166 경추의디스크병변으로인한방사통의치료에경추부의선택적신경차단술이많이사용되고있다. 고식적인방법으로방사선투시검사 (fluoroscopy) 에의한주사법이사용되고있으며 1) 이와관련된합병증으로인하여컴퓨터단층촬영 (computed tomograpissn : ,

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1 166 경추의디스크병변으로인한방사통의치료에경추부의선택적신경차단술이많이사용되고있다. 고식적인방법으로방사선투시검사 (fluoroscopy) 에의한주사법이사용되고있으며 1) 이와관련된합병증으로인하여컴퓨터단층촬영 (computed tomograpissn : , eissn : Original Article J Korean Orthop Assoc 2018; 53: 하부경추의방사통환자에서초음파를이용한선택적신경근차단술의효과 : 지속성과부작용평가 강형석 김창수 권영호 고신대학교복음병원정형외과 The Effectiveness of Ultrasound-Guided Selective Nerve Root Block for the Treatment of Radicular Pain in the Lower Cervical Spine: An Assessment of Sustainability and Side Effects Hyung Suk Kang, M.D., Chang Su Kim, M.D., and Young-Ho Kwon, M.D. Department of Orthopedic Surgery, Kosin University Gospel Hospital, Busan, Korea Purpose: The purpose of this study was to evaluate the sustainability and adverse effects of ultrasound-guided selective nerve root block in patients who complained of radiculopathy due to lower cervical disc herniation. Materials and Methods: Between February 2014 and February 2016, 39 out of 60 patients who visited Department of Orthopedic Surgery, Kosin University Gospel Hospital with a chief complaint of radiculopathy due to lower cervical disc herniation were treated with an ultrasound-guided selective nerve root block. To evaluate the efficacy and sustainability of this treatment, the degree of pain relief and functional improvement were evaluated before and 3 months after the procedure. Patients were categorized into two groups: The soft disc group and the hard disc group. The safety of the procedure was evaluated by examining the side effects occurring immediately after the procedure and the following day. Results: Visual analogue scale and Neck Disability Index were improved from 6.00 to 3.02 and from to 6.15, respectively (p<0.05). There were 2 cases of headache and 2 cases of dizziness; however, they were resolved within 1 hour after the procedure. In 32 patients (82.1%), there was improvement in pain, which persisted for more than 3 months in 24 patients. Contrastinly, 7 patients (17.9%) showed no improvement and 6 patients (15.4%) experienced recurrence of pain or symptoms within 1 month after the procedure. In the soft disc group, there was a reduction in pain, from a score of 5.88 before the procedure to 2.64 twelve weeks after the procedure (p<0.01). In the hard disc group, there was also a reduction in, from a score of 6.09 before the procedure to 3.22 at postoperative 12 weeks (p<0.01). There was no significant difference between the two groups. Conclusion: In patients with cervical disc herniation, an ultrasound-guided selective nerve root block appears to be an effective treatment option for outpatients due to its low risk of serious complications. Key words: herniated disc, nerve block, ultrasonography 서론 Received March 28, 2017 Revised June 13, 2017 Accepted July 27, 2017 Correspondence to: Chang Su Kim, M.D. Department of Orthopedic Surgery, Kosin University Gospel Hospital, 262 Gamcheonro, Seo-gu, Busan 49267, Korea TEL: FAX: mewha98@naver.com The Journal of the Korean Orthopaedic Association Volume 53 Number Copyright 2018 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.

