頚椎椎間関節症による頚髄症の1例

Cervical Myelopathy Secondary to Facet Joint Arthrosis : A Case Report

　症例は36歳の女性で，両上肢しびれと上肢巧緻性障害を自覚していた．MRIでC5/6椎間関節の変性・肥厚と側方からの脊髄圧迫があり，T2強調画像で脊髄に高信号を認めた．後方から両側内側椎間関節切除と前方固定術を施行し，良好な成績を得た．圧迫性頚髄症において，変性・肥厚した椎間関節の側方圧迫による頚髄症の報告は少ない．椎間関節症を生じうる病態がないにも関わらず，若年で高度の椎間関節症と脊髄圧迫を生じており，稀な症例といえる．病態の解明や低侵襲な術式の確立が今後の課題と考える．

　We report a case of cervical myelopathy secondary to facet joint arthrosis.　The patient was a 36-year-old female with bilateral hand clumsiness and a sensory disturbance of her upper limbs.　MRI showed severe facet joint arthrosis at the C5/6 level that had compressed the spinal cord bilaterally.　Laminectomy and medial facetectomy of C5/6 through a posterior approach and anterior spinal fusion were performed, and her complaints improved postoperatively.　Few cases of cervical myelopathy secondary to facet joint arthrosis have been reported.　Idiopathic cases of severe facet joint arthrosis are very rare.　We performed posterior decompression and anterior fusion to ensure decompression and prevent instability.　The procedure was highly invasive, and it is hoped that future research elucidates the pathology and enables less invasive surgery.