腰椎変性すべり症に対する内視鏡下除圧術後の腰痛に関する検討―日本整形外科学会腰痛評価質問票とVisual Analogue Scaleを用いた解析

Low Back Pain after Microendoscopic Decompression for Degenerative Lumbar Spondylolisthesis : Clinical Analyses Based on Visual Analogue Scale (VAS) Scores and the Japanese Orthopaedic Association Back Pain Evaluation Questionnaire (JOABPEQ)

　背景：腰椎変性すべり症に対する内視鏡下除圧術後の腰痛や，術前および術後の不安定性を詳細に検討した報告はない．

　対象と方法：腰椎変性すべり症に対する内視鏡下除圧術後の腰痛の改善度を日本整形外科学会腰痛評価質問票(JOABPEQ)とVisual Analogue Scaleを用いて評価し，不安定性との関連を検討した．

　結果：腰痛の改善は概ね良好であり，腰痛の改善に伴って他の障害や下肢症状も改善した．すべりや不安定性は腰痛の改善との間に有意な関連はなかった．

　まとめ：術後に腰痛が改善しない主因は，すべりや不安定性の残存または悪化よりも，神経根や馬尾障害の改善不良であると考えられ，腰椎変性すべり症の腰痛の主因はすべりや不安定性よりも，神経根や馬尾の圧迫である可能性が示唆された．

　Background：This study was undertaken to determine the influence of spondylolisthesis or instability on low back pain (LBP) after microendoscopic decompression (MED) for degenerative lumbar spondylolisthesis (DS).

　Method：MED was performed to treat DS in 52 patients.　The duration of follow-up was 28.1±8.7 months.　Clinical outcomes were evaluated by using a Visual Analogue Scale (VAS) to assess pain and numbness and the Japanese Orthopaedic Association Back Pain Evaluation Questionnaire (JOABPEQ).　Lateral radiographs in flexion, extension, and the neutral position were obtained before and after MED to measure the intervertebral angles and percentages of slipping.

　Outcome：LBP according to the VAS scores and LBP assessed by the JOABPEQ had significantly improved after MED.　Spondylolisthesis and instability before and after MED had no influence on the improvement in LBP and on LBP after MED.　However, the improvement in LBP was significantly correlated with the other four functional scores assessed on the JOABPEQ and with the improvement in leg pain and numbness assessed on the VAS.

　Conclusion：These findings suggest that radicular and/or cauda equina compression may be a cause of LBP in patients with DS.