脊椎脊髄手術における手術前後患者管理

Perioperative Management of Spine and Spinal Cord Surgery

Point

・各脊椎レベルに応じた知識を身につける．

・気道閉塞，硬膜外血腫，髄液漏は緊急対応を要する．

・頚椎手術では，窒息，食道損傷，反回神経損傷，C5麻痺，硬膜外血腫が生じる．

・胸椎は脊髄虚血に弱く，術後硬膜外血腫や髄液漏により重症化しやすい．

・腰椎手術では，硬膜外血腫や髄液漏，創部感染が主要な合併症である．

　Spinal surgery is primarily performed to improve neurological function; compared with intracranial surgery, it is rarely conducted to address life-threatening conditions. As the goal of treatment is functional recovery, postoperative complications must be minimized. Appropriate perioperative management is therefore essential, and includes careful preoperative neurological evaluation; postoperative monitoring of neurological, respiratory, and circulatory status; and early detection and management of complications.

　Several complications of spinal surgery require attention. Firstly, airway obstruction caused by cervical swelling after anterior cervical surgery, postoperative epidural hematoma leading to neurological deterioration, and cerebrospinal fluid (CSF) leakage are the major complications requiring urgent intervention. Cervical spine surgery has several characteristic complications, depending on the surgical approach; for example, anterior procedures may cause airway compromise, esophageal injury, or recurrent laryngeal nerve palsy, whereas posterior procedures are more commonly associated with C5 palsy and surgical site infection.

　Thoracic spine surgery requires careful postoperative management as the spinal canal is relatively narrow, while the spinal cord is vulnerable to ischemia. In lumbar spine surgery, symptoms primarily involve the cauda equina, while major complications include epidural hematoma, CSF leakage, and surgical site infection. Appropriate perioperative evaluation and prompt management of complications at the spinal level are essential for achieving favorable surgical outcomes.