• Journal of Korean Neurosurgical Society
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• v.57 no.5
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• pp.376-378
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• 2015

Cervical epidural steroid injection is indicated for radicular symptoms with or without axial neck pain. Complications are rare but can be serious. Here, we report the case of a 54-year-old man with cervical radicular pain who was treated with cervical epidural steroid injection. Injection was administered twice under fluoroscopic guidance with the loss-of-resistance technique using air to confirm the epidural space. After the second procedure, the patient complained of severe persistent headache and was diagnosed with pneumocephalus on brain computed tomography. The patient returned home without any neurological complication, after a few days of conservative treatment. Though, a fluoroscopic guidance cervical epidural injection is also known to diminish the risk of complications. Physicians should always keep in mind that it does not guarantee safety, particularly in the cervical region, related to its anatomical considerations.

• The Korean Journal of Pain
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• v.32 no.3
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• pp.147-159
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• 2019

Lumbar foraminal pathology causing entrapment of neurovascular contents and radicular symptoms are commonly associated with foraminal stenosis. Foraminal neuropathy can also be derived from inflammation of the neighboring lateral recess or extraforaminal spaces. Conservative and interventional therapies have been used for the treatment of foraminal inflammation, fibrotic adhesion, and pain. This update reviews the anatomy, pathophysiology, clinical presentation, diagnosis, and current treatment options of foraminal neuropathy.

• The Korean Journal of Pain
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• v.37 no.3
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• pp.256-263
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• 2024

Background: Cervical epidural block (CEB) is an effective intervention for managing cervical radicular pain. This study aimed to investigate the current status of performing CEB in South Korea. Methods: Pain physicians affiliated with the Korean Pain Society were asked to complete anonymous questionnaires regarding CEB between September and October 2022. The questionnaire consisted of 24 questions assessing the current status and methods of CEB in detail. Results: Of the 198 surveys collected, 171 physicians (86.4%) reported performing CEB. Among those, the majority (94.7%) used fluoroscopy during the procedure. The paramedian interlaminar (IL) approach was the most preferred method (50.3%). Respondents performing fluoroscopic-guided IL CEB were categorized into two groups based on clinical experience: those with ≤10 years of experience (≤10-year group, n = 91) and those with >10 years of experience (>10-year group, n = 71). The proportion of physicians obtaining informed consent in the ≤10-year group and >10-year group was 50.5% and 56.3%, respectively. When entering the epidural space during IL CEB, the contralateral oblique view was the second most frequently used in both groups (≤10-year group, 42.9%; >10-year group, 29.6%). In targeting the upper cervical lesions (C3-4), the proportion of respondents who used an IL space higher than C6-7 was 17.6% in the ≤10-year group and 29.5% in the >10-year experience group. Conclusions: This study demonstrated variability in the CEB technique used by pain physicians in South Korea. The findings highlight the need for education on informed consent and techniques to enhance safety.

• The Journal of Korean Physical Therapy
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• v.23 no.5
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• pp.29-34
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• 2011

Purpose: The purpose of this study is to evaluate the short term effects of the traction and decompression device, which is a newly developed domestic medical device, on pain and functional activity in patients with chronic low back pain with or without radicular pain. Methods: Forty patients with chronic low back pain were included and allocated to decompression (n=20) and traction groups (n=20). They received decompression or traction therapy for 20 minutes a day, 3 days per week for two weeks. For evaluating pain and functional activity, a visual analogue scale (VAS) for low back pain and the Oswestry back pain disability index (ODI) were obtained on pre-treatment, and at 6, 12 and 15 days after treatment. Patients'satisfaction levels were measured 15 days after treatment. Results: VAS was significantly decreased at 12 days and 15 days post-treatment compared to pre-treatment in both groups (p<0.05). ODI was significantly decreased at 12 days and 15 days post-treatment compared to pre-treatment in the decompression group (p<0.05). However, there was no significant difference between the two groups in the VAS and ODI scales (p>0.05). Patients' satisfaction levels were significantly higher in the decompression group than in the traction group (p<0.05). Conclusion: These findings suggest that decompression therapy might be effective for increasing functional activity in patients with low back pain and could provide patients with higher satisfaction than traction therapy. This study provided validity data for the therapeutic effects of the decompression device in patients with low back pain and it will be useful for medical cost development and patient education of this device.

• The Korean Journal of Pain
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• v.27 no.1
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• pp.63-67
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• 2014

Background: Epiduroscopic laser neural decompression (ELND) has been performed as a treatment tool for chronic refractory low back pain and/or radicular pain. There are some studies about the usefulness of epiduroscopy for post lumbar surgery syndrome, however, few studies about the effectiveness of epiduroscopy for patients without back surgery. We compared the satisfaction of patients who underwent ELND for chronic low back pain and/or radicular pain after back surgery and for the same symptoms without surgery. Methods: We compared the degree of satisfaction of patients after ELND between who had underwent the lumbar spine surgery and who had not retrospectively by chart reviewing. We divided 39 patients who had received ELND into two groups, one is the group of patients who got the lumbar surgery (group 1), and the other is the group of patients who did not (group 2). Their medical records including age, sex, previous treatment, duration of illness, degree of symptom relief were investigated. We compared each items between two groups. Results: The number of patients in group 1 was 17, and group 2 was 22. In group 1, 16 patients (94.1%) showed more than 'Acceptable', and 19 patients (86.4%) showed more than 'Acceptable' in group 2. There is no significant differences statistically in percentage of patients who showed more than 'Acceptable' in the satisfaction after ELND between two groups. Conclusions: ELND provided satisfaction (more than 85%) for patients with chronic low back pain and/or leg pain regardless of previous back surgery history.

