多数回手術を要した腰椎カリエスの1例

Lumbar Spinal Tuberculosis Treated by Multiple Surgery. Case Report

　症例は第4，5腰椎(L4，5)の脊椎カリエスと診断された73歳の男性である．抗結核薬による保存療法を行ったが症状は悪化し，10カ月後に手術となった．手術は第2腰椎から第1仙骨(L2～S1)の後方除圧固定術，両側侵入前方搔爬・腓骨移植を3期的に行った．術後4年でX線像・CTで骨癒合を確認した．MRIでは感染の再燃はみられない．結核菌はバイオフィルム形成に乏しく，前方固定の範囲が2椎間で，腰仙椎では移植骨の安定性が得にくいことから，後方インストゥルメンテーションを併用した前方固定術が必要と考えられた．

　We report the case of a 73-year-old man with spinal tuberculosis at L4-5.　Surgical treatment in two stages was performed after 10 months of conservative therapy with antitubercular agents, because it was ineffective.　Posterior decompression and fusion from L2 to S1 was performed first, and then curettage of the vertebral lesion on both sides and followed by fibular bone grafting.　Four years after surgery, bony union had been achieved based on the X-ray and CT findings, and MRI showed no evidence of the spinal tuberculosis.　Because biofilm formation by the tuberculosis bacterium was poor, two vertebral anterior fusions were needed, and the bone graft in the lumbosacral region was unstable, we concluded that anterior spinal fusion with posterior instrumentation was necessary in this case.