• Journal of Korean Neurosurgical Society
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• 제49권5호
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• pp.308-313
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• 2011

Posterior cervical foraminotomy is an attractive therapeutic option in selected cases of cervical radiculopathy that maintains cervical range of motion and minimize adjacent-segment degeneration. The focus of this procedure is to preserve as much of the facet as possible with decompression. Posterior cervical inclinatory foraminotomy (PCIF) is a new technique developed to offer excellent results by inclinatory decompression with minimal facet resection. The highlight of our PCIF technique is the use of inclinatory drilling out for preserving more of facet joint. The operative indications are radiculopathy from cervical foraminal stenosis (single or multilevel) with persistent or recurrent root symptoms. The PCIFs were performed between April 2007 and December 2009 on 26 male and 8 female patients with a total of 55 spinal levels. Complete and partial improvement in radiculopathic pain were seen in 26 patients (76%), and 8 patients (24%), respectively, with preserving more of facet joint. We believe that PCIF allows for preserving more of the facet joint and capsule when decompressing cervical foraminal stenosis due to spondylosis. We suggest that our PCIF technique can be an effective alternative surgical approach in the management of cervical spondylotic radiculopathy.

• 한방재활의학과학회지
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• 제32권3호
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• pp.109-117
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• 2022

Objectives To compare the therapeutic effect of ultrasound guided soyeom pharmacopuncture therapy and unguided soyeom pharmacopuncture therapy on cervical facet joint of patient who have cervical pain caused by traffic accidents. Methods The study was planned as a retrospective study that analyzes the patient's medical records. We analyzed medical records of 20 patients with acute cervical pain caused by traffic accidents from April 1, 2022 to May 31, 2022. 10 patients (Group A) were treated ultrasound guided soyeom pharmacopuncture therapy on cervical facet joint, 10 patients (Group B) were treated unguided soyeom pharmacopuncture therapy on cervical facet joint. We used visual analogue scale (VAS) and neck disability index (NDI) to evaluate improvements in cervical functions and pain, five point Likert scale to estimate patient's satisfaction. We used the IBM SPSS Statistics version 25 program (IBM Co., Armonk, NY, USA) for statistical analysis. Results Group A showed a significant decrease in the VAS on the 5^th day of the soyeom pharmacopuncture therapy (p=0.001). However, there was no statistically significant difference of VAS between two groups (p=0.142). Group A showed significant decrease in the NDI on the 5^th day of the therapy (p=0.002). Also, there was statistically significant difference on NDI between two groups (p=0.018). Difference of five point Likert scale between two groups was not statistically significant (p=0.407). Conclusions In patients of acute cervical pain caused by traffic accidents, ultrasound guided soyeom pharmacopuncture therapy on cervical facet joint showed significant efficacy on reduction of neck disability compared with unguided therapy.

• The Korean Journal of Pain
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• 제37권1호
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• pp.3-12
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• 2024

One of the most common sources of spinal pain syndromes is the facet joints. Cervical, thoracic, and lumbar facet joint pain syndromes comprise 55%, 42%, and 31% of chronic spinal pain syndromes, respectively. Common facet joint disorders are degenerative disorders, such as osteoarthritis, hypertrophied superior articular process, and facet joint cysts; septic arthritis; systemic and metabolic disorders, such as ankylosing spondylitis or gout; and traumatic dislocations. The facet pain syndrome from osteoarthritis is suspected from a patient's history (referred pain pattern) and physical examination (tenderness). Other facet joint disorders may cause radicular pain if mass effect from a facet joint cyst, hypertrophied superior articular process, or tumors compress the dorsal root ganglion. However, a high degree of morphological change does not always provoke pain. The superiority of innervating nerve block or direct joint injection for diagnosis and treatment is still a controversy. Treatment includes facet joint injection in facet joint osteoarthritis or whiplash injury provoking referred pain or decompression in mass effect in cases of hypertrophied superior articular process or facet joint cyst eliciting radicular pain. In addition, septic arthritis is treated using a proper antibiotic, based on infected tissue or blood culture. This review describes the diagnosis and treatment of common facet joint disorders.

