Effectiveness of Sodium Hyaluronate–Hydroxyethyl Starch (HA–HES) for Selective Nerve Root Block in Lumbar Radiculopathy: A Prospective Clinical Trial (Pilot Study)

고상봉 대한척추외과학회 2023 대한척추외과학회지 Vol.30 No.1

Study Design: Prospective study (pilot study). Objective: To evaluate the usefulness of hyaluronic acid–hydroxyethyl starch (HA–HES) for selective spinal nerve root block (SNRB). Summary of Literature Review: Hyaluronic acid–carboxymethyl cellulose (HA–CMC) is a potential alternative to corticosteroids. Materials and Methods: We recruited patients diagnosed with lumbar spinal stenosis, and those with lower leg radiating pain were selected for SNRB and assigned to the test group or control group. The test group received a mixture of 1 mL of HA–HES, 1 mL of lidocaine, 1 mL of bupivacaine, and 1 mL of normal saline, whereas the control group received a mixture of 1 mL of HA–CMC, 1 mL of lidocaine, 1 mL of bupivacaine, and 1 mL of normal saline. The degree of lower leg radiculopathy improvement was evaluated as a percentage. Spinal function was assessed using the Oswestry Disability Index (ODI) and Roland Morris Disability Questionnaire (RMDQ), whereas patients’ quality of life was evaluated using the Short Form 36 (SF-36). Results: At 7 days after SNRB, there was no statistically significant difference between the two groups in the rate of visual analog scale (VAS) score improvement or changes in VAS scores (p=0.054). The change in the ODI over time differed significantly between the groups (p=0.047). Conclusions: The findings suggest that HA–HES exerts a similar pain control effect to that of HA–CMC during SNRB, with better results in terms of function.

The Effectiveness of Oral Corticosteroids for Management of Lumbar Radiating Pain: Randomized, Controlled Trial Study

고상봉,Sungguk Kim,Jaejung Kim,Taebum Oh 대한정형외과학회 2016 Clinics in Orthopedic Surgery Vol.8 No.3

Background: Although both pregabalin and gabapentin are known to be useful for treating lumbar radiating pain and reducing the incidence of surgery, the oral corticosteroids sometimes offer a dramatic effect on severe radiating pain despite the lack of scientific evidence. Methods: A total of 54 patients were enrolled among 703 patients who complained of lumbar radiating pain. Twenty patients who received an oral corticosteroid was classified as group A and 20 patients who received the control drugs (pregabalin or gabapentin) as group B. Oswestry Disability Index (ODI), Revised Roland Morris disability questionnaire (RMDQ), Short Form 36 (SF-36) questionnaire, lumbar radiating pain, objective patient satisfaction, and objective improvement of patients or physicians were assessed at 2, 6, and 12 weeks after medication. Results: No difference in the sex ratio and age was observed between the groups (p = 0.70 and p = 0.13, respectively). Group A showed greater improvement in radiating pain after 2, 6, and 12 weeks than group B (p < 0.001, p = 0.001, and p < 0.001, respectively). No differences were observed between the groups in satisfaction at the beginning and 12 weeks after taking the medication (p = 0.062 and p = 0.061, respectively) and in objective improvement of patients and physicians (p = 0.657 and p = 0.748, respectively). Group A was less disabled and had greater physical health scores than group B (p = 0.014 and p = 0.017, respectively). Conclusions: Oral corticosteroids for the treatment of lumbar radiating pain can be more effective in pain relief than gabapentin or pregabalin. The satisfaction of patients and physicians with the drug and objective improvement status were not inferior to that with gabapentin or pregabalin.

