• The Korean Journal of Pain
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• v.13 no.2
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• pp.242-246
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• 2000

Radiofrequency medial branch neurotomy is an effective way of controlling pain in the posterior compartment of the spine such as the facet joint, and the interspinous ligament. However, it is difficult to determine the exact location of the medial branch. Up until now we have relied on sensory response provoked by 50 Hz stimulation. The responses elicited using this method are quite subjective and can originate from sources other than the medial branch such as the periosteum, the intermediate or lateral branch. We need a confirmed indicator to locate the medial branch reliably. We applied 2 Hz stimulation under 0.4 volts to locate the medial branch and elicited a motor response. Twitching of multifidus and muscles around the SI joint was observed. The observation of these muscles provides a much more reliable method for confirmation of the medial branch. We have treated 45 chronic nonspecific low back pain patients using radiofrequency medial branch neurotomy with this method of confirming the medial branch.

• Journal of Korean Medicine Rehabilitation
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• v.23 no.2
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• pp.151-161
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• 2013

Objectives : The purpose of this study was to compare the effects of acupuncture and medial branch block(collaborative treatment) with just medial branch block regarding acute low back pain. Methods : Forty inpatients who received treatment between January 2012 and February 2013 were divided into 2 groups. The East-West treatment group(EW group, n=20) received one treatment of medial branch block and then acupuncture afterwards. The Western treatment group(W group, n=20) received one treatment of medial branch block. Both groups continued to receive manual therapy 3 times a week. Evaluations were made before medial branch block, 7 days after, and 14 days after using the Numerical Rating Scale(NRS). Results : Compared to before treatment, the NRS score of both EW and W groups after 7 and 14 days of treatment significantly decreased(p=0.0001). But only the EW group showed additional improvement between days 7 and 14(p=0.005). Regarding group comparison, the NRS score of the EW group was significantly lower than the W group at 7 days(p=0.037), and even more at 14 days(p<0.0001). Conclusions : Although medial branch block alone significantly improved acute low back pain, collaborative treatment with acupuncture was even more effective, with increased efficacy as time passed. Further research is recommended regarding the effects of collaborative treatment with acupuncture on acute low back pain.

• The Korean Journal of Pain
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• v.8 no.2
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• pp.350-353
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• 1995

The first lesion in neural tissue produced by electrical currents were made in the 19th century by workers using direct current. In 1953, Sweet and Mark clearly demonstrated that DC lesions have unpredictable and ragged borders and may vary in size. They, as well as Hunsperger and Wyss, suggested that the use of high frequency currents might provide improved results and were proved correct. However, $Bovie^{(R)}$ electrosurgical unit may also be used in percutaneous medial branch neurotomy if a lesion made at a point or the dorsal surface of the transverse process just caudal to the most medial end of the superior edge of the transverse process (Bogduk's method). At this point the medial branch lies on the bone and its depth and medial displacement are defined by the bone which precludes the need for lateral radiographs to check placement. A lesion was made at same target point using the $Bovie^{(R)}$ electrosurgical unit in a 41 year male patient who had received a Kaneda operation because of L2 compression fracture. The patient was relieved of pain without any adverse effects.

• The Korean Journal of Pain
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• v.24 no.2
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• pp.81-86
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• 2011

Background: Facet joint disease plays a major role in axial low-back pain. Few diagnostic tests and imaging methods for identifying this condition exist. Single photon emission computed tomography (SPECT) is reported that it has a high sensitivity and specificity in diagnosing facet disease. We prospectively evaluated the use of bone scintigraphy with SPECT for the identification of patients with low back pain who would benefit from medial branch block. Methods: SPECT was performed on 33 patients clinically suspected of facet joint disease. After SPECT, an ultrasound guided medial branch block was performed on all patients. On 28 SPECT-positive patients, medial branch block was performed based on the SPECT findings. On 5 negative patients, medial branch block was performed based on clinical findings. For one month, we evaluated the patients using the visual analogue scale (VAS) and Oswestry disability index. SigmaStat and paired t-tests were used to analyze patient data and compare results. Results: Of the 33 patients, the ones who showed more than 50% reduction in VAS score were assigned 'responders'. SPECT positive patients showed a better response to medial branch blocks than negative patients, but no changes in the Oswestry disability index were seen. Conclusions: SPECT is a sensitive tool for the identification of facet joint disease and predicting the response to medial branch block.

