Journal of Korean Society of Spine Surgery Incidentally Detected Concurrent Lower Thoracic Lesions in Extended Lumbar Spine MRI Jae-Yoon Chung, M.D.,

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Journal of Korean Society of Spine Surgery Incidentally Detected Concurrent Lower Thoracic Lesions in Extended Lumbar Spine MRI Jae-Yoon Chung, M.D., Ji-Hyeon Yim, M.D., Hyoung-Yeon Seo, M.D., Ha-Sung Kim, M.

Sinheung-Dong, Jung-Gu, Incheon, 400-711, Korea Tel: 82-32-890-3044 Fax: 82-32-890-3467 Copyright 2011 Korean Society of Spine Surgery pissn 2093-4378 eissn 2093-4386 The online version of this

1 Journal of Korean Society of Spine Surgery Incidentally Detected Concurrent Lower Thoracic Lesions in Extended Lumbar Spine MRI Jae-Yoon Chung, M.D., Ji-Hyeon Yim, M.D., Hyoung-Yeon Seo, M.D., Ha-Sung Kim, M.D., Do-Youn Kim, M.D. J Korean Soc Spine Surg 2012 Sep;19(3): Originally published online September 30, 2012; Korean Society of Spine Surgery Department of Orthopedic Surgery, Inha University School of Medicine #7-206, 3rd ST. Sinheung-Dong, Jung-Gu, Incheon, , Korea Tel: Fax: Copyright 2011 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/3.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

2 Original Article pissn eissn J Korean Soc Spine Surg Sep;19(3): Incidentally Detected Concurrent Lower Thoracic Lesions in Extended Lumbar Spine MRI Jae-Yoon Chung, M.D., Ji-Hyeon Yim, M.D.*, Hyoung-Yeon Seo, M.D., Ha-Sung Kim, M.D.*, Do-Youn Kim, M.D.* Department of Orthopaedic Surgery, Chonnam National University Hospital, Gwangju, Korea Department of Orthopaedic Surgery, Chonnam National University Hwasun Hospital, Jeonnam, Korea* Study Design: Retrospective study. Objectives: To evaluate the prevalence and associated factors of the concurrent lower thoracic lesions in patients who have a lumbar spine disease, using the extended lumbar MRI. Summary of Literature Review: There are no studies regarding the concurrent thoracic lesions with lumbar disease. Materials and Methods: All the patients, who had visited the out-patient department (OPD) of orthopaedic surgery in our hospital and underwent lumbar spine MRI, were studied during 1 year. Totally, 750 patients were included. The extended lumbar spine MRI contained additional extended T2-weighted sagittal images that cover the lower thoracic vertebrae with 35 centimeters long. We analyzed the highest observable level, characteristics of detected thoracic lesions. Those lesions were classified according to the severity of compression of the spinal cord and investigation for associated factors of patients. Also, the times for additional tests were measured. Results: Additional tests were able to observe up to the 7th thoracic vertebrae. In 257 cases (34.3%), the lower thoracic lesions were detected and increased with aging (p<0.001). A total of 48 patients (6%) had the lesion compressing the spinal cord and 28 patients needed further evaluation for the lower thoracic lesion. Further, 2 cases were treated surgically for lower thoracic lesions. Scanning extra time for additional test were 3 minutes. Conclusions: The prevalence of lower thoracic lesions accompanied with the lumbar disease was 34% in this study. Therefore, additional extended lumbar spine MRI is needed to check possible concurrent lesions in the lower thoracic spine. Key Words: Thoracic spine, Concurrent lesion, MRI 서론 척추의퇴행성변화는어느부위에서도발생할수있지만대개운동성이많은요추부나경추부에서흔히일어난다. 1) 그리고척추후궁과후관절, 황색인대의비후나추간판의퇴행성변성등은척추관협착을유발하며, 척추관의협착은척수를압박하여다양한정도의척수증 (myelopathy) 이나신경근증 (radiculopathy) 을일으키는데, 흉추에서도이러한증상을동반한척추의퇴행성변화가발생할수있다. 2) 또한고령의환자에서자주발생하는골다공증성척추골절은흉요추이행부에서많이발생하지만, 흉추제 6, 7, 8 번부위에서도호발하는특성을보인다. 3) 그래서대부분의척추질환이환은어느한부위에서주로일어나지만, 두부위이상에서동시에발생한경우에는진단과치료에혼돈을유발한다. 따라서저자들은요통의원인질환진단을위해시행한요추자기공명영상검사에서, 요추부를포함한확장형의하부흉추 T2 강조시상면영상검사를추가시행하여, 동반된하부흉추 병변의유병률을알아보고, 이와관련된인자들을분석하여, 이 러한추가촬영의유용성을평가해보고자하였다. Received: August 6, 2011 Revised: December 5, 2011 Accepted: July 10, 2012 Published Online: September 30, 2012 Corresponding author: Ji-Hyeon Yim, M.D. Department of Orthopaedic Surgery, Chonnam National University Hwasun Hospital, 322 Seoyang-ro, Hwasun-eup, Hwasun-gun, Jeonnam, , Korea TEL: , FAX: presid50@naver.com This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License ( creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited. 본논문의요지는 2011 년대한정형외과학회추계학술대회에서구연발표되었음. 90 Copyright 2012 Korean Society of Spine Surgery

