脊髄髄膜瘤に伴う高度脊柱後弯変形に対する後弯部切除（kyphectomy）6例の治療経験

Kyphectomy for Severe Kyphosis in Myelomeningocele Patients

　脊髄髄膜瘤に伴う高度脊柱後弯に対し後弯部切除(kyphectomy)を行った6例の手術成績ならびに手術満足度について調査した．手術時平均年齢は9.3歳であった．3例はプレート，3例はロッドで固定した．後弯角は術前132°から術直後56°に改善した．最終観察時の後弯角は66°と概ね矯正位を維持していた．一方，合併症は3件の術後後弯進行を含む計9件で，4例に追加手術を要した．手術満足度は3例で「非常に満足」，2例で「やや満足」と満足度は高かった．後弯部切除は，合併症は少なくはなかったが手術満足度が高く，後弯によりADL障害が強い症例には積極的に行うべき手術と考える．

　We retrospectively reviewed the surgical results of kyphectomy in 6 myelomeningocele patients with severe lumbosacral kyphosis.　We also assessed patient satisfaction with the surgery.　Mean age at surgery was 9.3 years (4－19), and the mean follow-up period was 5.5 years (1－9.5).　Short fusion was performed using a plate in three cases, and long fusion was performed using a spinal instrument in the other three cases.　An average of 2.7 (1－4) vertebrae were resected.　The mean kyphotic angle was 132° preoperatively, 56° postoperatively, and 66° at the final follow-up examination.　We identified 9 postoperative complications, including recurrence of the kyphosis, protruding hardware, deep infection, and spinal fluid leakage.　The complications required additional surgery in 4 of the 6 patients.　The results of the assessment of patient satisfaction showed that 5 of the 6 patients were “satisfied” or “slightly satisfied”, despite the complications.　In conclusion, we strongly recommend kyphectomy for the treatment of severe kyphosis in myelomeningocele patients despite the relatively high complication rate.