頚椎laminoplasty術後の軸性疼痛

Axial Symptoms after Cervical Laminoplasty

　頚椎椎弓形成術後に生じる軸性疼痛予防策として，C2棘突起に付着する頚半棘筋を딵離しないこと，そのためにはC3は椎弓切除としても良いこと，C7棘突起に付着する僧帽筋および小菱形筋を딵離しないこと，C3から6の4椎弓形成術でも頚髄症は再発しないこと，いわゆる白石法は有用であるが慣れも必要なこと，などが報告された．また，術前から存在する軸性疼痛は術後も残存しやすく，必ずしも手術に起因するものばかりではないことも指摘された．

　手術侵襲の低減が軸性疼痛の予防に有用である可能性が示され，今後多くの施設での実施および検討が期待される．

　Although cervical laminoplasty is the most popular method of surgery for cervical compressive myelopathy, postoperative axial symptoms, such as nuchal pain or shoulder stiffness, have still not been overcome completely. In this symposium we mainly discussed whether new types of laminoplasty are effective in preventing postoperative axial symptoms. Preservation of the C2 or C7 spinous process without stripping off the attached muscles reduced the rate of postoperative axial symptoms to 10％ or less. Conflicting results were reported by two hospitals in regard to the so-called Shiraishi method, skip laminoplasty, or selective laminoplasty which may mean that certain skills are needed to perform them.

　Althogh less invasive methods of laminoplasty might be more effective in preventing postoperative axial symptoms, a further discussion is needed to prevent it completely.