後方進入椎体間固定術後に偽関節となった高度腰椎すべり症に対しtrans-sacral interbody fusionを施行した1例

Posterior Stabilization with Trans-sacral Interbody Fusion for Severe Spondylolisthesis Following Failed Posterior Interbody Fusion. Case Report

　症例は67歳，女性で，他院にて第4，第5腰椎すべり症に対し後方進入椎体間固定術（PLIF）を施行されたが，症状は改善しなかった．当院初診時にはPLIF後の偽関節を生じ，すべりの著明な進行がみられたため，trans-sacral interbody fusionを併用した後方固定術を施行した．その結果，良好な骨癒合と臨床症状の改善が得られた．本法はanterior supportが修復できない高度すべり症に対する有用な手術法と思われた．

　A 67-year-old woman with spondylolisthesis of the fourth and the fifth lumbar vertebrae underwent posterior lumbar interbody fusion at another hospital for disabling pain in her lower back and both legs. On the initial visit to our clinic she complained of no improvement in her symptoms and was found to have pseudarthrosis and progression of the slip at the L5-S1 level. Posterior stabilization with trans-sacral interbody fusion was performed as salvage therapy, and solid fusion was achieved with relief of her symptoms. Trans-sacral interbody fusion proved to be effective for the treatment of severe spondylolisthesis.