Annals of Rehabilitation Medicine

Efficacy of Transforaminal Epidural Steroid Injections According to Nerve Root Enhancement.: Do, Sung Jin , Ahn, Sang Ho , Cho, Yun Woo , Shim, Dae Seop , Cho, Hee Kyung , Kim, Han Seon , Jang, Sung Ho; J Korean Acad Rehabil Med 2010;34(2):204-208.

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Objective
To determine the efficacy of transforaminal epidural steroid injections according to nerve root enhancement in lumbar disc herniations. Method: Twenty seven patients who had extruded or seques tered lumbar disc herniations on enhanced MR imaging were investigated: fifteen patients with corresponding nerve root enhancement (enhanced group), and twelve patients without enhancement (non-enhanced group). All patients received transforaminal epidural steroid injection. Clinical outcomes were measured by visual analogue scale (VAS) for back and radicular pain, Oswestry disability index (ODI) before treatment and one month after injection. Results: The averages of VAS for lower extremity and back pain in both groups one month after injection significantly reduced compared to that of pretreatment, respectively (p＜0.001). The amount of decrease in pain in enhanced group was larger than that of non-enhanced group (p＜0.05). The averages of ODI in both group one month after injection significantly reduced compared to that of pretreatment (p＜0.0001), however, there was no difference between the two groups. Conclusion: The nerve root enhancement on contrast-enhanced MR imaging indicates the presence of severe inflammatory reaction of nerve root, which means well-responsiveness to anti-inflammatory treatment such as transforaminal epidural steroid injection, even if patients' symptom is very severe. (J Korean Acad Rehab Med 2010; 34: 204-208)

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Effect of Intensive Conservative Treatment on Extraforaminal Lumbar Disc Herniations - 1 Year Prospective Follow-up Study.: Cho, Yun Woo; J Korean Acad Rehabil Med 2009;33(1):89-93.

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To evaluate the outcomes of intensive conservative treatment on extraforaminal lumbar disc herniations. Method: Twenty five patients with extraforaminal lumbar disc herniations with symptomatic radicular pain were included. Under fluoroscopic guidance, 40 mg of triamcinolone was infused around the nerve root after provocation of patient's usual radicular pain. Lumbosacral dynamic stabilization exercise, thermal and electrical therapy, and education of posture correction were added. The clinical outcomes were measured by visual analogue scale (VAS) and Oswestry disability index (ODI) before treatment, one, three, six, and twelve months after the treatment. After twelve months, patients' satisfaction was classified to four categories: excellent, good, fair, or poor. Four patients were dropped out. Results: Follow-up VAS and ODI significantly decreased since post-treatment one month (p＜0.0001). The average score of VAS for lower extremity and back pain reduced significantly from 6.6, 4.5 at pretreatment to 1.5, 1.9 at 12 months post-treatment, respectively (p＜0.0001). The averages of ODI reduced significantly from 65.4% at pretreatment to 25.4% at post-treatment 12 months (p＜0.0001). In patients' satisfaction, seventeen patients (81.0%) were recorded as excellent or good after post-treatment 12 months. Conclusion: Intensive conservative treatment was effective on patients who underwent extraforaminal lumbar disc herniation. Pain relief and functional improvement sustained for 12 months. (J Korean Acad Rehab Med 2009; 33: 89-93)

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Effect of Aggressive Rehabilitative Treatment on Canalicular Sequestered Lumbar Disc Herniations : Long-term Follow-up Study.: Yang, Dong Seok , Ahn, Sang Ho , Lee, Dong Gyu , Park, Kyung A , Cho, Yun Woo , Jang, Sung Ho , Kim, Dong Gyu , Kang, Jae Hoon , Park, Hae Woon; J Korean Acad Rehabil Med 2006;30(6):584-589.

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To assess long term outcomes of aggressive rehabilitative treatment on canalicular sequestered lumbar disc herniations Method: Clinical outcomes of twenty four patients with sequestered disc herniation with symptomatic radicular pain were evaluated prospectively and longitudinally for one year. All patients received aggressive rehabilitative treatment including transforaminal epidural steroid injection, pelvic stabilization exercise, physical therapy, and back school. Clinical outcomes were measured by visual analogue scale (VAS) for back and radicular pain, Oswestry Disability Index (ODI) for back pain before treatment, posttreatment one, three, six, and twelve months. After twelve months, we categorized patients' satisfaction. Four patients were dropped out. Results: The averages of VAS for lower extremity and back pain reduced significantly from 6.6 and 5.8 at pretreatment to 0.7 and 0.9 at 12 months posttreatment, respectively (p＜0.001). The averages of ODI reduced significantly from 73.5% at pretreatment to 22.3% at posttreatment 12 months (p＜0.001). Sixteen of twenty patients (80.0%) were satisfied with their current status posttreatment 12 months. Conclusion: Sequestered disc herniations could be treated successfully by aggressive rehabilitative treatment. Clinical improvement was achieved from posttreatment one month and persisted for twelve months. Operation might be delayed until aggressive rehabilitation treatment fail to treat sequestered disc herniations. (J Korean Acad Rehab Med 2006; 30: 584-589)

