Tight filum terminaleの術後成績―若年発症と成人発症の比較

Outcomes of Surgery for Tight Filum Ferminale. Comparison between Adolescent-Onset and Adult-Onset Cases

　Tight filum terminaleの術後成績に関して，若年発症と成人発症の回復過程を比較検討した研究は渉猟し得た範囲ではいまだみられていない．当科で終糸切離を施行し術後6カ月以上経過観察した18例について，10代で発症した5例(A群)と20代以降で発症した13例(B群)の2群に分け，臨床症状，神経学的所見および術後成績について比較検討した．主訴は両群とも腰痛または下肢痛で大差なく，神経学的所見も明らかな違いはなかった．術前のJOAスコアはA群が平均15.5点，B群が平均15.2点と差はないが(p＝0.98)，術後2カ月ではA群25.8点，B群19.8点とA群の回復が良好で(p＝0.01)，術後6カ月ではA群28.3点，B群23.6点とともに回復するもA群の回復が有意に優れていた(p＝0.003)．今回の調査から，若年発症のtight filum terminaleは終糸切離により成人発症よりも速やかにかつ良好な改善が得られることが示唆された．

　No studies have compared the recovery process after surgical transection of a tight filum terminale in adolescent-onset and adult-onset cases.　The subjects of this study were 18 patients who underwent transection of the filum terminale in our department and who could be followed up for more than six months postoperatively.　The subjects were divided into two groups according to their age of onset：a group of five patients whose onset was in their teens (group A) and a group of 13 patients whose onset was in their twenties or later (group B).　The symptoms, neurological findings, and postoperative outcomes of the two groups were compared.　The chief complaints, back pain and leg pain, were similar in both groups, and there were no differences between the groups in neurological findings.　Although the mean preoperative JOA scores in the two groups were not significantly different (group A 15.5 and group B 15.2；p＝0.98), at two months postoperatively recovery was more satisfactory in group A (group A, 25.8 points；group B, 19.8 points；p＝0.01).　Moreover, while the patients in both groups had recovered at six months postoperatively, recovery was better in group A than in group B (28.3 points and 23.6 points, respectively：p＝0.003).　Our findings suggest that a satisfactory outcome can be achieved after transection of the filum terminale in adolescent-onset cases than in adult-onset cases.