• The Korean Journal of Pain
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• 제18권1호
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• pp.34-38
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• 2005

Background: Over the years, disc surgery has progressively evolved in the direction of decreasing trauma and its invasiveness. Conventional open surgery has many complications, such as scarring, instability, bleeding and a relative high mortality rate. Minimally invasive spinal surgery is now an alternative to a traditional discectomy. Herein, we present an operative technique, and the early results, for a percutaneous endoscopic lumbar discectomy in herniated lumbar disc disease. Methods: 43 patients, including 27 men and 16 women, with ages ranging from 18 to 66 years, were enrolled in this study. All the patients showed a protruded or extruded soft disc herniation at the lumbar level on magnetic resonance imaging and computed tomography. A percutaneous endoscopic lumbar discectomy was applied to the patients, and clinical responses evaluated using MacNab's criteria. Results: 40 patients were regarded as showing successful responses (93.1%), and there were no severe complications, such as a hematoma, nerve injury, postoperative dysesthesia or death. One patient underwent fusion surgery for remnant back pain six month later. Conclusions: We conclude that, in properly selected patients, a percutaneous endoscopic lumbar discectomy is a safe, noninvasive and effective treatment modality for herniated lumbar intervertebral disc disease.

• The Korean Journal of Pain
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• 제13권1호
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• pp.19-30
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• 2000

Background: Partial nerve injury to a peripheral nerve may induce the development of neuropathic pain which is characterized by symptoms such as spontaneous burning pain, allodynia and hyperalgesia. Though underlying mechanism has not fully understood, sensitization of dorsal horn neurons may contribute to generate such symptoms. Nitric oxide acts as an inter- and intracellular messenger in the nervous system and is produced from L-arginine by nitric oxide synthase (NOS). Evidence is accumulating which indicate that nitric oxide may mediate nociceptive information transmission. Recently, it has been reported that NOS inhibitor suppresses neuropathic pain behavior in an neuropathic pain animal model. This study was conducted to determine whether nitric oxide could be involved in the sensitization of dorsal horn neurons in neuropathic animal model. Methods: Neuropathic animal model was made by tightly ligating the left L5 and L6 spinal nerves and we examined the effects of iontophoretically applied NOS inhibitor (L-NAME) on the dorsal horn neuron's responses to mechanical stimuli within the receptive fields. Results: In normal animals, NOS inhibitor (L-NAME) specifically suppressed the responses to the noxious mechanical stimuli. In neuropathic animals, the dorsal horn neuron's responses to mechanical stimuli were enhanced and NOS inhibitor suppressed the dorsal horn neuron's enhanced responses to non-noxious stimuli as well as those to noxious ones. Conclusions: These results suggest that nitric oxide may mediate nociceptive transmission in normal animal and also mediate sensitization of dorsal horn neurons in neuropathic pain state.

• Journal of Korean Neurosurgical Society
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• 제42권3호
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• pp.179-183
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• 2007

Objective : Posterior arthrodesis in atlantoaxial instability has been performed using various posterior C1-2 wiring techniques. Recently, transarticular screw fixation (TASF) technique was introduced to achieve significant immediate stability of the C1-2 joint complex. The purpose of this study is to assess the clinical outcomes associated with posterior C1-2 TASF for the patient of atlantoaxial instability. Methods : We retrospectively reviewed data obtained from 17 patients who underwent C1-2 TASF and supplemented Posterior wiring technique (PWT) with graft between 1994 and 2005. There were 8 men and 9 women with a mean age of 43.5 years (range, 12-65 years). An average follow-up was 26 months (range, 15-108 months). Results : Successful fusions were achieved in 16 of 17 (94%). The pain was improved markedly (3 patients) or resolved completely (14 patients). There was no case of neurological deterioration, hypoglossal nerve injury, or vertebral artery injury. Progression of spinal deformity, screw pullout or breakage, and neurological or vascular complications did not occur. Conclusion : The C1-2 TASF with supplemental wiring provided a high fusion rate. Our result demonstrates that C1-2 TASF supplemented by PWT is a safe and effective procedure for atlantoaxial instability. Preoperative evaluation and planning is mandatory for optimal safety.

