• The Korean Journal of Physiology
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• v.25 no.2
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• pp.211-221
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• 1991

Although the existence of nerve cells which determine the activity of sympathetic nervous system in ventrolateral medulla is advocated recently, there are wide varieties on the location and function of them according to authors. Present study aimed to identify and characterize the medullospinal tract cells in rostral and caudal medulla of cats .which branch to the lateral horn of the upper thoracic spinal cord. Cats were anesthetized with ${\alpha}-chloralose$. The upper thoracic spinal cord and floor of the IVth ventricle were exposed. Medullospinal tract cells in rostral and caudal medulla were identified by anti-dromic stimulation of the intermediolateral nucleus in the upper thoracic cord and then the location and physiological characteristics of these cells were studied. A total of seventy cells in medulla had constant latency and responded to high frequency stimulation to thoracic cord. Among them fifty-six cells were identified as medullospinal tract cells either by collision with spontaneous activities or activities evoked by sciatic nerve stimulation(27/56), or by determining the refractory period (29/56). Thirty-one of these cells branched to the contralateral thoracic spinal cord, twenty-one cells to the ipsilateral side and remaining four cells branched to both sides. The conduction velocity of cells branching to the contralateral side was $29{\pm}2.9\;m/sec$ and that of cells to the ipsilateral side was $39.1{\pm}6.0\;m/sec$. When medulla was devided into two by a horizontal plane at 3 mm rostral to the obex, fifty-one among seventy cells were in the rostral medulla and nineteen were in the caudal medulla. The conduction velocities of these two groups were $21.6{\pm}1.0\;and\;33.3{\pm}3.9\;m/sec$, respectively. In this study, we confirmed the existence of two groups of medullospinal tract cells in rostral and caudal ventrolateral medulla, which branch to the lateral horn of thoracic cord and these cells have relatively few spontaneous activities and rapid conduction velocity, so we concluded that these cells are different from the previously known sympatho-related cells in ventrolateral medulla.

• The Korean Journal of Pain
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• v.19 no.2
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• pp.146-151
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• 2006

Background: Spinal cord stimulation is a well-established method for the management of several types of chronic and intractable pain. This form of stimulation elicits a tingling sensation (paresthesia) in the corresponding dermatomes. The goal of this study was to establish a correlation between the spinal levels of the implanted epidural electrodes and the paresthesia elicited due to stimulation of the neural structures. Methods: Thirty five patients, who received trial spinal cord stimulation, were evaluated. After the insertion of the lead to the selected position, the areas of paresthesia evoked by stimulation were evaluated. Results: Seventy-one percent of cases showed paresthesia in the shoulder area when the tip of the electrode was located between the C2⁣-C4 levels. At the upper extremities, paresthesia was evoked in 86⁣-93% of cases, regardless of the location of the electrode tip within the cervical spinal segments. The most common tip placement of the leads eliciting hand stimulation was at the C5 level. The most common level of electrode tip placement eliciting paresthesia of the anterior and posterior thigh and the foot were at the T7-⁣T12, T10⁣-L1 and T11-⁣L1 vertebral segments, respectively. Conclusions: Detailed knowledge of the patterns of stimulation induced paresthesia in relation to the spine level of the implanted electrodes has allowed the more consistent and successful placement of epidural electrodes at the desired spine level.

• The Korean Journal of Pain
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• v.21 no.3
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• pp.244-247
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• 2008

After a traumatic brachial plexus injury, 80% of patients develop severe pain in the deafferentated arm. This type of pain is considered very resistant to many forms of therapy. When we plan treatments for the patient who suffer from a pain from traumatic brachial plexus injury, clarifying the location of injured nerve is very important. EMG (electromyography), NCV (nerve conduction study), MRI (magnetic resonance imaging) and CT (computed tomography) myelography are recommended diagnostic method for this purpose. Here, we presented a patient who was suspected to have both preganglionic and postganglionic brachial plexus lesion by EMG and NCV study, he showed favorable response after spinal cord stimulation.

• Journal of Korean Neurosurgical Society
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• v.38 no.3
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• pp.234-237
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• 2005

The neuropathic pain caused by lumbosacral plexopathy as a sequela to extensive pelvic and sacral fractures is rare because many posttraumatic cases remain undiagnosed as a result of the high mortality associated with these types of injury and because of the survivors of multiple trauma, including pelvic fractures, frequently have an incomplete work-up. Although surgical treatments for medically refractory lumbosacral plexus avulsion pain have been reported, an effective surgical technique for pain relief in lumbosacral plexopathy has not been well documented. We describe the effectiveness of spinal cord stimulation [SCS] in a patient suffering from severe neuropathic pain caused by lumbosacral plexopathy after an extensive pelvic fracture.

