Clinical Research Article : Position of dorsal root ganglia in the Lumbosacral region in patients with radiculopathy

( Mi Hyeon Lee ),( Young Deog Cha ),( Hyun Seog Moon ),( Bang Hoon Song ),( Yeon Dong Kim ),( Jang Ho Song ) 대한마취과학회 2010 Korean Journal of Anesthesiology Vol.59 No.6

Background: When applying pulsed radiofrequency on dorsal root ganglia for treating chronic lower back pain, maximum efficiency can be expected when a needle is placed 1-2 cm peripheral to the dorsal root ganglion. The object of this study is to analyze images taken after adding contrast to transforaminal epidural injection, categorize root ganglia according to anatomical position, and provide a reference for efficient needle positioning in applying pulsed radiofrequency on dorsal root ganglia. Methods: From January 2008 to January 2009, 457 patients who visited our hospital for root pain or radiculopathy were treated with transforaminal epidural injection on the nerve roots based on the dermatome of the painful area. Anteroposterior views were taken after injection of contrast. A virtual line was made by connecting the internal and external parts of the spinal pedicle from the contrast images. Then the dorsal root ganglia were categorized as intraspinal (IS), intraforaminal (IF), or extraforaminal (EF). Results: In the fourth lumbar spine, dorsal root ganglia positions were 48% IF, 41% IS, and 6% EF. In the fifth lumbar spine, dorsal root ganglia positions were 75% IF, 10% IS, and 6% EF. In the first sacral spine, dorsal root ganglia locations were 8% IF and 83% IS. Conclusions: Positional categorization of dorsal root ganglia according to contrast images was proven to be good anatomical references for effective radiofrequency or blocking of dorsal root ganglia.

흰쥐 척수 및 등뿌리신경절에서 Tyrosine Hydroxylase 함유구조물의 분포

박매자,배용철,조희중,김지윤,김용주,김지윤 경북대학교 병원 1998 경북대학교병원의학연구소논문집 Vol.2 No.1

정상 흰쥐의 각 분절별 척수 및 등뿌리신경절에서 catecholamine 함유구조물의 분포를 알아보고자 tyrosine hydroxylase(TH)에 대한 항체를 이용하여 면역조직화학적 염색을 실시하였다. 그 결과 TH 함유신경세포는 목척수분절과 엉치척수분절에서 관찰되었다. 목척수분절의 TH 함유신경세포는 첫째와 둘째 목척수분절에서만 관찰되었으며 신경돌기가 잘 발달된 다각형의 세포인 것으로 보아 이들은 뇌줄기의 TH 함유신경세포군이 목척수분절로 연장된 것이라 생각된다. 그러나 엉치척수분절에서 관찰되는 대부분의 TH 함유신경세포는 세포돌기가 보이지 않고 세포체부분만 면역염색되어 관찰되는 것으로 보아 퇴화단계의 세포인 것으로 생각된다. TH 함유신경섬유는 척수의 모든 분절에서 관찰되었으며 이들 TH 함유신경섬유가 각 척수분절의 등뿔보다 배쪽뿔과 중간뿔에서 훨씬 높은 밀도로 관찰되는 것으로 보아 catecholamine은 척수에서 체성감각뿐만 아니라 자율신경계 및 운동신경계의 조절에 관여하리라 생각된다. 등뿌리신경절에서 관찰되는 TH 함유신경세포는 척수의 엉치분절에서 관찰되는 것과 마찬가지로 세포돌기가 거의 보이지 않고 세포체부분만 염색되어 보였다. 또한 등뿌리 신경절의 TH 함유신경섬유는 혈관의 벽을 나선형으로 감고 돌아가는 형태로 관찰되었으며 어느 것도 등뿌리신경절의 신경세포와 연관되어 관찰되지는 않았다. 이로 보아 정상 쥐의 등뿌리신경절에서 catecholamine은 신경세포 사이의 신경전달이나 졸절보다는 신경절 내의 혈류조절과 관계있을 것으로 생각된다. With the aim of gaining more insight into the catecholaminergic system in the nervous system of the rat, we have studied the precise distribution pattern of the tyrosine hydroxylase immunoreactive (TH-IR) fibers and soma in the spinal cord and dorsal root ganglion. In the dorsal root ganglion (DRG) TH-IR fibers were observed to run along the vessel wall, spirally and not found in the neural tissue itself. A few TH-IR fibers were found in the spinal nerve, not in the ventral root. Many TH-IR neurons were distributed in the L3, 4, 5, and 6 DRG but none of them were found in the other DRG segments. In the spinal cord, TH-IR fibers have shown sparse distribution all over spinal cord but relatively dense distribution in the ventral hom, intermediolateral column, lamina I of the dorsal horn of the cervical, lumbar, sacral, and coccygeal segment. TH-IR neurons were found in the interrmediolateral column, dorsal gray commissure, dorsal horn of the C1 and C2 segments and S1-4 segments. TH-IR neurons in the cervical segments were polygonal or spindle shaped with well developed processes. In contrast to this, TH-IR neurons in the sacral segments were oval or spindle shaped withe no processes. In conclusion, neurons in the DRG were not influenced by catecholaminergic nervous input. Intrinsic catecholaminergic nervous systems were found in both of spinal cord and DRG.

