척추관 협착증의 수술적 치료 = Surgical Treatment of Spinal Stenosis

국문 초록 (Abstract)

대부분의 척추관 협착증 환자에서 추궁판 전절제술을 하지 않고, 양측 후관절내측절제술로서 증상이 매우 호전되었으며, 감압술만 시행한 경우와 유합술을 병행한 경우를 비교할 때, 6개월 내지 수년의 단기적인 경과관찰에서 유합술을 병행한 군에서 결과가 더 좋았다. 그러나 확실한 결과는 좀 더 장기적인 경과관찰을 요한다고 사료된다. 감압술만 시행한 경우 수술시간이 적게 걸리고 출혈량도 적었으나, 불충분한 감압을 하여 결과가 좋지 않거나, 후관절증후군의 증상을 보인 경우가 상당히 있었다. 장기적인 결과를 보지 않았으므로 확실하지는 않지만 수술 후 6개월이상 수년사이의 경과관찰에서는 감압술만 한 경우보다, 감압술내고정술 및 유합술을 같이 한 경우가 좀 더 결과가 좋았으나 통계학적 의의는 없었다.

다국어 초록 (Multilingual Abstract)

Spinal stenosis is a fairly common low back disorder characterized by the narrowing spinal canal and compression of neural element with resultant leg pain and/or intermittent claudication. The usual cause of the spinal stenosis is the degenerative changes of the spine, so symptoms of this disease get worse as the patients get older. Our surgical indications include: 1) when the patient cannot walk more than 200-300 meters due to neurogenic intermittent claudication and/or 2) when the nerve root palsy is noted. From January 1996 to December 1998, there were 86 cases of spinal stenosis who underwent surgery. Of them, 9 cases were excluded due to loss of follow up or other causes, and 77cases were included in this study, who have been followed more than 6 months after surgery. Method of operation at first half of the series was bilateral laminotomy and medial facetectomy in most cases. But low back pain with buttock, thigh pain due to facet joint syndrome was common residual symptoms, so I added the procedure of posterior instrumentation and lateral fusion for decompression. We had analyzed symptoms and results of operation according to Kirkaldy-Willis' criteria. Of the 77 cases, results were graded as excellent or good in 69 cases(88.3%), and fair or poor in 9 cases(11.7%).
The result of decompression with instrumentation and fusion was better (91.7% Excellent or Good results) than that of decompression procedure only (82.8% Good or Excellent results). The problem in fusion group was the bone graft site pain. But this pain was self-limited in most cases or was controllable by medication or local steroid injection in some cases. Fusion was achieved in 72.7% of cases, which was interpreted by simple X-ray.