Review Article J Korean Soc Spine Surg Jun;24(2): Nucleoplasty: Percutaneous Plasma Disc Deco

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Journal of Korean Society of Spine Surgery Nucleoplasty: Percutaneous Plasma Disc Decompression for the Treatment of Lumbar Disc Herniation Dong-Yeong Lee, M.D., Soon-Taek Jeong, M.D., Jin-Young Oh, M.

1 Journal of Korean Society of Spine Surgery Nucleoplasty: Percutaneous Plasma Disc Decompression for the Treatment of Lumbar Disc Herniation Dong-Yeong Lee, M.D., Soon-Taek Jeong, M.D., Jin-Young Oh, M.D., Dong-Hee Kim, M.D. J Korean Soc Spine Surg 2017 Jun;24(2): Originally published online June 30, 2017; Korean Society of Spine Surgery Asan Medical Center, 88 Olympic-ro 43 Gil, Songpa-gu, Seoul, 05505, Korea Tel: Fax: Copyright 2017 Korean Society of Spine Surgery pissn eissn The online version of this article, along with updated information and services, is located on the World Wide Web at: This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License ( creativecommons.org/licenses/by-nc/4.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

2 Review Article J Korean Soc Spine Surg Jun;24(2): Nucleoplasty: Percutaneous Plasma Disc Decompression for the Treatment of Lumbar Disc Herniation Dong-Yeong Lee, M.D., Soon-Taek Jeong, M.D., Jin-Young Oh, M.D., Dong-Hee Kim, M.D. Department of Orthopaedic Surgery, Gyeongsang National University School of Medicine and Gyeongsang National University Hospital, Jinju, Republic of Korea Study Design: A review of the literature regarding nucleoplasty. Objectives: This aim of this article is to provide current information on nucleoplasty as a therapeutic intervention for herniated disc or discogenic back pain in degenerative disc disease. Summary of Literature Review: Nucleoplasty as a therapeutic intervention for discogenic pain is performed with increasing frequency, and has been reported to involve few complications and to have satisfactory clinical results. Materials and Methods: Review of the literature. Results: In nucleoplasty, the intervertebral disc is approached percutaneously. In this paradigm, a bipolar high frequency device in combination with ablation and coagulation is used to create a channel