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Neurological Surgery No Shinkei Geka Volume 53, Issue 1 （January 2025）

Neurological Surgery 脳神経外科 53巻1号（2025年1月発行）

Japanese English

特集脳神経外科診療における脊椎脊髄外科—手術安全性・低侵襲性・根治性への挑戦と解決策

Ⅱ 腰椎椎間板ヘルニア・腰部脊柱管狭窄症・腰椎変性すべり症

腰椎後方除圧術—基本方針と外視鏡手術の利点・欠点 Posterior Decompression Surgery for Degenerative Lumbar Disease:Basic Principles and Advantages/Disadvantages of Exoscopic Surgery 乾敏彦 ¹ , 富永良子 ¹ , 富永紳介 ¹ Toshihiko INUI ¹ , Yoshiko TOMINAGA ¹ , Shinsuke TOMINAGA ¹ ¹社会医療法人寿会富永病院脳神経外科 ¹Department of Neurosurgery, Tominaga Hospital キーワード：腰椎変性疾患 , 低侵襲腰椎後方除圧 , 片側進入両側除圧術 , 対側進入椎間孔部除圧術 , 外視鏡 , degenerative lumbar disease , minimally invasive lumbar posterior decompression , unilateral approach for bilateral decompression , contralateral approach for foraminal decompression , exoscope Keyword: 腰椎変性疾患 , 低侵襲腰椎後方除圧 , 片側進入両側除圧術 , 対側進入椎間孔部除圧術 , 外視鏡 , degenerative lumbar disease , minimally invasive lumbar posterior decompression , unilateral approach for bilateral decompression , contralateral approach for foraminal decompression , exoscope pp.52-67

発行日 2025年1月10日 Published Date 2025/1/10

DOI https://doi.org/10.11477/mf.030126030530010052

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参考文献 Reference

Point

・後方除圧術の利点と適応：腰椎変性疾患において，適切に行われた低侵襲の後方除圧術は神経圧迫の解消と脊椎安定性の維持が可能である．

・腰椎不安定性例に対する後方除圧：腰椎変性疾患は自己限定性であり，変性カスケードの過程である不安定性も適切な後方除圧で，症状の増悪なく再安定化が期待できる．

・片側進入両側除圧術（UBD），両側進入対側除圧術（BCD）や対側進入椎間孔部除圧術（CFD）の手術成果：UBD，BCDや対側進入術であるCFDにより，不安定性を抑えつつ，椎間孔部の十分な除圧を実現し，良好な成績を得ている．

・4K 3D外視鏡の利点と将来性：4K 3D外視鏡は，優れた人間工学の下に，顕微鏡では難しい角度や方向からの視覚化が容易で，次世代の標準技術としての発展が期待されている．

＊本論文中、［Video］マークのある図につきましては、関連する動画を見ることができます（公開期間：2028年2月まで）。

　This paper examines advancements in minimally invasive posterior decompression techniques for lumbar degenerative diseases. It focuses on the unilateral approach for bilateral decompression and bilateral approach for contralateral decompression, in which the entry side is determined independently of the symptomatic side to achieve a facet joint preservation rate of ≥ 70%, while also emphasizing contralateral foraminal decompression（CFD）. These techniques address spinal instability by minimizing facet joint resection, reducing postoperative instability. CFD is noteworthy because it enables single-stage decompression in the same surgical field as foraminal stenosis, which frequently coexists with spinal canal stenosis. Additionally, this paper discusses the effectiveness of real-time 3D CT navigation in enhancing surgical precision, especially in complex cases, to improve long-term outcomes by minimizing postoperative instability. Furthermore, exoscopic surgery is evaluated as a future standard, highlighting its superior ergonomics and flexible viewing angles, including steep oblique angles, which are challenging with conventional microscopes. Although exoscopic technology offers many advantages, it also has certain drawbacks and remains in the developmental stage; however, it holds the potential to become a new paradigm in spinal surgery. Balancing minimally invasive approaches with spinal stability remains critical for optimizing patient recovery, reducing complications, and minimizing reliance on spinal fusion surgery.