先天性第5腰椎すべり症の1例―脊椎矢状面配列の変化

Congenital Spondylolisthesis, Radiographic Finding Regarding Spinal Sagittal Balance. Case Report

　筆者らは，脊椎矢状面配列異常を来した先天性第5腰椎高度すべり症の症例を経験したので報告する．症例は8歳の女児で，dysplastic typeのすべり症を認め，腰仙椎は局所後弯を，胸椎は前弯位を呈していた．L5/S1単椎間後方進入腰椎椎体間固定術（PLIF）を施行し，slip angleは術前50°から術後24°に改善した．PLIFによる腰仙角の矯正により，胸椎は正常範囲内の後弯が形成された．先天性腰椎すべり症は，腰仙椎の後弯とそれに伴う胸椎前弯による脊椎矢状面配列の異常を引き起こし，すべりの矯正のみならず腰仙椎後弯の矯正が手術治療の鍵であると考えられた．

　We report a case of high-grade dysplastic spondylolisthesis with atypical sagittal alignment.

　Case：An 8-year-old female was diagnosed a with high-grade dysplastic spondylolisthesis associated with thoracic lordosis and lumbosacral junctional kyphosis. Pedicle screw fixation and interbody fusion were performed at L5/S1. The slip angle was corrected from 50° to 24°, and the lumbosacral lordosis was restored with subsequent correction of thoracic kyphosis. Although the slip angle was only partially reduced, the sagittal malalignment was restored to normal. The goal of surgical treatment is restoration of global spinal sagittal balance and an improved biomechanical milieu across the lumbosacral junction.