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Neurological Surgery No Shinkei Geka Volume 43, Issue 5 （May 2015）

Neurological Surgery 脳神経外科 43巻5号（2015年5月発行）

Japanese English

研究

変性すべり症に対する減圧術単独の長期成績—不安定性例も含めて Long-term Results Regarding the Instability 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 , lumbar canal stenosis laminotomy , laminectomy , instability Keyword: degenerative spondylolisthesis , lumbar canal stenosis laminotomy , laminectomy , instability pp.419-427

発行日 2015年5月10日 Published Date 2015/5/10

DOI https://doi.org/10.11477/mf.1436203040

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Abstract 文献概要
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参考文献 Reference

Ⅰ．はじめに

　腰椎疾患の病態や治療法を考える上でinstabilityの有無は重要な因子であり，減圧術を行うにあたっては固定術の併用を示唆する所見ともされている^{1,3,7,8,11,15,23)}．また，術後のinstabilityの発生は予後不良の兆候とされている⁹⁾．しかしながら，instabilityについては臨床上もX線撮影上も明確な定義はなく，その意義についても議論が多い^11,16,21,24)．筆者らは，変性すべり症を伴う腰部脊柱管狭窄症例に構造を極力温存するless invasive surgery（開窓術）を行った場合，固定術を併用せずとも術後すべりは悪化せず，長期的に良好な成績が維持されることを報告した²⁰⁾．しかし，instabilityを合併する症例にみられる問題点については未検討であった．そこで，今回はすべり症のみならずinstabilityを有する例に固定術を併用せずに減圧術単独で手術を行った場合，術後すべりやinstabilityが悪化し，臨床症状や手術成績が悪化する危険性はないのかといった点を中心にretrospectiveな検討を行った．

　Purpose:The long-term results of decompressive surgery for degenerative spondylolisthesis（DS）were evaluated with reference to instability.

　Materials and Methods：Patients（n＝48）undergoing decompressive surgery without fusion were studied. The diagnosis of spondylolisthesis was made based on the presence of sagittal vertebral slippage greater than 3mm. Instability was defined as translation more than 2mm on lateral functional radiography. Surgical interventions were divided into two groups：bilateral laminotomy（n＝25）and laminectomy（n＝23). Clinical results were evaluated according to the McCulloch's classification and Japanese Orthopedic Association（JOA）score.

　Results:Of 48 patients, 25 showed preoperative instability. Eleven patients showed both pre-and postoperative instability. The mean pre-and postoperative slippages were 7.5 and 7.6mm, respectively. Of 23 patients without preoperative instability, nine developed postoperative instability. In this group, slippage changed from 6.2 to 6.1mm. Instability was not related to slippage progression.

　Surgical results of patients undergoing laminotomy were superior to those undergoing laminectomy. The mean pre-and postoperative JOA scores and recovery rate were 14.5, 20.9, and 63.1 in instability group patients with laminotomy and 15.6, 23.2, and 59.0 in the non-instability group, respectively. Surgical results were similar and not related to preoperative instability. Low back pain（LBP）showed no correlation to the degree of slippage, instability, and surgery type. LBP improved in each group.

　Conclusions：Instability, defined by vertebral translation on lateral functional radiography, did not affect the surgical results of patients with DS treated with laminotomy.