神経麻痺を生じた骨粗鬆症性椎体骨折に対する手術治療―棘突起フックシステムを併用したshort-segment fusionの治療成績

Surgical Treatment of Osteoporotic Vertebral Fractures with Neurologic Deficits. Results of Short-Segment Pedicle Screw Fixation Combined with a Spinous Process Hook System

　背景：神経麻痺を有する骨粗鬆症性椎体骨折に対する1 above- 1 belowの椎弓根スクリューと棘突起フックシステムによる固定法の術後成績を報告する．

　方法：骨粗鬆症性椎体骨折による麻痺と診断された11例について，麻痺の回復，腰背部痛，局所後弯角，椎体楔状率などを調査した．

　結果：麻痺，腰背部痛は全例で改善し独歩可能となった．局所後弯角と椎体楔状率は術直後に改善したが，最終時には術前レベルまで矯正損失した．

　考察：本法は矯正位を保持できなかったが，麻痺と腰背部痛を改善することができ有用な手術法と思われた．

　Objective：To evaluate the results of short-segment pedicle screw fixation combined with a spinous process hook system in patients with osteoporotic vertebral fractures and neurologic deficits.

　Methods：Eleven patients with a total of 13 fractures were the subjects of this retrospective case review.　We assessed the state of paralysis by the modified Frankel grading system and lower back pain by the Denis pain scale.　The kyphotic angle and wedge ratio of the fractured vertebra were measured radiographically.

　Results：Although we were unable to maintain the postoperative kyphotic angle and wedge ratio, the neurological deficits and lower back pain of all patients had improved at the time of the final examination.

　Conclusion：The results indicate that short-segment pedicle screw fixation combined with use of a spinous process hook system is an effective treatment for osteoporotic vertebral fractures with neurologic deficits.