경막외강 조영술을 이용한 요하지통의 진단

Abstract

Epidurogram is one of the diagnostic radiologic methods for the lower back and lower extremity pain. We have evaluated the diagnostic usefulness and the therapeutic effects of epidurogram comparing to other radiologic methods in 99 patients who had lumbosacral and/or lower extremity pain. Under the C-arm fluoroscopic view dexamethasone 5 mg mixed to 1% lidocaine(5∼6 ml) and the radio-opaque dye 10∼20 ml were injected through the 22 G block needle placed in the sacral epidural space. Immediately after the injection we checked the six view X-ray(A-P, both oblique, and flexion, extension or neutral lateral view). We compared the findings with those of plain X-ray, CT-scanning or MRI. We classified the diagnosis into intervertebral disc herniation(LDH), degenerative spondylosis, failed back syndrome, cancer pain and psychosomatic pain. Age, pain duration, radiating pain and straight leg rasing test were different from each other group, though they are not helpful to specify the diagnosis. The findings of epidurography showed us more information about the patient's pain than plain X-ray and the those of LDH were compatable to MRI findings. The therapeutic effects of dexamethasone and lidocaine were variable depending on the patient's group, though their duration of degenerative spondylosis were longest in five groups. There was one complication occurred by puncture of dural sac located at 4th sacral foramen level. We concluded that epidurography was a simple, safe, and less invasive radiologic diagnostic method with some therapeutic effects and pain clinician, as a non-radiologist, could perform and use the epidurogram as one of supportive methods to diagnose the lumbosacral and lower extremity pain.