Correlation between lumbar lordosis and the treatment of chronic low back pain with pulsed radiofrequency applied to the L2 dorsal root ganglion

H.-T. Hsu, S.-J. Chang, K.-F. Huang, P.-A. Tai, T.-C. Li, C.-J. Huang

Research output: Contribution to journalArticle

1 Citation (Scopus)

Abstract

Background: Percutaneous pulsed radiofrequency (PRF) applied to the L2 dorsal root ganglion (DRG) is an alternative procedure for treating patients with chronic discogenic pain. It is assumed that afferent nerve fibers innervating the degenerated disc and facet joint might travel in the same pathway and finally enter into the L2 DRG. Blocking the L2 DRG with PRF might alleviate discogenic pain and facet joint pain concurrently. Purpose: The purpose of this study was to investigate the correlation between different types of lumbar lordosis (LL) and the treatment of chronic low back pain with PRF applied to the L2 DRG. Materials and Methods: Between 2008 and 2013, 84 patients (29 men and 55 women) were enrolled. Their mean age was 56.03 ± 9.04 years. All patients suffered from low back pain for more than 6 months that worsened on prolonged sitting or standing and did not improve with at least 3 months of conservative treatment. LL was classified into four types based on Roussouly's classification. The L2 DRG was blocked with 2-Hz PRF waves lasting for 120 s at 45 V with the temperature of the electrode tip not above 42°C. The functional outcomes were assessed pre- and post-operatively using a visual analog scale (VAS) and the Oswestry Disability Index (ODI). Results: Twenty-four patients were Type 1 LL, 26 were Type 2 LL, 21 were Type 3 LL, and 13 were Type 4 LL. The mean age of patients with each type of LL was type 1 (56.63 ± 12.09 years), Type 2 (55.39 ± 11.05 years), Type 3 (55.86 ± 11.40 years), and Type 4 (56.54 ± 12.73 years). There were similar improvements in the VAS and ODI scores for all LL types. Two patients experienced cerebrospinal fluid leakage when the needle was moved toward the L2 DRG, but neither patient experienced a neurological deficit. Conclusion: PRF applied to the L2 DRG is an alternative procedure for treating patients with chronic low back pain, regardless of which type of LL the patients have. Chronic low back pain, including discogenic pain and facet joint pain, may be treated by PRF applied to the L2 DRG. © 2017 Formosan Journal of Surgery.
Original languageEnglish
Pages (from-to)125-130
Number of pages6
JournalFormosan Journal of Surgery
Volume50
Issue number4
DOIs
Publication statusPublished - 2017
Externally publishedYes

Fingerprint

Lordosis
Spinal Ganglia
Low Back Pain
Zygapophyseal Joint
Therapeutics
Arthralgia
Visual Analog Scale
Pain
Nerve Fibers
Chronic Pain
Needles
Electrodes
Temperature

Keywords

  • Chronic low back pain
  • discogenic pain
  • facet joint pain
  • L2 dorsal root ganglion
  • lumbar lordosis
  • pulsed radiofrequency
  • Roussouly's classification
  • adult
  • Article
  • conservative treatment
  • disease classification
  • electrode
  • female
  • human
  • liquorrhea
  • lordosis
  • low back pain
  • lumbar spine
  • major clinical study
  • male
  • middle aged
  • needle
  • Oswestry Disability Index
  • percutaneous pulsed radiofrequency
  • priority journal
  • pulsed radiofrequency treatment
  • Roussouly classification
  • spinal ganglion
  • temperature measurement
  • visual analog scale

Cite this

Correlation between lumbar lordosis and the treatment of chronic low back pain with pulsed radiofrequency applied to the L2 dorsal root ganglion. / Hsu, H.-T.; Chang, S.-J.; Huang, K.-F.; Tai, P.-A.; Li, T.-C.; Huang, C.-J.

In: Formosan Journal of Surgery, Vol. 50, No. 4, 2017, p. 125-130.

