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Lumbar Facet Joint Injection: A Review of Efficacy and Safety (요추 후관절 주사: 임상적 유용성과 안전성에 대한 고찰)

  • Yoonah Do;Eugene Lee;Choong Guen Chee;Joon Woo Lee
    • 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.

Effects of Ovarian Function on the Hypophyseal Gonadotropin Secretion in Rats (흰쥐의 난소기능(卵巢機能)이 하수체(下垂體)의 성선(性腺) 날극(剌戟)호르몬 분비(分泌)에 미치는 영향(影響))

  • Seo, Kil Woong;Kim, Chong Sup;Park, Chang Sik;Lee, Kyu Seung
    • Korean Journal of Agricultural Science
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    • v.16 no.2
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    • pp.169-178
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    • 1989
  • The study was carried out to elucidate the feedback mechanism on the hypothalamo-hypophyseal system from the functional changes of ovary in female rats. One hundred and forty-four mature female rats were lloted into the three groups; ovariectoimzed group, estradiol treated group and intact control group. The varies of 48 heads of rat were completely removed. Forty eight heads of rat were administered with $200{\mu}g$ of estradiol benzoate every 48 hours. Serum FSH, LH and prolactin levels were determined with radioimmunoassay method at 3,6,12,24 ours, and 5,10, and 15days after treatment. The rats were necropsied to measure the weights of hypophysis and to examin the histological changes in the organs. The results obtained were as follows: The weights of hypophysis were increased after ovariectomy and decreased after estradiol injection. The differences in hypophysis weights were significant between the group from 5 days after treatment. The histological changes in hypophysis were appeared from 5th day after ovariectomy. Proliferation and hypertrophy began to occur in basophilic from 10th day after ovariectomy, chromophobes were slightly hypertrophied and acidophilic cells were atrophied. In estradiol injected rats the histological findings were appeard to be contrary to those of ovariectomized rats. Serum FSH levels significantly changed after ovariectomy and estradiol injection and were higher in both the treated groups than in the intact control group. Within 18 hours after treatment the level was the highest in ovariectomized group, and thereafter the highest level was found in estradiol treated gorup. In ovariectomized rats the levels were rapidly increased 3 hours after treatment and maximum levels were found 18 hours after treatment. In estradiol treated rats the levels started to increase 18 hours after treatment and reached maximum levels 24 hours treatment. 4. Serum LH levels started to increase 3 hours after ovariectomy and estradiol injection and reached maximum levels 12 hours after ovariectomy and 24 hours after estradiol injection. There were significant differences in LH levels between the groups in each observation time. Up to 18 hours after treatment levels were higher in ovariectomized rats than in estradiol treated rats. but thereafter the levels were higher in estradiol treated rats than in ovariectomized rats. The multiple range test showed that a significant difference in LH levels was not found between ovariectomized group and estradiol treated group 18 hours and 5 days after treatment. 5. Serum prolactin levels were significantly changed after ovariectomy and estradiol injection. The levels were lower in ovariectomized rats than in intact control rats.

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AN EXPERIMENTAL STUDY ON TUMOR INHIBITORY EFFECT OF RED GINSENG IN MICE AND RATS EXPOSED TO VARIOUS CHEMICAL CARCINOGENS