Journal of Korean Society of Spine Surgery Concurrent Thoracic Lesions in Lumbar MRI 대상및방법 2010 년 5 월부터 2011 년 4 월까지 1 년동안, 요통을주소로본원정형외과외래에서, 병력청취및이학적검사를받은환자를대상으로, 흉추부병변을의심할수있는흉추부압통이나통증이없고,

3 Journal of Korean Society of Spine Surgery Concurrent Thoracic Lesions in Lumbar MRI 대상및방법 2010 년 5 월부터 2011 년 4 월까지 1 년동안, 요통을주소로본원정형외과외래에서, 병력청취및이학적검사를받은환자를대상으로, 흉추부병변을의심할수있는흉추부압통이나통증이없고, 요추부병증에대하여정밀진단을위해본원영상의학과에서시행한모든요추자기공명영상검사 756 예에서, 특별한요추부병증이발견되지않은 6 예를제외한, 총 750 예를대상으로하였다. 남자가 281 예, 여자가 469 예였으며, 평균연령은 59.0( 범위, 9-90) 세였다. 영상의학과자기공명영상실과촬영의기술적인문제, 추가적인촬영시간과비용을협의하였고, 요추부검사에서추가적인인접부위선별검사 (screening test) 로서보험공단이나관계당국으로부터의이의제기사항을회피하기위하여요추부를포함하는영상을촬영하였다. 그래서기존의흉추부자기공명영상검사로얻을수있는흉추부관상면, 시상면, 축상면의모든영상을얻는것이아닌, 요추부를포함하여하부흉추까지관찰할수있는촬영범위 (field of view, FOV) 35 cm 높이의확장형 T2 강조시상면, 총 13 장의추가영상을환자의추가비용지불없이얻었다. 촬영범위 35 cm의길이는연구시작전, 미리여러차례의각각다른길이의실험적촬영에서범위에따른해상도와감별력, 진단에도움이되는영상의획득에대하여토의를통해저자들이결정하였고, 이후본원에서시행하는모든요추자기공명영상검사에서기본적인촬영매뉴얼로적용하였다. 검사결과분석은두명의독립적인저자들이시행하였으며, 관찰가능한하부흉추의범위확인및발견된병변의특성을파악하고, 검사를시행받은환자의연령, 성별, 골밀도 (BMD), 요통발현기간과관련성을조사하였다. 한명의환자에서두개이상의각각다른병변이발견된경우는병변의정도에따라심한경우로원인질환을산정하였다. 병변의정도는척수의압박으로평가하였으며추가촬영한확장형 T2 강조시상면영상에서 3 개의등급으로구분하였다. 먼저, 병변이있으나척추의경막 (thecal sac) 을압박하지않는것을 0 등급, 경막을압박하지만척수 (spinal cord) 를압박하지않는것을 1 등급, 그리고척수까지압박하는경우를 2 등급으로분류하였다 (Table 1)(Fig 1). 또한본원정형외과에서시행한치료과정에서추가흉부정밀검사시행여부및발견된흉부병변에대한치료여부도확인하였다. 그리고추가촬영에따른시간을측정하였으며, 기존의요추자기공명영상검사와비교하였다. 통계학적인분석은 SPSS 통계프로그램 18.0 (SPSS Inc., nc., hi- Chicago, Illinois, USA) 을이용하여, 로지스틱회귀분석을통해 p-value 가 0.05 미만일때유의성이있는것으로판단하였다. Table 1. Grade for severity of thoracic lesion. Grade 결과 1. 영상의학적결과 Criteria 0 No compress the thecal sac 1 Lesion compress the only thecal sac not spinal cord 2 Lesion compress the spinal cord Table 2. Data according to the age groups of the concurrent thoracic lesion. Age (yr) No. of total cases No. of concurrent lower thoracic lesion Fig. 1. Grades of the severity of lower thoracic lesion(white arrow). (A) Grade 0: No compressive lesion. (B) Grade 1: The herniated thoracic intervertebral disc compressed the thecal sac but there is no cord contact. (C) Grade 3: The herniated thoracic intervertebral disc and hypertrophic ligamentum flavum compress the spinal cord. 추가검사결과하부흉추는평균제 7 번부터관찰가능하였 다. 남자에서는관찰가능한흉추가평균 7.8( 범위, 4-10) 번, 여 자에서는평균 6.7( 범위, 3-10) 번으로차이가있었고, 이러한 차이는 35 cm 동일한촬영범위에따른남녀간의평균신장차 이 ( 남자 169.9( 범위, ) cm, 여자 156.2( 범위, ) cm) 에의한것이었다. 하부흉추병변이관찰된경우는 257 예 (34.3%) 였고 (Table 2), 50 세이상에서연령대에따라비례하여 91

