頚髄症に対する内視鏡下後方除圧術の臨床成績

Clinical Outcomes of Microendoscopic Laminoplasty for Cervical Myelopathy

　頚髄症に対する内視鏡下後方徐圧術(microendoscopic laminoplasty：MEL)の手術成績について報告する．対象は，頚髄症に対してMELを施行し，術後6カ月以上経過した51例で，頚椎症性44例，椎間板ヘルニア3例，黄色靱帯石灰化症4例であった．JOAスコアの改善率は平均52.5％であり，調査時のJOACMEQ，SF-36は，それぞれすべての項目で改善していた．周術期合併症は，硬膜損傷，術後硬膜外血腫をそれぞれ1例，術後C5麻痺を2例に認めた．頚髄症に対するMELの臨床成績は良好であり，周術期合併症に配慮すれば，MELは今後選択される手術方法の一つである．

　The purpose of this study was to evaluate the clinical outcomes of microendoscopic spinal surgery for cervical myelopathy.　A total of 51 cases (34 males and 17 females, mean age：62.9 years) treated by microendoscopic laminoplasty of cervical myelopathy at the authors' institution were reviewed retrospectively.　The mean follow-up period was 21.6 months.　The mean JOA score recovery rate was 52.5%.　Evaluation by the JOACMEQ and SF-36 at the final follow-up examination showed improvement in all items.　Four patients had perioperative complications.　One patient sustained a pin-hole-like dura mater injury inflicted by a high-speed air-drill during surgery.　One patient developed an epidural hematoma three days after surgery.　He had the progressive quadriplegia, and underwent the emergency surgery to remove the epidural hematoma using microendoscopy.　His quadriplegia improved immediately after surgery.　The other two patients had temporal C5 nerve root palsy immediately after surgery.　Both patients' neurological symptoms improved in response to conservative management, such as wearing a neck collar.　The results of this study suggest that the clinical outcomes of microendscopic spinal surgery for cervical myelopathy were relatively good or excellent.　This minimally invasive procedure would be helpful as a surgical method for cervical myelopathy.