Hee Chan Kim

Background and Objectives: Degenerative lumbar spinal stenosis (DLSS) frequently manifests as lower leg radiating pain (LLRP), requiring selective nerve root block (SNRB). Comprehensive and Integrative Medical Services (CIMS)—a multimodal program consisting of acupuncture, cupping, and manual therapy—have been increasingly incorporated into clinical practice in Korea. However, randomized evidence remains limited. This study evaluated the efficacy and safety of adjunctive CIMS in patients with DLSS presenting neuropathic LLRP requiring SNRB. Materials and Methods: In a single-center, parallel-group, assessor-blinded randomized controlled trial (CRIS KCT0006036), adults with DLSS (LANSS > 7; VAS > 5) were randomized 1:1 to experimental or control groups (n = 77; experimental 38, control 39). All participants received SNRB plus pharmacotherapy (limaprost, pregabalin). The experimental group additionally received CIMS, delivered eight times over 4 weeks. The primary outcome was pain intensity (VAS) at baseline and weeks 4, 8, and 12. Secondary outcomes included SF-36, ODI, and RMDQ at baseline and weeks 4, 8, and 12. Repeated-measures two-factor ANOVA assessed the main effects and time × group interaction. Results: Mean VAS (experimental vs. control) was 4.73 ± 1.67 vs. 4.70 ± 1.95 at baseline; 3.74 ± 1.68 vs. 4.66 ± 1.60 at week 4; 3.93 ± 2.03 vs. 4.79 ± 1.55 at week 8; and 3.98 ± 1.98 vs. 4.98 ± 1.68 at week 12. The significant time × group interaction was identified (p = 0.040), indicating a greater pain reduction with CIMS. No significant time × group interactions were observed across SF-36 domains. Adherence to CIMS modalities was high, and no unexpected adverse events occurred. Conclusions: In DLSS patients receiving SNRB and pharmacotherapy, adjunctive CIMS resulted in greater pain reduction over 12 weeks compared with standard care alone, without introducing new safety concerns. These findings support the clinical utility of CIMS as an effective adjunctive treatment option for DLSS.

Background and Objectives: Degenerative lumbar spinal stenosis (DLSS) frequently menifests as lower leg radiating pain (LLRP), requiring selective nerve root block (SNRB). Comprehensive and integrative medical services (CIMS) – a multimodal program consisting of acupuncture, cupping, and manual therapy – have been increasingly incorporated into clinical practice in Korea. However, randomized evidence remains limited. This study evaluated the efficacy and safety of adjunctive CIMS in patients with DLSS presenting neuropathic LLRP requiring SNRB. Materials and Methods: In a single-center, parallel-group, assessor-blinded randomized controlled trial (CRIS KCT0006036), adults with DLSS (LANSS > 7; VAS > 5) were randomized 1:1 to experimental or control groups (n = 77; experimental 38, control 39). All participants received SNRB plus pharmacotherapy (limaprost, pregabalin). The experimental group additionally received CIMS, delivered 8 times over 4 weeks. The primary outcome was pain intensity (VAS) at baseline, weeks 4,8, and 12. Secondary outcomes included SF-36, ODI, and RMDQ at baseline, weeks 4,8 and 12. Repeated-measures two-factor ANOVA assessed main effects and time x group interaction. Results: Mean VAS (experimental vs. control) was 4.73±1.67 vs. 4.70±1.95 at baseline; 3.74±1.68 vs. 4.66±1.60 at week 4; 3.93±2.03 vs. 4.79±1.55 at week 8; 3.98±1.98 vs. 4.98±1.68 at week 12. The significant time x group interaction was identified (p = 0.040), indicating a greater pain reduction with CIMS. No significant time x group interactions were observed across SF-36 domains. Adherence to CIMS modalities was high, and no unexpected adverse events occurred. Conclusions: In DLSS patients receiving SNRB and pharmacotherapy, adjunctive CIMS resulted in greater pain reduction over 12 weeks compared with standard care alone, without introducing new safety concerns. These findings support the clinical utility of CIMS as an effective adjunctive treatment option for DLSS.

Background and Objectives: Spinal stenosis, low back pain, and radiating pain to the lower extremities are caused by inflammation of the spinal canal and impaired blood flow around the nerves. Because JOINS tablets are known to have anti-inflammatory, pain-relieving, and blood circulation-enhancing properties, this research was conducted based on the assumption that they could improve spinal stenosis. Materials and Methods: This was a prospective, randomized, single-center, open-label clinical trial with a 6-month follow-up period. A total of 100 patients with lumbar spinal stenosis were randomized into two groups: 50 patients in the test group and 50 patients in the control group. The control group was prescribed the usual spinal stenosis medications (Naproxen, Limaprost, and Pregabalin), while the test group was prescribed JOINS tablets in addition to the usual medications. Results: The severity of low back pain and radiating leg pain was assessed using a Visual Analog Scale. Spinal functional outcomes were assessed using the Oswestry Disability Index (ODI) and Roland-Morris Disability Questionnaire (RMDQ), and quality of life was assessed using the Short Form 36 (SF-36), with division into Physical Component Score (PCS) and Mental Component Score (MCS). At 6 months, the JOINS group showed a greater reduction in low back pain compared with controls (p < 0.001). At all follow-up periods, the functional outcomes did not show statistically significant differences between the test and control groups. Conclusions: The significant reduction in pain suggests that JOINS tablets may be an effective adjunct for pain relief, particularly in patients at high risk of adverse effects from long-term NSAID use.