2 167 Effectiveness of Ultasound-Guide Selective Nerve Root Block phy, CT) 등을이용한방법들이사용되고있지만비용과시간같은외적인측면에서현실적인제약이많다. 2,3) 방사선투시유도하신경차단술은골조직을제외한신경, 혈관을포함한연부조직을확인할수없으며환자와시술자에게방사선노출위험의단점이있다. 4-6) 이에반해최근각광받고있는초음파를이용한신경차단술은방사선노출위험이없고신경이나혈관의위치를비교적정확하게파악할수있으며주사액의주입에따른연부조직의변화를실시간으로확인할수있어서혈관으로주사되거나혈관, 신경등의조직손상을주사제가퍼지는영역을보면서조절할수있다는장점을가지고있어사용이확대되고있다. 7-9) 단점으로는초음파의해상도문제와상대적으로시술자의숙련도가요구된다는점인데초음파기기의발전과해부학적이해를바탕으로안전한술기를위한연구들이진행되고있어앞으로경추부의신경차단술이새로운표준화된처치로발전할가능성이높다. 8,10,11) 안전성에대한앞선연구에서초음파유도를통해바늘을삽입한후추간공과의위치관계를확인하여신경근차단술의정확함을확인하였고, 8,10) Yamauchi 등 11) 은초음파가이드하경추신경근차단술을통해술후 24시간과 1개월후통증감소효과를보고하였으며사체연구를통해주입한약물이신경근근처로퍼짐을확인하였다. 그리고최근연구에서는방사선투시하신경근차단술과의비교연구를통하여기존의신경근차단술의표준적치료법에상응할만한치료효과를보고하였다. 12) 경추부의추간판질환으로인한신경근증은연성추간판 (soft disc) 과경성추간판 (hard disc) 의두가지경우로나누어볼수있다. 13,14) 먼저연성추간판증은추간판변성으로추간판의후외방이나외측추간공탈출및이로인한신경근의압박으로인해발생하며, 경성추간판증은퇴행성변화로인한추간판의높이감소와신경공주위의후관절및추간판후방변연부의골극형성으로인하여추간공의협소를일으켜신경근을압박한다. 두가지경우에서모두염증성매개물질의작용으로혈관반응을변화시키고신경내부종을 야기하여증상을유발한다 ) 본연구에서는경추부의디스크병변환자를대상으로정형외과외래기반의초음파를이용하여시술의효과의지속성과부작용및추가적으로디스크병변의분류에따른치료효과에대하여도알아보았다. 대상및방법 본연구는 2014년 2월부터 2016년 2월까지경추의추간판탈출증으로인한상지방사통을주소로외래내원하여초음파유도하선택적신경근차단술을시행한 60명의환자중임상적, 방사선적 ( 단순방사선, CT, 자기공명영상 ) 진단을통하여확인된하부경추부의문제로인한환자들을대상으로후향적연구를시행하였다. 두개이상의다분절을침범한경우를제외한한개의단일분절의추간판탈출증환자들을대상으로초음파유도하신경근차단술을시행하였고외래추시관찰이 3개월이상가능하였던환자들의시술후증상호전정도를평가하였다. 영상의학적검사와환자의임상적증상이일치하지않는환자는대상에서제외하였고경추부의외상이나기타퇴행성병변으로수술을받은과거력이있는환자와척추관협착증이나후종인대골화증등으로경추척수증이진행된환자, 한개이상의신경근이압박되었거나퇴행성변화로인한분절불안정성이있는환자도대상에서제외하였다. 그외에도추시기간중에이전에복용하지않던추가적인통증조절약물을복용한경우와타병원에서추가적인주사요법을시행받은경우는결과판정에영향을미칠수있으므로제외하였다. 이렇게선별된 39명의환자들은평균나이 59.18세 (43-85세 ) 였으며남자가 22명여자가 17명이었다 (Table 1). 자기공명영상, CT 및경추부단순방사선사진을분석하여경성추간판과 (Fig. 1) 연성추간판을 (Fig. 2) 구분하여각군의시술후효과를비교하였으며경성추간판군은 22예, 연성추간판군은 17예였다. 방사통의원인이제5 신경근인경우 8예, 제6 신경근인경우 18예, Table 1. Characteristics of Patients Characteristic All patient (n=39) Soft disc group (n=17) Hard disc group (n=22) P-value Age (yr) (43 85) (43 85) (44 63) >0.05 Sex (male/female) 22/17 8/9 14/8 >0.05 Body mass index (kg/m 2 ) 25.5± ± ±3.5 >0.05 No. of injection 1.35± ± ±0.5 >0.05 Root level >0.05 C C C Values are presented as median (range), number only, or mean±standard deviation.

168 Hyung Suk Kang, et al. A C P A B D Figure 1.

(A, B) Anteroposterior and lateral x-rays show C5/C6 degenerative spondylosis.

