L1／2椎間板ヘルニアの1手術例

L1-2 lumbar disc herniation:a case report

I．はじめに

　L1-2椎間板ヘルニアは，その発生頻度が0.1-0.7％と少なく，生理的・解剖学的にも下位腰椎椎間板ヘルニアとは異なった特徴を有する．今回われわれは，L1／2椎間板ヘルニアに対し，後方進入法によるmicrodiscec—tomy（Love法）を行ったので，治療上の問題点につき若干の文献的考察を加えて報告する．

A 49-year-old female presented a two-year history of pain in the right thigh and lower back. Neurological ex-amination on admission demonstrated weakness of the right iliopsoas and quadriceps, hypesthesia on the right L1-2 dermatome. Radiological examination including myelography, CT myelography and discography dis-closed an L1-2 herniated disc. Sagittal MRI also re-vealed an L1-2, an L4-5 and L5-S1 protruded disc. A posterior microcliscectomy (Love's method) was per-formed for the L1-2 disc. A controlateral protruded disc which compressed the L-2 nerve root was identi-fied and partially removed. The postoperative myelography showed residual disc. The patient was free from pain and regained normal sensorimotor func-tion. Love's posterior microcliscectomy has a disadvan-tage in that the operative field is limited. Careful sur-gical procedure was needed to avoid injury to nerve roots and the cauda equina in a tight L1-2 lumbar canal.