• The Journal of Korean Physical Therapy
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• v.22 no.3
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• pp.71-77
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• 2010

Purpose: To determine whether upregulation of inducible nitric oxide synthase (iNOS) transcription and translation is related to radicular pain in a model of lumbar disc herniation. Also, to investigate the temporal changes of mRNA expression of iNOS and the identity of iNOS and transient receptor potential vanilloid (TRPV) 1 channel expression cells in dorsal root ganglion (DRG) of a model of lumbar disc herniation. Methods: A lumbar disc herniated rat model was developed by implantation of the autologous nucleus pulposus, harvested from the coccygeal vertebra of each tail, on the left L5 nerve root just proximal to the DRG. Rats were tested for mechanical allodynia of the plantar surface of both hind paws 2 days before surgery and 1, 5, 10, 20 and 30 days postoperatively. Reverse transcription polymerase chain reaction (RT-PCR) was used to follow iNOS mRNA expression. To stain iNOS and TRPV1 in DRG, an immunohistochemical study was done 10 days after surgery. Results: A significant drop in mechanical withdrawal threshold on the ipsilateral and contralateral hind paws was observed 1 day after surgery and was prolonged to 30 days in rats with lumbar disc herniation. The expression of mRNA for iNOS peaked at postoperative day 10 on both sides of the DRG. iNOS-positive sensory neurons in the DRG varied in size from large to small diameter cells. A majority of small and intermediate sensory neurons were TRPV1-positive cells. Double immunofluorescence staining for TRPV1 and iNOS revealed that most intermediate TRPV1-positive sensory neurons co-localized with iNOS-positive neurons. Conclusion: Nucleus pulposus-induced mechanical allodynia can be generated without mechanical compression. This pain is related to temporal changes in expression of iNOS mRNA in the DRG. Co-localization of TRPV1 and iNOS in intermediate neurons of the DRG is correlated with pain modality and intensity.

• Journal of Korean Physical Therapy Science
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• v.3 no.2
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• pp.975-980
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• 1996

The purpose of study was aimed at analysing the body deformity types through LHNP(lumbar herniated nucleus pulposus) patients without considering of lower extremity radiating pain. This study was proceeded in a time-series method through the ninety LHNP patients visited the hospital for the first time. The results were as follows. 1. Body type I : Deformity style of Lt shoulder & pelvis forward tilt 2. Body type II : Deformity style of Rt shoulder & pelvis forward tilt style 3. Body type III : Deformity style of Lt shoulder & Rt pelvis forward tilt style 4. Body type N : Deformity style of Rt shoulder & Lt pelvis forward tilt style.

• PNF and Movement
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• v.10 no.2
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• pp.33-39
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• 2012

Purpose : The purpose of this case report was to examine the effects of intergrative intervention approach on a patient with lumbar herniated nucleus pulposus (HNP). Methods : The subject was a 53 years old woman with lumbar HNP. The subject received conventional physical therapy combined with exercise therapy and manual therapy. Pain on visual analog scale (VAS), finger to floor (FTF), lumbar lateral flexion, L5 motor, and straight Leg-Raising (SLR) were evaluated at baseline and after 4 weeks. Results : The change of VAS, FTF, left lateral flexion, and right lateral flexion were decreased (9 vs. 5, 41 vs, 25, 56 vs. 42, 54 vs. 41, respectively) and the change of L5 motor and SLR were increased (Fair vs. Fair+, 60 vs. 75, respectively). Conclusion : Our findings suggest that Integrative intervention may be considered in patient with lumbar HNP.

• The Korean Journal of Pain
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• v.14 no.2
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• pp.234-238
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• 2001

Percutaneous laser discectomy has potential advantages over conservative therapy and classical open surgery as a minimally invasive procedure, although clinical experiences are limited. We experienced a patient treated with herniated lumbar discs using Nd：YAG laser. A 55-year-old woman complained of severe back pain with sciatica on L4/5 and L5/S1 dermatome for several months. The MRI finding showed bulging discs at L4/5 and L5/S1. Epidural, transsacral and root block treatments were attempted without effect. Under fluoroscopic guidance, a 14 G biopsy needle was inserted into the L4/5 and L5/S1 disc spaces to the margin of the nucleus pulposus. Laser irradiation for vaporization of tissue was performed at 20 W/second to 1200 J. A laser fiber ($600{\mu}m$) was advanced 1 cm from the tip of the needle. At the end of the procedure, the patient began to feel relief of pain (VAS changed from 9 to 4) and was discharged the same day after staying 2 hours in the recovery room. Antibiotics were administered for prevention of discitis. She had no complaints of pain until the 1-month follow up visit. Percutaneous laser discetomy technique has the disadvantages of expensive equipment, high temperature and amount of vaporing disc tissue is empirical. However, this technique, as one of the therapeutic modalities for disc herniation, provides faster relief from acute attack than conservative management techniques in carefully selected patients with sciatica due to disc prolapse.

