経椎体前方除圧術を行った第2/3胸椎椎間板ヘルニアの1例

Transvertebral Discectomy for T2/3 Disc Herniation. Case Report

　経椎体前方除圧術を施行した第2/3胸椎椎間板ヘルニアの1例を経験した．症例は51歳の男性で，第2/3胸椎椎間板ヘルニアによる急速な排尿障害，歩行障害が出現した．手術は頚椎前方アプローチを下方に延長し，胸骨を縦割せず，T2椎体前上縁からT2/3椎間板脱出部に向かって経椎体アプローチによる前方除圧術を施行した．術後症状は改善し，独歩可能となった．本法は正中ヘルニアを前方，正面から除圧可能である前方進入の利点を有し，また胸骨柄縦割が不要であり，安全に，低侵襲に手術を行うことが可能であった．

　We conducted microscopic transvertebral discectomy for T2/3 disc herniation. Our case was a 51-year-old man with acute lower extremity paraparesis and bowel-bladder dysfunction due to spinal cord compression. After microscopic transvertebral discectomy without sternum splitting and satisfactory decompression, his symptoms were well relieved functionally. Several surgical approaches to upper thoracic spine have been reported because the approach especially T2/3 is difficult due to the anatomical structure. The transvertebral approach for cervical disc lesions is less invasive and safer than sternum splitting or a transthoracic or transpedicular approach.