頚椎前方除圧固定術—解剖の理解に基づいた安全な手術操作とコツは？

Anterior Cervical Discectomy and Fusion:Safe Surgical Operation Based on Detailed Anatomical Knowledge

Point

・頚椎前方除圧固定術は，米国の脳神経外科医が開発し，長きにわたり改良され，受け継がれてきた信頼性が高い治療方法である．

・頚椎は運動器として動きながら頭蓋を支える側面をもつため，脊髄への圧迫も「動態」での評価が必要であり，「固定」することで圧迫を解除することは理にかなっている．

・この方法を安全かつ効果的に行うためには，局所解剖を十分に理解し，術中の操作に取り入れることが大切である．

　Anterior cervical discectomy and fusion（ACDF）was developed by R.B. Cloward in the 1950s and it has spread over the world for the treatment of the spinal degenerative disorders. It is considered to be the most effective treatment for patients with anterior compression of the spinal cord. Because most of the surgical complications reportedly occur while approaching the vertebral column through the subcutaneous tissues, precise knowledge of the topographic anatomy of the neck is crucial for effective and safe surgery.

　In this paper, we describe the appropriate surgical maneuvers in each surgical step, based on anatomical knowledge, for avoiding surgery-related complications. We would like to emphasize that anatomical features differ with individual patients; therefore, careful preoperative evaluation is very important. Surgical strategy, based on adequate preoperative evaluation, will lead to good postoperative results.