Pedicle screw fixationを併用したPLIF施行例における術後脊髄造影所見の検討

Evaluations of Postoperative Myelograms after PLIF with Pedicle Screw Fixation

　腰椎変性疾患に対するPLIF（後方進入椎体間固定術）は除圧および脊柱支持性を再建できるが，神経組織への侵襲が危惧される．PLIF施行例のうち術前後脊髄造影を行った36例を用いて硬膜，神経根への影響を検討した．神経根像は，多彩な像を呈し癒着性変化と考えられる像も認めたが，臨床成績とは一致しなかった．硬膜管の広がりをCTM（脊髄造影および造影後CT）にて検討すると術後は有意に広がり，また馬尾の集束像などの硬膜内での癒着性変化を疑わせる所見も認められなかった．PS（pedicle screw）を併用したPLIFは，危惧された癒着もなく術後硬膜の広がりを得ることができた．

　PLIF with pedicle screws for lumbar degenerative disease can be used for simultaneous decompression and reconstruction of anterior support, but PLIF may cause dural sac and nerve root adhesions. To determine whether adhesions of nerve tissue were present after surgery, we reviewed the myelographic finding and CTM preoperatively and postoperatively. Adhesion of several nerve roots was noted postoperatively, but there was no relationship to the clinical results. However, the dural canals had expanded more than preoperatively. No adhesion of the cauda equina was noted in the postoperative CTM. If the surgical procedure is performed, atraumatially, PLIF may not cause adhesions of nerve tissue.