요추 전방 재수술 도중 발생한 내 장골 정맥 파열의 “압정”을 이용한 치료 - 증례 보고 -

고상봉,오태범,박기혁 대한척추외과학회 2017 대한척추외과학회지 Vol.24 No.2

Study Design: Case report. Objectives: To report a rare case in which a tack was used to control bleeding due to a torn iliac vein during revisional anterior spine surgery. Summary of Literature Review: During anterior lumbar surgery, bleeding following a vascular injury is possible to control and reparable in most cases. During revisional anterior lumbar surgery, however, there are irreparable cases of bleeding as well. In some cases, it can threaten the patient’s life. Material and Methods: A 56-year-old man suffered from potentially fatal bleeding following iliac vein rupture during revisional anterior lumbar surgery. Primary vascular closure was impossible due to severe adhesion. We attempted to stop the venous bleeding with a tack, as an alternative treatment. The potentially fatal bleeding was controlled and the patient’s vital signs stabilized after hemostasis by the tack. Results: Hemostasis using the tack saved the patient’s life without any rebleeding. Conclusions: During revisional anterior lumbar surgery, bleeding following an iliac vein rupture can be controlled by a tack in cases that are irreparable due to severe adhesion. 연구 계획: 증례 보고목적: 척추 전방 재수술시 발생한 장골 정맥의 파열에 의한 출혈을 압정을 이용하여 지혈한 드문 증례를 보고하고자 한다. 선행 문헌의 요약: 척추 전방 접근 시 대부분의 혈관 손상에 의한 출혈은 조절 가능하며 복구가 가능하다. 하지만, 재수술의 경우 복구가 불가능한 경우도있으며 때에 따라 환자의 생명이 위험할 수도 있다. 대상 및 방법: 척추 전방 재수술시에 장골정맥의 손상으로 심각한 출혈이 발생한 56세 남자를 대상으로 하였다. 심한 유착으로 일차 봉합이 불가능 하였다. 이에 저자들은 압정을 이용한 정맥출혈의 지혈을 시도하였고, 치명적인 출혈은 조절되었으며 생체징후는 안정화 되었다. 결과: 압정을 이용한 지혈로 인해 환자의 생명을 살릴 수 있었으며, 재출혈은 발생하지 않았다. 결론: 척추 전방 재수술의 경우 유착 등에 의해 파열된 장골정맥의 봉합이 불가능한 경우 압정을 이용하여 지혈할 수도 있다. 약칭 제목: 파열된 장골 정맥 출혈의 지혈

3세 소아의 제1천추의 골절-탈구 - 증례 보고 -

고상봉,이상욱 대한골절학회 2010 대한골절학회지 Vol.23 No.2

천추가 아직 유합되지 않은 소아에서 천추의 골절 및 탈구는 주로 천미관절 부위의 원위부에서 발생하지만, 제1천추의 골절 및 탈구는 흔하지 않다. 이런 환자는 대부분 신경학적 증상이 있어 수술적 감압 치료가 필요하지만 본 저자들은 신경학적 이상을 동반하지 않은 제1천추의 골절-탈구를 가진 3세 소아환자를 단순 피부 견인 및 침상안정으로 만족할 만한 결과를 보여 관련 문헌고찰과 함께 증례보고 하는 바이다.

An Evaluation of the Effectiveness of Hyaluronidase in the Selective Nerve Root Block of Radiculopathy: A Double Blind, Controlled Clinical Trial

고상봉,Alexander R. Vaccaro,장호진,신동영 대한척추외과학회 2015 Asian Spine Journal Vol.9 No.1

Study Design: Prospective, double-blind, randomized controlled trial. Purpose: To determine the ability of hyaluronidase to provide longer lasting pain relief and functional improvement in patients with lumbar radiculopathy. Overview of Literature: Selective nerve root block (SNRB) is a good treatment option in lumbar radiculopathy. We studied the effectiveness of hyaluronidase when added to the traditional SNRB regimen. Methods: A sample size of 126 patients per group was necessary. A sample of 252 patients who underwent an injection procedure with or without hyaluronidase due to radiculopathy was included in this study. The patients were randomly divided into two groups: the control (C) group and the hyaluronidase (H) group. After SNRB due to radiculopathy, the visual analog scale (VAS) was compared at 2, 4, 6, 8, and 12 weeks between the two groups, and the Oswestry disability index (ODI) was compared at 12 weeks between the two groups. Results: Both groups seemed to have general improvement in VAS, but in C group, the VAS was higher than the H group 2 and 4 weeks after the surgery, and the difference in time-group change between 2 groups was statistically significant (p <0.05). ODI improved in both groups, and the difference in time-group change between 2 groups was not statistically significant (p >0.05). Conclusions: The rebound pain (the re-occurrence of pain within 2–4 weeks after injection) that occurs within 2–4 weeks after the injection of the routine regimen can be reduced when hyaluronidase is added to the routine SNRB regimen.