Jae-Yoon Chung et al Volume 19 Number 3 September 2012 많은것으로나타났다 (Fig. 2)(p<0.001). 하부흉추의병변은황색인대비후가 97 예 (38%)(Fig. 3A), 외상성및골다공증성압박골절이 81 예 (31%)(Fig. 3B), 추간판돌출이나탈출증이 69 예 (27%)(Fig.

4 Jae-Yoon Chung et al Volume 19 Number 3 September 2012 많은것으로나타났다 (Fig. 2)(p<0.001). 하부흉추의병변은황색인대비후가 97 예 (38%)(Fig. 3A), 외상성및골다공증성압박골절이 81 예 (31%)(Fig. 3B), 추간판돌출이나탈출증이 69 예 (27%)(Fig. 3C) 로많은경우를보였으며, 이번검사에서우연히발견된종양성질환은모두 10 예 (4%)(Fig. 3D) 였고, 하부흉추의병변을가진환자중에서도척수를압박하는 2 등급의병변을가지고있는경우는 48 예 (19%)(Table 3), 발견된흉추부병변의부위는제11-12 흉추간에서가장많았으며, 제 8번흉추이하에서 233 예 (90.7%) 로대다수를차지하였다 (Table 4). 환자요인들과분류질환과의관련성조사에서, 황색인대비후는연령에비례하여많은수에서발견되었으나 (p<0.001), 성별, 골밀도및요통의발현기간과의통계학적유의성은나타나지않았다. 또한, 압박골절은연령과 (p<0.001) 여성에서 (p=0.021) 관련성을나타냈으나, 추간판돌출이나탈출증은환자요인들과관련성에서유의한결과를보이지않았다. 그리고, 기존의요추자기공명검사가약 20 분이걸리는것에비하여, 추가촬영의시간은약 3 분이더소요되었다. 2. 임상적결과 확장형요추부자기공명영상검사로발견된하부흉추의동 반병변을가진환자에서, 영상의학적으로척수를압박하는정 도에따른 0 등급과 1 등급의경우에서는 7 예에서경도의흉추 척수증의증상이의심되었고, 5 예에서추가정밀검사 ( 흉추부 자기공명영상검사 ) 를시행하였으나흉추부에대한특별한추 가치료는시행하지않았다. 그리고 2 등급의 48 예의환자중 에서도, 재진료시이학적검사에서흉추척수증증상이의심되 Fig. 2. The rate of concurrent thoracic lesion is increased with aging(p<0.001). Fig. 3. The lower thoracic spine lesion(white arrow) detected in extended lumbar spine MRI, T2 sagittal images. (A) Hypertrophic ligamentum flavum involving T11/12 in a 72-year-old man. (B) Osteoporotic fracture at T7 and T12 in a 68-year-old woman. (C) Disc herniation at T10/11 in a 81 year-old woman. (D) Metastatic tumor lesion at T9 in a 56-year old man. 92