Sequential Changes of CX3CR1 in Dorsal Root Ganglion in a Rat Model of Lumbar Disc Herniation

서혜진,조윤우,나운우,윤승현,안상호,김수정,최규식,박해운,장성호,손수민 대한재활의학회 2011 Annals of Rehabilitation Medicine Vol.35 No.1

Objective To investigate the pain-related behaviors and the changes of CX3CR1 expression in the dorsal root ganglion (DRG) in a rat model of lumbar disc herniation. Method A total of 90 male Sprague-Dawley rats were used. A laminectomy was performed to expose left L5 nerve roots and corresponding DRG. Autologous nucleus puplosus was implanted on the left L5 nerve root proximal to the DRG without mechanical compression. Sham operation was also done with the same procedure as mentioned above. Thermal hyperalgesia and mechanical allodynia were assessed at 1, 5, 10, 20 and 30 days after surgery. Real time PCR and immunohistochemistry after behavioral test were performed. Results In the lumbar disc herniation rats, significant reduction of thermal withdrawal latency indicating thermal hyperalgesia was shown on the ipsilateral hindpaw on postoperative day 1 (p<0.01) and peaked on day 10 (p<0.05) and maintained throughout day 30 (p<0.05). The reduction of mechanical allodynia threshold, indicating mechanical allodynia, was observed on the ipsilateral hindpaw on postoperative day 1 (p<0.01) and continued throughout day 30 (p<0.01). Real time PCR showed the decrease in mRNA expression of CX3CR1 in the ipsilateral DRG on day 1 (p<0.05) and the significant increase on day 20 (p<0.05). The immunoreactivity for CX3CR1 was also increased in ipsilateral DRG on day 10 and 20. Conclusion These data suggest that lumbar disc herniation induces thermal hyperalgesia and mechanical allodynia and upregulates the expression of CX3CR1 in dorsal root ganglion. Expression of CX3CR1 might be associated with subacute neuropathic pain after intervertebral disc herniation.

흰쥐 척수 및 등뿌리신경절에서 Tyrosine Hydroxylase 함유구조물의 분포

김용주,김지윤,김동선,조희중,배용철,박매자 대한해부학회 1997 Anatomy & Cell Biology Vol.30 No.2

갑상선 비대증을 가진 환자에서 경추부 후근신경절의 박동성 고주파술 시행 후 발생한 혈종 -증례 보고-

조석주,이형철,김재헌,박수영,김용철,이상철 대한마취통증의학회 2011 Anesthesia and pain medicine Vol.6 No.2

A 62-year-old woman visited our pain clinic and she presented with radicular pain on her neck, right shoulder and arm. Cervical MRI showed a right subarticular protruded disc with right foraminal stenosis at C6-7 together with multinodular thyroid goiter. She was initially treated with transforaminal steroid injection under C-arm fluoroscopy at the C6-7 level, but the effect didn’t last for more than 4 days. Therefore, pulsed radiofrequency (PRF) treatment was done at the right 7th cervical dorsal root ganglion. After 15 minutes,the neck gradually swelled up and then neck pain and dyspnea developed. The CT image revealed cervical hematoma and left sided tracheal shift. These symptoms were spontaneously relieved after 12 hours and then the patient was discharged without any other complications. This case demonstrates the necessity of having thorough knowledge of the anatomical variations and standard anatomy for conducting safe and efficient medical practice. (Anesth Pain Med 2011; 6: 113∼117)

Identification of an evolutionarily conserved, functional noncoding element regulated by Six1 homeoprotein

Jeong, Yongsu,Oh, Sangtaek The Genetics Society of Japan 2010 Genes & genetic systems Vol.85 No.3

<P>Six1, which belongs to the <I>sine oculis</I> homeobox (<I>Six</I>) protein family, is an evolutionarily conserved transcription factor found in diverse organisms ranging from flatworms to humans. <I>Six1</I> is expressed in various tissues including the nervous system during ontogenesis and has been implicated in cell differentiation, morphogenesis, and organogenesis of the ganglia and sensory placodes. However, the molecular mechanisms by which Six1 influences these events at the transcriptional level remain largely unknown. In this study, we used ChIP-Display to discover genomic regions occupied <I>in vivo</I> by Six1 homeoprotein in the developing mouse embryo. To validate Six1 occupancy at each of Six1-bound regions, ChIP - Quantitative PCR was performed using locus-specific primers, and it showed robust enrichment of the Six1-bound sequences. To address their regulatory potential, each of the Six1-bound sequences was cloned into a reporter cassette containing beta-globin minimal promoter and <I>lacZ</I> gene and assayed for enhancer activity in transgenic mouse embryos. One of the novel sequences, which was designated Six1-bound Regulatory Element 1 (SRE1), was sufficient to activate <I>lacZ</I> reporter expression in the cranial and spinal ganglia. Comparative genomic analysis identified SRE1 sequences from a number of vertebrate phyla. Transgenic embryos carrying SRE1 sequences from human, chicken and frog showed reporter expression in a pattern similar to that of mouse SRE1, indicating their functional conservation. Through mutational analysis, we further showed that a conserved binding site matching the consensus for Six1/2/4/5 is required for the SRE1 regulatory activity. These data suggest that SRE1 is a functionally conserved transcriptional enhancer regulated by Six1.</P>