• Journal of Korean Neurosurgical Society
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• v.54 no.6
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• pp.501-506
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• 2013

Objective : Spinal cord stimulation (SCS) is an effective means of treatment of chronic neuropathic pain from failed back surgery syndrome (FBSS). Because the success of trial stimulation is an essential part of SCS, we investigated factors associated with success of trial stimulation. Methods : Successful trial stimulation was possible in 26 of 44 patients (63.6%) who underwent insertion of electrodes for the treatment of chronic pain from FBSS. To investigate factors associated with successful trial stimulation, patients were classified into two groups (success and failure in trial). We investigated the following factors : age, sex, predominant pain areas (axial, limb, axial combined with limbs), number of operations, duration of preoperative pain, type of electrode (cylindrical/paddle), predominant type of pain (nociceptive, neuropathic, mixed), degree of sensory loss in painful areas, presence of motor weakness, and preoperative Visual Analogue Scale. Results : There were no significant differences between the two groups in terms of age, degree of pain, number of operations, and duration of pain (p>0.05). Univariate analysis revealed that the type of electrode and presence of severe sensory deficits were significantly associated with the success of trial stimulation (p<0.05). However, the remaining variable, sex, type of pain, main location of pain, degree of pain duration, degree of sensory loss, and presence of motor weakness, were not associated with the trial success of SCS for FBSS. Conclusion : Trial stimulation with paddle leads was more successful. If severe sensory deficits occur in the painful dermatomes in FBSS, trial stimulation were less effective.

• The Korean Journal of Physiology
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• v.28 no.2
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• pp.113-122
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• 1994

The present study was carried out to characterize the functional properties of spinomesencephalic tract (SMT) neurons in the lumbar spinal cord of urethane anesthetized rats. Extracellular single unit recordings were made from neurons antidromically activated by stimulation of the midbrain area, including the deep layers of superior colliculus, periaqueductal gray and midbrain reticular formation. Recording sites were located in laminae I-VII of spinal cord segments of L2-L5. Receptive field properties and responses to calibrated mechanical stimulation were studied in 78 SMT cells. Mean conduction velocity of SMT neurons was $19.1{\pm}1.04\;m/sec$. SMT units were classified according to their response profiles into four groups: wide dynamic range (58%), deep/tap (23%), high threshold (9%) and low threshold (3%). A simple excitatory receptive field was found for most SMT neurons recorded in superficial dorsal horn (SDH). Large complex inhibitory and/or excitatory receptive fields were found for cells in lateral reticulated area which usually showed long after-discharge. Most of SMT cells received inputs from $A{\delta}$ and C afferent fiber types. These results suggest that sensory neurons in the rat SMT may have different functional roles according to their location in the spinal cord in integrating and processing sensory inputs including noxious mechanical stimuli.

• The Korean Journal of Physiology and Pharmacology
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• v.12 no.6
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• pp.299-306
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• 2008

Sometimes, spinal cord injury (SCI) results in various chronic neuropathic pain syndromes that occur diffusely below the level of the injury. It has been reported that behavioral signs of neuropathic pain are expressed in the animal models of contusive SCI. However, the observation period is relatively short considering the natural course of pain in human SCI patients. Therefore, this study was undertaken to examine the time course of mechanical and cold allodynia in the hindpaw after a spinal cord contusion in rats for a long period of time (30 weeks). The hindpaw withdrawal threshold to mechanical stimulation was applied to the plantar surface of the hindpaw, and the withdrawal frequency to the application of acetone was measured before and after a spinal contusion. The spinal cord contusion was produced by dropping a 10 g weight from a 6.25 and 12.5 mm height using a NYU impactor. After the injury, rats showed a decreased withdrawal threshold to von Frey stimulation, indicating the development of mechanical allodynia which persisted for 30 weeks. The withdrawal threshold between the two experimental groups was similar. The response frequencies to acetone increased after the SCI, but they were developed slowly. Cold allodynia persisted for 30 weeks in 12.5 mm group. The sham animals did not show any significant behavioral changes. These results provide behavioral evidence to indicate that the below-level pain was well developed and maintained in the contusion model for a long time, suggesting a model suitable for pain research, especially in the late stage of SCI or for long term effects of analgesic intervention.

