びまん性特発性骨増殖症に伴った胸腰椎過伸展損傷の2例

Thoracolumbar Injury Due to Hyper-extension in Patients with Diffuse Idiopathic Skeletal Hyperostosis. Report of 2 Cases

　びまん性特発性骨増殖症に伴った胸腰椎過伸展損傷を来した2例を経験したので報告する．症例1は61歳の男性で，窓から転落し受傷した．第1腰椎に椎体前面から棘突起にかけて骨折を認めた．保存治療ののちに腰痛，両下肢筋力低下が出現したため後方から脊椎除圧固定術を行った．術後早期に症状は改善した．症例2は75歳の男性で自宅で転倒した．3週間後から腰痛，両下肢筋力低下が増悪し，第10-11胸椎の椎体から椎弓にかけて骨折を認めた．家族の希望により手術は選択せず保存治療を行った．

　本損傷においては保存治療では神経症状の改善は得られず，早期の診断，可及的早期の手術による除圧と強固な内固定が必要であると考えた．

　This report describes 2 cases of thoracolumbar injury due to hyper-extension in patients with diffuse idiopathic skeletal hyperostosis (DISH).　Patient 1 was a 61-year-old man who fell from a window.　Radiographical findings showed a fracture of L1 between the spinous process from the front of the vertebral body.　The patient complained of back pain, hyperesthesia in his leg, and weakness of the lower extremity.　Spinal decompression and instrumentation were performed, and the symptoms showed early improvement.　Patient 2 was a 75-year-old man who was injured in a fall.　Three weeks after injury, he developed back pain and weakness of the lower extremity.　Computed tomography (CT) showed vertebral fractures of Th10 and Th11 between pedicles from the front of the vertebral body.　The patient was treated conservatively because he had dementia.　Early diagnosis and operative decompression are required for patients with thoracolumbar spinal injury accompanying DISH.