in the intervertebral disc in order to reduce intervertebral disc volume and to decrease intervertebral pressure and inflammatory markers. Standard indications for nucleoplasty have not been established, but it has been reported that the procedure had excellent outcomes regardless of the presence of radiculopathy or the results of discography. Many studies have reported their outcomes using various categories, because the procedure is comparatively new. Concomitantly, long-term follow-up studies remain to be performed, and each study reported a different follow-up period. Conclusions: Nucleoplasty has been found to show an excellent prognosis for discogenic back pain and a low incidence of complications. Moreover, since it is a minimally invasive procedure, it offers improved possibilities for return to daily life and work. If degenerative changes have not progressed to a great extent or the intervertebral level remains intact, nucleoplasty may be considered prior to surgery. Due to the lack of reports on the subject, prospective analyses in the future are required. Key words: Discogenic pain, Disc herniation, Degenerative disc disease, Minimally invasive procedure, Nucleoplasty 요추부통증은가장흔한통증의양상중하나로, 연간유병률은 50% 이상으로보고되며, 일생동안모든인구의 80% 이상에서요추부통증을경험하게되어큰사회경제적부담을야기한다. 1) 한연구에따르면이러한요추부통증중약 40% 는추간판성통증 (discogenic pain) 에의한것으로보고되어있다. 2) 추간판성통증은대부분추간판의탈출 (disc prolapse) 이나퇴행성추간판질환 (degenerative disc disease, DDD) 에의해나타나는것으로보고되어있으며, 기존연구들에서추간판파열이나퇴행성추간판질환의치료로보존적치료에실패한경우추간판절제술 (discectomy) 이나척추유합술 (fusion) 을시행후좋은임상경과를나타낸연구들이많이보고되어있다. 3,4) 하지만요추부통증의치료를위한보존적치료와척추유합술의임상결과를비교한몇몇전향적연구결과를통해볼때, 두치료방법중어느것이우월한지에대해서는아직 까지논란의여지가있으며, 최근의한메타분석에서는추간 판성만성요통의치료방법으로수술적치료가비수술적치료 에비해우월한것은아니라고주장하였다. 5) 과거에는비수술 적치료로약물치료, 물리치료, 생활습관교정및심리치료 Received: January 5, 2017 Revised: January 10, 2017 Accepted: April 12, 2017 Published Online: June 30, 2017 Corresponding author: Dong-Hee Kim, M.D. ORCID ID: Department of Orthopaedic Surgery, Gyeongsang National University School of Medicine, Gyeongsang National University Hospital, 15, Jinju-daero 816beon-gil, Jinju-si, Gyeongsangnam-do, Republic of Korea TEL: , FAX: dhkim8311@gnu.ac.kr Copyright 2017 Korean Society of Spine Surgery Journal of Korean Society of Spine Surgery. pissn eissn This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License ( which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited. 129