Research output: Contribution to journalArticle

@article{ca2ac73409e04a06acbcafe40d3caa0e,
title = "Correlation between lumbar lordosis and the treatment of chronic low back pain with pulsed radiofrequency applied to the L2 dorsal root ganglion",
abstract = "Background: Percutaneous pulsed radiofrequency (PRF) applied to the L2 dorsal root ganglion (DRG) is an alternative procedure for treating patients with chronic discogenic pain. It is assumed that afferent nerve fibers innervating the degenerated disc and facet joint might travel in the same pathway and finally enter into the L2 DRG. Blocking the L2 DRG with PRF might alleviate discogenic pain and facet joint pain concurrently. Purpose: The purpose of this study was to investigate the correlation between different types of lumbar lordosis (LL) and the treatment of chronic low back pain with PRF applied to the L2 DRG. Materials and Methods: Between 2008 and 2013, 84 patients (29 men and 55 women) were enrolled. Their mean age was 56.03 ± 9.04 years. All patients suffered from low back pain for more than 6 months that worsened on prolonged sitting or standing and did not improve with at least 3 months of conservative treatment. LL was classified into four types based on Roussouly's classification. The L2 DRG was blocked with 2-Hz PRF waves lasting for 120 s at 45 V with the temperature of the electrode tip not above 42°C. The functional outcomes were assessed pre- and post-operatively using a visual analog scale (VAS) and the Oswestry Disability Index (ODI). Results: Twenty-four patients were Type 1 LL, 26 were Type 2 LL, 21 were Type 3 LL, and 13 were Type 4 LL. The mean age of patients with each type of LL was type 1 (56.63 ± 12.09 years), Type 2 (55.39 ± 11.05 years), Type 3 (55.86 ± 11.40 years), and Type 4 (56.54 ± 12.73 years). There were similar improvements in the VAS and ODI scores for all LL types. Two patients experienced cerebrospinal fluid leakage when the needle was moved toward the L2 DRG, but neither patient experienced a neurological deficit. Conclusion: PRF applied to the L2 DRG is an alternative procedure for treating patients with chronic low back pain, regardless of which type of LL the patients have. Chronic low back pain, including discogenic pain and facet joint pain, may be treated by PRF applied to the L2 DRG. {\circledC} 2017 Formosan Journal of Surgery.",
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author = "H.-T. Hsu and S.-J. Chang and K.-F. Huang and P.-A. Tai and T.-C. Li and C.-J. Huang",
note = "Export Date: 24 November 2017 參考文獻: Skovron, M.L., Epidemiology of low back pain (1992) Baillieres Clin Rheumatol, 6, pp. 559-573; Luoma, K., Riihim{\"a}ki, H., Raininko, R., Luukkonen, R., Lamminen, A., Viikari-Juntura, E., Lumbar disc degeneration in relation to occupation (1998) Scand J Work Environ Health, 24, pp. 358-366; Videman, T., Sarna, S., Batti{\'e}, M.C., Koskinen, S., Gill, K., Paananen, H., The long-term effects of physical loading and exercise lifestyles on back-related symptoms, disability, and spinal pathology among men (1995) Spine (Phila Pa 1976), 20, pp. 699-709; Cinotti, G., Della Rocca, C., Romeo, S., Vittur, F., Toffanin, R., Trasimeni, G., Degenerative changes of porcine intervertebral disc induced by vertebral endplate injuries (2005) Spine (Phila Pa 1976), 30, pp. 174-180; Batti{\'e}, M.C., Videman, T., Gill, K., Moneta, G.B., Nyman, R., Kaprio, J., Volvo award in clinical sciences. Smoking and lumbar intervertebral disc degeneration: An MRI study of identical twins (1991) Spine (Phila Pa 1976), 16, pp. 1015-1021. , 1991; Batti{\'e}, M.C., Videman, T., Lumbar disc degeneration: Epidemiology and genetics (2006) J Bone Joint Surg Am, 88, pp. 3-9; De Schepper, E.I., Damen, J., Van Meurs, J.B., Ginai, A.Z., Popham, M., Hofman, A., The association between lumbar disc degeneration and low back pain: The influence of age, gender, and individual radiographic features (2010) Spine (Phila Pa 1976), 35, pp. 531-536; Leboeuf-Yde, C., Body weight and low back pain A systematic literature review of 56 journal articles reporting on 65 epidemiologic studies (2000) Spine (Phila Pa 1976), 25, pp. 226-237; Batti{\'e}, M.C., Videman, T., Kaprio, J., Gibbons, L.E., Gill, K., Manninen, H., The twin spine