腰部脊柱管狭窄症に対する棘突起縦割式後方除圧術の治療成績

Clinical Outcome of Spinous Process Splitting Approach for Lumbar Spinal Canal Stenosis

　棘突起縦割進入により後方除圧術を施行した腰部脊柱管狭窄症52例の治療成績を調査した．本術式では開窓術を第一選択とした除圧の後，縦割された棘突起と基部を締結するため，傍脊柱筋に対し愛護的で遺残性腰痛も軽く，術後成績も良好であった．しかし，変性側弯や多椎間除圧例，椎弓切除術施行例の成績は軽度劣っていた．ただし，変性すべり症では術後にすべりが増大して再狭窄する可能性があり，除圧を椎弓切除術とする必要がある．

　In order to decompress the spinal canal in lumbar spinal canal stenosis, the authors have used a spinal process splitting approach to expose the dorsal surface of the laminae and interlaminar spaces in which the paravertebral muscles are preserved and not detached from the surface of the spinal processes.　The fenestration technique with partial laminectomies was mainly selected as the method of decompression and was followed by reconstruction of the separated spinal processes and their base at the laminae by a figure-eight tie method.　The surgical results of this procedure were satisfactory with no postoperative low back pain limiting the normal ADL of the patients.　On the other hand, the surgical results were less satisfactory in the cases of degenerative scoliosis, the cases decompressed at more than one level, and the cases decompressed by laminectomy instead of fenestration.　However, laminectomy is recommended for cases of degenerative spondylolisthesis in order to avoid aggravation of the stenosis by the postoperative increase in anterior slippage of the vertebral body.