片側経腋下進入腰椎椎体間固定術―腰背筋を温存した低侵襲アプローチの試み

Unilateral Transaxillary Lumbar Interbody Fusion (UTaLIF). : A Minimally Invasive Approach that Avoids Extensive Dissection of the Paravertebral Muscles

　後方支持組織，特に傍脊柱筋，脊髄神経後枝内側枝を温存する目的で，片側の多裂筋，胸最長筋の間から進入する腰椎後方除圧，椎体間固定術を開発した．進入側にpedicle screw，対側に経椎弓椎間関節固定術，椎体間ケージを用いる手技で，片側経腋下進入腰椎椎体間固定術（UTaLIF）と命名した．本術式を施行した7例の平均改善率は64.8％で，腰痛，下肢痛のvisual analog scaleは2.2cm，1.0cmとそれぞれ改善し，比較的良好な短期成績であった．本術式は後方支持組織を温存した低侵襲脊椎固定手術の1つとなる可能性がある．

　We developed a new method of lumbar posterior decompression and interbody fusion through a unilateral approach between the multifidis and longissimus thoracis muscles that uses the Aperture Spinal Across System (DePuy Spine) to preserve lumbar posterior elements, including the paravertebral muscles and the medial branch of the posterior ramus of the spinal nerve. We call this method, which consists of lumbar interbody fusion with interbody cages, unilateral pedicle screw and translaminar facet screw through the aiming devise (Synthes) at the opposite side, unilateral transaxillary lumbar interbody fusion (UTaLIF). Seven patients have been treated with UTaLIF, and the mean follow-up period has been 6.1months. The mean recovery rate at follow-up was 64.8％, and the scores on the visual analog scales for low back pain and leg pain were 2.2 and 1.0cm, respectively. This is a new method of minimally invasive lumbar spinal fusion that enables the paravertebral muscles to be preserved.