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1 65 pissn : , eissn : Original Article J Korean Orthop Assoc 2017; 52: 퇴행성요추질환에서발생한후관절근접낭종의방사선적특징및수술의결과 김환정 장선호 양화열 권원조 성환일 박경훈 최원식 을지대학교병원정형외과 Radiologic Features and Surgical Outcome of Juxtafacet Cyst Associated with Degenerative Lumbar Disease Whoan Jeang Kim, M.D., Shann Haw Chang, M.D., Hwa Yeol Yang, M.D., Won Jo Kwon, M.D., Hwan Il Sung, M.D., Kyung Hoon Park, M.D., and Won Sik Choy, M.D. Department of Orthopaedic Surgery, Eulji University Hospital, Daejeon, Korea Purpose: The purpose of this study was to evaluate the radiologic features of juxtafacet cyst and determine the correlation between these features and clinical outcome. Materials and Methods: We analyzed a total of 23 patients. The degree of facet joint degeneration was classified using the Fujiwara method. The facet joint angles were measured with an magnetic resonance imaging to determine whether there was a difference between the cystic lesion that was occupied and the cystic lesion that was not occupied. Disc degeneration was measured by the Pfirrmann classification method. The clinical result was evaluated using the Oswestry disability index score and visual analogue scale. Results: The L4 5 level of juxtafacet cyst was mostly affected, as found in previous studies. Facet joint arthritis was more severe within the side with the cystic lesion. Significant correlation was found between disc degeneration and juxtafacet joint cyst. All patients underwent wide decompression and fusion. Clinical result was excellent. No patients had signs of recurrence during the follow-up periods. Conclusion: Juxtafacet cyst has a significant correlation with facet joint degeneration. Therefore, aggressive surgical treatment not just simple cyst excision should be considered as the treatment option for juxtafacet cyst associated with degenerative lumbar disease. Key words: juxtafacet cyst, degenerative lumbar disease, wide decompression and fusion 서론 척추후관절근접낭종 (juxtafacet joint synovial cyst) 은비교적드 물게보고되고있는질환으로정확한발생원인은밝혀지지않았 지만일반적으로척추후관절의퇴행성변화와외상, 과도한분 절의운동성등이발병원인과관련이있다고알려져있으며퇴 행성척추관협착증과유사하게주로요추부에발생하며주로제 Received February 9, 2016 Revised May 2, 2016 Accepted July 5, 2016 Correspondence to: Shann Haw Chang, M.D. Department of Orthopaedic Surgery, Eulji University Hospital, 95 Dunsanseo-ro, Seogu, Daejeon 35233, Korea TEL: FAX: chang2016@eulji.ac.kr 4-5 요추간에서호발한다. 1,2) 이러한후관절근접낭종에의해마미총혹은요추신경근이압박되면요배부통및하지방사통을초래할수있으며, 척추전방전위증이나척추분리증, 척추불안정을잘동반하여단순낭종흡입술이나스테로이드주사와같은보존적치료로는좋은결과를얻기가어렵고낭종절제술이나감압술을통한수술적치료를요하는경우가많다고보고되어있다. 3-5) 수술적치료의방법으로단순낭종절제술, 단순감압술, 광범위감압술및유합술이시행되고있으며여러저자들은각기다른방법으로좋은임상적결과를발표하여수술방법의선택에현재논란의여지가있다. 6,7) 본연구는척추후관절근접낭종이동반된퇴행성요추부질환으로수술받은 23명의환자를대상으로수술전단순방사선촬 The Journal of the Korean Orthopaedic Association Volume 52 Number Copyright 2017 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.

66 Whoan Jeang Kim, et al. A C B D Figure 1.

(B) Grade 2: narrowed both facet joint space and left facet joint shows mild osteophyte.

(D) Grade 4: not only marked osteophytes but also sclerotic changes are observed within both facet joint.

대상및방법 2005년 6월부터 2013년 3월동안본원에서척추후관절근접낭종이동반된퇴행성요추부질환으로진단받고보존적치료로호전이없어수술을시행받은 23명의환자를대상으로하였다. 모든환자에게서단순방사선촬영및굴곡신전촬영을통해불안정성과척추전방전위증유무를판단하였고, MRI상척추관협착증동반유무를판단하였다.

1) grade 1은정상, grade 2는후관절공간감소를보이거나경미한골편이관찰되는경우, grade 3은후관절의경화및중등도의골편을보이는경우, grade 4는저명한후관절의골편을보이는경우로분류하였으며양측후관절각도를평가하였다 (Fig. 2).

