後方侵入脊椎内視鏡視下手術の短期成績と問題点

Short-term Results and Technical Problems of Posterior Endoscopic Spinal Surgery

　後方侵入脊椎内視鏡視下手術（MED法）を施行した190例を対象に術後短期成績と問題点について検討した．腰椎椎間板ヘルニア89例，腰部脊柱管狭窄症92例，頚部神経根症・脊髄症9例であった．術後平均1.5年時のJOAスコアの平均改善率はそれぞれ82％，73％，79％であり，良好な成績が得られていた．術中・術後合併症を20例に認め導入初期例で多く発生したが，手技の向上および合併症対策により改善された．MED法は腰椎椎間板ヘルニアのみならず腰部脊柱管狭窄症や頚部神経根症・脊髄症にも応用可能な術式である．

　We applied the MED (microendoscopic discectomy) technique in the treatment of lumbar and cervical radiculopathy in 190 consecutive patients. There were 89 patients with lumbar disc herniation (LDH), 92 patients with lumbar spinal stenosis (LSS), and 9 patients with cervical radiculomyelopathy (CRM). The mean improvement rate in the JOA score was 82％ in LDH, 73％ in LSS, and 79％ in CRM at the mean of 1.5 years after surgery. Although several complications occurred in 20 patients, especially in the initial patients, the incidence of the complications decreased with the increase in the surgeon's experience and the applications of several policies. The indication of the MED technique could be expanded to LSS and CRM, and the surgical outcomes of the MED techniques were excellent.