ドミノを用いた脊椎再手術の経験

Salvage Surgery of Spine Using “Domino”

　ドミノを用いた脊椎後方再固定術は極めて有用であるので，手術手技を紹介する．ドミノを用いて脊椎再固定術を行ったのは合計11例で，原疾患は変形性脊椎症6例，特発性側弯症4例，原発性脊椎腫瘍1例であった．再手術に至った原因としてはインストゥルメントの破損が3例，隣接部障害が8例であった．再手術では初回手術のロッドを取り除くことなく固定の延長が可能であった．再手術時には固定を追加する部位と初回手術部位の一部を展開するだけでよく，手術時間や出血量も少なくできるため非常に有用であると考える．

　The “Domino” connector has been shown to be extremely useful for posterior re-fusion of the spine. Cases in which re-fusion was performed using this method are presented here, with relevant discussion. The subjects were 11 patients who underwent spinal re-fusion. The reason for the second surgery was instrumentation failure in 3 patients, the lesions at neighboring sites in 8. Salvage surgery included elongation of the fusion instrument by using an end-to-end or side-to-side “Domino”. Bone grafting was conducted, as a rule, at the junction between the rods. The site of fusion could be elongated without removal of the rods applied during the first surgery. This method of salvage surgery is considered to allow reduction of the operative time and the volume of blood loss. Elongation of fusion using the “Domino” connector was found to be extremely useful for overcoming this difficult situation.