2 66 Whoan Jeang Kim, et al. A C B D Figure 1. Four grades of facet joint osteoarthritis on magnetic resonance imaging (grade classification according to the Fujiwara methods). (A) Grade 1: normal facet joint. (B) Grade 2: narrowed both facet joint space and left facet joint shows mild osteophyte. (C) Grade 3: narrowed both facet joint space and right facet joint shows moderate osteopytes. (D) Grade 4: not only marked osteophytes but also sclerotic changes are observed within both facet joint. 영및자기공명영상 (magnetic resonance imaging, MRI) 을관찰하여낭종이이환된분절의퇴행성변화를분석하고이러한특징들이임상적결과와어떠한연관성을갖는지연구하여더적합한수술적방법의선택에대하여고찰하고자계획되었다. 대상및방법 2005년 6월부터 2013년 3월동안본원에서척추후관절근접낭종이동반된퇴행성요추부질환으로진단받고보존적치료로호전이없어수술을시행받은 23명의환자를대상으로하였다. 모든환자에게서단순방사선촬영및굴곡신전촬영을통해불안정성과척추전방전위증유무를판단하였고, MRI상척추관협착증동반유무를판단하였다. 모든환자들의후관절퇴행성정도는 Fujiwara methods를통해 4단계로좌측과우측을구분하여평가하였으며 (Fig. 1) grade 1은정상, grade 2는후관절공간감소를보이거나경미한골편이관찰되는경우, grade 3은후관절의경화및중등도의골편을보이는경우, grade 4는저명한후관절의골편을보이는경우로분류하였으며양측후관절각도를평가하였다 (Fig. 2). 추간판의퇴행성정도는 Pfirrmann이제시한 5단계 8) 에따라평가하였다. 환자의내원당시의증상양상, 이환기간및동반된요추부질환과같은임상적자료는진료기록, 수술기록과같은의무기록을통해평가하였다. 수술은후관절광범위절제술, 광범위감압술및후관절절제술후방기기유합술을시행하였다. 임상적결과는 Oswestry low back pain disability questionnaire Figure 2. Measurement of facet joint angle. (ODI), back 및 leg visual analogue scale (VAS) 을이용하여분석하였으며 VAS는 0은 no pain, 1은 mild pain, 2는 unconfortable pain, 3은 distressing pain, 4는 intense pain, 5는 worst possible pain으로구분하였다. ODI는 0-20은 1점, 21-40은 2점, 41-60은 3점, 은 4점, 은 5점으로분류하였고 ODI 점수와 back 및 leg VAS score를합산하여 0-3점은 excellent, 4-6점은 good, 7-9점은 fair, 10-12점은 poor, 13점이상은 bad로결과를분류하였다. 통계적분석은 SPSS for Windows ver (SPSS Inc., Chicago, IL,

3 67 Radiologic Features and Surgical Outcome of Juxtafacet Cyst USA) 을이용하였고, p-value 0.05가이하일때유의한것으로판단하였다. 결과 대상환자들의수술당시평균연령은 58.3세 (33-74세) 였으며, 남자가 10명 (43.5%), 여자가 13명 (56.5%) 으로성별에따른차이는없었다. 모든환자들은요통과방사통을호소하고있었으며그중 7 예에서는신경학적파행이관찰되었다. 증상을호소한기간은평균 16.2개월 (3-48개월) 이었다. MRI상후관절근접낭종의위치는제4-5 요추 16예 (69.6%), 제3-4 요추 4예 (17.4%), 제5 요추-제1 천추 3예 (13.0%) 로제4-5 요추에가장많았고우측이 11예 (47.8%) 좌측이 12예 (52.2%) 로좌측과우측의차이는없었다 (Table 1). 22예 (95.7%) 의환자에게서낭종이발생한분절의후관절에퇴행성변화가관찰되었으며 Fujiwara 분류법상낭종이이환된측의후관 절의퇴행단계는평균 2.73 이었고낭종이이환되지않은측의후 관절의퇴행단계는 2.26 으로낭종이이환된측의후관절이편측 보다비교적높은단계의퇴행성변화를보이고있었다 (p<0.01) (Table 2). 양측후관절의굴성 (tropism) 은평균 7.58 로측정되었으 며후관절낭종의유무에따른양측후관절각도에는유의한차 Table 2. The Comparison of Both Sides of Facet Joint Arthritis and Facet Joint Angle Paired differences Facet joint arthritis (grade) Facet joint angle (degree) Mean±SD 0.3± ±10.93 SE % CI of the difference p-value SD, standard deviation; SE, standard error; CI, confidence interval. Table 1. Summary of the Clinical and Radiological Findings of Patients Patient No. Age (yr) Sex Symptoms Level Side Facet joint degeneration grade Cyst (+) Cyst ( ) DD 1 38 Male BP, RP L4 5 Left Female RP L4 5 Right Female BP, RP L4 5 Right Female BP, RP L4 5 Left Female BP, RP L3 4 Right Female C L4 5 Right Male BP, RP, C L4 5 Left Male RP L4 5 Left Male BP, RP, C L3 4 Left Female RP, BP L4 5 Left Male BP, RP L5 S1 Right Female BP, RP L3 4 Right Female BP, RP L4 5 Right Female BP, RP L4 5 Left Female RP, C L4 5 Left Female BP, RP, C L4 5 Left Male RP L5 S1 Right Male BP, RP, C L4 5 Left Male BP, RP L5 S1 Right Male RP L3 4 Left Female BP, RP L4 5 Left Male BP, RP, C L4 5 Right Female RP L4 5 Right BP, back pain; RP, radiating pain; C, claudication; DD, disc degeneration.

