頚椎後縦靱帯骨化症患者の特定疾患申請に関する実態調査

Fact-finding Survey in Relation to Applications Special Disease for Patients with Ossification of the Posterior Longitudinal Ligament

　頚椎後縦靱帯骨化症の手術適応は診療科の違いにより必ずしも統一したものではない．特に最近，症状が発現する以前に予防的手術を行う施設もある．本論文では鹿児島県における頚椎後縦靱帯骨化症の診療科別による申請状況の実態を知る目的で平成14年（2002）度の特定疾患申請のための調査表を検討した．対象は84名であり，年齢は49～73歳，平均59.4歳であった．骨化型は分節型31名，連続型29名，混合型24名であった．診療科別では整形外科が61名と最も多く，脳神経外科が17名，神経内科が5名，その他が1名であった．重症認定が20例であったが，その85％は整形外科からの申請であった．また，整形外科以外の診療科では分節型骨化の症例が多かった．今回の調査により，整形外科からの申請に比べ脳神経外科からの申請患者は軽症である傾向があることがわかった．手術適応の違いによる差である可能性もある．

　The criteria used to determine the indications for surgery in patients with ossification of posterior longitudinal ligament of the cervical spine (OPLL) are not always the same in all departments, and at some hospitals prophylactic surgery has recently been selected for patients with mild neurological symptoms. This paper reports the results of our review of the assessment forms attached to applications for official registration of OPLL cases filed during 2002 in Kagoshima Prefecture under the specific-disease registration system as a means of comparing application practices departments. The subjects of this study consisted of 84 patients with OPLL. Their mean age was 59.4 years (range：49-73 years). The disease was the segmental type in 31 cases, the continuous type in 29 cases and the mixed type in 24 cases. The department that managed the patient was the orthopaedic surgery department in 61 cases, neurosurgery department in 17 cases, neurology department in 5 cases, and unspecified in 1 case. An application for registration as severe OPLL was the field in 20 cases, and 85％ of them were field by the department of orthopaedic surgery. The percentage of segmental type OPLL cases was higher in the department of neurosurgery than the other departments. This study revealed that the patients with OPLL managed in departments of neurosurgery tended to be diagnosed as having milder by the attending physician than patients managed in department of orthopaedic surgery. This difference may represnt an inter-departmental difference in the criteria used to determine the indications for surgery for OPLL patients.