脊椎腫瘍に対するSpinal Instrumentation Surgeryの1例—重複癌への施行例について

Instrumentation Surgery for the Tumor of the Spine

I．はじめに

　Spinal Instrumentation Surgery（SI）は近年めざましい発展を遂げ，各種脊椎疾患の外科治療成績の向上に貢献している．特に脊柱変形の矯正・固定，損傷脊柱の整復，神経障害の改善・除痛等を目的に行われ，その意味では脊椎腫瘍はSIが適応となる疾患の1つであり，脳神経外科領域でも注目を浴びつつある．今回われわれは，頸椎の多発性骨髄腫に前立腺癌を合併した重複癌に対し，SIを施行し良好な結果を得たので報告する．

Spinal instrumentation surgery has come into wide use recently, especially for tumor of the spine. It is very effective for fixing the spine for relieving the patient from pain. But the decision about the indication of in-strumenation surgery for tumor of the spine must be made carefully. In cases of double malignant tumors in-cluding spinal tumor, it is hard to decide how to treat tumor of the spine. We report a case of 78-year-old male with multiple myloma of the cervical spine and cancer of the prostate. The patient had been in good health until one year previously, when he started to complain of nuchal pain. He became bedridden with loss of voluntary control of the right upper extremity for the last two months. Then he was admitted to our hospital and radiological examination was carried out. It revealed tumor of the cervical spine and it seemed to be bone metastasis. Further examination revealed that the patient was suffering from multiple myeloma and cancer of the prostate. The tumor of the spine was dia-gnosed as either multiple myeloma or metastasis of cancer of the prostate. Spinal instrumentation surgery using Luque-rod was carried out as one of the compre-hensive treatment plans for double malignant tumors. The instrumentation surgery was effective for fixing the spine and improving the patient's quality of life. In operative procedures, intraoperative spinal cord moni-toring was carried out. Intraoperative spinal cord moni-toring was indispensable for preventing spinal cord in-jury. The tumor of the spine was diagnosed as multiple myeloma by pathological examination. Further treat-ment for double cancer was performed and the patient came to be able to stroll in a wheelchair. The patient died due to renal failure 139 days after surgery, but the patient's quality of life had undoubtedly improved.

Therefore instrumentation surgery was thought to improve the patient's quality of life.