1. 요추퇴행성질환의질환별단계별분류연구 1.1 Osteophyte - Atsushi Fujiwara 등에의한분류 (1) grade 1: no osteophyte (2) grade 2: mild or possible osteophyte (3) grade 3: moderate osteophyte (4) grade 4: large osteophyte - Margulies JY 등과 Nathan H 에의한분류 1,2) (1) grade 0: 골극이없는경우 (2) grade 1: 뚜렷이골극이형성되어있는경우 (3) grade 2: 골극이커새부리이거나, 상하추체간연결하는경우 1.2 Ligament ossification or calcification: ALL, PLL, ligament flavum - Resnick D 와 Okada K 등에의한분류 (1) ALL (ant. Longitudinal lig.) & anterolateral ligament of vertebral body DISH (diffuse idiopathic skeletal hyperostosis) (= Forestier s disease) (2) PLL (posterior longitudinal ligament) OPLL (ossification of PLL) : segmental type, continous type, mixed type, other type (3) Ligament flavum (Yellow ligament) OLF (ossification of lig. Flavum) (=OYL) : lateral type, diffuse type, thickened nodular type 페이지 1
1.3 Disc height, osteophyte, endplate sclerosis - Kellgren JH 와 Gore 등과 Elisha Ofiram 등에의한분류 (1) grade 0: no disc space narrowing (2) grade 1: 25% disc space narrowing, with barely visibleend-plate sclerosis and osteophyte formation (3) grade 2: 50% disc space narrowing, with moderate end-plate sclerosis and moderate size osteophyte formation (4) grade 3: 75% disc space narrowing, severe end-plate Sclerosis, and large osteophyte formation 1.4 End plate degeneration - Modic MT 에의한분류 3) (bone marrow change according to signal intensity on MR images) (1) type 1 change: hypointense on T1, hyperintense on T2WI (2) type 2: with time, BM converts to predominantly fatty marrow so hyperintense on T1, isointense to hypointense on T2WI (3) type 3: hypointense on both T1 and T2WI chronic disc disease 로인해 dense sclerotic end plate 가됨 1.5 Herniation of nucleus pulposus (HNP) classification (1) Bulging ( 팽윤 ): 섬유륜파열없음 (2) Protrusion ( 돌출 ): 내측섬유륜파열 (+), 외측섬유륜파열 (-) 페이지 2
(3) Extrusion ( 탈출 ): 외측섬유륜까지파열되어수핵의일부가섬유륜의전층뚫고돌출 되었으나, 탈출된수핵은추간판중심부수핵과연결상태임 (4) Sequestration ( 격리 ): 탈출된수핵이모체와완전히단절된상태 1.6 Disc degeneration - Thompson JP 등에의한분류 4) <Thompson JP 등에의한추간판퇴행의진행단계구분 > - Adams MA 등에의한분류 (1) Cotton ball ( 솜뭉치형 ): 퇴행성변화의징후가없다, 수핵은희고부드러우며무정형 (2) Lobular ( 소엽형 ): 숙성된추간판, 수핵은점차섬유덩어리로변화 (3) Irregular ( 불규칙형 ): 수핵과내측섬유륜에열구 (+), 변성된추간판 (4) Fissured ( 열구형 ): 방사상열구가섬유륜의외측가장자리까지연장 (5) Ruptured ( 파열형 ): 추간판에방사상열구가섬유륜끝까지연결 페이지 3
<Adams MA 등에의한추간판퇴행의진행단계구분 > 1.7 Facet joint degeneration - Pathria M 등에의한분류 5) (1) grade 0: normal facet joint space(2~4mm width) (2) grade 1: narrowing of the facet joint space(<2mm) and/or small osteophtes and/or mild hypertrophy of the articular process and/or mild subarticular bone erosions 페이지 4
