• The Korean Journal of Pain
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• v.18 no.2
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• pp.251-254
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• 2005

Spondylolysis, also known as stress injury of pars interarticularis, is a common cause of back pain in athletes, particularly children and young adults. Repeated minor traumas during flexion and extension of the spine are thought to result in bony failure due to excessive bone resorption. These lesions are common in the low back, with the majority found at the L5 vertebra. In the majority of cases of spondylolysis, non-operative treatments are recommended, such as NSAIDs, physiotherapy and bracing. Only if symptoms do not respond to conservative treatments should surgical intervention be considered. Recently, pars interarticularis injections for diagnostic and therapeutic purposes have been found to allow significant pain relief from spondylolysis for long periods. Here, the case of a 57-year-old man with spondylolysis, who suffered from back pain, which was not relieved by an epidural steroid injection, but in whom pars interarticularis injections of local anesthetic and steroid induced complete transient pain relief, following by moderate long-term relief, is presented.

• Journal of Korean Society of Spine Surgery
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• v.25 no.4
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• pp.185-195
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• 2018

Study Design: Literature review. Objective: Ultrasound-guided injections are a common clinical treatment for lower lumbosacral pain that are usually performed before surgical treatment if conservative treatment fails. The aim of this article was to review ultrasound-guided injections in the lumbar and sacral spine. Summary of Literature Review: Ultrasound-guided injections, unlike conventional interventions using computed tomography or C-arm fluoroscopy, can be performed under simultaneous observation of muscles, ligaments, vessels, and nerves. Additionally, they have no radiation exposure and do not require a large space for the installation of equipment, so they are increasingly selected as an alternative method. Materials and Methods: We searched for and reviewed studies related to the use of ultrasound-guided injections in the lumbar and sacral spine. Results: In order to perform accurate ultrasound-guided injections, it is necessary to understand the patient's posture during the intervention, the relevant anatomy, and normal and abnormal ultrasonographic findings. Facet joint intra-articular injections, medial branch block, epidural block, selective nerve root block, and sacroiliac joint injections can be effectively performed under ultrasound guidance. Conclusions: Ultrasound-guided injections in the lumbar and sacral spine are an efficient method for treating lumbosacral pain.

• Journal of Korean Neurosurgical Society
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• v.60 no.2
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• pp.205-210
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• 2017

Objective : This study was performed to evaluate and compare the efficacies of caudal epidural injections performed at prone and lateral decubitus positions. Methods : A total of 120 patients suffering from low back pain and radicular leg pain were included and patients were randomly distributed into 2 groups according to the position during injection. In Group 1 (n=60; 32 women, 28 men), caudal epidural injection was performed at prone position, whereas it was implemented at lateral decubitus position in Group 2 (n=60; 33 women, 27 men). Visual analogue scale, Oswestry Disability Index (ODI), walking tolerance (WT) and standing tolerance (ST) were compared in 2 groups before and after injection. Results : In Group 1, ODI values were higher at 30th minute (p=0.007), 3rd week (p=0.043) and 6th month (p=0.013). In Group 1, ODI, VAS and ST values were improved significantly at all follow-up periods compared to initial values. In Group 1, WT scores were better than initial values at 30th minute, 3rd week and 3rd month. In Group 2, ODI scores at 30th minute, 3rd week, 3rd month and 6th month were improved while VAS and ST scores were improved at all periods after injection. WT scores were better at 30th minute, 3rd week and 3rd month compared to initial WT scores. Conclusion : Our results indicated that application of injection procedure at lateral decubitus position allowing a more concentrated local distribution may provide better relief of pain.

