51 외상성중심성척수증후군치료결과 (plateau) 를이루는것이아니며어느시점이후에는악화되는것을알게되었다. 그이후여러저자들 4-6) 이선택적경우에서수술적치료후좋은결과들을보고하고있지만수술적치료가장기적추시에서기능적결과에영향을미치지않는다는보고들 4,7,8) 도있어중심성척수증후

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1 50 pissn : , eissn : Original Article J Korean Orthop Assoc 2014; 49: 외상성중심성척수증후군후신경학적및기능적결과 송경철 유재원 김현학 손홍문 조선대학교의과대학정형외과학교실 Neurologic and Functional Outcomes after Traumatic Central Cord Syndrome Kyoung-Chul Song, M.D., Jae-Won You, M.D., Hyun-Hak Kim, M.D., and Hong-Moon Sohn, M.D. Department of Orthopaedic Surgery, College of Medicine, Chosun University, Gwangju, Korea Purpose: The purpose of this study was to determine the direction for treatment and to evaluate factors influencing improvement by comparison of neurologic and functional outcomes of surgical treatment and conservative treatment for traumatic central cord syndrome. Materials and Methods: A total of 28 patients, who were available for follow-up for at least more than one year from January 2005 to December 2008, who were diagnosed as traumatic central cord syndrome were analyzed retrospectively. Fifteen patients underwent surgical treatment (group 1), and 13 patients received conservative treatment (group 2). Maximum canal compromise (MCC), and maximum spinal cord compression (MSCC) were used for radiologic assessment, and American Spinal Injury Association (ASIA) motor score, Japanese Orthopaedic Association (JOA) score, and neck disability index (NDI) were used for assessment of functional outcomes. Results: The mean MCC was 47.2%, mean MSCC was 20.0%, and mean ASIA motor scale was 92.0 (group 1: 92.9, group 2: 90.9) at the final follow-up. The mean JOA score was 12.8 (group 1: 14.0, group 2: 11.4) and mean NDI was 25.0 (group 1: 25.7, group 2: 24.3) at the final follow-up. Conclusion: It is concluded that if a patient with traumatic central cord syndrome is young, with a high energy injury combined with fractures, and has severe spinal compression and mild initial neurologic defect, early surgical treatment would be needed as soon as possible. Key words: spinal cord injuries, central cord syndrome, cervical spine, treatment outcome 서론 외상성중심성척수증후군 (central cord syndrome) 은불완전척수 손상의가장흔한형태로, 1887 년처음으로 Thorburn 1) 이보고한 이후, 1954 년 Schneider 등 2) 에의해 외상성중심성척수증후군은 하지에비해상지의운동약화가있으며방광의기능부전이빈 Received June 25, 2013 Revised September 5, 2013 Accepted October 18, 2013 Correspondence to: Hong-Moon Sohn, M.D. Department of Orthopaedic Surgery, Chosun University Hospital, 365 Pilmun-daero, Dong-gu, Gwangju , Korea TEL: FAX: hmsohn@chosun.ac.kr *This study was supported by research fund from Chosun University Hospital, 번히동반되고손상부위아래에서의감각소실이다양한정도로나타나는불완전척수손상 으로정의되었다. Schneider 등 2) 은중심성척수증후군은척수부종이호전되면서운동기능이회복되어상당히좋은예후를보이기때문에수술적치료는금기라고하였는데, 실제당시의척추궁절제수술환자중일부에서술후악화된경우가많이있었기때문이었다. 이런이유로중심성척수증후군에대한보존적치료방법은 1970 년대초반까지일반적인치료방법으로받아들여졌으나 1971 년 Bosch 등 3) 이보존적치료를받은환자중장기적인추적관찰에서 60% 정도만기능회복을유지하였고 25% 의환자들은만성척수병증의결과에의해점차기능적인악화를보여보행이불가능한상태를보인다고보고하면서외상성중심성척수증후군의자연경과가손상초기에는증상이호전되다가일정한고원부 The Journal of the Korean Orthopaedic Association Volume 49 Number Copyright 2014 by The Korean Orthopaedic Association 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.

