脊髄症を呈する頚椎椎間板ヘルニアに対して内視鏡下頚椎後方除圧術を行った2例

Cervical Microendoscopic Laminoplasty for Cervical Myelopathy Caused by Cervical Disc Herniation. Report of Two Cases

　頚髄症を呈する正中型の頚椎椎間板ヘルニア(CDH)に対して内視鏡下頚椎後方除圧術(CMEL)を行い，症状の速やかな改善を認めた2例を経験した．また本症例はともに術後経過中，ヘルニアの吸収を認めた．CDHの自然消退に関しては広く認識され，軽症例では保存療法も試みられるが，重症例では前方除圧固定術や椎弓形成術が適応されることが多い．しかし今回の結果から，頚髄症を呈するCDHに対する低侵襲治療の選択肢の1つとして，CMELを挙げることができると考えられた．

　We report two cases of cervical myelopathy in patients with cervical disc herniation (CDH) who underwent cervical posterior microendoscopic laminoplasty (CMEL).　The patients were a 62-year-old male and a 50-year-old female, and both had a single level CDH.　The patients complained of typical symptoms of myelopathy, and their primary care physicians recommended operative treatment.　Anterior cervical discectomy and fusion (ACDF) was planned, however, both patients refused it and desired a minimally invasive procedure.　CMEL was performed in both cases, and the patients' myelopathic symptoms improved immediately after the operation.　MRI showed no evidence of CDH at six months and 12 months, respectively, after the operation.　ACDF is recognized as the gold standard for the treatment of cervical myelopathy secondary to CDH.　We report two cases of cervical myelopathy patients associated with CDH in which treatment by CMEL was followed by rapid resolution of the symptoms and spontaneous absorption of the herniated disc within a year.　CMEL is a possible alternative procedure for the treatment of cervical myelopathy with CDH by minimally invasive surgery.