骨粗鬆症性椎体圧潰に対する椎体形成と後方脊柱再建の併用―手術適応と短期成績

Vertebroplasty Combined with Posterior Spinal Reconstruction for Osteoporotic Vertebral Collapse : Preliminary Report

　抄録：前方手術単独で対処困難と判断した骨粗鬆症性椎体圧潰10例に，椎体形成術と後側方固定術を併用した．固定は原則として上下2椎以内としたが，多椎圧潰例や脊椎固定術の既往例ではより長い固定を要した．圧潰椎体にリン酸カルシウム骨ペーストを用いて椎体形成を行った．全例で臨床成績は良好であり，画像上も脊柱安定性が獲得・保持された．手術侵襲は前後合併手術や後方短縮術に比し小さかった．本法は骨粗鬆症性椎体圧潰に対する手術治療の1つとして有用であるが，特に前方手術が困難な例に対し極めて有用である．

　This study retrospectively reviewed 10 cases in which vertebroplasty combined with posterior spinal reconstruction was used to treat osteoporotic vertebral collapse. All patients complained of severe back pain, and five of them were unable to walk. Posterior spinal reconstruction was performed from two levels above to two levels below the collapsed vertebra. Three patients required more extensive reconstruction because of previous spinal fusion or multiple fractures. Vertebroplasty was performed by using calcium phosphate cement (CPC) on the collapsed vertebra. All patients experienced significant pain relief/improvement postoperatively and could walk without a cane. Posterolateral bony fusion was achieved in all cases. Local kyphosis was 34.2 degrees preoperatively, 14.9 degrees postoperatively, and 15.7 degrees at the most recent follow-up. Vertebroplasty combined with posterior spinal reconstruction can be recommended because it provides anterior column support and posterior segmental fixation via a posterior single approach. This procedure is especially useful when anterior surgery is difficult or both anterior surgery and posterior surgery are required.