51 외상성중심성척수증후군치료결과 (plateau) 를이루는것이아니며어느시점이후에는악화되는것을알게되었다. 그이후여러저자들 4-6) 이선택적경우에서수술적치료후좋은결과들을보고하고있지만수술적치료가장기적추시에서기능적결과에영향을미치지않는다는보고들 4,7,8) 도있어중심성척수증후군의치료방법은여전히논란이되고있다.

2 51 외상성중심성척수증후군치료결과 (plateau) 를이루는것이아니며어느시점이후에는악화되는것을알게되었다. 그이후여러저자들 4-6) 이선택적경우에서수술적치료후좋은결과들을보고하고있지만수술적치료가장기적추시에서기능적결과에영향을미치지않는다는보고들 4,7,8) 도있어중심성척수증후군의치료방법은여전히논란이되고있다. 이에본연구에서는급성외상성중심성척수증후군환자의치료에서수술적치료와보존적치료의신경적및기능적결과를비교하여치료의방향을결정하고, 또한환자의신경적, 기능적호전에영향을미치는요소들을알아보고자하였다. 대상및방법 2005 년 1월부터 2008 년 12월까지조선대학교병원에서외상후하지의신경적증상보다상지의신경적증상이우세하며방광의기능부전이동반되고손상부위아래에서의감각소실이다양한정도로나타나급성중심성척수증후군으로진단받은후최소 1년이상추시관찰이가능했던 28예의환자를대상으로후향적으로연구하였다. 수술적치료를시행한군 (group 1) 이 15예, 보존적치료를시행한군 (group 2) 이 13예였다. 암이나다발성경화증, 심한간질환이나신부전같은내과적질환이심하거나기질성뇌질환이있어신경적, 기능적평가척도를측정할수없는경우, 다발성외상환자나기능평가에영향을줄수있는추가적손상이있는경우, 자기공명영상 (magnetic resonance imaging, MRI) 에서척수압박의증거가없는경우는대상에서제외하였다. 수술적적응증은인접분절과비교하여 11도이상의각변형이나척추체의 3.5 mm 이상의전위, 후방인대복합체의손상같은불안정증이있는경우, 신경적증상의결손과연관된부위에서척수를지속적으로압박하고척수손상의영상의학적인소견을보이거나신경적결손이악화되는경우로하였다. 수술적치료는전방, 후방, 또는전 후방감압및유합술의세가지로분류하였다. 전방수술은단분절추간판탈출, 추체골절로인한척수의전방압박, 큰골극, 후종인대골화증이나척추증성협착 (spondylotic stenosis) 이 2분절이하에서있는경우, 후방인대복합체의손상이있는경우에감압술및유합술을하였고, 후방수술은 3분절이상의척추관협착이있거나후방압박이있는경우에후궁성형술이나감압술및유합술을시행하였다. 양군간대상환자들의성별, 수상당시연령, 수상원인, 수상당시에너지의양, 손상부위, 동반된경추질환, 진단, 동반된내과질환, 스테로이드대량요법, 9) 추시기간을조사하였으며수술적치료를한경우에는수술적접근방법과수상후수술까지의시간을추가적으로조사하였다. 수상원인은교통사고, 실족, 추락, 폭행, 스포츠손상, 기타그룹으로나누어조사하였고, 수상당시에너지의양은 American College of Surgeons Committee on Trauma 에서분류한고 / 저에너지손상으로분류하였다. 진단은외상성 추간판탈출증을포함하는골절없이척추증이있는경우, 치아 돌기 (odontoid process) 골절을포함하는전주나중주의골절, 후 주및후방인대복합체의손상의 3 가지로나누어분류하였고, 스 테로이드대량요법은수상시간으로부터 8 시간이내일경우에만 시행하였다. 방사선적평가는 maximum canal compromise (MCC), maximum spinal cord compression (MSCC) 10,11) 을사용하였고 (Fig. 1), 기능적평가는 American Spinal Injury Association (ASIA) motor score (AMS) 의내원당시 (I), 최종추시 (F), 그리고내원당시와최 종추시값들의차이값 ( 변화값, G), 최종추시상의 Japanese Orthopaedic Association (JOA) scale, 12-14) neck disability index (NDI), 합병증등을조사하였다. NDI 설문지는총 10 문항으로대상자의 경부통과기능장애를측정하였는데 15) 통증강도, 일상생활, 들어 올리기, 읽기, 두통, 집중도, 일, 운전, 수면, 여가생활의 10 개항목 에대하여각각 6 개의항목중하나를선택하게되어있다 (0-5 점 ). NDI 점수는각항목의합계로점수가높을수록경부이상과관련 된기능장애가큰것을나타낸다. 