• 대한정형외과 초음파학회지
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• 제3권2호
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• pp.54-58
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• 2010

목적: 만성적으로 경추 동통을 호소하는 환자의 통증의 근원은 대부분 후관절인데, 증상을 일으키는 관절의 정확한 위치 확인의 어려움과 합병증 및 위약효과의 가능성으로 인해 임상에서의 적용에 의구심을 가지게 된다. 본 연구에서는 만성 경추 동통을 호소하는 환자에서 후관절 동통의 유병율을 평가하고 진단 및 치료적 목적의 초음파를 이용한 후관절 차단술의 유용성에 대해 보고한다. 대상 및 방법: 만성적이면서 비특이적인 경추 동통을 6개월 이상 호소하는 환자를 대상으로 하였다. 방사통을 동반한 추간판 탈출 관련 통증을 호소하는 환자는 그 대상에서 제외되었으며, 물리 치료나 척추 교정 요법, 약물 치료 등의 보존적 치료 요법에 실패한 환자 160명을 대상으로 하였다. 경추 동통에 대한 진단적 후관절 차단술은 1% 리도카인(lidocaine)을 사용하여 시행하였으며, 리도카인에 양성 반응을 보인 환자에 대해서는 2주 뒤 0.25% 부피바카인(bupivacaine)을 사용하였으며, 후관절 차단술 시행 이후 경추 운동시 75% 이상의 통증 감소를 보일 경우를 양성 반응으로 고려하였다. 결과: 만성 경추 동통을 호소하는 환자 160명 가운데 리도카인을 이용한 후관절 차단술에 96명, 60% 양성반응을 보였으며, 리도카인에 음성반응을 보인 환자 64명 가운데 부피바카인에 48명, 75% 양성반응을 보였다. 리도카인에 양성반응을 보였으나 부피바카인에 음성반응을 보인 가양성 환자는 48명, 50%에 해당하였다. 총 160명의 환자들의 시술 전 VAS는 평균 8.5이었으며, 2주 추시시 2.7 (p=0.001), 4주 추시시 3.6 (p=0.001)로 감소하였다. 초기 시술로 증상의 호전이 만족스럽지 않았던 8명과 경과 관찰 도중에 악화되었던 3명은 4주째 후관절 차단술을 추가적으로 실시하여 통증의 완화를 보였다. 결론: 만성 경추 동통을 호소하는 환자에 대해 초음파를 이용한 단일 차단술은 가양성 반응이 높아 진단적 가치가 상대적으로 낮으며, 후관절에 시행한 두 번의 차단술은 만성 경추 동통 환자의 중재적 통증 조절에 유용한 방법으로 사료된다.

• Journal of Korean Neurosurgical Society
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• 제48권3호
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• pp.193-198
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• 2010

Objective : The purpose of this study is to compare the incidence of possible complications of cervical lateral screw fixation and the achievements of bicortical purchase using the Roy-Camille, Magerl and the modified methods. Methods : Six fresh-frozen cervical spine segments were harvested. The Roy-Camille technique was applied to C3 and C4, and the Magerl technique was applied to C5, C6, and C7 of one side of each cadaver. The modified technique was applied to the other side of each cadaver. The nerve root injury, violation of the facet joint, vertebral artery injury, and the bicortication were examined at each screwing level. Results : No vertebral artery injury was observed in any of the three methods. One nerve root injury was observed in each cervical spine segment using the Roy-Camille method (8.3%), the Magerl method (5.6%), and the modified method (3.3%). Facet joint injuries were observed in two cervical spinal segments using the Roy-Camille method (16.7%) and three with the Magerl method (16.7%), while five facet joint violations occurred when using the modified method (16.7%). Bicortical purchases were achieved on ten cervical spinal segments with the Roy-Camille method (83.3%) and Magerl method (55.6%), while twenty bicortical purchases were achieved in the modified method (66.7%). Conclusion : The advantages of the modified method are that it is performed by using given anatomical structures and that the complication rate is as low as those of other known methods. This modified method can be performed easily and safely without fluoroscopic assistance for the treatment of many cervical diseases.

• 대한정형외과학회지
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• 제56권5호
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• pp.413-418
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• 2021

목적: 경추에서 후관절 비대칭성이 후관절 퇴행과 추간판 퇴행에 미치는 영향력에 대해 조사하고자 한다. 대상 및 방법: 2017년 1월부터 2018년 12월까지 총 100명의 환자를 대상으로 경추 제5-6번의 후관절 비대칭성을 후향적으로 분석하였다. 컴퓨터 단층촬영(computed tomography, CT)에서 수평면, 시상면, 관상면에 대한 양쪽 후관절 각도를 측정하였으며 자기공명영상 촬영(magnetic resonance imaging, MRI) 및 CT에서 후관절의 퇴행을 등급 체계를 이용하여 평가하였다. 추간판 퇴행은 MRI 시상면, 수평면에서 5등급으로 나누어 평가하였다. 좌우 후관절 각도 차이가 7도 이상인 경우를 비대칭군으로, 7도 미만인 경우를 대조군으로 구분하였다. 결과: 환자의 평균 나이는 비대칭군에서 55.44±12.3세(31-81세)였으며 대조군에서는 55.66±10.7세(32-76세)였다. 비대칭군의 경우 남성이 32명, 여성이 18명이었고 대조군에서는 남성이 24명, 여성이 26명이었다. 관절 퇴행은 비대칭군에서 24명(48.0%), 대조군에서 14명(28.0%)으로 측정되었으며 유의한 차이를 보였다(p=0.037). 추간판 퇴행은 비대칭군에서 29명(58.0%), 대조군에서 17명(34.0%)으로 측정되었으며 유의한 차이를 보였다(p=0.005). 다변량 분석 결과상 후관절 비대칭성이 후관절 퇴행과 추간판 퇴행에 영향을 주는 인자였다. 결론: 경추 제5-6번에서 경추 후관절 퇴행 및 추간판 퇴행이 유의하게 많이 발생하였으며 후관절 비대칭성이 후관절 퇴행 및 추간판 퇴행에 영향을 주는 인자로 생각된다.

