雑誌文献を検索します。書籍を検索する際には「書籍検索」を選択してください。

Neurological Surgery No Shinkei Geka Volume 42, Issue 12 （December 2014）

Neurological Surgery 脳神経外科 42巻12号（2014年12月発行）

Japanese English

研究

変性すべり症を伴った腰部脊柱管狭窄症に対する減圧術の長期予後 Long-term Results of Decompressive Surgery without Fusion for Degenerative Spondylolisthesis 佐々木修 ¹ , 中村公彦 ¹ , 梨本岳雄 ¹ , 山下慎也 ¹ , 矢島直樹 ¹ , 鈴木健司 ¹ , 斎藤明彦 ¹ Osamu SASAKI ¹ , Kimihiko NAKAMURA ¹ , Takeo NASHIMOTO ¹ , Shinya YAMASHITA ¹ , Naoki YAJIMA ¹ , Kenji SUZUKI ¹ , Akihiko SAITO ¹ ¹新潟市民病院脳神経外科 ¹Department of Neurosurgery, Niigata City General Hospital キーワード： degenerative spondylolisthesis , laminotomy , laminectomy , lumbar spinal stenosis Keyword: degenerative spondylolisthesis , laminotomy , laminectomy , lumbar spinal stenosis pp.1109-1117

発行日 2014年12月10日 Published Date 2014/12/10

DOI https://doi.org/10.11477/mf.1436200045

PDF(566KB)

有料閲覧

Abstract 文献概要
1ページ目 Look Inside
参考文献 Reference

Ⅰ．はじめに

　腰部脊柱管狭窄症には変性すべり症を合併することがあり，このような症例を手術するにあたっては，固定術を併用するか否かが問題となってくる．椎弓切除単独だと術後すべりが増強し，不安定性が発生，症状が悪化する可能性があるからである^{3,6,7,9,12,13,22,26)}．一方，すべり症があっても椎弓切除術単独で十分良好な成績が得られ，固定術は必要ないとする報告もあり^5,8,20)，意見の一致をみていない．椎弓切除術後にすべりが増強するのか，すべりが増強したとすると症候性となるのかといった疑問に明確な回答が与えられてないのが一因と言えよう．

　近年，椎弓切除の変法として，構造を極力温存したまま減圧を図るいわゆるless invasive surgeryが導入され，良好な成績が報告されるようになってきた^1,2,4,27,29)．このような低侵襲の減圧術を行えば固定術を併用せずともすべり症の悪化が減少し，良好な手術成績が得られる可能性が想定される．そこで今回変性すべり症を合併する腰部脊柱管狭窄症に対し，固定術を併用しない従来行ってきた椎弓切除術単独で手術した例と，less invasive surgeryを行った例の2群で，術後のすべり症と臨床症状の継時的変化をretrospectiveに比較検討した．

　Purpose:The long-term results of decompressive surgery for degenerative spondylolisthesis with symptomatic lumbar spinal stenosis were evaluated retrospectively with regard to the postoperative progression of slippage and clinical symptoms.

　Materials and Methods:The study included 53 patients who underwent surgery, and for whom follow-up of at least 5 years was conducted. Spondylolisthesis was diagnosed based on the presence of sagittal vertebral translation greater than 3mm on lateral radiographs. The patients were divided into two groups:Group Ⅰ:37 patients undergoing bilateral laminotomy, and Group Ⅱ:16 patients undergoing laminectomy. The clinical results were evaluated according to McCulloch's classification and the Japanese Orthopaedic Association（JOA）score.

　Results:The mean pre-and postoperative JOA scores were 14.6 and 22.9 in Group Ⅰ and 14.7 and 21.0 in Group Ⅱ, respectively. The JOA scores improved soon after surgery, after which the scores declined gradually in both groups. The recovery rate was 63.0% in Group Ⅰ and 43.7% in Group Ⅱ. The average amount of pre- and postoperative slippage was 7.3mm and 6.9mm in Group Ⅰ and 6.2mm and 6.9mm in Group Ⅱ, respectively. In Group Ⅰ, the slippage progressed within the first year, after which the degree of slippage slowly decreased to lower values than those observed preoperatively, whereas slippage progressed for 5 years before declining in Group Ⅱ. No correlations were observed between progression of slippage and clinical outcomes in either group.

　Conclusions:Laminotomy produces satisfactory long-term results both clinically and radiographically in patients with degenerative spondylolisthesis.