원개발자인 Vernon 은점수를 해석함에있어서 0-4= 장애없음 (no disability), 5-14= 약간의장애 Figure 1. Sagittal T2-weighted magnetic resonance image shows parameters used for measurement of midsagittal diameter, maximum canal compromise (MCC), and maximum spinal cord compression (MSCC). The following measurements were obtained: spinal cord diameter one segment above the end of spinal stenosis (da), sagittal diameter of the spinal canal one segment above the stenotic segment (Da), sagittal diameter of the spinal cord (di) and spinal canal (Di) at the point of maximum compression, sagittal diameter of the spinal canal one segment below the stenotic segment (Db), the diameter of the spinal cord below the stenotic segment (db). MCC and MSCC were calculated according to the formulas. MCC=[1-Di/{1/2(Da+Db)}] 100, MSCC=[1- di/{1/2(da+db)}] 100.

3 52 송경철 유재원 김현학외 1 인 (mild disability), 15-24= 중등도의장애 (moderate disability), 25-34= 심한장애 (severe disability), 35 이상 = 완전한장애 (complete disability) 로제시하였다. 수집된자료는 SPSS 16.0 통계프로그램 (SPSS Inc., Chicago, IL, USA) 을사용하여분석하였으며, 유의수준 5% 에서검정하였다. 통계처리는성별, 진단, 동반내과질환, 스테로이드대량요법, 합병증은피셔의정확한검정 (Fisher exact test) 을사용하였으며, 추시기간, 내원당시상지의 AMS, 최종추시상하지의 AMS 는 Mann-Whitney 검정을사용하였고, 결과에영향을미치는요소들은단순회귀분석 (univariate regression analysis) 을사용하였으며그외변수들은독립표본 T검정을사용하였다. Table 1. Characteristics of 28 Patients with Traumatic Central Cord Syndrome Demographics Variable Operative treatment (n=15) Conservative treatment (n=13) p-value Gender (male/female) 12/3 11/ Age (yr) 47.2± ± * Mechanism of injury Motor vehicle accidents 4 4 Fall, standing 3 1 Height >1 m 1 1 Assault 3 4 Sports 4 3 High/low energy injury 6/9 5/ Diagnosis Spondylosis without fracture Anterior column fracture 1 2 Posterior element fracture 3 0 Comorbidities (0/1/2) 13/1/1 4/8/ * NASCIS II protocol Follow-up periods (mo) 16.9± ± Radiologic assessments MCC (%) 48.0± ± MSCC (%) 22.8± ± * Neurologic & functional assessments AMS (I) 56.5± ± Upper extremities score 25.1± ±3.6 Lower extremities score 31.5± ±3.7 AMS (F) 92.9± ± Upper extremities score 45.7± ±2.9 Lower extremities score 47.3± ±2.6 AMS (G) 36.4± ± * JOA scale (F) 14.0± ± * NDI (F) 25.7± ± Complications Values are presented as number only or mean±standard deviation. *Symbol represents statistically significant difference (p<0.05). NASCIS, National Acute Spinal Cord Injury Study; MCC, maximum canal compromise; MSCC, maximum spinal cord compression; AMS, American Spinal Injury Association motor score, JOA, Japanese Orthopaedic Association; NDI, neck disability index; I: initial; F, final follow-up; G, gap.

