마미증후군의 한의학적 치료에 대한 연구 분석

박종한,정수현 한방재활의학과학회 2019 한방재활의학과학회지 Vol.29 No.2

Objectives The purpose of this study was to assess the use of Korean Medicine for treating cauda equina syndrome. Methods We searched for studies of the use of Korean Medicine for the treatment of cauda equina syndrome in 8 electronic databases and analyzed these studies. Results We found 297 studies on cauda equina syndrome from 8 electronic databases. We excluded 230 duplicate studies, 53 studies that did not involve the use of Korean Medicine and 1 review article. In addition, 13 case studies (13 patients) were included. Acupuncture, herbal medicine (13 times), moxibustion (9 times), pharmacopuncture (8 times), physical therapy (6 times), cupping therapy (5 times), and the bladder stimulation technique (4 times) were used. ST36 for acupuncture, Bojoongikgi-tang as a herbal medicine, CV4 for moxibustion, bee venom as a pharmacopuncture material and BL23 in pharmacopuncture point were the most frequently used. Conclusions Korean Medcine for cauda equina syndrome was effective. However, we found limited evidence regarding Korean Medicine for cauda equina syndrome. Thus, we think various type of studies including much more case reports, for cauda equina syndrome should be performed in the future. (J Korean Med Rehabil 2019;29(2):159-169)

마미 증후군의 원인과 임상 양상

황창주,김영태,이동호,이춘성,하정기,이태균 대한척추외과학회 2013 대한척추외과학회지 Vol.20 No.4

Study Design: A literature review. Objectives: To describe the causes and clinical characteristics of cauda equina syndrome. Summary of Literature Review: The cauda equina syndrome, complex symptoms and signs expressed as variable clinical manifestation, has rare incidence but needs attention since it can bring about serious complications and sequales if neglected. Materials and Methods: The Author reviewed articles reporting the causes and clinical manifestation of cauda equina syndrome. Results: There are marked inconsistencies in the current evidence base surrounding the definition due to various clinical presentation of cauda equina syndrome. Conclusion: As there is no symptom or sign which has an absolute diagnostic value in establishing the diagnosis of cauda equina syndrome, any patient in whom a clinical suspicion of cauda equina syndrome arises must undergo urgent magnetic resonance imaging for diagnosis. 연구 계획: 마미 증후군에 대한 문헌 고찰. 목적: 마미 증후군의 원인 및 임상 양상 등에 대해 알아보고자 한다. 선행 문헌의 요약: 다양한 임상 양상으로 발현되는 증상 및 징후의 복합체인 마미 증후군은 드물게 나타나기는 하지만, 간과할 경우 심각한 합병증 및후유증을 초래할 수 있기 때문에 주의를 요한다. 대상 및 방법: 문헌 고찰결과: 마미 증후군은 발현 양상이 다양하기 때문에 아직까지 널리 인정되고 있는 명확한 정의는 없다. 결론: 마미 증후군을 진단하는데 있어서 절대적인 진단적 가치를 가지는 증상 및 징후는 없기 때문에 임상적으로 의심되는 환자에 대해서는 진단을 위해 자기 공명 영상을 긴급하게 시행하여야 한다.

A Case of Cauda Equina Syndrome in Early-Onset Chronic Inflammatory Demyelinating Polyneuropathy Clinically Similar to Charcot-Marie-Tooth Disease Type 1

Lee, Seung Eun,Park, Seung Won,Ha, Sam Yeol,Nam, Taek Kyun The Korean Neurosurgical Society 2014 Journal of Korean neurosurgical society Vol.55 No.6

To present a case of cauda equina syndrome (CES) caused by chronic inflammatory demyelinating polyneuropathy (CIDP) which seemed clinically similar to Charcot-Marie-Tooth disease type1 (CMT1). CIDP is an immune-mediated polyneuropathy, either progressive or relapsing-remitting. It is a non-hereditary disorder characterized by symmetrical motor and sensory deficits. Rarely, spinal nerve roots can be involved, leading to CES by hypertrophic cauda equina. A 34-year-old man presented with low back pain, radicular pain, bilateral lower-extremity weakness, urinary incontinence, and constipation. He had had musculoskeletal deformities, such as hammertoes and pes cavus, since age 10. Lumbar spine magnetic resonance imaging showed diffuse thickening of the cauda equina. Electrophysiological testing showed increased distal latency, conduction blocks, temporal dispersion, and severe nerve conduction velocity slowing (3 m/s). We were not able to find genetic mutations at the PMP 22, MPZ, PRX, and EGR2 genes. The pathologic findings of the sural nerve biopsy revealed thinly myelinated nerve fibers with Schwann cells proliferation. We performed a decompressive laminectomy, intravenous IgG (IV-IgG) and oral steroid. At 1 week after surgery, most of his symptoms showed marked improvements except foot deformities. There was no relapse or aggravation of disease for 3 years. We diagnosed the case as an early-onset CIDP with cauda equine syndrome, whose initial clinical findings were similar to those of CMT1, and successfully managed with decompressive laminectomy, IV-IgG and oral steroid.