5 Journal of Korean Society of Spine Surgery Concurrent Thoracic Lesions in Lumbar MRI Table 3. Classification and severity of the concurrent thoracic lesion. Classification of the lesion No. of concurrent thoracic lesion Grade for severity of the lesion Thickness of ligamentum flavum Compression fracture Disc herniation Tumorous lesion Total Table 4. Details of the concurrent thoracic lesion. Level No. of concurrent lesion Thickness of ligamentum flavum Classification of the lesion Compression fracture Disc herniation Tumorous lesion T T T T T T T T T T T T T T T 는환자는 28 예였고, 증상이없는나머지 20 예의환자중에서추가촬영을원한 5 명을포함하여, 2 등급 48 예중, 총 33 예에서추가정밀검사 ( 흉추부자기공명영상촬영 ) 를받았다. 이중 FOV 35 cm의 T2 강조시상면영상에서발견된동반병변외에, 하부흉추에서 1등급이상의척수를압박하는새로운병변은없었다. 하흉추부병변에대하여수술적치료를한경우는 2 예로, 모두황색인대골화증 ( 흉추제 9-11 번, 제 번 ) 에대하여후방접근에의한골화된황색인대제거술과후방유합술을시행하였고, 나머지 31 명의환자들은모두경과관찰및보존적치료를하였다. 고찰 척추는다분절성분절로되어있어신체의안정과운동에중요한기능을한다. 그렇지만나이가들어감에따라세포의생명력감소나반복적기계적하중이척추에생역학적인변형을일으켜결과적으로척추의퇴행성변화로구조적인변형까지유발한다. 4) 퇴행성변화로인한흉추추간판의변성과흉추의후관절비후및황색인대골화증도움직임이많은하부흉추에서주로발생하여각각추간판탈출증이나척추관협착증을일으키는데, 5,6) 이러한병변으로척수가압박되면동통및방사통뿐만아니라이상감각, 근력약화, 방광기능장애등이나타나고, 양쪽하지를침범하는경한마비형태나족간대성경련, 바빈스키징 93