4 53 외상성중심성척수증후군치료결과 결과 남자가 23예, 여자가 5예였고, 전체평균연령은 51.3 세 (26-72 세 ) 였다. Group 1이평균 47.2 세 (26-61 세 ), group 2에서 56.1 세 (44-72 세 ) 로수술적치료를시행한군에서좀더젊은환자군이많이포함되어있었으며 group 2에서동반된내과질환이좀더많았고이는각각통계적으로유의하였다 (p=0.022). Group 1에서압박된척수의비율 (MSCC) 이 group 2보다많았으며 (p=0.045), 최종추시상 group 1에서큰폭의 AMS 향상 (p=0.025) 과높은 JOA 점수를보였고 (p=0.004) 이는통계적으로유의하였다. 두군에서수상원인은교통사고가 8예로가장많았으며, 골절없는퇴행성변화로진단받은경우가 22예로가장많았다 (Table 1). 병변부위는다발성병변을포함하여제 5-6 경추가 20예 (group 1: 12예, group 2: 8예 ) 로가장많았고, 제 4-5 경추 15예 (group 1: 9예, group 2: 6예 ), 제 3-4 경추 7예 (group 1: 2예, group 2: 5예 ), 제 6-7 경추 5예 (group 1: 1예, group 2: 4예 ), 제 1-2 경추 1예 (group 1) 였다. 동반된경추의병변은퇴행성변화가 14예, 추간판탈출증 10예, 후종인대골화증이 4 예였다. 합병증은 group 1에서빈뇨 3예, 수부의저린감 2예, 수부의둔감 (clumsiness) 1예로총 6예 (40%) 있었고, group 2에서견관절유착성관절낭염 1예, 수부의저린감 1예로총 2예 (15.4%) 있었다. Group 1에서수술방법은전방감압술이 12예, 후방감압술 3예였고, 수상후수술까지의시간은 1일이내가 4예, 3일이내가 11 예였으며 24시간이내로수술한경우가최종추시상의 AMS 및 JOA 점수에영향을주었다 (p=0.034, p=0.004) (Table 2). Group 1에서신경적및기능적결과에있어최종추시상 AMS 는나이가어리고척수압박정도를반영하는 MSCC 가낮고, 내원당시높은 AMS 를보일수록높은점수를보였다. 낮은점수일 Table 2. Mann-Whitney Test with Surgical Approach and Timing of Operation Approach (anterior/posterior) Operative treatment Operative timing (<1 day/1-3 days) Patient (n), total=15 12/3 4/11 Neurologic and functional outcomes (p-value) AMS (F) * JOA scale (F) * NDI (F) *Symbol represents statistically significant difference (p<0.05). AMS, American Spinal Injury Association motor score; JOA, Japanese Orthopaedic Association; NDI, neck disability index; F, final follow-up. Table 3. Univariate Regression Analysis with AMS (F), JOA Scale (F), NDI (F) Outcome Measures in the Operative Group Predictor variable Dependent (outcome) variable AMS (F) JOA scale (F) NDI (F) Regression coefficient p-value Regression coefficient p-value Regression coefficient p-value Male Age at injury * * Energy mechanism (high/low) * Diagnosis: fractures/spondylosis <0.001* Comorbidities (yes/no) NASCIS II protocol MCC MSCC * AMS (I) * * AMS (G) Complications *Symbol represents statistically significant difference (p<0.05). AMS, American Spinal Injury Association motor score; JOA, Japanese Orthopaedic Association; NDI, neck disability index; NASCIS, National Acute Spinal Cord Injury Study; MCC, maximum canal compromise; MSCC, maximum spinal cord compression; F, final follow-up; I, initial; G, gap.

