腰部脊柱管狭窄症に対する直視下片側進入両側除圧術

Bilateral Decompression through a Unilateral Approach in Lumbar Spinal Canal Stenosis

　混合型腰部脊柱管狭窄症に対する片側進入両側除圧術を直視下に行い，その成績を評価した．24例を対象とし，原則として症状の優位側から進入し，全46椎間に除圧を行った．術中所見，術後のCTから，全椎間で反対側神経根の除圧が可能であった．他施設で両側開窓術が行われた16例を比較対象として成績を比べると，手術時間，出血量，術前術後JOAスコア，改善率などにおいて有意な差を認めなかった．脊柱の後方支持組織，ならびに反対側の傍脊柱筋を温存しうる本術式は開窓術に比べてより低侵襲と考えられた．

　In decompression surgery for lumbar canal stenosis, we conducted bilateral decompression through a unilateral approach without using microscopy or endoscopy. We analyzed 24 consecutive patients undergoing the procedure prospectively and compared results to these in 16 undergoing bilateral decompression with a bilateral approach during the same period. The JOA score improved statistically in both groups postoperatively. No statistical difference was seen between groups in operating time, intraoperative bleeding, pre-and postoperative JOA score, or recovery rate. The procedure appears to be less invasive because the supra-/interspinous ligament complex and contralateral musculature are preserved.