Background: We aimed to conduct a systematic review and meta-analysis comparing perioperative blood loss between navigation or robot-assisted total knee arthroplasty (TKA), or patient-specific instrumentation (PSI), which are surgical techniques that do not violate the femoral medullary cavity, and conventional TKA. Methods: The PICO (population, intervention, comparison, and outcome) of this study are as follows. (1) Population: patients undergoing primary unilateral TKA. (2) Intervention: navigation or robot-assisted TKA or PSI that do not violate intramedullary cavity of the femur. (3) Comparison: traditional TKA surgical techniques that violate intramedullary cavity of the femur. (4) Outcome: perioperative blood loss or hemoglobin reduction or transfusion rate during admission. Results: In the 16 studies, 640 participants who underwent surgery not violating intramedullary cavity of the femur (navigation or robot-assisted TKA or PSI) and 637 participants who underwent surgery violating intramedullary cavity of the femur. There was statistically significant difference in perioperative blood loss. The effect size of the perioperative blood loss for all cases by 2 groups was −150.65 (95% CI: −219.53 to −81.77, P-value < .001). The effect size of the perioperative blood loss on the second day after surgery by 2 groups was −164.29 (95% CI: −320.62 to −7.96, P-value = .040). There was statistically significant difference in hemoglobin between the 2 groups before surgery and 1 day after surgery. The effect size of the difference in hemoglobin between before surgery and 1 day after surgery by 2 groups was −0.20 (95% CI: −0.38 to −0.02, P-value = .030). Conclusions: Navigation or robot-assisted TKA, or PSI, exhibited lower perioperative blood loss compared to conventional TKA. Additionally, they showed lower decreases in hemoglobin levels postoperatively. With these findings, it can be concluded that navigation or robot-assisted TKA, or PSI, may be considered as a selective option for reducing postoperative bleeding in TKA.

고상봉, et al. J Korean Soc Spine Surg. 2025 Sep;32(3):45-53. https://doi.org/10.4184/jkss.2025.32.3.45

Background: Although vitamin D is one of the essential nutrients associated with musculoskeletal system function, there is no standard treatment method for vitamin D deficiency. This study aimed to investigate the effects of vitamin D supplementation on the improvement in symptoms, functional recovery of the spine, and changes in the quality of life in patients with spinal stenosis. Methods: In this prospective study, patients with spinal stenosis and serum 25-hydroxy vitamin D levels < 10 ng/mL were randomly assigned to a supplementation group (Group S) and a non-supplementation group (Group NS): 26 participants in Group S (16 females and 10 males) and 25 in Group NS (15 females and 10 males). The degree of lower back pain in both groups was assessed using the visual analog scale; spine function was assessed using the Oswestry disability index and Roland–Morris disability questionnaire; and patient quality of life was assessed using the 36-item short form health survey. We compared and analyzed the values that were measured at baseline, between 4 and 6 weeks (V1), 10 and 12 weeks (V2), and 22 and 26 weeks (V3). Results: No statistically significant difference was observed in lower back pain, spine function, or quality of life between both groups at baseline. In terms of lower back pain in V1, Group S scored 4.15 ± 3.12, while Group NS scored 5.64 ± 1.85 (P = .045). In V2, Group S scored 3.15 ± 2.38, while Group NS scored 4.52 ± 1.87 (P = .027). Moreover, in V3, Group S scored 3.58 ± 1.65, while Group NS scored 4.60 ± 1.68 (P = .033), indicating a statistically significant improvement in each period. Conclusion: If a vitamin D deficiency that does not require surgical treatment exists in patients with lumbar spinal stenosis, high-dose vitamin D injections can improve lower back pain, which is the main symptom of lumbar spinal stenosis, as well as the functional outcomes of the spine and quality of life.

Background: This study was performed to compare glenoid version and inclination measured using two-dimensional (2D) images from computed tomography (CT) scans or three-dimensional (3D) reconstructed bone models.Methods: Thirty patients who had undergone conventional CT scans were included. Two orthopedic surgeons measured glenoid version and inclination three times on 2D images from CT scans (2D measurement), and two other orthopedic surgeons performed the same measurements using 3D reconstructed bone models (3D measurement). The 3D-reconstructed bone models were acquired and measured with Mimics and 3-Matics (Materialise).Results: Mean glenoid version and inclination in 2D measurements were –1.705º and 9.08º, respectively, while those in 3D measurements were 2.635º and 7.23º. The intra-observer reliability in 2D measurements was 0.605 and 0.698, respectively, while that in 3D measurements was 0.883 and 0.892. The inter-observer reliability in 2D measurements was 0.456 and 0.374, respectively, while those in 3D measurements was 0.853 and 0.845.Conclusions: The difference between 2D and 3D measurements is not due to differences in image data but to the use of different tools. However, more consistent results were obtained in 3D measurement. Therefore, 3D measurement can be a good alternative for measuring glenoid version and inclination.