Microsurgical Lumbar Discectomy 270例の検討

Clinical Analysis of 270 Cases of Microsurgical Lumbar Discectomy

I．はじめに

　腰椎椎間板ヘルニアは日常よく見られる疾患であり，治療の主体は各種の保存的療法であるが，これらの保存的療法が無効の場合にはさまざまな外科的療法が行われている．しかしながらこれら腰椎椎間板ヘルニアに対する手術は，患者の活動制限の期間を短くし得るが，将来におけるヘルニアの再発は予防し得ないとの意見^15）や，ヘルニア除去後には，上下の椎間に過重な負荷が加わって，新たに異なるレベルにヘルニアが生じるとの意見もみられ，実際ある程度の再手術はいずれの手術法においてもみられている^{1,5,8-10,13-15,18-20,22,23,26-28,29-31,33,35,36）}．このたび腰椎椎間板ヘルニアの270例に対して行ったmicrosurgical lumbar discectomyにつき，その術式について述べ，その術後成績を検討した．特に再手術を必要とした症例については詳しく検討を行った．考察では腰椎椎間板ヘルニアにおける外科的療法の問題につき論じた．

Abstract

Since 1983, the authors encountered 270 cases of lumbar disc hernia, which were operated on with the microsurgery. In the present study, the operative proce-dures were described and the results, especially the re-sults of the reoperations were examined. Good results were obtained in 252 patients (93%) . In nine patients, some kind of lumbago continued, which required other treatments, such as epidural blook (3.3%). Reoperations were performed in nine patients (3.3%). In lumbar dis-cectomy, extent of removal of the bony structures and the disc material seemed important. In “microlumbar discectomy”, which was advocated by Williams, only the flavectomy with no bony structure removal was performed. In this procedure, discectomy is limited to the protruded disc material. On the contrary, some au-thors, who also adopt microsurgical lumbar discectomy as Wilson and Hudgins do, perform subtotal removal of the disc material with removal of some bony structures. In the present series, microsurgical lumbar discectomy following the procedures advocated by Wilson et al was performed. Reoperations after lumbar discectomy have been reported after all kinds of operations. In the present series, the rate of reoperation was 3.3%. As to the reasons for reoperations, true recurrence of disc hernia was the most prevalent. The hernias recurred at the same level and on the same side. Adhesion or fibro-sis around the nerve root also played an important role. From the results of the present study, microsurgical lumbar discectomy with good illumination and high magnification has proved to bring satisfactory results. Recurrence, however, can occur after this procedure, so further inventions are required to ensure more satisfac-tory results.