頚椎椎弓根スクリュー固定における新たな後外側アプローチ

New Posterolateral Approach for Minimally Invasive Cervical Pedicle Screw Fixation

　背景：頚椎椎弓根スクリューは固定力が強く臨床に広く応用されているが，椎骨動脈損傷の危険性がある．

　対象と方法：脱臼骨折をはじめとした頚椎疾患13例を対象とし，小皮切で後外側から進入し椎弓根スクリュー固定・骨移植を行った．スクリューの逸脱，手術時間，出血量を検討した．

　結果：椎骨動脈損傷の危険性のある外側への逸脱はなかった．手術時間は平均181分，出血量は平均98mLであった．

　まとめ：本アプローチは出血や手術時間の短縮に加え，外側から進入するため椎骨動脈損傷の危険性を低減させる可能性があると考える．

　Background：Cervical pedicle screw (CPS) fixation provides greater mechanical strength than fixation by other methods, but it entails the risk of vertebral artery injury.

　Materials and methods：The subjects were 13 patients with cervical spinal injury and degenerative disease.　CPS fixation was performed via a small posterolateral skin incision, and iliac bone grafting was also performed.　Screw deviation, surgery time, and blood loss were assessed.

　Results：No lateral deviation of the CPS, which is considered a risk factor for vertebral artery injury, was observed.　Average operative time was 181 minutes, and average blood loss was 98 ml.

　Conclusion：This new posterolateral approach has the potential to reduce vertebral artery injury.　Less blood loss and a shorter operative time can also be expected.