前方掻爬，後方インストゥルメンテーション固定を行った腰仙椎カリエスの1例

Lumbosacral Spinal Caries Treated by Anterior Curettage and Posterior Fusion with Instrumentation. Case Report

　腰仙椎の結核性脊椎炎に対して前方掻爬術，後方インストゥルメンテーション手術を行い良好な成績を得た．症例は67歳の女性で腰下肢痛，下肢不全麻痺，排尿障害を認めた．L3椎体から仙骨にかけての病巣と仙骨前面の巨大膿瘍を認めた．手術は病巣掻爬（前方）と二期的に後方固定術を施行した．本症例は腰仙椎の広範囲にわたる病巣のため，病巣掻爬後の前方骨移植が不能であった．前方支持が得られず後方のみでの脊柱の支持を余儀なくされたが，インストゥルメンテーションによる強固な固定が得られ，極めて有用であった．

　We encountered a 67-year-old woman with tuberculous spondylitis. An MRI study revealed lesions of the vertebral bodies extending from L3 to S1 and a mass lesion on the anterior surface of the sacral bone. The first curettage of the vertebral lesions was performed. Since bone grafting could not be performed and anterior support for the spine was inadequate, we performed a posterior reconstruction of the spine with instrumentation as a secondary surgery. At present, the patient has not suffered from any lower back pain for three years since the surgery. Imaging examinations also revealed the absence of any instrument failure or evidence of relapse of the tuberculosis. Our experience with this case highlights the potential utility of spinal instrumentation. However, the long-term results of using instrumentation for the treatment of tuberculous spondylitis must be taken into consideration, and meticulous attention must be paid to the use of instruments in infected lesions.