CAJ | 학술논문

背景:椎间盘突出症患者腰痛原因很难判断,一直以来,认为突出的椎间盘是椎间盘突出症患者腰痛及腿痛重要原因,椎间盘突出临近退变节段是否导致腰痛需进一步研究证实.目的:通过椎间盘造影判断突出临近退变节段是否是椎间盘突出症患者腰痛原因,并报告经椎间盘镜摘除椎间盘后残留腰痛在临近退变疼痛椎间盘经亚甲蓝注射治疗的效果.方法:20例同时具有腰痛和腿痛椎间盘突出症患者行椎间盘造影检查,这些患者腰椎MRI表现为有1个突出椎间盘外至少合并1个或1个以上的临近退变的椎间盘,全部患者均经椎间盘镜摘除椎间盘切除突出的椎间盘,5例临近退变椎间盘造影阳性患者在椎间盘镜切除后经椎间盘内注射亚甲蓝治疗.腰痛、腿痛采用目测类比评分评定.结果与结论:20例患者总共64个椎间盘行椎间盘造影,共11个椎间盘造影阳性,其中6个位于椎间盘突出临近退变节段,5个位于引起神经根性痛的椎间盘突出节段.全部病例腿痛行椎间盘镜切除突出椎间盘后明显缓解,腰痛有部分缓解,6例临近椎间盘造影阳性患者经椎间盘镜摘除椎间盘后腰痛明显,影响日常生活,其中5例行临近疼痛椎间盘亚甲蓝注射后腰痛缓解,1例患者拒绝亚甲蓝注射治疗仍有明显腰痛.结果显示椎间盘突出症患者腰痛可能来源于突出临近退变节段.
배경:추간반돌출증환자요통원인흔난판단,일직이래,인위돌출적추간반시추간반돌출증환자요통급퇴통중요원인,추간반돌출림근퇴변절단시부도치요통수진일보연구증실.목적:통과추간반조영판단돌출림근퇴변절단시부시추간반돌출증환자요통원인,병보고경추간반경적제추간반후잔류요통재림근퇴변동통추간반경아갑람주사치료적효과.방법:20례동시구유요통화퇴통추간반돌출증환자행추간반조영검사,저사환자요추MRI표현위유1개돌출추간반외지소합병1개혹1개이상적림근퇴변적추간반,전부환자균경추간반경적제추간반절제돌출적추간반,5례림근퇴변추간반조영양성환자재추간반경절제후경추간반내주사아갑람치료.요통、퇴통채용목측류비평분평정.결과여결론:20례환자총공64개추간반행추간반조영,공11개추간반조영양성,기중6개위우추간반돌출림근퇴변절단,5개위우인기신경근성통적추간반돌출절단.전부병례퇴통행추간반경절제돌출추간반후명현완해,요통유부분완해,6례림근추간반조영양성환자경추간반경적제추간반후요통명현,영향일상생활,기중5례행림근동통추간반아갑람주사후요통완해,1례환자거절아갑람주사치료잉유명현요통.결과현시추간반돌출증환자요통가능래원우돌출림근퇴변절단.
BACKGROUND: It is often difficult to determine the cause of low back pain (LBP) in the patients with lumbar disc herniation. The herniated disc has long been thought to be an important cause of the patient's complaint about LBP and sciatica. Whether the adjacent degenerative disc results in LBP needs further confirmations. OBJECTIVE: This study sought to determine whether the degenerative disc adjacent to the herniated disc in patients with LBP and radicular pain can result in discogenic LBP, as assessed by provocative discography, and to report the outcomes of the residual LBP when adjacent symptomatic disc were treated with methylene blue after microendoscopic discectomy. METHODS: Twenty lumbar disc herniation patients complaint about LBP and radicular pain underwent provocative discography. There was one degenerative herniated disc with one or more adjacent degenerative discs in their MRI. Provocative discography was performed on all degenerative discs and at least one normal disc for control. The severity of LBP and leg pain of all patients was assessed using visual analog scale before discography. All patients underwent microendoscopic discectomy at herniated level, and intradiscal injection of methylene blue was given at painful adjacent level in five patients after microendoscopic discectomy. RESULTS AND CONCLUSION: Discographies were performed on 64 discs of 20 patients, from L2-3 to L5-S1. There were 11 discs satisfying the positive response criteria, including 6 in degenerative segment adjacent to the herniated disc and 5 in the herniated disc that induced corresponding radiculopathy. The leg pains were evidently improved in all patients, while LBP was partially improved after microendoscopic discectomy. Six patients with symptomatic adjacent degenerative disc still had evident LBP, influencing their daily living. Five of them received intradiscal injection of methylene blue treatment and the LBP was relived. One patient refusing to the treatment still complained the LBP. Results evidenced that accompanying LBP for many LDH patients may come from the degenerative levels adjacent to the herniated disc.