202 Original Article J Korean Orthop Assoc 2014; 49: 202-208 http://dx.doi.org/10.4055/jkoa.2014.49.3.202 www.jkoa.org 신경성파행을보이는척추관협착증을동반한골다공증성척추체압박골절환자의치료시척추체성형술에추가로시행한선택적신경차단술의임상결과및효용성 민상혁 윤성현 단국대학교의과대학정형외과학교실 pissn : 1226-2102, eissn : 2005-8918 Clinical Results and Efficacy of Selective Nerve Root Blocks with Vertebroplasty in Treatment of Patients with Osteoporotic Compression Fracture Accompanied by Spinal Stenosis Sang-Hyuk Min, M.D., and Sung-Hyun Yoon, M.D. Department of Orthopaedic Surgery, Dankook University Medical College, Cheonan, Korea Purpose: The purpose of this study is to evaluate the efficacy of selective nerve root blocks with vertebroplasty in treatment of patients with osteoporotic compression fracture accompanied spinal stenosis showing neurogenic claudication. Materials and Methods: Of 80 patients admitted to our orthopedic department for osteoporotic vertebral compression fracture accompanied by neurogenic claudication due to spinal stenosis between May 2010 and September 2011, 40 patients who underwent only vertebroplasty and 40 patients who also underwent an additional selective nerve block were studied with a minimum follow-up period of one year. The two groups were compared for their age, sex, grade of spinal stenosis, bone mineral density (BMD), lordotic angle, pelvic tilt, sacral slope, pelvic incidence, restoration rate of vertebral height, preexisting fracture, intradiscal cement leakage, and for new adjacent vertebral fractures during a follow-up period of at least one year. Statistical analysis was performed using SPSS version 17.0 and statistical significance was determined using the Student t-test and chi-square test with p<0.05. Results: No statistically significant difference (p 0.05) in age sex, grade of spinal stenosis, BMD, lordotic angle, pelvic tilt, pelvic incidence, restoration of vertebral height, preexisting fracture, and intradiscal cement leakage was observed between the vertebroplasty only group and the additional selective root block group. However, the incidence of new adjacent vertebral fractures between the groups was 13 of 40 patients in the vertebroplasty only group and four of 40 patients in the selective nerve block addition group; a statistically significant reduction was observed in the nerve block group (p<0.05). Conclusion: In treatment of patients with osteoporotic compression fracture with neurogenic claudication due to spinal stenosis, addition of selective nerve block to vertebroplasty can lessen pain and the resulting postural change, thereby mitigating dynamic sagittal instability, which in turn results in reduced incidence of new adjacent vertebral fractures. As such, selective nerve block should be considered as a safe, simple, and effective tool for use in prevention of new adjacent vertebral fractures in patients with osteoporotic fracture who are suffering from neurogenic claudication. Key words: osteoporotic compression frature, neurogenic claudication, vertebroplasty, selective nerve root block Received September 9, 2013 Revised December 2, 2013 Accepted December 8, 2013 Correspondence to: Sung-Hyun Yoon, M.D. Department of Orthopaedic Surgery, Dankook University Medical College, 119 Dandae-ro, Dongnam-gu, Cheonan 330-715, Korea TEL: +82-41-550-7684 FAX: +82-41-556-3238 E-mail: medi01@hanmail.net The Journal of the Korean Orthopaedic Association Volume 49 Number 3 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 (http://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.