6 Jae-Yoon Chung et al Volume 19 Number 3 September 2012 후, 넓은보폭및강직성보행과같은척수증증상이동반될수있다. 그리고퇴행성의흉추척수증증상이요추병변에의한증상과동반되는경우에는진단이늦어지거나놓치게되는경우도발생할수있다. 특히급성외상이나척추종양으로인하여추체골절이동반되어척수를압박하는경우는급격한통증과신경장애의소견을보여진단적이용이하지만, 서서히발생한흉추후관절의골극과퇴행성추간판은점진적인흉추척수증의소견을보여환자들이나의사들도조기에는인식하지못하는경우가많다. 7) 따라서임상적증상과이학적소견이전형적이지않으면서요배부나하지의불분명한통증이있으면, 요추상위병변을고려해보아야한다. 8,9) 특히흉추추간판탈출증은약 70% 에서증상이없다고하였으며, 증상이발현되는경우대개하부흉추분절의과도한움직임 (hypermobility) 과관련이있고, 증상은서서히진행하지만탈출된추간판의위치나크기에크게관련이없다고하였다. 10) 그리고증상의발현기간으로 Benjamin 11) 은약 1 년에서 3 년정도걸린다고하였으며, 임상증상으로띠모양의감각영역의장애, 근력약화및척수증에이르기까지다양하게나타난다고하였다. 12,13) 본연구에서도자기공명영상검사로하부흉추에병변이발견된환자들의거의대부분이요통에대한질병을치료받고자내원하였으며, 2 등급의척수압박의소견을가진 48 예에서도척수증의저명한증상이없는경우가 20 예 (42%) 였다. 본연구의환자들도많은경우에서환자자신들이요통을호소한이후서서히발생한대퇴부통증을요추부병증으로여겼으며, 동반된보행장애증상도고령에따른근력약화로간과하여정밀검사보다는통증치료에주된관심이있는상태였다. 그리고점진적으로발생한척수압박은급성척수증에서동반되는병적반사가아직발현되지않은것으로사료되었다. 이번조사에서도첫진료에서는발견하지못했던하흉추부병변이있는환자들중재진료를시행한경우, 이학적검사상에서는 35 명에서흉추척수증양성소견을확인할수있었다. 그리고수술적치료를시행한 2 예의경우모두에서, 요추부병변으로하지근력약화및통증, 그리고이학적검사상경미한병적반사로인하여, 확장형요추부자기공명영상검사를시행하지않았다면상위병변에대한발견및치료시기가늦었을가능성이높았다. 그리고본연구에서는외상성이나골다공증성골절의병변도하부흉추에서 81 예가발견되었다. 특히다른연구에따르면흉요추부골절이발견된경우에서도외상력이없다고진술하는경우가많고, 척추골절의 25% 만임상적으로확인되고, 경험하지못했거나자각하고있지못할정도로경미한외력으로골절이발생한경우가흔하다고하였다. 14) 그리고골다공증성척추골절은첫번째골절이발생한후 1 년내에두번째골절이발생할 위험성이 20% 이며척추골절의숫자가많을수록골절의위험성은증가한다. 15) 그리고척추에서의골절은기형, 통증, 심폐기능저하, 자존감저하, 보행장애등으로환자의삶의질을저하하며, 이러한삶의질저하에영향을평가한연구에따르면, 다른골절부위에비교하여가장낮은삶의질수치를보였다. 16) 따라서척추부위의골절을놓치지않고정확하게진단하는것이매우중요한임상적과제이다. 그러나 2000 명이상의폐경후여성의단순방사선사진을전문센터에판독을의뢰한결과, 정상으로분류되었던 30% 에서척추골절을추가로찾을수있었다는보고에서도알수있듯이, 17) 단순방사선검사에서진단을놓치는경우가있을수있으며, 퇴행성변화등다른질환과감별이필요한경우도많다. 이번연구에서도대상환자들이흉추부증상이없고, 또한병변을인지하지못했던상황에서확장형요추부자기공명영상촬영검사를통해골절진단을할수있었으며, 경우에따라예방적행동교육과, 보존적골다공증치료를시작할수있었다. 그러므로자기공명영상검사의하부흉추의시상면영상은정확한진단에큰도움이될것이다. 본연구에서연령대에따른하부흉추동반병변의유병률은고연령대일수록많은수에서나타나통계학적으로도유의하게비례하여증가하는것으로나타났다. 이는고령에따른퇴행성질환의발생및상대적으로높은골다공증성척추골절에의한것으로보인다. 따라서병원에내원하는환자중에서고령의경우에는상위동반질환이있을수있다는점을고려해야할것으로사료된다. 그러나이번의연구에서는요통을주소로외래를내원한환자를대상으로시행하였기때문에, 본연구결과를일반집단에적용하기에는무리가있으며, 특히연령별집단간분포에서도 50 세이상의대상자가 565 명 (75%) 으로서분포적인한계 (skewed to the left distribution) 가있었다. 그러므로본연구에서시행한하부흉추추가시상면자기공명영상검사의필요성에대하여, 특정연령을시점으로한유의한결과로는결론내리지못하였다. 결국이를위해서는인구비에따른대단위의전향적연구가필요할것으로생각된다. 또한일반적인척추의자기공명영상은 T1, T2 강조관상면, 시상면, 축상면의영상을얻는다. 그리고 T1 강조영상에서는신경조직과주위구조의관계를잘알수있으나, 수핵과섬유륜을구별할수없는단점이있는반면, T2 강조영상은영상의질은다소떨어지지만연부조직의퇴행성정도와병변부위를관찰하는장점이있으며척수조영술과같은영상을볼수있다. 18) 그리고시상면영상은척추정렬및병변의위치파악이용이하고, 축상면영상보다는떨어지지만경막의압박과협착을관찰할수있다. 따라서본연구에서는시간적으로제한된조건에서, 하부흉추의병변에대한선별검사로서가능한추가영상으로서 94

