超音波骨メスが有効であった腰椎椎間孔狭窄症の1手術例

Foraminal Stenosis of the Lumbar Spine Treated by Decompression with an Ultrasonic Bone Curette：A Case Report

Ⅰ．はじめに

　腰椎椎間孔狭窄症は神経根性症状を呈する重要な疾患の1つであるが，診断が困難な部位であり，failed back surgeryの原因の1つに挙げられている¹³⁾．今回われわれは，関節突起間部の骨棘による腰椎椎間孔狭窄に対して，超音波骨メスを用いた外側開窓法を行い，良好な手術結果を得たので報告する．

　Lumbar foramimal stenosis is one of the important disorders underlying radicular symptoms and unrecognized or recurrent foraminal stenosis may result in failed back surgery. We report a 47-year old man with foraminal stenosis of the lumbar spine associated with a bone spur at the pars interarticularis. He suddenly experienced severe right leg pain, lumbago and gait disturbance. Radiographic studies revealed foraminal stenosis on the right L5/S1associated with a bone spur at the pars interarticularis. There was no dural sac compression by spondylolysis. As his symptoms failed to respond to conservative treatment, he underwent decompression without fusion with an ultrasonic bone curette.

We performed lateral fenestration and foraminotomy at the right L5/S1 using the extraforaminal approach. After partial foraminotomy, the right L5 nerve root was compressed by the bone spur at the pars interarticularis. For satisfactory decompression we removed the bone spur using an ultrasonic bone curette. His symptoms disappeared immediately after surgery.

　Although long-term follow-up is necessary, we suggest that microdecompression with an ultrasonic bone curette is a useful method to treat patients with foraminal stenosis of the pars interarticularis.