Journal of the Korean Orthopaedic Association (대한정형외과학회지)

Korean Orthopaedic Association (대한정형외과학회)
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Current Concepts of Degenerative Disc Disease -A Significance of Endplate-

퇴행성 추간판 질환의 최신 지견 -종판의 중요성-

  • Soh, Jaewan (Department of Orthopedic Surgery, Soon Chun Hyang University Cheonan Hospital) ;
  • Jang, Hae-Dong (Department of Orthopedic Surgery, Spine Center, Soon Chun Hyang University Bucheon Hospital) ;
  • Shin, Byung-Joon (Department of Orthopedic Surgery, Spine Center, Soon Chun Hyang University Seoul Hospital)
  • 소재완 (순천향대학교 부속 천안병원 정형외과) ;
  • 장해동 (순천향대학교 부속 부천병원 정형외과 척추센터) ;
  • 신병준 (순천향대학교 부속 서울병원 정형외과 척추센터)
  • Received : 2021.02.26
  • Accepted : 2021.05.15
  • Published : 2021.08.30
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Abstract

Degenerative disc disease has traditionally been thought of as low back pain caused by changes in the nucleus pulposus and annulus fibrous, in recent studies, however, changes in the upper and lower endplates cause degeneration of the disc, resulting in mechanical pressure, inflammatory reactions and low back pain. Recently, the bone marrow of the vertebral body-endplate-nucleus pulposus and annulus fibrous were considered as a single unit, and the relationship was explained. Once the endplate is damaged, it eventually aggravates the degeneration of the bone marrow, nucleus pulposus, and annulus fibrosus. In this process, the compression force of the annulus fibrosus increases, and an inflammatory reaction occurs due to inflammatory mediators. Hence, the sinuvertebral nerves and the basivertebral nerves are stimulated to cause back pain. If these changes become chronic, degenerative changes such as Modic changes occur in the bone marrow in the vertebrae. Finally, in the case of degenerative intervertebral disc disease, the bone marrow of the vertebral body-endplate-nucleus pulposus and annulus fibrous need to be considered as a single unit. Therefore, when treating patients with chronic low back pain, it is necessary to consider the changes in the nucleus pulposus and annulus fibrosus and a lesion of the endplate.

퇴행성 추간판 질환은 전통적으로 수핵과 섬유륜의 변화에 따른 요통으로 생각되어 왔으나, 최근 연구들에서 추간판을 이루고 있는 상·하 종판의 변화가 추간판의 퇴행을 유발하고, 그 결과로 기계적 압박과 염증 반응에 의해 요통이 유발된다고 한다. 또한 최근에는 추체 골수-종판-수핵과 섬유륜을 하나의 단위로 생각하고, 그 연관성을 설명하고 있다. 종판이 손상되면 결국 추체, 수핵과 섬유륜의 퇴행성 변화를 가중시킨다. 이 과정에서 섬유륜에 가해지는 압박력이 증가하고, 염증성 매개 물질들에 의한 염증 반응이 일어나서, 동척추 신경(sinuvertebral nerve)과 기저추 신경(basivertebral nerve)이 자극을 받으면서 요통을 발생시킨다. 이런 변화가 만성화되면, 추체 내 골수에도 Modic 변화 같은 퇴행성 변화가 발생하게 된다. 결국, 퇴행성 추간판 질환은 추체 골수-종판-수핵과 섬유륜을 하나의 단위로 연관지어서 생각해야 할 필요가 있다. 그러므로 만성 요통 환자 진료 시에는 수핵과 섬유륜의 변화 소견뿐 아니라, 종판의 병변에 관심을 가질 필요가 있다고 생각된다.

Keywords

Acknowledgement

논문 작성에 도움을 주신 강태욱 선생님께 감사의 말씀 드립니다.

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