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이준규,안재성,권순태,김환정,정제택 충남대학교 의과대학 지역사회의학연구소 1997 충남의대잡지 Vol.24 No.2
This study was compared pre-operative MRI finding with operative finding on 36 cases with the failed back surgery syndrome (FBSS) retrospectively. The purpose of this study was to determine the accuracy of the MRI on the FBSS including early complications such as hematoma of infection. Of the 51 patients with FBSS, we analyzed pre-operative MRI finding compared with operative finding on 36 cases excluding nonunion, instability, metal failure and pseudoarthrosis who underwent an operation for the FBSS from December 1994 to June 1997. There were 25 men (69.4%) and 11 women (30.6%), aged from 16 to 68 years (average 43.6 years). These were divided into 5 sub-groups and calculated sensitivity, specificity and positive predictability. MRI accuracy in recurred disc was 84%, scar adhesion, recurred or developed stenosis, infection and hematoma 100% each and all, overall accuracy of the MRI 93%, respectively. Average interval of re-operation in FBSS WAS 4.3 years. In the 18 cases (50%), symptoms persist without pain-free interval after first operation. Early complications including hematoma and infection are easily detected with MRI. Especially if patient complains of severe leg pain or neurologic deficit, it is a good diagnostic procedure to check the MRI. The MRI is a useful method for evaluation of most cases of the FBSS, but it has limitations to evaluate recurred disc or scar adhesion only in T1, T2 weighted image. Therefore Gd-DTPA enhancement is necessary for the accurate diagnosis.
최원식,김환정,김남훈,김규현,송대화 대한척추외과학회 1997 대한척추외과학회지 Vol.4 No.1
Study of Design : This is a report of the effect of automated percutaneous lumbar discectomy (APLD) for lumbar disc herniation. Eighty seven patients with symptomatic lumbar disc herniation who had not been relieved by conservative managements were treated with APLD from January 1991 to April 1994. Among them 71 patients were followed for more than two years. Objectives : Percutaneous discectomy has been widely used for the lumbar disc herniation in recent years because it is simple, safe and semi-invasive. The aim of this current study was to investigate the effect of APLD for lumbar disc herniation. Literature Review : Percutaneous lumbar discectomy for lumbar disc herniation was developed by Hijikata et al in 1975. Since then, their original procedure has been used and modified by other researchers, who have published their clinical results. In 1986, Kambin and Sampson reported an 85% success rate and in 1985, Onik et al first reported on the use of an automated reciprocating suction cutter to perform percutaneous discectomy. Materials and Methods : Every patient had preoperative symptoms suggestive of either one or two level herniated lumbar disc, which was confirmed by magnetic resonance imaging. There were 55 men (77%) and 16 women (23%), aged from 14 to 59 years (average 27.4 years). Average duration of procedure was 33 minutes, average amount of disc material 4.4 grams and average hospital stay 9.1 days(range, 3-21 days). Clinical evaluation was made after APLD with the Japaneses Orthopaedic Association (JOA) scoring system. Patients with scores higher than 12 points (out of 15) were included in the "successful" group; all others were included in the "unsuccessful" group. Results : The results were satisfactory in 57 patients (81%) and satisfactory in 14 patients (19%). One patient ultimately underwent surgical discectomy for continued symptoms after the procedure. No intraoperative or postoperative serious complications occurred. Conclusions : APLD is safe and effective. Careful patient selection, correct use of instruments, sufficient evacuation, and adequate annular fenestration greatly enhance the chances of a successful outcome. Overall, APLD is believed to be an acceptable treatment technique for those patients with contained herniated nucleus pulposus.