• The Korean Journal of Pain
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• v.35 no.3
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• pp.345-352
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• 2022

Background: Optimal needle depth in transforaminal epidural injection (TFEI) is determined by body measurements and is influenced by the needle entry angle. Physician can choose the appropriate needle length and perform the procedure more effectively if depth is predicted in advance. Methods: This retrospective study included patients with lumbosacral pain from a single university hospital. The skin depth from the target point was measured using magnetic resonance imaging transverse images. The depth was measured bilaterally for L4 and L5 TFEIs at 15°, 20°, and 25° oblique angles from the spinous process. Results: A total of 4,632 measurements of 386 patients were included. The lengths of the left and right TFEI at the same level and oblique angle were assessed, and no statistical differences were identified. Therefore, linear regression analysis was performed for bilateral L4 and L5 TFEIs. The R-squared values of height and weight combined were higher than the height, weight, and body mass index (BMI). The following equation was established: Depth (mm) = a - b (height, cm) + c (weight, kg). Based on the equation, maximal BMI capable with a 23G, 3.5-inch, Quincke-type point spinal needle was presented for three different angles (15°, 20°, and 25°) at lumbar levels L4 and L5. Conclusions: The maximal BMI that derived from the formulated equation is listed on the table, which can help in preparations for morbid obesity. If a patient has bigger BMI than the one in the table, the clinician should prepare longer needle than the usual spinal needle.

• The Korean Journal of Pain
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• v.36 no.1
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• pp.98-105
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• 2023

Background: Ultrasound-guided first sacral transforaminal epidural steroid injection (S1 TFESI) is a useful and easily applicable alternative to fluoroscopy or computed tomography (CT) in lumbosacral radiculopathy. When a needle approach is used, poor visualization of the needle tip reduces the accuracy of the procedure, increasing its difficulty. This study aimed to improve ultrasound-guided S1 TFESI by evaluating radiological S1 posterior foramen data obtained using three-dimensional CT (3D-CT). Methods: Axial 3D-CT images of the pelvis were retrospectively analyzed. The radiological measurements obtained from the images included 1st posterior sacral foramen depth (S1D, mm), 1st posterior sacral foramen width (S1W, mm), the angle of the 1st posterior sacral foramen (S1A, °), and 1st posterior sacral foramen distance (S1ds, mm). The relationship between the demographic factors and measured values were then analyzed. Results: A total of 632 patients (287 male and 345 female) were examined. The mean S1D values for males and females were 11.9 ± 1.9 mm and 10.6 ± 1.8 mm, respectively (P < 0.001); the mean S1A 28.2 ± 4.8° and 30.1 ± 4.9°, respectively (P < 0.001); and the mean S1ds, 24.1 ± 2.9 mm and 22.9 ± 2.6 mm, respectively (P < 0.001); however, the mean S1W values were not significantly different. Height was the only significant predictor of S1D (β = 0.318, P = 0.004). Conclusions: Ultrasound-guided S1 TFESI performance and safety may be improved with adjustment of needle insertion depth congruent with the patient's height.

• The Korean Journal of Pain
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• v.32 no.3
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• pp.196-205
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• 2019

Background: Hypertonic saline (HS) injections for decompressive neuroplasty (DN) can cause pain. We assessed whether a continuous infusion of HS through an infusion pump would reduce injection-related pain compared with repeated bolus administrations. Methods: Fifty patients scheduled for DN were randomized to either the bolus injection or the continuous infusion group. After appropriately placing the epidural catheter, 4 mL of 5% NaCl was injected as four boluses of 1 mL each at 15-minute intervals or infused over 1 hour using an infusion pump. The severity of pain induced by HS injection, as measured by the 11-point numerical rating scale (NRS), was the primary outcome. The severity of low back or lower extremity pain, as measured by the 11-point NRS and Oswestry Disability Index (ODI), 3 months following the procedure, was the secondary outcome. Results: Data from 21 patients in the bolus group and 23 in the continuous infusion group were analyzed. No statistically significant difference in injection-related pain was identified between the two groups during the initial HS administration (P = 0.846). However, there was a statistically significant reduction in injection-related pain in the continuous infusion group compared to the bolus injection group from the second assessment onwards (P = 0.001, < 0.001, and < 0.001, respectively). No significant between-group differences in the NRS and ODI scores 3 months post-procedure were noted (P = 0.614 and 0.949, respectively). Conclusions: Our study suggests that administering HS through a continuous infusion is a useful modality for reducing HS injection-related pain during DN.