(3) grade 2: narrowing of the facet joint space and/or moderate osteophtes and/or moderate hypertrophy of the articular process and/or mild subarticular bone erosions (4) grade 3: narrowing of the facet joint space and/or large osteophtes and/or severe hypertrophy of the articular process and/or severe subarticular bone erosions and/or subchondral cysts - Grogan J 등에의한분류 based on shape & amount of cartilage covering articular joint surfaces (1) grade 1: uniformly thick cartilage covering both articular joint surface (2) grade 2: cartilage covering entire surface with eroded or irregular regions (3) grade 3: cartilage incompletely covering articular surface, with underlying bone exposed to joint space (4) grade 4: complete absence of cartilage except for traces evident on articular surface 1.8 Degenerative scoliosis ( 퇴행성측만증 ) - Robin GC 등과 Schmorl G 등에의한분류 6) (1) grade 0: 서로마주보는척추제변연에골극이형성되어지지를하는경우로, 척추 변형부위의신연, 굴곡검사시움직임이없으며, 회전아탈구정도가 grade 0, 1 인경우, 측방전이가 2mm 이하인경우 (2) grade 1: 골극의형성이부족한경우로, 회전아탈구정도가 grade 1, 2 에해당괴는 경우, 측방전이가 2~5mm 인경우 (3) grade 2: 골극형성이아주부족한경우, 회전아탈구정도가 3, 4 인경우, 외측 페이지 5
전이가 5mm 이상인경우 1.9 Degenerative kyphosis ( 퇴행성후만증 ) - Takemitsu 에의한분류 7) 변형의각도는흉추부후만곡의경우 T3 상단에서 T12 하단까지, 요추부전만곡의경우 L1 상단에서 S1 상단까지측정 (1) type 1: straight back 척추전체가일자로편평해진정도 (2) type 2: mild lumbar kyphosis 약간의후만변형상태 (3) type 3: moderate lumbar kyphosis 좀더진행된후만변형상태 (4) type 4: extended round back 척추전체가심한후만변형을보임 <Takemitsu 에의한척추후만증의진행단계 > 페이지 6
1.10 Spinal stenosis anatomical classification (1) Central ( 중심부 ) absolute stenosis CT 상에서 midsagittal diameter < 10mm relative stenosis 10~13mm (2) Lateral ( 외측부 ) lateral recess ( 함요부 ) foraminal ( 추간공 ) CT 상에서정상은 5mm 이상이나그폭이 2mm 이하일경우외측부협착증으로진단할수있고 3~4mm 의경우의심할수있음 1.11 Osteoporosis - WHO (1994) 에의한분류 표준편차를이용한기준으로, 뼈가가장튼튼한사람을기준으로벗어난정도가 (1) 정상 : T-score -1.0 이상 (2) 골감소증 (osteopenia): T-score -1.0 부터 -2.5 사이 (2) 골다공증 : -2.5 이하 (3) 확립된골다공증 : -2.5 이하의범위에비외상성골절이있었거나있는경우 - Singh s index by x-ray 에의한분류 (1) grade 1~6 (2) grade 1 로갈수록 severe 페이지 7
<Singh s index 에따른골다공증의진행단계 > 1.12 Osteoporotic compfx (1) type 1: wedge type 쐐기형 (2) type 2: biconcave type 양요형 (3) type 3: flat type 편평형 측면방사선사진상, 척추체를전방, 중간, 후방부의척추체높이를재고이중적어도한 개이상이인접부척추체보다 15% 이상높이감소가있을시, 혹은전방추체의높이가 후방보다 20% 이상소실시, 척추골절로진단 1.13 Thoraco-lumbar spine fracture McAfee classification (1) Wedge compression Fx isolated failure of anterior column (2) Stable burst Fx anterior, middle column involve 페이지 8
(3) Unstable burst Fx anterior, middle & posterior column disruption (4) Chance Fx axis anterior to ALL (anterior longitudinal ligament) (5) Flexion-distraction injury axis posterior to ALL ant. column (compression) / mid, post col tension) (6) Translation injury malalignment, all 3 column involved (by shear or rotation force) <Thoraco-Lumbar Spine Fracture 의다양한양상 > 1.14 Isthmic defect ( 척추분리증 - 협부결손 ) (1) Unilateral isthmic defect: about 20% (2) Bilateral isthmic defect 페이지 9
1.15 Spondylolisthesis - Spondylolisthesis grade Meyer s scale (A /A x 100 (%)) (1) grade 1: < 25% (2) grade 2: 25~50% (3) grade 3: 50~75% (4) grade 4: 75~100% (5) grade 5: > 100% (spondyloptosis) <Meyer s scale 에의한 Spondylolisthesis 진단 > - Spondylolisthesis classification (1) congenital or dysplastic ( 선천형 ) (2) isthmic ( 협부형 ) (3) degenerative ( 퇴행성 ) (4) post-traumatic ( 외상형 ) (5) pathologic ( 병적형 ) (6) post-surgical ( 수술후형 ) 페이지 10