• The Korean Journal of Pain
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• 제1권1호
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• pp.74-79
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• 1988

Caudal narcotic analgesia was assesses after the injection of 3mg morphine diluted in 30ml (physiologic) saline into the sacral canal in 15 Patients after upper abdominal surgery, in 20 patients after lower abdominal surgery under general anesthesia, and in 20 patients after perianal surgery under caudal block. Pain relief was evaluated by the subsequent need for systemic analgesics. All eases had considerable relief from pain an4 the morphine was effective for 12 or more hours. There were no significant differances between pain relief of the upper abdominal and lower abdominal surgery group, upper abdominal and perianal surgery group, and lower abdominal and perianal surgery group (p>0.05, p>0.05, p>0.05). It is suggested that the morphine, which was administered into the sacral, cannal, reached the subarachnoid space and produced it's effect by direct action on the specific opiate receptors in the substantia gelatinosa of th.8 posterior horn cell of the spinal cord. Consequently, whether analgesia from epidural narcotics appears to be segmental in distribution or not is still in controversy.

• The Korean Journal of Pain
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• 제28권2호
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• pp.122-128
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• 2015

Background: Caudal epidural injections have been commonly performed in patients with low back pain and radiculopathy. Although caudal injection has generally been accepted as a safe procedure, serious complications such as inadvertent intravascular injection and dural puncture can occur. The present prospective study was designed to investigate the influence of the depth of the inserted needle on the success rate of caudal epidural blocks. Methods: A total of 49 adults scheduled to receive caudal epidural injections were randomly divided into 2 groups: Group 1 to receive the caudal injection through a conventional method, i.e., caudal injection after advancement of the needle 1 cm into the sacral canal (n = 25), and Group 2 to receive the injection through a new method, i.e., injection right after penetrating the sacrococcygeal ligament (n = 24). Ultrasound was used to identify the sacral hiatus and to achieve accurate needle placement according to the allocated groups. Contrast dyed fluoroscopy was obtained to evaluate the epidural spread of injected materials and to monitor the possible complications. Results: The success rates of the caudal injections were 68.0% in Group 1 and 95.8% in Group 2 (P = 0.023). The incidences of intravascular injections were 24.0% in Group 1 and 0% in Group 2 (P = 0.022). No intrathecal injection was found in either of the two groups. Conclusions: The new caudal epidural injection technique tested in this study is a reliable alternative, with a higher success rate and lower risk of accidental intravascular injection than the conventional technique.

• The Korean Journal of Pain
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• 제29권4호
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• pp.270-273
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• 2016

Muscular hypertrophy is caused mainly due to myopathic disorder. But, it is also rarely produced by neurogenic disorder. A 74-year-old woman complained of right calf pain with hypertrophy for several years. Recent lumbar spine magnetic resonance imaging (MRI) showed central and lateral canal narrowing at the L4-L5 intervertebral space. Lower extremity MRI revealed fatty change of right medial head of the gastrocnemius and soleus, causing right calf hypertrophy. Electrodiagnostic examinations including electromyography and nerve conduction velocity testing demonstrated $5^{th}$ lumbar and $1^{st}$ sacral polyradiculopathy. Integrating all the results, the diagnosis was neurogenic muscle hypertrophy. Neurogenic muscle hypertrophy is very rare, but we recommend that clinicians consider this problem when a patient complains of lower limb hypertrophy and pain.

• Journal of Korean Neurosurgical Society
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• 제63권6호
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• pp.747-756
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• 2020

Objective : To evaluate the effectiveness and long-term outcome predictors of percutaneous sacroplasty (PSP). Methods : This single-center study assessed 40 patients with sacral insufficiency fractures using the short-axis technique under C-arm flat-panel detector computed tomography (CT). Two radiologists reviewed the patients' magnetic resonance and CT images to obtain imaging findings before PSP and determine technical success, respectively. The short-term outcomes were visual analog scale score changes and opioid usage reductions. Long-term outcomes were determined using telephone interviews and the North American Spine Society (NASS) patient-satisfaction index at least one year after PSP. Results : Technical success was achieved without any significant complications in 39 patients (97.5%). Telephone interviews were possible with 12 patients and failed in 10 patients; death was confirmed in 18 patients. Fifteen patients (50%) re-visited the hospital and received conservative treatment, including spinal injections. Nine patients reported positive satisfaction (NASS patient-satisfaction index 1 or 2), while the negative satisfaction group (NASS patient-satisfaction index 3 or 4, n=3) showed a higher incidence of compression fractures at the thoracolumbar spine level (66.7% vs. 22.2%) and previous spinal injection history (66.7% vs. 33.3%). The poor response group also showed higher incidences of facet joint arthrosis (100% vs. 55.6%), central canal stenosis (100% vs. 22.2%), neural foraminal stenosis (33.3% vs. 22.2%), scoliosis (100% vs. 33.3%), and sagittal malalignment (100% vs. 44.4%). Conclusion : PSP was effective for sacral insufficiency fractures and showed good long-term outcomes. Combined compression fractures in the thoracolumbar spine and degenerative lumbar pathologies could be possible poor outcome predictors.