• Clinical Pain
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• v.20 no.1
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• pp.39-42
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• 2021

A 29-year-old woman had 1-month history of back pain radiating into lower extremities, motor weakness, and sensory abnormalities in both lower extremities. Contrast-enhanced spinal magnetic resonance imaging (MRI) revealed a homogeneously enhancing mass at the T12~L1 and several intradural enhancing nodular lesions at L2~S1. Tumor resection surgery was performed and following histological examination showed that the tumor satisfied the diagnostic criteria for atypical choroid plexus papilloma (CPP). To find primary tumor sites, contrast-enhanced brain MRI, whole spine MRI, and PET-CT were carried out and additional lesions were detected at the fourth ventricle, right cerebellum, and upper thoracic spinal cord. This is a very rare case of metastatic atypical CPP that involves brain, upper thoracic spinal cord, and cauda equina with initial manifestation of radicular symptoms without clinical signs of primary brain lesion.

• Journal of the korean academy of Pediatric Dentistry
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• v.39 no.1
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• pp.84-89
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• 2012

The radicular cyst is the most common odontogenic cyst which is caused by pulpal inflammation, pulp death, and secondary to trauma or dental caries. Usually, the radicular cyst is asymptomatic, but a secondary inflammation can cause pain, swelling and redness. Getting larger, the radicular cyst can cause facial asymmetry and paresthesia by pressure on nerves. It requires conservative endodontic treatment or surgical approach. When the size of cyst is large or invasion of the adjacent tissue is not expected, cyst enucleation is carried out. And most of the case can be completely cured and shows low recurrence. In these radicular cysts cases, by cyst enucleation or apicoectomy after root canal treatment simultaneously, the infected teeth can be preserved successfully.

• Clinical Pain
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• v.18 no.2
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• pp.65-69
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• 2019

Objective: This study aims to evaluate the efficacy of high-voltage microcurrent therapy in patients with herniated lumbar disc (HLD) presenting radicular or back pain. Method: This is a retrospective study with 33 patients who are complaining pain with HLD findings on magnetic resonance image. Microcurrent therapy was applied to leg or paralumbar area. Treatment was conducted for seven minutes with 250~1000 uA intensity as high as the patients could tolerate via stimulating probe with roller type and the frequency was 60 Hz with a sine wave pulse. The visual analogue scale (VAS) was measured just before and after the treatment. Results: The degree of pain reduction (△VAS) was 1.6 points after treatment on average. The △VAS according to the diagnosis, stenosis, dermatome area, medication, pain site and caudal epidural block was not statistically significant. However, the △VAS according to the number of treatments (< 3, ≥ 3 times) showed a statistically significant difference (p=0.04). Conclusion: High-voltage microcurrent therapy may help reduce lumbar or lumbosacral radiating pain after the procedure. The effect was better when microcurrent was applied three times or more. This result suggests that the microcurrent would have cumulative effect on reducing radicular or back pain in patients with HLD.

• The Korean Journal of Pain
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• v.5 no.2
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• pp.273-278
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• 1992

With the medical progress that has given spinal cord injured(SCI) individuals greater longevity and better overall health, chronic pain is emerged as major challenge in treating this population. According to past reports, estimates of prevalance of severe/disabling chronic pain in SCI patients have ranged from 18% to 63%. In etiologies of chronic pain in SCI patients, psychic or psychogenic pain categories should be included and more recent data have demonstrated that the persistant pain is directly related to higher levels of psychosocial distress and impairment. Recently, neurophysiological classification of the SCI pain syndrome into three etiologic groups(a; mechanical pain, b; radicular pain, c; deafferentation pain) is more frequently adopted for the classification of chronic SCI pain syndrome. The deafferentation pain is most common of the pain syndromes associated with SCI. After cervical epidural anesthesia for the surgical intervention of decubitus ulcer on the hip of two SCI patients, there were much reduction of existing chronic deafferentation character pain.

• The Korean Journal of Pain
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• v.19 no.1
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• pp.123-126
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• 2006

Spinal cord stimulation (SCS) has been used since 1967 for refractory chronic pain. SCS has recently undergone a variety of technical modifications and advances, and it has been applied in a variety of pain conditions. SCS has been most commonly applied for those patients with chronic back and leg pain and failed back surgery syndrome (FBSS). The clinical hallmark of FBSS is chronic postoperative pain. The pain pattern varies and the pain may show an axial or radicular distribution. Chronic intractable pain after FBSS is difficult to treat. This report describes our experience with treating chronic pain in two patients who suffered from FBSS with a spinal cord stimulator. A permanent spinal cord stimulator was implanted after a successful trial of stimulation with temporarily implanted electrodes. After 5 months of follow-up, the two patients had satisfactory improvement of their pain.