腰痛의 最新 保存療法에 對한 臨床的 硏究

초록

Surgical procedures for discogenic low back pain have been widely performed for decades. The results, however, have not always been satisfactory due to recurrence, extensive scarring of the nerve roots following surgery or a prolonged period of rehabilitation even if the operation is successful. On the other hand, conventional conservative treatment does not always give good results, either. In this connection, new methods of conservative treatment have been sought by many investigators. There are two approaches to the non-surgical treatment, one aiming to eliminate the etiologic mechanism and the other to treat the secondary radiculopathy which results from the primary mechanism. One of the former approaches, e.g. chemonucleolysis has commanded considerable attention but has been abandoned recently due to its frequent complications. The latter approaches are infiltration of steroids combined with or without local anesthetics into the involved nerve root by means of either epidural, intrathecal or intervertebral nerve root injection. On the basis of the above facts the author has followed new forms of conservative treatment, e.g. by means of either intervertebral nerve root injection (60 patients) or epidural injection (40 patients). Of 60 patients with intervertebral nerve root injection there were good results in 41 patients (68.3%), fair in 8(13.3%) and poor in 11(18.4%). Of 40 patients with an epidural injection there were good results in 29 patients (72.5%), fair in 6(15%) and poor in 5(12.5%). Age, sex, duration of symptom, mode of onset and trauma did not significantly influence the end results in both groups. In the intervertebral nerve root injection group, patients with only low back pain, absence of limited back motion and a straight leg raising test result above 70° appear to have a better prognosis. In the epidural injection group, patients with only low back pain or sciatia, absence of limited back motion and a straight leg raising test result above 30° appear to have a better prognosis. With the intervertebral nerve root injection, good results were observed in 14 cases (82.3%) out of 17 with degenerative spondylosis, 21 cases (70%) out of 30 with degenerative disc, and 6 cases (46.2%) out of 13 with a herniated disc. With the epidural injection, good results were observed in 13 cases (86.6%) out of 15 patients with degenerative spondylosis, 12 cases (70.6%) out of 17 with degenerative disc, and 4 cases (50%) out of 8 with a herniated disc.

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