• Journal of Genetic Medicine
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• 제11권2호
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• pp.83-85
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• 2014

Dural ectasia refers to the widening or ballooning of the dural sac surrounding the spinal cord. It can affect any plane of the spinal canal, but occurs primarily in the lumbosacral region. Dural ectasia is present in 63-92% patients who have Marfan syndrome, and is related to Ehlers-Danlos syndrome, neurofibromatosis type I, and ankylosing spondylitis. The most common symptoms are low back pain, headache, weakness, numbness above and below the affected limb, and occasional rectal and genital pain. However, in most patients, dural ectasia is usually asymptomatic. We report the case of a 5-year-old boy who presented with a severe headache who had been diagnosed with Marfan syndrome. During the evaluation, magnetic resonance imaging of the lumbar and sacral spine revealed dural ectasia. To our knowledge, this is the first report on Marfan syndrome with symptomatic dural ectasia in Korea. We concluded that dural ectasia should be suspected in patients diagnosed with Marfan syndrome who have a severe headache.

• 대한정형외과 초음파학회지
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• 제7권2호
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• pp.105-112
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• 2014

목적: 미추 경막외 차단술은 요통과 하지 방사통에 효과적으로 외래환자의 치료에 자주 사용되고 있으나 임상 경험이 풍부한 의사에 의해 시술되어도 25%의 실패율이 보고되고 있다. 저자들은 초음파 유도하 미추 경막외 차단술의 유효성을 추간판 탈출증 환자군과 척추관 협착증 환자군으로 나누어 결과를 비교하였다. 대상 및 방법: 요통과 하지 방사통을 호소하여 본원 외래에 내원한 55명의 환자를 대상으로 초음파 유도하 미추 경막외 차단술을 시행하였다. 환자를 복와위 자세로 눕힌 후 방사형 탐지자(round probe)를 이용하여 22게이지 바늘이 천-미추막을 통과한 것을 확인 후 약물을 투여하였다. 추간판 탈출증 환자군은 31명이었으며, 척추관 협착증 환자군은 24명이었다. 임상적 평가는 시각통증척도(VAS)를 이용하여 통증의 변화를 평가하였으며, 시행 전, 시행 후, 시행 2주 후, 시행 4주 후 전화 인터뷰와 외래 방문 시 조사하였다. 결과: 초음파 유도하 미추 경막외 차단술은 55예 중 53예에서 바늘이 성공적으로 삽입되어 96.4%의 성공률을 보였다. 추간판 탈출증 환자군과 척추관 협착증 환자군에서 성별의 차이는 없었으나 나이는 추간판 탈출증군에서 $42.3{\pm}10.8$세로 척추관 협착증군의 $62.8{\pm}15.1$세와 비교할 때 유의한 차이가 있었다(p<0.001). 시각통증척도는 추간판 탈출증 군에서 시행 전 6.8, 시행 후 3.1, 시행 2주 후 1.8, 시행 4주 후 1.77로 나타났으며, 척추관 협착증 군에서 시행 전6.9, 시행 후 3.6, 시행 2주 후 4.3, 시행 4주 후 4.9로 나타났다. 시행 전에 비해 시행 후 시각통증척도는 양 군에서 유의하게 호전되었으며(p<0.001), 나이를 보정한 후의 결과, 시간에 따라 양 군간 시각통증척도의 차이는 통계적으로 유의하였다(p<0.001). 결론: 초음파 유도하 미추 경막외 차단술은 높은 성공률을 보이며 척추관 협착증 환자군에 비해 추간판 탈출증 환자군에서 더 효과적인 것으로 사료된다.

• 대한영상의학회지
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• 제82권4호
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• pp.862-875
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• 2021

목적 요추신경근병증이 있는 60세 이상의 환자의 신경공 협착에 영향을 줄 수 있는 인자를 자기공명영상 평가를 통해 알아보고자 하였다. 대상과 방법 요추신경근병증이 있는 60세 이상의 환자 133명이 본원에서 시행 받은 2018년 1월부터 4월까지의 요추 자기공명영상을 대상으로 하였다. 제4/5 요추간과 제5 요추/제1 천추간에서 신경공 협착이 있는 군과 없는 군으로 나눈 후 척추전방전위증, 척추후방전위증, 추간판 간격 감소, 추간판탈출증, 중심성 척추관 협착, 황색인대비후, 척추후관절 비후 여부를 2명의 판독자가 분석한 후 단변량 및 다변량 로지스틱 회귀분석을 시행하였다. 결과 단변량 분석에서 제4/5 요추간에 대해 추간판 간격 감소(p = 0.006), 제5 요추/제1 천추간에 대해서는 척추전방전위증(p = 0.005)과 척추후관절 비후(p = 0.006)가 신경공 협착과 유의한 연관성을 보였다. 다변량 분석에서는 제4/5 요추간에 대해 추간판 간격 감소[odds ratio(이하 OR) = 4.272; 95% confidence interval (이하 CI) 1.736~10.514]가 신경공 협착과 관련된 인자였다. 제5 요추/제1 천추간에서는 척추전방전위증(OR = 3.696; 95% CI 1.297~10.530)과 척추후관절 비후(OR = 6.468; 95% CI 1.238~32.617)가 이와 관련된 인자였다. 결론 제4/5 요추간에서는 추간판 간격 감소가, 제5 요추/제1 천추간에서는 척추전방전위증과 척추후관절 비후가 신경공 협착과 관련된 인자였다.