18歳以下の腰椎椎間板ヘルニア手術例の検討

Lumbar Intervertebral Disc Herniation Less Than 18 Years of Age

　18歳以下の腰椎椎間板ヘルニア手術例は，当科本手術例全体の2.3％に相当する10例（男6，女4）であった．BMI 25以上の肥満症例を5例（50％）に認め，誘因としてスポーツが4例（40％）で関与していた．MRI撮像6例中，4例（66.7％）で当該椎間板以外の変性を，CTでは椎間関節非対称性を4例（40％）に認めた．臨床像は下肢伸展挙上テスト（SLR），腰痛の障害度に著しい特徴があった．ヘルニアは被膜下脱出が9例（90％）を占め，apophysis解離は3例（30％）に上った．手術よる改善率（平林法）は83.1％と良好であった．

　We analyzed 10 cases (2.3％) of lumbar disc hernia treated surgically in patients under 18 years old. Five patients (50％) were obese and had a body mass index (BMI) over 25. In four cases (40％) symptoms were induced by sports activity. MRI revealed all of the disc except the herniated disc as low intensity in 66.7％ of the cases. CT examinations revealed an asymmetrical facet joint in 40％ of the cases. Straight leg raising and low back pain were the most prominent finding and symptom judging from the JOA scores. The disc herniation was the contained type in 90％ of the cases. Dissociated ring apophysis was present in 30％ of the cases. All patients recovered well clinically. A good recovery rate (Hirabayashi) of 83.1％ was obtained.