203 척추체성형술과병행한신경차단술의효용성 서론 전세계적으로평균연령이증가하면서골다공증성척추체압박골절환자의수가점차증가하고있다. 최근골다공증성척추체압박골절의치료에있어경피적척추체성형술은골절된척추체에안정성을부여할뿐만아니라골절부위의통증도경감시켜주어널리사용되고있다. 하지만여러연구에서골다공증성척추체압박골절환자에있어척추체성형술후새로운인접부위척추체골절의발생을보고하고있다. 1) 여러연구에서새로운인접부위척추체골절발생의위험인자로연령, 골밀도 (bone mineral density, BMD), 체질량지수 (body mass index) 등개별적인자뿐만아니라, 과도한척추체높이회복, 국소후만변형, sagittal index, preexisting fracture 등방사선적으로보이는정적인시상면의불균형을언급하였다. 2,3) 그럼에도불구하고경피적척추체성형술과새로운인접부위척추체골절사이의인과관계에대해서는불확실한상태이다. 단국대학교의과대학정형외과학교실에서는신경성파행을보이는척추관협착증을동반한골다공증성척추체압박골절환자에서신경성파행으로인한환자의자세변화가환자의역동적인시상면불균형을초래하고, 척추체성형술후새로운인접부위척추체골절을일으킬수있는또다른원인이될수있을것으로생각하였다. 이에척추체성형술에추가로시행한선택적신경차단술이신경성파행의증상을완화시켜줌으로써동적시상면불균형에영향을주어새로운인접부위척추체골절을감소시키는데도움이될것으로생각하여선택적신경차단술이새로운인접부위척추체골절발생에미치는영향에대해비교분석하고자하였다. 대상및방법 1. 연구대상 2010 년 5월부터 2011 년 9월까지신경성파행을보이는척추관협착증을동반한골다공증성척추체압박골절로진단받은환자를 대상으로단국대학교병원정형외과에서척추체성형술을시행받고최소 1년이상추시관찰이가능하였던 80명 ( 척추체성형술만시행한환자군 40명, 척추체성형술에추가로선택적신경차단술을시행한환자군 40명 ) 을대상으로하여후향적으로연구하였다. 매달전반부 (15 일이전 ) 에입원한환자는척추체성형술만시행하였고, 후반부 (15 일이후 ) 에입원한환자는척추체성형술에추가로선택적신경차단술을시행하였다. 방사선촬영및컴퓨터단층촬영 (computed tomography, CT), 자기공명영상 (magnetic resonance imaging, MRI), 골주사검사 (bone scan) 상명확히골다공증성척추체압박골절로진단받고신경성파행을보이는척추관협착증이있으며최소 2주이상의보존적치료에반응이없는 55세이상의환자를대상으로하였다. 80명중 9명이기존에척추관협착증을진단받고보존적치료를받던환자였고, 71명은이번골다공증성척추체압박골절로새롭게진단받은환자였다. 골다공증성골절과척추관협착증은별개부위이며골편으로인해기존협착증이악화되거나발생한경우는없었다. 본원의의료영상저장전송시스템에방사선사진, CT, MRI 영상을사용하지못하는경우, 뇌졸증, 치매, 악성종양및이전척추수술병력이있는경우, 장기간부신피질호르몬을사용한경우, 집중치료를필요로하는중증내과질환이있는경우, 전이성척추종양, myeloma, hemangioma, infection 에의한골절및제4 흉추보다상위척추체골절인경우는제외하였다. 척추체성형술만시행한환자군 40명중남자는 12명, 여자는 28명이었고, 평균연령은 75.85 세 (59-90 세 ) 였다. 압박골절부위는흉추부 6명 (15.0%), 흉요추이행부 23명 (57.5%), 요추부 11명 (27.5%) 이었다. 이중 2부위이상다발성골절환자는 7명 (17.5%) 명이었다. 척추체성형술에추가로선택적신경차단술을시행한환자군 40명중남자 10명, 여자 30명이었고, 평균연령은 74.33 세 (61-86 세 ) 였다. 압박골절부위는흉추부 5명 (12.5%), 흉요추이행부 25명 (62.5%), 요추부 10명 (25.0%) 이었다. 이중 2부위이상다발성골절환자는 8명 (20.0%) 이었다. BMD 는각각의군에서 -3.47 과 -3.44 로측정되었다 (Table 1). 척추체전방부및중간부척추체 Table 1. Comparison between the Vertebroplasty Only Group and the Additional Selective Root Block Group Variable Vertebroplasty only group (n=40) Additional selective root block group (n=40) Age (yr) 75.85 (56 90) 74.33 (61 86) Sex (male:female) 12:28 10:30 Initial fracture level Thoracic 6 (15.0) 5 (12.5) Thoracolumbar junction (T12, L1 spine) 23 (57.5) 25 (62.5) Lumbar 11 (27.5) 10 (25.0) Bone mineral density (t-score) -3.47-3.44 Values are presented as median (range), number only, or number (%).
