Clinical calcium
-
In oriental medicine, not only the local pathological state but also disharmony within the body and the stagnation of Ki are examined. For this purpose, diagnoses in modern western medicine are also used as references. The pathological condition is evaluated by the 4 diagnostic methods as original methods of oriental medicine, treatment points are decided, and acupuncture and moxibustion are performed. If meridians and reactive points that appear with Ki stagnation impairing natural healing ability can be determined, not only low back pain but also symptoms such as constipation disappear, resulting in harmony of the body and improvement in constitutional symptoms.
-
There are various causes of low back pain, but if the cause of low back pain was determined as a discogenic pain, anterior lumbar interbody fusion was indicated. The surgical treatment should be determined after MRI and other radiological imaging studies and pain response, and also it is important to examine the social factor and psychological status. Extra-peritoneal approach is selected for above L(4)-L(5) level, and trans-peritoneal approach is selected for L(5)-S(1). Recent endoscopic approaches to the anterior lumbar spine is also presented.
-
Various spinal diseases that cause low back pain have two distinct pathologies, including mechanical disruption of the spinal column and compression of the cauda equina and the nerve roots. Although, the advancement in surgical techniques has brought satisfactory neural recovery, resolution of low back pain still remains unpredictable. The development of low back pain is affected by psychosocial factors besides pathological lesions in the lumbar spine leading to functional impairment. Surgical indication for low back should be carefully decided considering such nonorganic aspects of low back pain.
-
Neurophysiologic function and ischemia causes neurogenic symptoms in lumbar spinal stenosis. Neurophysiologic function and potential therapeutic agents were investigated using a chronic cauda equina compression model that was developed according to a clinical pathogenesis. In the chronic cauda equina compression model, nerve conduction velocity and blood flow in spinal nerves decreased but mechanical allodynia was not induced. Prostaglandins and 5-HT receptor antagonist effected to improve blood flow in nerve roots after cauda equina compression;therefore, they might be potential agents for lumbar spinal stenosis.
-
Neural blocks are commonly used for patients with acute or chronic low back pain. It is important to do correctly technical procedure of neural blocks and more important to be well aware of the indication and clinical value of neural blocks. Neural blocks have two aspects of diagnostic and therapeutic value. In this article, the indication and clinical value of neural blocks were reviewed in trigger point blocks, epidural blocks, selective nerve root blocks, facet blocks and lumbar posterior medial branch blocks.