견관절의 화농성 및 결핵성 복합 관절염의 관절경적 치료 - 증례보고 -

고상봉,김신근,최원기,박재현,최창혁,Ko, Sang-Bong,Kim, Shin-Keun,Choi, Won-Kee,Park, Jae-Hyun,Choi, Chang-Hyuk 대한관절경학회 2008 대한관절경학회지 Vol.12 No.2

결핵은 새로운 항결핵제의 개발, 생활 여건의 향상, 예방 대책의 발달로 유병률이 적어진 질환으로 알려지고 있으나, 최근 예방 접종률의 저하와 항결핵제에 내성을 보이는 균주가 출연하는 등 다시 증가하는 추세이며 또한, 견관절 질환에 대한 관심이 높아지며 일차 치료로써 다양한 견관절내 주사 치료가 시행되면서 화농성 견관절염 역시 증가하는 추세이다. 이에 저자들은 견관절의 결핵과 화농성 관절염이 동반 감염된 증례를 경험하여 만족할 만한 결과를 얻었기에, 관련 문헌과 함께 보고하는 바이다. Although the incidence of tuberculosis has been decreased due to new anti-tuberculous agents, improved socioeconomic status and development of multimodal preventive methods, in recent that is increased due to low vaccination rate and appearance of multidrug resistence organism. And the incidence of pyogenic shoulder joint arthritis is increasing due to frequent injection therapy as primary treatment. We have managed the mixed shoulder joint arthritis-pyogenic and tuberculous-with arthroscopic debridement and antituberculous medication successfully and then we report this case with relevant literatures.

Esophageal Perforation after Anterior Cervical Spine Surgery

고상봉,박종범,송경진,이동호,김성완,김영율,전택수,조윤주 대한척추외과학회 2019 Asian Spine Journal Vol.13 No.6

Study Design: Retrospective case analyses. Purpose: To investigate the causes, diagnosis, and management of esophageal perforation, depending on the time of diagnosis. Overview of Literature: To date, few studies have addressed these issues. Methods: A total of seven patients were included in this study. The patients were classified into three groups based on esophageal perforation diagnosis time: intraoperative (diagnosed during surgery), perioperative (diagnosed within 30 days postoperatively), and delayed (diagnosed >30 days postoperatively) groups. Results: In the intraoperative group (N=2), infectious spondylitis was the main cause of esophageal perforation. Anterior plate and screw removal, followed by posterior instrumentation, was performed. The injured esophagus was managed by omentum flap repair in one patient and primary repair in one patient. In the perioperative group (N=2), revision surgery for infection and metal failure were the main causes of esophageal perforation. In both cases, food residue was drained on the third postoperative day. The injured esophagus was managed conservatively. In the delayed group (N=3), chronic irritation caused by metal failure was the main cause of esophageal perforation. In all patients, there was no associated infection. The anterior instrumentation was removed, and the two patients were treated by primary repair, and one patient was treated using sternocleidomastoid muscle flap. One patient in intraoperative group died of sepsis. Conclusions: The main cause of intraoperative esophageal perforation was esophageal adhesions because of infectious spondylitis. However, perioperative and delayed esophageal perforations were caused by chronic irritation because of metal failure. Anterior plate and screw removal was necessary, and posterior instrumentation and fusion may be considered, depending on the fusion status.