5 54 송경철 유재원 김현학외 1 인 Table 4. Univariate Regression Analysis with AMS (F), JOA Scale (F), NDI (F) Outcome Measures in the Conservative Group Predictor variable Dependent (outcome) variable AMS (F) JOA scale (F) NDI (F) Regression coefficient p-value Regression coefficient p-value Regression coefficient p-value Male Age at injury * * Energy mechanism (high/low) Diagnosis: fractures/spondylosis Comorbidities (yes/no) * NASCIS II protocol MCC MSCC AMS (I) * * AMS (G) Complications * * *Symbol represents statistically significant difference (p<0.05). AMS, American Spinal Injury Association motor score; JOA, Japanese Orthopaedic Association; NDI, neck disability index; NASCIS, National Acute Spinal Cord Injury Study; MCC, maximum canal compromise; MSCC, maximum spinal cord compression; F, final follow-up; I, initial; G, gap. 수록좋은예후를보여주는최종추시상 NDI 는수상당시의연령이어리고, 고에너지손상이거나골절이있는경우, 내원당시높은 AMS 를보일수록낮은점수를보였다 (Table 3). Group 2에서신경적및기능적결과에있어서최종추시상 AMS 는나이가어리고내원당시높은 AMS 를보일수록높은점수를보였고, 최종추시상 JOA score 는합병증이있을수록낮은점수를보였다. 최종추시상 NDI 는수상당시의연령이많고동반된내과질환이많으면서내원당시높은 AMS 를보이고합병증이있는경우높은점수를보였다 (Table 4). 고찰 외상성중심성척수증후군은경수손상의약 15% 에서 25% 정도의발생빈도를보이고, 3,16,17) 대체로경추척추증 (cervical spondylosis) 을동반하고있는 60세이상의노인환자에서는척추골구조의손상이없는비교적경한과신전의손상에의해발생한다. 2,18-21) 반면젊은환자에서는경추의골절또는불안정을동반한고에너지손상에의해많이발생하여 4,18,19) 사실상모든연령층에서발생가능하다고볼수있다. 보존적혹은수술적치료가환자의예후에미치는영향에대한연구에서 Song 등 22) 은 22예의외상성중심성척수증후군환자에게수술적치료를하고나서신경적인기능회복이좀더즉각적이고빠르게이루어졌다고하였으나, Aito 등 7) 은 82예의환자중 38예를수술적치료, 44예를보존적치료를시행하였으나수술적치료가단, 장기추시상에서신경적, 기능적결과에영향을주지 못했다고보고하였다. Chen 등 4) 은경추척추증이동반된 37예의환자에서수술적치료를 16예, 보존적치료를 21예에서시행한후수술적치료군에서좀더빠른기능회복과짧은입원기간과재활기간이소요되었으나최종 2년추시상에서는신경적및기능적회복이두군간에차이가없었다고보고하였다. 본연구에서도단순회귀분석을통해수술적처치를시행한군에서좀더높은최종추시상의 JOA 점수를보였다. 수술적치료에있어서수상후언제수술을시행할것인지는매우논란이많은부분으로, Guest 등 23) 은척추의골구조손상없이척추관협착을동반한경우에는수술시점이중요하지않았으나외상성추간판탈출이나경추골절및탈구의경우수상후 24 시간이내에조기수술을시행하는것이운동기능의회복에유용하다고하였다. 하지만 Stevens 등 24) 은 126 예환자를 24시간이내, 첫내원 24시간이후 ( 수상후평균 6.4 일 ), 두번째내원시 ( 수상후평균 137 일 ) 에수술을시행한 3개의그룹으로나누어신경적기능회복을평가하였으나수술시점이신경적기능에영향을주지는못한다고하였다. Fehlings 등 25) 은 971 명의척추전문의에게설문조사를시행해서그중 80% 의척추전문의가급성경추척수손상인경우 24시간이내감압술을시행한다고응답하여조기감압술의당위성을주장하였으나외상후척추관협착증에의한중심성척수증후군이발생한경우에는조기감압술에대한합의된주장이없었다고보고하였다. 본연구에서는 24시간이내에감압술및유합술을시행한군에서좀더높은최종추시상 AMS, JOA 점수를보였다. 치료의예후에영향을미치는인자에대한연구도활발하게진

