본 연구자는 척주 측만증 및 허리뼈 분쇄 골절된 환자의 수술 후 단순 엑스선 척주 측방향 촬영에서 두 개의 철심이 겹친 영상을 얻어내기 위해 엑스선관 및 인체팬톰의 각도를 변화시켜 영상을 얻었다. 영상 평가를 위해 대학병원 영상의학과에서 10년 이상 근무한 방사선사 5명에게 주관적 평가를 하였다. 측정 결과 척주 측만증 측방향 촬영은 정중 이마면을 IR면 중심에 일치되게 하고 일곱 번째 등뼈가 중앙이 되도록 자세를 조정한 후 엑스선관과 척주팬톰 자세를 각각 수직으로 촬영하면 척주 측방향 촬영에서 두 개의 겹쳐진 영상을 얻을 수 있었고 주관적 평가에서도 높은 점수를 얻었다. 또한 허리뼈 탈구 골절된 허리뼈 측방향 촬영은 이마면을 IR면 중심에 일치시키고 네번째 허리뼈가 중앙이 되도록 자세를 조정하여 엑스선관 각도를 수직되게 하고 척주 팬톰을 네번째 허리뼈를 수직하여 촬영 하게 되면 척주 측방향 촬영에서 두개의 철심이 겹치는 영상을 얻을 수 있었고 주관적 평가에서도 높은 점수를 얻었다.

Focal myositis is a rare disease associated with inflammatory changes invading the skeletal muscles and may be triggered by nerve lesion. We describe a case of 33-year-old woman who was diagnosed focal denervation myositis of piriformis and gluteal muscles associated with sciatic neuropathy because of severe uterine enlargement due to twin pregnancy misdiagnosed as lumbar herniated nucleus pulposus. MRI is one of the key diagnostic tools in the assessment of focal denervation myositis for differential diagnosis. Nonsteroidal anti-inflammatory drugs are commonly used for treatment of focal myositis. Spontaneous regression is obtained in numerous cases.

Percutaneous lumbar epidural adhesiolysis is widely used a treatment for various chronic spinal pain but inadvertent complications of subdural, spinal, or intravascular injection can occur. We report a case of 63-year-old female with unusual pulsatile subdural injection image during attempted lumbar epidural adhesiolysis with fluoroscopy. Pulsatile image confined to the posterior aspect of the spinal canal at L3-4 level was observed. After recognizing subdural injection, we performed epidural adhesiolysis carefully without using steroid and local anesthetics under fluoroscopic guidance. Although unusual, pain physician needed to the understanding of the various subdural fluoroscopic contrast images.

Measures of radiographic pelvic and spinal parameters of sagittal balance analysis have become of considerable importance for reconstructive surgery of the spine, particularly in cases of degenerative spondylolisthesis. The authors conducted a retrospective study of clinical outcomes and a radiological review on 231 patients with one or two level degenerative spondylolisthesis. First, patients were classified using preoperative pelvic parameters and evaluations were conducted using mean values of pre- and postoperative spinopelvic parameters. Second, patients were divided into two study groups, that is, Group A (n=105; exhibited no improvement (increase or no change) in pelvic tilt postoperatively) and Group B (n=126; exhibited pelvic tilt improvement (decrease) postoperatively). Clinical outcomes in the two groups were compared using Visual Analogue Pain Scores (VAS) and Oswestry disability index (ODI). All preoperative pelvic parameters show restoration tendency after PLIF surgery for spondylolisthesis, and greater deviations of preoperative pelvic parameters from normality showed greater recovery postoperatively. VAS and ODI improvements at follow-up were poorer in group A than in group B.

투시조영촬영은 인체 내부의 조직이나 장기를 검사할 때 시행하며 특히 척추 질환의 진단 및 시술에 사 용된다. 영상증배관(image intensifier tube)을 사용하는 투시조영 촬영장비는 영상에서 중심부보다 주변부에 왜곡이 나타난다. 본 연구에서는 교정 알고리즘을 적용하여 교정전과 교정후의 수직길이비 왜곡비율과 대 각길이비의 왜곡비율을 측정하였다. 수직길이비의 측정결과는 교정후의 표준편차가 교정전보다 0.04감소 하였고 대각길이비의 측정결과는 교정후의 표준편차가 교정전보다 0.06감소하여 교정 후 투시영상의 왜곡 이 감소되었다. 향후 교정 알고리즘의 적용과 성능향상을 통해서 영상왜곡을 감소시키면 요추디스크의 치료를 위한 수핵감압술시 요추천자의 정확한 위치를 찾는데 도움을 줄 것으로 사료된다.