The Prevalence of Cervical Foraminal Stenosis on Computed Tomography of a Selected Community-Based Korean Population

고상봉,최원희,이재준 대한정형외과학회 2018 Clinics in Orthopedic Surgery Vol.10 No.4

Background: Cervical foraminal stenosis (CFS) is one of the degenerative changes of the cervical spine; however, correlations between the severity of stenosis and that of symptoms are not consistent in the literature. Studies to date on the prevalence of stenosis are based on images obtained from the departments treating cervical lesions, and thus patient selection bias may have occurred. The purpose of this study was to investigate the prevalence of CFS according to the site, extent, and morphology of stenosis using cervical computed tomography (CT) images obtained from patients who were visiting not because of symptoms related to the cervical spine, cervical pain, or upper limb pain. Methods: Among patients who underwent CT from January 2016 to March 2016 for reasons other than cervical spine symptoms, a total of 438 subjects were enrolled, and 2,628 cervical disc images (C4–5, C5–6, and C6–7; left and right sides) were examined. Three orthopedic surgeons performed two measurements each at 4-week intervals. Values were used for analysis if matched by more than two surgeons; if no match was found, the median values were used for analysis. The left and right sides on the same axial image were independently classified. Results: Left C5–6 stenosis was most common (24.66%) among patients. At the left C6–7, there were 20 focal types and 33 diffuse types. At bilateral C4–5 and right C6–7, the focal type was more common, whereas at bilateral C5–6 and left C6–7, the diffuse type was more common. Age and the severity of stenosis showed statistically significant correlation at all cervical levels. Conclusions: The prevalence of CFS was highest at the C5–6 level (19.06%). Compared to other levels, focal stenosis was more frequent at C4–5 and diffuse stenosis was more common at C5–6. At C6–7, the incidence of focal stenosis was higher on the right side and that of diffuse stenosis was higher on the left side

Correlation between Short-Form 36 Scores and Neck Disability Index in Patients Undergoing Anterior Cervical Discectomy and Fusion

고상봉,최원기,채승범,권재범,이영식 대한척추외과학회 2018 Asian Spine Journal Vol.12 No.4

Study Design: Case control study. Purpose: To determine how the Neck Disability Index (NDI), a cervical spine-specific outcome, reflects health-related quality-of-life, and if NDI is correlated to the 36-item Short-Form Health Survey (SF-36) scores. Overview of Literature: NDI is a useful tool for assessing health-related quality of life in patients with neck pain. Methods: We used the Pearson product-moment correlation coefficient to assess the validity of all items under NDI and SF-36, and the Pearson’s correlation coefficient to assess the correlation between NDI and total SF-36 scores. The primary outcome measures were spine-specific health status- and general health status-measures after spine surgery, and these were evaluated every year for 2 years, using both NDI and SF-36 scores. Results: NDI had a strong linear correlation with SF-36 and its two scales, the Physical Component Score (PCS) and the Mental Component Score (MCS), attesting to the validity of these two instruments. Among the eight subscales of SF-36, there was a strong linear correlation between NDI and PCS-physical functioning, PCS-bodily pain, and MCS-role emotional. Further, a moderate linear correlation was observed between NDI and subscales of PCS-role physical, PCS-general health, and MCS-social functioning, and between NDI and MCS-vitality and MCS-mental health. Conclusions: Our findings suggest that the NDI adequately reflects the patient’s physical and mental quality of life, implying that the use of NDI to assess functional outcomes can also be ultimately used to evaluate the patient’s quality of life.

당뇨발 환자의 치료시 초기 절단 결정의 예상인자

고상봉,이상욱,정대의,Ko, Sang-Bong,Lee, Sang-Wook,Jeung, Dae-Ui 대한족부족관절학회 2005 대한족부족관절학회지 Vol.9 No.1

Purpose: To evaluate the precipitating factors of amputation as initial treatment in diabetic foot patients. Materials and Methods: Between March, 1994 and February 2003, 41 cases (37 patients) diabetic foot patients who had diabetic ulcer, pyogenic inflammation and gangrene and followed up over 1 year were collected. Among them, We evaluate the precipitating factors of amputation for average 39.6months (12-118months). Results: Among many factors, Wagner classification, pulse volume recording of toes, Ankle-Brachial Index and Albumin level are statistically significant in amputation patients. Conclusion: In determining the amputation of diabetic foot as initial treatment, the trauma history, circulation of foot and serum albumin level are important precipitating factors. So the education about preventing even minor trauma and maintaining good nutrition state decrease the amputation rate in diabetic foot patients.