• Biomolecules & Therapeutics
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• 제25권3호
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• pp.259-265
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• 2017

This study aimed to investigate the analgesic effect of substance P (SP) in an animal model of neuropathic pain. An experimental model of neuropathic pain, the chronic constriction injury (CCI) model, was established using ICR mice. An intravenous (i.v.) injection of SP (1 nmole/kg) was administered to the mice to examine the analgesic effects of systemic SP on neuropathic pain. Behavioral testing and immunostaining was performed following treatment of the CCI model with SP. SP attenuated mechanical allodynia in a time-dependent manner, beginning at 1 h following administration, peaking at 1 day post-injection, and decaying by 3 days post-injection. The second injection of SP also increased the threshold of mechanical allodynia, with the effects peaking on day 1 and decaying by day 3. A reduction in phospho-ERK and glial fibrillary acidic protein (GFAP) accompanied the attenuation of mechanical allodynia. We have shown for the first time that i.v. administration of substance P attenuated mechanical allodynia in the maintenance phase of neuropathic pain using von Frey's test, and simultaneously reduced levels of phospho-ERK and GFAP, which are representative biochemical markers of neuropathic pain. Importantly, glial cells in the dorsal horn of the spinal cord (L4-L5) of SP-treated CCI mice, expressed the anti-inflammatory cytokine, IL-10, which was not seen in vehicle saline-treated mice. Thus, i.v. administration of substance P may be beneficial for improving the treatment of patients with neuropathic pain, since it decreases the activity of nociceptive factors and increases the expression of anti-nociceptive factors.

• Journal of Trauma and Injury
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• 제35권1호
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• pp.56-60
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• 2022

The most common cause of foot drop is lumbar degenerative disc herniation, particularly at L4/5. We present a rare case of spinal cord injury accompanied by a thoracolumbar lesion that presented with bilateral foot drop. A 69-year-old male patient presented with sudden-onset severe bilateral leg pain and bilateral foot drop. Radiologic findings revealed T12 spondylitis compressing the conus medullaris. He had undergone vertebroplasty for a T12 compression fracture after a fall 6 months before. A physical examination showed bilateral foot drop, paresthesia of both L5 dermatomes, increased deep tendon reflex, and a positive Babinski sign. An acute bilateral L5 root lesion and a conus medullaris lesion were suspected based on electromyography. A surgical procedure was done for decompression and reconstruction. After the operation, bilateral lower extremity muscle strength recovered to a good grade from the trace grade, and the patient could walk without a cane. The current case is a very rare report of bilateral foot drop associated with T12 infectious spondylitis after vertebroplasty. It is essential to keep in mind that lesions of the thoracolumbar junction can cause atypical neurological symptoms. Furthermore, understanding the conus medullaris and nerve root anatomy at the T12-L1 level will be helpful for treating patients with atypical neurological symptoms.

• The Korean Journal of Physiology and Pharmacology
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• 제1권6호
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• pp.625-637
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• 1997

Calcium ions are implicated in a variety of physiological functions, including enzyme activity, membrane excitability, neurotransmitter release, and synaptic transmission, etc. Calcium antagonists have been known to be effective for the treatment of exertional angina and essential hypertension. Selective and nonselective voltage-dependent calcium channel blockers also have inhibitory action on the acute and tonic pain behaviors resulting from thermal stimulation, subcutaneous formalin injection and nerve injury. This study was undertaken to investigate the effects of iontophoretically applied $Ca^{++}$ and its antagonists on the responses of WDR (wide dynamic range) cells to sensory inputs. The responses of WDR cells to graded electrical stimulation of the afferent nerve and also to thermal stimulation of the receptive field were recorded before and after iontophoretical application of $Ca^{++}$, EGTA, $Mn^{++}$, verapamil, ${\omega}-conotoxin$ GVIA, ${\omega}-conotoxin$ MVIIC and ${\omega}-agatoxin$ IVA. Also studied were the effects of a few calcium antagonists on the C-fiber responses of WDR cells sensitized by subcutaneous injection of mustard oil (10%). Calcium ions and calcium channel antagonists ($Mn^{++}$, verapamil, ${\omega}-conotoxin$ GVIA & ${\omega}-agatoxin$ IVA) current-dependently suppressed the C-fiber responses of WDR cells without any significant effects on the A-fiber responses. But ${\omega}-conotoxin$ MVIIC did not have any inhibitory actions on the responses of WDR cell to A-fiber, C-fiber and thermal stimulation. Iontophoretically applied EGTA augmented the WDR cell responses to C-fiber and thermal stimulations while spinal application of EGTA for about $20{\sim}30\;min$ strongly inhibited the C-fiber responses. The augmenting and the inhibitory actions of EGTA were blocked by calcium ions. The WDR cell responses to thermal stimulation of the receptive field were reduced by iontophoretical application of $Ca^{++}$, verapamil, ${\omega}-agatoxin$ IVA, and ${\omega}-conotoxin$ GVIA but not by ${\omega}-conotoxin$ MVIIC. The responses of WDR cells to C-fiber stimulation were augmented after subcutaneous injection of mustard oil (10%, 0.15 ml) into the receptive field and these sensitized C-fiber responses were strongly suppressed by iontophoretically applied $Ca^{++}$, verapamil, ${\omega}-conotoxin$ GVIA and ${\omega}-agatoxin$ IVA. These experimental findings suggest that in the rat spinal cord, L-, N-, and P-type, but not Q-type, voltage-sensitive calcium channels are implicated in the calcium antagonist-induced inhibition of the normal and the sensitized responses of WDR cells to C-fiber and thermal stimulation, and that the suppressive effect of calcium and augmenting action of EGTA on WDR cell responses are due to changes in excitability of the cell.