study: Contributions to a changing view of disc degeneration (2009) Spine J, 9, pp. 47-59; Schwarzer, A.C., Aprill, C.N., Derby, R., Fortin, J., Kine, G., Bogduk, N., The relative contributions of the disc and zygapophyseal joint in chronic low back pain (1994) Spine (Phila Pa 1976), 19, pp. 801-806; Datta, S., Lee, M., Falco, F.J., Bryce, D.A., Hayek, S.M., Systematic assessment of diagnostic accuracy and therapeutic utility of lumbar facet joint interventions (2009) Pain Physician, 12, pp. 437-460; Roussouly, P., Gollogly, S., Berthonnaud, E., Dimnet, J., Classification of the normal variation in the sagittal alignment of the human lumbar spine and pelvis in the standing position (2005) Spine (Phila Pa 1976), 30, pp. 346-353; Goel, A., Facet distraction spacers for treatment of degenerative disease of the spine: Rationale and an alternative hypothesis of spinal degeneration (2010) J Craniovertebr Junction Spine, 1, pp. 65-66; Bogduk, N., The innervation of the lumbar spine (1983) Spine (Phila Pa 1976), 8, pp. 286-293; Bogduk, N., Long, D.M., The anatomy of the so-called {"}articular nerves{"} and their relationship to facet denervation in the treatment of low-back pain (1979) J Neurosurg, 51, pp. 172-177; Bogduk, N., Tynan, W., Wilson, A.S., The nerve supply to the human lumbar intervertebral discs (1981) J Anat, 132, pp. 39-56; Nakamura, S., Takahashi, K., Takahashi, Y., Morinaga, T., Shimada, Y., Moriya, H., Origin of nerves supplying the posterior portion of lumbar intervertebral discs in rats (1996) Spine (Phila Pa 1976), 21, pp. 917-924; Nakamura, S.I., Takahashi, K., Takahashi, Y., Yamagata, M., Moriya, H., The afferent pathways of discogenic low-back pain. Evaluation of L2 spinal nerve infiltration (1996) J Bone Joint Surg Br, 78, pp. 606-612; Tsou, H.K., Chao, S.C., Wang, C.J., Chen, H.T., Shen, C.C., Lee, H.T., Percutaneous pulsed radiofrequency applied to the L-2 dorsal root ganglion for treatment of chronic low-back pain: 3-year experience (2010) J Neurosurg Spine, 12, pp. 190-196; Maurer, P., Block, J.E., Squillante, D., Intradiscal electrothermal therapy (IDET) provides effective symptom relief in patients with discogenic low back pain (2008) J Spinal Disord Tech, 21, pp. 55-62; Lee, C.K., Vessa, P., Lee, J.K., Chronic disabling low back pain syndrome caused by internal disc derangements. The results of disc excision and posterior lumbar interbody fusion (1995) Spine (Phila Pa 1976), 20, pp. 356-361; Sasso, R.C., Foulk, D.M., Hahn, M., Prospective, randomized trial of metal-on-metal artificial lumbar disc replacement: Initial results for treatment of discogenic pain (2008) Spine (Phila Pa 1976), 33, pp. 123-131; Pauza, K.J., Howell, S., Dreyfuss, P., Peloza, J.H., Dawson, K., Bogduk, N., A randomized, placebo-controlled trial of intradiscal electrothermal therapy for the treatment of discogenic low back pain (2004) Spine J, 4, pp. 27-35; Shuff, C., An, H.S., Artificial disc replacement: The new solution for discogenic low back pain? (2005) Am J Orthop (Belle Mead NJ), 34, pp. 8-12; Ohtori, S., Kinoshita, T., Yamashita, M., Inoue, G., Yamauchi, K., Koshi, T., Results of surgery for discogenic low back pain: A randomized study using discography versus discoblock for diagnosis (2009) Spine (Phila Pa 1976), 34, pp. 1345-1348; Pedersen, H.E., Blunck, C.F., Gardner, E., The anatomy of lumbosacral posterior rami and meningeal branches of spinal nerve (sinu-vertebral nerves); With an experimental study of their functions (1956) J Bone Joint Surg Am, 38-A, pp. 377-391; Cohen, S.P., Raja, S.N., Pathogenesis, diagnosis, and treatment of lumbar zygapophysial (facet) joint pain (2007) Anesthesiology, 106, pp. 591-614; Shealy, C.N., Facet denervation in the management of back and sciatic pain (1976) Clin Orthop Relat Res, 115, pp. 157-164; Rashbaum, R.F., Radiofrequency facet denervation A treatment alternative in refractory low back pain with or without leg pain (1983) Orthop Clin North Am, 14, pp. 569-575",
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doi = "10.4103/fjs.fjs_43_17",
language = "English",
volume = "50",
pages = "125--130",
journal = "Formosan Journal of Surgery",
issn = "1011-6788",
publisher = "臺灣外科醫學會",
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TY - JOUR