204 민상혁 윤성현 던환자들중배부동통이발생한경우이전에경피적척추체성형술을시행받은척추체를포함하여환자가동통을호소하는부위에대하여단순방사선사진, MRI 및골주사검사를시행하여단순방사선사진상척추체높이의현저한감소가있는경우, MRI 사진상 T1 강조영상에서저신호강도, T2 강조영상에서고신호강도를보이는경우및핵의학검사상고흡수 (hot uptake) 를보이는경우새로운인접부위골절로진단하였고매추시때마다신경성파행을유발하는증상에대해통증진단척도 (visual analogue scale [VAS] score) 를측정하였다. Figure 1. The method of estimation of vertebral body height restoration rate. (A) Preoperative radiograph; (B) postoperative radiograph. Vertebral body height before compression fracture (Y); Y=(a+c)/2. Anterior height restoration rate (AR); AR=(e-b)/Y 100(%). Middle height restoration rate (MR); MR=(f-d)/Y 100(%). 높이회복률은척추의측면방사선사진에서골절척추체상하위 척추체높이의평균을골절척추체의가상척추체높이로정하고 경피적척추체시행전과후의척추체높이차를가상척추체높 이대한백분율로표현하였다 (Fig. 1). 2) 요추전만각은제 1 요추의 상부척추종판과제 1 천추의상부척추종판사이의각도로측정 하였다. 천추경사 (sacral slope) 는천추상연을평행하게그은선과수평 선이이루는각으로, 골반기울기 ( 천추 - 골반각 ) 는고관절축을 지나는수선과고관절축과제 1 천추체상연의중심을잇는선이 이루는각으로하였으며, 골반기울기와천추경사의합인골반 투사각을구하였다. 4) 척추관협착증정도는 T2 강조축면영상에서말총신경의분산 정도에따라 4 개의등급으로나누었다. 5) 2. 시술및술후처치 배부동통 (back pain) 을주소로내원한환자들중 MRI 혹은골주 사검사를통해골절이진단된환자들에대하여경피적척추체성 형술을시행하였으며, MRI 상신경성파행을유발시키는병변에 대하여선택적신경차단술을추가로시행하였다. 시술후다음 날부터보행을시작하였으며시술후 2 주, 6 주, 3 개월및이후 3 개 월마다외래추시가이루어졌으며, 외래추시 1 년마다 BMD 검사 를하였고 2 년이상골다공증약투여를권장하였다. 또한모든환 자에서비스테로이드성진통제등약물치료를병행하여시행하 였다. 3. 평가 경피적척추체성형술을시행받고정기적인추시를시행받고있 4. 분석방법두군간에나이, 성별, 척추관협착증정도, BMD, 요추전만각, 천추경사각, 골반경사각, 골반투사각, 척추체높이회복정도, 기존척추체골절, 추간판내골시멘트누출등에대하여비교분석하였고최소 1년추시기간내새로운인접부위척추체골절유무에대해조사하였다. 각군간의비교에있어서통계적분석은 SPSS version 17.0 (SPSS Inc., Chicago, IL, USA) 을사용하였고, 각군의비교는 Student t-test 와 chi-square test 를사용하여 p<0.05 인경우를통계적으로유의하다고판정하였다. 결과 경피적척추체성형술만시행한환자군과척추체성형술에추가로선택적신경차단술을시행한환자군사이에나이, 성별, 척추관협착증정도, BMD, 요추전만각, 천추경사각, 골반경사각, 골반투사각, 척추체높이회복정도, 기존척추체골절, 추간판내골시멘트누출에있어통계적으로유의한차이를보이지않았다 (p 0.05). 그러나최소 1년추시기간동안새로운인접부위척추체골절이척추체성형술만시행한환자 40명중 13명, 척추체성형술과함께선택적신경차단술을시행한환자 40명중 4명에서발생하여, 척추체성형술에추가로선택적신경차단술을시행한경우새로운인접부위척추체골절의발생이통계적으로유의하게감소하였다 (p<0.05). 고찰 골다공증성척추체압박골절은고령의성인에서극심한통증과여러합병증및삶의질저하를유발시키는드물지않은질환이다. 전통적으로골다공증성척추체골절의치료로침상안정, 보조기치료, 물리치료및약물치료등이사용되어져왔으나오랜기간의침상안정은새로운골절의발생과폐색전증과같은전신적인합병증의발생을증가시킨다. 6) 그러므로조기보행이골다공증성척추체골절환자의회복에중요하며여러합병증을감소시키는데도움이된다. 7) 최근들어통증과관련된골다공증성척추
205 척추체성형술과병행한신경차단술의효용성 체압박골절에대한최소침습적치료로척추체성형술이널리사용되고있다. 8-10) 그러나경피적척추체성형술이최소침습적이고효과가좋은시술임에도불구하고여러연구에서시술후인접부위새로운척추체골절이발생할확률이 12%-52% 에이른다고하였다. 11-13) 이로인해경피적척추체성형술과새로운인접부위척추체골절의연관성에대해여러연구에서여러가지인자들에대해논의되고있다. 6,12,13) Liu 등 14) 은척추체의하부및종판에가까운골시멘트분포, 기존척추체골절등이새로운인접부위척추체골절과통계적으로상관관계가있다고하였다. 본교실의이전연구에서도경피적척추체성형술후새로운인접부위척추체골절은일으키는위험인자로낮은 BMD, 척추체높이회복정도, 기존척추체골절, 추간판내골시멘트누출등을언급하였다. 