6 55 외상성중심성척수증후군치료결과 행되었다. Roth 등 26) 은연령이어릴수록우수한재활결과를보인다고하였고, Penrod 등 19) 은 51예의환자를수상당시의연령이 50 세미만인군과 50세이상인군으로비교연구하였는데, 최종추시시독립적인보행능력이 50세미만인군에서좋은것으로나타났다. 외상성중심성척수증후군의치료에있어연령에관한 2010 년에시행된체계적인연구 27) 에서는 50예의환자를 50세미만, 세, 70세초과의 3개의그룹으로나누어 ASIA scoring system 을통한근력과감각의향상정도를조사한결과모든그룹에서양측의상하지근력및감각이향상되었다고하였다. 특히 50세미만의그룹에서가장큰향상을보였으며장과방광의괄약근장애는전체환자의 42% 에서발생하였는데최종추시시 70 세초과그룹의 60% 가장과방광의괄약근장애가잔존하였고 70 세이하에서는장애가잔존하지않아수상당시의연령이 70세를초과할경우예후가불량할것이라고보고하였다. 본연구에서도연령이높을수록최종추시상낮은 AMS 와높은 NDI 점수를보여기능장애가큰것으로나타났다. Dvorak 등 8) 은외상성중심성척수증후군으로진단받은 72예의환자에서내원당시의 AMS 가높을수록, 교육수준이높을수록, 강직이없는경우에최종추시 AMS 가높았다고하였다. 또한최종추시 functional independence measure (FIM) 15,17,28) 는내원당시의 AMS 가높을수록, 교육수준이높을수록, 강직이없는경우와함께동반내과질환이없을수록높았다고보고하였다. Hohl 등 29) 은최종 1년추시 motor FIM 의결과에수상당시의 AMS 와 MRI 에서척수에비정상적인신호강도의증거가영향을준다고하였다. Aarabi 등 30) 의최근의연구에서내원당시의 AMS 가낮을수록, 시상면에서의척추관직경이작을수록최종추시 AMS 는낮고, MCC 는높을수록최종추시 AMS 는높았으며내원당시의연령이낮을수록, AMS 와 MCC 가높을수록최종추시 FIM 은높았다고보고하였다. 또한내원당시의 AMS 가낮을수록, 수술전 MRI 에서척수의손상된실질이길수록최종추시손기민성 (manual dexterity) 은낮았고수상당시연령이낮을수록, 내원당시수술전 MRI 에서척수의손상된실질이길수록최종추시상감각이상성통증 (dysesthetic pain) 이더심했다고보고하였다. 본연구에서신경적, 기능적결과에영향을미치는인자는수술적치료군에서수상당시연령, 손상에너지의양, 골절유무, MSCC, 초기신경적결손정도였고보존적치료군에서는수상당시연령, 동반된내과질환, 초기신경학적결손정도, 합병증유무였다. 외상성중심성척수증후군의치료는치료방법의차이와상관없이나이가어릴수록, 내원당시 AMS 가높을수록좋은예후를기대할수있었으나수술적치료군이보존적치료군에비해좀더높은최종추시상 JOA score 와큰폭의 AMS 향상을기대할수있었다. 수술적치료를시행할때는골절을동반한고에너지손상이면서골절을동반한경우 MRI 에서척수압박이심하고초기 신경적결손이심하지않다면 24시간이내에조기감압술을시행하는것이좀더좋은예후를기대할수있을것으로생각한다. 본연구의제한점으로후향적연구였으며증례수가충분히많지않고연령분포가수술적치료군에서좀더젊다는점이다. 향후다각적인신경적, 기능적결과에영향을미치는인자에대한전향적연구가필요할것으로생각된다. 결론 외상성중심성척수증후군환자의치료에서연령이비교적젊고골절이동반된고에너지손상이면서척수압박은심하나초기신경적결손이심하지않은경우에가능하다면조기에수술적치료를시행하는것이좋을것으로생각한다. REFERENCES 1. Thorburn W. Cases on injury to the cervical region of the spinal cord. Brain. 1887;9: Schneider RC, Cherry G, Pantek H. The syndrome of acute central cervical spinal cord injury; with special reference to the mechanisms involved in hyperextension injuries of cervical spine. J Neurosurg. 1954;11: Bosch A, Stauffer ES, Nickel VL. Incomplete traumatic quadriplegia. A ten-year review. JAMA. 1971;216: Chen TY, Dickman CA, Eleraky M, Sonntag VK. The role of decompression for acute incomplete cervical spinal cord injury in cervical spondylosis. Spine (Phila Pa 1976). 1998;23: Dai L. Magnetic resonance imaging of acute central cord syndrome: correlation with prognosis. Chin Med Sci J. 2001;16: Song J, Mizuno J, Inoue T, Nakagawa H. Clinical evaluation of traumatic central cord syndrome: emphasis on clinical significance of prevertebral hyperintensity, cord compression, and intramedullary high-signal intensity on magnetic resonance imaging. Surg Neurol. 2006;65: Aito S, D'Andrea M, Werhagen L, et al. Neurological and functional outcome in traumatic central cord syndrome. Spinal Cord. 2007;45: Dvorak MF, Fisher CG, Hoekema J, et al. Factors predicting motor recovery and functional outcome after traumatic central cord syndrome: a long-term follow-up. Spine (Phila Pa 1976). 2005;30: Bracken MB. Methylprednisolone and acute spinal cord in-

