Journal of the Korean Society of Radiology (대한영상의학회지)

The Korean Society of Radiology (대한영상의학회)
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Imaging of Sequestered Lumbar Discs

요추 분리추간판의 영상 소견

  • Gangwon Jeong (Department of Radiology, Inje University College of Medicine, Busan Paik Hospital) ;
  • Heecheol Park (Department of Radiology, Inje University College of Medicine, Busan Paik Hospital) ;
  • Sun Joo Lee (Department of Radiology, Inje University College of Medicine, Busan Paik Hospital) ;
  • Dae-Hyun Park (Department of Orthopaedic Surgery, Inje University College of Medicine, Busan Paik Hospital) ;
  • Sung Hwa Paeng (Department of Neurosurgery, Inje University College of Medicine, Busan Paik Hospital) ;
  • Eugene Lee (Department of Radiology, Seoul National University Bundang Hospital)
  • 정강원 (인제대학교 의과대학 부산백병원 영상의학과) ;
  • 박희철 (인제대학교 의과대학 부산백병원 영상의학과) ;
  • 이선주 (인제대학교 의과대학 부산백병원 영상의학과) ;
  • 박대현 (인제대학교 의과대학 부산백병원 정형외과) ;
  • 팽성화 (인제대학교 의과대학 부산백병원 신경외과) ;
  • 이영준 (분당서울대학교병원 영상의학과)
  • Received : 2023.12.10
  • Accepted : 2024.01.15
  • Published : 2024.01.01
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Abstract

Intervertebral disc herniation is frequently encountered in radiological practice. Sequestered disc herniation occurs when the disc material undergoes degeneration and completely loses continuity with the parent nucleus pulposus. Sequestered discs can reside within and outside the spinal canal, exerting a mass effect on adjacent structures, compressing nerve pathways, and eliciting a range of clinical symptoms. In particular, sequestered discs within the dura cannot be identified without durotomy. Therefore, precise preoperative localization is crucial for surgical planning. On MRI, the signal intensity of the sequestered disc may vary due to independent degeneration processes. Additionally, most sequestered disc fragments show varying degrees of peripheral enhancement depending on the degree of angiogenesis and granulation around the isolated tissue. In this article, we review various imaging findings and the location of the sequestered disc to provide patients with an accurate diagnosis and appropriate treatment direction.

임상에서 자주 접하게 되는 추간판탈출증 중 분리추간판은 추간판의 성분이 원래의 수질핵과 완전히 분리되는 특별한 경우를 의미한다. 이러한 분리추간판은 척추관 내부뿐만 아니라 외부에도 위치할 수 있으며, 주변 구조물에 압력을 가하거나 신경 경로를 압박하게 되고 이로 인해 다양한 임상 증상을 유발할 수 있다. 특히 경막 내에 위치한 분리추간판의 경우, 경막절개술을 통해서만 병변을 식별할 수 있다. 따라서 수술 전에 분리추간판의 정확한 위치와 범위를 파악하는 것은 수술 계획을 세우는 데 중요하다. 자기공명영상에서 분리추간판은 초기에는 모체 추간판과 유사한 신호강도를 보이지만 이후 독립적인 퇴행 변화를 거치며 신호강도가 달라질 수 있다. 또한 대부분의 분리추간판 조각은 염증 반응의 결과로 인해 인접한 혈관발생과 육아조직의 형성 정도에 따라 다양한 정도의 주변 조영증강을 보일 수 있다. 이종설에서는 분리추간판의 다양한 영상 소견과 위치를 소개하여 환자에게 정확한 진단과 적절한 치료 방향을 제시하는 데 도움이 되고자 한다.

Keywords

References

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