ハイブリッド前方除圧固定術―頚椎多椎間病変に対して椎体亜全摘と椎間固定を併用する工夫

A Hybrid Decompression and Fixation Technique : A Novel Technique That Combines Corpectomies and Discectomies for the Management of Multilevel Cervical Myelopathy

　頚椎多椎間病変に対して多椎体亜全摘を施行する場合，移植骨・インプラント脱転リスクが高まるとされている．その対策として椎体亜全摘と椎間除圧を併用するハイブリッド前方除圧固定術を行った3椎間以上の頚椎症48例について調査し，その安全性と有用性を検証した．臨床成績は良好で，前方法単独で目的を達成し，術後halo-vest装着も回避できた．頚椎アライメントおよび固定椎間高は良好に維持されていた．本法は複数椎間の高度な狭窄とこれに隣接する中等度の狭窄を有する症例に適用できる安全で有用な術式である．

　Anterior cervical corpectomy is an effective method of managing multilevel cervical myelopathy (CSM), but a higher incidence of graft/instrumentation-related failure has been reported in patients who have undergone multilevel decompression.　We describe a novel “hybrid decompression fixation” technique that consists of a combination of corpectomies and discectomies to increase the inherent mechanical stability of the post-decompressed cervical spine.　We retrospectively reviewed the outcomes of 48 patients with multilevel CSM who had been treated by the hybrid technique.　The clinical outcome was excellent, with no evidence of graft/instrumentation-related failure observed in any of the 48 patients.　We are convinced that the hybrid technique is safe and efficient for anterior decompression in patients with multilevel CSM.　This novel technique obviates the need for staged circumferential procedures or halo-vest immobilization.