胸腔鏡を使用した胸椎脊髄症に対する脊髄前方除圧術

Thoracoscopic Anterior Spinal Cord Decompression for Thoracic Myelopathy

　胸椎脊髄症に対する脊髄前方除圧に胸腔鏡を応用した．対象は18例（男性7例，女性11例，平均57.3歳）で術前診断は椎間板ヘルニア8例，骨粗鬆症による遅発性脊髄症8例，後縦靱帯骨化症3例，術後観察期間は平均45.4カ月であった．平均手術時間5.1時間，平均出血量672gで，JOAスコア改善率は平均46.1％であった．合併症は硬膜損傷1例，一過性肋間神経痛1例，表層皮膚感染1例があった．胸腔鏡手術は新しい技術で手技的に高度な反面，胸壁や横隔膜切開が不要で術後の創部痛や呼吸抑制が少ない利点があった．

　The thoracoscopic technique was applied for the decompression of thoracic myelopathy. Eighteen patients (7 males and 11 females, average age 57.3 y.o.) underwent this surgery. The mean postoperative follow-up was 45.4 months. Diagnosis included disc herniation, osteoporotic pseudarthrosis, and OPLL. The mean operation time and E. B. L. were 5.1 hours and 672 gm, respectively. The mean JOA score recovery ratio was 46.1％. Complications consisted of dural tear in 1, temporary intercostal neuralgia in 1, and superficial skin infection in 1 case. There have been few reports of thoracoscopic corpectomy and spinal cord decompression in the literature. Although this new strategy is technically demanding, thoracotomy as well as sectioning of the diaphragm both of which are associated with postoperative severe chest pain and respiratory suppression, could be avoided.