Rectal cancer, which accounts for approximately 40% of colorectal cancers, remains a major clinical concern. Recent advances in diagnostic imaging, surgical techniques, radiotherapy, and systemic treatment have steadily improved rectal cancer outcomes. Considering this, the Korean Rectal Cancer Multidisciplinary (KRCM) Committee has aimed to provide clinicians and policymakers with up-to-date, evidence-based clinical practice guidelines to support optimal decision-making, reflecting current evidence, the Korean healthcare context, and patient values and preferences. The Clinical Practice Guidelines for Rectal Cancer version 2.0 were developed through multidisciplinary collaboration with related academic societies, building upon and updating the KRCM Clinical Practice Guidelines version 1.0 (titled “Multidisciplinary guidelines for the management of rectal cancer”). These consensus guidelines of the KRCM were established based on a comprehensive literature review, evidence synthesis, with recommendation development guided by the GRADE (Grading of Recommendations Assessment, Development and Evaluation) methodology, and consideration of applicability in real-world clinical practice under the national health insurance system. Each recommendation has been presented with its strength and level of evidence.

Baclofen, a gamma-aminobutyric acid-B receptor agonist, is commonly used for central-origin muscle spasticity and spasm and neuropathic pain. Baclofen toxicity has been reported to cause a range of symptoms including drowsiness, confusion, respiratory depression, seizures, and even coma, particularly with dosage significantly exceeding therapeutic levels. Given that the baclofen is predominantly eliminated through the kidneys, patients with renal failure are at substantial risk for neurotoxic effects. We report a case of baclofen-induced encephalopathy in a patient with end-stage renal disease, characterized by an altered mental state with myoclonus following the consumption of a low dose of baclofen.

OBJECTIVES: In the current study, we aimed to (1) evaluate the early and late therapeutic effects of selective nerve root block (SNRB) for cervical radiculopathy, and (2) to determine the optimal time point for predicting the long-term effectiveness of cervical SNRB.SUMMARY OF LITERATURE REVIEW: Although SNRB is an important option for cervical radiculopathy, various studies of cervical SNRB have failed to specify its efficacy, especially long-term effectiveness. MATERIALS AND METHODS: We retrospectively enrolled 35 patients with cervical radiculopathy who were regularly followed-up for at least 1 year after SNRB. Clinical outcomes were evaluated using a visual analogue scale (VAS) for pain intensity and the modified Kim's method for patient satisfaction at regular follow-up intervals. In the correlation analysis, stepwise multiple linear regression was used to identify selected and unselected factors. RESULTS: The average VAS score decreased over time (p<0.05); the values just before the injection and at 1 week, 3 weeks, and 1 year of follow-up were 6.11, 3.29, 2.89, and 1.37, respectively. In the stepwise multiple regression analysis, the 1-week VAS score was related to the initial VAS score, the 3-week VAS score was related to the 1-week VAS score, and the last VAS score was related to the 3-week VAS score and symptom duration before the injection. The degree of satisfaction at the 1-year follow-up point was significantly associated with the 3-week VAS score (p=0.011). CONCLUSIONS The current study showed that pain intensity at the 3-week time point after cervical SNRB might be the optimal time point for predicting long-term effectiveness.

STUDY DESIGN: Retrospective study. OBJECTIVES: In the current study, we aimed to (1) evaluate the early and late therapeutic effects of selective nerve root block (SNRB) for cervical radiculopathy, and (2) to determine the optimal time point for predicting the long-term effectiveness of cervical SNRB. SUMMARY OF LITERATURE REVIEW: Although SNRB is an important option for cervical radiculopathy, various studies of cervical SNRB have failed to specify its efficacy, especially long-term effectiveness. MATERIALS AND METHODS: We retrospectively enrolled 35 patients with cervical radiculopathy who were regularly followed-up for at least 1 year after SNRB. Clinical outcomes were evaluated using a visual analogue scale (VAS) for pain intensity and the modified Kim's method for patient satisfaction at regular follow-up intervals. In the correlation analysis, stepwise multiple linear regression was used to identify selected and unselected factors. RESULTS: The average VAS score decreased over time (p<0.05); the values just before the injection and at 1 week, 3 weeks, and 1 year of follow-up were 6.11, 3.29, 2.89, and 1.37, respectively. In the stepwise multiple regression analysis, the 1-week VAS score was related to the initial VAS score, the 3-week VAS score was related to the 1-week VAS score, and the last VAS score was related to the 3-week VAS score and symptom duration before the injection. The degree of satisfaction at the 1-year follow-up point was significantly associated with the 3-week VAS score (p=0.011). CONCLUSIONS: The current study showed that pain intensity at the 3-week time point after cervical SNRB might be the optimal time point for predicting long-term effectiveness.
Follow-Up Studies ; Humans ; Linear Models ; Methods ; Patient Satisfaction ; Radiculopathy ; Retrospective Studies ; Therapeutic Uses

