圧迫性頚髄症に対する4椎弓形成術の試み

Prospective Trial of C3-6 Laminoplasty for Multisegmental Cord Compression

　抄録：現在まで圧迫性頚髄症に対する椎弓形成術の至適除圧範囲に関する検討はなされていない．今回われわれは，本症に対してprospectiveにC3～6の形成術を行い（4椎弓群，n＝22），それまでのC3～7の5椎弓群（n＝37）と比較検討した．日整会スコアの改善・合併症に差はなかった．また術後MRIでは両群とも脊髄に対して十分なくも膜下腔が確保されていた．術後頚椎可動域は4椎弓群では術前の88％と術前と有意差のない範囲に保たれていた．C3～6形成術はより低侵襲の術式として従来のC3～7形成術に代わりうる可能性が示唆された．

　Cervical laminoplasty has been generally performed over five laminae (C3-7) irrespectire of number of compression levels. However, the number of laminae that should be elevated to obtain both excellent neurological and radiological outcome has never been assessed. A year ago we began prospectively applying C3-6 laminoplasty instead of the C3-7 procedure in most cases of myelopathy due to multiple levels of cord compression. The neurological improvement in the C3-6group (n＝22) and the C3-7group (n＝37) was identical. In both groups, postoperative MRI demonstrated an adequate antero-posterior diameter of the dural sac for the spinal cord at each disc level. Range of motion of the cervical spine decreased to 88％ of the range before surgery in the C3-6 group, whereas it was 71％ in the C3-7 group. Postoperative axial neck pain occurred in only 13％ of the patients after C3-6 laminoplasty, as opposed to 30％after C3-7 laminoplasty. C3-6 laminoplasty proved to be an attractive alternative to C3-7 laminoplasty for compression myelopathy.