좌골신경통에서 진단 및 치료를 위한 요추 신경근 주사의 효과

Abstract

Clinical evaluation and imaging studies such as magnetic resonance imaging, computed tomography, and/or myelography can localize the pathologic process in most patients with lumbar radiculopathy. However, these studies occasionally fail to demonstrate exactly the cause and site for ongoing radicular symptom. So we evaluated 54 patients for the efficacy of selective nerve root blocks to identify a symptomatic nerve. The lumbar nerve root injections were performed at L3 root in 1 patients, at L4 root in 4 patients, at L5 root in 46 patients, and at S1 root in 3 patients. Among them, forty two patients were done before operation(HNP 32, stenosis 5, spondylolisthesis 5), 9 patients were done after operation due to poor results（root injury 2, infection 2, adhesion 1, incorrect diagnosis 4）, and 3 patients had improved radiculopathies following nerve root injection(HNP 2, stenosis 1). The results of the nerve root injections and of the operations were not affected by age and sex. There was a good correlation between the response of the nerve root injection and the result of the operation(p<0.05). The concentration of bupivacaine 0.5% has no additional effect comparing to 0.25%(70%/73.5%) solution in spite of its adverse effect causing transient motor weakness. Additional use of depomedrol(50mg) proved to be no more beneficial. Three patients had Improved symptoms for a long period after nerve root injection which consequently made operation unnecessary. Five patients with previous history of operations had moderate pain relief. In summary, lumbar nerve root injection can be used as a functional diagnostic tool to predict operative result and as a treatment modality following failure of a previous surgery.

저자들은 1995년 11월부터 1996년 8월까지 54명을 대상으로 요추 신경근 주사요법을 실시한 후 그 결과를 분석하였다. 신경근 주사요법은 신경학적 진찰소견과 방사선학적 진단으로 정확한 진단이 힘들 경우 특히 과거에 수술한 경우나 여러 부위에 병변을 나타내고, 이때 증상을 나타내는 부위와 증상을 나타내지 않는 부위와의 감별이 쉽지 않을 경우에 증상을 유발하는 정확한 신경근을 찾음으로 해서 수술 결과를 향상시키는 진단적 가치가 있다. 또한 수술 후 발생한 통증으로 여러 가지 통증치료에서 증상 호전을 얻을 수 없던 환자의 경우 고식적 치료의 한 방법으로서도 가능성이 있었다.