• The Korean Journal of Pain
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• v.20 no.1
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• pp.31-39
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• 2007

Background: Cervical radicular pain can arise fromvarious structures, including spinal nerves, discs, zygapophyseal joints, ligaments, and myofascial connective tissue. However, no adequate experiments have been found regarding methods for the microadhesiolysis of adhesional connective tissue around the zygapophyseal joints and nerves. The first objective of this study was to ascertain the effect of fluoroscopy guided interventional microadhesiolysis and nerve stimulation (FIMS) on chronic cervical radicular pain caused by zygapophyseal joint dysfunction. The second objective was to identify the duration of pain alleviation, as well as commonly occurring regions for zygapophyseal joint dysfunction. Methods: Twenty-eight patients were diagnosed with cervical radicular pain. The cervical zygapophyseal joints and adhesional structures around the cervical zygapophyseal joints were stimulated by adhesiolysis with a rounded needle; the procedure was performed once every second week. A visual analogue scale (VAS) for pain and neck range of motion (ROM) were used as indices for evaluating the degree of pain 1 and 3 months after completion of the procedures. A relief effect of FIMS was accepted when the VAS index decreased 50% compared with a previous VAS, and when there was absence of limitation of ROM. Results: Among the patients, 52% showed zygapophyseal joint dysfunction in C5-6, 38% in C4-5, 7% in C2-3, and 3% in C6-7. After performing FIMS, the VAS index decreased in most of the patients after 1 and 3 months (92.8% and 75%, respectively), and treatment frequency was $2.7{\pm}1.2$. There was no correlation between the number of FIMS procedures and the degree of VAS. Conclusions: FIMS is considered an effective modality in patients suffering from cervical radicular pain.

• The Korean Journal of Pain
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• v.28 no.4
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• pp.275-279
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• 2015

Facet joint synovial cysts are usually associated with osteoarthritis of the adjacent facet joint and/or spondylolisthesis. In between the conservative and operative ends of the treatment spectrum lie minimally invasive techniques such as cyst rupture using epiduroscopy. In this report, we describe an 82-year-old male patient presenting with low back pain radiating to his lower left extremity and associated paresthesia. Magnetic resonance imaging of the lumbar spine revealed a synovial cyst at left L4/5 facet joint. Using epiduroscopy, the cyst was mechanically ruptured by popping it with the tip of the scope. The patient remained symptom-free at his successive visits until 12 months after the procedure, and was opened for desired follow up.

• The Korean Journal of Pain
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• v.37 no.1
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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.

• Journal of the Korean Society of Radiology
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• v.85 no.1
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• pp.54-76
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• 2024

Facet joint arthrosis is a progressive degenerative disease that is frequently associated with other spinal degenerative disorders such as degenerative disc disease or spinal stenosis. Lumbar facet joint arthrosis can induce pain in the proximal lower extremities. However, symptoms and imaging findings of "facet joint syndrome" are not specific as they mimic the pain from herniated discs or nerve root compression. Currently, evidence for therapeutic intra-articular lumbar facet joint injections is still considered low, with a weak recommendation strength. Nevertheless, some studies have reported therapeutic effectiveness of facet joint injections. Moreover, the use of therapeutic facet joint injections in clinical practice has increased. This review article includes opinions based on the authors' experience with facet joint injections. This review primarily aimed to investigate the efficacy of lumbar facet joint injections and consider their associated safety aspects.

• Journal of Korean Medicine Rehabilitation
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• v.32 no.3
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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.

• Journal of Korean Medicine Rehabilitation
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• v.31 no.3
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• pp.85-93
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• 2021

Objectives This study aims to compare the effect of an ultrasound on a guided group and an unguided group on Soyeom pharmacopuncture therapy on the facet joint in patients with acute low back pain caused by traffic accidents. Methods 21 patients with acute low back pain caused by traffic accidents from March 1, 2021 to May 31, 2021 were included in this study. The study was conducted as a retrospective study which analyzes the patient's medical records. 11 patients (Group A) received ultrasound guided Soyeom pharmacopuncture therapy and 10 patients (Group B) received unguided Soyeom pharmacopuncture therapy on the facet joint. Visual analogue scale (VAS) and Oswestry disability index (ODI) was used to evaluate improvements in functions and pain, and five point Likert scale to evaluate patient's satisfaction. Results Both groups showed a statistically significant decrease in the VAS and ODI on the 5th day of hospitalization. However, there was no statistically significant difference between the groups. Difference in the Likert scale between the groups was not statistically significant either. Conclusions We found that ultrasound guided Soyeom pharmacopuncture therapy on the facet joint showed similar efficacy compared with unguided Soyeom pharmacopuncture therapy at facet joint on acute low back pain patients caused by traffic accidents.