• 동의생리병리학회지
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• 제25권2호
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• pp.195-201
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• 2011

Nardostachys chinensis;Anti-proliferation;Cell cycle arrest;Differentiation;U937 cells; This study was conducted to determine the analgesic effect of Sokyungwhalhyul-tang(SKWHT) using the model of peripheral neuropathic pain model. A model of neuropathic pain was made by ligating left 5th lumbar spinal nerve of rats. After 1 days, the extract of SKWHT was orally administered daily. Rats were divided into four groups; (1) Control group(n=6), (2) Experimental group I(SKWHT-OA1, 100 mg/kg, n=6), (3) Experimental group II(SKWHT-OA2, 300 mg/kg, n=6), (4) Experimental group III(SKWHT-OA3, 500 mg/kg, n=6). After that, we examined the withdrawl response of neuropathic rats legs by von Frey filament and Hot plate at pre, $1^{th}$, $4^{th}$, $7^{th}$, $14^{th}$, $21^{th}$ days after the induction of neuropathic pain. And also we examined c-fos, GOT, GPT and histological study of Liver at 21th days. von Frey filament and Hot plate were increase in experimental group I, II, III than Con. especially group III was most significantly analgesic effect than the other groups at $14^{th}$, $21^{th}$ days. In c-fos protein expression on spinal cord, group III was most significantly reduction immunoreactivity at $21^{th}$ days and in blood serum GOT & GPT levels and histologic finding of Liver in all experimental groups were no significant difference with Con at $21^{th}$ days. According to the above results, SKWHT(500 mg/kg) may have a significant analgesic effect on the neuropathic pain.

• Journal of Korean Neurosurgical Society
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• 제63권2호
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• pp.237-247
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• 2020

Objective : Fixation of the C1-2 segment is challenging because of the complex anatomy in the region and the need for a high degree of accuracy to avoid complications. Preoperative 3D-computed tomography (CT) scans can help reduce the risk of complications in the vertebral artery, spinal cord, and nerve roots. However, the patient may be susceptible to injury if the patient's anatomy does not match the preoperative CT scans. The intraoperative 3D image-based navigation systems have reduced complications in instrument-assisted techniques due to greater accuracy. This study aimed to compare the radiologic outcomes of C1-2 fusion surgery between intraoperative CT image-guided operation and fluoroscopy-guided operation. Methods : We retrospectively reviewed the radiologic images of 34 patients who underwent C1-2 fusion spine surgery from January 2009 to November 2018 at our hospital. We assessed 17 cases each of degenerative cervical disease and trauma in a study population of 18 males and 16 females. The mean age was 54.8 years. A total of 139 screws were used and the surgical procedures included 68 screws in the C1 lateral mass, 58 screws in C2 pedicle, nine screws in C2 lamina and C2 pars screws, four lateral mass screws in sub-axial level. Of the 34 patients, 19 patients underwent screw insertion using intraoperative mobile CT. Other patients underwent atlantoaxial fusion with a standard fluoroscopy-guided device. Results : A total of 139 screws were correctly positioned. We analyzed the positions of 135 screws except for the four screws that performed the lateral mass screws in C3 vertebra. Minor screw penetration was observed in seven cases (5.2%), and major pedicle screw penetration was observed in three cases (2.2%). In one case, the malposition of a C2 pedicle screw was confirmed, which was subsequently corrected. There were no complications regarding vertebral artery injury or onset of new neurologic deficits. The screw malposition rate was lower (5.3%) in patients who underwent intraoperative CT-based navigation than that for fluoroscopy-guided cases (10.2%). And we confirmed that the operation time can be significantly reduced by surgery using intraoperative O-arm device. Conclusion : Spinal navigation using intraoperative cone-beam CT scans is reliable for posterior fixation in unstable C1-2 pathologies and can be reduced the operative time.