  • Yun Taik Koo;Yun Yeon Sook;Han In Won
    • Proceedings of the Ginseng society Conference
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    • 1980.09a
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    • pp.87-113
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    • 1980
  • This experiment was carried out to evaluate the effects of Korean ginseng extract on carcinogenesis induced by various chemical carcinogens. Red ginseng extract was used for this study and was administered orally to the experimental animals. Carcinogens that were injected in subscapsular region of ICR newborn mice within 24 hours after birth were 9,10-dimethyl-1,2-benzan-thracene (DMBA), urethane, N-2-fluorenylacetamide(AAF), aflatoxin $B_1$ and tobacco smoke condensate. N -methyl-N -nitroso-N'-nitroguani-dine(MNNG) was injected subcutaneously at the back of wistar rats. Experimental animals were autopsied in immediately after being sacrificed. All major organs were examined grossly and weighted. After fixation histopathological preparations were made for microscopical study. Following results were obtained. In DMBA group sacrificed at the 26th week after the treatment with DMBA, the incidence of lung adenoma was $77\%$ and the average number of the tumor was 17. However, in DMBA combined with red ginseng group, the incidence was $78\%$ and the average number of lung adenoma was 14.1. This indicates that ginseng extract had no effect on the incidence of lung adenoma but decreased the average number of lung adenoma by $17\%.$ In DMBA group sacrificed at the 48th week after the injection of DMBA, the lung adenoma incidence was $88\%.$ The average diameter of the largest lung adenoma was 3.5 cm, the incidence of diffuse pulmonary infiltration was $18\%$ and the average lung weight of male experimental mice was $528.2{\pm}469.1\;gm.$ On the other hand, in DMBA combined with red ginseng group sacrificed at the 48th week, the incidence of lung adenoma was $96\%.$ The average diameter of the largest adenoma was 2.7 cm, the incidence of diffuse pulmonary infiltration was $7\%$ and the average lung weight of male mice was $418.0{\pm}520\;gm.$ These observations show that ginseng extract did not have any inhibitory effect on the incidence of lung adenoma but decreased the average diameter of the largest lung adenoma by $23\%,$ the incidence of duffuse pulmonary infiltration by $63\%$ and the average lung weight of male experimental mice by $21\%.$ From these results we have found that the prolonged administration with ginseng extract showed no inhibitory effect on the incidence of adenoma but it had the inhibitory effect on the proliferation of lung adenomas induced by DMBA. In urethane group sacrificed at the 28th week after the injection of urethane, the incidence of lung adenoma was $94\%$ and the average number of lung adenoma was 8.6. In urethane combined with red ginseng group, the. incidence of lung adenoma was $73\%$ and the average number of adenoma was 6.0. These results indicate that there were $22\%$ decrease of the lung adenoma incidence and $31\%$ decrease of the average number of adenoma in urethane combined with red ginseng group. And in urethane group sacrificed at the 50th week, the incidence of lung adenoma was $98\%$ and the incidence of diffuse pulmonary infiltration was $14\%$. In urethane combined with ginseng group the incidence of lung adenoma was $85\%$ and the incidence of diffuse pulmonary infiltration was $12\%$. Therefore the ginseng administration resulted in $15\%$ decrease of the lung adenoma incidence and $14\%$ decrease of the diffuse pulmonary infiltration incidence. From these results we knew that the prolonged administration with ginseng extract inhibited the incidence and also the proliferation of the lung adenoma induced by urethane. Lung adenoma and hepatoma were induced in the experimental mice sacrificed at the 68th week but not in the experimental mice sacrificed at the 28th week after the injection of AAF. In AAF group sacrificed at the 68th week after the injection of AAF the incidence of lung adenoma was $18\%$ and the incidence of hepatoma was $27\%$. And in AAF combined with ginseng group the lung adenoma incidence was $12\%$ and the hepatoma incidence was $37\%$. So the ginseng seemed to decrease the lung adenoma incidence by AAF, but we were unable to conclude the significant inhibitory effect of the ginseng extract on the incidence of lung adenoma by AAF because the above incidence of lung adenoma were similar to that of control group which was $11\%$. And these experimental data revealed that ginseng extract didn't have any inhibitory effect on the incidence of hepatoma induced by AAF. In aflatoxin $B_1$ group sacrificed at the 56th week, the incidence of lung adenoma was $24\%$ and hepatoma was $11\%$. However in aflatoxin $B_1$ combined with ginseng group the incidence of lung adenoma was $17\%$ and hepatoma was $3\%$ These results indicate that there were $29\%$ decrease of the lung adenoma incidence and $75\%$ decrease of the hepatoma incidence in aflatoxin $B_1$ combined with ginseng group. In tobacco smoke condensate experimental group sacrificed at 67th week, no tumors were induced except just a few lung adenoma. The lung adenoma incidence both in tobacco smoke condensate group and in tobacco smoke condensate combined with ginseng group was $8\%$. And this incidence rate was similar to that of control group. These results indicate that the injection of 320 ug tobacco smoke condensate per ICR newborn mouse was unable to induce lung adenoma in our experiments. In MNNG group sacrificed at the 27th week the tumor incidence was $38.5\%$ and in MNNG combined with ginseng extract group was $37\%$. In MNNG group for investigation of the life span of tumor bearing rats the tumor incidence was $93\%$ and the average life span of tumor bearing rats was 318 days. And in MNNG combined with ginseng extract group the tumor incidence was $96\%$ and the average life span was 337 days. Tumor induced by MNNG was almost sarcoma. This indicates that there was no inhibitory effect of ginseng extract on the tumor incidence, but the extract prolonged the average life span of tumor bearing rats by approximately 19 days.