원발성 Sjogren증후군에 동반된 아급성 감각 신경병 1예

정원희,정근호,한동균,박희정,조필자,김승민,선우일남 대한신경과학회 1999 대한신경과학회지 Vol.17 No.5

Neurochemical Characterization of the TRPV1-Positive Nociceptive Primary Afferents Innervating Skeletal Muscles in the Rats

Shin, Dong-Su,Kim, Eun-Hyun,Song, Kwan-Young,Hong, Hyun-Jong,Kong, Min-Ho,Hwang, Se-Jin The Korean Neurosurgical Society 2008 Journal of Korean neurosurgical society Vol.43 No.2

Objective: Transient receptor potential vanilloid subfamily type 1 (TRPV1), a most specific marker of the nociceptive primary afferent, is expressed in peptidergic and non-peptidergic primary afferents innervating skin and viscera. However, its expression in sensory fibers to skeletal muscle is not well known. In this study, we studied the neurochemical characteristics of TRPV1-positive primary afferents to skeletal muscles. Methods: Sprague-Dawley rats were injected with total $20{\mu}l$ of 1% fast blue (FB) into the gastrocnemius and erector spinae muscle and animals were perfused 4 days after injection. FB-positive cells were traced in the L4-L5 (for gastrocnemius muscle) and L2-L4 (for erector spinae muscle) dorsal root ganglia. The neurochemical characteristics of the muscle afferents were studied with multiple immunofluorescence with TRPV1, calcitonin gene-related peptide (CGRP) and $P2X_3$. To identify spinal neurons responding to noxious stimulus to the skeletal muscle, 10% acetic acids were injected into the gastrocnemius and erector spinae muscles and expression of phospho extracellular signal-regulated kinase (pERK) in spinal cords were identified with immunohistochemical method. Results: TRPVl was expressed in about 49% of muscle afferents traced from gastrocnemius and 40% of erector spinae. Sixty-five to 60% of TRPV1-positive muscles afferents also expressed CGRP. In contrast, expression of $P2X_3$ immnoreaction in TRPV1-positive muscle afferents were about 20%. TRPV1-positive primary afferents were contacted with spinal neurons expressing pERK after injection of acetic acid into the muscles. Conclusion: It is consequently suggested that nociception from skeletal muscles are mediated by TRPV1-positive primary afferents and majority of them are also peptidergic.

Successful Treatment of Occipital Radiating Headache Using Pulsed Radiofrequency Therapy

Lee, Sun Yeul,Jang, Dae Il,Noh, Chan,Ko, Young Kwon The Korean Neurosurgical Society 2015 Journal of Korean neurosurgical society Vol.46 No.4

Rheumatoid arthritis (RA) is a chronic inflammatory disease involving multiple joints. The cervical spine is often affected, and cases involving atlantoaxial joint can lead to instability. Anterior atlantoaxial subluxation in RA patients can lead to posterior neck pain or occipital headache because of compression of the C2 ganglion or nerve. Here, we report the successful treatment of a RA patient with occipital radiating headache using pulsed radiofrequency therapy at the C2 dorsal root ganglion.

The Efficacy of Pulsed Radiofrequency Treatment of Cervical Radicular Pain Patients

Young Moon Yoon,한성록,이승준,최찬영,손문준,이채혁 대한척추신경외과학회 2014 Neurospine Vol.11 No.3

Objective: Cervical radicular pain is defined as pain arising in the arm caused by irritation of a cervical spinal nerve or its roots. Although many treatment modalities are described in the literature, the available evidence for efficacy is not sufficient to allow definitive conclusions. The goal of this study was to establish the benefits and prognostic factors of pulsed radiofrequency (PRF) on the adjacent cervical dorsal root ganglia (DRG) of cervical radicular pain patients. Methods: A retrospective study of PRF treatment of patients with cervical radicular pain was carried out. Two times diagnostic block of cervical DRG were performed before PRF. PRF was applied for 2 minutes at a setting of 2 Hz and 45 V by two times on the same targets, with the end point being an electrode tip temperature 42℃. Numerical rating scale (NRS) scorewas evaluated post-treatment 2 week, 1 month, 3 months and 6 months, which were compared with pretreatment value. A successful outcome was defined that NRS change was improved more than 50% at 6 months. Results: The mean age was 54 years. The success rate was 68%(15/22) after six months of follow-up. PRF induced complications were not observed. Between success and failure group, we do not find any positive outcome prognostic factor. Interestingly, PRF treatment on foraminal stenosis is better outcome than herniated cervical disc. Conclusions: PRF on adjacent cervical DRG is effective and safe treatment option for cervical radicular pain patients. However, more long-term follow up and larger patients are needed to establish effectiveness PRF treatment on cervical radicular pain patients.