腰部脊柱管狭窄症に伴う腰痛に対する正中進入内視鏡下除圧術の成績

Clinical Study of Microendoscopic Decompression via a Midline Interspinous Approach for Low Back Pain Associated with Lumbar Spinal Canal Stenosis

　腰部脊柱管狭窄症に対し正中進入内視鏡下除圧術を施行し，3年以上経過観察した62例の腰痛に関する臨床成績を検討した．本法は術直後でも創部痛が強くなく，部位も限局しているため，術前後の腰痛の変化を創部痛と区別して評価できる．術後早期の腰痛visual analogue scale(VAS)は下肢痛VASと同様に経過し，術前平均54mmが術翌日に32mmに軽減し，1週間後には13mmに軽快していた．日本整形外科学会腰痛疾患治療成績判定基準の腰痛点数は，術前1.8点が最終経過観察時に2.4点に改善していた．本研究の結果から，本症に伴う腰痛の病態の一つとして神経の圧迫が示唆された．

　The purpose of this study was to investigate the clinical results of microendoscopic decompression via a midline interspinous approach for low back pain associated with lumbar spinal canal stenosis (LSCS). We evaluated 62 patients with LSCS who underwent this procedure and whose postoperative course had been followed for over 3 years. We assessed their preoperative and postoperative low back pain, and evaluated the changes and the factors that affected them. The low back pain as well as the patients' leg pain improved in the early postoperative period. There was no significant relationship between the clinical results and patient age, the number of segments decompressed, type of neurological disorder, or the presence of lumbar spondylolisthesis. We concluded that the low back pain was caused by compression of the nerve tissue in LSCS, and that it was improved by the decompression.