後方進入腰椎椎体間固定術を安全に行うための手法：椎間関節全切除―従来法との合併症比較

Total Facet Excision Can Reduce Neurological Complications of Posterior Lumbar Interbody Fusion

　背景：後方進入腰椎椎体間固定術(PLIF)において椎間関節を全切除すると外側の操作空間を広く取ることができ，神経根の術中牽引も少なくできる．

　方法：この手法により周術期神経合併症が減少したかどうかを検討した．

　結果：46例の変性すべり症において全合併症は11例(24％)，神経合併症は9例(20％)であった．重度の筋力低下例や麻痺が後遺した症例はなくすべて一過性であった．

　まとめ：椎間関節を部分的に残して行っていた以前のPLIFと比較すると神経合併症は少なく，椎間関節全切除は特別な器具を必要とせずに神経合併症を減らす有用な方法であることが示唆された．

　Methods：Postoperative complications of posterior lumbar interbody fusion (PLIF) were retrospectively investigated in 46 patients who had undergone of total resection facet joints.

　Results：Although transient postoperative neurologic complications had occurred in 9 patients (20%), none of the patients experienced severe or permanent paralysis.　There were fewer conplications in this series of cases than among the cases in our previous report, in which PLIF with partial facetectomy had been performed and neurologic complications developed in 25% and permanent paralysis in 8%.

　Conclusion：Since total facetectomy facilitates safe access to the disc space with less need for nerve retraction,it can be a useful option for PLIF.