腰椎椎間孔内狭窄に対する内視鏡下椎間孔拡大術

Microendscopic Intraforaminal Decompression for the Lumbar Foraminal Stenosis

　腰椎椎間孔内狭窄に対する新しい手術方法の開発を目的とし，内視鏡による椎間孔拡大術を試みてきた．手術方法は，内視鏡下に外側部を開窓し第5腰神経を確認後，椎間孔内のS1上関節突起，椎体骨棘，椎間板を切除することを原則とし，必要に応じて椎弓根の部分切除を追加することで狭小化した椎間孔を拡大し神経除圧を行った．12例全例とも根性坐骨神経痛による間欠跛行は術後に消失し，患者の満足度は高かった．今回の結果から，脊椎内視鏡を用いた椎間孔拡大術は椎間孔内狭窄に対する新しい手術方法として推奨し得る．

　In an attempt to develop a new surgical method for the treatment of intraforaminal stenosis at L5-S1, we tried performing foraminotomy endoscopically.　Vertebral body osteophytes and bulging discs were resected, and the upper portion of the superior articular process and ligamentum flavum are resected to enlarge the intervertebral foramen.　When necessary, we also resected the inferolateral portion of the pedicle with a new ultrasonic bone curette.　Intermittent claudication and sciatica resolved in all 12 cases, and the patient satisfaction was very high.　Based on the results of this study we can recommend microendoscopic intraforaminal decompression (MEID) as a new method of surgical treatment for intraforaminal stenosis.