4 68 Whoan Jeang Kim, et al. 이가없었다 (p=0.62) (Table 2). 추간판의퇴행성정도는 Pfirrmann 분류법상 grade 1이 4예 (17.4%), grade 2가 2예 (8.7%), grade 3이 14 예 (60.9%), grade 4가 2예 (8.7%), grade 5가 1예 (4.3%) 로 grade 3 이상을퇴행성추간판으로판단하였으며 17예 (73.9%) 에서추간판의퇴행성변화를보였다. 23예중 19예 (82.6%) 에서척추관협착증이낭종과동일한분절에동반되었고, 4예 (17.4%) 에서는후관절낭종이독립적으로존재하였다. 이중 7예 (30.4%) 에서낭종이이환된분절에불안정성이동반되어있었으며모두전방전위가동반되어있었다. 모든환자에게서광범위후방감압술및기기고정유합술을시행하였다. 수술후추적기간은평균 65.3개월이었다 (24개월-12년). 수술후모든대상환자들에게서증상의호전을관찰하였고수술과연관된합병증은없었다. 추적기간중증상이재발한경우는없었다. 수술 2년후평가한 ODI 점수는 0%-20% 가 19명 (82.6%), 21%-41% 가 4명 (17.4%) 으로양호하였으며 back 및 leg VAS는수술전과비교하여유의하게감소하였다 (p=0.03) (Table 3). 고찰 1974년 Kao 등 9) 이척추강내후방관절에인접한부위의경막외낭종을활액낭종이라는명칭으로처음 3예를보고하였고이후경추부에발생한활액낭종 1예를재차보고하면서후관절근접낭종 (juxtafacet cyst) 10,11) 결절종 (ganglion cyst) 12) 등의명칭이혼용되어왔다. 결절종과활액낭종은임상양상이나진단적방사선영상에서구별되지않으나조직학적으로구분할수있으며후방관절의활액막 (synovial membrane) 에서기원하는활액낭종과신경 Table 3. The Comparison of ODI and VAS Score* between Preoperative and Postoperative Patient No. Age (yr) Sex Preoperative ODI score Back VAS Leg VAS POD 2 years Preoperative POD 2 years Preoperative POD 2 years 1 38 Male Excellent 2 33 Female Excellent 3 70 Female Excellent 4 74 Female Excellent 5 74 Female Excellent 6 71 Female Good 7 68 Male Excellent 8 67 Male Excellent 9 49 Male Excellent Female Excellent Male Excellent Female Excellent Female Good Female Excellent Female Excellent Female Excellent Male Good Male Excellent Male Excellent Male Good Female Excellent Male Excellent Female Excellent *Grade 0: no pain, Grade 1: mild, annoying pain, Grade 2: uncomfortable, troublesome pain, Grade 3: distressing, miserable pain, Grade 4: intense, horrible pain, Grade 5: worst possible, unbearable pain. ODI, Oswestry low back pain disability questionnaire; VAS, visual analogue scale; POD, postoperative day. Result

