頸椎後縦靱帯骨化症に対する外科的治療

Surgical Treatment for Ossification of the Posterior Longitudinal Ligament of the Cervical Spine

I．はじめに

　頸椎後縦靱帯骨化症に対する外科的治療法としては，前方除圧^{1-5,9-13,19,20）}又は後方除圧^{4,5,8,9,13-15,17）}が行われているが，手術法の選択に関しては，種々，議論のあるところである．今回，われわれは，頸椎後縦靱帯骨化症に対する手術経験を述べると共に，手術法選択につき言及する．又，頸椎前方固定術として，われわれが行っている手術法（頸椎椎体より採取した骨片を移植骨として用いた頸椎前方固定術^6,7））が有用であることを強調したい．

The surgical results in 37 patients with cervical myelopathy due to ossification of the posterior longitu-dinal ligament of the cervical spine were described. This series consisted of 32 patients who underwent anterior decompression with anterior cervical fusion us-ing bone grafts obtained from cervical vertebral bodies, and 5 patients who underwent expansive laminoplasty or laminectomy as a method of posterior decompres-sion. 6 out of 32 patients with anterior cervical fusion were operated on at one level, 18 at two levels and 8 at three levels. The patients were out of bed within two days and treated using a soft collar for 3 months. In all patients, the symptoms improved postoperatively. Post-operative X-ray films showed solid bone fusion in all patients with anterior cervical fusion at a mean follow up time of one year and nine months (range 6 months to 3 years 6 months). Anterior angulation was found in one (3%) out of 32 patients who underwent anterior cervical fusion. Concerning the method of operation, the authors think that anterior decompression is to be recommended for cases with ossification within three consecutive vertebrae and posterior decompression should be applied to cases in which anterior decom-pression is very difficult. If necessary, a two-stage com-bined decompression is recommended.