any clnical benefit of microdiscectomy(MD) over standard discectomy(SD). They were all followed up by an impartial observer at 1 year and 5 years. MATERIALS AND METHODS: All patients were operated on by the same surgeon by either method. We evaluate retrospectively 30 cases of microdiscectomy and 30 cases of standard discectomy using data derived from a questionnaire and chart review from January 1. 1988 to December 31. 1993. The operative results were analysed with Kim's criteria and that clinical results were statistically used to Paired two-tailed T test. RESULTS: 1) Mean operating time was about 117minutes in the standard discectomy, while 98 minutes in the microdiscectomy. 2) Mean time to return to work was about 9.6 weeks in the standard discectomy, while 5.9 weeks in the microdiscectomy, 3) In initial and 1 year follow up, microdiscectomy was superior to the standard discectomy but in 5 years follow up, the two procedures have a similar outcome. CONCLUSION: The advantage of microdiscectomy was more safe than standard discectomy, because it was magnified vision and brilliant illumination, precise identification of structures in deep fields(including nerve root and its related structures), a marked advantage to dissect the adhere nerve root to its surroundings structures, its capacity to preserve the integrity of normal tissue, and meticulous hemostasis. From this analysis, we conclude that microdiscetomy represents a small but significant refinement of standard discectomy

Selective Microscopic Decompression for Multi-level Lumbar Spinal Stenosis: More than 5 Years Follow Up / 대한척추외과학회지

STUDY DESIGN: A rectrospective study of microscopic lumbar decompressions was performed elderly patients suffering from multiple level of lumbar stenosis. OBJECTIVES: The Purpose of this study were to assess the outcome of this procedure performed only microscopic decompression on multiple lesions in 5 years follow up and to identify the clinical features of the elderly patients with multiple stenosis. SUMMARY OF BACKGROUND DATA: There was a common to perform fusion and instrumentation in spinal stenosis surgery, because of extensive decompression and instability. However the introduction of microscope in spine operation can minimize lesions and the incidence of spinal fusion. MATERIALS AND METHODS: Twenty-one patients were identified as having had a microscopic decompression without arthrodesis, for degenerative lumbar spinal stenosis over 60 years. The follow up period was more than 5 years. The clinical results was evaluated by Low-Back Outcome scale. RESULTS: Ten cases were above good results in two levels involved 14 cases, 4 cases above good results in three levels involved 6 cases, one case above good results in four levels. In the cases of affected duration, 4 of 5 cases in less than 1 year, 8 of 12 cases in 1 to 5 years, 3 of 4 cases in more than 5 years were above good results by the criteria. We had calculated the average score (54.8) and concluded that the long-term outcome of decompressive surgery in the elderly is good. CONCLUSION: Selective microscopic decompression is one of the effective method for the elderly patients or patients with osteoporosis in addition to multiple stenotic lesions. And preoprative root block is also useful for selective microscopic decompression.

The Evaluation of the Treatment Modality in Low Back Pain / 대한척추외과학회지

OBJECT: The Authors compaired the treatment interval, the motive of admission and costs of episodes of back pain care between different provide type in a population representation of the Korea. MATERIAL AND METHOD: We reviewed 100 different patients undergone back pain care from October 1997 to March 1998 in Wonkwang Medical Center. This study was a prospective, nurse community based and observational design. Male were 42 and female were 58, mean age was 51(18-81)years. Patients with back pain had been treated with 62 patients operation and 38 patients conservative treatment. RESULTS: The results were as follows 1. The from preadmmision treatment to admission treatment time is consume over 6 months, that makes chronic phase of back pain until 72%, more than 80% of the patients were admitted after the herb medical treatment. 2. The cost of preadmission treatment is average 1,000,000 won. In the cases of herb medicine are average 1,300,000won. The medical fee in the herb medicine is seven times as much as in the medical clinics for a visit. 3. The motive of admission is recommended by neighbour that major to 89%, 62 patients were operated that showed 12 excel-lent, 35 good, 13 fair and 2 poor results. CONCLUSION: There were correlations of three factors, that is high cost, patients chronicity and preference of the herb medicine.