頸椎後縦靱帯骨化による頸髄障害の手術法の研究—ならびに本骨化とその近縁疾患との関連についての考察

SURGICAL TREATMENT OF CERVICAL MYELO-PATHY DUE TO THE OSSIFICATION OF THE POSTERIOR LONGITUDINAL LIGAMENT

　頸椎後縦靱帯骨化による頸髄障害に対する手術法は，まだ確立されておらず，前方固定術^{3）23）7）}，減圧椎弓切除術^{2）16）17）7）}あるいは両者併用^3）18）など種々の論議がある。著者はこの手術法について，まず屍体を用いて研究し，Bilateral multiple facetectomy, extensive laminecto—my with or without foramen magnum decompressi—onが合理的であることを知り，1964年以降，10例に本法を行ない，最長6年有余の観察で，好結果を得た。

　レ線上，本骨化の初期変化を含めて，18例の頸椎後縦靱帯骨化について，脊椎全般のレ線学的検索を行なつた。そして，本症とCervical spondylosis, Forestier's senileankylosis hyperostosis^20）との関連について考察した。

Surgical procedure presented here was evolvedfrom observations either in cadavers or in the cer-vical vertebral columns removed en bloc at autopsy.Ventro-doral pressure was excerted to the ventralaspect of the dural tube through a burr hole placedin the vertebral bodies and the effects of dorsalmigration were compaired between the cases with laminectomy alone and with laminectomy plusbilateral facetectomy. More extensive dorsal migra-tion was obtained by bilateral facetectomy pulslaminectomy. No limitation of movement of cer-vical cord was observed by the dentate ligament tothe ventro-doral pressure.

Ten case of the ectopic ossification of the post-erior longitudinal ligament producing spinal cordcompression have been described. Although thisdisease may represent a different manifestation ofthe degenerating changes, this disease should beincluded in the differential diagnosis of cervicalmyelopathy because of its unique clinical, radiolo-gical and pathological behaviour and it seems toconstitute a distinct clinical entity. Ten patientstreated by the extensive decompressive laminectec-tomy with or without foramen magnum decom-pression associated with bilateral multiple facetec-tomy had favorable results. Postoperative myelo-graphy demonstrated the rationale with dorsalmigration of the entire dural contents.