7 56 송경철 유재원 김현학외 1 인 jury: an update of the randomized evidence. Spine (Phila Pa 1976). 2001;26:S Fehlings MG, Furlan JC, Massicotte EM, et al; Spine Trauma Study Group. Interobserver and intraobserver reliability of maximum canal compromise and spinal cord compression for evaluation of acute traumatic cervical spinal cord injury. Spine (Phila Pa 1976). 2006;31: Fehlings MG, Rao SC, Tator CH, et al. The optimal radiologic method for assessing spinal canal compromise and cord compression in patients with cervical spinal cord injury. Part II: results of a multicenter study. Spine (Phila Pa 1976). 1999;24: Ishida Y, Ohmori K, Suzuki K, Inoue H. Analysis of dural configuration for evaluation of posterior decompression in cervical myelopathy. Neurosurgery. 1999;44: Naderi S, Ozgen S, Pamir MN, Ozek MM, Erzen C. Cervical spondylotic myelopathy: surgical results and factors affecting prognosis. Neurosurgery. 1998;43: Tanaka J, Seki N, Tokimura F, Doi K, Inoue S. Operative results of canal-expansive laminoplasty for cervical spondylotic myelopathy in elderly patients. Spine (Phila Pa 1976). 1999;24: Bovim G, Schrader H, Sand T. Neck pain in the general population. Spine (Phila Pa 1976). 1994;19: Merriam WF, Taylor TK, Ruff SJ, McPhail MJ. A reappraisal of acute traumatic central cord syndrome. J Bone Joint Surg Br. 1986;68: Gupta MC, Benson DR, Keenan TL. Skeletal trauma: basic science, management, and reconstruction. In: Browner BD, Jupiter JB, Levine AM, Trafton PG, ed. Philadelphia, PA: Saunders; Ishida Y, Tominaga T. Predictors of neurologic recovery in acute central cervical cord injury with only upper extremity impairment. Spine (Phila Pa 1976). 2002;27: Penrod LE, Hegde SK, Ditunno JF Jr. Age effect on prognosis for functional recovery in acute, traumatic central cord syndrome. Arch Phys Med Rehabil. 1990;71: Trombly R, Guest JD. Acute central cord syndrome arising from a cervical epidural abscess: case report. Neurosurgery. 2007;61:E Schneider RC, Thompson JM, Bebin J. The syndrome of acute central cervical spinal cord injury. J Neurol Neurosurg Psychiatry. 1958;21: Song J, Mizuno J, Nakagawa H, Inoue T. Surgery for acute subaxial traumatic central cord syndrome without fracture or dislocation. J Clin Neurosci. 