連続型頚胸椎後縦靱帯骨化症に対するposterior expansive cervico-thoracic laminoplastyの適応と限界

Indications and Limits of Posterior Expansive Cervicothoracic Laminoplasty for Ossification of the Posterior Longitudinal Ligament in the Cervicothoracic Spine

　当科では胸椎病変を主病巣とする連続型頚胸椎後縦靱帯骨化症(OPLL)に対して頚椎から胸椎にわたる後方拡大頚胸椎椎弓形成術(posterior extensive cervico-thoracic laminoplasty＝PECTL)で対応し，良好な結果を報告してきた．しかしながら，最近，神経症状が悪化した症例を3例経験した．悪化した症例は全例神経麻痺症状が強く独歩不能で，頂椎部に嘴状型OPLLを有していた．このような症例では，PECTLでの対応は症状悪化を来す可能性があり，術式の選択には注意を要すると考えられた．

　Posterior expansive cervicothoracic laminoplasty (PECTL) has been performed in our department to treat patients with ossification of the posterior longitudinal ligament (OPLL) in the cervicothoracic spine, and good outcomes have been reported.　However, we recently encountered three patients who experienced neurological deterioration after PECTL.　Preoperatively all three patients had severe neurological paresis and were unable to walk without orthoses, and they all had beak-shaped OPLL at the apex of the thoracic spine.　PECTL may cause neurological deterioration in such cases, and care is necessary when selecting the surgical method of treatment.