• 대한정형외과 초음파학회지
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• 제6권2호
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• pp.81-93
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• 2013

본 종설에서는 요추부 중재술에 있어서 초음파라는 장비가 영상 장치로서 얼마나 유용한가에 대해 기술하였다. 우선 요천추부의 표면 해부학과 초음파 해부학에 대하여 기술하였는데, 이는 초음파 유도하 중재술에서 영상의 판독과 술기의 수행에 있어 해부학의 자세한 이해가 반드시 필요하기 때문이다. 방사선 투시하에 척추 중재술을 하는 것이 보편화 되어 있지만 방사선을 피폭해야 하는 문제가 늘 존재한다. 초음파는 방사선이 없고 간편하며 높은 정확도로 실시간 영상을 제공하는 장점들이 있으며 어떠한 임상 환경적 조건에서도 시행할 수 있다. 초음파 유도하 요추부 중재술은 방사선 투시기나 컴퓨터 단층촬영 유도로 시행하였던 기존의 방식을 대신할 수 있으며 방사선 피폭 없이 안전하게 시행할 수 있는 방법이다.

• The Korean Journal of Pain
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• 제24권4호
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• pp.205-215
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• 2011

Background: Interventional pain management (IPM) is a branch of medical science that deals with management of painful medical conditions using specially equipped X-ray machines and anatomical landmarks. Interventional physiatry is a branch of physical medicine and rehabilitation that treats painful conditions through intervention in peripheral joints, the spine, and soft tissues. Methods: A cross-sectional study was conducted using three years of hospital records (2006 to 2008) from the Physical Medicine and Rehabilitation Department at Chittagong Medical College Hospital in Bangladesh, with a view toward highlighting current interventional pain practice in a tertiary medical college hospital. Result: The maximum amount of intervention was done in degenerative peripheral joint disorders (600, 46.0%), followed by inflammatory joint diseases (300, 23.0%), soft tissue rheumatism (300, 23.0%), and radicular or referred lower back conditions (100, 8.0%). Of the peripheral joints, the knee was the most common site of intervention. Motor stimulation-guided intralesional injection of methylprednisolone into the piriformis muscle was given in 10 cases of piriformis syndrome refractory to both oral medications and therapeutic exercises. Soft tissue rheumatism of unknown etiology was most common in the form of adhesive capsulitis (90, 64.3%), and is discussed separately. Epidural steroid injection was practiced for various causes of lumbar radiculopathy, with the exception of infective discitis. Conclusion: All procedures were performed using anatomical landmarks, as there were no facilities for the C-arm/diagnostic ultrasound required for accurate and safe intervention. A dedicated IPM setup should be a requirement in all PMR departments, to provide better pain management and to reduce the burden on other specialties.

• The Korean Journal of Pain
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• 제27권3호
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• pp.266-270
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• 2014

Background: Knowledge of the anatomical variation of the vertebral artery has clinical importance not only for the performance of interventional or surgical procedures itself but also to ensure their safety. We conducted a study of the anatomical variation by reviewing multi-detector computed tomography (MDCT) images of the cervical spine from 460 Korean patients. Methods: 16-row MDCT data from 460 patients were used in this study. We observed 920 vertebral arteries. Examination points included level of entrance of the artery into the transverse foramen of the cervical vertebra, origin site of the vertebral artery, course of a vertebral artery with aberrant entrance. Result: The vertebral artery in 2 (0.2%) cases in this study entered into the transverse foramen of the 7th cervical vertebra from the left. In 45 (4.9%) cases, the vertebral artery entered into the transverse foramen of the 5th cervical vertebra. Of these, the entrance was on the right in 15 (1.6%) and on the left in 30 (3.3%). We found 17 (1.8%) cases in which the artery entered into the transverse foramen of the 4th cervical vertebra, 10 (1.1%) on the right and 7 (0.7%) on the left side. As is commonly acknowledged, the 6th cervical vertebra was the most common site of entry; the vertebral artery entered the transverse foramen of the 6th cervical vertebra in the remaining 855 (93.0%) cases, on the right in 434 (47.2%) and on the left in 421 (45.8%). Conclusions: In conclusion, the possibility of an atypical course of the vertebral artery in segments V1 and V2 should be evaluated with magnetic resonance imaging (MRI) or CT images before carrying out procedures involving the anterior cervical vertebrae.