5 69 Radiologic Features and Surgical Outcome of Juxtafacet Cyst 절에서기원하는결절종으로구별이된다. 활액낭종의경우조직학적으로활액막을포함하나, 신경절낭종은활액막이없고, 느슨한낭종벽과혈관분포가비교적좋은섬유성연부조직을포함하는것이일반적이다. 3) 본연구에서낭종의조직학적분류를확인하고자하였으나광범위감압술및후관절절제술로인한낭종의파괴로적절한검체를얻지못하여병리학적평가가이루어지지못하였다. 척추의활액낭종의정확한발생기전은분명하지않으나척추관절의이상운동, 외상, 퇴행성변화등이연관되었을것으로추정하고있다. 1,4,7,9,13) 일반적으로척추후관절의퇴행성변화는컴퓨터단층촬영을통해서분류하였으나 Fujiwara 등 14) 은 MRI를통해서도약 94% 이상의정확도로후관절의퇴행단계를구분할수있다고발표하였고, 본연구에서도 MRI를통하여후관절의퇴행도를분석하였다. Khan 등 15) 은 39 예의요추활액낭종의수술적치료경험을보고하면서제4-5 요추간분절에서가장흔하였고, 단순낭종절제술을시행한군보다골유합술을추가로시행한군의수술후임상경과가우월하여이는제4-5 요추간분절의과도한운동성과연관이있는것으로주장하였다. 본연구에서도제4-5 요추간분절에생긴낭종의빈도가 16예 (69.6%) 로가장높았으며다른여러저자들의연구에서도마찬가지로제4-5 요추간의낭종발생이비교적더높은것으로보고하였다 ) 따라서척추분절의과도한운동성과활액낭종의발생은어느정도유의한연관이있을것으로생각된다. Wilby 등 6) 과 Doyle과 Merrilees 19) 는후방관절의퇴행화과정에서발생하는관절의유리와반흔형성에서낭종이쉽게발생할수있는환경이조성된다고추정하면서후관절퇴행의진행과활액낭종의발생이밀접한관계가있다고제시하였다. 본연구에서도 22예 (95.7%) 의대상에서낭종이발생한분절에양측성후관절퇴행성변화가관찰되었으며더불어낭종이발생한방향과일치한방향의후관절퇴행도가유의하게높게나타났고 (p<0.01) Fujiwara 등 14) 이발표한바와마찬가지로후관절의퇴행성변화와동반된추간판의퇴행성변화 (73.9%) 를관찰할수있었다. 따라서후관절낭종과후관절퇴행성변화는밀접한연관이있을것으로판단된다. Noren 등 20) 의연구에따르면후관절굴성 (tropism) 은추간판의퇴행성변화가있는경우유의하게증가하는것으로발표하였다. 본연구에서는후관절의퇴행성변화와더불어추간판의유의한퇴행성변화를관찰하였으나 Noren 등 20) 과는상반되게후관절의굴성은증가하지않는결과를보였다. 이러한상반된결과의원인으로서대상환자의나이가 Noren 등 20) 의연구에서는평균 32.5세였으나본연구에서는평균 58.3세로높았던점이어느정도영향이있을것으로생각되며 Farfan과 Sullivan 21) 은후관절굴성은젊은환자군에서초기추간판의퇴행성변화와관련성이있을것으로발표하였다. Grogan 등 22) 은후관절굴성의정도와후관절의퇴행성변화와는관계가없다고주장하였다. 본연구에서도마찬가지로진행 된후관절의퇴행성변화와상반되게후관절의굴성은크지않아 Grogan 등 22) 이발표한내용과일치하는결과를보였다. Métellus 등 7) 은편측부분척추후궁절제술 (partial hemilaminectomy), 부분내측후관절절제술 (partial medial facetectomy), 근위추간공절개술 (proximal foraminotomy) 과같은최소침습적수술방법을선택하여양호한임상적결과를발표하였으며이과같은수술적방법을선택할경우광범위감압술과는달리척추분절간불안정성을유발하지않기때문에유합술은필수적이지않다고발표하였다. 하지만그들또한척추분절의과도한운동성과퇴행성변화를낭종발생의유력한원인으로제시하였으며위와같은수술방법을시행한후재발시에는유합술을시행하였다. 반면 Lyons 등 13) 은척추후관절낭종환자들의약 50% 의높은빈도로척추전방전위증이동반된다고보고하였고후궁절제술, 후관절절제술과같은수술적치료후에약 25% 의환자에서지연적으로척추전방전위증및불안정성이발생할수있어유합술을병행하는것에대하여긍정적인견해를제시하였다. 마찬가지로본연구에서도약 30.4% 의환자에게서척추전방전위증이관찰되었으며유합술로좋은임상결과를얻었고추시기간내재발은발생하지않았다. 후관절의퇴행성변화는요통의가장흔한원인중하나이며 23) 비록아직까지논란의여지가남아있긴하지만척추분절의과도한운동성과후관절의퇴행성변화를여러저자들이낭종발생의유력한원인으로제시하고있다. 7,9,16-18) 본연구에서요추제4-5 분절에낭종의발생빈도가가장높았던것과높은비율 (30.4%) 로척추전방전위증이동반되어있던점, 그리고낭종이발생한분절에서낭종의방향과일관되게후관절과추간판의퇴행성변화의단계가높았던사실은위의두가지가설에더욱힘을실어주는결과로해석할수있다. 이렇듯척추후관절근접낭종이발생하는원인에관해서는현재어느정도의견의합치가이뤄지는것으로보여지나아직까지수술적치료방법에대한정립은부족한상태이다. 최근최소침습적인다양한수술법들의양호한임상결과들이발표되면서광범위감압술과유합술을배제한수술적접근법들이시행되고있으며특히분절간불안정성이나척추전방전위증이동반되지않은경우에는단순낭종감압만으로도좋은임상결과를보고하고있다. 1,4,7,13,24) 하지만유합술을배제한수술시 2%-15% 의재발이보고되고있으며 7,13,24) 이는결국낭종의단순절제나부분후궁절제술, 부분후관절절제술, 부분추간공절개술을시행하였을경우낭종의감압에효과에의한임상적증상은다소호전을보일수있으나앞서낭종발생의유력한병인으로받아들여지고있는후관절의퇴행성변화및분절간의과도한운동성대한근본적인치료는되지못할것으로생각된다. 이를고려하여광범위감압술및유합술을시행하는것이보다병인론적으로근본적인치료법이될수있으며재발률을낮추는데도유리할것으로생각

