Ho Young Gil

Background/Objectives: Atelocollagen is used for soft tissue repair and reconstruction by replacing defective or damaged muscles, membranes, ligaments, and tendons. This study aimed to evaluate the clinical efficacy and safety of additional paraspinal intramuscular injection of atelocollagen on lumbar epidural steroid injection for reducing pain and improving functional capacity of patients with chronic low back pain (CLBP). Methods: We retrospectively enrolled 608 consecutive patients with CLBP who received lumbar epidural steroid injection with or without additional paraspinal intramuscular injection of atelocollagen. The Numerical Rating Scale and the Oswestry Disability Index were used to assess pain and functional capacity, respectively, before the procedure, and three months after the injection. Also, we analyzed the relationship between the additional paraspinal intramuscular injection of atelocollagen and the success rate. Results: Both Numerical Rating Scale and the Oswestry Disability Index scores were significantly reduced in both groups at three months after injection. However, there was a significant difference between the two groups. Furthermore, the success rate was significantly higher in the additional paraspinal intramuscular injection of atelocollagen group. Conclusions: This study’s results showed that additional paraspinal intramuscular injection of atelocollagen on lumbar epidural steroid injection reduced pain and improved functional capacity for patients with CLBP. Therefore, the paraspinal intramuscular injection of atelocollagen may be a promising option for the treatment of patients with CLBP.

Percutaneous plasma disc decompression (PPDD) is a minimally invasive treatment for discogenic low back pain and herniated disc-related symptoms. However, there are no known outcome predictive variables during the procedure. The purpose of this study was to evaluate and validate epidurography as an intra-procedure outcome predictor. We retrospectively enrolled 60 consecutive patients who did not respond to conventional treatments. In the next stage of treatment, PPDD was performed, and the epidurography was conducted before and after the PPDD. We analyzed the relationship between epidurographic improvement and the success rate. The Numerical Rating Scale and the Oswestry Disability Index were used to assess pain and functional capacity, respectively, before the procedure and 1 month after the procedure. The pain reduction and the success rate in the epidurographic improvement group were significantly higher than in the epidurographic non-improvement group. Both the Numerical Rating Scale and the Oswestry Disability Index scores were significantly reduced in both groups, but there was no significant difference in Oswestry Disability Index scores. This study’s results showed that PPDD is an effective treatment method. We also suggested that epidurography may be a potential outcome predictor for ensuring successful outcomes and determining the endpoint of the procedure.

Objective. Nonsurgical spinal decompression therapy (NSDT) is a conservative treatment for the lumbosacral herniated intervertebral disc (L‐HIVD). This study aimed to evaluate the clinical effectiveness of the NSDT and change in disc volume through magnetic resonance imaging (MRI) in subacute L‐HIVD. Methods. Sixty patients with subacute L‐HIVD were randomized into either the decompression group (group D, n = 30) or the nondecompression group (group N, n = 30). In group D, NSDT was performed ten times in eight weeks. In group N, pseudodecompression therapy (no force) was performed with the same protocol. Lower back and lower leg pain intensities and functional improvements were measured by the visual analog scale and the Korean Oswestry Disability Index (K‐ODI). The change in the lumbosacral disc herniation index (HI) was evaluated through a follow‐up MRI three months after the therapy. Results. The lower leg pain intensity in group D was lower than that in group N at two months (p = 0.028). Additionally, there were significantly lower K‐ODI scores in group D at two and three months (p = 0.023, 0.019) than in group N. The change in HI after the therapy was −27.6 ± 27.5 (%) in group D and −7.1 ± 24.9 (%) in group N, with a significant difference (p = 0.017). Approximately 26.9% of patients in group D and no patients in group N showed over 50% reduction in HI (p = 0.031). Conclusion. NSDT may be a suitable treatment option for conservative treatment of subacute L‐HIVD.

Remifentanil has been used to suppress peri-extubation cough. Palonosetron, a 5-HT₃ receptor antagonist, is an effective antiemetic, and 5-HT receptors mediate the cough reflex. We assessed the impact of palonosetron on effect-site concentration (Ce) of remifentanil for preventing emergence cough in females. Forty-five female patients undergoing laparoscopic cholecystectomy randomly received 0.075 mg of palonosetron (n = 21) or normal saline (n = 24) intravenously at the end of surgery. The remifentanil Ce for 50% (EC₅₀) and for 95% (EC₉₅) of patients were estimated via Dixon’s up-and-down method or isotonic regression. Using Dixon’s method, EC₅₀ in the control group (1.33 ± 0.38 ng/mL) was comparable to that of the palonosetron group (1.42 ± 0.75 ng/mL) (p = 0.813). Using isotonic regression, EC₅₀ (83% CIs) and EC₉₅ (95% CIs) did not reveal significant differences between the control and the palonosetron groups (1.17 (0.86–1.43) and 1.90 (1.45–1.96) ng/mL and 0.88 (0.78–1.23) and 2.43 (1.94–2.47) ng/mL, respectively). No difference was found in the remifentanil Ce to suppress emergence cough in the palonosetron group compared with the control group. It may indicate no effect of palonosetron on antitussive activity of remifentanil.