• The Korean Journal of Pain
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• v.29 no.1
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• pp.40-47
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• 2016

Background: Neuropathic pain, including paresthesia/dysesthesia in the lower extremities, always develops and remains for at least one month, to variable degrees, after percutaneous endoscopic lumbar discectomy (PELD). The recently discovered dual analgesic mechanisms of action, similar to those of antidepressants and anticonvulsants, enable nefopam (NFP) to treat neuropathic pain. This study was performed to determine whether NFP might reduce the neuropathic pain component of postoperative pain. Methods: Eighty patients, who underwent PELD due to herniated nucleus pulposus (HNP) at L4-L5, were randomly divided into two equal groups, one receiving NFP (with a mixture of morphine and ketorolac) and the other normal saline (NS) with the same mixture. The number of bolus infusions and the infused volume for 3 days were compared in both groups. The adverse reactions (ADRs) in both groups were recorded and compared. The neuropathic pain symptom inventory (NPSI) score was compared in both groups on postoperative days 1, 3, 7, 30, 60, and 90. Results: The mean attempted number of bolus infusions, and effective infused bolus volume for 3 days was lower in the NFP group for 3 days. The most commonly reported ADRs were nausea, dizziness, and somnolence, in order of frequency in the NFP group. The median NPSI score, and all 5 median sub-scores in the NFP group, were significantly lower than that of the NS group until postoperative day 30. Conclusions: NFP significantly reduced the neuropathic pain component, including paresthesia/dysesthesia until 1 month after PELD. The common ADRs were nausea, dizziness, somnolence, and ataxia.

• Journal of Korean Neurosurgical Society
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• v.60 no.5
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• pp.540-549
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• 2017

Objective : To evaluate the diagnostic value of computed tomography-myelography (CTM) compared to that of magnetic resonance imaging (MRI) in patients with lumbar radiculopathy. Methods : The study included 91 patients presenting with radicular leg pain caused by herniated nucleus pulposus or lateral recess stenosis in the lumbar spine. The degree of nerve root compression on MRI and CTM was classified into four grades. The results of each imaging modality as assessed by two different observers were compared. Visual analog scale score for pain and electromyography result were the clinical parameters used to evaluate the relationships between clinical features and nerve root compression grades on both MRI and CTM. These relationships were quantified by calculating the receiver-operating characteristic curves, and the degree of relationship was compared between MRI and CTM. Results : McNemar's test revealed that the two diagnostic modalities did not show diagnostic concurrence (p<0.0001). Electromyography results did not correlate with grades on either MRI or CTM. The visual analog pain scale score results were correlated better with changes of the grades on CTM than those on MRI (p=0.0007). Conclusion : The present study demonstrates that CTM could better define the pathology of degenerative lumbar spine diseases with radiculopathy than MRI. CTM can be considered as a useful confirmative diagnostic tool when the exact cause of radicular pain in a patient with lumbar radiculopathy cannot be identified by using MRI. However, the invasiveness and potential complications of CTM are still considered to be pending questions to settle.

• The Korean Journal of Pain
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• v.21 no.3
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• pp.217-223
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• 2008

Background: Lumbar transforaminal epidural injections (LTEIs) have been utilized in the treatment of radicular pain, and LTEIs have the advantage of target-specificity. However, there have not been enough studies on the contrast patterns in LTEIs with using fluoroscopy. The purpose of this study was to evaluate the spreading epidural contrast patterns that are seen during real-time fluoroscopic guided LTEIs. Methods: A total of 131 patients who underwent fluoroscopic guided LTEIs were studied. The inclusion criteria were those patients with low back pain and/or lower extremity pain that was caused by a herniated nucleus pulposus, lumbar spinal stenosis, failed back surgery syndrome, and herpes zoster-associated pain. We classified the contrast patterns in regard to the contrast flow spreading to the nerve root and/or the unilateral, bilateral or cylinderic type of epidural spreading on the AP view of the fluoroscopy and the ventral or dorsal epidural filling on the lateral view. In addition to the pattern analysis, we evaluated the range of contrast spreading from the cranial to the caudal epidural filling and the incidence of an intravascular flow pattern. Results: Epidural spreading was seen in 126 cases (96.2%) of the total patients through the nerve root. Ventral spreading occurred in 120 cases (95.2%). On the AP view, a nerve root with unilateral, bilateral and cylinderic epidural filling was noted for 108 (85.7%), 9 (7.1%) and 9 (7.1%) cases, respectively. The contrast spreading to vertebral segments was smaller for the patients with lumbar spinal stenosis and failed back surgery syndrome than for the other groups (P < 0.0083). The incidence of intravascular injection was 11.1% (14/126). Conclusions: LTEIs using fluoroscopic visualization provided excellent assessment of the ventral epidural filling as well as nerve root filling. However, unilateral epidural spreading was prominent for the LTEIs.

