• Journal of Acupuncture Research
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• v.35 no.4
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• pp.248-251
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• 2018

This retrospective study reports the effects of combined traditional Korean treatment of cervical radiculopathy in patients who underwent ineffective epidural steroid injection treatment. This study analyzed cervical radiculopathy in patients who visited traditional Korean medicine hospital following an ineffective epidural steroid injection. There were 29 cases included in this study. Scores for Visual Analog Scale (VAS) and Neck Disability Index (NDI) were measured before and after combined treatment with acupuncture, herbal medicine, and chuna therapy. The results of this study showed that patient VAS scores for neck and shoulder pain were significantly reduced (p < 0.001) when comparing scores before treatment ($6.03{\pm}2.04$) with after treatment ($2.14{\pm}1.27$). In addition, the VAS score for radiating pain before treatment ($6.67{\pm}1.44$) compared with after treatment ($2.89{\pm}1.83$) showed a significant reduction (p < 0.001). Furthermore, the NDI score before treatment ($25.85{\pm}6.33$) compared with after treatment ($11.33{\pm}7.47$), also showed a significant reduction (p < 0.001). The results in this study showed the positive effects of combined traditional Korean medicine treatment in significantly reducing pain for patients with cervical radiculopathy, who had ineffective anesthesia.

• Clinical Pain
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• v.19 no.2
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• pp.116-119
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• 2020

Cervical transforaminal epidural steroid injection (TFESI) is commonly performed to provide relief of pain caused by radiculopathy. Intra-arterial injection of particulate steroid or direct needle injury can lead to spinal artery embolism or thrombosis. Also there is a possibility of vascular spasm. To our knowledge, this is the first reported case of spinal cord infarction that occurred after TFESI with non-particulate steroid in Korea. A 47-year-old female patient underwent C7 TFESI at local pain clinic. Injected materials were dexamethasone and mepivacaine. Right after the intervention, she felt muscle weakness and decreased sensation. On physical examination, she had decreased sensation from C4 to T2 dermatome in light touch and pin-prick test. Proprioception and vibration were intact. The motor grades of upper extremities were grade 1. Cervical and thoracic spine MRI was checked. Diffusion-weighted image and apparent diffusion coefficient image showed long extension of spinal cord infarction from C2 to T1 level.

• The Korean Journal of Pain
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• v.27 no.1
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• pp.35-42
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• 2014

Background: Epidural steroid injection (ESI) is one of the most common procedures for patients presenting low back pain and radiculopathy. However, there is no clear consensus on what constitutes appropriate steroid use for ESIs. To investigate optimal steroid injection methods for ESIs, surveys were sent to all academic pain centers and selected private practices in Korea via e-mail. Methods: Among 173 pain centers which requested the public health insurance reimbursements for their ESIs and were enrolled in the Korean Pain Society, 122 completed questionnaires were returned, for a rate of 70.5%; also returned were surveys from 39 academic programs and 85 private practices with response rates of 83.0% and 65.9%, respectively. Results: More than half (55%) of Korean pain physicians used dexamethasone for ESIs. The minimum interval of subsequent ESIs at the academic institutions (3.1 weeks) and the private practices (2.1 weeks) were statistically different (P = 0.01). Conclusions: Although there was a wide range of variation, there were no significant differences between the academic institutions and the private practices in terms of the types and single doses of steroids for ESIs, the annual dose of steroids, or the limitations of doses in the event of diabetes, with the exception of the minimum interval before the subsequent ESI.

• Journal of Korean Neurosurgical Society
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• v.58 no.5
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• pp.483-486
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• 2015

Cervical epidural steroid injection is frequently used in the conservative management of neck pain and cervical radiculopathy. Epidural cervical transforaminal injections are usually well-tolerated with mild side effects such as transient decreased sensory and motor function, or headache due to dural puncture. Although there are a few case reports about adverse effects of cervical epidural injection in the literature, it can cause severe complications such as large hematoma, infarction by spinal vascular injury. Subdural hematoma has been occurred much less common rather than epidural hematoma in the spinal cord. We report a rare catastrophic case of cervical spinal subdural hematoma with quadriparesis after cervical transforaminal epidural block.

• Journal of Korean Neurosurgical Society
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• v.29 no.3
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• pp.420-425
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• 2000

Epidural steroid injection(ESI) has been a commonly applied conservative therapy for the management of chronic low back pain and sciatica. However, there are many reports concerning various local, systemic and neurological complications related to ESI. We report two cases with fatal complications after ESI for low back pain and sciatica. In both patients, ventriculitis and meningitis were causative factors to be fatal. Aseptic procedures and careful post-procedure assessment are essential to avoid serious complications following ESI.

• The Academic Congress of Korean Shoulder and Elbow Society
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• 2003.03a
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• pp.48-57
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• 2003

• Clinics in Shoulder and Elbow
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• v.6 no.1
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• pp.8-14
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• 2003

• The Korean Journal of Pain
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• v.27 no.3
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• pp.197-199
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• 2014

• The Korean Journal of Pain
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• v.22 no.1
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• pp.83-87
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• 2009

Case reports after accidental subdural injection during attempted epidural block have usually described extensive neuraxial blocks with a characteristic radiographic appearance on contrast injection. We experienced a case of cervical subdural injection with unusual clinical findings and radiographic appearance. A 51-year-old female patient with central herniated nucleus pulposus at cervical (C5/6) and lumbar level (L4/5, L5/S1) was referred to the pain clinic. During attempted cervical epidural block at the C6/7 interspace with fluoroscopy, injection of the 4 ml contrast showed posterior spread at cervical level. After cervical epidural steroid injection, the contrast was also confined to the posterior aspect of the spinal canal at lumbar level with fluoroscopy. In order to discriminate subdural space from epidural space, we performed transforaminal epidural injection of the 2 ml contrast at the L5/S1 interspace and we could confirm cervical epidural injection was made into the subdural space. We discuss the clinical characteristics of a subdural injection and the appearance of the cervical and lumbar subdurogram.

• The Korean Journal of Pain
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• v.4 no.2
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• pp.157-161
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• 1991

Low back pain and/or lumbosacral radiculopathy have become one of the most common pain problems in our pain clinic center. There are several kinds of conservative management for low back pain and/or lumbosacral radiculopathy. We as pain clinicans, focused on epidural administration of local anesthetics and steroids. The rationale for epidural steroid administration is to reduce inflammation and to inhibit the action of nociceptive agents. Eighty mg of methylprednisolone acetate in 10 ml of 0.25% bupivacaine was infected, into epidural space 3 times at one week intervals for 1 year, to 921 patients(male: 422, female: 499) seen in the period between March 1986 and December 1989. The effectiveness was evaluated a month after the final injection. The results were as follows: Excellent pain relieved group 122 patients(13.25%) Good pain relieved group: 485 patients(52.66%) Fair pain relieved group: 184 patients(19.98%) No effect group: 130 patients(14.11%) We recommend the epidural steroid inject to the patients following failure of conservative management of discogenic pain.