• Korean Journal of Computational Design and Engineering
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• v.15 no.1
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• pp.33-42
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• 2010

In this study, new medial surface calculation methods using Voronoi diagrams are investigated for the point samples extracted on closed surface models. The medial surface is defined by the closure of all points having more than one closest point on the shape boundary. It is a one of essential geometric information in 3D and can be used in many areas such as 3D shape analysis, dimension reduction, freeform shape deformation, image processing, computer vision, FEM analysis, etc. In industrial parts, the idealized solid parts and shell shapes including sharp edges and vertices are frequently used. Other medial surface extraction methods using Voronoi diagram have inherent separation and branch problems, so that they are not appropriate to the sharp edged objects and have difficulties to be applied to industrial parts. In addition, the branched surfaces on sharp edges in shell shapes should be eliminated to obtain representative medial shapes. In order to avoid separation and branch problems, the new approach by analyzing the shapes and specially sampling on surfaces has been developed.

• Journal of Korean Neurosurgical Society
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• v.56 no.4
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• pp.338-343
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• 2014

Objective : The aim of this study is to evaluate the clinical results of endoscopic radiofrequency ablation of medial branch in patients with chronic low back pain originating from facet joints. Methods : Between October 2010 and December 2013, 52 consecutive patients had suffering from chronic low back pain had undergone endoscopic radiofrequency denervation of medial branch of dorsal ramus. The clinical outcomes of these 52 patients were reviewed retrospectively. Preoperative and postoperative Visual Analogue Scale (VAS) and Korean version of Oswestry Disability Index (K-ODI), and patients' satisfaction with the procedure were assessed. Results : The pain scores on the VAS for back pain had improved significantly from a preoperative mean of 7.1 to a postoperative mean of 2 at the last follow-up (p<0.001). The clinical outcomes based on the K-ODI had also improved significantly from a preoperative mean of 26.5% to postoperative mean of 7.7% at the last follow-up (p<0.001). 80% of patients were satisfied with the procedure. There were no complications associated with the procedure. Conclusion : Our preliminary results demonstrate that endoscopic radiofrequency denervation of medial branch could be an effective alternative treatment modality for chronic back pain originating from facet joints that provides long-term pain relief.

• The Korean Journal of Pain
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• v.20 no.2
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• pp.111-115
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• 2007

Background: Selective diagnostic blocks of the medial branches of the dorsal primary ramus are usually performed under the guidance of fluoroscopic or computed tomography. Recently, however, ultrasound guidance has been suggested as an altemative method. In this study, the distances between the vertebral structures were measured and compared with the values measured using magnetic resonance imaging (MRI) to assess the clinical feasibility of using ultrasound-guided block in Korean patients. Methods: Five male and 15 female patients were enrolled in this study. The target point of the medial branch block in our study was the groove at the base of the superior articular process, We measured the depth from the skin to the target point at the transverse process (d-TP) and to the most superficial point of the superior articular process (d-AP). Results: The d-TP and d-AP values measured under ultrasound guidance were concordant with the values measured using MRI. Conclusions: The images of the bony landmarks obtained under ultrasound examination could be useful for ultrasound-guided lumbar medial branch block.

• Journal of Korean Neurosurgical Society
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• v.48 no.3
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• pp.240-243
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• 2010

Objective : Radiofrequency (RF) medial branch neurotomy is an effective management of lumbar facet syndrome. However, pain may recur after period of time. When pain recurs, it can be repeated, but the successful outcome and duration of relief from repeated procedures are not clearly known. The objective of this study was to determine the success rate and duration of pain relief from repeated radiofrequency medial branch neurotomy for lumbar facet syndrome. Methods : A retrospective review of medical records was done on 60 consecutive patients, from March of 2006 to February of 2009, who had an initial successful RF neurotomy but subsequently underwent repeated procedures due to recurrence of pain. All procedures were done in carefully selected patients after at least two responsive medial branch nerve blocks. C-arm fluoroscopic guide, impedance, sensory and motor threshold monitoring tools were used for the precise placement of electrodes. Responses of repeated procedures were compared with initial radiofrequency neurotomy for success rates and duration of pain relief. Results : There were 48 females and 12 males. Mean age was 52.4 years (range, 26-83). RF medial branch neurotomy was done on one side in 38 and both sides in 22 patients, each covering at least three segments. Average visual analog scale at last procedure was 6.8. Twelve patients had previous lumbar operations, including 4 patients with instrumentations. Fifty-five patients had two procedures and five patients had three procedures. Mean duration of successful pain relief (> 50% of previous pain for at least 3 months period) after initial radiofrequency neurotomy was 10.9 months (range, 3-28) in 51 (85%) patients. From repeated procedures, successful pain relief was seen in 50 (91%) patients with average duration of 10.2 months (range, 3-24). Five patients had third procedure, which was successful in 4 (80%) patients with mean duration of 9.8 months (range, 5-16). This was not statistically different from initial results. There were no permanent neurological complications from the procedures. Conclusion : Results of this study indicate that the frequency of success and durations of relief from repeated RF medial branch neurotomy for lumbar facet syndrome are similar to initial results that provided relatively prolonged period of pain relief without major side effects Each procedure seems to provide successful pain relief for about 10 months in more than 85% of carefully selected patients when properly done.