6 70 Whoan Jeang Kim, et al. 되나충분한근거를제시할만한연구는아직불충분한상태이다. 단순낭종감압술과광범위감압술및유합술간의임상결과및추시결과를비교분석하고대규모의대조연구를통해각각의환자에게맞는수술의적응증을확립하기위한추가적인연구가필요할것으로생각된다. 본연구의모든환자들은광범위감압술및후방기기를이용한유합술을시행받았고술후최소 2년에서 12년간추적관찰하였으며모두양호한경과를보였고재발은없었다. 결론 후관절근접낭종은제4-5 요추에가장호발하였으며후관절근접낭종이위치한분절의퇴행성변화는대개양측성으로발생하였으나 MRI를통한 grading 시낭종이이환된측의후관절에퇴행성변화가더유의하게높은것으로나타났으며양측후관절각도에는유의한차이가없었다. 낭종이위치한분절에척추관협착증이대부분동반되었으며, 추간판은퇴행성변화가동반되었고불안정성이동반되는경우전방전위가가장많았다. 후관절낭종과동반된퇴행성요추부질환에서광범위감압술및후방기기를이용한유합술을병행하는것도좋은치료방법이될수있을것이라고생각된다. CONFLICTS OF INTEREST The authors have nothing to disclose. REFERENCES 1. Epstein NE. Lumbar synovial cysts: a review of diagnosis, surgical management, and outcome assessment. J Spinal Disord Tech. 2004;17: Onofrio BM, Mih AD. Synovial cysts of the spine. Neurosurgery. 1988;22: Choi JY, Kim SH, Sung KH. Synovial cyst forming encircling mass around the traversing nerve root in a patient with faradvanced degenerative spondylolisthesis. Korean J Spine. 2004;1: Min JH, Chung BJ, Lee SH. Endoscopically managed synovial cyst of the lumbar spine. A case report. Korean J Spine. 2006; 3: Cho YD, Kim DH, Choi KH. Lumbar radiculopathy caused by intraspinal synovial cyst: a case report. Korean J Spine. 2008;5: Wilby MJ, Fraser RD, Vernon-Roberts B, Moore RJ. The prevalence and pathogenesis of synovial cysts within the ligamentum flavum in patients with lumbar spinal stenosis and radiculopathy. Spine (Phila Pa 1976). 2009;34: Métellus P, Fuentes S, Adetchessi T, et al. Retrospective study of 77 patients harbouring lumbar synovial cysts: functional and neurological outcome. Acta Neurochir (Wien). 2006;148: Pfirrmann CW, Metzdorf A, Zanetti M, Hodler J, Boos N. Magnetic resonance classification of lumbar intervertebral disc degeneration. Spine (Phila Pa 1976). 2001;26: Kao CC, Winkler SS, Turner JH. Synovial cyst of spinal facet. Case report. J Neurosurg. 1974;41: Oertel MF, Ryang YM, Gilsbach JM, Rohde V. Lumbar foraminal and far lateral juxtafacet cyst of intraspinal origin. Surg Neurol. 2006;66:197-9; discussion Paolini S, Ciappetta P, Santoro A, Ramieri A. Rapid, symptomatic enlargement of a lumbar juxtafacet cyst: case report. Spine (Phila Pa 1976). 2002;27:E Baba H, Furusawa N, Maezawa Y, et al. Ganglion cyst of the posterior longitudinal ligament causing lumbar radiculopathy: case report. Spinal Cord. 1997;35: Lyons MK, Atkinson JL, Wharen RE, Deen HG, Zimmerman RS, Lemens SM. Surgical evaluation and management of lumbar synovial cysts: the Mayo Clinic experience. J Neurosurg. 2000;93:S Fujiwara A, Tamai K, Yamato M, et al. The relationship between facet joint osteoarthritis and disc degeneration of the lumbar spine: an MRI study. Eur Spine J. 1999;8: Khan AM, Synnot K, Cammisa FP, Girardi FP. Lumbar synovial cysts of the spine: an evaluation of surgical outcome. J Spinal Disord Tech. 2005;18: Choi JK, Ryu KS, Lee H, Lee K, Park CK. Correlation between the symptomatic lumbar synovial cyst and facet degeneration: retrospective study of 13 surgical cases. Korean J Spine. 2011;8: Alicioglu B, Sut N. Synovial cysts of the lumbar facet joints: a retrospective magnetic resonance imaging study investigating their relation with degenerative spondylolisthesis. Prague Med Rep. 2009;110: Apostolaki E, Davies AM, Evans N, Cassar-Pullicino VN. MR imaging of lumbar facet joint synovial cysts. Eur Radiol. 2000;10: Doyle AJ, Merrilees M. Synovial cysts of the lumbar facet joints in a symptomatic population: prevalence on magnetic