2005;12: Guest J, Eleraky MA, Apostolides PJ, Dickman CA, Sonntag VK. Traumatic central cord syndrome: results of surgical management. J Neurosurg. 2002;97:S Stevens EA, Marsh R, Wilson JA, Sweasey TA, Branch CL Jr, Powers AK. A review of surgical intervention in the setting of traumatic central cord syndrome. Spine J. 2010;10: Fehlings MG, Rabin D, Sears W, Cadotte DW, Aarabi B. Current practice in the timing of surgical intervention in spinal cord injury. Spine (Phila Pa 1976). 2010;35:S Roth EJ, Lawler MH, Yarkony GM. Traumatic central cord syndrome: clinical features and functional outcomes. Arch Phys Med Rehabil. 1990;71: Lenehan B, Fisher CG, Vaccaro A, Fehlings M, Aarabi B, Dvorak MF. The urgency of surgical decompression in acute central cord injuries with spondylosis and without instability. Spine (Phila Pa 1976). 2010;35:S Stineman MG, Hamilton BB, Goin JE, Granger CV, Fiedler RC. Functional gain and length of stay for major rehabilitation impairment categories. Patterns revealed by function related groups. Am J Phys Med Rehabil. 1996;75: Hohl JB, Lee JY, Horton JA, Rihn JA. A novel classification system for traumatic central cord syndrome: the central cord injury scale (CCIS). Spine (Phila Pa 1976). 2010;35:E Aarabi B, Alexander M, Mirvis SE, et al. Predictors of outcome in acute traumatic central cord syndrome due to spinal stenosis. J Neurosurg Spine. 2011;14:

8 57 pissn : , eissn : Original Article J Korean Orthop Assoc 2014; 49: 외상성중심성척수증후군치료결과 외상성중심성척수증후군후신경학적및기능적결과 송경철 유재원 김현학 손홍문 조선대학교의과대학정형외과학교실 목적 : 외상성중심성척수증후군에서수술적치료와보존적치료의신경적및기능적결과를비교하여치료의방향을결정하고호전에영향을미치는요소들을알아보고자하였다. 대상및방법 : 2005 년 1월부터 2008 년 12월까지중심성척수증후군으로진단받고, 최소 1년이상추시관찰이가능했던 28예를후향적으로분석하였다. 수술적치료군 (group 1) 이 15예, 보존적치료군 (group 2) 이 13예였으며, 방사선적평가는 maximum canal compromise (MCC), maximum spinal cord compression (MSCC), 기능적결과는 American Spinal Injury Association motor score (AMS), Japanese Orthopaedic Association (JOA) score, neck disability index (NDI) 를사용하였다. 결과 : MCC 는평균 47.2%, MSCC 는평균 20.0% 였으며, 최종 AMS 는평균 92.0 (group 1: 92.9, group 2: 90.9), JOA score 는평균 12.8 (group 1: 14.0, group 2: 11.4), NDI 는평균 25.0 (group 1: 25.7, group 2: 24.3) 이었다. 결론 : 외상성중심성척수증후군치료에서연령이젊고, 골절이동반된고에너지손상이면서척수압박은심하나초기신경적결손이심하지않은경우조기에수술적치료를시행하는것이좋을것으로생각된다. 색인단어 : 척수손상, 중심성척추증후군, 경추, 치료결과 접수일 2013 년 6 월 25 일수정일 2013 년 9 월 5 일게재확정일 2013 년 10 월 18 일책임저자손홍문광주시동구필문대로 365, 조선대학교병원정형외과 TEL , FAX , hmsohn@chosun.ac.kr * 이논문은 2012 년도조선대학교병원선택진료학술연구비에의하여연구되었음. 대한정형외과학회지 : 제 49 권제 1 호 2014 Copyright 2014 by The Korean Orthopaedic Association 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