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Correlation between Epidurographic Contrast Flow Patterns and Clinical Effectiveness in Chronic Lumbar Discogenic Radicular Pain Treated with Epidural Steroid Injections Via Different Approaches

  • Gupta, Ruchi;Singh, Saru;Kaur, Sukhdeep;Singh, Kulvinder;Aujla, Kuljeet
    • The Korean Journal of Pain
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    • v.27 no.4
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    • pp.353-359
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    • 2014
  • Background: Epidural steroid injections are an accepted procedure for the conservative management of chronic backache caused by lumbar disc pathology. The purpose of this study was to evaluate the epidurographic findings for the midline, transforaminal and parasagittal approaches in lumbar epidural steroid injections, and correlating them with the clinical improvement. Methods: Sixty chronic lower back pain patients with unilateral radiculitis from a herniated/degenerated disc were enrolled. After screening the patients according to the exclusion criteria and randomly allocating them to 3 groups of 20 patients, fluoroscopic contrast enhanced epidural steroids were injected via midline (group 1), transforaminal (group 2) and parasagittal interlaminar (group 3) approaches at the level of the pathology. The fluoroscopic patterns of the three groups were studied and correlated with the clinical improvement measured by the VAS over the next 3 months; any incidences of complications were recorded. Results: The transforaminal group presented better results in terms of VAS reduction than the midline and parasagittal approach groups (P < 0.05). The epidurography showed a better ventral spread for both the transforaminal (P < 0.001) and the paramedian approaches (P < 0.05), as compared to the midline approach. The nerve root filling was greater in the transforaminal group (P < 0.001) than in the other two groups. The ventral spread of the contrast agent was associated with improvement in the VAS score and this difference was statistically significant in group 1 (P < 0.05), and highly significant in groups 2 and 3 (P < 0.001). In all the groups, any complications observed were transient and minor. Conclusions: The midline and paramedian approaches are technically easier and statistically comparable, but clinically less efficacious than the transforaminal approach. The incidence of ventral spread and nerve root delineation show a definite correlation with clinical improvement. However, an longer follow-up period is advisable for a better evaluation of the actual outcom.

