第5腰椎分離症に対し経皮的操作による分離部修復術を施行した1例

Repair of L5 Lysis by Percutaneous Screw-rod-hook Technique. Case Report

　症例はラグビー部所属の16歳男性で，保存療法無効の第5腰椎分離症による腰痛を主訴に来院した．両側第5腰椎分離症に対し，鏡視下経皮的screw-rod-hook法による分離部修復術を施行した．術後，腰痛は消失し良好な成績が得られた．本術式はスクリューやフック設置を経皮的に，分離部修復，骨移植の操作を鏡視下に行う．適応の制限や長期成績の欠如などの問題点もあるが，従来法に比べて筋組織の剝離が少なく低侵襲でスポーツ復帰に有利であると考えられた．若年者の分離症に対する手術療法の選択肢の1つとなりうる．

　A 16-year-old man came to our hospital with low back pain due to L5 spondylolysis after conservative treatment had failed.　We repaired the bilateral L5 lysis by endoscopic and percutaneous screw-rod-hook fixation.　The low back pain resolved after surgery, and the result was excellent.　The procedure consisted of percutaneously inserting pedicle screws, rods, and hooks, and transplanting a bone graft endoscopically.　Our technique has a limitation, i.e., we have to make another incision for harvesting the bone graft, for the lysis of upper lumber spine.　Although we do not know the long-term outcome, our technique is less invasive than conventional techniques, because there is less damage to the paraspinal muscles.　Thus, it is more advantageous in terms of the patient's activity and return to sports.　Our technique is one option for the treatment of juvenile L5 lysis.