腰部脊柱管狭窄症に対する後方除圧術の術式による比較研究―片側進入両側除圧術と棘突起骨切りアプローチによる椎弓切除術

Comparative Study of Surgical Methods of Treating Lumbar Spinal Canal Stenosis : Bilateral Decompression by a Unilateral Approach Versus Laminectomy with Osteotomy of the Spinous Process

　腰部脊柱管狭窄症に対する2つの術式を比較検討した．対象は片側進入両側除圧術28例と棘突起骨切りアプローチによる椎弓切除術19例である．日本整形外科学会腰痛疾患治療成績判定基準(JOAスコア)は両群とも術後有意に改善したが，改善率は骨切り群で有意に優っていた．最終調査時の腰痛は全くないか，あっても鎮痛薬を要さない程度のものがほとんどであった．術後に不安定性が増大した症例はなかった．棘突起骨切りアプローチによる椎弓切除術は，広い視野のもと安全に除圧が行える有用な術式である．

　We compared the results of two surgical methods of treating lumbar spinal canal stenosis.　The group treated by bilateral decompression via a unilateral approach (28 cases) and the group treated by laminectomy with osteotomy of the spinous process (19 cases) both showed significant improvement in their JOA scores postoperatively, but the average improvement in JOA score was significantly higher in the spinous process osteotomy group.　At the final follow-up examination most patients in both groups had no low back pain or only occasional minimal pain that did not require medication.　None of the patients was found to have postoperative progression of instability at the affected level.　Laminectomy with spinous process osteotomy is a safe procedure that provides an excellent outcome for lumbar spinal canal stenosis.