メッシュケージを用いた経椎間孔腰椎椎体間固定術（TLIF）における移植骨の椎間占拠率

Rate of Graft Bone Filling by Transforaminal Lumbar Interbody Fusion (TLIF) with Mesh Cages

　経椎間孔腰椎椎体間固定術（TLIF）において片側からどの程度骨移植が可能かを検証した報告はない．今回メッシュケージを用いたTLIF症例と同時期に施行した後方経路腰椎椎体間固定術（PLIF）症例の術後CTで移植骨の椎間占拠率を測定し，臨床成績についても比較，検討した．TLIFとPLIFとの間で占拠率は変わらず，成績も差がなかった．TLIFでも十分な骨移植は可能であり，同等の臨床成績を獲得できる．合併症の回避と術式の特性からTLIFの最もよい適応は椎間板症，椎間孔狭窄症および再手術と考える．

　Compared to PLIF, the TLIF procedure has a latent disadvantage in terms of bone grafting because of being a unilateral approach. We calculated the rate of graft bone filling in TLIF cases by postoperative CT and evaluated the clinical results. The rate of filling in the TLIF cases was not significantly less than in the PLIF cases. The results also showed no significant difference between TLIF and PLIF. An adequate amount of bone were grafted into the intervertebral space even by the unilateral TLIF approach, however the procedure is not easy. An incidental dural tear occurred in 1 case each treated by TLIF and PLIF. The exposure of the dural tube increases the risk of epidural bleeding and neural tissue injury. We recommend TLIF for discopathy, foraminal stenosis, and repeat surgery to avoid latent risk.