자하거약침요법을 이용한 마미증후군 FBSS 환자에 대한 증례보고

김성필,김재홍,류혜선,천혜선,신정철 대한침구의학회 2011 대한침구의학회지 Vol.28 No.5

Objectives : This study was to investigate on the hominis placenta pharmacopuncture of FBSS patient who were diagnosed as the cauda equina syndrome which has been described as a complex of low back pain, bilateral sciatica, saddle anesthesia and hypoesthesia in the lower extremity with bladder and bowel incontinence. Methods : The patient was treated with hominis placenta parmacopuncture at Samchosu(BL_(22)), Shinsu(BL_(23)), Sangryo(BL_(31)), Charyo(BL_(32)), Jungryo(BL_(33)) and Haryo(BL_(34)) with oriental medical conser- vative treatment. We estimated by visual analog scale and Oswestry disability index and nerve level dermatome test for evaluate the effect of Hominis Placenta Pharmacopuncture with oriental conservative treatment. Results : After treatment, patient’s visual analogue scale score, Oswestry disability index score, bilateral sciatica, saddle anesthesia and hypoesthesia in the lower extremity with bladder and bowel incontinence were generally decreased. Conclusions : The hominis placenta pharmacopuncture with oriental medical conservative treatment might be an effective method to treat the FBSS patient who were diagnosed as the cauda equina syndrome.

마미 증후군 FBSS 증례보고

황희상,전재천,차정호,정기훈,이참결,노정두,이은용 대한침구의학회 2009 대한침구의학회지 Vol.26 No.1

Objectives : The purpose of this study was to evaluate the oriental conservative treatment for FBSS patient who were diagnosed as the Cauda equina syndrome. Methods : The patient were treated by the oriental medical conservative treatment including herbal medication, dry needle acupuncture, direct moxibustion and indirect moxibustion, cupping therapy and, physical therapy. We estimated by Visual Analog Scale and Oswestry disability index for evaluate the effect of Oriental conservative treatment. Results : After treatment, patient’s visual analogue scale score and Oswestry disability index score were generally decreased. Conclusions : The oriental medical conservative treatment might be an effective method to treat the FBSS patient who were diagnosed as the Cauda equina syndrome.

Lumbar Disc Herniation Presenting Cauda Equina Syndrome

Kim, Tae-Wan,Yoon, Jae-Woong,Heo, Weon,Park, Hwa-Seung,Rhee, Dong-Youl The Korean Neurosurgical Society 2006 Journal of Korean neurosurgical society Vol.39 No.1

Objective : To determine the relationship between the clinical outcome and the extent of surgical laminectomy for adequate decompression on the cases of cauda equina syndrome, the authors review and analyze their cases and compared with those of literatures. Methods : The authors reviewed 655 patients retrospectively who had underwent surgery on the cases of lumbar disc herniation from January 2000 to December 2004. There were 19 patients [2.9%] who presented for clinical cauda equina syndrome. Among them, we selected and analyzed 15 patients who were treated by unilateral partial hemilaminectomy with discectomy or bilateral partial laminectomy with discectomy, and they had been followed from 5 weeks to 47 months postoperatively [mean, 13.47 months]. The levels of the disc herniations were L4-5 in 8 patients, following L5-S1 in 4 patients and 2 levels [L4-5 and L5-S1] in 3 patients. Motor and sensory recoveries were recorded. Postoperative urinary function recovery Was defined according to Gleave and Macfarlane. Results : In 12 months postoperatively, the bladder function was obtained in 14 of 15 patients[93%] with regaining urinary continence. Thirteen of 15 patients[86%] with preoperative motor weakness of lower extremities were recovered. Sensory deficit of lower extremities, perianal and saddle anesthesia were all recovered. Patients had recovered on lumbosciatic pain and saddle hypesthesia, in turn, motor function and urinary incontinence. Conclusion : In treating cauda equina syndrome, the authors did less extensive surgery, such as unilateral partial hemilaminectomy with discectomy or bilateral partial laminectomy with discectomy for adequate decompression. The outcome is satisfactory and comparable with those of subtotal or total laminectomy.