• The Korean Journal of Pain
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• 제21권1호
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• pp.1-10
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• 2008

Spinal joint pain syndrome is composed of atlanto-occipital, atlanto-axial, facet, and sacro-iliac joints pain. The syndrome is characterized as referred pain which is originated from deep somatic tissues, which is quietly different from radicular pain with dermatomal distribution originated from nerve root ganglion. The prevalence of facet joint pain in patients with chronic spinal pain of cervical, thoracic, and lumbar regions has been known 56%, 42%, and 31% as in order. It is generally accepted in clinical practice that diagnostic blocks are the most reliable means for diagnosing spinal joints as pain generators. The sacroiliac joint has been shown to be a source of 10% to 27% of suspected cases with chronic low back pain utilizing controlled comparative local anesthetic blocks. The treatment of spinal joints ideally consists of a multimodal approach comprising conservative therapy, medical management, procedural interventions, and if indicated.

• The Korean Journal of Pain
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• 제21권2호
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• pp.150-154
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• 2008

Pulsed or conventional radiofrequency (RF) denervation of the third occipital nerve (TON) is considered to be a safe and effective alternative for the treatment of pain originating from the cervical 2-3 facet joint, including cervicogenic headache. However, proper positioning of the RF probe in the TON can be difficult and time consuming due to the possible involvement of various lesions along the target nerve. We found that bipolar RF is easier to perform and more convenient than unipolar RF when administering a lumbar medial branch block. Here, we report the successful treatment of a patient with a cervicogenic headache by pulsed RF (PRF) denervation of the TON, using a bipolar probe. We believe that bipolar PRF denervation of the TON is an effective alternative to unipolar RF or PRF for the treatment of pain originating from the cervical 2-3 facet joint.

• Journal of Korean Neurosurgical Society
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• 제61권2호
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• pp.243-250
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• 2018

Objective : To compare the morphometry of subaxial cervical spine between cerebral palsy (CP) and normal control. Methods : We retrospectively analyzed 72 patients with CP, as well as 72 patients from normal population. The two groups were matched for age, sex, and body mass index. Pedicle, lateral mass (LM), and vertebral foramen were evaluated using computed tomography (CT) imaging. Pedicle diameter, LM height, thickness, width and vertebral foramen asymmetry (VFA) were measured and compared between the two groups. Cervical dynamic motion, disc and facet joint degeneration were investigated. Additionally, we compared the morphology of LM between convex side and concave side with cervical scoliotic CP patients. Results : LM height was smaller in CP group. LM thickness and width were larger in CP group at mid-cervical level. In 40 CP patients with cervical scoliosis, there were no height and width differences between convex and concave side. Pedicle outer diameter was not statistically different between two groups. Pedicle inner diameter was significantly smaller in CP group. Pedicle sclerosis was more frequent in CP patients. VFA was larger in CP group at C3, C4, and C5. Disc/facet degeneration grade was higher in the CP group. Cervical motion of CP group was smaller than those of the control group. Conclusion : LM morphology of CP patients was different from normal population. Sclerotic pedicles and vertebral foramen asymmetry were more commonly identified in CP patients. CP patients were more likely to demonstrate progressive disc/facet degeneration. This data may provide useful information on cervical posterior instrumentation in CP patients.

• Imaging Science in Dentistry
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• 제54권2호
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• pp.201-206
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• 2024

This report showed a case of temporomandibular joint (TMJ) ankylosis suspected to be associated with ankylosing spondylitis based on the observation of bony ankylosis of the cervical spine on computed tomography (CT) images. A 53-year-old man presented with a chief complaint of difficulty in opening his mouth. His medical history indicated that in his 20 s, he became aware of the difficulty in moving his neck. CT revealed marked osteoarthritic changes in the right mandibular condyle, suggesting fibrotic TMJ ankylosis. In addition, bony ankylosis of the cervical vertebral body and facet joints from the axis (C2) to C5 in continuity was observed. CT of the entire spine also showed bony deformity of the sacroiliac joints and bony ankylosis. Based on these findings, ankylosing spondylitis was suspected. The possibility of an ankylosing spondylitis complication should be considered in cases of TMJ ankylosis if bony ankylosis of the cervical spine is observed.