経皮的レーザー椎間板除圧術（PLDD）成績不良例に対する再治療法の検討―保存的治療の有用性

Management of Postoperative Complications after Percutaneous Laser Disc Decompression

　腰椎椎間板ヘルニアに対して，他院で経皮的レーザー椎間板除圧術(以下PLDD)施行後に成績不良にて，当院で加療を行った34例について調査した．PLDDの成績不良の主な原因の一つである適応の誤りが67.6％(23/34例)に認められた．まず保存的治療を行い，保存的治療無効例に対しては手術を施行した．保存例でもJOAスコアは改善した．他院PLDD後成績不良例でも保存的治療の有効例があり，まず標準的な保存的治療を試みるべきである．

　The patients undergoing percutaneous laser disc decompression (PLDD) are increasing in Japan.　A total of 34 cases that required treatment after percutaneous laser disc decompression (PLDD) performed at another hospital were retrospectively studied.　The most common causes of failure after PLDD were incorrect preoperative diagnosis and indications, which included a non-contained disc, lateral recess stenosis, lumbar disc injury, and segmental instability.

　Conservative and surgical management was effective.　The results of this study demonstrate the importance of proper patient selection for PLDD.　PLDD should be performed only at institutions capable of managing revision in failed cases.