2) 이와같이대부분의연구에서개별적인인자및경피적척추체고정술후방사선적으로보이는정적인시상면의불균형만을중요한인자로언급하였다. Lee 등 4) 은낮은 BMD 및높은골반투사각를포함한 spinopelvic parameter 가시상면균형을결정하는데중요한역할을하며, 성인의척추시상만곡은체중이나노화에따른분절간퇴행성변화, 골반및척추주변근육의근력변화등의동적인인자와외상등에의해변화되고, 이상만곡의형태로발전할수있다고하였다. Suzuki 등 15) 은신경성파행을보이는척추관협착증환자에있어시상면수직축 (sagittal vertical axis) 이신경성파행을보이지않는군에비해통계적으로유의하게큰수치를보이며더작은요추전만각과더큰골반기울기각 (pelvic tilting angle) 을보인다고하였다. 그래서신경인성파행환자는체간의전방굴곡 (forward bending) 과골반후방기울기 (pelvic back tilt) 를나타낸다고하였다. Lee 등 16) 은척추의시상면불균형은보행시에보다분명하며 이는정적인것보다동적인성향이강함을제시하는것이라하였고, 방사선적인검사는척추의정적인상태만나타내므로동적인척추시상면불균형을실질적으로평가하기위해서는보행분석을시행하여골반및하지와관계된동적인척추불균형을반드시확인하여야한다고하였다. 신경성파행을보이는척추관협착증을동반한골다공증성척추체압박골절환자에서신경성파행으로인한환자의자세변화가환자의역동적인시상면불균형을초래하며, 척추체성형술후새로운인접부위척추체골절을일으킬수있는또다른원인이될수있을것으로생각하였다. 또한 Tran 등 17) 은신경차단술이신경성파행을동반한요추부척추관협착증환자에게서단기적으로통증이나기능을개선한다고하였다. Delport 등 18) 은 140 명의척추관협착증환자에게경막외주사를시행한결과 71% 환자에서통증이경감되었고, 53% 환자에서기능적능력이개선되었으며 74% 의환자가경막외주사치료에만족하였음을발표하였다. Botwin 등 19) 은퇴행성척추관협착증으로인한신경성파행을보이는 34명의환자에게선택적신경차단술을시행한결과경막외주사를시행한결과 64% 환자에서 walking tolerance 가개선되었고, 57% 환자에서 standing tolerance 가개선되었음을발표하였다. 본연구에서도수술전신경성파행에대한평균 VAS score 가 6.45 에서술후 1일째 2.12, 술후 3개월째 3.64, 술후 1년째 4.89 로호전된상태로유지되었다. 또한인접부위척추체골절이발생한 17명중 9명 (52.9%)( 경피적척추체성형술만시행한환자군 13 명중 8명 [61.5%], 척추체성형술에추가로선택적신경차단술을시행한환자군 4명중 1명 [25.0%]) 에서 3개월이전에새로운골절이발생하였다. 경피적척추체성형술만시행한환자군 13명중 11명 (84.6%), 척추체성형술에추가로선택적신경차단술을시행한환자군 4명중 2명 (50.0%) 에서 6개월이전에새로운인접부위 Table 2. Comparison of Risk Factors between the Vertebroplasty Only Group and the Additional Selective Root Block Group Variable Vertebroplasty only group (n=40) Additional selective root block group (n=40) p-value Age (yr) 75.83 74.33 0.352 Sex (female), n 28 30 0.666 Grade of spinal stenosis (>grade 2), n 34 31 0.691 Bone mineral density (T-score) -3.47-3.44 0.781 Lordotic angle ( o ) 27.07 28.18 0.768 Pelvic tilt ( o ) 32.95 29.88 0.068 Sacral slope ( o ) 31.78 29.18 0.274 Pelvic incidence ( o ) 64.73 59.05 0.054 Anterior restoration rate of vertebral height (%) 19.57 19.72 0.834 Middle restoration rate of vertebral height (%) 17.09 17.09 0.997 Preexisting fracture (n) 9 10 0.746 Intradiscal cement leakage (n) 5 5 0.967
206 민상혁 윤성현 Table 3. Incidence of New Compression Fractures in Adjacent Vertebroplasty Variable Vertebroplasty only group (n=40) Additional selective root block group (n=40) p-value New fracture (n) 13 4 0.016 척추체골절이발생하여선택적신경차단술로인한신경성파행증상완화가새로운인접부위척추체골절에영향을주었을것으로생각된다. 본연구의결과상경피적척추체성형술만시행한환자군과척추체성형술에추가로선택적신경차단술을시행한환자군사이에나이, 성별, 척추관협착증정도, BMD, 요추전만각, 천추경사, 골반기울기, 골반투사각, 척추체높이회복정도, 기존척추체골절, 추간판내골시멘트누출에있어두군간에통계적으로차이가없었다 (p>0.05)(table 2). 그러나척추체성형술만시행한환자 40명중 13명, 척추체성형술과함께선택적신경차단술을시행한환자 40명중 4명에서새로운인접부위척추체골절이발생하였다. 즉, 척추체성형술에추가로선택적신경차단술을시행한경우새로운인접부위척추체골절의발생이통계적으로유의하게감소하였다 (p=0.016)(table 3). 