추간판 내장증의 치료

Abstract

Internal disc derangement(IDD), first described by HV. Crock is characterized by chronic intractable low back pain with or without referred type limb pain and other symptoms. This condition has been a poorly understood and controversial subject for many years. But we think it is a relatively common disorder causing low back pain and/or limb pain which requires differential diagnosis with disc herniation, spinal stenosis, facet joint syndrome, segmental instability and so on. The conservative treatment of IDD is not so easy because the symptom of IDD usually tend to be chronic and resistant to common forms of treatment regimens. Of the various conservative measures for the treatment of IDD, the epidural steroid injection was the most effective followed by patient education, McKenzie exercise, or moist heat application. Other forms of treatment including traction, transcutaneous nerve stimulation, medications were not so effective. Of the 126 cases of clinically diagnosed IDD patients, 94 patients(80.1%) were controllable by conservative treatment. Of the other 32 patients who had a chronic intractable pain over 6 months, 16 patients(12.7%) required the surgical treatment. Before the surgical treatment we performed discogram and identified the symptomatic discs and the performed interbody fusion and posterior instrumentation for those symptomatic levels. Fusion was achieved in all cases and clinical results of the operative treatment were excellent(4), good(7), fair(3), and poor(2) by Neil's criteria. There were no postoperative infections, nonunions or metal failures.