腰部脊柱管狭窄症に対する新しい低侵襲内視鏡下除圧術―病態に合わせて考案した3つの手術法

New Minimally Invasive Microendoscopic Decompression Surgery for Lumbar Spinal Canal Stenosis. : Three Approaches According to Pathology

　腰部脊柱管狭窄症に対する3つの新しい内視鏡下低侵襲除圧術の術式と短期成績を報告した．1．神経根型症状の外側型狭窄に対し，反対側から除圧する片側進入対側除圧術15例，2．混合型症状の中心型狭窄に対し，両側からそれぞれの対側を除圧する両側進入対側除圧術17例，3．馬尾型症状の強い中心型狭窄やすべりを伴う狭窄に対し，脊柱管の真上から除圧する棘突起間進入除圧術21例であった．短期成績は良好で，従来の片側進入両側除圧術では困難であった進入側の椎間関節の温存が可能なこれらの方法は，有用な低侵襲術式と考えた．

　We report three new microendoscopic decompression procedures for lumbar spinal canal stenosis and the short-term results of these procedures. Each of the operative procedures was developed with a specific pathology of spinal canal stenosis in mind.

　1．Unilateral approach for contralateral decompression, indicated for lateral-type spinal canal stenosis with nerve root compression：15 cases.

　2．Bilateral approach for contralateral decompression, indicated for central-type spinal canal stenosis with nerve root compression and cauda equina syndrome：17 cases.

　3．Midline interspinous interlaminar approach, indicated for severe central-type spinal canal stenosis or spondylolisthesis：21 cases.

　In patients with narrow vertebral arches, the use of a unilateral approach for bilateral decompression of the lumbar spinal canal is difficult to perform while preserving the facet joints on the approached side. Using our new procedures, we succeeded in decompressing the spinal canal without damaging the facet joints and obtained good clinical results. These new procedures are useful for minimally invasive surgery for lumbar spinal canal stenosis.