脊髄性間欠跛行を呈した頚椎症性脊髄症の1例

Spinal Intermittent Claudication Secondary to Cervical Spondylotic Myelopathy : Case Report

　抄録：脊髄性間欠跛行を呈した72歳男性の頚椎症性脊髄症に対し，前方除圧固定術を行ったところ間欠跛行が消失した．安静時には自覚症状はなく，他覚的所見も乏しかった．歩行負荷試験にて自覚的には体幹から下肢にかけての絞扼感，下肢のしびれ，脱力が生じ，他覚的には深部腱反射の亢進，足クローヌスの出現，知覚障害の増悪を認めた．さらにわれわれは，頚椎カラー着用にての歩行負荷試験を行うことで発現する自覚症状および他覚的所見が軽減することを確認した．頚椎カラーを使用した歩行負荷試験は本症の診断に有用であると思われた．

　We report the case of a 72-year-old man with spinal intermittent claudication secondary to cervical spondylotic myelopathy. The symptoms of spinal intermittent claudication improved in response to three-level cervical corpectomy and fusion with fibula. At rest had no symptoms and seldom had objective findings. MRI and CT myerogram revealed moderate cervical spondylosis and anterior compression of the spinal cord at the C3/4 and 4/5 levels, but no abnormalities were detected in the thoracic or lumber lesions. During a gait loading test the patient experienced a strangulating sensation in his trunk and lower limbs, and weakness and numbness in his lower limbs. Ankle clonus, hyperactive deep tendon reflexes, and sensory disturbance in the lower limbs were also noted. Wearing a Philadelphia cervical collar during a gait loading test with the patient responsible for the effectively reduced both the patient's subjective symptoms and the objective finding. The mechanism disturbance in improvement appears to the cervical collar reduced the dynamic factor, which is one of the causes of the insufficient blood supply in cervical stenotic lesions. In conclusion our expenence indicates that a gait loading test with a cervical collar is useful in diagnosing spinal intermittent claudication secondary to cervical spondylotic myelopathy.