Bovie R 를 이용한 Percutaneous Lumbar Medial Branch Neurotomy

신근만(Keun Man Shin),김종균(Jong Gyoon Kim),김수 대한통증학회 1995 The Korean Journal of Pain Vol.8 No.2

The first lesion in neural tissue produced by electrical currents were made in the l9th century by workers using direct current. In 1953, Sweet and Mark clearly demonstrated that DC lesions have unpredictable and ragged borders and may vary in size. They, as well as Hunsperger and Wyss, sug- gested that the use of high frequency currents might provide improved results and were proved correct. However, Bovie electrosurgical unit may also be used in percuta- neous medial branch neurotomy if a lesion made at a point or the dorsal surface of the transverse process just caudal to the most medial end of the superior edge of the transverse process(Bogduks method). At this point the medial branch lies on the bone and its depth and medial displacement are defined by the bone which precludes the need for lateral radiographs to check placement. A lesion was made at same target point using the Bovie electrosurgical unit in a 41 year male patient who had received a Kaneda operation because of L2 compression fracture. The patient was relieved of pain without any adverse effects.

고주파열응고를 이용한 정위적 접형구개신경절절개술

신근만(Keun Man Shin) 대한통증학회 1999 The Korean Journal of Pain Vol.12 No.2

The sphenopalatine ganglion lies behind the middle nasal concha in the sphenopalatine foramen which connects the fossa to the nasal cavity. It has sympathetic and parasympathetic fibers as well as sensory fibers which innervate the nasal cavity, palate and nasopharynx. Current indications for blockade of the sphenopalatine ganglion include the management of migraine, cluster headache and a variety of facial neuralgias. Blockage of this ganglion can be attempted when more conservative treatments have failed. If the pain relief gained through the procedure is of short duration and the blockage needs to be repeated frequently, then radiofrequency thermocoagulation should be considered. Since the sphenopalatine ganglion lies close to the maxillary nerve, neurolytics can cause facial dysesthesia, radiofrequency thermocoagulation is the preferred method for ganglionotomy. Radiofrequency thermocoagulation of the sphenopalatine ganglion was done for 3 patients who suffered from postherpetic neuralgia, cluster headache, atypical facial pain respectively. Good results were obtained with the exception of the patient suffering from atypical facial pain. Although we were concerned about complications such as epistaxis, none were encountered. However it should be noted that caution must be exercised when repeatedly redirecting the cannula in the sphenopalatine fossa as serious bleeding and pronounced facial swelling may result.

경막외 스테로이드 주입에 의한 경부 신경근증의 치료

신근만(Keun Man Shin),홍순용(Soon Yong Hong),최영 대한통증학회 1991 The Korean Journal of Pain Vol.4 No.2

N/A Cervical epidural steroid injection, although not as familiar to many anesthesiologists, can be useful in the management of patients with acute and chronic neck, shoulder and arm pain. My clinic personally contacted and interviewed thirty patients with cervical radiculopathy who re- ceived cervical epidural steroid injection. Twenty seven percent of the patients had a excellent response(greater than 75% improvement) and fifty percent of the patients had a good response (greater than 50% improvement) to an injection of steroid into the cervical epidural space. We have conciuded that cervical epidural steroid injection was very effective in the management of cervical radiculopathy and represented a possible alternative to surgery. Many anesthesiologists should add to their armamentarium the use of such techniques in the man- agement of cervical radiculopathy.

환추축관절 차단술

신근만(Keun Man Shin),윤선혜(Seon Hye Yun) 대한통증학회 1999 The Korean Journal of Pain Vol.12 No.2

Until several years ago we didn't think seriously about cervical problems as a cause of headaches, but since the publication of articles by Bogduk et al they have gotten more attention. Cervical headaches are associated with movement abnormalities of the structures of the neck such as cervical nerve roots, discs, joints and soft tissues. Considering this, we thought that the atlanto-axial joint could be one of the causes of these headaches. Headaches originating from this joint can be recognized by the fact that the pain worsens with rotation of the head in the horizontal plane. Pain can also be referred to the frontal , area or around the orbit. We did atlanto-axial joint blocks using a posterior approach on 10 patients who suffered from this type of headache. The results were promising with 9 out of 10 patients showing more than 50% improvement on the numeric rating scale. There were no serious complications observed. We concluded that the atlanto-axial joint block can be an effective procedure in treating this specific type of headache.

회음부통증 환자를 위한 Ganglion Impar의 정위적 신경절제술

신근만(Keun Man Shin),김진수(Jin Soo Kim),조용노(Y 대한통증학회 1996 The Korean Journal of Pain Vol.9 No.2

The first reported the neural blockade of ganglion impar for pain control of perineal pain in l990 by Plancarte and his fellows. They used 6ml of 10 percent phenol. But the point of issues, same as other neurolytics, are that it is impossible to check and control its spreading, so it might be possible to destruct the coccygeal plexus and sacral nerve, and also it has only short aetion time. Because of these problems, it could be very dangerous to attempt this procedure especially not for relieving the pain on cancer terminal patient, but for the sympathectomy of ganglion impar on the other purpose. We used the RF generator which had the control ability to point out the destructive le- sion accurately. inserted We made the small burr hole on the sacrum near the sacrococc ygeal junction directly through the hole, and performed thermocoagulation to the gan- glion impar.