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8 72 pissn : , eissn : Original Article J Korean Orthop Assoc 2017; 52: 퇴행성요추질환에서발생한후관절근접낭종의방사선적특징및수술의결과 김환정 장선호 양화열 권원조 성환일 박경훈 최원식 을지대학교병원정형외과 목적 : 후관절근접낭종이동반된퇴행성요추부질환으로수술받은 23명의환자를대상으로방사선적특징과임상적결과를분석하고자한다. 대상및방법 : 23명의환자를대상으로척추관협착증동반여부, 불안정성, 척추전방전위증동반여부, 낭종의위치및방향, 후관절의퇴행성변화정도, 후관절각도, 추간판퇴행정도를확인하였다. 모든환자에게광범위감압술및기기고정유합술을시행하였다. 임상적결과를 Oswestry low back pain disability questionnaire 및 visual analogue scale 을이용하여평가하였다. 결과 : 23예중 19예 (82.6%) 에서척추관협착증이동반되었고, 4예 (17.4%) 에서는후관절낭종이독립적으로존재하였다. 이중 7예 (30.4%) 에서불안정성과전방전위가동반되었다. 낭종의발생은제4-5 요추간 (69.6%) 이가장많았으며이환된병변측의후관절이반대측에비하여심한퇴행성변화를보였다. 후관절각도는좌우측에유의한차이가없었으며해당분절의추간판은 17예 (69.6%) 에서퇴행성변화를보였다. 임상적결과는수술후 2년추시양호하였다. 결론 : 낭종의발생과퇴행성변화는유의한상관관계가있었으며후관절낭종과동반된퇴행성요추부질환에서광범위감압술및유합술이좋은임상적결과을얻어유용한술식으로생각된다. 색인단어 : 후관절근접낭종, 퇴행성요추부질환, 후방감압술및유합술 접수일 2016 년 2 월 9 일수정일 2016 년 5 월 2 일게재확정일 2016 년 7 월 5 일책임저자장선호 35233, 대전시서구둔산서로 95, 을지대학교병원정형외과 TEL , FAX , chang2016@eulji.ac.kr 대한정형외과학회지 : 제 52 권제 1 호 2017 Copyright 2017 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