BackgroundNon-surgical spinal decompression therapy has been used for treating the lumbosacral herniated intervertebral disc as one of the conservative treatments. This study aimed to evaluate the effectiveness of the therapy in acute lumbosacral herniated intervertebral disc through magnetic resonance imaging.MethodsProspective, randomized, controlled study. Sixty patients with acute lumbar herniated intervertebral disc were randomized into either the decompression group (n = 30) or non-decompression group (n = 30). In the decompression group, non-surgical spinal decompression therapy was performed ten times in eight weeks. In the non-decompression group, pseudo-decompression therapy (no force) was performed with the same protocol. The change in the lumbosacral disc herniation index was evaluated through follow-up magnetic resonance imaging at three months after the therapy.ResultsThe change in herniation index after the therapy was −27.6 ± 27.5 (%) in the decompression group and −7.1 ± 24.9 (%) in the non-decompression group, with significant difference (P = 0.017). Approximately 26.9% of patients in decompression group and no patients in the non-decompression group showed over 50% reduction in herniation index (P = 0.031).ConclusionNon-surgical spinal decompression therapy can be a good treatment option for conservative treatment of acute lumbosacral herniated intervertebral disc.Trial registrationKorean Clinical Research Information Service (https://cris.nih.go.kr/cris/search/search_result_st01_en.jsp?seq=5355<ype=&rtype=), Registration No. KCT0002614. Registered 26 December, 2017.

Spinal stenosis is a common condition in elderly individuals. Many patients are unresponsive to the conventional treatment. If the transforaminal epidural block does not exert a sufficient treatment effect, percutaneous transforaminal epidural adhesiolysis (PTFA) through the safe-triangle approach using an inflatable balloon catheter can reduce the patients’ pain and improve their functional capacity. We aimed to evaluate the safety and efficacy of the Kambin’s-triangle approach for PTFA using an inflatable balloon catheter and compare this approach to the traditional safe-triangle approach. Thirty patients with chronic unilateral L5 radiculopathy were divided into two groups: the safe-triangle-approach and Kambin’s-triangle-approach groups, with 15 patients each. The success rate of the procedure was assessed. Pain and dysfunction were assessed using the Numerical Rating Scale and Oswestry Disability Index, respectively, before the procedure and at 1 and 3 months after the procedure. The success rate of the procedure was high in both the groups, with no significant difference between the groups. The Numerical Rating Scale and Oswestry Disability Index scores significantly decreased 3 months after the procedure in both the groups, with no significant difference between the groups. For patients in whom the safe-triangle approach for PTFA is difficult, the Kambin’s-triangle approach could be an alternative.

Ho-Jin Lee, Jaewoo Lee, Yeon wook Park, Ho Young Gil, Eunjoo Choi, Francis Sahngun Nahm, and Pyung Bok Lee. Korean J Pain 2019;32:196-205. https://doi.org/10.3344/kjp.2019.32.3.196

Purpose: Complex regional pain syndrome (CRPS) is a rare but refractory pain disorder. Recent advanced information retrieval studies using text-mining and network analysis have suggested nuclear factor kappa B (NFκB) as a possible central mediator of CRPS. The brain is also known to play important roles in CRPS. The aim of this study was to evaluate changes in cerebral NFκB in rats with CRPS. Materials and methods: The chronic post-ischemia perfusion (CPIP) model was used as the CRPS animal model. O-rings were applied to the left hind paws of the rats. The rats were categorized into three groups according to the results of behavioral tests: the CPIP-positive (A) group, the CPIP-negative (B) group, and the control (C) group. Three weeks after the CPIP procedure, the right cerebrums of the animals were harvested to measure NFkB levels using an ELISA. Results: Animals in group A had significantly decreased mechanical pain thresholds (PP=0.024). Conclusion: This finding indicates that peripheral injury increases cerebral NFκB levels and implies that minor peripheral injury can lead to the activation of pain-related cerebral processes in CRPS.