The Korean Journal of Pain

  • 제19권2호
  • /
  • Pages.207-212
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  • 2006
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  • 2005-9159(pISSN)
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  • 2093-0569(eISSN)
대한통증학회 (The Korean Pain Society)
권호 표지

추간판 탈출증 환자에서 길잡이철사가 삽입된 경막외카테터를 이용한 미추경막외조영술

Caudal Epidural Injection with a Guidewire-Reinforced Epidural Catheter in Patients with Herniated Nucleosus Pulpose

  • 고상욱 (성균관대학교 의과대학 삼성서울병원 마취통증의학과) ;
  • 이석진 (성균관대학교 의과대학 삼성서울병원 마취통증의학과) ;
  • 황희윤 (성균관대학교 의과대학 삼성서울병원 마취통증의학과) ;
  • 심우석 (성균관대학교 의과대학 삼성서울병원 마취통증의학과) ;
  • 최수주 (성균관대학교 의과대학 삼성서울병원 마취통증의학과) ;
  • 김지애 (성균관대학교 의과대학 삼성서울병원 마취통증의학과) ;
  • 김정수 (성균관대학교 의과대학 삼성서울병원 마취통증의학과) ;
  • 함태수 (성균관대학교 의과대학 삼성서울병원 마취통증의학과) ;
  • 김갑수 (성균관대학교 의과대학 삼성서울병원 마취통증의학과) ;
  • 조현성 (성균관대학교 의과대학 삼성서울병원 마취통증의학과) ;
  • 김태형 (성균관대학교 의과대학 삼성서울병원 마취통증의학과)
  • Ko, Justin Sangwook (Department of Anesthesiology and Pain Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine) ;
  • Lee, Seok Jin (Department of Anesthesiology and Pain Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine) ;
  • Hwang, Hee Youn (Department of Anesthesiology and Pain Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine) ;
  • Sim, Woo Seok (Department of Anesthesiology and Pain Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine) ;
  • Choi, Soo Joo (Department of Anesthesiology and Pain Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine) ;
  • Kim, Jie Ae (Department of Anesthesiology and Pain Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine) ;
  • Kim, Chung Su (Department of Anesthesiology and Pain Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine) ;
  • Hahm, Tae Soo (Department of Anesthesiology and Pain Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine) ;
  • Kim, Gaab Soo (Department of Anesthesiology and Pain Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine) ;
  • Cho, Hyun Sung (Department of Anesthesiology and Pain Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine) ;
  • Kim, Tae Hyeong (Department of Anesthesiology and Pain Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine)
  • 투고 : 2006.10.09
  • 심사 : 2006.12.01
  • 발행 : 2006.12.30
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초록

Background: The epidural injection technique is a commonly used intervention in the management of chronic spinal pain, which has the advantage of delivering various drugs, such as local anesthetics or steroids, in higher concentrations to the inflamed nerve root. A guidewire-reinforced epidural catheter was introduced through a Tuohy needle during the caudal epidural procedure, with a catheter threaded into the affected nerve roots and the spread-pattern of contrast agents observed under fluoroscopy. Methods: Sixty-seven patients with low back pain, who showed evidence of a herniated nucleus pulposus on magnetic resonance imaging, were included. All patients received fluoroscopically guided caudal epidural injections, with the guidewire-reinforced epidural catheter introduced through a Tuohy needle and threaded either to the right or left side toward the target nerve roots. After confirming the catheter tip position at the affected nerve root, 2 ml increments of contrast agents (up to 6 ml) were injected, and their corresponding AP fluoroscopic views were obtained. Three radiologists reviewed all the radiographic findings and measured the proportion of the area of contrast spread at the side of target nerve roots. Results: Greater proportion of the area of contrast spread was observed at the side of the target nerve roots (P < 0.0001). At each level of contrast injection (2-⁣, 4- ⁣ and 6 ml), more than 70% of the spread of contrast dye was observed at the side of the target nerve roots in 85%, 70%, and 55% of cases, respectively. Conclusions: The combination of a caudal epidural injection and use of a guidewire-reinforced epidural catheter significantly enhances the target specificity, as revealed by the selective spread of contrast dye at the side of target nerves.

키워드

참고문헌

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