腰椎椎間板ヘルニアに対する内視鏡下椎間板摘出術は椎間関節にとって低侵襲であるか？

Is Microendoscopic Discectomy Minimum Invasive Surgery for Facet Joint in Surgical Treatment of Lumbar Disc Herniation?

　腰椎椎間板ヘルニア(LDH)に対する内視鏡下椎間板摘出術(MED)の椎間関節切除量を調査し，従来法(Love変法)と比較を行った．対象は同一施設，同一術者により施行された113例(MED群66例，Love群47例)であり，臨床成績は2群間で差がなかった．椎間関節温存率はMED群46.9％，Love群44.9％と差はなかったが，切除角度はMED群－10.1°，Love群0.9°で(p＜0.0001)，MED群は内向きに切除された．MED群の椎間関節切除量は椎間関節面の傾斜角，ヘルニア高位，working spaceと相関関係を認めた．MED法は従来法に比べ椎間関節への侵襲は小さくなく，患者の骨形状によっては臨機応変に術式を選択すべきである．

　The purpose of this study was to compare the degree of surgical invasion of facet joints between microendoscopic discectomy (MED) and modified Love's procedure for the surgical treatment of lumbar disc herniation.　We divided 113 patients into 2 groups；MED group (n＝66) and Love group (n＝47).　There were no significant differences between the 2 groups for age, clinical outcomes, and preservation ratio of facet joints (MED：46.9%, Love：44.9%, p＞0.05).　The MED group demonstrated inward resection angle of facet joints compared to the Love group (MED：－10.1°, Love：0.9°, p＜0.0001).　The degree of invasion of facet joints in the MED group had a significant correlation with inclination of the facet joints, the level of surgery, and working space between the spinous process and inner border of the pedicle.　Overresection of the inferior articular process by MED was more common than by conventional open surgery, and physicians should select the surgical procedure flexibly depending on the configuration of the facet joints and spinal canal.