• The Korean Journal of Pain
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• v.31 no.1
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• pp.27-38
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• 2018

Background: Related to escalating health care costs and the questionable effectiveness of multiple interventions including lumbar facet joint interventions, cost effectiveness or cost utility analysis has become the cornerstone of evidence-based medicine influencing coverage decisions. Methods: Cost utility of therapeutic lumbar facet joint nerve blocks in managing chronic low back pain was performed utilizing data from a randomized, double-blind, controlled trial with a 2-year follow-up, with direct payment data from 2016. Based on the data from surgical interventions, utilizing the lowest proportion of direct procedural costs of 60%, total cost utility per quality adjusted life year (QALY) was determined by multiplying the derived direct cost at 1.67. Results: Patients in this trial on average received $5.6{\pm}2.6$ procedures over a period of 2 years, with average relief over a period of 2 years of $82.8{\pm}29.6$ weeks with $19{\pm}18.77$ weeks of improvement per procedure. Procedural cost for one-year improvement in quality of life showed USD $2,654.08. Estimated total costs, including indirect costs and drugs with multiplication of direct costs at 1.67, showed a cost of USD $4,432 per QALY. Conclusions: The analysis of therapeutic lumbar facet joint nerve blocks in the treatment of chronic low back pain shows clinical effectiveness and cost utility at USD $2,654.08 for the direct costs of the procedures, and USD $4,432 for the estimated overall cost per one year of QALY, in chronic persistent low back pain non-responsive to conservative management.

• The Korean Journal of Pain
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• v.28 no.2
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• pp.105-108
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• 2015

Background: The most definitive diagnosis of neck pain caused by facet joints can be obtained through cervical medial branch blocks (CMBBs). However, intravascular injections need to be carefully monitored, as they can increase the risk of false-negative blocks when diagnosing cervical facet joint syndrome. In addition, intravascular injections can cause neurologic deficits such as spinal infarction or cerebral infarction. Digital subtraction angiography (DSA) is a radiological technique that can be used to clearly visualize the blood vessels from surrounding bones or dense soft tissues. The purpose of this study was to compare the rate of detection of intravascular injections during CMBBs using DSA and static images obtained through conventional fluoroscopy. Methods: Seventy-two patients were included, and a total of 178 CMBBs were performed. The respective incidences of intravascular injections during CMBBs using DSA and static images from conventional fluoroscopy were measured. Results: A total of 178 CMBBs were performed on 72 patients. All cases of intravascular injections evidenced by the static images were detected by the DSAs. The detection rate of intravascular injections was higher from DSA images than from static images (10.7% vs. 1.7%, P < 0.001). Conclusions: According to these findings, the use of DSA can improve the detection rate of intravascular injections during CMBBs. The use of DSA may therefore lead to an increase in the diagnostic and therapeutic value of CMBBs. In addition, it can decrease the incidence of potential side effects during CMBBs.

• The Journal of Korean Academy of Orthopedic Manual Physical Therapy
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• v.12 no.1
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• pp.57-67
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• 2006

Musculoskeletal neck dysfunction syndromes are common in outpatient musculoskeletal pain practice. The underlying musculoskeletal and neurologic causes of pain are variable. In the management of these patients, it is important to accurately identify and treat these pain generators to optimize patient outcome. It is the purpose of this review to discuss three main categories of functional anatomy, the role of superficial/deep muscular system and the scientific evidence for optimal physical therapy intervention for cervical dysfunction. Specifically there is evidence of lowered microcirculation in the upper trapezius muscle, morphological signs of disturbed mitochondrial function which appears to be limited to type I fibers and an increased cross-sectional area of type I muscle fibers despite a lower capillary to fiber area ratio. In acute neck pain syndrome, changes in muscle activity of painful muscles may result from segmental and supraspinal inhibitory effects. Muscle activation is closely related to the control of joint movements and postures and it is difficult to separate the influence of the two components. Both the altered muscle recruitment patterns and altered kinematics appear to be a poor adaptation for pain of the head - neck region, as they are likely to result in increased compressive loading in the cervical spine, affecting muscles, articular structures such as zygapophyseal joints, connective tissues and neural tissues which are all peripheral generators of referred pain. The rectus capitus posterior minor muscle shows that it is one of the most important muscles of the suboccipital region. In this article, i reviewed the anatomy, neurophysiology, function and dysfunction as well as the treatment of cervical dysfunction.

• Journal of Korean Neurosurgical Society
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• v.60 no.5
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• pp.550-559
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• 2017

Objective : Subsidence is a frequent complication of anterior cervical discectomy and fusion. Postoperative segmental micromotion, thought to be a causative factor of subsidence, has been speculated to increase with uncinate process resection area (UPR). To evaluate the effect of UPR on micro-motion, we designed a method to measure UPR area based on pre- and postoperative computed tomography images and analyzed the relationship between UPR and subsidence as a proxy of micro-motion. Methods : We retrospectively collected clinical and radiological data from January 2011 to June 2016. A total of 38 patients (53 segments) were included. All procedures included bilateral UPR and anterior plate fixation. UPR area was evaluated with reformatted coronal computer tomography images. To reduce level-related bias, we converted UPR area to the proportion of UPR to the pre-operative UP area (pUPR). Results : Subsidence occurred in 18 segments (34%) and positively correlated with right-side pUPR, left-side pUPR, and the sum of bilateral pUPR (sum pUPR) (R=0.310, 301, 364; p=0.024, 0.029, 0.007, respectively). Multiple linear regression analysis revealed that subsidence could be estimated with the following formula : $subsidence=1.522+2.7{\times}sum\;pUPR$($R^2=0.133$, p=0.007). Receiver-operating characteristic analysis determined that sum $pUPR{\geq}0.38$ could serve as a threshold for significantly increased risk of subsidence (p=0.005, area under curve=0.737, sensitivity=94%, specificity=51%). This threshold was confirmed by logistic regression analysis for subsidence (p=0.009, odds ratio=8.471). Conclusion : The UPR measurement method confirmed that UPR was correlated with subsidence. Particularly when the sum of pUPR is ${\geq}38%$, the possibility of subsidence increased.