大後頭孔部脊髄腫瘍術後に発生し，治療に難渋した頸椎後彎変形の1例

Postlaminectomy Kyphosis of the Cervical Spine Complicating Spinal Cord Tumor in the Foramen Magnum

I．はじめに

　椎弓切除術後の頸椎後彎変形は，成人では比較的稀とされている^1-11）．今回われわれは，大後頭孔部脊髄腫瘍の治療のための2回の椎弓切除術で悪化し，治療に難渋していた頸椎後彎変形の1症例を経験し，サルベージ手術として，後頭・頸・胸椎後方固定術を施行し良好な結果を得た．この論文ではその臨床経過を報告し，治療上の問題点を論じる．

Postlaminectomy kyphosis is rarely encountered as a sequela of decompression of the upper cervical spine, especially in adults. We present a case of disabling cer-vical kyphosis which developed after laminectomy for excision of a foramen magnum tumor and was treated successfully by occipito-vertebral fusion.

A sixty-one-year old female was treated by laminec-tomy of the first through to the third cervical spine for a foramen magnum meningioma. One year later, the laminectomy was extended downward to include the fourth through to the seventh cervical spine because of neurological deterioration. Seven years after the first laminectomy, she was referred to our spinal service be-cause of severe neck pain, numbness and muscle weak-ness of both upper extremities. Lateral X-ray of her cervical spine presented a severe kyphosis. Roentgeno-gram two months after the first laminectomy already showed slight deformity and, timewise, it corresponded with the time when the patient experienced neurologic-al deterioration. Subsequent X-rays showed progression of kyphosis. After we confirmed a lessening of the pain and improvement of the neurological symptoms during an axial traction using a halo-vest, posterior occipito-cervico-thoracic fusion was performed using Luque seg-mental spinal instrumentation and autogenous bone graft. After surgery the pain decreased and neurologic-al symptoms improved. It is important to be aware of the complication of kyphotic deformity after laminec-tomy and once it has developed, it is recommended to stabilize the progression by early spinal fusion.