T1 - Correlation between lumbar lordosis and the treatment of chronic low back pain with pulsed radiofrequency applied to the L2 dorsal root ganglion

AU - Hsu, H.-T.

AU - Chang, S.-J.

AU - Huang, K.-F.

AU - Tai, P.-A.

AU - Li, T.-C.

AU - Huang, C.-J.

N1 - Export Date: 24 November 2017 參考文獻: Skovron, M.L., Epidemiology of low back pain (1992) Baillieres Clin Rheumatol, 6, pp. 559-573; Luoma, K., Riihimäki, H., Raininko, R., Luukkonen, R., Lamminen, A., Viikari-Juntura, E., Lumbar disc degeneration in relation to occupation (1998) Scand J Work Environ Health, 24, pp. 358-366; Videman, T., Sarna, S., Battié, M.C., Koskinen, S., Gill, K., Paananen, H., The long-term effects of physical loading and exercise lifestyles on back-related symptoms, disability, and spinal pathology among men (1995) Spine (Phila Pa 1976), 20, pp. 699-709; Cinotti, G., Della Rocca, C., Romeo, S., Vittur, F., Toffanin, R., Trasimeni, G., Degenerative changes of porcine intervertebral disc induced by vertebral endplate injuries (2005) Spine (Phila Pa 1976), 30, pp. 174-180; Battié, M.C., Videman, T., Gill, K., Moneta, G.B., Nyman, R., Kaprio, J., Volvo award in clinical sciences. Smoking and lumbar intervertebral disc degeneration: An MRI study of identical twins (1991) Spine (Phila Pa 1976), 16, pp. 1015-1021. , 1991; Battié, M.C., Videman, T., Lumbar disc degeneration: Epidemiology and genetics (2006) J Bone Joint Surg Am, 88, pp. 3-9; De Schepper, E.I., Damen, J., Van Meurs, J.B., Ginai, A.Z., Popham, M., Hofman, A., The association between lumbar disc degeneration and low back pain: The influence of age, gender, and individual radiographic features (2010) Spine (Phila Pa 1976), 35, pp. 531-536; Leboeuf-Yde, C., Body weight and low back pain A systematic literature review of 56 journal articles reporting on 65 epidemiologic studies (2000) Spine (Phila Pa 1976), 25, pp. 226-237; Battié, M.C., Videman, T., Kaprio, J., Gibbons, L.E., Gill, K., Manninen, H., The twin spine study: Contributions to a changing view of disc degeneration (2009) Spine J, 9, pp. 47-59; Schwarzer, A.C., Aprill, C.N., Derby, R., Fortin, J., Kine, G., Bogduk, N., The relative contributions of the disc and zygapophyseal joint in chronic low back pain (1994) Spine (Phila Pa 1976), 19, pp. 801-806; Datta, S., Lee, M., Falco, F.J., Bryce, D.A., Hayek, S.M., Systematic assessment of diagnostic accuracy and therapeutic utility of lumbar facet joint interventions (2009) Pain Physician, 12, pp. 437-460; Roussouly, P., Gollogly, S., Berthonnaud, E., Dimnet, J., Classification of the normal variation in the sagittal alignment of the human lumbar spine and pelvis in the standing position (2005) Spine (Phila Pa 1976), 30, pp. 346-353; Goel, A., Facet distraction spacers for treatment of degenerative disease of the spine: Rationale and an alternative hypothesis of spinal degeneration (2010) J Craniovertebr Junction Spine, 1, pp. 65-66; Bogduk, N., The innervation of the lumbar spine (1983) Spine (Phila Pa 1976), 8, pp. 286-293; Bogduk, N., Long, D.M., The anatomy of the so-called "articular nerves" and their relationship to facet denervation in the treatment of low-back pain (1979) J Neurosurg, 51, pp. 172-177; Bogduk, N., Tynan, W., Wilson, A.S., The nerve supply to the human lumbar intervertebral discs (1981) J Anat, 132, pp. 39-56; Nakamura, S., Takahashi, K., Takahashi, Y., Morinaga, T., Shimada, Y., Moriya, H., Origin of nerves supplying the posterior portion of lumbar intervertebral discs in rats (1996) Spine (Phila Pa 1976), 21, pp. 917-924; Nakamura, S.I., Takahashi, K., Takahashi, Y., Yamagata, M., Moriya, H., The afferent pathways of discogenic low-back pain. Evaluation of L2 spinal nerve infiltration (1996) J Bone Joint Surg Br, 78, pp. 606-612; Tsou, H.K., Chao, S.C., Wang, C.J., Chen, H.T., Shen, C.C., Lee, H.T., Percutaneous pulsed radiofrequency applied to the L-2 dorsal root ganglion for treatment of chronic low-back pain: 3-year experience (2010) J Neurosurg Spine, 12, pp. 190-196; Maurer, P., Block, J.E., Squillante, D., Intradiscal electrothermal therapy (IDET) provides effective symptom relief in patients with discogenic low back pain (2008) J Spinal Disord Tech, 21, pp. 55-62; Lee, C.K., Vessa, P., Lee, J.K., Chronic disabling low back pain syndrome caused by internal disc derangements. The results of disc excision and posterior lumbar interbody fusion (1995) Spine (Phila Pa 1976), 20, pp. 356-361; Sasso, R.C., Foulk, D.M., Hahn, M., Prospective, randomized trial of metal-on-metal artificial lumbar disc replacement: Initial results for treatment of discogenic pain (2008) Spine (Phila Pa 1976), 33, pp. 123-131; Pauza, K.J., Howell, S., Dreyfuss, P., Peloza, J.H., Dawson, K., Bogduk, N., A randomized, placebo-controlled trial of intradiscal electrothermal therapy for the treatment of discogenic low back pain (2004) Spine J, 4, pp. 27-35; Shuff, C., An, H.S., Artificial disc replacement: The new solution for discogenic low back pain? (2005) Am J Orthop (Belle Mead NJ), 34, pp. 8-12; Ohtori, S., Kinoshita, T., Yamashita, M., Inoue, G., Yamauchi, K., Koshi, T., Results of surgery for discogenic low back pain: A randomized study using discography versus discoblock for diagnosis (2009) Spine (Phila Pa 1976), 34, pp. 1345-1348; Pedersen, H.E., Blunck, C.F., Gardner, E., The anatomy of lumbosacral posterior rami and meningeal branches of spinal nerve (sinu-vertebral nerves); With an experimental study of their functions (1956) J Bone Joint Surg Am, 38-A, pp. 377-391; Cohen, S.P., Raja, S.N., Pathogenesis, diagnosis, and treatment of lumbar zygapophysial (facet) joint pain (2007) Anesthesiology, 106, pp. 591-614; Shealy, C.N., Facet denervation in the management of back and sciatic pain (1976) Clin Orthop Relat Res, 115, pp. 157-164; Rashbaum, R.F., Radiofrequency facet denervation A treatment alternative in refractory low back pain with or without leg pain (1983) Orthop Clin North Am, 14, pp. 569-575