Dong-Yeong Lee et al Volume 24 Number 2 June 2017 와같은방법이이용되었으며, 이에실패시수술적치료를고려하였다. 하지만보존적치료의한계와수술에대한부담감과수술후의합병증을초래할수있어, 최근에는추간판성통증을치료하기위해여러가지최소침습적술기들이개발되어왔다.

3 Dong-Yeong Lee et al Volume 24 Number 2 June 2017 와같은방법이이용되었으며, 이에실패시수술적치료를고려하였다. 하지만보존적치료의한계와수술에대한부담감과수술후의합병증을초래할수있어, 최근에는추간판성통증을치료하기위해여러가지최소침습적술기들이개발되어왔다. 이러한최근의경향에비추어추간판성요추부통증의치료를위한비수술적미세침습중재술을통한치료방법이점점더증가하고있으며, 추간판성통증에대한미세침습적인추간판내중재술에는카이모파파인화학적수핵분해술 (chymopapain chemonucleolysis), 6) 자동화요추부경피적디스크절제술 (automated percutaneous lumbar discectomy), 7) 요추부경피적레이저디스크절제술 (percutaneous laser lumbar discectomy), 8) 디스크내고주파열치료술 (intradiscal electrothermal annuloplasty, IDET) 9) 가사용되어왔고, 최근최소침습수핵감압술인수핵성형술 (nucleoplasty) 10,11) 이사용되고있다. 본연구에서는최근각광받고있는비수술적치료방법중하나인수핵성형술에대해알아보고자한다. 본론 1. 수핵성형술의술식수핵성형술은국소마취하에조영투시영상을이용하여시행가능하다. 외래로내원한환자에대해당일시행이가능하며, 시술전예방적항생제로 cefazolin 1 g을 1회사용후복와위자세에서무균적처치이후시술을시행한다. 조영투시영상을이용하여목표로하는추간판의위치를확인하여표시한후체간의중심에서외측으로 8~10 cm에서 17G 6-inch Crawford type 가이드핀 (introducer needle) (ArthroCare, Sunnyvale, CA, USA) 을이용하여추간판을관통시킨다. 이때 가이드핀의방향은 30도사면조영투시영상에서하방추체의상위종판 (superior endplate of low vertebra) 과하방추체의위관절돌기의전방 (anterior border of superior articular process of low vertebra), 그리고신경근이이루는삼각형인 Kambin s triangle 내부로향하는것이신경근손상의합병증을예방할수있다 (Fig. 1). 12) 그리고조영투시영상의전후면상과측면상을확인하여, 가이드핀의끝을섬유륜과수핵의경계부에위치시키고가이드핀내부를통하여 Perc-DLE Spine Wand (ArthroCare, Sunnyvale, CA, USA) 를통과시켜가이드핀삽입부위반대측의섬유륜내측면가까이에위치시킨다 (Fig. 2). 소작술 (ablation) 과응고술 (coagulation) 을반복하여채널을형성하며, 2시, 4시, 6시, 8시, 10시, 12시방향에 6개의채널을만드는것을추천한다. 11,13) 이후핀을제거하며핀삽입부위소독후시술을마친다. 수술후핀삽입부위통증을호소하는경우가있어, 가이드핀이삽입된길을따라 1% lidocaine 을핀을빼면서주는것도도움이된다. 14) 수핵성형술후특이합병증이없는경우시술을시행한당일걸어서퇴원이가능하다. 2. 수핵성형술의기전수핵성형술은추간판성통증의치료를위한최소침습적시술중하나로 2000년에미국식품의약국 (Food and Drug Administration) 의정식승인을받았다. 15) 추간판내로경피적침습방법으로접근하며, 양극성고주파 (bipolar radiofrequency) 장치 (ArthroCare, Sunnyvale, CA, USA) 를이용해소작술 (ablation) 과응고술 (coagulation) 을혼합하여추간판내에채널을형성하여추간판의부피를감소시키며, 추간판내압력을감소시키는것이원리이다. 16) 소작술 (ablation) 과응고술 (coagulation) 시전도성유체에고주파 (radiofrequency) 에너 A B Fig. 1. Kambin s triangle (triangle). (A) Kambin s triangle on a fluoroscopic image (the empty dot indicates the guide pin tip). (B) A schematic diagram of Kambin s triangle. The schematic diagram was adapted from the study of Hoshide et al. 12) 130

