경추 방사통과 연관통의 병태생리 및 임상양상

Abstract

Cervical radicular pain and referred pain represent two distinct clinical syndromes commonly encountered in the context of cervical spine pathology. Cervical radicular pain is classified as a neuropathic condition, resulting from mechanical compression or chemical irritation of the dorsal root ganglion (DRG) or cervical spinal nerve root. Such irritation induces ectopic discharges in Aβ and C fibers, often mediated by inflammatory cytokines resulting in sharp, electric-like pain radiating into the upper extremity. Notably, this pain does not conform to a classic dermatomal pattern but more closely aligns with the segmental innervation of deep musculoskeletal structures. In contrast, cervical referred pain arises from non-neural deep somatic tissues such as intervertebral discs, zygapophysial joints, or cervical musculature. It is mediated by spinal convergence of somatic afferents onto shared dorsal horn neurons, often compounded by central sensitization and dichotomizing afferent fibers. These mechanisms lead to spatial mislocalization of pain, which is typically experienced as dull, diffuse, and poorly localized, without accompanying neurological deficits. Experimental and clinical studies demonstrate that nerve root compression alone does not provoke pain unless the DRG is involved, whereas stimulation of deep cervical structures can evoke widespread, non-dermatomal pain. Understanding the distinct pathophysiological basis of cervical radicular and referred pain is essential for accurate diagnosis, clinical differentiation and the implementation of mechanism-targeted treatment strategies in patients with neck pain.

경추 질환은 목과 어깨 및 상지 부위에 다양한 양상의 통증을 유발할 수 있으며, 이는 임상적으로 방사통(radicular pain)과 연관통(referred pain)으로 구분된다. 두 통증의 증상은 유사할 수 있으나, 병태생리과 해부학적 기원이 다르며, 이에 따라 진단과 치료적 접근도 구분된다. 경추 방사통은 후근 신경절(dorsal root ganglion) 또는 신경근의 기계적 자극이나 염증 반응에 의해 발생하는 신경병증성 통증으로, 비-피부 분절적 양상의 날카로운 통증이 특징이다. 반면, 연관통은 추간판, 관절, 근육 등 심부 체성 구조물의 자극에 의해 유발되며, 수렴-투사(convergence- projection) 등의 기전에 의해 광범위하고 둔한 통증이 나타난다. 이에 본 종설에서는 경추 질환에 의한 방사통과 연관통의 병태생리학적 차이와 통증 양상의 임상적 특징을 살펴보고, 진단적 감별에 유용한 근거를 고찰해 보고자 한다.