• The Korean Journal of Pain
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• 제21권2호
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• pp.136-142
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• 2008

Background: A transforaminal epidural steroid injection (TFESI) is one of the methods for the conservative treatment of the lumbar spinal stenosis. As efforts to prolong the therapeutic duration and to predict the outcome of TFESI are very important, we analyzed factors considered to be associated with the therapeutic duration of a TFESI. Methods: Between August 2006 and March 2007, 69 patients (Group A: patients with no pain relief, Group B: patients with pain relief of less than 6 months, Group C: patients with pain relief of more than 6 months) who failed to the medical treatment were included to undertake a fluoroscopic-guided TFESI. Prior to treatment, the VAS (visual analogue scale), ODI (Oswestry disability index), BDI (Beck depression inventory), and BAI (Beck anxiety inventory) scores were determined to evaluate the degree of pain, disability, and psychological status. The VAS and ODI scores were used to assess the degree of pain relief. To identify the total duration of pain relief, regular outpatient visits for six months were conducted, and for the patients who were not able to visit the outpatient clinic regularly, outcome was assessed by telephone interviews after six months. Results: The dural sac cross-sectional area (DSCSA), ODI, pain duration, BDI, BAI, and age showed similar distribution for patients in the A, B, and C groups. Conclusions: The DSCSA, ODI, pain duration, BDI, BAI, and age were not associated with the therapeutic duration of TFESI in lumbar spinal stenosis patients.

• 대한물리의학회지
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• 제2권1호
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• pp.93-99
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• 2007

Purpose : The aim of this study is to consider degenerative spine disease theoretically and compare plain radiography which is a basic study for low back pain with MRI in cases of degenerative lumbar spine disease to find out whether the abnormalities agree with each other. Methods : In 4 cases of lumbar degenerative disease, we studied the relation of the abnormalities such as disc space narrowing, spinal space narrowing, loss of lordosis and osteophytes on plain radiography with those on MRI of HIVD, spinal stenosis and spondylolisthesis. Results : Many abnormalities such as disc space narrowing, spinal space narrowing, loss of lordosis, osteophytes and change of cortex & bone marrow on plain radiography suggest HIVD, spinal stenosis, spondylolysis or spondylolisthesis on MRI. Conclusion : For low back pain patients, plain radiography is a basic study in diagnosis of HIVD, spinal stenosis, spondylolysis or spondylolisthesis but MRI or CT scan is necessary to develop(build) a treatment plan like an operation.

• Journal of Korean Neurosurgical Society
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• 제49권4호
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• pp.231-233
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• 2011

Chronic spinal epidural hematoma related to Kummell's disease is extremely rare. An 82-year-old woman who had been managed conservatively for seven weeks with the diagnosis of a multi-level osteoporotic compression fracture was transferred to our institute. Lumbar spine magnetic resonance images revealed vertebral body collapse with the formation of a cavitary lesion at L1, and a chronic spinal epidural hematoma extending from L1 to L3. Because of intractable back pain, a percutaneous vertebroplasty was performed. The pain improved dramatically and follow-up magnetic resonance imaging obtained three days after the procedure showed a nearly complete resolution of the hematoma. Here, we present the rare case of a chronic spinal epidural hematoma associated with Kummell's disease and discuss the possible mechanism.

• Journal of Korean Neurosurgical Society
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• 제39권5호
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• pp.385-388
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• 2006

An Intramedullary subependymoma of the spinal cord is a rare tumor with only 43 reported cases in the literature. Most of them are reported to be localized within the cervical spinal cord. We report a rare case of a thoracic spine intramedullary subependymoma in a 37-year-old female who presented with back pain and radiating leg pain. Subtotal resection and post-operative radiotherapy were performed. Subependymomas developing in the spinal cord are benign with a low proliferative potential. Complete resection of the tumor appears to be the optimal method for a complete cure. However aggressive surgery may cause severe neurological deficit. Therefore, if severe neurological deficits are expected after complete removal, a partial removal and postoperative radiation therapy is an alternative method for treatment in selected cases. A large-scale randomized study is mandatory to clarify the effectiveness of radiotherapy and to establish the recurrence rate and prognosis with respect to the surgical removal of these tumors.

• The Korean Journal of Pain
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• 제23권1호
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• pp.51-54
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• 2010

A herniated intervertebral disc is the most common type of soft tissue mass lesion within the lumbar spinal canal. Magnetic resonance imaging (MRI) is a useful tool for the assessment of patients with lower back pain and radiating pain, especially intervertebral disc herniation. MRI findings of intervertebral disc herniation are typical. However, from time to time, despite an apparently classic history and typical MRI findings suggestive of disc herniation, surgical exploration fails to reveal any lesion of an intervertebral disc. Our patient underwent lumbar disc surgery with the preoperative diagnosis of lumbar disc herniation; however, nothing could be found during the surgical procedure, except a swollen nerve root.

• 한국약용작물학회지
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• 제16권3호
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• pp.183-187
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• 2008

Nerve injury can lead to neuropathic pain, which is often resistant to current analgesics and interventional therapeutic methods. Extracellular signal-regulated kinase (ERK) plays important role in the induction of neuropathic pain. We explored the antinociceptive effect of curcumin and its effect on ERK in the spinal cord in the neuropathic pain model of rats induced by chronic constriction injury (CCI) of the sciatic nerve. In injured rats, mechanical allodynia, which is one of characteristics of neuropathic pain developed and the activation of ERK in spinal cord significantly increased compared with control group. However, administration of curcumin (50 mg/kg/day p.o) for 7 days started from one day before the injury prevented the development of mechanical allodynia and increase of ERK phosphorylation. These results indicate that curcumin can be a new therapeutic agent in the treatment of neuropathic pain.

