脊椎・脊髄疾患に対するリエゾン精神医学的アプローチ（第3報）―腰仙椎部退行性疾患に対する手術成績に関与する精神医学的問題の検討

Evaluation of Psychiatric Problems in Relation to Surgical Treatment for Degenerative Lumbar Spinal Diseases

　抄録：腰仙椎部退行性疾患により手術が施行された47例を対象とし，術前から合併している精神医学的問題が治療成績に与える影響について検討した．調査時に治療成績不良と判定された症例は47例中6例（13％）であった．一方，術前からすでに精神医学的問題を合併していると診断された症例は47例中3例であった．その3例の治療成績は，1例（33％）が優で，残りの2例（67％）が不可であった．手術前の精神医学的診断は，優と判定された1例がうつ病，不可と判定された2例がともに身体表現性障害であった．不可と判定された2例は術後になっても術前と同様の症状を訴えていた．したがって，手術成績不良と判定された6例のうちの2例（33％）は，術前からの精神医学的問題が関与して治療成績が不良となったと考えられる．腰仙椎部退行性疾患に対する手術療法の治療成績不良例を減少させる対策として，術前における心理的評価を行う必要がある．

　The surgical outcome of 47 patients who underwent surgery for cauda equina symptoms and radicular pain caused by degenerative lumbar spine disease more than 10 years previously was evaluated retrospectively. In six of the patients (13％) there was little change in the main symptoms at the time of the evaluation. We judged these six patients to have a failed back. Assessment of their mental status before the operation revealed that three of the 47 subjects had psychiatric disorders in addition to the physical symptoms of degenerative lumbar spine disease. One patient had a depressive disorder in addition to lumbar spinal canal stenosis before the operation, and the patient's preoperative physical symptoms had improved satisfactorily 10 years postoperatively. The other two patients had a somatoform disorder in addition to lumbar spinal canal stenosis before the operation, but their preoperative physical symptoms had persisted for the 10 years after the operation. We judged these two patients to also have a failed back. It was therefore concluded that the outcome of operations for degenerative lumbar spine disease was influenced by preoperative psychiatric problems, i.e., a somatoform disorder in two (33％) of the six failed back patients. We concluded that preoperative psychiatric problems, especially somatoform disorders, are a factor that adversely affects the outcome of surgery for degenerative lumbar spine disease. The mental state of patients with degenerative lumbar spine disease should be evaluated before performing surgery as a means of preventing failed back.