• The Korean Journal of Physiology
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• 제26권2호
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• pp.143-150
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• 1992

The purpose of this study is to obtain the effective concentration of capsaicin to relieve pain with no change in the number of C-fibers and its effective duration for pain relief. Capsaicin has been used extremely as a experimental tool and as topical medications for acute or chronic tissue injuries and partial nerve injury is the main cause of causalgiform pain disorders in humans. Here, the left sciatic nerve was ligated unilaterally at the high level of the thigh to prepare an animal model of this pain condition. The rat developed guarding behavior of the ipsilateral hind paw within a few hours after the operation and this behavior was maintained for several months thereafter, suggesting the possibility of spontaneous pain. These animals were divided into two groups(4-week & 8-week) and each group was subdivided into five groups by different concentration (0.05, 0.1, 0.5, 1.0 & 2.0%). Each capsaicin concentration was treated locally on the spinal cord-side of the ligated nerve and the foot withdrawal latency was measured. Thereafter, the dorsal roots of L5 were removed from both sides immediately after in tracardial perfusion for the counting of C-fibers by the histological procedure. There were no significant differences in the foot-withdrawal latency and the number of C-fibers between the left side treated with 0.05% capsaicin and the right side treated with the vehicle. However, latencies of the left sides treated with 0.1, 0.5, and 1.0% capsaicin increased significantly throughout 4-6 weeks with almost no change in the number of C-fibers, and the latencies showed the trends to approach slowly to those of the conditions after operation. The latency of subgroup treated with 2.0% increased by approximate 10% more than that of the right side throughout 8 weeks, and the number of C-fibers decreased by about 30% or more These results suggest that the elevated latency with capsaicin(0.1-1.0%) treatment is due to the inhibition of impulse transmission throughout the primary afferent fiber and the data from 2.0% are due to partial destruction of C-fibers. Therefore, capsaicin concentrations from 0.1% to 1.0% are probably very effective for the treatment of causalgiform pain with almost no destruction of C-fibers.

• 대한정형외과학회지
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• 제54권3호
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• pp.203-210
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• 2019

최소 침습적 외측 요추체간 유합술의 최신 지견에 대하여 알아보고자 하였다. 아직 도입된 지 얼마 되지 않았으나 근래에 각광받고 있는 최소 침습적 외측 요추체간 유합술에 대한 적응증 및 임상 결과와 유합률, 그리고 합병증에 대하여 문헌 고찰을 하였다. 외측 요추간 유합술의 적응증은 퇴행성 요추부 질환에서 고식적인 전방, 후방 추체간 유합술의 적응증과 거의 유사하다. 특히 척추관 협착증 및 퇴행성 척추 전방 전위증, 퇴행성 척추 변형, 퇴행성 추간판 질환, 인접 분절 퇴행성 질환에서 최소 침습적 수술로서 효과적이다. 또한 고식적 요추부 유합술과 비교하여 임상적 결과 및 유합률이 대등한 것으로 보고되고 있다. 하지만 수술 접근 및 과정에서 발생하는 수술 후 고관절 굴곡근 약화 및 신경 손상, 혈관 손상, 장기 손상, 케이지 침강, 위탈장 등의 비특이적 합병증들이 보고되고 있다. 외측 추체간 유합술은 고식적인 전방 또는 후방 추체간 유합술의 장점을 취합하고 단점을 보완한 수술이며 그 임상 결과나 유합률에도 큰 차이가 없어 퇴행성 요추부 질환의 치료에 최소 침습 수술로서 유용한 치료법이다. 하지만 수술 과정에서 발생하는 비특이적 합병증들을 개선해야 하는 것이 향후 과제이다.