脊髄鏡

MYELOSCOPY

I．はじめに

　生体内部を直視下に観察することは疾患の診断確立のためにもつとも有力な補助手段の1つである。いろいろな体腔の観察はすでに臨床医学の各分野で広く行われているがわれわれは1966年来腰痛疾患の診断と治療に役立てるべく脊髄鏡myeloscopeを開発し研究して来た。症例数も増加しその手技の安全性，今後の問題点などについても見通しが立つようになつたので若干の討論を試みたい^4〜9）。

Clinical experiences with myeloscopy werepresented and discussed. Since Ooi's independentobservation of the intrathecal space by the endo-scope in 1967, we have been using (at the low backpain clinic), the intrathecal lumbar endoscope andwe are certain that this will be become the es-tablished method for diagnosis of low back painsyndrome.

In spite of many methods that have been usedto establish diagnosis of low back pain syndrome,none of them have been able to detail the lesionsdirectly. Our method makes it possible to observedirectly the subarachnoid space as well as the extra-dural space. In this report, we are presenting 107cases of patients who suffered from low back painand who underwent myeloscopic examinations fromApril 1967 through August 1975.

The examinations have been done on 107 caseswith no deleterious side effects. The cauda equinaecould be seen as well as their accompanying bloodvessels and the blood flow itself.

The endoscope which we used initially had a5.6mm outer diameter. Our current myeloscopeis 2.8mm in diameter, then progressed into 1.9mm. (Machida Medical Instrument Company)Watanabe's No. 25 type arthroscope (Shinko MedicalInstrument Company) is another very good endo-scope for observation of intrathecal space. Actually,we modified it and have been using recently withgreat success.

It is now quite easy to see the arachnoidmembrane, the underlying cauda equinae and theiraccompanying blood vessels. We are presentlydeveloping a flexible myeloscope which is lessdangerous, potentially capable of going up or downthe spinal canal.

By use of the mycloscope it is possible to observemany structures around lumbar region. Headacheis not an uncommon complication in this procedure.2/3 cases out of 107 suffered from this but in allcases it did not last long.

The myeloscope, therefore, is definitely helpfulin the diagnosis of low back pain as well as inclinical research in the study of blood flow andcerebrospinal fluid in the subarachnoid spece. Wealso believe that the treatment of low back painwithout open surgery may be expected throughthe myeloscopy in near future.