骨傷のない頚髄損傷の予後調査

Outcome of Cervical Cord Injury without a Fracture or Dislocation

　骨傷を伴わない頚髄損傷の予後調査を行い，狭窄因子が予後に及ぼす影響を調べた．骨傷のない頚髄損傷17症例を対象とし，手術治療の有無，MRI上狭窄の有無，神経症状などについて評価した．全17例中，手術例7例を含めた15例が退院時には狭窄がなく，そのうち11例（73％）において神経症状の改善が得られていた．また，狭窄があり，かつ保存的治療のみを受けていた2例では麻痺症状が悪化していた．当院では，狭窄のある患者には受傷後2週頃に積極的に除圧手術を行っており，試みてよい治療法である．

　The purpose of this study was to evaluate the influence of the stenotic factor on cervical cord injury without a fracture or dislocation. Of the 27 patients treated at our center between 1995 and 2005, 17 patients could be followed up in regard to surgery, the stenotic factor on X-ray or MRI, images and the neurological findings. The average age of the patients was 57 years old. The average follow-up period was 38 months. Surgrey was performed in 7 cases and conservative therapy in 10 cases. The damage level was at C4 in 3 cases, C5 in 10 cases, C6 in 3 cases and C7 in one case. Stenosis was present in 9 cases based on the X-ray or MRI findings. The neurological findings had improved at the most recent follow-up examination in 6 of the 7 cases treated surgically. There was stenosis in 2 of the conservatively treated cases and the neurological findings were worse at the most recent follow-up examination. There was no stenosis in the other 8 cases and the neurological findings had improved or there was no change at the most recent follow-up examination. In our experience decompression surgery is a better choice of treatment for cervical cord injury without a fracture or dislocation, based on the stenotic factor.