Enhancement of radiation effect using beta-lapachone and underlying mechanism

  • Ahn, Ki Jung;Lee, Hyung Sik;Bai, Se Kyung;Song, Chang Won
    • Radiation Oncology Journal
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    • v.31 no.2
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    • pp.57-65
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    • 2013
  • Beta-lapachone (${\beta}$-Lap; 3,4-dihydro-2, 2-dimethyl-2H-naphthol[1, 2-b]pyran-5,6-dione) is a novel anti-cancer drug under phase I/II clinical trials. ${\beta}$-Lap has been demonstrated to cause apoptotic and necrotic death in a variety of human cancer cells in vitro and in vivo. The mechanisms underlying the ${\beta}$-Lap toxicity against cancer cells has been controversial. The most recent view is that ${\beta}$-Lap, which is a quinone compound, undergoes two-electron reduction to hydroquinone form utilizing NAD(P)H or NADH as electron source. This two-electron reduction of ${\beta}$-Lap is mediated by NAD(P)H:quinone oxidoreductase (NQO1), which is known to mediate the reduction of many quinone compounds. The hydroquinone forms of ${\beta}$-Lap then spontaneously oxidizes back to the original oxidized ${\beta}$-Lap, creating futile cycling between the oxidized and reduced forms of ${\beta}$-Lap. It is proposed that the futile recycling between oxidized and reduced forms of ${\beta}$-Lap leads to two distinct cell death pathways. First one is that the two-electron reduced ${\beta}$-Lap is converted first to one-electron reduced ${\beta}$-Lap, i.e., semiquinone ${\beta}$-Lap $(SQ)^{{\cdot}-}$ causing production of reactive oxygen species (ROS), which then causes apoptotic cell death. The second mechanism is that severe depletion of NAD(P)H and NADH as a result of futile cycling between the quinone and hydroquinone forms of ${\beta}$-Lap causes severe disturbance in cellular metabolism leading to apoptosis and necrosis. The relative importance of the aforementioned two mechanisms, i.e., generation of ROS or depletion of NAD(P)H/NADH, may vary depending on cell type and environment. Importantly, the NQO1 level in cancer cells has been found to be higher than that in normal cells indicating that ${\beta}$-Lap may be preferentially toxic to cancer cells relative to non-cancer cells. The cellular level of NQO1 has been found to be significantly increased by divergent physical and chemical stresses including ionizing radiation. Recent reports clearly demonstrated that ${\beta}$-Lap and ionizing radiation kill cancer cells in a synergistic manner. Indications are that irradiation of cancer cells causes long-lasting elevation of NQO1, thereby sensitizing the cells to ${\beta}$-Lap. In addition, ${\beta}$-Lap has been shown to inhibit the repair of sublethal radiation damage. Treating experimental tumors growing in the legs of mice with irradiation and intraperitoneal injection of ${\beta}$-Lap suppressed the growth of the tumors in a manner more than additive. Collectively, ${\beta}$-Lap is a potentially useful anti-cancer drug, particularly in combination with radiotherapy.

Laminotomy with Continuous Irrigation in Patients with Pyogenic Spondylitis in Thoracic and Lumbar Spine

  • Kim, Sung-Hyun;Lee, Jung-Kil;Jang, Jae-Won;Seo, Bo-Ra;Kim, Tae-Sun;Kim, Soo-Han
    • Journal of Korean Neurosurgical Society
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    • v.50 no.4
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    • pp.332-340
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    • 2011
  • Objective : Pyogenic spondylitis often results in acute neurological deterioration requiring adequate surgical intervention and appropriate antibiotic treatment. The purpose of this study was to conduct an analysis of the clinical effect of continuous irrigation via laminotomy in a series of patients with pyogenic spondylitis in thoracic and lumbar spine. Methods : The authors conducted a retrospective investigation of 31 consecutive patients with pyogenic thoracic and lumbar spondylitis who underwent continuous irrigation through laminotomy from 2004 to 2008. The study included 22 men and 9 women, ranging in age from 38 to 78 years (mean 58.1 years). The average follow-up duration was 13.4 months (range, 8-34 months). We performed debridement and abscess removal after simple laminotomy, and then washed out epidural and disc space using a continuous irrigation system. Broad spectrum antibiotics were administered empirically and changed according to the subsequent culture result. Clinical outcomes were based on the low back outcome scale (LBOS), visual analogue scale (VAS) score, and Frankel grade at the last follow-up. Radiological assessment involved plain radiographs, including functional views. Results : Common predisposing factors included local injection for pain therapy, diabetes mellitus, chronic renal failure, and liver cirrhosis. Causative microorganisms were identified in 22 cases (70.9%) : Staphylococcus aureus and Streptococcus spp. were the main organisms. After surgery, LBOS, VAS score, and Frankel grade showed significant improvement in most patients. Spinal stability was maintained during the follow-up period, making secondary reconstructive surgery unnecessary for all patients, except one. Conclusion : Simple laminotomy with continuous irrigation by insertion of a catheter into intervertebral disc space or epidural space was minimally invasive and effective in the treatment of pyogenic spondylitis. This procedure could be a beneficial treatment option in patients with thoracolumbar spondylitis combined with minimal or moderate destructive change of vertebrae.