고관절통을 위한 폐쇄신경 및 대퇴신경 관절지의 고주파열응고술

신근만 ( Keun Man Shin ),남성근 ( Sung Keun Nam ),양묘진 ( Myo Jin Yang ),홍성준 ( Seong Joon Hong ),임소영 ( So Young Lim ),최영룡 ( Young Ryong Choi ) 대한통증학회 2006 The Korean Journal of Pain Vol.19 No.2

급성 천장골관절 염좌에 스테로이드 및 국소마취제의 관절내 주사 효과

신근만(Keun Man Shin) 대한통증학회 1995 The Korean Journal of Pain Vol.8 No.2

N/A Despite applying recent advances in research and technology and taking into acount proper histories and performing thorough physical examinations, a high percentage of patients with low back pain have no identifiable pathology. Problems especially of the sacroiliac joint are commonly missed. The purpose of this article is to describe the ef- fects of sacroiliac injection of local anesthetics and corticosteroids on patients with acute sacroiliac sprain. The sacroiliac joints are essentially nonweight-bearing joints that allows a small amount of anteroposterior rotatory movement around transverse axis usually about 5 to l0cm below the promontory of the sacrum vertically. The liga- mentous portion of sacroiliac joint is vulnerable to rotatory movement particularly when the individual is in an awkward position. Injections of 3 ml of 2% lidocaine and 10 mg of methylprednisolone were given twice at two day intervals to 26 patients with acute sacroiliac sprain. Most of those patients obtained excellent results without any adverse effects.

침을 이용한 전기자극 통증치료

신근만(Keun Man Shin),홍순용(Soon Yong Hong),최영 대한통증학회 1992 The Korean Journal of Pain Vol.5 No.1

N/A For pain relief my collegue and I used thin acupuncture neddles as electrodes in electric stimulation. The needles were inserted into a trigger point and into another point located in the same muscle instead of meridian points of electro-acupuncture. Low frequency electric stimulation was given through the needles to l30 patients for 15 min. The results were as follws In 25 acute sprain patients electric stimulation was given 3.14±1.12 times and the pain was reduced on the average by 83.00±6.77 (VAS). In 45 chronic sprain patients electric stimulation was given 5.5l±1.38 times and the pain was reduced on the average by 70.22±8.98% (VAS). In 28 myofascial pain syndrome patients electric stimulation was given 6.22X1.25 times and the pain was reduced on the average by 66.48±8.75(%). In 7 muscle contraction headache patients electric stimulation was given 4.141.57 times and the pain was reduced on the average by 75.00±9.57% (VAS). In 25 radiculopathy patients electric stimulation was given 4.73±1.13l times and the pain was reduced on the average by 21.37+9.31% (VAS). We he conclude that electric stimulation therapy using acupuncture needles is very effective in acute sprain, chronic sprain, myofascial pain syndrome and muscle contraction headache. Any doctor with knows anatomy and trigger points can practice this method without studying oriental medicine or difficult acupuncture techniques.

난치성 통증 환자의 치료를 위한 정위적 요부 후근신경절 절제술

신근만(Keun Man Shin),안철수(Cheol Soo Ahn),홍순용 대한통증학회 1996 The Korean Journal of Pain Vol.9 No.2

Stereotactic radiofrequency dorsal root ganglionotomy can be very useful procedures for the treatment of pain emanating from the lumbar segmental nerves. This procedure is reserved for patients who have failed conservative interventional treatments and in whom open surgical intervention is not an option. The advantages of the radiofrequency lesion method are presented, excellent control of the lesion process using temperature monitoring to quantify the lesion size, prevent boiling, and to produce differential destruction of neur- al tissue. The afferent fibers in the ventral root which are spared by dorsal rhizotomy but nerve fibers with their cells in the ganglion from either dorsal or ventral root can be destructed with stereotactic radiofrequency ganglionotomy. This technique is performed using a 100mm cannula with a 5 mm active tip. Repeated lateral fluoroscopic view should be taken to make sure that cannlua still resides within the superior, dorsal quadrant of the foramen. With the cannula in this position, electrostimulation is performed and good paresthesia on the leg should be noted with 0.3 and 0.5 volt at 50 Hz stimulation. At 2 Hz stimulation distinct dissociation between motor and sensory should be shown. Percutaneous lumbar ganglionotomy have carried out under local anesthesia on an inpa- tient basis in 6 patients. A series of 5 patients with metastatic cancer pain and a patient with compression fracture have been relieved of pain without serious complications.

정위적 삼차신경절 고주파열응고술

신근만(Keun Man Shin),신삼철(Sam Chyul Shin),조용 대한통증학회 1996 The Korean Journal of Pain Vol.9 No.1

When medical therapy fail to relieve pain at tolerable level for patients confirmed with tri- geminal neuralgia, presence of mass lesion excluded, surgery is indicated. Innumerable surgical strategies have been attempted for the treatment of trigeminal neuralgia but only four have proven appropriate: stereotactic radiofrequency gasserian ganglionotomy, ­ percutaneous glycerol gangliolysis, ® percutaneous microcompression, ? microvascular decompression. Radiofrequency thermocoagulation of the gasserian ganglion stems from the efforts of Sweet. This technique is the surgical treatment of choice around the world for surgical treatment for trigeminal neuralgia. Since 1986, over 14,000 cases have been reported utilizing this technique. To improve the treatment method further, an electrode with a flexible curved tip has been de- veloped for easier and more precise electrode placement and lesion produetion during the thermocoagulation of gasserian ganglion. This operation was performed recently on three patients at Hallym University Hospital, using a curved tip electrode. Complete relief of pain was achieved for all patient. However, some complications were noted.