高齢者腰椎変性疾患に対する片側進入両側除圧術の成績

Outcomes of Bilateral Decompression by a Unilateral Approach for Degenerative Lumbar Disease in the Elderly

　不安定性のない腰椎変性疾患に対し片側進入両側除圧術を行った症例を75歳以上の高齢者群22例(平均79歳：75～87歳)と，70歳以下の非高齢者群46例(平均61歳：33～69歳)に分け，各群の治療成績を比較検討した．高齢者は非高齢者と比べ治療成績が若干不良な傾向があり，術後のせん妄も有意に頻回であった．しかし手術時間や出血量，術中合併症といった手術関連項目では両群間で有意差がなく，術前後の歩行能力や症状といった治療効果についても全項目で有意に改善しており，本術式は高齢者に対しても有用な術式と考えられた．

　This study investigated the surgical outcomes of bilateral decompression by a unilateral approach in the elderly.　Twenty-two patients 75 years of age and over (mean age：79 years；range 75-87 years) and 46 patients under 70 years of age (mean age：61 years；range 33-69 years) with lumbar degenerative disease who underwent surgery were the subjects of this study.　Outcomes according to the Odom scale, 2 of the 3 visual analogue scale (VAS) items, i.e., Low-back pain and Lower-leg pain, and one of the 5 items of JOABPEQ (Lumbar spine dysfunction) were significantly worse in the elderly group.　However, the elderly group had significant postoperative improvement in all items of the VAS and JOABPEQ, and in every other factor assessed in this study.　The unilateral approach is a less invasive approach and provides significant improvement in symptoms and disability in the elderly.