Journal of Korean Society of Spine Surgery Nucleoplasty for Lumbar Disc Herniation A B Fig. 2. Fluoroscopic images, with the guide needle placed at the center of the intervertebral L4-L5 disc.

4 Journal of Korean Society of Spine Surgery Nucleoplasty for Lumbar Disc Herniation A B Fig. 2. Fluoroscopic images, with the guide needle placed at the center of the intervertebral L4-L5 disc. (A) Anteroposterior view, (B) lateral view. 지가적용되면 플라즈마 라고불리는이온화된증기층으로변환하게되고, 이때발생한활동성이온이디스크의분자결합을붕괴시킨다. Perc-DLE Spine Wand 를수핵내부로진입시소작술 (ablation) 을시행하면 45~55 C의열에너지를이용하여채널이형성되고, Wand 수핵외측으로이탈시응고술 (coagulation) 을시행하면 70 C의열에너지를이용하여채널을응고시킨다. Chen 등 16) 은사체연구를통하여퇴행성변화가적은추간판에서 ArthroCare 에서권장하는 6개의채널을형성하지않더라도, 오직 2개또는 3개의채널만형성하더라도추간판내압력이급격하게감소하는것을관찰하였으며, 퇴행성변화가적은추간판에서시행하는것이추간판내압력을감소시키는데중요하다고강조하였다. Kasch 등 17) 은동물실험연구에서수핵성형술을통하여소작술을시행하기전후를비교하였을때, 소작술을시행한후수핵의부피가약 7% 감소하는것을관찰하였다. 그리고수핵성형술이추간판성통증을완화시키는또다른기전으로는, 추간판내염증성사이토카인조절에관여하는것으로알려져있다. O Neill 등 18) 은동물실험모델을통하여수핵성형술후추간판내에 interleukin-1 (IL-1) 과 interleukin-8 (IL-8) 이변화하는것을관찰하였으며, 이두가지 interleukin 은모두통증발생기전에관여하는사이토카인으로알려져있어, 수핵성형술이염증물질조절을통한통증조절및수핵의재생에도관여하는것으로주장하였다. 또한최근연구에서는하지방사통을동반한추간판성요추통증에도수핵성형술이효과적이라보고하고있는데, 이는추간판의용적감소로인한간접적인감압에의한것으로생각되며, 방사통과관련된생화학적매개체인 tumor necrosis factor-alpha (TNFα), interleukin 1-beta (IL-1β), phospholipase A2 (PLA2) 를 줄여서통증에대한신경근의민감도를완화시키는기전으로증상을호전시켜주는것으로밝혀기존의연구결과와유사한기전으로치료효과를설명하였다. 19) 따라서, 수핵성형술이추간판성요통의치료에작용하는기전은단일요인으로서는설명되기어렵고, 여러가지복합적인요인이관여하는것으로생각된다. 하지만현재까지밝혀진연구들은많은부분에서동물연구를통해이루어진부분이많으며이러한점들은향후인간대상연구를통하여증명이되어야할것으로생각된다. 3. 수핵성형술의적응증수핵성형술은수술적치료에비해회복이빠르고노동으로빨리복귀할수있는점, 시술시간이짧다는것과시술과관련된합병증이적은장점이있어최근그시행빈도는증가하고있다. 하지만수핵성형술을시행하는데있어표준화된적응증은아직까지는명확하게확립되어있지않다. Karaman 등 13) 은나이가통증의 VAS 척도의호전정도에영향을미치지않는다하였으며, Zhu 등 11) 은방사통유무와관계없이 6개월이상의보존적치료에도반응하지않는만성요통환자를대상으로수핵성형술을시행하였으며, 추간판조영술에서추간판성통증이유발된경우, 추간판의높이가 50% 이상유지되는경우와자기공명영상 (MRI) 에서추간판파열이없는환자의경우수핵성형술의시행이적합한것으로주장하였다. 하지만자기공명영상에서추간판이척추관으로 1/3 이상돌출된경우, 과거수술을받았던경우, 심한신경학적결손이있는경우, 그리고종양이나감염성질환이동반된경우에는수핵성형술이적합하지않은것으로판단하였다. Gerzten 등 20) 은하지방사통을동반하는추간판성통증에서수핵성형술이효과적이라하였으 131