• The Journal of Korean Medicine
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• v.26 no.1 s.61
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• pp.11-17
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• 2005

This study was carried out to identify the components of the human heart meridian muscle, the regional muscle group being divided into outer, middle, and inner layers. The inner parts of the body surface were opened widely to demonstrate muscles, nerves, blood vessels and to expose the inner structure of the heart meridian muscle in the order of layers. We obtained the following results; $\cdot$ The heart meridian muscle is composed of muscles, nerves and blood vessels. $\cdot$ In human anatomy, the difference between terms is present (that is, between nerves or blood vessels which control the meridian muscle and those which pass near by). $\cdot$ The inner composition of the heart meridian muscle in the human arm is as follows: 1) Muscle H-l: latissimus dorsi muscle tendon, teres major muscle, coracobrachialis muscle H-2: biceps brachialis muscle, triceps brachialis muscle, brachialis muscle H-3: pronator teres muscle and brachialis muscle H-4: palmar carpal ligament and flexor ulnaris tendon H-5: palmar carpal ligament & flexor retinaculum, tissue between flexor carpi ulnaris tendon and flexor digitorum superficialis tendon, flexor digitorum profundus tendon H-6: palmar carpal ligament & flexor retinaculum, flexor carpi ulnaris tendon H-7: palmar carpal ligament & flexor retinaculum, tissue between flexor carpi ulnaris tendon and flexor digitorum superficial is tendon, flexor digitorum profundus tendon H-8: palmar aponeurosis, 4th lumbrical muscle, dorsal & palmar interrosseous muscle H-9: dorsal fascia, radiad of extensor digiti minimi tendon & extensor digitorum tendon 2) Blood vessel H-1: axillary artery, posterior circumflex humeral artery H-2: basilic vein, brachial artery H-3: basilic vein, inferior ulnar collateral artery, brachial artery H-4: ulnar artery H-5: ulnar artery H-6: ulnar artery H-7: ulnar artery H-8: palmar digital artery H-9: dorsal digital vein, the dorsal branch of palmar digital artery 3) Nerve H-1: medial antebrachial cutaneous nerve, median n., ulnar n., radial n., musculocutaneous n., axillary nerve H-2: median nerve, ulnar n., medial antebrachial cutaneous n., the branch of muscular cutaneous nerve H-3: median nerve, medial antebrachial cutaneous nerve H-4: medial antebrachial cutaneous nerve, ulnar nerve H-5: ulnar nerve H-6: ulnar nerve H-7: ulnar nerve H-8: superficial branch of ulnar nerve H-9: dorsal digital branch of ulnar nerve.

• Korean Journal of Acupuncture
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• v.35 no.3
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• pp.117-122
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• 2018

Objectives : Most meridians have each well point located at the distal end of fingers or toes, congruous with their meridian courses. Exceptively, ST45(Yeotae), stomach meridian(ST)'s final point, is located at the lateral side of the tip of the second toe, while the tip of the second toe was not mentioned in the course of ST. So, we studied the course of lower limb region of ST. Methods : Courses of ST in Categorized Collection of Literatures on Chinese Meridians and Collaterals(CCM) was examined. The literatures included in CCM was selected as study subjects to be studied if the meridian route was different from "Youngchu" or more detailed notes were attached. There are 3 branches in lower limb region of ST, we analyzed theories of scholars of all time about the 3 branches of ST. Results and Conclusions : Branch 1 descends along the lateral margin of the fibula to the dorsum of foot, entering into the medial side of the middle toe. Branch 2 leaves ST36 separately, terminating at the lateral side of the middle toe. Branch 3 leaves ST42 and descends to the end of the great toe. The medial side of the middle toe equate to the lateral side of the second toe, and it is connected to ST45. So branch 1 is the main stream of ST. Branch 3 drives to the great toe passing between first and second toe, it goes medial side of LR2.