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The Relationship between Lumbar Shape and Lumbar Disc Herniation.: Kim, Ho Seong , Jang, Sung Ho , Lee, Kyung Hoon , Lee, Sung Yong , Lee, Yang Gyun; J Korean Acad Rehabil Med 2005;29(6):619-623.

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We designed this study to investigate the relationship among lumbar disc herniation, vertebral endplate area and shape, and lumbar and sacral parameters. Method: 78 experimental patients with low back pain and 27 controls were enrolled. Experimental patients were divided into group A with low back pain without trauma and lumbar disc herniation and group B with low back pain due to lumbar disc herniation without trauma. Controls had low back pain due to recent trauma but no previous history of back pain and lumbar disc herniation. We reviewed MRI (magnetic resonance image) films of these patients with anteroposterior and transverse diameter of endplates, lumbarlordosis angle, and sacral angle. The relationship of these data and sex, age, body weight, height, intervertebral disc herniation, low back pain were statistically studied. Results: Patients' sex, age, body weight, height, vertebral endplate area and shape, lumbar and sacral parameters were not related to disc herniation. But the more circular vertebral shape was, the larger lumbar lordosis angle was. And the larger lumbar lordosis angle was, the less sacral angle was. Conclusion: There were no relationships between the development of disc herniation at L4-5, L5-S1 and the shape of the vertebral body at the endplate level. (J Korean Acad Rehab Med 2005; 29: 619-623)

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Follow-Up MRI of Lumbar Facet Joint Orientation in the Patients with Herniated Lumbar Intervertebral Disc Treated Operatively and Conservatively.: Min, Seong Ki , Kim, Hee Sang , Ahn, Kyung Hoi; J Korean Acad Rehabil Med 1999;23(1):140-147.

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Objective: The purposes of this study were to observe the radiographic changes of lumbar facet joints by magnetic resonance imaging (MRI) in conservatively and operatively treated groups of patients with herniated intervertebral disc, and to compare the biomechanical effects to lumbar facet joints according to the treatment methods

Method: The patients composed of 20 conservatively treated control group and 40 operatively treated group who had disc herniation at lower lumbar spine. Follow-up MRIs were performed in order to assess the radiographic changes of intervertebral disc and lumbar facet joints, such as disc degeneration, lumbar facet joint angle and tropism in either treatment groups individually.

Results: There are significant increase in lumbar facet joint angle in operatvely treated group at the level of both L4/5, right L5/S1 compared to that of conservately treated group, but the disc degeneration and facet joint tropism were not changed after treatment in both groups. There's no relationship between treatment period and each parameters.

Conclusion: The radiographic biomechanical lumbar facet joint changes on MRI seems to be related to degenerative change of lumbar facet joint in operatively treated group with a lumbar disc herniation. Therefore, careful selection of optimal operation time and criteria would be important.

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Follow-up Magnetic Resonance Imaging Study of Patients with Herniated Lumbar Intervertebral Disc Who Were Treated Conservatively.: Kim, Eun Kyoung , Yang, Chang Sub , Min, Sung Ki , Jung, Byung Jun , Lee, Won Yung , Kwon, Jung Ho; J Korean Acad Rehabil Med 1998;22(3):587-594.

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Objective: To clarify the relationship between the morphologic changes of disc herniation and the clinical course of conservatively treated herniated lumbar disc patients.

Method: Follow-up MRIs and clinical assessments by the Visual Analogue Scale and Japanese Orthopaedic Association(JOA) Score were performed in 20 patients at a mean interval of 11.3 month.

Results: An average reduction ratio of herniation on the sagittal and axial images, were 21.4% and 20.8% respectively. The clinical features improved significantly and the degree of clinical improvement correlated with the reduction ratio of herniation, althougy 4 patients improved symptomatically despite increased or unchanged degree of herniation. Ten patients with extruded discs showed a higher reduction ratio of heniation with better clinical outcome than those with protruded discs.

Conclusion: The morphologic change verified on MRI of conservatively treated patients with a lumbar disc herniation is responsible for the clinical outcome although the anatomical factor alone is not enough to explain the outcome. The patients with extruded disc herniation shows more morphologic changes on MRI and better clinical outcomes than the patients with protruded discs.