• The Korean Journal of Pain
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• 제4권2호
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• pp.142-146
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• 1991

One hundred twenty patients with acute and chronic pain treated by a low power laser were divided into several groups by their pathology and evaluated according to their response rate to laser therapy through a follow-up study. 1) The ages of the patients were between the early twenties and late forties (71.7%), and there was no differences between sexes. 2) The spinal pathology group was the most common(52.5%) and the articular pathology group occupied next (14.2%). 3) The average duration of Laser therapy was about 20 days and response to the therapy appeared about the eighth day. 4) The response to the therapy in the spinal pathology group appeared about the eighth day and the average duration of therapy was about 18 days. 5) The response to the therapy in the articular pathology group appeared about the eighth day and the average duration of therapy was about 28 days. 6) The response rate of the spinal pathology group was 81.0%, and remarkable symptom relief was noted when compaired to a 58.7% response rate in the control group, 7) The response rate of the articular pathology group was 82.4%, which was similar to the control group. 8) The response rate of the miscellaneous group was 87.0%, and remarkable symptom relief was noted when compaired to a 66.7A response rate in the control group. 9) The mean response rate of all patients treated by a low power laser was 82.5% and that of the control group was 70.5%. Laser therary proved to be an effective treatment modality for acute and chronic pain.

• The Korean Journal of Pain
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• 제19권1호
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• pp.101-103
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• 2006

Oral prostaglandin E1 (PGE1) is a medicine that is clinically applied during a treatment of patients suffering with vascular disease with chronic arterial obstruction because it has vasodilation and anti-platelet effects. The mechanisms of lumbosacral symptoms associated with spinal stenosis probably include vascular insufficiency with hypoxic injury to the cauda equina and the nerve roots. Thus, increasing the blood supply would be beneficial to improve the pathophysiologic condition. Several studies on the improvement of clinical symptoms of spinal stenosis by PGE1 treatment have been reported on. In this case, 47-year old female underwent posterior compression and posterolateral fusion with a cage at L2-4 due to L3 compression fracture, and she did not show improvement of the radiating pain of her right leg after the operation. Therefore, she received repetitive epidural catheterization and adhesiolysis, epidural block and physical therapy, but her symptoms deteriorated after temporary improvement. Finally, she was given PGE1 and the radiculopathy was completely improved, although some muscle weakness still remained.

• 대한물리의학회지
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• 제11권4호
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• pp.49-54
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• 2016

PURPOSE: The purpose of this study was to determine the effect of different frequencies (4Hz and 100Hz) of transcutaneous electrical nerve simulation (TENS) on pain relief using c-fos expression in the spinal cord of rat osteoarthritis to investigate the appropriate frequency for pain relief. METHODS: Total of 30 Sprague-Dawley rats was used and randomly divided 2 groups according TENS frequency and applicate the TENS during 3 period (3 days, 7 days, 10 days). The induction of osteoarthritis by 3mg monosodium iodoacetat was injected into the right knee joint of rats. Three days later, commercially available TENS unit was used for stimulation was set to 20minutes on 3, 7, 10 days after surgery. Western blot analysis system was used to detect immunoreactive proteins. The thickness of the bands were photographically measured by Scion Image. RESULTS: When investigating the c-fos expression of TENS on spinal cord in OA knee over 10 days, between-groups differences in c-fos expression reached a significant level by day 10. For within-groups comparisons, the c-fos expression decreased significantly across days in low- and high-frequency TENS groups. CONCLUSION: Whether at low- and high-frequency, the TENS as a therapy obtained beneficial effects of pain relief and TNES at high-frequency is more beneficial effects on the pain relief when TENS applied at injury site.

• Journal of Korean Neurosurgical Society
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• 제46권6호
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• pp.538-544
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• 2009

Objective : Primary treatment of spinal metastasis has been external beam radiotherapy. Recent advance of technology enables radiosurgery to be extended to extracranial lesions. The purpose of this study was to determine the clinical effectiveness and safety of stereotactic radiosurgery using Cyberknife in spinal metastasis. Methods : From June, 2002 to December, 2007, 129 patients with 167 spinal metastases were treated with Cyberknife. Most of the patients (94%) presented with pain and nine patients suffered from motor deficits. Twelve patients were asymptomatic. Fifty-three patients (32%) had previous radiation therapy. Using Cyberknife, 16-39 Gy in 1-5 fractions were delivered to spinal metastatic lesions. Radiation dose was not different regarding the tumor pathology or tumor volume. Results : After six months follow-up, patient evaluation was possible in 108 lesions. Among them, significant pain relief was seen in 98 lesions (91%). Radiological data were obtained in 83 lesions. The mass size was decreased or stable in 75 lesions and increased in eight lesions. Radiological control failure cases were hepatocellular carcinoma (5 cases), lung cancer (1 case), breast cancer (1 case) and renal cell carcinoma (1 case). Treatment-related radiation injury was not detected. Conclusion : Cyberknife radiosurgery is clinically effective and safe for spinal metastases. It is true even in previously irradiated patients. Compared to conventional radiation therapy, Cyberknife shows higher pain control rate and its treatment process is more convenient for patients. Thus, it can be regarded as a primary treatment modality for spinal metastases.