術後早期からのリハビリテーション治療により新生児の育児が可能となった，脊髄腫瘍による運動麻痺が生じ緊急分娩・腫瘍摘出術を施行した産褥期女性の1症例

Early Postoperative Rehabilitation for a Postpartum Woman with Motor Paralysis due to Spinal Cord Tumor Who Could Raise a Newborn Child after Emergent Delivery and Tumor Removal : A Case Report

はじめに

　脊髄腫瘍は脊髄疾患の中でもまれな疾患である¹⁾．脊髄腫瘍による身体症状の1つに腰痛がある¹⁾．一方，妊娠中の腰痛は頻度の高い症状であり，妊婦の2/3以上に認められると報告されている²⁾．そのため，妊娠中に生じた脊髄腫瘍による腰痛は妊娠関連のホルモンの変化や筋骨格系障害と判断されやすい³⁾．また，妊娠中は胎児への影響を考慮し不必要な被曝を避けるよう画像検査を慎重に行うため⁴⁾，妊娠中の脊髄腫瘍の早期発見は困難である．

　脊髄腫瘍の機能予後を規定する因子として，症状出現から手術を受けるまでの期間^{5, 6)}や術前歩行状態^{5, 6)}，神経圧迫の程度⁷⁾が報告されている．そのため，妊娠のため発見が遅れた脊髄腫瘍患者の機能予後は悪い可能性があるが，妊娠を伴う脊髄腫瘍患者の術後の身体機能の回復過程やリハビリテーション治療の効果に関する報告はほとんどみられない．

　今回，妊娠関連腰痛と考えられていたが，下肢麻痺により歩行困難となり，緊急入院，脊髄腫瘍診断，緊急分娩，腫瘍摘出術となった患者を担当したため，そのリハビリテーション治療経過を報告する．なお，本報告は症例に対して十分な説明を行ったうえで，口頭および書面にて同意を得ており，ヘルシンキ宣言に基づく倫理的配慮を十分に行った．

We report a case of a 32-weeks pregnant woman in her early 30s. The patient experienced pregnancy-related low back pain and difficulty walking due to rapid muscular weakness in her lower limbs. She was diagnosed with lower limb paralysis caused by the spinal cord tumor and underwent emergency cesarean section for maternal indication, followed by laminectomy and tumor removal. After 3 days of surgery, rehabilitation interventions, including early mobilization, muscle strengthening training, balance training, and activities of daily living (ADL) training, were performed to improve voluntary movement and muscle strength in her lower limbs and ADL. Prior to rehabilitation, the patient showed lower limb muscle weakness in manual muscle test 1 (MMT1) due to motor paralysis, required assistance for walking, and expressed anxiety about the degree of recovery of her physical functions and her role as a mother. After approximately 1 month of rehabilitation, the patient was able to perform ADL independently and was discharged from the hospital with physical functions that allowed her to take care of her newborn baby. It is important to provide positive rehabilitation intervention from the early postoperative period, according to the guidelines for the disability caused by primary diseases, as well as care and movement guidance before discharge, considering the changes in mental and physical symptoms during the postpartum period in a woman with a spinal cord tumor.