• 대한기계학회:학술대회논문집
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• 대한기계학회 2007년도 춘계학술대회A
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• pp.378-383
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• 2007

As the Minimally Invasive Surgery (MIS) is developed, an interventional procedure becomes the major of the spine surgery in the world. Despite of the use of the expensive medical equipments, the success chance of the nucleoplasty is about 30%. The reason is that the shape of the cannular needle is similar to that of the conventional injector and looks like the straight. Because the tip of these straight needles is not able to reach in the vicinity of the disc bulging or the protrusion, which are the cause of the low back pain and because the far indirect plasma discharge results in the decompression, the nucleoplasty has the limit. Many incurable diseases has not been solved due to the unexistence of the advanced technique for the MIS human body cannula device. If 3-D direction controllable cannular catheter (whose direction is accurately controlled after inserting into the bodies to cure the lesion) is developed, it is expected that new devised cannular catheter can cure many incurable diseases simultaneously. Therefore, the aims of this research are to develop the new devised cannular catheter of SMA direction controller for the medical situation, which has been produced through many previous trial-error procedures, and to produce the commercial medical device.

• The Korean Journal of Pain
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• 제36권1호
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• pp.11-50
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• 2023

As the field of interventional pain management (IPM) grows, the risk of surgical site infections (SSIs) is increasing. SSI is defined as an infection of the incision or organ/space that occurs within one month after operation or three months after implantation. It is also common to find patients with suspected infection in an outpatient clinic. The most frequent IPM procedures are performed in the spine. Even though primary pyogenic spondylodiscitis via hematogenous spread is the most common type among spinal infections, secondary spinal infections from direct inoculation should be monitored after IPM procedures. Various preventive guidelines for SSI have been published. Cefazolin, followed by vancomycin, is the most commonly used surgical antibiotic prophylaxis in IPM. Diagnosis of SSI is confirmed by purulent discharge, isolation of causative organisms, pain/tenderness, swelling, redness, or heat, or diagnosis by a surgeon or attending physician. Inflammatory markers include traditional (C-reactive protein, erythrocyte sedimentation rate, and white blood cell count) and novel (procalcitonin, serum amyloid A, and presepsin) markers. Empirical antibiotic therapy is defined as the initial administration of antibiotics within at least 24 hours prior to the results of blood culture and antibiotic susceptibility testing. Definitive antibiotic therapy is initiated based on the above culture and testing. Combination antibiotic therapy for multidrug-resistant Gram-negative bacteria infections appears to be superior to monotherapy in mortality with the risk of increasing antibiotic resistance rates. The never-ending war between bacterial resistance and new antibiotics is continuing. This article reviews prevention, diagnosis, and treatment of infection in pain medicine.

• The Korean Journal of Pain
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• 제25권2호
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• pp.81-88
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• 2012

Background: In discography performed during percutaneous endoscopic lumbar discectomy (PELD) via the posterolateral approach, it is difficult to create a fluoroscopic tunnel view because a long needle is required for discography and the guide-wire used for consecutive PELD interrupts rotation of fluoroscope. A stereotactic system was designed to facilitate the determination of the needle entry point, and the feasibility of this system was evaluated during interventional spine procedures. Methods: A newly designed stereotactic guidance system underwent a field test application for PELD. Sixty patients who underwent single-level PELD at L4-L5 were randomly divided into conventional or stereotactic groups. PELD was performed via the posterolateral approach using the entry point on the skin determined by premeasured distance from the midline and angles according to preoperative magnetic resonance imaging (MRI) findings. Needle entry accuracy provided by the two groups was determined by comparing the distance and angle measured by postoperative computed tomography with those measured by preoperative MRI. The duration and radiation exposure for determining the entry point were measured in the groups. Results: The new stereotactic guidance system and the conventional method provided similarly accurate entry points for discography and consecutive PELD. However, the new stereotactic guidance system lowered the duration and radiation exposure for determining the entry point. Conclusions: The new stereotactic guidance system under fluoroscopy provided a reliable needle entry point for discography and consecutive PELD. Furthermore, it reduced the duration and radiation exposure associated with determining needle entry.

• The Korean Journal of Pain
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• 제30권4호
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• pp.287-295
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• 2017

Background: Recently, the use of ultrasound (US) techniques in regional anesthesia and pain medicine has increased significantly. However, the current extent of training in the use of US-guided pain management procedures in Korea remains unknown. The purpose of the present study was to assess the current state of US training provided during Korean Pain Society (KPS) pain fellowship programs through the comparative analysis between training hospitals. Methods: We conducted an anonymous survey of 51 pain physicians who had completed KPS fellowships in 2017. Items pertained to current US practices and education, as well as the types of techniques and amount of experience with US-guided pain management procedures. Responses were compared based on the tier of the training hospital. Results: Among the 51 respondents, 14 received training at first- and second-tier hospitals (Group A), while 37 received training at third-tier hospitals (Group B). The mean total duration of pain training during the 1-year fellowship was 7.4 months in Group A and 8.4 months in Group B. Our analysis revealed that 36% and 40% of respondents in Groups A and B received dedicated US training, respectively. Most respondents underwent US training in patient-care settings under the supervision of attending physicians. Cervical root, stellate ganglion, piriformis, and lumbar plexus blocks were more commonly performed by Group B than by Group A (P < 0.05). Conclusions: Instruction regarding US-guided pain management interventions varied among fellowship training hospitals, highlighting the need for the development of educational standards that mandate a minimum number of US-guided nerve blocks or injections during fellowships in interventional pain management.

