• 한방재활의학과학회지
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• 제31권3호
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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.

• Investigative Magnetic Resonance Imaging
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• 제22권1호
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• pp.18-25
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• 2018

Purpose: To investigate the various imaging factors associated with aggravation of lumbar disc herniation (LDH) and develop a scoring system for prediction of LDH aggravation. Materials and Methods: From 2015 to 2017, we retrospectively reviewed the magnetic resonance imaging (MRI) findings of 60 patients (30 patients with aggravated LDH and 30 patients without any altered LDH). Imaging factors for MRI evaluation included the level of LDH, disc degeneration, back muscle atrophy, facet joint degeneration, ligamentum flavum thickness and interspinous ligament degeneration. Flexion-extension difference was measured with simple radiography. The scoring system was analyzed using receiver operating characteristic (ROC) analysis. Results: The aggravated group manifested a higher grade of disc degeneration, back muscle atrophy and facet degeneration than the control group. The ligamentum flavum thickness in the aggravated group was thicker than in the group with unaltered LDH. The summation score was defined as the sum of the grade of disc degeneration, back muscle atrophy and facet joint degeneration. The area under the ROC curve showing the threshold value of the summation score for prediction of aggravation of LDH was 0.832 and the threshold value corresponded to 6.5. Conclusion: Disc degeneration, facet degeneration, back muscle atrophy and ligamentum flavum thickness are important factors in predicting aggravation of LDH and may facilitate the determination of treatment strategy in patients with LDH. The summation score is available as supplemental data.

• 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.

• 대한정형도수물리치료학회지
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• 제2권1호
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• pp.39-49
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• 1996

The techniques of joint mobilization and traction are used to improve joint mobility or to decrease pain by restoring accessory movements to the shoulder joints and thus allowing full, nonrestriced, pain-free range of motion. In the glenohumeral joint, the humeral head would be the convex surface, while the glenoid fossa would be the concave surface. The medial end of the clavicle is concave anterioposteriorly and convex superioinferiorly, the articular surface of the sternum is reciprocally curved. The acromioclavicular joint is a plane synovial joint between a small convex facet on lateral end of the clavicle and a small concave facet on the acromion of the scapula. The relationship between the shape of articulating joint surface and the direction of gliding is defined by the convex-concave rule. If the concave joint surface is moving on a stationary convex surface, gliding occur in the same direction as the rolling motion. If the convex surface is moving on a stationary concave surface, gliding will occur in an opposite direction to rolling. Hypomobile shoulder joint are treated be using a gliding technique.

• 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.

• The Korean Journal of Pain
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• 제18권2호
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• pp.246-250
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• 2005

Facet joint synovial cysts are uncommon intraspinal abnormalities, which appear to be secondary to degenerative changes of the joints. They can cause chronic back pain and radiculopathy, as shown in spinal stenosis. When symptomatic cysts fail to respond to conservative measurements, surgical decompression is known as the standard treatment. Percutaneous steroid injections, and distension of the cysts under fluoroscopic guidance, may be a minimally invasive treatment option. Here, the case of a patient with a symptomatic L5-S1 facet joint synovial cyst and left S1 radiculopathy, who responded satisfactorily to percutaneous treatment, is presented.

• The Korean Journal of Pain
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• 제31권1호
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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.

• 한방재활의학과학회지
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• 제15권2호
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• pp.183-191
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• 2005

Objectives : The 5th lumbar - 1st sacrum facet joint is unstable area from an anatomical viewpoint, so that it is clinically major causes of low back pain. The purpose of this study is to assess the difference of the Van Akkerveeken measurement and intervertebral disc angle, Ferguson angle betwoon the 5th lumbar - 1st sacrum facet syndrome patients and sample group patients.Methods : Van Akkerveeken measurement, intervertebral disc angle and Ferguson angle were measured in 30 patients who had 5th lumbar - 1st sacrum facet syndrome and 31 sample group patients.Results :1. Van Akkerveeken measurement of 5th lumbar - 1st sacrum facet syndrome patients is statistically larger that of than sample group patients.2. Intervertebral disc angle of the 5th lumbar - 1st sacrum facet syndrome patients is statistically larger that of than sample group patients.3. Ferguson angle is the 5th lumbar - 1st sacrum facet syndrome patients is statistically larger than that of sample group patients.Conclusions : These results suggest that Van Akkerveeken measurement and intervertebral disc angle is able to be used for diagnosis of facet syndrome.

• 한국전문물리치료학회지
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• 제2권2호
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• pp.108-118
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• 1995

The techniques of joint mobilization and traction are used to improve joint mobility or to decrease pain by restoring accessory movements to the shoulder joints and thus allowing full, nonrestriced, pain-free range of motion. In the glenohumeral joint, the humeral head would be the convex surface, while the glenoid fossa would be the concave surface. The medial end of the clavicle is concave anterioposteriorly and convex superioinferiorly, the articular surface of the sternum is reciprocally curved. The acromioclavicular joint is a plane synovial joint between a small convex facet on lateral end of the clavicle and a small concave facet on the acromion of the scapula. The relationship between the shape of articulating joint surface and the direction of gliding is defined by the Convex-Concave Rule. If the concave joint surface is moving on a stationary convex surface, gliding occur in the same direction as the rolling motion. If the convex surface is moving on a stationary concave surface, gliding will occur in an opposite direction to rolling. Hypomobile shoulder joints are treated be using a gliding technique.

• The Korean Journal of Pain
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• 제9권2호
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• pp.390-394
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• 1996

Background: Occipital neuralgia is characterized by pain, usually deep and aching, in the distribution the second and/or third cervical dorsal root. Two broad groups of patients include primary occipital neuralgia with no apparent etiology and secondary neuralgia with structural pathology. Patients with occipital neuralgia can develop autonomic changes and hyperesthesia. In patients who have not improved with conservative treatment, we have carried out various nerve blocks and evaluated the effectiveness. Methods: In a series of 20 occipital neuralgia patients with no apparent etiolgy, we have carried out great occipital nerve blocks with needle TEAS. In patients who have not improved more than 75% on VAS with great occipital block, we have carried out C2 ganglion blocks and in patients who have not improved more than 75% with C2 ganglion block, C3 root blocks, C2/C3 facet joint blocks have been carried out in due order. Results: In 3 patients out of 10 patients who have not improved with great occipital nerve block, C2 ganglion block led to pain relief. A good response of C3 root block was achived in 2 of 7 patients without response to C2 ganglion block and C2/C3 facet joint block led to improvement in 1 of 5 patients without response to C3 root block. Conclusions: Nerve blocks like great occipital nerve block, C2 ganglion block, C3 root block, or C2/C3 facet joint block were effective in the patients who have not improved with conservative treatment.