RA中下位頚椎病変に対するインストゥルメントを用いない固定術

Posterior Fusion without Instrumentation for Subaxial Cervical Involvement in RA Patients

　抄録：上位頚椎亜脱臼に引き続き，あるいは上位頚椎固定術後に生じた多関節破壊型RA患者の中下位頚椎病変に対し，脊髄の除圧と脊柱の安定性を獲得する目的で，脊柱管拡大術に加え腸骨移植による椎間固定，椎弓間固定を図る手術を行った．全例で同時に，あるいは前回手術時に上位頚椎の固定が図られ，結果として全頚椎固定を目的とした．術後1年以上経過した5例を調査の対象とし成績を評価した．2例2椎間でわずかな動きが残ったが，他の全椎間に骨癒合が得られた．ADLや神経症状は全例で不変，あるいは改善した．後頭部～後頚部痛も全例で消失した．

　Expansive laminoplasty followed by posterior fusion with iliac bone graft was performed in 5 cases of MES-type RA with subaxial cervical involvement to achieve decompression of the spinal cord and stabilization of the cervical spine. Since the subaxial cervical involvement developed after C1/C2 subluxation in four of the cases and after C1/C2 fusion surgery in the other case, we attempted to achieve total cervical fusion in every case. More than a year postoperatively fusion had been obtained in three of the cases, and although slight motion persisted in one segment in the other two cases, progression of the cord compression, neurological deterioration, and cervical instability had been prevented. All the patients experienced relief of their neck pain and occipitalgia after surgery.