• The Journal of Korea CHUNA Manual Medicine
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• v.1 no.1
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• pp.55-65
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• 2000

The present study retrospectively investigated clinical outcome at patients with low back pain or sciatica during Chuna treatment (flexion-distraction technique). The study population consisted of 29 patients. Discogenic group consisted of 21 patients who were already diagnosed as HNP of lumbar spine with serial MRIs(magnetic resonance imaging) or CTs(computerized tomography). Simple LBP group consisted of 8 patients with low back pain & sciatica who were non-specific disorder on radiologic examination. All patients were treated with flexion-distraction technique, one of Chuna technique, under analysis of Moire Topography. And the evaluation of clinical outcome was done twice during this study by Moire Topography Analytic Point and Low Back Pain Assesment, Visual Analogue Scale. The results were summarized as follows; Total improvement rate of Moire Topography was $25.8{\pm}17.8%$, and the rate of Low Back Pain Assesment was $56.5{\pm}23.0%$, Visual Analogue Scale of post-treatment was $32.6{\pm}22.5$ Between Improvement rate of Moire Topography and improvement rate of Low Back Pain Assesment, significant correlation was proved(Person's coefficient was 0.381, p<0.05). After all, it is certain improvement of Moire Topography represents symptom's improvement.

• Journal of Korean Neurosurgical Society
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• v.58 no.4
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• pp.350-356
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• 2015

Objective : Cases of contralateral radiculopathy after a transforaminal lumbar interbody fusion with a single cage (unilateral TLIF) had been reported, but the phenomenon has not been explained satisfactorily. The purpose of this study was to determine its incidence, causes, and risk factors. Methods : We did retrospective study with 546 patients who underwent a unilateral TLIF, and used CT and MRI to study the causes of contralateral radicular symptoms that appeared within a week postoperatively. Clinical and radiological results were compared by dividing the patients into the symptomatic group and asymptomatic group. Results : Contralateral symptoms occurred in 32 (5.9%) of the patients underwent unilateral TLIF. The most common cause of contralateral symptoms was a contralateral foraminal stenosis in 22 (68.8%), screw malposition in 4 (12.5%), newly developed herniated nucleus pulposus in 3 (9.3%), hematoma in 1 (3.1%), and unknown origin in 2 patients (6.3%). 16 (50.0%) of the 32 patients received revision surgery. There was no difference in visual analogue scale and Oswestry disability index between the two groups at discharge. Both preoperative and postoperative contralateral foraminal areas were significantly smaller, and postoperative segmental angle was significantly greater in the symptomatic group comparing to those of the asymptomatic group (p<0.05). Conclusion : The incidence rate is not likely to be small (5.9%). If unilateral TLIF is performed for cases when preoperative contralateral foraminal stenosis already exists or when a large restoration of segmental lordosis is required, the probability of developing contralateral radiculopathy is increased and caution from the surgeon is needed.

• The Korean Journal of Pain
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• v.22 no.1
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• pp.83-87
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• 2009

Case reports after accidental subdural injection during attempted epidural block have usually described extensive neuraxial blocks with a characteristic radiographic appearance on contrast injection. We experienced a case of cervical subdural injection with unusual clinical findings and radiographic appearance. A 51-year-old female patient with central herniated nucleus pulposus at cervical (C5/6) and lumbar level (L4/5, L5/S1) was referred to the pain clinic. During attempted cervical epidural block at the C6/7 interspace with fluoroscopy, injection of the 4 ml contrast showed posterior spread at cervical level. After cervical epidural steroid injection, the contrast was also confined to the posterior aspect of the spinal canal at lumbar level with fluoroscopy. In order to discriminate subdural space from epidural space, we performed transforaminal epidural injection of the 2 ml contrast at the L5/S1 interspace and we could confirm cervical epidural injection was made into the subdural space. We discuss the clinical characteristics of a subdural injection and the appearance of the cervical and lumbar subdurogram.