대한영상의학회지 (Journal of the Korean Society of Radiology)

  • 제64권1호
  • /
  • Pages.25-32
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  • 2011
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  • 1738-2637(pISSN)
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  • 2288-2928(eISSN)
대한영상의학회 (The Korean Society of Radiology)
권호 표지

경추의 경추간공 경막외 스테로이드 주사요법: 자기공명영상과 경막외조영영상의 역할

Cervical Transforaminal Epidural Steroid Injection (TFESI): Role of MR Imaging and Epidurography

  • 최수정 (울산대학교 의과대학 강릉아산병원 영상의학과) ;
  • 안재홍 (울산대학교 의과대학 강릉아산병원 영상의학과) ;
  • 김정환 (울산대학교 의과대학 강릉아산병원 정형외과) ;
  • 송재석 (관동대학교 의과대학 예방의학과) ;
  • 정승문 (울산대학교 의과대학 강릉아산병원 영상의학과) ;
  • 류대식 (울산대학교 의과대학 강릉아산병원 영상의학과) ;
  • 박만수 (울산대학교 의과대학 강릉아산병원 영상의학과) ;
  • 이종혁 (울산대학교 의과대학 강릉아산병원 영상의학과)
  • Choi, Soo-Jung (Department of Radiology, GangNeung Asan Hospital, University of Ulsan College of Medicine) ;
  • Ahn, Jae-Hong (Department of Radiology, GangNeung Asan Hospital, University of Ulsan College of Medicine) ;
  • Kim, Chung-Hwan (Department of Orthopedic Surgery, GangNeung Asan Hospital, University of Ulsan College of Medicine) ;
  • Song, Jae-Seok (Department of Preventive Medicine, University of Kwandong College of Medicine) ;
  • Jung, Seung-Moon (Department of Radiology, GangNeung Asan Hospital, University of Ulsan College of Medicine) ;
  • Ryu, Dae-Sik (Department of Radiology, GangNeung Asan Hospital, University of Ulsan College of Medicine) ;
  • Park, Man-Soo (Department of Radiology, GangNeung Asan Hospital, University of Ulsan College of Medicine) ;
  • Lee, Jong-Hyeog (Department of Radiology, GangNeung Asan Hospital, University of Ulsan College of Medicine)
  • 발행 : 2011.01.01
⟨ 이전 논문 다음 논문 ⟩

초록

목적: 경추부의 경추간공 경막 외 스테로이드 주사요법을 받은 환자에서 시술 전의 자기공명영상과 경막외조영영상 소견을 시술 후 임상경과와 비교하고자 한다. 대상과 방법: 경추부 병변으로 투시장비 유도 하 경추간공 경막외 스테로이드 주사요법을 받은 45명 환자의 자기공명영상과 경막외조영영상 소견을 후향적으로 분석하여 환자의 동통 감소 정도와 비교, 통계처리하였다. 환자의 동통 감소 정도는 visual analog pain scale을 시술 전과 후 문진하여 백분율로 표시하였다. 결과: 자기공명영상 소견 중 추간판탈출증의 위치는 특히 외측함요에 위치할 때 동통감소가 많았다(central: 54.4%, lateral recess: 69.4%, foraminal: 59%; p = 0.048). 경막외조영영상 소견에서는 조영제의 확산 범위가 신경근 주변에만 있는 경우보다 경막 외 공간까지 확산된 경우 더 동통감소가 많았고(epidural and epineural space, 65.3%; epineural space only, 64.2%; p = 0.03), 바늘의 위치는 신경공안에 있을 때보다 바깥쪽에 있을 때 더 동통감소가 많았다(in the foramen, 59.4%; outside the foramen, 68.4%; p = 0.002). 결론: 경추부의 경추간공 경막 외 스테로이드 주사요법은 특히 추간판탈출증의 위치가 외측함요에 있는 경우 좋은 적응증이 될 수 있으며, 시술 시 바늘의 위치는 신경공 밖에서 조영제가 경막외 공간까지 확산되도록 하는 것이 바람직하다.

Purpose: To evaluate the relationship between MR/epidurographic findings and the clinical outcome after a fluoroscopy-guided transforaminal epidural steroid injection (TFESI) in patients with cervical radicular pain. Materials and Methods: Forty-five patients who had taken a cervical TFESI in our department were included in this study. We retrospectively reviewed MR and epidurographic findings to see if there was a relationship between these methods and the amount of pain relief, by way of a multiple regression analysis. Results: On MR imaging, there was significant relationship between the amount of pain relief and location of herniated intervertebral disc (HIVD, central: 54.4%, lateral recess: 69.4%, foraminal: 59%; p = 0.048). There was no significant difference regarding the other MR findings. On epidurographic findings, there was significant difference in the amount of pain relief with the extent of the contrast (epidural and epineural space, 65.3%; epineural space only, 64.2%; p = 0.03) and location of the needle tip (in the foramen, 59.4%; outside the foramen, 68.4%; p = 0.002). Conclusion: The results indicate that TFESI could be more useful in patients with cervical HIVD in lateral recess rather than another location. Contrast spread into epidural reflux appears to be a favorable injection pattern. Needle tip location is recommended outside the foramen rather than in the foramen.

키워드

참고문헌

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