• 대한방사선기술학회지:방사선기술과학
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• 제44권6호
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• pp.623-627
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• 2021

Cervical foraminal stenosis is a disease in which the nerves that pass from the spinal canal to the limbs are narrowed and the nerves are compressed or damaged. Due to the lack of an imaging method that provides quantitatively stenosis, this study attempted to evaluate the area of the cervical vertebrae by reconstructing a three-dimensional computed tomography image, and to determine the area of the neural foramen in normal adults to calculate the stenosis rate. Using a three-dimensional image processing program, the surrounding bones including the posterior spinous process, lateral process, and lamellar bones of the cervical vertebra were removed so that the neural foramen could be observed well. A region of interest including the neural foraminal area of the three-dimensional image was set using ImageJ, and the number of pixels in the neural foraminal area was measured. The neural foraminal area was calculated by multiplying the number of measured pixels by the pixel size. To measure the largest neural foraminal area, it was measured between 40~50 degrees in the opposite direction and 15~20 degrees toward the head. The average area of the right C2-3 foramen was 44.32 mm², C3-4 area was 34.69 mm², C4-5 area was 36.41 mm², C5-6 area was 35.22 mm², C6-7 area was 36.03 mm². The average area of the left C2-3 foramen was 42.71 mm², C3-4 area was 32.23 mm², C5-6 area was 34.56 mm², and C6-7 area was 31.89 mm². By creating a reference table based on the neural foramen area of normal adults, the stenosis rate of patients with neural foraminal stenosis could be quantitatively calculated. It is expected that this method can be used as basic data for the diagnosis of cervical vertebral foraminal stenosis.

• Korean Journal of Radiology
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• 제24권3호
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• pp.224-234
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• 2023

Magnetic resonance imaging (MRI) is a standard imaging modality for diagnosing spinal stenosis, which is a common degenerative disorder in the elderly population. Standardized interpretation of spinal MRI for diagnosing and grading the severity of spinal stenosis is necessary to ensure correct communication with clinicians and to conduct clinical research. In this review, we revisit the Lee grading system for central canal and neural foraminal stenosis of the cervical and lumbar spine, which are based on the pathophysiology and radiologic findings of spinal stenosis.

• 한국방사선학회논문지
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• 제14권7호
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• pp.975-980
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• 2020

경추 신경공 협착은 모든 연령대의 비교적 많은 수의 사람들에게 침범하는 매우 흔한 척추 질환이다. 그러나 신경공 협착을 정량적으로 제공하는 영상검사법이 부족하므로, 본 연구는 3차원 전산화단층촬영상을 재구성하여 정량적인 측정방법을 제시하고자 한다. 3차원 영상처리 프로그램을 이용하여 경추의 후극돌기와 측돌기, 층뼈를 포함하여 신경공이 잘 관찰되도록 주변 뼈를 제거하였다. Image J를 이용하여 3차원 영상의 신경공 면적을 포함하는 관심영역을 설정하고, 신경공 면적의 화소수를 측정하였다. 측정 화소수에 화소크기를 곱하여 신경공 면적을 산출하였다. 가장 넓은 신경공 면적을 측정하기 위하여 측정 반대쪽 방향으로 40~50도 사이와, 머리쪽으로 15~20도 사이에서 측정하였다. 측정한 경추 신경공의 면적은 일관된 측정값을 보였다. 가장 크게 측정한 우측 신경공 C5-6 면적은 12.21 ㎟에서, 2년 후에 9.95 ㎟으로 18% 협착이 진행된 것을 알 수 있었다. 기존에 CT 검사 영상을 이용하여 3차원 재구성하므로 추가적인 방사선 피폭을 받지 않으며 신경공 협착 면적을 객관적으로 제시할 수 있다. 또한 3차원 영상을 보면서 신경공 협착 환자에게 설명하기 좋으며, 협착의 진행정도와 수술 후 평가에서도 사용하기 좋은 방법이라 사료된다.

