胸椎偽関節に対してインストゥルメンテーションを用いた後方固定術が奏功したSAPHO症候群の1例

Surgical Treatment of Thoracic Destructive Spondylitis in a Patient with SAPHO Syndrome : A Case Report

　胸椎に進行性骨破壊を生じたSAPHO症候群の1例を経験した．症例は72歳の女性で第7-9胸椎の著明な骨破壊および後弯変形を認めた．前医で胸腔鏡補助下搔爬，腸骨移植による前方固定術を施行されたが偽関節となった．初回手術より1年8カ月後，後方固定術を行った．術後椎体偽関節部に良好な骨形成，骨癒合が得られた．SAPHO症候群は骨増殖(hyperostosis)を特徴とする疾患であり，安定性が得られれば良好な骨形成が期待される．SAPHO症候群に対してはインストゥルメンテーションによる固定術が望ましいと考えられた．

　We report the case of a patient with synovitis, acne, pustulosis, hyperostosis, osteitis (SAPHO) syndrome in which thoracic destructive spondylitis caused a kyphotic change, and the patient ultimately required posterior instrumentation surgery.　The patient was a 72-year-old woman who presented with severe back pain and a kyphotic change.　Magnetic resonance imaging revealed spondylitis of T7-T9.　Curettage and bone grafting were performed using thoracic endoscopy.　However, the graft had been absorbed, and the thoracic kyphosis progressed.　Posterior fusion (T4-11) using a pedicle screw was performed without the anterior bone graft.　Approximately 1.5 years after the operation, bony fusion was achieved and bony bridging around the vertebral body was observed.

　Structural destruction of the spine in SAPHO syndrome is thought to be very rare.　Grafted bone without instrumentation can be absorbed because of synovitis and spinal instability.　SAPHO syndrome causes hyperostosis.　Therefore,rigid spinal fusion using instrumentation can achieve bone formation and fusion of unstable vertebra.