• The Korean Journal of Pain
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• 제19권1호
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• pp.72-76
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• 2006

Background: The objective of this study was to describe the extent of pain relief after an epidural steroid injection in the patients suffering from chronic low back pain from herniated disks or lumbar spinal stenosis. Methods: The study was prospectively designed for patients suffering with lumbar spinal stenosis (LSS) and herniated disks (HD) who were referred to a hospital-based pain clinic for epidural steroid injections (ESI). The pain was assessed with using a visual analog scale at baseline, two weeks after the first ESI and two weeks after the third ESI. Results: Eighty patients were enrolled, and all of them provided pain ratings before and after the injections. The LSS patients seemed to improve less than did the HD patients. The results showed no significant differences in the triamcinolone dosage and the frequency of injections for determining the efficacy of ESI. Conclusions: The LSS patients tended to have a less effective respond to ESIs than did the HD patients. The unsatisfactory response to ESI by the LSS patients underscores the need for randomized controlled trials of performing ESI in this population.

• 대한영상의학회지
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• 제85권1호
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• pp.54-76
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• 2024

후관절병증은 퇴행성 추간판 질환 또는 척추관 협착증과 같은 척추 퇴행성 질환과 잘 동반되는 진행성 퇴행성 질환이다. 요추의 후관절병증은 근위부 하지의 통증을 유발할 수 있지만 그 증상과 영상 소견이 비특이적이기 때문에 추간판 탈출증이나 신경근 압박에 의한 통증과 감별이 어렵다. 또한 치료적 요추 후관절 내 스테로이드 주사는 현재까지 그 근거가 낮다고 분류되어 있으나, 다른 여러 연구들에서는 후관절 내 스테로이드 주사의 치료적 효과를 보고하고 있다. 실제 진료 현장에서는 치료적 후관절 내 스테로이드 주사 시술이 증가하고 있는 추세로, 본 종설에서는 후관절 내 주사에 대한 저자들의 경험을 바탕으로 요추 후관절 내 주사의 임상적 유용성 및 시술의 안전성에 대해서 소개하고자 한다.

• Journal of Yeungnam Medical Science
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• 제37권2호
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• pp.84-89
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• 2020

Spinal pain is a common patient complaint in clinical practice. Conservative treatment methods include oral medication, physical therapy, injections, and spinal orthoses. The clinical application of orthoses is debated because of potential complications associated with long-term use, such as muscle weakness and joint contracture. We reviewed the orthoses most frequently used to manage spinal pain. We review the use of soft cervical and Philadelphia collars, lumbosacral corsets, and thoracolumbosacral orthosis to manage spinal pain. Spinal orthoses can help reduce pain by protecting the muscles and joints of the injured spinal region, preventing or correcting malformations, and limiting trunk flexion, extension, lateral flexion, and rotation. The short-term use of spinal orthoses is known to improve pain and disability during the treatment period without significant adverse effects. Spinal orthoses are expected to alleviate pain and improve patients' lifestyle.

• The Korean Journal of Pain
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• 제25권1호
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• pp.55-59
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• 2012

Lumbar spinal stenosis is a commonly treated with epidural injections of local anesthetics and corticosteroids, however, these therapies may relieve leg pain for weeks to months but do not influence functional status. Furthermore, the majority of patients report no substantial symptom change over the repeated treatment. Utilizing balloon catheters, we successfully treated with three patients who complained persistent symptoms despite repeated conventional steroid injections. Our results suggest that transforaminal decompression using a balloon catheter may have potential in the nonsurgical treatment of spinal stenosis by modifying the underlying pathophysiology.

• The Korean Journal of Pain
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• 제21권1호
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• pp.38-43
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• 2008

Background: Spinal stenosis and herniated intervertebral discs are the principal causes of lumbosacral radiculopathy. This study was conducted to compare the therapeutic value and duration of pain relief of fluoroscopic guided transforaminal epidural steroid injections (TFESIs) in patients with refractory radicular leg pain. Methods: Between August 2006 and March 2007, 87 patients (H group: patients with herniated intervertebral disc, S group: patients with spinal stenosis) who met the inclusion criteria were treated with fluoroscopic guided TFESIs. Prior to treatment, the VAS and ODI scores were determine to evaluate the degree of pain and level of disability. The degree of pain relief was then assessed 1 month after treatment with the TFESIs and graded as excellent (no residual pain), good (improvement of pain symptoms by more than 50%), fair (improvement of pain symptoms by less than 50%) and Poor (no improvement of pain). In addition, the duration of pain relief was evaluated by regular outpatient visits for 6 months, and by telephone interviews after 6 months. Results: The H and S group both had excellet results at 1 month after treatment with TFESIs showing improvements of 44.1% and 20.8% respectively. However this difference was not significant between groups. In addition, a duration of pain relief greater than 6 months was achieved in 32.4% of the patients in the H group and 37.7% of those in the S group. Conclusions: TFESIs had a similar degree of therapeutic effectiveness and duration of pain relief in patients with spinal stenosis and herniated intervertebral discs.