• Journal of Korean Physical Therapy Science
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• v.10 no.1
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• pp.180-189
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• 2003

The experiments were designated to evaluate the anti-nociceptive effect of low power laser stimulation on acupoint or non-acupoint using arthrogenic solution induced poly arthritis animal model. Evaluation of potential antinociceptive effect of low power laser on arthritis has employed measurements of the foot bending test, the development of either thermal or mechanical hyperalgesia following the arthritis induction. The analysis of thermal hyperalgesia includes Hargreaves's method. Randall-Sellitto test was utilized for evaluating mechanical hyperalgesia. In addition, the antinociceptive effect of low power laser stimulation on arthritis induced spinal Fos expression was analyzed using a computerized image analysis system. The results were summerized as follows: 1. In laser stimulation on acupoint treated animal, laser stimulation dramatically inhibited the development of pain in foot bending test as compared to those of non acupoint treated animal group and non treated animal group. 2. The threshold of thermal stimulation was significantly increased by low power laser stimulation on acupoint as compared to that of non treated control group. 3. Laser stimulation on acupoint dramatically attenuated the development of mechanical hyperalgesia as compared to that of non treated group. 4. Low power laser stimulation on acupoint significantly suppressed arthritis induced Fos expression in the lumbar spinal cord at 3 week post arthritis induction. In conclusion, the results of the present study demonstrated that low power laser stimulation on acupoint has potent anti-nociceptive effect on arthritis. Additional supporting data for an antinociceptive effect of laser stimulation was obtained using Fos immunohistochemical analysis on spinal cord section. Those data indicated that laser stimulation induced antinociception was mediated by suppression of spinal neuron activity in pain sensation.

• Journal of Acupuncture Research
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• v.15 no.2
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• pp.17-28
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• 1998

The present study was designed to investigate the effect of different stimulation-duration of high frequency electroacupuncturet(EA) treatment on the neuronal activities in the spinal cord and brainstem using Fos immunohistochemical technique. Three different stimulus-duration was used in this experiment : 30minutes, 1 hour and 2 hours. The summerized results were summerized as follow : 1. The number of Fos expression was significantly increased in the spinal cord dorsal horn depending upon the increase of stimulus-duration (P<0.05). Otherwise, there was no significant difference between 30 minutes EA treated group and anesthetic control. 2. High frequency EA biphasic stimulation significantly enhanced the Fos expression in the DR, middle and rostral portion of PAG LD, and caudal PAG LV after 1 hour and 2 hours treatment. The number of Fos immunoreactive neuron in the brainstem was increased accorcting to the length of stimulus-duration. Those results indicate that at least 1 hour EA treatment was necessary to increase the neuronal activities in the spinal cord and brainstem. Those basic data from this study can be applied to establish the effective treatment of EA for pain control in the clinical field.

• Archives of Plastic Surgery
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• v.37 no.1
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• pp.71-74
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• 2010

Purpose: Nowadays spinal cord stimulator is frequently used for the patients diagnosed as complex regional pain syndrome. The lead is placed above the spinal cord and connected to the stimulation generator, which is mostly placed in the subcutaneous layer of the abdomen. When the complication occurs in the generator inserted site, such as infection or generator exposure, replacement of the new generator to another site or pocket of the abdomen would be the classical choice. The objective of our study is to present our experience of the effective replacement of the existing stimulation generator from subcutaneous layer to another layer in same site after the wound infection at inexpensive cost and avoidance of new scar formation. Methods: A 50-year-old man who was diagnosed as complex regional pain syndrome after traffic accident received spinal cord stimulator, Synergy$^{(R)}$ (Medtronic, Minneapolis, USA) insertion 1 month ago by anesthetist. The patient was referred to our department for wound infection management. The patient was presented with erythema, swelling, thick discharge and wound disruption in the left upper quadrant of the abdomen. After surgical debridement of the capsule, the existing generator replacement beneath the anterior layer of rectus sheath was performed after sterilization by alcohol. Results: Patient's postoperative course was uneventful without any complication and had no evidence of infection for 3 months follow-up period. Conclusion: Replacement of existing spinal cord stimulation generator after sterilization between the anterior layer of rectus sheath and rectus abdominis muscle in the abdomen will be an alternative treatment in wound infection of stimulator generator.