Journal of Korean Society of Spine Surgery (대한척추외과학회지)

Korean Society of Spine Surgery (대한척추외과학회)
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Clinical Outcome Based Cauda Equina Syndrome Scoring System for Prediction of Prognosis

임상 결과를 근거로한 마미 증후군 환자의 예후 평가 점수 체계

  • Yang, Jun-Young (Department of Orthopedic Surgery, Research Institute of Medical Science, Chungnam National University, School of Medicine) ;
  • Lee, June-Kyu (Department of Orthopedic Surgery, Research Institute of Medical Science, Chungnam National University, School of Medicine) ;
  • Song, Ho-Sup (Department of Orthopedic Surgery, Research Institute of Medical Science, Chungnam National University, School of Medicine) ;
  • Joo, Yong-Bum (Department of Orthopedic Surgery, Research Institute of Medical Science, Chungnam National University, School of Medicine) ;
  • Cha, Soo-Min (Department of Orthopedic Surgery, Research Institute of Medical Science, Chungnam National University, School of Medicine)
  • 양준영 (충남대학교 의학전문대학원 정형외과학교실) ;
  • 이준규 (충남대학교 의학전문대학원 정형외과학교실) ;
  • 송호섭 (충남대학교 의학전문대학원 정형외과학교실) ;
  • 주용범 (충남대학교 의학전문대학원 정형외과학교실) ;
  • 차수민 (충남대학교 의학전문대학원 정형외과학교실)
  • Published : 2011.06.30
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Abstract

Study Design: This is a retrospective study. Objectives: We made a scoring system using the symptoms of cauda equina syndrome(CES) and we studied the efficacy of the scoring system. Summary of the Literature Review: There has been no definite scoring system with clear factors that can predict the clinical results of cauda equine syndrome. Materials and Methods: Between 1998 and 2006, 21 patients who were diagnosed with CES and who were followed for more than 2 years were enrolled in this study. There were 6 cases of HIVD, 6 cases of degenerative spondylosis, 7 cases of vertebral fracture and 2 cases of metastatic spinal tumor. We made a scoring system for CES (SSCES) using 8 symptoms among the general clinical manifestations that accompany CES, which are low back pain, sciatic neuropathy, sensory and motor disorder of the lower extremities, loss of a saddle sensation, voiding difficulty, disorder of the anal sphincter tone and deep tendon reflex disorder. Results: The last clinical outcomes were 3 excellent patients, 5 good patients, 5 fair patients and 8 poor patients. The mean preoperative SSCES was $11.7{\pm}2.8$(7-16) and the mean final follow up score was $7.6{\pm}3.4$(2-13). Eight cases that had a mean preoperative SSCES score of 6 or below showed good clinical results with a mean SSCES of $3.9{\pm}11$(2-5) on the final follow up, and 13 cases with a mean preoperative SSCES score of 7 or above showed bad clinical results with a mean SSCES of $9.9{\pm}1.9$(7-13) on the final follow up. Conclusions: The prognosis was better on the final follow up for the patients with a lowere preoperative SSCES. So, for the treatment of CES, preoperative evaluation using the SSCES is thought to be very useful for predicting the prognosis.

연구 계획: 후향적 연구. 목적: 마미 증후군의 임상증상을 이용한 평가 점수 체계를 만들고 예후 예측에 대한 유용성을 평가하였다. 선행문헌의 요약: 마미 증후군의 임상 결과를 예측할 만한 명확한 인자들에 대한 적절한 평가 점수 체계는 현재까지 알려져 있지 않다. 대상 및 방법: 1998년부터 2006년까지 마미 증후군으로 진단받고 2년 이상 추시가 가능하였던 21예를 대상으로 하였고, 추간판 탈출증 6예, 퇴행성 척추병변 6예, 척추골절 7예, 전이성 척추종양 2예였다. 일반적으로 마미 증후군에 동반되는 임상 증상 중 요통, 좌골 신경통, 하지감각장애, 하지운동 장애, 안장감각 소실, 배뇨장애, 항문 괄약근 수축력장애, 심부건반사장애를 이용하여 8가지로 평가 점수 체계를 만들었다(Scoring System for Cauda Equina Syndrome (SSCES)). 결과: 최종 추시결과 우수 3예, 양호 5예, 보통 5예, 불량 8예였다. 마미 증후군의 술전 점수는 평균 $11.7{\pm}2.8$점(7-16점)이었고, 최종 추시상 점수는 평 균 $7.6{\pm}3.4$점(2-13점)이었다. 술전 SSCES 점수가 6점 이하인 8예는 최종 추시상 점수는 평균 $3.9 {\pm}11$점(2-5점)으로 임상결과가 양호하였으며 술전 SSCES 점수가 7점 이상인 13예는 최종 추시상 점수가 평균 $9.9 {\pm}1.9$점(7-13점)으로 임상결과가 나쁜 경향을 보였다. 결론: 술전 환자의 SSCES가 낮을수록 최종 추시상 좋은 예후를 보이는 것을 확인할 수 있었다. 그러므로 마미 증후군 환자의 치료에 있어서 SSCES를 이용한 술전 평가는 환자의 예후를 예측하는데 있어서 매우 유용한 것으로 사료된다.

Keywords

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