• The Korean Journal of Pain
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• 제35권4호
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• pp.433-439
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• 2022

Background: Repeated administration of opioid analgesics for pain treatment can produce paradoxical hyperalgesia via peripheral and/or central mechanisms. Thus, this study investigated whether spinally (centrally) administered orexin A attenuates opioid-induced hyperalgesia (OIH). Methods: [D-Ala², N-Me-Phe⁴, Gly⁵-ol]-enkephalin (DAMGO), a selective µ-opioid receptor agonist, was used to induce mechanical hypersensitivity and was administered intradermally (4 times, 1-hour intervals) on the rat hind paw dorsum. To determine whether post- or pretreatments with spinal orexin A, dynorphin A, and anti-dynorphin A were effective in OIH, the drugs were injected through an intrathecal catheter whose tip was positioned dorsally at the L3 segment of the spinal cord (5 ㎍ for all). Mechanical hypersensitivity was assessed using von Frey monofilaments. Results: Repeated intradermal injections of DAMGO resulted in mechanical hypersensitivity in rats, lasting more than 8 days. Although the first intrathecal treatment of orexin A on the 6th day after DAMGO exposure did not show any significant effect on the mechanical threshold, the second (on the 8th day) significantly attenuated the DAMGO-induced mechanical hypersensitivity, which disappeared when the type 1 orexin receptor (OX1R) was blocked. However, intrathecal administration of dynorphin or an anti-dynorphin antibody (dynorphin antagonists) had no effect on DAMGO-induced hypersensitivity. Lastly, pretreatment with orexin A, dynorphin, or anti-dynorphin did not prevent DAMGO-induced mechanical hypersensitivity. Conclusions: Spinal orexin A attenuates mechanical hyperalgesia induced by repetitive intradermal injections of DAMGO through OX1R. These data suggest that OIH can be potentially treated by activating the orexin A-OX1R pathway in the spinal dorsal horn.

• The Korean Journal of Physiology
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• 제30권2호
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• pp.289-297
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• 1996

Excitatory amino acids (EAA) are thought to play an important role in producing cell death associated with ischemic and traumatic spinal cord injury. The present study was carried out to determine if the response characteristics of spinal sensory neurons in segments adjacent to degeneration sites induced by EAA are altered following these morphological changes. Intraspinal injections of quisqualic acid (QA) produced neuronal degeneration and spinal cavitation of gray matter. The severity of lesions was significantly attenuated by pretreatment with a non-NMDA antagonist NBQX. In extracellular single unit recordings, dorsal horn neurons in QA injected animal showed the increased mechanosensitivity, which included a shift to the left in the stimulus-response relationship, an increased background activity and an increase in the duration of after-discharge responses. Neuronal responses, especially the C-fiber response, to suprathreshold electrical stimulation of sciatic nerve also increased in most cases. These results suggest that altered functional states of neurons may be responsible for sensory abnormalities, e.g. allodynia and hyperalgesia, associated with syringomyolia and spinal cord injury.

• Journal of Korean Neurosurgical Society
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• 제50권2호
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• pp.134-138
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• 2011

The authors report a case of epidural and extraforaminal calcification caused by repetitive triamcinolone acetonide injections. A 66-year-old woman was admitted presenting with lower extremity weakness and radiating pain in her left leg. Ten months before admission, the patient was diagnosed as having an L4-5 spinal stenosis and underwent anterior lumbar interbody fusion followed by posterior fixation. Her symptoms had been sustained and she did not respond to transforaminal steroid injections. Repetitive injections (10 times) had been performed on the L4-5 level for six months. She had been taking bisphosphonate as an antiresorptive agent for ten months after surgery. Calcification in the ventral epidural and extraforaminal space was detected. The gritty particles were removed during decompressive surgery and these were proven to be a dystrophic calcification. The patient recovered from weakness and radiating leg pain. Repetitive triamcinolone acetonide injections after discectomy may be the cause of dystrophic calcification not only in the degenerated residual disc, but also in the posterior longitudinal ligament. Possible mechanisms may include the toxicity of preservatives and the insolubility of triamcinolone acetonide. We should consider that repetitive triamcinolone injections in the postdisectomy state may cause intraspinal ossification and calcification.

• Annals of Clinical Neurophysiology
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• 제19권1호
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• pp.71-73
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• 2017

The spinal segmental myoclonus by viral radiculitis has been rarely reported and the pathophysiology remains to be elucidated. However, the hyperactivity of contiguous anterior horn neurons induced by viral irritation has been suggested to be a possible patho-mechanism. In general, spinal segmental myoclonus is not well-controlled by medication and the patient suffers from continuous involuntary movement. We recently experienced a case of spinal segmental myoclonus induced by herpes zoster radiculitis, and which was successfully relieved by epidural injections.

• The Korean Journal of Pain
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• 제33권3호
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• pp.226-233
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• 2020

Background: We aimed to compare interlaminar epidural steroid injections (ILESI) and bilateral transforaminal epidural steroid injections (TFESI) on pain intensity, functional status, depression, walking distance, and the neuropathic component in patients with lumbar central spinal stenosis (LCSS). Methods: The patients were divided into either the ILESI or the bilateral TFESI groups. Prime outcome measures include the numerical rating scale (NRS), Oswestry disability index (ODI), Beck depression inventory (BDI), and pain-free walking distance. The douleur neuropathique en 4 questions score was used as a secondary outcome measure. Results: A total of 72 patients were finally included. NRS, ODI, and BDI scores showed a significant decline in both groups in all follow-ups. Third-month NRS scores were significantly lower in the ILESI group (P = 0.047). The percentages of decrease in the ODI and BDI scores between the baseline and the third week and third month were significantly higher in the ILESI group (P = 0.017, P = 0.001 and P = 0.048, P = 0.030, respectively). Pain-free walking distance percentages from the baseline to the third week and third month were significantly higher in the ILESI group (P = 0.036, P < 0.001). The proportion of patients with neuropathic pain in the bilateral TFESI group significantly decreased in the third week compared to the baseline (P = 0.020). Conclusions: Both ILESI and TFESI are reliable treatment options for LCSS. ILESI might be preferred because of easier application and more effectiveness. However, TFESI might be a better option in patients with more prominent neuropathic pain.