人工骨スペーサーを使用した頸椎前方固定術後長期経過例におけるX線学的変化の検討

Long term evaluation of radiographic changes following cervical anterior fusion with hydroxyapatite ceramic spacer

I．はじめに

　頸椎前方固定術の問題点に固定部隣接椎間の変化と採骨部痛などが上げられる．採骨部痛に対して移植骨を使わないwithout fusion法^10,15）が注目されているが，術野が狭く手術手技上相当な熟練が必要とされる．また近年，自己椎体より採取したものをそのまま加工して挿入する方法^4）も報告されているが，これも手技が煩雑で，採取骨自体の耐久性に問題がある．これらに対してわれわれは人工骨スペーサーを用いた1椎間の前方固定術（anterior fusion with apaserum；AAF）を過去10年間にわたり施行してきた．

　今回，AAFの手術方法，手術合併症およびAAF後長期経過例のX線上の変化を隣接椎間を中心に検討しえたので併せて報告する．

Cervical anterior fusion with iliac bone crest has be-come a popular surgical technique for cervical spon-dylotic disease. Since about 10 years ago, we have sub-stituted hydroxyapatite ceramic spacer for autologous graft because of postoperative painful hip syndrome. Fourteen patients who underwent cervical anterior fu-sion with ceramic spacer were evaluated by plain radio-graphs for over eight years postoperatively. In six among the fourteen patients plain films demonstrated minimal stenosis of intervertebral disc height, of which the ratio ranged from 15% to 28% (mean 22%). The in-crease in mobility of the adjacent segment after fusion was noted in ten of the fourteen patients, although the ratio ranged only between 12% and 24% (mean 18%).In none of all the patients did dynamic plain films show cervical instability such as slippage and swan neck deformity. It seems that anterior fusion with cera-mic spacer is a useful and safe method for a cervical spondylotic disease.