Leonuri Fructus Ameliorates Acute Inflammation via the Inhibition of NF-${\kappa}B$-mediated Nitric Oxide and Pro-inflammatory Cytokine Production (NF-${\kappa}B$ 조절(調節)을 통한 충울자(茺蔚子)의 염증억제효과)

  • Park, Seong Gyu;Jegal, Kyung-Hwan;Jung, Ji Yun;Back, Young Doo;Byun, Sung Hui;Kim, Young Woo;Cho, Il Je;Park, Sang Mi;Kim, Sang Chan
    • Journal of Physiology & Pathology in Korean Medicine
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    • v.28 no.2
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    • pp.178-185
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    • 2014
  • Leonuri Fructus, a semen of Leonuri Herba, has been used for the treatment of menstrual disorders such as amenorrhea, dysmenorrhea and leukorrhea and for the remedy of hyperemia. The present study was conducted to evaluate the anti-inflammatory effects of the Leonuri Fructus extract (Leonurus japonicus Houtt. EtOH extract; LJE) in vivo and in vitro. In vitro study, the MTT assay for cell viability was conducted to determine the non-cytotoxic concentration of LJE treatment in media. The levels of NO were measured with Griess reagent. Pro-inflammatory cytokines were detected by ELISA method. The inflammation-related proteins of this study were detected by immunoblot anlaysis. The increases of NO production and iNOS expression were detected in LPS-treated cells compared with control, but LJE attenuated the increases of NO and iNOS by LPS. LJE reduced the production of TNF-${\alpha}$ and IL-$1{\beta}$ induced by LPS stimulation. LJE suppresses the signaling pathways of NF-${\kappa}B$ and MAPKs in LPS-induced macrophage cells. In vivo study, carrageenan-induced hind paw acute edematous inflammation rat model was used for evaluation of anti-inflammatory activity of LJE. LJE significantly inhibited the increases of hind paw swelling, skin thicknesses and inflammatory cell infiltrations, and decreased the numbers of mast cell induced by carrageenan injection. These results suggest that LJE has an anti-inflammatory therapeutic potential, which is mediated through modulating NF-${\kappa}B$ activation and MAPK phosphorylation. Inhibition of the rat paw edema induced by carrageenan is considered as direct evidence that LJE may be a useful source to treat inflammation.

Synergistic Effect of Oxygen Pressure and Sonophoresis for Skin Permeability (산소 압력과 초음파를 이용한 피부투과도 증대에 관한 연구)

  • 차민석;이철규;윤영로;이원수
    • Journal of Biomedical Engineering Research
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    • v.23 no.3
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    • pp.189-196
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    • 2002
  • Transdermal drug delivery offers an alternative method to the conventional oral and injection delivery method. Its advantages include its ability to deliver drugs directly into systemic circulation. However, there have been restrictions in its application to deliver drugs because of the skin's barrier function. In this study, we try to combine a Sonophoresis and oxygen Pressure method in order to increase the Permeability of the skin. we used water as the compound and by utilizing the skin impedance method. we measured the hydration Permeability of skin Ultrasound was applied using a sonicator(Solcare-U1000. Solco, Korea) operating at a frequency of 1MHz. oxygen Pressure was applied using a compressor(Oxyjet-Pointer, Nora Bode. Germany) operating at a pressure of 2Bar/cm2. Experiment was performed in vivo for 42 People. We divided the subjects into four smaller groups. A different transdermal drug delivery method was applied for each group on the back of their hand. We measured the skin impedance variations on the hand. during a 20-minute time Period. The control group did not show any significant increase or variation of skin impedance to water. In comparison to the control group(Passive diffusion) the hydration Permeability of the ultrasound group and the oxygen Pressure group was approximately 25 and 30 times higher consecutively. Futhermore, the hydration permeability of the combination of ultrasound and oxygen Pressure group was about 70-fold higher in comparison to the control group(passive diffusion) . The results reveal that a combination of ultrasound and oxygen Pressure will significantly enhance transdermal water transport compared when only one of them is used.

