8椎体に及ぶ広範な胸腰椎カリエスの手術経験

Surgical Treatment of Extensive Thoracolumbar Spinal Caries Involving Eight Vertebral Bodies. Case Report

　8椎体に及ぶ胸腰椎カリエスを経験した．症例は中国籍の32歳の女性だった．背部痛の出現から1年後に脊椎カリエスと診断され，化学療法の効果なく手術となった．CT，MRIでT7からL2まで及ぶ椎体破壊と椎体周囲膿瘍を認めた．手術は右開胸を2カ所で行い，8椎体に及ぶ病巣を掻爬した．反対側の椎体周囲膿瘍も椎体前方より掻爬できた．2週間後に脊柱の補強を目的に，椎弓根スクリューの挿入高位のみ皮膚切開を行い，病巣範囲外で後方インストゥルメンテーションを追加した．術後1年6カ月の現在，後弯の進行なく脊椎固定部は骨癒合し，脊椎カリエスは鎮静化している．

　We report the case of 32-year-old female with thoracolumbar spinal caries involving eight vertebral bodies.　It took about 1 year to diagnose her illness as it.　CT and MRI revealed that destructive changes in vertebral bodies from T7 to L2 with paraspinal abscesses.　Anterior debridement and bone graft were performed using the right thoracotomies at 2 sites.　Paraspinal abscesses surrounding vertebral bodies were curetted adequately through the inside of the abscess wall by only the right-side approach.　Two weeks after the operation, posterior instrumentation was performed by the minimum invasion outside the lesion of spinal caries.　Eighteen months after the 2-stage operation, the radiologic evidence of spine fusion was observed without the progression of kyphosis and the laboratory data showed no sign of inflammation.