胸部脊髄症の神経症候

Neurological Manifestations of Thoracic Myelopathy

　背景：胸部脊髄症の術前症候に対する統計的に詳細な検討はされていない．

　方法：胸部脊髄症に対し手術を施行した203例の術前症候を原因疾患・圧迫高位・罹病期間から多変量解析を用いて詳細に検討した．

　結果・まとめ：圧迫高位と症候の関連としてT10/11前方圧迫と下肢筋力低下，T11/12圧迫と腰痛，T11/12前方およびT12/L1前方圧迫と下肢痛，T12/L1前方圧迫と下垂足，T11/12圧迫およびT12/L1前方圧迫と膝蓋腱反射低下が抽出された．罹病期間は重症の症状(下肢脱力感や下肢筋力低下)や胸椎精査の契機となる症状(背部痛)では短く，下肢つっぱり感のような軽症の症状や腰椎疾患類似の症状(下肢痛)で長かった．

　Background：No previous studies have investigated the preoperative manifestations of thoracic myelopathy in a large patient population.

　Methods：We assessed 203 patients who underwent surgery for thoracic myelopathy in order to determine whether there were associations between their preoperative manifestations and clinical/radiographic findings, which included compressed segments, causative diseases, and interval between the time of the initial manifestation and surgery, by means of a multivariate analysis.

　Rusults＆Conclusions：significant associations were found between preoperative manifestations and compressed segments, including between T10/11 anterior compression and lower limb muscle weakness;T11/12 compression and low back pain;T11/12 anterior and T12/L1 anterior compression and lower limb pain;T12/L1 anterior compression and drop foot; and T11/12 or T12/L1 anterior compression and diminished patellar tendon reflexes.　Unexplained complaints, such as "abnormal tightness in the lower limbs" and lower limb pain, which might be confused with lumbar disease, tended to lengthen the interval before surgery.　In contrast, severe manifestations that impair activities of daily living, typified by loss of lower limb strength and lower limb muscle weakness, significantly shortened the interval before surgery as did middle back pain, which can lead physicians to search for thoracic lesions.