7 Journal of Korean Society of Spine Surgery Concurrent Thoracic Lesions in Lumbar MRI 13 장의 T2 강조시상면영상이가장적절한것으로판단하였다. 또한연구결과흉추제 8 번이하에서 90.7% 의병변이발견되었으므로, 향후하부흉추의동반병변선별추가검사를확대시행한다면, 흉추제 8 번을포함하는촬영이필요할것이다. 결론 본원외래로요통을주소로내원한환자군에서요추부병증에동반된하부흉추의전체유병률은 34% 였으며, 대부분흉추제 8번이하에서발견되었고, 특히연령대가높을수록증가하는추세를보였다. 따라서요추부자기공명영상촬영에서약 3 분의비교적짧은시간이소요되고, 촬영기술적으로도크게어려운문제가없으므로, 하부흉추를포함하는확장형 T2 강조시상면영상검사를동시에시행하여, 동반병변의유무를확인하는것이적절한치료에도움이될것으로사료된다. REFERENCES 1. Epstein NE, Epstein JA, Carras R, Murthy VS, Hyman RA. Coexisting cervical and lumbar spinal stenosis: diagnosis and management. Neurosurgery. 1984;15: Smith DE, Godersky JC. Thoracic spondylosis: an unusual cause of myelopathy. Neurosurgery. 1987;20: Moon ES, Kim HS, Park JO, et al. The incidence of new vertebral compression fractures in women after kyphoplasty and factors involved. Yonsei Med J. 2007;48: Benoist M. Natural history of the aging spine. Eur Spine J. 2003;12(Suppl): Barnett GH, Hardy RW Jr, Little JR, Bay JW, Sypert GW. Thoracic spinal canal stenosis. J Neurosurg. 1987;66: Niemelainen R, Battie MC, Gill K, Videman T. The prevalence and characteristics of thoracic magnetic resonance imaging findings in men. Spine (Phila Pa 1976). 2008;33: Abhaykumar S, Tyagi A, Towns GM. Thoracic vertebral osteophyte-causing myelopathy: early diagnosis and treatment. Spine (Phila Pa 1976). 2002;27:E Bosacco SJ, Berman AT, Raisis LW, Zamarin RI. High lumbar disk herniations. Case reports. Orthopedics. 1989;12: Fukuta S, Miyamoto K, Iwata A, et al. Unusual back pain caused by intervertebral disc degeneration associated with schmorl node at Th11/12 in a young athlete, successfully treated by anterior interbody fusion: a case report. Spine (Phila Pa 1976). 2009;34:E Okada Y, Shimizu K, Ido K, Kotani S. Multiple thoracic disc herniations: case report and review of the literature. Spinal Cord. 1997;35: Benjamin V. Diagnosis and management of thoracic disc disease. Clin Neurosurg. 1983;30: Chen CF, Chang MC, Liu CL, Chen TH. Acute noncontiguous multiple-level thoracic disc herniations with myelopathy: a case report. Spine (Phila Pa 1976). 2004;29:E Otani K, Yoshida M, Fujii E, Nakai S, Shibasaki K. Thoracic disc herniation. Surgical treatment in 23 patients. Spine (Phila Pa 1976). 1988;13: Fink HA, Milavetz DL, Palermo L, et al. What proportion of incident radiographic vertebral deformities is clinically diagnosed and vice versa? J Bone Miner Res. 2005;20: Lindsay R, Silverman SL, Cooper C, et al. Risk of new vertebral fracture in the year following a fracture. JAMA. 2001;285: Adachi JD, Adami S, Gehlbach S, et al. Impact of prevalent fractures on quality of life: baseline results from the global longitudinal study of osteoporosis in women. Mayo Clin Proc. 2010;85: Delmas PD, van de Langerijt L, Watts NB, et al. Underdiagnosis of vertebral fractures is a worldwide problem: the IMPACT study. J Bone Miner Res. 2005;20: Bates D, Ruggieri P. Imaging modalities for evaluation of the spine. Radiol Clin North Am. 1991;29:

8 Jae-Yoon Chung et al Volume 19 Number 3 September 2012 확장형요추부자기공명영상검사에서발견된동반하부흉추병증 정재윤 임지현 서형연 김하성 김도연전남대학교의과대학정형외과학교실 연구계획 : 후향적연구 목적 : 요추부병증을가지고있는환자에서확장형의요추부자기공명영상검사를시행하여, 동반된하부흉추의유병률과관련인자들을알아보고자 하였다. 선행문헌의요약 : 요추부병증과동반된하부흉추병변에대한연구는아직보고되지않았다. 대상및방법 : 1 년동안본원정형외과외래에방문하여요추자기공명영상검사를시행한모든환자 756 예를대상으로하였다. 확장형요추부자기 공명영상검사는하부흉추가포함되는 35 cm 의높이의 T2 강조시상면영상을촬영하였다. 관찰가능한하부흉추의범위확인및발견된병변의특 성을파악하였으며, 척수를압박하는정도에따라분류하고환자의관련요인을조사하였다. 또한추가검사에걸리는시간을측정하였다. 결과 : 검사결과평균적으로제 7 흉추까지관찰가능하였다. 동반된하부흉추병변이관찰된경우는 257 예 (34.3%) 였고, 연령대에따라비례하여많 은것으로나타났다 (p<0.001). 동반병변중에서도척수를압박하는병변을가지고있는경우는 48 예 (6%) 였다. 그리고발견된하부흉추의동반병변 에대하여추가정밀검사를받은경우는 28 예, 수술적치료를받은경우는 2 예였다. 추가촬영시간은 3 분이더소요되었다. 결론 : 요추부병증에동반된하부흉추의유병률은 34% 였다. 따라서확장형요추자기공명영상검사를시행하여, 동반된하부흉추병변을확인하는 것이필요할것으로사료된다. 색인단어 : 흉추, 동반병변, 자기공명영상검사 약칭제목 : 요추부 MRI 에발견된동반흉추병증 96

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