(D) Ultrasound-guided selective nerve root block (target nerve root was left C6).

모든초음파를이용한차단술은한명의시술자에의해시행되었으며, 모든환자에대해외래상태에서시행하였다. 초음파는 SEQUOIA512 ultrasound system (Simens, Munich, Germany) 을이용하여시행하였으며선형탐촉자 (linear probe) 를이용하였다. 시술시 22-gauge epidural needle을사용하였다.

3 168 Hyung Suk Kang, et al. A C P A B D Figure 1. A 56-year-old man with C6 radiculopathy showed a pain reduction with a visual analogue scale of 6 before the procedure to 2 at 12 weeks after the procedure. (A, B) Anteroposterior and lateral x-rays show C5/C6 degenerative spondylosis. (C) Axial T2-weighted image (C5/6 level): magnetic resonance imaging shows narrowing of the left neural foramen with structure of low signal intensity (hard disc). (D) Ultrasound-guided selective nerve root block (target nerve root was left C6). Arrowheads, point to the needle; A, anterior tubercle of C6 transverse process; P, posterior tubercle of C6 transverse process. 제7 신경근인경우 13예였다 (Table 1). 모든초음파를이용한차단술은한명의시술자에의해시행되었으며, 모든환자에대해외래상태에서시행하였다. 초음파는 SEQUOIA512 ultrasound system (Simens, Munich, Germany) 을이용하여시행하였으며선형탐촉자 (linear probe) 를이용하였다. 시술시 22-gauge epidural needle을사용하였다. 환자를측면으로눕힌자세로경추의위치및경동맥, 경정맥의위치확인후 inplane 술기로경추부측돌기의후방에서전방으로삽입하여후결절에서나오는신경근부위를목표로주사하였다. 정확한위치확인후혼합액 (ropivacain, dexamethasone, saline) 0.5 ml 주입한후 1분간두통, 어지러움, 과민반응유무를확인한다음한부위에 ropivacain 0.6 ml, dexamethasone 0.6 ml, saline 0.8 ml를섞은혼합액총 2.5 ml를주사하였다. 시술전후의효과판정을위하여시행전의외래면담을통하여상지방사통에대한시각통증척도 (visual analogue scale, VAS) 와 Neck Disability Index (NDI) 를평가하였고, 시술후외래추시관찰을통하여 1주일째와 3개월째의 VAS와 NDI를평가하였다. NDI는경추부질환을가진환자의활동도장애정도를측정하는데가장일반적으로사용하는설문지로환자에게직접문답형식 으로작성하였다. NDI는경추부활동도장애정도에대한질문들의답에대한점수의합산으로 4점이하는 no disability, 5-14점은 mild disability, 15-24점은 moderate disability, 25-34점은 sever disability, 35점이상은 complete disability로해석하였다. 시술전통증정도를기준으로하여 50% 이상통증의호전이있는경우를의미있는통증감소로판정하였다. 시술을받은모든환자는외래옆에따로준비된방에서약 2시간의침상안정과활력징후측정및시술후부작용발생유무를확인한뒤귀가하였으며시술다음날전화면담을통하여부작용유무를추가로확인하였다. 통계자료의분석은 IBM SPSS ver (IBM Co., Armonk, NY, USA) 을이용하였으며나이, 체질량지수와같은연속성변수에대해서는 Mann-Whitney U-test를사용하였고, 성별, root level 등의범주형변수에대해서는 chi-square test, Fisher s exact test를사용하였다. 그룹내시술전, 후의 VAS 및 NDI 비교는정규분포를따르지않는경우로 Wilcoxon signed rank test를, 두군간의시간에따른변화비교는 repeated measured ANOVA (RM ANOVA) 를사용하였다. 통계적유의수준은 p-value가 0.05 미만인값을유의한것으로하였다.

169 Effectiveness of Ultasound-Guide Selective Nerve Root Block A B C P A D Figure 2.

(A, B) Anteroposterior and lateral x-rays show narrowing of C5/6 disc space. (C) Sagittal T2-weighted image: magnetic resonance imaging shows disc herniation (soft disc).