5 Dong-Yeong Lee et al Volume 24 Number 2 June 2017 며, Chen 등 16) 은사체연구를통하여퇴행성변화가진행된추간판에서는수핵성형술을시행하더라도추간판내압력감소는효과적이지못하다고주장하였고, Ren 등 19) 은그들의임상연구에서퇴행성변화가있는분절의수가적고, 추간판높이가유지되며, 추간판의퇴행성변화정도가낮은경우에더좋은결과를나타낸다고하였다. 하지만이러한연구결과와는달리 Kumar 등 21) 은추간판조영술의유발검사결과나섬유륜파열, 추간판의높이감소는수핵성형술후의결과에영향을미치지않으며, Ren 등 19) 은섬유륜의전층파열이있는환자에서도비교적만족스러운임상결과를얻어추간판조영술음성의결과가반드시수핵성형술의금기는아니라주장하여기존연구들과는상이한결과를주장하였다. 또한, Gerges 등 15) 은방사통이없이추간판성통증만있는환자에서는수핵성형술이덜효과적이라고하였고, 축성통증보다다리통증이심한경우수핵성형술이더좋은적응증이라하였다. 따라서, 이처럼상이한결과들을종합하여추간판탈출환자의치료시에표준화된적응증을확립하기위해서는향후잘설계된대규모전향적연구를통하여확인해야할필요가있을것으로생각된다. 4. 수핵성형술의임상결과수핵성형술시행후유의한호전을나타낸결과가 48.1~82% 까지보고되어있다. 9-11,21) 게다가최근의수핵성형술후임상결과를비교한연구를대상으로하여시행한메타연구에서도수핵성형술에대해장기적인통증감소효과가있으며환자의기능적회복에도움이된다고주장하고있다. 22) 이들연구에서임상결과의평가척도로는요추부나하지의통증평가척도 (visual analog scale, VAS) 를이용하였으며, 일상생활의불편함정도를 Oswestry Disability Index (ODI) 를이용하여평가하였다. Lemcke 등 23) 은추간판감압기 (disc dekompressor) 를이용한군과비교하였을때수핵성형술을시행한군에서 VAS 척도의호전이더나은것으로보고하였고, Sharp 와 Issac 9) 은 1년추시관찰결과약 80% 이상의성공적인결과를나타내었으며, Zhu 등 11) 은수핵성형술후 2년추시관찰에서도 VAS 와 ODI의유의한호전결과를보고하였다. 게다가 Abrishamkar 등24) 은수핵성형술과개방성추간판절제술을비교한연구에서, 수핵성형술이개방성추간판절제술만큼효과적이며, 덜침습적이고, 환자들의순응도가좋은것으로보고하였다. 특히방사통을동반한요추추간판탈출증환자를대상으로, Nikoobakht 등 25) 은단순히물리치료와같은보존적치료를시행한경우보다수핵성형술을시행한경우유의하게통증 (VAS) 을감소시키고생활척도지수 (ODI, Short-Form-26) 를상승시키는것으로보고하였으며, 특히젊고, 방사통의이환기관이짧으며, 남성, 낮은 BMI, 그리고만성통증보다는아급성통증인경우수핵성 형술의효과가좋은것으로보고하였다. Gerszten 등 26) 은추간공경막외스테로이드주사요법보다수핵성형술이우수한것으로보고하여, 방사통이동반된추간판탈출증환자에서도수핵성형술이효과적인중재술임을증명하였다. 수핵성형술을이용한연구들을이용하여총 971명을대상으로한 27개임상연구를포함한최근의메타분석에서는, 수핵성형술은경막외주사요법과같은보존적치료를시행한군과비교하였을경우 6주째와 3개월째 VAS 와 ODI의증가가유의하게호전된결과를나타내었으며, 경추수핵성형술을시행한경우요추수핵성형술을시행한경우보다통증완화에효과적인결과를나타내었으나, 유의한차이는나타내지않았다. 22) 많은연구에서수핵성형술의시행후성공률에대해서다양한범주로보고되고있는데, 이는수핵성형술이비교적최근에시행되기시작한시술 Table 1. Factors were associated with the outcomes after nucleoplasty Positive factors Ch ronic lower back pain had been treated with conservative therapy for six months Pain must be significant enough to interfere with daily activities Preservation of disc height 50% Disc protrusion 6 mm Ac curate identification of the symptomatic disc level prior to the procedure On MRI (such as black disc or Modic change [phase I or II]) Th e disc in question falls within Pfirrmann grade 2 to 4 on pre-procedure MRI Axial back pain with radiculopathy Po sitive or negative provocative discography findings (Concordant pain during discography did not influence