Cervical Spondylosisによる椎骨・脳底動脈循環不全症の手術に関する研究

Surgical Treatment of the Vertebral Artery Insufficiency due to Cervical Spondylosis:Uncectomy, unroofing of the transverse foramina and periarterial denervation

I．緒言

　1966年，第7回日本神経学会総会シンポジウム《Cervical Spondylosisと神経症状》において，著者は，Cervical Spondylosisによる神経症状はつぎの3つに大別しうることを報告した^1）。すなわち

（1） cervical radiculopathy

A new surgical technique of vertebro-basilar insuf-ficiency due to narrowing and kinking of the ver-tebral artery by compression of cervical spondylosis was presented. This consists of the three procedures, metioned below.

1) Uncectomy ;-Through the anterior approach, uncal osteophyte, fibrocartilaginous mass and part of uncal portion of the vertebral body are removed by either electric drill or Hohl's air drill. Section-ing or partial removal of the longus colli muscle greatly facilitate to obtain good exposure of the uncal osteophyte and the transverse process.

2) Unroofing of the transverse foramina ;-Follow-ing subperiosteal exposure of the transverse pro-cess, transverse forminae are un-roofed by removal of anterior portion of the transverse process. Two foramina of the transvere processes above and below the site of the osteophyte are un-roofed so that the vertebral artery is freed from its com-promised bony canal.

3) Perivascular denervation ;-The vertebral artery is then decompressed, although a crease remained in its adventitia with constriction by perivascular fibrosis where the compression had been most severe. The fibrosis is dissected away and peri-vascular denervation of this area is accomplished.

Twenty cases were operated on by this method from March 1967 to March 1969 with satisfactony end results.