경피적 내시경 디스크 제거술시에 나타나는 뒷목통증과 경부 경막외강압과의 관계에 대한 관찰
- 주제(키워드) cervical epidural pressure , ICP , neck pain , percutaneous endoscopic lumbar discectomy
- 발행기관 고려대학교 대학원
- 지도교수 장성호
- 발행년도 2008
- 제출일 2008-7-4
- 학위수여년월 2008. 8
- 학위명 석사
- 학과 일반대학원 의학과
- 세부전공 마취통증의학
- 원문페이지 26 p
- 본문언어 한국어
- 제출원본 000045501028
초록/요약
Background: Percutaneous endoscopic lumbar discectomy (PELD) is becoming a very popular tool for the treatment of low back diseases for its advantage over open lumbar surgery. Occasionally patients complain posterior neck pain during PELD, and due to the massive irrigation with normal saline during the procedure, the possibility of increased ICP as the cause is quite strong. By monitoring cervical epidural pressure changes throughout the procedure, the author investigated the effect of PELD on cervical epidural pressure and the correlationship between neck pain and increased cervical epidural pressure. Methods: Twenty-eight patients undergoing PELD with ASA physical status 1 or 2 were enrolled in this study. In each patient, a cervical epidural catheter was placed at C6-7 level before the procedure and was connected to a pressure transducer. Cervical epidural pressures were monitored continuously throughout the procedure. Baseline epidural pressure (EP), EP at the time of neck pain, maximal EP during the procedure, and EP at the end of the procedure were checked. The onset time of neck pain from the beginning of irrigation and total irrigation time were also recorded. Results: Out of 28 patients, 8 patients complained of neck pain. Neck pain onset time from the beginning of irrigation was 35.6 ± 11.3 (mean ± SD) minutes. The EP at the time of neck pain (52.9 ± 9.2 mmHg) was significantly higher than the maximal EP in patients without neck pain (34.8 ± 14.7 mmHg). The maximal EP in those with neck pain (73.6 ± 25.8 mmHg) was also significantly higher than the maximal EP in those without neck pain (34.8 ± 14.7 mmHg). In the correlationship study, patients with higher maximal EP had higher probabilities of neck pain. In 6 out of 8 patients, an abrupt increase in EP was observed after the onset of neck pain, while in the other 2 patients, the procedure ended just after neck pain appeared. Conclusions: Neck pain during PELD is a symptom of increased cervical epidural pressure and thus might be of increased intracranial pressure.
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