• Journal of Korean Neurosurgical Society
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• 제41권6호
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• pp.377-381
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• 2007

Objective : The aim of this study was to evaluate the morphometric changes in neuroforamen in grade I isthmic spondylolisthesis by anterior lumbar interbody fusion [ALIF]. Methods : Fourteen patients with grade I isthmic spondylolisthesis who underwent single level ALIF with percutaneous pedicle screw fixation were enrolled. All patients underwent standing lateral radiography and magnetic resonance imaging [MRI] before surgery and at 1 week after surgery. For quantitative analysis, the foraminal height, width, epidural foraminal height, epidural foraminal width, and epidural foraminal area were evaluated at the mid-portion of 28 foramens using T2-weighted sagittal MRI. For qualitative analysis, degree of neural compression in mid-portion of 28 foramens was classified into 4 grades using T2-weighted sagittal MRI. Clinical outcomes were assessed using Visual Analogue Sale [VAS] scores for leg pain and Oswestry disability index before surgery and at 1 year after surgery. Results : The affected levels were L4-5 in 10 cases and L5-S1 in 4. The mean foraminal height was increased [p<0.001], and the mean foraminal width was decreased [p=0.014] significantly after surgery. The mean epidural foraminal height [p<0.001], epidural foraminal width [p<0.001], and epidural foraminal area [p<0.001] showed a significant increase after surgery. The mean grade for neural compression was decreased significantly after surgery [p<0.001]. VAS scores for leg pain [p=0.001] and Oswestry disability index [p=0.001] was decreased significantly at one year after surgery. Conclusion : Foraminal stenosis in grade I isthmic spondylolisthesis may effectively decompressed by ALIF with percutaneous pedicle screw fixation.

• 한국방사선학회논문지
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• 제16권7호
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• pp.919-925
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• 2022

본 연구는 경추 CT 검사 후에 영상을 재구성하는 방법으로, 사위 관상면(oblique coronal) 재구성 각도에 따라서 신경공 골성 협착을 가장 잘 표현할 수 있는 재구성 각도를 제시하고자 한다. 경추의 정중시상면과 구추관절에서 척수 중심을 지나는 선을 그어 만들어지는 각도를 측정하였다. 신경공에서 척수 중심을 지나는 선을 그어, 정중시상면과 이루는 각도를 측정하여 비교하였다. 경추 4-5 레벨에서는 평균 9.2°, 경추 5-6 레벨에서는 평균 9.9°, 경추 6-7 레벨에서는 평균 8.4° 로 구추관절각보다 돌기사이관절각이 크게 측정되었으며, 통계적으로 평균에 유의한 차이가 있었다(p<0.01). 또한, 하부 경추로 갈수록 각도가 증가하는 것을 알수 있었다. 하부 경추(C5-6, C6-7)의 신경공과 척수 중심이 이루는 각은 55~60° 사이이며, 여기에 90°가 되도록 사위 관상면 영상을 재구성하면 신경공협착 정도가 잘 관찰된다. 기존 CT 스캔 영상을 이용한 재구성 영상이므로 추가적인 방사선 피폭을 받지 않으면서, 경추 신경공 골성 협착을 진단하는데 큰 의의가 있다.

• Journal of Korean Neurosurgical Society
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• 제65권1호
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• pp.74-83
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• 2022

Objective : Oblique lumbar interbody fusion (OLIF) is a surgical technique that utilizes a large interbody cage to indirectly decompress neural elements. The position of the cage relative to the vertebral body could affect the degree of foraminal decompression. Previous studies determined the position of the cage using plain radiographs, with conflicting results regarding the influence of the position of the cage to the degree of neural foramen decompression. Because of the cage obliquity, computed tomography (CT) has better accuracy than plain radiograph for the measurement of the obliquely inserted cage. The objective of this study is to find the correlation between the position of the OLIF cage with the degree of indirect decompression of foraminal stenosis using CT and magnetic resonance imaging (MRI). Methods : We review imaging of 46 patients who underwent OLIF from L2-L5 for 68 levels. Segmental lordosis (SL) was measured in a plain radiograph. The positions of the cage were measured in CT. Spinal canal cross-sectional area (SCSA), and foraminal crosssectional area (FSCA) measurements using MRI were taken into consideration. Results : Patients' mean age was 69.7 years. SL increases 3.0±5.1 degrees. Significant increases in SCSA (33.3%), FCSA (43.7% on the left and 45.0% on the right foramen) were found (p<0.001). Multiple linear regression analysis shows putting the cage in the more posterior position correlated with more increase of FSCA and decreases SL correction. The position of the cage does not affect the degree of the central spinal canal decompression. Obliquity of the cage does not result in different degrees of foraminal decompression between right and left side neural foramen. Conclusion : Cage position near the posterior part of the vertebral body increases the decompression effect of the neural foramen while putting the cage in the more anterior position correlated with increases SL.

