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Neurological Surgery No Shinkei Geka Volume 36, Issue 10 （October 2008）

Neurological Surgery 脳神経外科 36巻10号（2008年10月発行）

Japanese English

症例

頸椎前方手術の稀な合併症例―Horner症候群 Rare Complication of Anterior Spinal Surgery: Horner Syndrome 安本幸正 ¹ , 阿部祐介 ¹ , 堤佐斗志 ¹ , 近藤聡英 ¹ , 野中宣秀 ¹ , 伊藤昌徳 ¹ Yukimasa YASUMOTO ¹ , Yusuke ABE ¹ , Satoshi TSUTSUMI ¹ , Akihide KONDO ¹ , Senshu NONAKA ¹ , Masanori ITO ¹ ¹順天堂大学医学部附属浦安病院脳神経外科 ¹Department of Neurosurgery, Juntendo University Urayasu Hospital キーワード： anterior cervical surgery , Horner syndrome , cervical sympathetic trunk , longus colli muscle Keyword: anterior cervical surgery , Horner syndrome , cervical sympathetic trunk , longus colli muscle pp.911-914

発行日 2008年10月10日 Published Date 2008/10/10

DOI https://doi.org/10.11477/mf.1436100822

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Abstract 文献概要
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参考文献 Reference

Ⅰ．はじめに

　Horner症候群は頸部腫瘍，肺尖部癌または外傷や頸部手術に合併することが知られているが，頸椎前方手術においてHorner症候群が合併する率は，1989年までの報告では0.2～4％^2-4,7,8,13)であり，稀な合併症である．最近の英文文献検索では，頸椎前方中央部から到達する除圧固定術の合併症としてHorner症候群に関する報告は渉猟し得ず，Horner症候群は通常の頸椎前方手術合併症として，認識されなくなっていると想像され，われわれは患者への手術説明の際に，Horner症候群の合併について言及していなかった．

　今回われわれは，頸椎症に対し行った前方中央部から侵入した徐圧固定術直後にHorner症候群が合併した症例を経験したので報告するとともに，頸部交感神経幹に関する解剖学的文献から外科解剖について考察する．

　Horner syndrome due to injury to the cervical sympathetic trunk (CST) is a very rare complication of anterior cervical decompression and fusion (ACDF). We have not mentioned the possibility of Horner syndrome as a postoperative complication in patients before surgery. We present a patient with Horner syndrome after ACDF and discuss the anatomical background of the CST and the causes and preventative measures against postoperative Horner syndrome.

　A 48-year-old man presented with disturbance of fine movement and reduction of grasping power in the right hand. MRI revealed osteophytes and a prolapsed disc compressing the spinal cord at C5-6 and C6-7. Two-level ACDF with inclusion of titan cages was performed via a right-sided exposure. Anisocoria (right ＞ left) and right blepharoptosis were observed immediately after surgery. Postoperatively, disturbance of fine movement was resolved. Japanese Orthopaedic Association (JOA) score improved from 12 to 16. Horner syndrome disappeared at 6 months after surgery.

　The CST runs 10-15mm lateral to the medial edge of the longus colli muscle (LCM) and exists in the loose fascia and approaches most medially at C6. During the decompressive procedure under microscopic viewing, the right blade of a retractor was found to come out of the medial edge of the LCM on the level of C6. It is postulated that the blade injured the right CST.

　Knowledge of the anatomical relation between the CST and the LCM is very important to avoid Horner syndrome in ACDF. The tip of a retractor blade must be placed between the medial edge of the LCM and the vertebral body.