E-Mail: kisenam@naver.com

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80 13-40% (Frymoyer JW : JBJS, 1983) 30% . (Boden SD : JBJS, 1990)

: 7, 12, 5, 5, 4 : , , , , , , , , , , , , ,

SupportConnect head and pelvisMotionFlexion, extension , rotationProtectionProtection of CNS and PNS

23 discsNucleus pulposisAnnulus fibrosusCartilagenous endplateFunctionProvide mobilityShock absorptionStress equalization

(Spondylogenic) , , , , , , , , , , , , , (Neurogenic) ,

(Viscerogenic) (Vasculogenic) , (Psychogenic) ,

: 50% 1, 95% 3 : 50% 1 , 75% 3 (Bush K : Spine, 1992) vs (, ) 1 , 4 . (Weber H : Spine, 1983)

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(3)

(3)

(Epidural Neurolysis)

Arthroscopic microdiscectomy Microlumbr discectomy Laminectomy and discectomy Total discectomy and interbody fusion Total Disc Replacement

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, . 10 20 , . , , .

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, , . 4 70% 15% 15% (Johnsson KE : Spine, 1991) , .

( )Zigzag-motion Inflatable Neuroplasty (ZiNeu) catheter

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85% 3 6 .

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(Nucleoplasty) (IDET) (Percutaneous Thermoannuloplasty) (Total Disc Replacement, TDR)

(Spondylolytic Spondylolisthesis) (Pars interarticularis)

(Degenerative Spondylolisthesis) (facet joint)

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4, 5 6, 7 (90%)5, 6 7 1 .

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(Conventional management) (Percutaneous vertebral augmentation, Vertebroplasty, Osteoplasty, ) (Balloon kyphoplasty)

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Are you treating the patient, or the doctor? Think about it!

. , . . . . .

PELD (Percutaneous Endoscopic Discectomy)

(Nucleoplasty),

Device for Posterior Stabilization

Surgical vs Nonsurgical ? (LDH)

Surgical vs Nonsurgical ? (LDH)

Surgical vs Nonsurgical ? (LDH)Surgically treated patients with a herniated lumbar disc had more complete relief of leg pain and improved function and satisfaction compared with nonsurgically treated patients over 10 years. Nevertheless, improvement in the patients predominant symptom and work and disability outcomes were similar regardless of treatment received. individualized treatment plan

Surgical vs Nonsurgical ? (Stenosis)

Surgical vs Nonsurgical ? (Stenosis)

Surgical vs Nonsurgical ? (Stenosis)low back pain relief, predominant symptom improvement, and satisfaction with the current state were similar in patients initially treated surgically or nonsurgically.However, leg pain relief and greater back-related functional status continued to favor those initially receiving surgical treatment.

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* , . Sacral hiatus .

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*Nucleoplasty .

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