Arrowheads, point to the needle; A, anterior tubercle of C6 transverse process; P, posterior tubercle of C6 transverse process. 결과 초음파를이용한경추부의선택적신경근차단술을시행한후통증의호전정도는 VAS로평가하였고시술전 6.00±1.8, 시술 1주일후 3.

0로유의한통증감소효과를확인할수있었다 (p<0.01) (Table 3). 그러나 RM ANOVA에서두군사이의시간에따른통증변화는유의한차이를확인할수없었다 (p>0.05). 32명 (82.1%) 의환자에서시술후유의한통증의호전이있었으며, 그중 24명 (75.0%) 의경우통증호전이 3개월이상지속되었다. 7명 (17.

4 169 Effectiveness of Ultasound-Guide Selective Nerve Root Block A B C P A D Figure 2. A 64-year-old woman with C6 radiculopathy showed pain reduction with a visual analogue scale of 8 before the procedure to 3 at postoperative 12 weeks. (A, B) Anteroposterior and lateral x-rays show narrowing of C5/6 disc space. (C) Sagittal T2-weighted image: magnetic resonance imaging shows disc herniation (soft disc). (D) ultrasound-guided selective nerve root block (target nerve root was left C6). Arrowheads, point to the needle; A, anterior tubercle of C6 transverse process; P, posterior tubercle of C6 transverse process. 결과 초음파를이용한경추부의선택적신경근차단술을시행한후통증의호전정도는 VAS로평가하였고시술전 6.00±1.8, 시술 1주일후 3.02±1.9, 12주후 2.97±1.9로시술전에비하여유의한통증감소효과를보였다 (p<0.01) (Table 2). 그룹별로는연성추간판군에서시술전 5.88±2.0, 시술 1주일후 3.00±1.7, 12주후 2.64±1.8로유의한통증감소효과를보였고 (p<0.01), 경성추간판군에서시술전 6.09±1.8, 시술 1주일후 3.04±2.1, 12주후 3.22±2.0로유의한통증감소효과를확인할수있었다 (p<0.01) (Table 3). 그러나 RM ANOVA에서두군사이의시간에따른통증변화는유의한차이를확인할수없었다 (p>0.05). 32명 (82.1%) 의환자에서시술후유의한통증의호전이있었으며, 그중 24명 (75.0%) 의경우통증호전이 3개월이상지속되었다. 7명 (17.9%) 의환자에서는시술후전혀증상의호전이없었으며유의한통증의호전이있었던환자들중 1개월이내에통증의악화나증상이재발한환자는 6명 (15.4%) 이었다. NDI 또한평균 15.82±8.9에서시술 1주일후 6.15±6.7, 시술 12주후 6.33±6.4로향상된결과를확인 Table 2. Improved Score of VAS and NDI After US-Guided Selective Nerve Root Block Follow-up dation VAS NDI Preoperative 6.00± ±8.9 Postoperative After 1 week 3.02± ±6.7 After 12 weeks 2.97± ±6.4 p-value <0.01 <0.01 Values are present as mean±standard deviation. VAS, visual analogue scale; NDI, Neck Disability Index; US, ultrasound. 하였고통계적으로유의한차이를보였다 (p<0.01) (Table 2). 그룹별로는연성추간판군에서시술전 14.35±7.8, 시술 1 주일 후 4.76±4.5, 12 주후 4.82±4.08 로유의한통증감소효과를보였 으며 (p<0.01), 경성추간판군에서시술전 16.95±8.9, 시술 1 주일 후 7.22±7.9, 12 주후 7.50±7.5 로유의한통증감소효과를확인할 수있었다 (p<0.01) (Table 4). 그러나 RM ANOVA 에서두군사이의시간에따른통증변화 는유의한차이를확인할수없었다 (p>0.05). 연성추간판군에서