STUDY DESIGN: A retrospective review of prospectively collected data. PURPOSE: To introduce the sternum-disk distance (SDD) method for approaching the exact surgical level without C-arm guidance during anterior cervical discectomy and fusion (ACDF) surgery and to evaluate its accuracy and reliability. OVERVIEW OF LITERATURE: Although spine surgeons have tried to optimize methods for identifying the skin level for accessing the operative disk level without C-arm guidance during ACDF, success has rarely been reported. METHODS: In total, 103 patients who underwent single-level ACDF surgery with the SDD method were enrolled. The primary outcome measure was the accuracy of the SDD method. The secondary outcome measures were the mean SDD value at each cervical level from the cranial margin of the sternum in the neutral and extension positions of the cervical spine and the inter- and intra-observer reliability of the SDD outcome determined using repeated measurements by three orthopedic spine surgeons. RESULTS: The SDD accuracy (primary outcome measure) was indicated in 99% of the patients (102/103). The mean SDD values in the neutral-position magnetic resonance imaging (MRI) were 108.8 mm at C3–C4, 85.3 mm at C4–C5, 64.4 mm at C5–C6, 44.3 mm at C6–C7, and 24.1 mm at C7–T1; and those in the extension-position MRI were 112.9 mm at C3–C4, 88.7 mm at C4–C5, 67.3 mm at C5–C6, 46.5 mm at C6–C7, and 24.3 mm at C7–T1. The Cohen kappa coefficient value for intra-observer reliability was 0.88 (excellent reliability), and the Fleiss kappa coefficient value for inter-observer reliability as reported by three surgeons was 0.89 (excellent reliability). CONCLUSIONS: Based on the results of the present study, we recommend performing ACDF surgery using the SDD method to determine the skin level for approaching the surgical cervical segment without fluoroscopic guidance.
Cervical Vertebrae ; Diskectomy* ; Female ; Fluoroscopy* ; Humans ; Magnetic Resonance Imaging ; Methods* ; Orthopedics ; Outcome Assessment (Health Care) ; Prospective Studies ; Retrospective Studies ; Skin* ; Spinal Fusion ; Spine ; Sternum ; Surgeons

BACKGROUND: Vitamin C has critical features relavant to postoperative pain management and functional improvement; however, no study has yet evaluated the effectiveness of vitamin C on improving the surgical outcomes for spine pathologies. Thus, this study aimed to explore the impact of vitamin C on postoperative outcomes after single-level posterior lumbar interbody fusion (PLIF) for lumbar spinal stenosis in prospectively randomized design. We conducted a 1-year prospective, randomized, placebo-controlled, double-blind study to evaluate the impact of vitamin C on the postoperative outcomes after PLIF surgery. METHODS: A total of 123 eligible patients were randomly assigned to either group A (62 patients with vitamin C) or group B (61 patients with placebo). Patient follow-up was continued for at least 1 year after surgery. The primary outcome measure was pain intensity in the lower back using a visual analogue scale. The secondary outcome measures were: (1) the clinical outcome assessed using the Oswestry Disability Index (ODI); (2) the fusion rate assessed using dynamic radiographs and computed tomography scans; and (3) complications. RESULTS: Pain intensity in the lower back was significantly improved in both groups compared with preoperative pain intensity, but no significant difference was observed between the 2 groups over the follow-up period. The ODI score of group A at the third postoperative month was significantly higher than the score of group B. After the sixth postoperative month, the ODI score of group A was slightly higher than the score of group B; however, this difference was not significant. The fusion rates at 1 year after surgery and the complication rates were not significantly different between the 2 groups. CONCLUSIONS: Postoperative pain intensity, the primary outcome measure, was not significantly different at 1 year after surgery between the 2 groups. However, vitamin C may be associated with improving functional status after PLIF surgery, especially during the first 3 postoperative months.
Ascorbic Acid* ; Double-Blind Method ; Follow-Up Studies ; Humans ; Outcome Assessment (Health Care) ; Pain, Postoperative ; Pathology ; Prospective Studies ; Spinal Stenosis ; Spine ; Treatment Outcome ; Vitamins*

