腰椎変性すべり症の椎間板ヘルニア合併例に関する検討―椎間板ヘルニアを摘出すべきか？―日本整形外科学会腰痛評価質問票を用いた解析

Is Discectomy with Lumbar Disc Herniation Effective in Degenerative Lumbar Spondylolisthesis?

　腰椎変性すべり症に椎間板ヘルニアが合併し，内視鏡下除圧術(以下MED)に椎間板ヘルニア摘出術を併用したH群と，椎間板ヘルニア合併がないか軽度でMEDのみで神経根と硬膜の緊張がなくなったC群を比較した．H群はC群よりも術前の重症度スコアが低かったが，摘出術併用により，椎間板腔の狭小化とともにすべりや椎間可動域も減少し，C群と同等の術後成績が得られた．以上から，腰椎変性すべり症に対してMEDのみで神経根または硬膜の緊張が残存した場合，椎間板ヘルニア摘出術を併用することにより良好な手術成績が得られる可能性が示唆された．

　A series of patients with degenerative lumbar spondylolisthesis (DS) were enrolled in this study to compare outcomes of 2 surgical methods.　The patients were divided into the following 2 groups：group H (14 DS patients treated by microendoscopic decompression ［MED］ and discectomy with lumbar disc herniation ［DH］) and group C (19 DS patients treated by MED without DH).　The mean duration of follow-up was 29 months.　Clinical outcomes were evaluated by using the Japanese Orthopaedic Association Back Pain Evaluation Questionnaire.　All the preoperative scores in group H were lower than those in group C.　There was no statistically significant difference in the postoperative scores and degrees of improvement between groups H and C.　The intervertebral motions at the level of the slip were stabilized after surgery in group H, and the surgical outcome in both groups were similar.　Therefore, discectomy with DH may lead to good clinical outcome in DS.