the outcomes after nucleoplasty) Nagative factors Moderate to severe spinal stenosis or foraminal stenosis on MRI Disc protrusion occupying more than a third of the canal More than 3 suspected levels involved Le ss effective for patients with discogenic back pain without radicular symptom Previously operated segments Spinal instability Sequestrated disc Severe neurologic deficits Spinal tumor, trauma or infection Diabetic, heavy opioid usage or drinking, significant comorbidities Uncontrolled psychological disorder 132

6 Journal of Korean Society of Spine Surgery Nucleoplasty for Lumbar Disc Herniation 로수핵성형술후임상결과에대한장기추시연구가드물며, 각각의연구마다추시연구기간이다르기때문으로생각된다. 또한수핵성형술의적응증이명확하게확립되어있지않아, 임상결과에영향을미칠수있는위험인자 (Table 1) 들에대해충분히고려되지못하였으며이로인해연구에포함된환자군의이질성또한이러한결과의차이를야기하였을것으로생각되며, 향후연구에서는이러한점들이보완되어야할것으로생각된다. 5. 수핵성형술의합병증경막외스테로이드주사요법의합병증은약 18% 까지보고되고있는반면, 26) 수핵성형술시행후합병증의발생빈도는약 1.5% 로상대적으로낮은것으로알려져있다. 22) 가장흔한합병증은시술후주사침부위의통증이며, 새롭게발생한요통이나하지통증도흔하게보고되고있으며, 주사침삽입을위한관을따라출혈이나감염의발생도보고되어있다. 14) Bhagia 등 27) 은수핵성형술을시행한직후 24시간동안의관찰에서시술후주사침부위의통증은 76%, 새롭게발생한무딘감은 26%, 그리고새롭게발생한요통은 15% 로관찰되었다하였다. 하지만이러한통증은시술후 2주내에모두소실되었으며, 무딘감은약 15% 에서 2주후에도지속되는것을관찰하였다. 척수손상또는복부대혈관손상과같은심각한합병증의발생가능성도있을수있으나, 실제로하지마비나사망과같은심각한합병증이보고된사례는아직까지없다. 22) 또한다른연구에서동물을이용하여수핵성형술을시행한후추간판의조직학적검사를통하여, 소작술과응고술을시행한채널과정상수핵과의경계가명확하게관찰되는것을확인하였으며, 추체의종판, 인접수핵, 섬유륜, 신경근과척수에는정상조직학적소견을나타내어수핵성형술이인접조직의열손상및구조적변화를유발하지않아인접조직에는손상을주지않는다고주장하였고, 목표로하는추간판의용적을감소시키는데안전하고효과적인치료방법이라하였다. 28) 따라서, 숙련된의사에의해수핵성형술이시행된다면추간판성통증의치료에있어위험한합병증없이안전하고효과적인방법일것이라생각된다. 6. 수핵성형술후의재활수핵성형술은추간판병변의치료방법으로고려될수있는좋은방법중하나이나, 수핵성형술후의재활치료에대한보고는드물다. 요추부수술적치료후재활치료에관한연구는많으며, Cochrane review를통하여처음으로추간판절제술을시행한환자에서 4~6주간의재활치료를시행한군에서수술후아무런보조요법을시행하지않은군에비하여통증과기능적장애가감소하는것을관찰할수있었다. 29) 이에반하여 수핵성형술후의재활치료에대한문헌은매우드물며, 최근의 Puentedura 등 30) 의연구에서 phase 1 (0~2주 ), phase 2 (3~5 주 ), and phase 3 (6~8주 ) 로구성된재활프로토콜을제안하였으며, 수핵성형술후프로토콜에따라재활치료를시행한환자에서, 수술전 ODI가 64% 에서 phase 1, phase 2, phase 3을시행후각각 24%, 4%, 4% 로관찰되었으며, 완전히일상생활및노동력을회복하는것을관찰할수있었다. Phase 1에서는조심스럽게능동적요추부관절운동 (gentle active ROM exercise) 을시작하며, phase 2에서는점진적으로요추부관절운동 (progressive ROM exercise) 을증가시키며, 체중부하상태에서복근수축을유지하는것 (deep corset contracture) 과손발이바닥에지지한채로운동하는닫힌사슬운동 (close kinetic chain activity) 을할수있도록하는것이다. Phase 3에서는닫힌사슬운동뿐만아니라손발이자유롭게움직이며운동할수있는열린사슬운동 (open kinetic chain activity) 까지가능하게하여, 일상생활및노동으로복귀할수있도록하는것이다. 