아직정확한기전이밝혀지진않았으나추가로시행한선택적신경차단술이신경성파행의증상을완화시켜줌으로써, 자세변화로인해동적시상면불균형에영향을주어, 새로운인접부위척추체골절발생을감소시켰을것으로생각된다. 물론신경성파행의증상을완화시켜줌으로써, 자세변화로인해동적시상면불균형에영향을주는다른척추관협착증치료에대한연구도필요할것으로생각한다. 또한추후보행분석을포함한정확한기전을증명할수있는검사방법을추가하여보다더체계적인연구를하여야할것이다. 결론 신경성파행을보이는척추관협착증을동반한골다공증성척추체골절환자의치료에있어척추체성형술에추가로시행한선택적신경차단술이신경성파행의증상을완화시켜줌으로써동적시상면불균형에영향을주어새로운인접부위척추체골절을감소시키는것으로생각된다. 따라서신경성파행을보이는골다공증성척추체골절환자치료시척추체성형술에추가적으로비교적안전하고간단하며효과적인선택적신경차단술시행을고려하는것이향후새로운인접부위척추체골절예방에도움이될수있을것이다. REFERENCES 1. Trout AT, Kallmes DF, Kaufmann TJ. New fractures after vertebroplasty: adjacent fractures occur significantly sooner. AJNR Am J Neuroradiol. 2006;27:217-23. 2. Kim MH, Lee AS, Min SH, Yoon SH. Risk factors of new compression fractures in adjacent vertebrae after percutaneous vertebroplasty. Asian Spine J. 2011;5:180-7. 3. Kang SK, Lee CW, Park NK, et al. Predictive risk factors for refracture after percutaneous vertebroplasty. Ann Rehabil Med. 2011;35:844-51. 4. Lee CS, Chung SS, Chung KH, Kim SR. Significance of pelvic incidence in the development of abnormal sagittal alignment. J Korean Orthop Assoc. 2006;41:274-80. 5. Lee GY, Lee JW, Choi HS, Oh KJ, Kang HS. A new grading system of lumbar central canal stenosis on MRI: an easy and reliable method. Skeletal Radiol. 2011;40:1033-9. 6. Lyles KW, Gold DT, Shipp KM, Pieper CF, Martinez S, Mulhausen PL. Association of osteoporotic vertebral compression fractures with impaired functional status. Am J Med. 1993;94:595-601. 7. Grados F, Depriester C, Cayrolle G, Hardy N, Deramond H, Fardellone P. Long-term observations of vertebral osteoporotic fractures treated by percutaneous vertebroplasty. Rheumatology (Oxford). 2000;39:1410-4. 8. Kallmes DF, Comstock BA, Heagerty PJ, et al. A randomized trial of vertebroplasty for osteoporotic spinal fractures. N Engl J Med. 2009;361:569-79. 9. Klazen CA, Lohle PN, de Vries J, et al. Vertebroplasty versus conservative treatment in acute osteoporotic vertebral compression fractures (Vertos II): an open-label randomised trial. Lancet. 2010;376:1085-92. 10. DePalma MJ, Ketchum JM, Frankel BM, Frey ME. Percutaneous vertebroplasty for osteoporotic vertebral compression fractures in the nonagenarians: a prospective study evaluating pain reduction and new symptomatic fracture rate. Spine (Phila Pa 1976). 2011;36:277-82. 11. Lin EP, Ekholm S, Hiwatashi A, Westesson PL. Vertebroplasty: cement leakage into the disc increases the risk of new fracture of adjacent vertebral body. AJNR Am J Neuroradiol. 2004;25:175-80. 12. Tseng YY, Yang TC, Tu PH, Lo YL, Yang ST. Repeated and multiple new vertebral compression fractures after percutane-