복합적 한방 치료를 시행한 마미증후군 수술 실패 환자 1례에 대한 증례 보고

김정섭,조성우,Kim, Jung-Sup,Cho, Sung-Woo 척추신경추나의학회 2015 척추신경추나의학회지 Vol.10 No.2

Objectives : The purpose of this study is to evaluate clinical effect of Korean medical treatments for the patient who were diagnosed as the Cauda Equina Syndrome. Methods : The patient was treated by Korean medical treatments including acupuncture, pharmacopuncture, herbal medication. The Improvement of clinical symptoms was assessed by Visual Analog Scale(VAS), Oswestry Disability Index(ODI) and Muscle Manual Test(MMT). Results : After treatments, VAS and ODI were generally decreased, MMT was improved in case. Conclusions : The Oriental medical treatments might be effective methods to treat the patient who were diagnosed as the Cauda Equina Syndrome.

경막외 마취 후 발생한 지속성 마미증후군 환자 1예

정점순,박기덕,임오경 대한근전도전기진단의학회 2009 대한근전도 전기진단의학회지 Vol.11 No.2

Cauda equina syndrome (CES) is a rare complication of spinal and epidural anesthesia. We report a case of persistent cauda equina syndrome after epidural anesthesia with single shot 0.5% bupivacaine. There was no pain or paresthesia during needle placement or drug injection. 35-year-old woman experienced pain and weakness in the both lower extremities and alterations in bowel and urinary habits after epidural anesthesia for caesarean section. Electrodiagnostic examination revealed asymmetric bilateral lumbosacral polyradiculopathies compatible with cauda equine syndrome. The patient MRI revealed arachnoiditis, but did not show suspicious lesions such as hematoma and abscess. She was treated with medication, bladder training and physical therapy, but her symptoms remained unchanged during a 2 year follow- up. We suggest the chronic adhesive arachnoiditis resulting from bupivacaine neurotoxicity have played a role in producing this devastating chronic complication.

마미증후군 환자 증례보고(症例報告)

곽민아,이은주,박치상,변준석,박창국,황희정,Kwak, Min-Ah,Lee, Eun-Ju,Park, Chi-Sang,Byun, Joon-Seok,Park, Chang-Gook,Hwang, Hui-Jeung 대한한방내과학회 2001 大韓韓方內科學會誌 Vol.22 No.4

Cauda Equina Syndrom is caused by compression of nerve root resulted from trauma or neoplasm and so forth in the lumbasacral lesion, so the patients suffer from the incontinence or urgency in urination and feces. We are extended to find out the effect of serveral kinds of Herbal Medicine that administrated to the patient suffering from Cauda Equina Syndrom. This patient was differenciated as defiency of Yang. When administrated Palmijihwang-Hwan gami-Bang, there was dominent improvement in both of symptom and dermatome test. From this case it is thought that Herbal Medicine treatment according to differenciation of symptom is very effective to Cauda Equina Syndrom and that more studies and examinations are needed in futher.

증례보고 : 심한 척주관 협착증 환자에서 척추 마취 후 발생된 마미 증후군

정규돈 ( Kyu Don Chung ),유승준 ( Sung Jun Yu ),이상묵 ( Sang Mook Lee ),조현숙 ( Hyun Sook Cho ),손윤숙 ( Youn Suk Son ),윤건중 ( Keon Jung Yoon ),윤은경 ( Eun Kyeung Yoon ) 대한마취과학회 2009 Korean Journal of Anesthesiology Vol.57 No.3

Cauda equina syndrome is a well-known but rare complication of spinal anesthesia. An 80-year-old man was scheduled for both herniorrhaphy. Spinal anesthesia was performed at the L3-4 interspinous space with 0.5% hyperbaric bupivacaine 12 mg. Eight hours after anesthesia, the patient complained bilateral sensorimotor deficits of the lower extremities and peroneal region. Urinary and fecal incontinence were also observed. MRI and myelography showed severe central spinal stenosis at L3-4 and L4-5. EMG showed cauda equina syndrome. Seven weeks after the procedure, left decompressive subtotal laminectomy L2-L5 was done. The patient still complains the neuropathic pain in the both lower extremities and ambulates using a walker. The local anesthetic was injected into thecal sac between maximum stenoses, and it is likely that there was poor upward spread leading to maldistribution of local anesthetic and resultant local anesthetic toxicity. (Korean J Anesthesiol 2009;57:364∼6)