5 170 Hyung Suk Kang, et al. Table 3. Improved VAS of the Soft Disc Group and Hard Disc Group Follow-up dation Soft disc group (n=17) Hard disc group (n=22) Preoperative 5.88± ±1.8 Postoperative After 1 week 3.00± ±2.1 After 12 weeks 2.64± ±2.0 p-value <0.01 <0.01 Values are present as mean±standard deviation. VAS, visual analogue scale. Table 4. Improved NDI of the Soft Disc Group and Hard Disc Group Follow-up dation Soft disc group (n=17) Hard disc group (n=22) Preoperative 14.35± ±8.9 Postoperative After 1 week 4.76± ±7.9 After 12 weeks 4.82± ±7.5 p-value <0.01 <0.01 Values are present as mean±standard deviation. NDI, Neck Disability Index. 는유의미한 NDI 호전이 22예중 14예 (63.6%), 경성추간판군에서는 17예중 12예 (70.6%) 가확인되었다. 전체환자중에서의식소실, 활력징후변화, 과민반응등중대한부작용은없었다. 시술후 2예 (5.1%) 에서두통, 2예 (5.1%) 에서어지러움등의일시적인부작용을보였으나두경우모두 1시간이내의침상안정으로호전되었으며시술다음날까지지속되는부작용은없었다. 고찰 Macnab 16) 이선택적신경차단술을소개한이후진단및치료목적의신경근차단술의유용성에대한많은연구들이있었으며현재는경추방사통을호소하는환자들에게증상완화및진단목적으로선택적신경차단술이널리시행되고있다. 17,18) 최근에는초음파를이용한신경차단술의유용성에대하여다양한연구들이진행되고있으며, 10-12) 방사선투시하신경근차단술과의비교연구에서도차이가없다고보고되고있다. 12) 본연구에서도초음파를이용한신경차단술후시술전, 후 VAS와 NDI 비교로증상의호전이일상생활에도움이될정도라는것을확인할수있었다. 시술후 12주후의 VAS와 NDI의비교를통해치료효과의지속성또한확인가능하였다. Odom 등 19) 은경추추간판질환을 4가지로분류하였다 ; (1) 편측성연성디스크탈출로인한신경근압박 ; (2) 추간공돌출및경성디스크로인한신경근압박 ; (3) 내측연성디스크탈출로인한척수압박 ; (4) 경부척추증으로인한척수압박. 연성추간판탈출증은급성으로나타나며, 단일분절에영향을주는경우가많다. 시간의경과에따라그크기가감소할수있다 ) 반면에경성추간판탈출증은퇴행성변화로인하여만성적으로나타나며여러분절에영향을주는경우가많다. 본연구에서는척수증이동반된환자는제외하였으며, 연성추간판탈출증과경성추간판탈출증의치료에대한반응차이가있을것으로생각하여연성추간판군과경성추간판군의두군으로나누어증상의호전정도및기간에대하여비교하였으나두군간의통계적차이 는없었다. 이결과는추간판탈출증의증상유발메커니즘과연관이있다고보인다. 추간판탈출증의증상유발메커니즘은염증반응이중요한역할을한다고알려져있으며, 수핵은염증반응과신경흥분을일으킬수있는물질들을포함하고있어서수핵이신경절에닿으면신경의이소성방전이일어나증상이유발된다. 15) 주사시사용되는스테로이드는추간판탈출증의염증매개물질인 phopholipase A2, interleukin 등염증전구물질들의활성을억제하는효과가있어추간판탈출증에서의통증을경감시킨다. 15) 연성추간판군과경성추간판군모두에서염증반응억제를통한통증경감효과가있었던것으로여겨지며, 이는초음파를이용한선택적차단술이연성추간판탈출증과경성추간판탈출증모두에서효과가있다고볼수있다. 경추부선택적신경차단술의유용성에도불구하고고식적으로사용되고있는방사선투시검사에의한주사법의경우시술자와환자모두에게방사선노출로인한전신적인위험성과, 4,5) 최근에는시술자의손에서방사선으로인한연부조직괴사발생이보고되고있고, 6) 드물지만혈관내주사, 중추신경계의허혈또는출혈과같은심각한합병증으로인해일반외래환자를대상으로하기에꺼려지는시술로생각되었다. 2,3) 최근초음파기계의발달및대중화로비교적간단하게시술이가능하게되었으며초음파를통하여시술부위의신경과혈관주사액의퍼짐현상이육안으로확인가능하므로정확하고안전하게시술이가능하다고보고있다. 7,8) 본연구에서도시술시경동맥, 경정맥등중요혈관의위치를컬러도플러초음파를이용하여위치를확인할수있었고주사액투여시연부조직의변화양상을육안으로확인하며시술을진행할수있었다. 하지만초음파를이용한선택적신경근차단술이작은혈관으로의마취약의혈관내주사가능성 23) 및척추바늘로인한신경근손상위험성에서부터완전히자유롭지는못하므로끝부위가둔탁한바늘과비입자성스테로이드를사용하고혼합액을 0.5 ml만먼저투여하여환자의반응유무확인을통하여부작용을예방할수있었다. 본연구를통하여초음파를이용한경추의선택적신경근차단술효과와안전성에대하여확인할수있었다. 하지만본연구는

