Journal of the Korea Academia-Industrial cooperation Society (한국산학기술학회논문지)

The Korea Academia-Industrial cooperation Society (한국산학기술학회)
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Effect of Lumbar Epidural Nerve Block using the Transforamimnal Approach and the Interlaminar Approach on Magnetic Resonance Imaging Findings

추간공 접근법과 추궁간판 접근법을 사용한 요부 경막외 신경차단술이 자기공명영상 소견에 미치는 영향

  • Hwang, Byeong-Mun (Department of Anesthesiology and Pain Medicine, School of Medicine, Kangwon National University)
  • 황병문 (강원대학교 의학전문대학원 의학과 마취통증의학교실)
  • Received : 2017.06.30
  • Accepted : 2017.08.17
  • Published : 2017.08.31
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Abstract

This study was conducted to investigate the differences in magnetic resonance imaging (MRI) findings after lumbar epidural nerve block using the transforaminal approach and the interlaminar approach in patients with low back pain. This study was an observational analysis study of abnormal findings of MRI after epidural nerve block. This study included 78 patients who underwent MRI at approximately 24 h after lumbar epidural nerve block at a pain clinic of a university hospital between January 2007 and December 2016. Among patients who received epidural nerve block, 36 used the interlaminar approach and 42 used the transforaminal approach. The incidence of patients with abnormal changes in MRI findings was higher among patients using the interlaminar approach (53%) than those using the transforaminal approach (7%). Abnormal MRI findings included epidural air or fluid, needle tracks, and soft tissue changes, with epidural air being the most frequent abnormal finding (72%). We recommend use of the transforaminal approach to reduce the possibility of misreading or difficulty in interpretation of images of patients who underwent MRI at approximately 24 h after lumbar epidural nerve block. Practitioners should consider the possibility of abnormal findings such as epidural air on MRI in cases of epidural nerve block using the interlaminar approach.

본 연구의 목적은 요통으로 추간공 접근법과 추궁간판 접근법을 사용하여 요부 경막외 신경차단술을 받은 환자를 대상으로 시술 후 자기공명영상 소견이 어떻게 다른지 조사하는 것이었다. 연구 방법은 신경차단술 후 자기공명영상의 이상 소견에 대해 분석한 관찰 연구이다. 연구 대상자는 2007년 1월에서 2016 12월 사이에 일개 대학병원 통증클리닉에서 요부 경막외 신경차단술 24시간 후에 요추부 자기공명영상을 촬영한 78명의 환자를 대상으로 하였다. 신경차단술을 받은 대상자 중에서 추궁간판 접근법을 사용한 환자는 36명이었고, 추간공 접근법을 사용한 환자는 42명이었다. 경막외 신경차단술 후 자기공명영상에서 비정상적인 소견을 보인 환자들의 비율은 추간공 접근법을 사용한 군(7%)에 비해 추궁간판 접근법을 사용한 군(53%)에서 많았다. 비정상적인 자기공명영상 소견은 경막외 공기, 유체, 연부 조직의 변화, 바늘 자국 등이었다. 전체 비정상소견 중에서는 경막외 공기가 72%로 다수를 차지했다. 위의 연구결과를 고려할 때 요부 경막외 신경차단술을 시행 후 24시간 이내에 자기공명영상을 촬영할 경우에는, 시술 시 추간공 접근법을 이용하는 것이 자기공명영상의 판독 오류 또는 해석의 어려움을 줄이는데 도움이 될 것이다. 또한 추궁간판 접근법을 이용하여 시술하는 경우에는 자기공명영상에서 경막외 공기 등의 이상 소견이 발견될 가능성에 주의할 필요가 있다.

Keywords

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