Percutaneous endoscopic lumbar discectomy is getting popular technique as an alternative to conventional discectomy. This endoscopic surgery have many advantages such as less injury to muscle and soft tissue, less postoperative pain, and shorter operation time without general anesthesia and shortened hospitalization. We performed retrospective controlled randomized study from January 2008 to April 2015. Total 250 patients were treated by surgery (open microdiscectomy and endoscopic discectomy) during eight years. Age, sex, and operation level were not statistically significant difference about recurrent rate. Likewise, operation technique such as endoscopic discectomy or open discectomy were not statistically significant difference for recurrent rate.

The lumbar discectomy is the surgery with low morbidity itself and need the prone position, which is essential for this surgery. However, the increased intra-abdominal pressure after changing supine to prone position may lead intra-abdominal hypertension or abdominal compartment syndrome, consequently acute mesenteric ischemia. Acute mesenteric ischemia is one of the fatal conditions of acute abdomen with overall mortality of 60% to 100%. Unfortunately, the early detection of mesenteric ischemia in perioperative period of spinal surgery is difficult. We herein report an experience of acute mesenteric ischemia after lumbar discectomy in prone position, and review the relative literatures.

Globally, as well as domestically, patients without risk factors for spontaneous spinal epidural hematoma (SSEH) have rarely been reported. SSEH often results from trauma, epidural catheter insertion for anesthesia and invasive spinal procedures. It could also occur in patients with risk factors such as hypertension, coagulopathy, pregnancy, and vascular anomaly. We encountered a case of a 51-year-old female without prior medical history or any risk factors. Magnetic resonance imaging (MRI) showed subacute SSEH at lumbar spine regions. The patient was treated successfully by surgical decompression. Therefore, we report this case with a review of the relevant literature.

Spontaneous intracranial hypotension (SIH) causes headache in the absence of tissue injury such as trauma, spinal cord injury, surgery, or epidural anesthesia. Epidural blood patch in the epidural space where CSF leakage occurs is effective for treatment of SIH. However, when the leakage site is unknown, administration of autologous blood into the lumbar epidural space could be effective. Here we report on patients who suffered from headache by SIH and could not confirm the leakage site, however, treatment by lumbar epidural blood patch was administered successfully.

본 연구에서는 일반 촬영 검사 부위 중 조사 조건이 가장 높은 요추 검사에서, 최적의 조사 조건에 대하여 알아보고 자 하였다. 이를 위해 통계적으로 많이 이용하고 있는 조사 조건을 기준으로 선정하였고, 선량 변화 인자를 적용한 실 험군을 선정하였으며, 환자선량 권고량을 활용하여 임상에 적합한 실험군을 선별하였다. 블라인드 테스트는 전문의 및 방사선사 10명에 의해 수행되었고, 결과 최적화된 조사 조건에서, 전후 방향 검사의 경우 2.09 mGy, 측방향 검사의 경우 4.42 mGy, 사방향 검사의 경우 3.65 mGy 만큼의 선량 저감화가 가능할 것으로 사료된다. 차후에는 환자의 상태 에 따른 조사 조건의 최적화 연구가 수행되어야 할 것으로 사료된다.

After percutaneous endoscopic lumbar discectomy (PELD), postoperative radiating leg pain could persist and become a common problem. This symptom provides important information for use in deciding on performance of reoperation for remnant disc or recurrent disc herniation. Of 225 patients who underwent PELD, 51 patients had persistent radicular pain. Steroid injection to epidural space resulted in pain reduction of at least 50 % in 15 (30.3 %) of these patients. Thirty five cases showed a bad outcome after steroid injection, indicating high sensitivity for detection of a remnant or disc herniation in follow up Magnetic Resonance images (25 cases, 71.4%). Twenty one patients were treated by reoperation. Steroid injection has a diagnostic value with a high sensitivity for mechanical compression of the nerve root as remaining or recurrent disc herniation in MRI for the necessity of a re-operation.