6 171 Effectiveness of Ultasound-Guide Selective Nerve Root Block 후향적연구방법과이시술의부작용을판단하기엔모집단의수가적은단점을가지고있다. 이에전향적이며모집단의수를더늘려서연구가필요할것으로생각된다. 결론 경추부디스크로인한신경근증환자에서초음파를이용한경추의선택적신경근차단술은연성추간판탈출증과경성추간판탈출증모두에서효과적이고, 혈관내직접주사와같은중대한합병증의가능성이낮아외래환자를대상으로사용해볼수있는좋은치료방법중하나로생각된다. CONFLICTS OF INTEREST The authors have nothing to disclose. REFERENCES 1. Rathmell JP, Aprill C, Bogduk N. Cervical transforaminal injection of steroids. Anesthesiology. 2004;100: Wallace MA, Fukui MB, Williams RL, Ku A, Baghai P. Complications of cervical selective nerve root blocks performed with fluoroscopic guidance. AJR Am J Roentgenol. 2007;188: Brouwers PJ, Kottink EJ, Simon MA, Prevo RL. A cervical anterior spinal artery syndrome after diagnostic blockade of the right C6-nerve root. Pain. 2001;91: Huston CW, Slipman CW, Garvin C. Complications and side effects of cervical and lumbosacral selective nerve root injections. Arch Phys Med Rehabil. 2005;86: Ma DJ, Gilula LA, Riew KD. Complications of fluoroscopically guided extraforaminal cervical nerve blocks. An analysis of 1036 injections. J Bone Joint Surg Am. 2005;87: Shim DM, Kim YM, Oh SK, Lim CM, Kown BT. Radiation induced hand necrosis of an orthopaedic surgeon who had treated a patient with fluoroscopy-guided spine injection. J Korean Orthop Assoc. 2014;49: Nakagawa M, Shinbori H, Ohseto K. Ultrasound-guided and fluoroscopy-assisted selective cervical nerve root blocks. Masui. 2009;58: Narouze SN, Vydyanathan A, Kapural L, Sessler DI, Mekhail N. Ultrasound-guided cervical selective nerve root block: a fluoroscopy-controlled feasibility study. Reg Anesth Pain Med. 2009;34: Martinoli C, Bianchi S, Santacroce E, Pugliese F, Graif M, Derchi LE. Brachial plexus sonography: a technique for assessing the root level. AJR Am J Roentgenol. 2002;179: Galiano K, Obwegeser AA, Bodner G, et al. Ultrasound-guided periradicular injections in the middle to lower cervical spine: an imaging study of a new approach. Reg Anesth Pain Med. 2005;30: Yamauchi M, Suzuki D, Niiya T, et al. Ultrasound-guided cervical nerve root block: spread of solution and clinical effect. Pain Med. 2011;12: Jee H, Lee JH, Kim J, Park KD, Lee WY, Park Y. Ultrasound-guided selective nerve root block versus fluoroscopy-guided transforaminal block for the treatment of radicular pain in the lower cervical spine: a randomized, blinded, controlled study. Skeletal Radiol. 2013;42: Yamano Y. Soft disc herniation of the cervical spine. Int Orthop. 1985;9: Bush K, Chaudhuri R, Hellier S, Penny J. The pathomorphologic changes that accompany the resolution of cervical radiculopathy. A prospective study with repeat magnetic resonance imaging. Spine (Phila Pa 1976). 1997;22:183-6; discussion McLain RF, Kapural L, Mekhail NA. Epidural steroid therapy for back and leg pain: mechanisms of action and efficacy. Spine J. 2005;5: Macnab I. Negative disc exploration. An analysis of the causes of nerve-root involvement in sixty-eight patients. J Bone Joint Surg Am. 1971;53: Razzaq AA, O'Brien D, Mathew B, Bartlett R, Taylor D. Efficacy and durability of fluoroscopically guided cervical nerve root block. Br J Neurosurg. 2007;21: Anderberg L, Annertz M, Rydholm U, Brandt L, Säveland H. Selective diagnostic nerve root block for the evaluation of radicular pain in the multilevel degenerated cervical spine. Eur Spine J. 2006;15: Odom GL, Finney W, Woodhall B. Cervical disk lesions. J Am Med Assoc. 1958;166: Saal JA, Saal JS. Nonoperative treatment of herniated lumbar intervertebral disc with radiculopathy. An outcome study. Spine (Phila Pa 1976). 1989;14: Komori H, Shinomiya K, Nakai O, Yamaura I, Takeda S, Furuya K. The natural history of herniated nucleus pulposus with radiculopathy. Spine (Phila Pa 1976). 1996;21:225-9.