Renal Localization of Ga-67 Citrate in Noninfectious Nephritis (비세균성 신염환자에서 신장내 $^{67}Ga-Citrate$ 흡수에 관한 연구)

  • Lee, Kang-Wook;Jeong, Min-Soo;Rhee, Sunn-Kgoo;Kim, Sam-Yong;Shin, Young-Tai;Ro, Heung-Kyu
    • The Korean Journal of Nuclear Medicine
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    • v.26 no.2
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    • pp.318-326
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    • 1992
  • Ga-67 citrate scan has been requested for detection or follow-up of inflammatory or neoplastic disease. Visualization of Ga-67 citrate in the kidneys at 48 and 72 hr post injection is usually interpreted as evidence of renal pathology. But precise mechanisms of abnormal Ga-67 uptake in kidneys were unknown. We undertook a study to determine the clinical value of Ga-67 citrate imaging of the kidneys in 68 patients with primary or secondary nephropathy confirmed by renal biopsy and 66 control patients without renal disease. Renal uptake in 48 to 72 hr images was graded as follows: Grade 0=back-ground activity:1=faint uptake greater than background;2=definite uptake, but less than lumbar vertebrae; 3=same uptake as lumbar vertebrae, but less than liver; 4=same or higher uptake than liver. The results were as follows. 1) 42 of 65 (62%) patients with noninfectious nephritis showed grade 2 or higher Ga-67 renal uptake but only 10 percent of control patients showed similar uptake. 2) In 14 patients with systemic lupus erythematosus, 8 of 9 (89%) patients with lupus nephritis exhibited marked renal uptake 3) 36 of 41 patients (88%) with combined nephrotic syndrome showed Grade 2 or higher renal uptake. 4) Renal Ga-67 uptake was correlated with clinical severity of nephrotic syndrome determined by serum albumin level, 24 hr urine protein excretion and serum lipid levels. 5) After complete remission of nephrotic syndrome, renal uptake in all 8 patients who were initially Grade 3 or 4, decreased to Grade 1 or 0. In conclusion, we think that the mechanism of renal Ga-67 uptake in nephrotic syndrome might be related to the pathogenesis of nephrotic syndrome. In systemic lupus erythematosus, Ga-67 citrate scan is useful in predicting renal involvement.

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Effect of Poria Cocos on the Scopolamine-induced Memory Impairment and Its Underlying Molecular Mechanism (스코폴라민으로 유도된 기억력 손상에 대한 복신의 보호 효과 및 작용기전 연구)

  • JeGal, Kyoung-Hwan;Park, Sung-Jun;Kim, Chang-Yul;Lee, Chan;Park, Jong-Hyun;Jang, Jung-Hee
    • Journal of Physiology & Pathology in Korean Medicine
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    • v.24 no.2
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    • pp.228-235
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    • 2010
  • This study was performed to investigate the memory enhancing effect of Poria cocos Wolf (Hoelen cum radix) against scopolamine-induced amnesia in Sprague-Dawley (SD) rats. To induce amnesia, scopolamine (0.75 mg/kg) was intraperitonically injected into SD rats 30 min before starting behavior tests. We have conducted Morris water-maze and Y-maze tests to monitor learning and memory functions. Poria cocos effectively reversed scopolamine-induced memory impairment in SD rats which was represented by an improvement of mean escape latency in water-maze test and spontaneous alterations in Y-maze test. To elucidate possible molecule mechanism, we have measured mRNA as well as protein expression of acetylcholine esterase (AchE), choline acetyltransferase (ChAT), muscarinic acetylcholine receptor (mAchR), and brain-derived neurotrophic factor (BDNF) using RT-PCR and Western blot analysis, respectively. Poria cocos increased mRNA levels of ChAT and mAchR in rat hippocampus compared with those in the scopolamine-injected amnesic group. In addition, protein expression of ChAT and BDNF was also elevated by Poria cocos intake. Furthermore, as an upstrem regulator, the activation of cAMP response element-binding protein (CREB) was assessed by immunohistochemistry. In this immunohistochemical analysis, the phosphorylation of CREB (p-CREB) was reduced by scopolamine injection, which was restored back to control levels by administration of Poria cocos. These results suggest that Poria cocos may improve memory and cognitive deficit in amnesia and have therapeutic potentials through up-regulation of ChAT, mAchR, and BDNF, which seemed to be mediated by activation of CREB.