腰椎椎間板ヘルニアに対する椎間板内加圧注射―造影所見と臨床成績について

Pressurizing Intradiscal Injection for Lumbar Disc Herniation

　椎間板内加圧注射の臨床成績について調査を行った．対象は薬物やブロック療法などの保存治療が無効な57例（男性36，女性21）で，平均50歳であった．発症から本注射までの期間は平均7.7週だった．透視下に健側から穿刺し，造影剤を注入後，生理食塩水を注入した．患肢への放散痛の有無を確認し，2方向で造影所見を評価した．治療効果は注射後約3週間で判定した．全57例中，著効17例（30％），有効24例（42％），無効14例（25％），悪化2例（4％）であった．著効・有効例はL4/5，sequestrationタイプで多く，患肢放散痛と罹患神経根の造影が同時に得られた11例では著効が9例であった．筋力や知覚の悪化した例はなく，安全・低侵襲であり，一般の保存治療に抵抗する場合の次なる治療手段になると考えられた．

　We report the clinical results of pressurizing injection into the intervertebral disc for lumbar disc herniation in 57 cases in which conservative treatment was ineffective. The average interval between the onset of symptoms and the pressurizing injection was 7.7 weeks. The needle is inserted under fluoroscopic guidance. Normal saline is injected after injecting contrast medium. We recorded the presence of radiating pain and the contrast discography findings. The pressurizing injection was very effective in 17 cases (30％), effective in 24 cases (42％), and in effective in 14 cases (25％), and in 2 cases (3％) the symptoms were aggravated. It was effective in 85％ of the herniations at L4/5 and in 88％ of the sequestration type herniations. There was no worsening of motor or sensory status. Pressurizing injection for lumbar disc herniation is safe and worth trying when ordinary conservative treatment is ineffective.