術中電気診断法に基づいた単椎間頚椎前方除圧固定術の中期成績―椎弓形成術との比較検討

Middle Term Outcomes of Intraoperative Electrodiagnosis Guided Single-Level Anterior Decompression : Fusion in Cervical Spondylotic Myelopathy Cases

　頚椎症性脊髄症113例に対して，前方圧迫が主要因の場合や，高齢である場合，脊柱管が中間位もしくは後弯を呈している場合には前方除圧固定術（n＝70）を，後方からの圧迫が主要因の場合や，壮年期症例，脊柱管狭窄を伴う場合，前弯例に対しては椎弓形成術（n＝43）を施行した．前方除圧固定術を行った患者のうち60症例では伝導ブロック所見から脊髄伝導障害は単椎間であると判断し，単椎間手術を行った．手術成績では単椎間前方除圧固定術を施行した群では椎弓形成術と同等以上の成績を得ることができた．

　The clinical features and surgical outcomes of 113 consecutive patients with cervical spondylotic myelopathy (CSM) were studied. Anterior decompression and spinal fusion surgery (ADF) were perfomed in 70 patients who had 1）cervical cord compression from the anterior side, 2）no significant canal stenosis, 3）a kyphotic or neutral spinal alignment, and 4）a relatively advanced age. Laminoplasty was performed in 43 patients who had 1）cervical cord compression from the posterior side, 2）cervical canal stenosis, and 3）lordosis. The spinal cord evoked potentials (SCEPs) were recorded intraoperatively using needle electrodes inserted into serial cervical intervertebral discs/interlamina spaces after caudal epidural or transcranial electrical stimulation. In 60 patients, single-level ADFs were applied after distinct spinal conduction blocks were detected using the recorded SCEPs. Although the severity of the clinical signs was similar in both the single-level ADF group and the laminoplasty group, the clinical outcome was better or similar in the single-level ADF group.