PY - 2017

Y1 - 2017

N2 - Background: Percutaneous pulsed radiofrequency (PRF) applied to the L2 dorsal root ganglion (DRG) is an alternative procedure for treating patients with chronic discogenic pain. It is assumed that afferent nerve fibers innervating the degenerated disc and facet joint might travel in the same pathway and finally enter into the L2 DRG. Blocking the L2 DRG with PRF might alleviate discogenic pain and facet joint pain concurrently. Purpose: The purpose of this study was to investigate the correlation between different types of lumbar lordosis (LL) and the treatment of chronic low back pain with PRF applied to the L2 DRG. Materials and Methods: Between 2008 and 2013, 84 patients (29 men and 55 women) were enrolled. Their mean age was 56.03 ± 9.04 years. All patients suffered from low back pain for more than 6 months that worsened on prolonged sitting or standing and did not improve with at least 3 months of conservative treatment. LL was classified into four types based on Roussouly's classification. The L2 DRG was blocked with 2-Hz PRF waves lasting for 120 s at 45 V with the temperature of the electrode tip not above 42°C. The functional outcomes were assessed pre- and post-operatively using a visual analog scale (VAS) and the Oswestry Disability Index (ODI). Results: Twenty-four patients were Type 1 LL, 26 were Type 2 LL, 21 were Type 3 LL, and 13 were Type 4 LL. The mean age of patients with each type of LL was type 1 (56.63 ± 12.09 years), Type 2 (55.39 ± 11.05 years), Type 3 (55.86 ± 11.40 years), and Type 4 (56.54 ± 12.73 years). There were similar improvements in the VAS and ODI scores for all LL types. Two patients experienced cerebrospinal fluid leakage when the needle was moved toward the L2 DRG, but neither patient experienced a neurological deficit. Conclusion: PRF applied to the L2 DRG is an alternative procedure for treating patients with chronic low back pain, regardless of which type of LL the patients have. Chronic low back pain, including discogenic pain and facet joint pain, may be treated by PRF applied to the L2 DRG. © 2017 Formosan Journal of Surgery.

AB - Background: Percutaneous pulsed radiofrequency (PRF) applied to the L2 dorsal root ganglion (DRG) is an alternative procedure for treating patients with chronic discogenic pain. It is assumed that afferent nerve fibers innervating the degenerated disc and facet joint might travel in the same pathway and finally enter into the L2 DRG. Blocking the L2 DRG with PRF might alleviate discogenic pain and facet joint pain concurrently. Purpose: The purpose of this study was to investigate the correlation between different types of lumbar lordosis (LL) and the treatment of chronic low back pain with PRF applied to the L2 DRG. Materials and Methods: Between 2008 and 2013, 84 patients (29 men and 55 women) were enrolled. Their mean age was 56.03 ± 9.04 years. All patients suffered from low back pain for more than 6 months that worsened on prolonged sitting or standing and did not improve with at least 3 months of conservative treatment. LL was classified into four types based on Roussouly's classification. The L2 DRG was blocked with 2-Hz PRF waves lasting for 120 s at 45 V with the temperature of the electrode tip not above 42°C. The functional outcomes were assessed pre- and post-operatively using a visual analog scale (VAS) and the Oswestry Disability Index (ODI). Results: Twenty-four patients were Type 1 LL, 26 were Type 2 LL, 21 were Type 3 LL, and 13 were Type 4 LL. The mean age of patients with each type of LL was type 1 (56.63 ± 12.09 years), Type 2 (55.39 ± 11.05 years), Type 3 (55.86 ± 11.40 years), and Type 4 (56.54 ± 12.73 years). There were similar improvements in the VAS and ODI scores for all LL types. Two patients experienced cerebrospinal fluid leakage when the needle was moved toward the L2 DRG, but neither patient experienced a neurological deficit. Conclusion: PRF applied to the L2 DRG is an alternative procedure for treating patients with chronic low back pain, regardless of which type of LL the patients have. Chronic low back pain, including discogenic pain and facet joint pain, may be treated by PRF applied to the L2 DRG. © 2017 Formosan Journal of Surgery.

KW - Chronic low back pain

KW - discogenic pain

KW - facet joint pain

KW - L2 dorsal root ganglion

KW - lumbar lordosis

KW - pulsed radiofrequency

KW - Roussouly's classification

KW - adult

KW - Article

KW - conservative treatment

KW - disease classification

KW - electrode

KW - female

KW - human

KW - liquorrhea

KW - lordosis

KW - low back pain

KW - lumbar spine

KW - major clinical study

KW - male

KW - middle aged

KW - needle

KW - Oswestry Disability Index

KW - percutaneous pulsed radiofrequency

KW - priority journal

KW - pulsed radiofrequency treatment

KW - Roussouly classification

KW - spinal ganglion

KW - temperature measurement

KW - visual analog scale

U2 - 10.4103/fjs.fjs_43_17

DO - 10.4103/fjs.fjs_43_17

M3 - Article

VL - 50

SP - 125

EP - 130

JO - Formosan Journal of Surgery

JF - Formosan Journal of Surgery

SN - 1011-6788

IS - 4

ER -