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8 173 pissn : , eissn : Original Article J Korean Orthop Assoc 2018; 53: 하부경추의방사통환자에서초음파를이용한선택적신경근차단술의효과 : 지속성과부작용평가 강형석 김창수 권영호 고신대학교복음병원정형외과 목적 : 하부경추의디스크병변으로인한상지방사통을호소하는환자들을대상으로초음파를이용한선택적신경근차단술을시행 하여그효과의지속성과부작용에대하여평가해보고자하였다. 대상및방법 : 2014 년 2 월부터 2016 년 2 월까지경추추간판탈출증으로인한상지방사통을주소로내원한환자들 60 명중 39 명에 게초음파유도하선택적신경근차단술을시행하였다. 시술의효과및지속성을평가하기위하여시술전, 후및 3 개월째통증의호 전정도와기능적향상정도를조사하였다. 연성추간판 (soft disc) 군과경성추간판 (hard disc) 군 2 개군으로나누어비교하였으며시 술과정과직후, 다음날까지발생한부작용을조사하여시술의안전성을평가해보았다. 결과 : 통증의호전정도를평가한시각통증척도는평균 6.00 에서시술후평균 3.02 로호전되었고 Neck Disability Index 또한평균 에서 6.15 로향상된결과를보였다 (p<0.05). 시술후 2 예에서두통, 2 예에서어지러움등의일시적인부작용을보였으나 1 시간내로호전되었으며시술다음날까지지속되는부작용은없었다. 32 명 (82.1%) 의환자에서시술후통증의호전이있었으며, 그중 24 명의경우통증호전이 3 개월이상지속되었다. 7 명 (17.9%) 의환자에서는시술후전혀증상의호전이없었으며 1 개월이내에통 증의악화나증상이재발한환자는 6 명 (15.4%) 이었다. 연성추간판군에서시술전 5.88, 12 주후 2.64 로통증감소효과를보였고 (p<0.01). 경성추간판군에서시술전 6.09, 12 주후 3.22 로통증감소효과를확인할수있었다 (p<0.01). 그러나두군사이의유의한차이는확인할수없었다. 결론 : 경추부디스크로인한신경근증환자에서초음파를이용한경추의선택적신경근차단술은효과적이며중대한합병증의가능 성이낮아외래환자를대상으로사용해볼수있는좋은치료방법중에하나로생각된다. 색인단어 : 추간판탈출증, 신경차단술, 초음파 접수일 2017 년 3 월 28 일수정일 2017 년 6 월 13 일게재확정일 2017 년 7 월 27 일책임저자김창수 49267, 부산시서구감천로 262, 고신대학교복음병원정형외과 TEL , FAX , mewha98@naver.com 대한정형외과학회지 : 제 53 권제 2 호 2018 Copyright 2018 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