脊髄症を呈した先天性頚椎後弯症の1例

Surgical Treatment for Congenital Cervical Kyphosis Causing Myelopathy. Case Report and Review of the Literatures

　脊髄症を呈した先天性頚椎後弯症の1例を報告した．症例は1歳9カ月の女児で，運動発達障害と短頚を主訴に来院した．単純X線像にてC6を頂椎とする著明な後弯変形を，MRIでは頂椎による脊髄の圧迫を認めた．先天性頚椎後弯症の診断にて頭蓋直達牽引後に一期的前方除圧固定術と後方固定術を施行した．手術は前側方から進入しC5，6椎体部分切除による脊髄の除圧を行い，チップ状の自家骨移植を施行した．後方にも十分な自家骨を移植した．術後は1カ月間の頭蓋直達牽引を行い後弯のさらなる矯正を試みた．本症例は体が小さく，C2からC7まで連続する二分脊椎を認めたため，一塊とした骨移植や内固定材の使用は困難であった．チップ状の骨移植と術後直達牽引により緩徐な後弯矯正と良好な骨癒合を得た．

　We report the case of a 21-month-old girl with myelopathy secondary to severe congenital cervical kyphosis and spina bifida who was successfully treated by anterior decompression and anterior-posterior fusion with minced bone graft and postoperative halo traction. Plain preoperative radiographs demonstrated a severe kyphotic deformity of 102 degrees at the C5-7 level, and MR scans revealed severe spinal cord compression at the C6 level. An anterolateral approach was employed, and after partial resection of the vertebral bodies of C5 and C6 to achieve spinal cord decompression, minced bone from her tibia was grafted. Postoperatively, halo traction was continued for one month to further correct the kyphosis. At the final follow-up, fusion with no correction loss, and recovery of motor function had been obtained. A treatment strategy that uses unstructured bone grafts followed by postoperative traction provides favorable results in cases of severe congenital cervical kyphosis such as this.