透析に伴う頚椎病変（頚髄症）に対する手術成績について

Surgical Treatment of Destructive Spondyloarthropathy in Cervical Spine Associated with Long-term Haemodialysis

　透析に伴う頚椎病変により頚髄症を来した慢性透析患者16名に対して，頚椎椎弓形成術15例，頚椎前方後方固定術1例を行った．JOAスコア，握力，10秒テストで評価した，手術成績は満足できるものであった．しかし，周術期合併症を5例（31％）に認め，うち1例は死亡した．生命予後については，経過観察期間中に9例（56％）が死亡し，頚椎術後の平均生存期間は3年11カ月であった．術後のDSA変化進行のために再手術を要した症例は1例（6％）であった．透析に伴う頚椎病変による頚髄症に対しては，初回手術としてインストゥルメンテーションを行わなくても，椎弓形成術のみで十分な意義があるものと考えた．

　We report the long-term surgical outcomes and survival rate of patients with cervical myelopathy receiving hemodialysis. Fifteen patients underwent a laminoplasty, and one patient underuent on anterior-posterior fusion. The surgical outcomes of the cervical myelopathy patients receiving hemodialysis were satisfactory. However, peri-operative complications were frequently encountered (31％), and the average survival period was only 3.9 years after surgery. Though progressive cervical destructive changes after surgery were observed in 54％ of the patients, only one patient developed recurrent myelopathy. Considering the high frequency of complications and the short survival period, laminoplasty without instrumentation should be indicated for patients with cervical myelopathy receiving long-term hemodialysis.