十歳台の腰椎椎間板ヘルニアをめぐる諸問題について

Clinical Evaluation of Lumbar Disc Hernia in the Teenagers

I．はじめに

　腰椎椎間板ヘルニアは，日常臨床においてよく遭遇する疾患であるが，この病態が十歳台に生じることは比較的稀なことである．しかし若年者腰椎椎間板ヘルニアでは，特異な問題点が含まれているために，従来から様々に論じられてきた．すなわち，若年者腰椎椎間板ヘルニアにおいては，その発生頻度，性差，発症誘因，成人例の腰椎椎間板ヘルニアとの臨床像の異同，椎間板自体の変性の程度，診断上の問題点，治療法および予後などが問題となるが，未だ解明されていない点も多い．このたび昭和58年以降，静岡県立総合病院脳神経外科で手術的療法を加えた十歳台の腰椎椎間板ヘルニアの9症例につき，その臨床像，神経放射線学的所見，手術時所見，術後経過について検討を加えた．また現在までに国内外において報告された，18シリーズ，総計687例の若年者腰椎椎間板ヘルニア症例をもとに，この病態における種々の問題点につき考察を加えた．

Abstract

Lumbar disc herniation is a rare occurrence in teena-gers. There are several questions as to its pathogenesis, relationship to trauma, and clinical manifestations com-pared with those in adults. In the present paper, we de-scribed nine cases of teen-age lumbar disc herniation, which accounts for about 3.3% of all the operated lum-bar disc herniations in our clinic. In the discussion, 687 cases of teen-age lumbar disc herniation were analyzed from the world literature. The clinical signs and symp-toms in teenagers showed no distinct difference from those in adults. Lasegue's sign was found in nearly all the patients. Although direct or indirect trauma to the lumbar region may play an important role in causing disc herniation in teenagers, a more imporatant factor seems to be the degeneration of the disc material, which begins in children earlier than usually suspected. Although surgical therapy has been advocated by many authors, it must be followed up for a long term before the efficacy of such treatment for teenagers can be con-fidently ascertained.