아직까지재활운동후의추시관찰에대한연구는없으나, 적절한재활운동의시행은수핵성형술후의요추의기능적회복에도움을줄수있을것으로생각되며, 이에대한연구가활발히시행될수있도록장려하는바이다. 결론 많은연구에서수핵성형술은방사통을동반한추간판성요통의치료에좋은결과를나타내며, 합병증의빈도도낮으며, 최소침습적시술이라시술후일상생활로의복귀및노동으로의복귀도빨라좋은치료방법으로알려져있다. 하지만이러한장점에도불구하고아직까지장기추시관찰에대한연구결과가부족하며, 표준화된적응증이아직까지명확하게확립되지않은것은앞으로풀어야할과제라생각한다. 퇴행성변화가심하지않고섬유륜이보존된추간판탈출 (contained disc herniation) 환자에서추간판성동통이적극적인보존적치료에호전이없는경우, 수핵성형술은위험성이적고효과가확인된안전한시술이므로수술전시도해볼수있는좋은치료방법중하나로생각된다. REFERENCES 1. Schmidt CO, Raspe H, Pfingsten M, et al. Back pain in the german adult population: prevalence, severity, and sociodemographic correlates in a multiregional survey. Spine (Phila Pa 1976). 2007;32: Schwarzer AC, Aprill CN, Derby R, et al. The relative con

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9 Review Article J Korean Soc Spine Surg Jun;24(2): 요추추간판탈출증의치료로서경피적수핵성형술 이동영 정순택 오진영 김동희 경상대학교의학전문대학원정형외과학교실 연구계획 : 경피적수핵성형술에관한문헌고찰목적 : 추간판탈출및퇴행성추간판질환에서추간판성통증의치료적중재술로수핵성형술에관한최신정보를문헌고찰을통하여제공하고자한다. 선행문헌의요약 : 최근추간판성통증의치료적중재술로수핵성형술의사용빈도는점점증가하고있으며, 합병증이적고, 만족할만한임상결과를나타내는것으로보고되고있다. 대상및방법 : 문헌고찰결과 : 수핵성형술은추간판내로경피적침습방법으로접근하며, 양극성고주파장치를이용해소작술과응고술을혼합하여추간판내에채널을형성하여, 추간판의부피를감소시키며추간판내압력을감소시키는것과생화학적인매개체인염증물질을제거하는것이원리이다. 표준화된적응증은아직까지없으나방사통유무나추간판조영술의결과와관계없이효과적인결과를나타내는것으로알려져있다. 많은연구에서수핵성형술의시행후성공률에대해서다양한범주로보고되고있는데, 이는수핵성형술이비교적최근에시행되기시작한시술로수핵성형술후임상결과에대한장기추시연구가드물며, 각각의연구마다추시연구기간이다르기때문으로생각되며, 향후연구에서는이러한점들이보완된대규모전향적연구가필요할것으로생각된다. 결론 : 수핵성형술은추간판탈출의치료에만족스러운결과를나타내며, 합병증의빈도도낮으며, 최소침습적시술이라시술후일상생활로의복귀및노동으로의복귀도빨라효과적인치료방법으로알려져있다. 퇴행성변화가심하지않은추간판의높이가유지되어있는추간판성동통이있는경우, 수핵성형술은수술전에최소침습적시술로시도해볼수있는좋은치료방법중하나로생각된다. 색인단어 : 추간판성통증, 추간판탈출, 퇴행성추간판질환, 최소침습적시술, 수핵성형술 약칭제목 : 추간판탈출에대한수핵성형술 접수일 : 2017년 1월 5일 수정일 : 2017년 1월 10일 게재확정일 : 2017년 4월 12일 교신저자 : 김동희 경상남도진주시진주대로 816번길 15 경상대학교의학전문대학원정형외과학교실 TEL: FAX: dhkim8311@gnu.ac.kr 136 Copyright 2017 Korean Society of Spine Surgery Journal of Korean Society of Spine Surgery. pissn eissn This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License ( which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Lumbar spine

Lumbar spine CT 32 111 DOI : 10.3831/KPI.2010.13.2.111 Lumbar Spine CT 32 Received : 10. 05. 23 Revised : 10. 06. 04 Accepted : 10. 06. 11 Key Words: Disc herniation, CT scan, Clinical analysis The Clinical