• Journal of Korean Neurosurgical Society
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• 제63권6호
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• pp.747-756
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• 2020

Objective : To evaluate the effectiveness and long-term outcome predictors of percutaneous sacroplasty (PSP). Methods : This single-center study assessed 40 patients with sacral insufficiency fractures using the short-axis technique under C-arm flat-panel detector computed tomography (CT). Two radiologists reviewed the patients' magnetic resonance and CT images to obtain imaging findings before PSP and determine technical success, respectively. The short-term outcomes were visual analog scale score changes and opioid usage reductions. Long-term outcomes were determined using telephone interviews and the North American Spine Society (NASS) patient-satisfaction index at least one year after PSP. Results : Technical success was achieved without any significant complications in 39 patients (97.5%). Telephone interviews were possible with 12 patients and failed in 10 patients; death was confirmed in 18 patients. Fifteen patients (50%) re-visited the hospital and received conservative treatment, including spinal injections. Nine patients reported positive satisfaction (NASS patient-satisfaction index 1 or 2), while the negative satisfaction group (NASS patient-satisfaction index 3 or 4, n=3) showed a higher incidence of compression fractures at the thoracolumbar spine level (66.7% vs. 22.2%) and previous spinal injection history (66.7% vs. 33.3%). The poor response group also showed higher incidences of facet joint arthrosis (100% vs. 55.6%), central canal stenosis (100% vs. 22.2%), neural foraminal stenosis (33.3% vs. 22.2%), scoliosis (100% vs. 33.3%), and sagittal malalignment (100% vs. 44.4%). Conclusion : PSP was effective for sacral insufficiency fractures and showed good long-term outcomes. Combined compression fractures in the thoracolumbar spine and degenerative lumbar pathologies could be possible poor outcome predictors.

• 대한영상의학회지
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• 제82권4호
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• pp.862-875
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• 2021

목적 요추신경근병증이 있는 60세 이상의 환자의 신경공 협착에 영향을 줄 수 있는 인자를 자기공명영상 평가를 통해 알아보고자 하였다. 대상과 방법 요추신경근병증이 있는 60세 이상의 환자 133명이 본원에서 시행 받은 2018년 1월부터 4월까지의 요추 자기공명영상을 대상으로 하였다. 제4/5 요추간과 제5 요추/제1 천추간에서 신경공 협착이 있는 군과 없는 군으로 나눈 후 척추전방전위증, 척추후방전위증, 추간판 간격 감소, 추간판탈출증, 중심성 척추관 협착, 황색인대비후, 척추후관절 비후 여부를 2명의 판독자가 분석한 후 단변량 및 다변량 로지스틱 회귀분석을 시행하였다. 결과 단변량 분석에서 제4/5 요추간에 대해 추간판 간격 감소(p = 0.006), 제5 요추/제1 천추간에 대해서는 척추전방전위증(p = 0.005)과 척추후관절 비후(p = 0.006)가 신경공 협착과 유의한 연관성을 보였다. 다변량 분석에서는 제4/5 요추간에 대해 추간판 간격 감소[odds ratio(이하 OR) = 4.272; 95% confidence interval (이하 CI) 1.736~10.514]가 신경공 협착과 관련된 인자였다. 제5 요추/제1 천추간에서는 척추전방전위증(OR = 3.696; 95% CI 1.297~10.530)과 척추후관절 비후(OR = 6.468; 95% CI 1.238~32.617)가 이와 관련된 인자였다. 결론 제4/5 요추간에서는 추간판 간격 감소가, 제5 요추/제1 천추간에서는 척추전방전위증과 척추후관절 비후가 신경공 협착과 관련된 인자였다.