• Journal of Korean Neurosurgical Society
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• 제61권3호
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• pp.363-375
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• 2018

Intraoperative monitoring (IOM) utilizes electrophysiological techniques as a surrogate test and evaluation of nervous function while a patient is under general anesthesia. They are increasingly used for procedures, both surgical and endovascular, to avoid injury during an operation, examine neurological tissue to guide the surgery, or to test electrophysiological function to allow for more complete resection or corrections. The application of IOM during pediatric brain tumor resections encompasses a unique set of technical issues. First, obtaining stable and reliable responses in children of different ages requires detailed understanding of normal age-adjusted brain-spine development. Neurophysiology, anatomy, and anthropometry of children are different from those of adults. Second, monitoring of the brain may include risk to eloquent functions and cranial nerve functions that are difficult with the usual neurophysiological techniques. Third, interpretation of signal change requires unique sets of normative values specific for children of that age. Fourth, tumor resection involves multiple considerations including defining tumor type, size, location, pathophysiology that might require maximal removal of lesion or minimal intervention. IOM techniques can be divided into monitoring and mapping. Mapping involves identification of specific neural structures to avoid or minimize injury. Monitoring is continuous acquisition of neural signals to determine the integrity of the full longitudinal path of the neural system of interest. Motor evoked potentials and somatosensory evoked potentials are representative methodologies for monitoring. Free-running electromyography is also used to monitor irritation or damage to the motor nerves in the lower motor neuron level : cranial nerves, roots, and peripheral nerves. For the surgery of infratentorial tumors, in addition to free-running electromyography of the bulbar muscles, brainstem auditory evoked potentials or corticobulbar motor evoked potentials could be combined to prevent injury of the cranial nerves or nucleus. IOM for cerebral tumors can adopt direct cortical stimulation or direct subcortical stimulation to map the corticospinal pathways in the vicinity of lesion. IOM is a diagnostic as well as interventional tool for neurosurgery. To prove clinical evidence of it is not simple. Randomized controlled prospective studies may not be possible due to ethical reasons. However, prospective longitudinal studies confirming prognostic value of IOM are available. Furthermore, oncological outcome has also been shown to be superior in some brain tumors, with IOM. New methodologies of IOM are being developed and clinically applied. This review establishes a composite view of techniques used today, noting differences between adult and pediatric monitoring.

• 한국콘텐츠학회논문지
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• 제22권9호
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• pp.570-582
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• 2022

수핵성형술은 경피적 디스크 감압술의 한 종류로 디스크 탈출증의 치료를 위해 개발된 시술법이다. 현재 몇몇 임상 현장에선 이 기술을 원래의 적응증인 디스크 탈출증을 지닌 환자들에 대해서 뿐 아니라, 디스크 내장증을 지닌 환자들에게도 사용하고 있다. 이 연구의 목적은 이와 같은 임상 현장에서의 수핵성형술의 적응증의 확대가 타당한 의학적 논리 위에서 수행된 것인지 평가하는 것이다. 그것을 위해 논자는 수핵성형술을 디스크 내장증 환자들에게 적용한 논문들을 분석하였다. 분석의 요점은 첫째, 연구자들이 제시하는 치료 근거의 타당성과 둘째, 환자 선별 기준의 적절성이다. 그 결과 수핵성형술을 디스크 내장증의 치료에 적용한 기존 논문들이 제시하는 치료 근거는 불분명하거나 일반적인 의학의 논리에 부합하지 않는 측면이 있는 것으로 판단되며, 환자 선별의 과정에선 경피적 감압술이 기능을 발휘할 수 있는 조건을 지닌 디스크를 찾기 위한 절차를 엄밀히 수행하지 않거나 경피적 감압술에 부적합한 것으로 판단될 수 있는 디스크도 시술 대상에 포함시킨 것으로 평가된다. 따라서 논자는 수핵성형술을 디스크 내장증 치료에 적용한 기존 연구들은 불필요하거나 잠재적 부작용을 발생시킬 수 있는 다소 모험적인 실험의 성격을 갖고 있다고 판단한다. 이 주제에 대한 연구과정에서 환자의 권익을 지키고 연구의 완성도를 높이기 위해선 현재의 이해 수준보다 선명한 치료적 근거의 확립과 이에 기반한 정교한 환자 선별 과정이 필수적으로 갖추어져야 할 것이라 생각한다.