神経根障害を引き起こした第4腰椎上関節突起陳旧性骨折と思われる1例

A Possible Case of Radiculopathy Caused by Old Fracture of the Superior Articular Process of the Fourth Lumber Vertebra. Case Report

　症例は，左殿部から大腿部の疼痛に対して9カ月間の保存療法が奏効せず入院となった25歳の男性である．CTで左L4上関節突起陳旧性骨折が疑われた．また左L4神経根ブロックで疼痛の再現性と消失を認めた．以上から偽関節骨片が左L4神経根を圧迫していると考え，内視鏡下に骨片を摘出した．術直後から症状は消失し職場復帰している．脊椎内視鏡手術は，腰椎後方要素を十分に温存でき，本症例においても，椎間関節への侵襲を最小限にとどめた．このため，術後不安定性が出現する可能性は低いと考える．

　A 25-year-old man presented with radicular pain of the left leg. Pain did not improve after conservative therapy for 9 months. Old fracture of the superior articular process of the L4 vertebra was suspected on a computed tomography. And block for the lt. L4 nerve root was effective. These results suggested that his symptom was caused by the nonunion fragment compressing lt. L4 nerve root. Microendoscopic surgery was applied to this case, and the fragment was removed safely. After surgery he has resumed his former occupation without pain. Microendoscopic surgery minimizes resection of the posterior elements of the spine, and prevents postoperative instability. In this case, microendoscopic decompression seems to decrease risk of delayed spinal instability.