STUDY DESIGN: Retrospective exploratory imaging study. PURPOSE: To investigate the significance of the coronal magnetic resonance imaging (MRI) using Proset technique to detect the hidden zone in patients with mid-zone stenosis by comparing with conventional axial and sagittal MRI and to explore the morphologic characteristic patterns of the mid-zone stenosis. OVERVIEW OF LITERATURE: Despite advancements in diagnostic modalities such as computed tomography and MRI, stenotic lesions under the pedicle and pars interarticularis, also called the mid-zone, are still difficult to definitely detect with the conventional axial and sagittal MRI due to its inherited anatomical peculiarity. METHODS: Of 180 patients scheduled to undergo selective nerve root block, 20 patients with mid-zone stenosis were analyzed using MRI. Characteristic group patterns were also explored morphologically by comparing MRI views of each group after verifying statistical differences between them. Hierarchical cluster analysis was performed to classify morphological characteristic groups based on three-dimensional radiologic grade for stenosis at all three zones. RESULTS: At the mid-zone, the stenosis of grade 2 or more was found in 14 cases in the coronal image,13 cases in the sagittal image, and 9 cases in the axial image (p<0.05). Especially, mid-zone stenosis was not detected in six of 20 cases at the axial images. At the entrance and exit-zone, coronal image was also associated with more accurate detection of hidden zone compared to other views such as axial and sagittal images. After repeated statistical verification, the morphological patterns of hidden zone were classified into 5 groups: 6 cases in group I; 1 case in group II; 4 cases in group III; 7 cases in group IV; and 2 cases in group V. CONCLUSIONS: Coronal MRI using the Proset technique more accurately detected hidden zone of the mid-zone stenosis compared to conventional axial and sagittal images.
Constriction, Pathologic* ; Humans ; Lumbar Vertebrae ; Magnetic Resonance Imaging* ; Retrospective Studies ; Spinal Stenosis ; Spine*

OBJECTIVE: To investigate the significance of intra-appendiceal air at CT for the evaluation of appendicitis. MATERIALS AND METHODS: We retrospectively analyzed 458 patients (216 men, 242 women; age range, 18-91 years) who underwent CT for suspected appendicitis. Two independent readers reviewed the CT. Prevalence, amount, and appearance of intra-appendiceal air were assessed and compared between the patients with and without appendicitis. Performance of CT diagnosis was evaluated in two reading strategies: once ignoring appendiceal air (strategy 1), and the other time considering presence of appendiceal air as indicative of no appendicitis in otherwise indeterminate cases (strategy 2), using receiver operating characteristic (ROC) analysis. RESULTS: Of the 458 patients, 102 had confirmed appendicitis. The prevalence of intra-appendiceal air was significantly different between patients with (13.2%) and without (79.8%) appendicitis (p < 0.001). The amount of appendiceal air was significantly lesser in patients having appendicitis as compared with the normal group, for both reader 1 (p = 0.011) and reader 2 (p = 0.002). Stool-like appearance and air-fluid levels were more common in the appendicitis group than in the normal appendix for both readers (p < 0.05). Areas under the ROC curves were not significantly different between strategies 1 and 2 in reader 1 (0.971 vs. 0.985, respectively; p = 0.056), but showed a small difference in reader 2 (0.969 vs. 0.986, respectively; p = 0.042). CONCLUSION: Although significant differences were seen in the prevalence, amount, and appearance of intra-appendiceal air between patients with and without appendicitis, it has a limited incremental value for the diagnosis of acute appendicitis.
Acute Disease ; Adolescent ; Adult ; Aged ; Aged, 80 and over ; Appendicitis/pathology/*radiography ; Appendix/pathology/*radiography ; Female ; Humans ; Male ; Middle Aged ; Prevalence ; ROC Curve ; Retrospective Studies ; Tomography, X-Ray Computed ; Young Adult

STUDY DESIGN: A nation-wide, outpatient-based, cross-sectional survey with the use of questionnaires. PURPOSE: To evaluate the pain, disability and satisfaction of patients with osteoporotic vertebral compression fractures (OVCFs). OVERVIEW OF LITERATURE: There are no nation-wide data in Korea on the degree of pain, disability and satisfaction with treatment in patients with OVCFs. METHODS: We performed a cross-sectional survey of 573 patients with OVCFs. After excluding incomplete questionnaires (missing more than 30% of the variables), 430 patient-physician-matched data sets were collected for this survey. RESULTS: Patients with OVCFs were managed with conservative treatment in 63% and with a vertebroplasty in 37%. The means of the latest visual analogue scale (VAS, 5.2) and Oswestry Disability Index (ODI, 47.7) scores checked at the time of survey were significantly higher than those VAS and ODI scores prior to OVCFs (the prefracture VAS and ODI scores, 3.6 and 26.3, respectively; p<0.001 for both comparisons). However, the means of the latest VAS and ODI scores were insignificantly different between the conservative and vertebroplasty groups, irrespective of the duration from the fractures. Overall, 75% of patients were satisfied with their clinical outcomes. However, the percentages of patient's satisfaction were not significantly different between the conservative and vertebroplasty groups. Eighty-eight percent of patients felt some or marked deterioration of their general health condition following OVCFs. CONCLUSIONS: These results indicate that although most patients with OVCFs were satisfied with their clinical outcomes, their subjective general health conditions, as well as their pain and disability, did not recover to the prefracture state.
Cross-Sectional Studies ; Fractures, Compression* ; Humans ; Korea ; Vertebroplasty ; Surveys and Questionnaires