腰仙椎移行部の椎間孔外狭窄症に対する後方侵入脊椎内視鏡手術の治療成績

Microendoscopic Spinal Surgery for Extraforaminal Stenosis at the Lumbosacral Junction

　腰仙椎移行部の椎間孔外狭窄症に対する後方侵入脊椎内視鏡手術の治療成績について検討した．対象は術後2年以上の追跡が可能であった19例である．再手術を要した1例を除く全例で根性坐骨神経痛と間欠跛行の消失が得られ，最終調査時の日本整形外科学会腰痛治療成績判定基準(JOAスコア)を用いた平均改善率は56.3％であった．再手術の原因は同時に合併する椎間孔内狭窄病変の除圧不足であった．脊椎内視鏡は体深部に位置する本疾患には最適の手術手技と考えられ，過去の術式にはない多くの利点を有している．したがって今後は標準術式となる可能性がある．

　We performed microendoscopic spinal surgery to treat extraforaminal stenosis at the lumbosacral junction in 19 patients (9 men and 10 women, mean age 64.5 years) with L5 radiculopathy.　All patients except one experienced immediate pain relief postoperatively.　The mean improvement rate in JOA score was 56.3% after a mean postoperative follow-up period of 2 years 11 months.　Mean operation time was 139.5minutes, and mean blood loss was 47.1ml.　There were no major complications.　One patient had residual leg pain and intermittent claudication due to concomitant foraminal stenosis and underwent revision surgery after 1 year.　The surgical outcome in our series was excellent.　This minimally invasive technique has the potential to become the gold standard for the treatment of extraforaminal stenosis at the lumbosacral junction and should be introduced into clinical practice.