• The Korean Journal of Pain
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• v.10 no.2
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• pp.270-273
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• 1997

Caudal epiduroscopy has been introduced as an alternative technique for direct injection of epidural steroid and lysis of adhesion. Futher, it gives a better understanding of the role of epidural adhesion in recurrence of sciatica and low back disorder after surgery. We experienced a clinical application of flexible fiberoptic epiduroscope inserted through the sacral canal. A 37-year-old woman was suffering from right lumbar radiculopathy after an operation for a herniated disc. A series of volumetric caudal steroid injections and physical therapy had little effect on her symptoms. Patient was thought to be a good candidate for epiduroscopy. Flexible flberoptic epiduroscopy was as follows: 60 ml of normal saline irrigation and epidurogram, 40 mg of triamcinolone in 10m1 of normal saline was directed around right L5 nerve root. The following morning, patient reported reduced pain in her leg.

• The Korean Journal of Pain
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• v.2 no.1
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• pp.61-65
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• 1989

Chloroma is a localized myeloblastic tumor which may develop during the course of myelogenous leukemia or as a presenting sign of the disease. A 47-year-old female diagnosed as chronic myelogenous leukemia in her hematologic remission period complained of left lower leg pain. The lumbar-spine series showed multiple osteolytic changes in the left lateral border of the lumbar spine. An inhomogenous soft tissue mass involving left lateral aspects of lumbar vertebrae was identified by CT-scanning. At the first pain attack, lumbar epidural steroid and local anesthetic injection could abolish her pain and the patient could go a few days without pain. The following radiation therapy could also improve the symptom and retain the pain free interval. One month later, a second pain attack occurred and lumbar and caudal epidural steroid and local anesthetic injections could result only in an incidental relief of pain. Radiation and chemotherapy were started but failed to relieve pain. A neurolytic block was considered but the patient's general condition was aggravated and even verbal communication with her became impossible.

• The Korean Journal of Pain
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• v.34 no.3
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• pp.346-368
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• 2021

Background: Recalcitrant disc herniation may result in chronic lumbar radiculopathy or sciatica. Fluoroscopically directed epidural injections and other conservative modalities may provide inadequate improvement in some patients. In these cases, percutaneous neurolysis with targeted delivery of medications is often the next step in pain management. Methods: An evidence-based system of methodologic assessment, namely, the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) was used. Multiple databases were searched from 1966 to January 2021. Principles of the best evidence synthesis were incorporated into qualitative evidence synthesis. The primary outcome measure was the proportion of patients with significant pain relief and functional improvement (≥ 50%). Duration of relief was categorized as short-term (< 6 months) and long-term (≥ 6 months). Results: This assessment identified one high-quality randomized controlled trial (RCT) and 5 moderate-quality non-randomized studies with an application of percutaneous neurolysis in disc herniation. Overall, the results were positive, with level II evidence. Conclusions: Based on the present systematic review, with one RCT and 5 non-randomized studies, the evidence level is II for percutaneous neurolysis in managing lumbar disc herniation.

• Journal of Acupuncture Research
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• v.32 no.4
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• pp.203-211
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• 2015

Objectives : The purpose of this study was to assess the effectiveness of integrative Korean Medical treatments for patients with L-spine disk herniation that showed no response to Epidural Steroid Injections (ESI). Methods : In this study, we reviewed the medical records of ten patients who showed no improvement or relapsed after ESI. The patients each received more than three weeks of integrative treatments at Mokhuri Neck&Back Hospital. The Visual Analog Scale (VAS) and Oswestry Disability Index (ODI) was measured before and after treatment. A statistical analysis to compare before and after treatments was assessed using paired t-test the SPSS 12.0 Windows program. Results : After three weeks of treatment, patients showed a significant decrease in VAS and ODI scores compared to before receiving treatment. VAS scores decreased from $5.3{\pm}1.25$ to $1.9{\pm}0.99$ (p<0.001), and ODI scores decreased from $59.8{\pm}22.2$ to $32.7{\pm}14.11$ (p<0.001). Conclusions : Complex Korean Medical treatment showed effectiveness in the treatment of L-spine HIVD patients that showed no response to ESI, and more objective research is needed.