後方進入脊椎内視鏡視下手術の適応と臨床成績―315例の検討

Indications and Clinical Outcome of Posterior Endoscopic Surgery for Lumbar and Cervical Radiculopathy

　抄録：後方進入内視鏡視下手術（MED法）を施行した315症例を対象として，術後追跡調査期間は平均2.5年で手術成績，安全性を評価し，その適応と問題点を検討した．男性211例，女性104例，平均年齢39.3±16.4歳であった．疾患の内訳は腰椎椎間板ヘルニア246例，椎体後方終板障害15例，腰部脊柱管狭窄症44例，腰椎囊腫病変2例，頚椎神経根症8例であった．手術成績（JOAスコア）は腰椎疾患の平均が術前13.5から術後27.1，頚椎神経根症が術前9.1から術後17.8と良好に改善した．合併症は12例（3.8％）で硬膜損傷3例，部位の誤認3例，術後血腫による悪化3例，化膿性脊椎炎1例，一過性の筋力低下2例であった．再手術が7例（1.5％）に行われた．MED法は腰椎椎間板ヘルニアのみならず，後方除圧手術として適応可能であり，手術手技に熟練すれば安全で良好な成績が期待できる．

　Posterior endoscopic surgery by microendscopic discectomy (MED) was used to treat lumbar and cervical radiculopathy in 315 consecutive patients. The mean postoperative follow-up period was 2.5 years. There were 211men and 104 women, and the patient's average age was 39.3±16.4 years. There were 246 cases of lumbar disc herniation, 15 cases of posterior endoplate lesions, 44 cases of lumbar canal stenosis, 2 cases of lumbar spinal cyst, and 8 cases of cervical radiculopathy. The surgical outcome was an improvement in JOA score for lumbar radiculopathy from 13.5 preoperatively to 27.1 postoperatively, and for 9.1 preoperatively to 17.8 postoperatively for cervical radiculpathy. Complications occurred in 12 cases (3.8％)：dural tears in 3 cases, mistaken operative site in, in 3 cases, postoperative hematoma in 3 cases, osteomyelitis in 1 case, and transient motor weakness in 2 cases. The reoperation rate was 1.5％ (7 cases). The surgical outcome of MED was excellent, and it is indicated not only for lumbar disc herniation, but for posterior decompression surgery as well.