207 척추체성형술과병행한신경차단술의효용성 ous transpedicular vertebroplasty. Spine (Phila Pa 1976). 2009; 34:1917-22. 13. Lindsay R, Silverman SL, Cooper C, et al. Risk of new vertebral fracture in the year following a fracture. JAMA. 2001;285: 320-3. 14. Liu WG, He SC, Deng G, et al. Risk factors for new vertebral fractures after percutaneous vertebroplasty in patients with osteoporosis: a prospective study. J Vasc Interv Radiol. 2012;23:1143-9. 15. Suzuki H, Endo K, Kobayashi H, Tanaka H, Yamamoto K. Total sagittal spinal alignment in patients with lumbar canal stenosis accompanied by intermittent claudication. Spine (Phila Pa 1976). 2010;35:E344-6. 16. Lee CS, Lee CK, Kim YT, Hong YM, Yoo JH. Dynamic sagittal imbalance of the spine in degenerative flat back: significance of pelvic tilt in surgical treatment. Spine (Phila Pa 1976). 2001; 26:2029-35. 17. Tran de QH, Duong S, Finlayson RJ. Lumbar spinal stenosis: a brief review of the nonsurgical management. Can J Anaesth. 2010;57:694-703. 18. Delport EG, Cucuzzella AR, Marley JK, Pruitt CM, Fisher JR. Treatment of lumbar spinal stenosis with epidural steroid injections: a retrospective outcome study. Arch Phys Med Rehabil. 2004;85:479-84. 19. Botwin KP, Gruber RD, Bouchlas CG, et al. Fluoroscopically guided lumbar transformational epidural steroid injections in degenerative lumbar stenosis: an outcome study. Am J Phys Med Rehabil. 2002;81:898-905.
208 pissn : 1226-2102, eissn : 2005-8918 Original Article J Korean Orthop Assoc 2014; 49: 202-208 http://dx.doi.org/10.4055/jkoa.2014.49.3.202 www.jkoa.org 민상혁 윤성현 신경성파행을보이는척추관협착증을동반한골다공증성척추체압박골절환자의치료시척추체성형술에추가로시행한선택적신경차단술의임상결과및효용성 민상혁 윤성현 단국대학교의과대학정형외과학교실 목적 : 신경성파행을보이는골다공증성척추체압박골절환자의치료시척추체성형술에추가로시행한선택적신경차단술이새로운인접부위척추체골절발생에미치는영향에대해분석하였다. 대상및방법 : 신경성파행을보이는골다공증성척추체압박골절로진단받은환자중척추체성형술만시행한환자군 40명과추가로선택적신경차단술을시행한환자군 40명을최소 1년이상추시관찰하였다. 결과 : 두군사이에나이, 성별, 척추관협착증정도, 골밀도, 요추전만각, 천추경사각, 골반경사각, 골반투사각, 척추체높이회복정도, 기존척추체골절, 추간판내골시멘트누출에있어통계적으로유의한차이를보이지않았다 (p 0.05). 그러나새로운인접부위척추체골절이, 척추체성형술만시행한환자 40명중 13명, 추가적선택적신경차단술을시행한환자 40명중 4명에서발생하여새로운인접부위척추체골절의발생이통계적으로유의하게감소하였다 (p<0.05). 결론 : 신경성파행을동반한골다공증성척추체골절환자의치료에있어척추체성형술에추가로시행한선택적신경차단술이새로운인접부위척추체골절을감소시킬수있는치료옵션이될수있을것으로생각된다. 색인단어 : 골다공증성척추체압박골절, 신경성파행, 척추체성형술, 선택적신경차단술 접수일 2013 년 9 월 9 일수정일 2013 년 12 월 2 일게재확정일 2013 년 12 월 8 일책임저자윤성현천안시동남구단대로 119, 단국대학교의과대학정형외과학교실 TEL 041-550-7684, FAX 041-556-3238, E-mail medi01@hanmail.net 대한정형외과학회지 : 제 49 권제 3 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 (http://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.