Neurological Surgery 脳神経外科37巻12号

2009年12月発行

連載 脳神経外科疾患治療のスタンダード

13．脊椎・脊髄損傷

著者： 小柳泉¹

所属機関： ¹札幌医科大学脳神経外科

ページ範囲：P.1249 - P.1259

Ⅰ．脊椎・脊髄損傷治療の最近の動向

　わが国での1990年代初めの調査では⁶⁰⁾，脊髄損傷の頻度は，人口100万人あたり年間40.2人と推測された．これは，全国の病院・医院への郵送による調査で，3年間に登録された9,752例のうちFrankel分類¹⁸⁾A～Dの7,471例について，回収率（51％）を計算して推計された数字である．したがって正確な頻度とは言えないが，わが国でこれまで行われた唯一の大規模調査である．この調査では，脊髄損傷について多くの情報がもたらされた．性別では男性が約80％を占め，交通事故が原因として最も多く（44％），転落（29％），転倒（13％）と続く．年齢分布は，二峰性の分布（60歳前後に大きなピークがあり，20歳に次のピークがある）を示した．損傷レベルは，頚髄が75％を占めるが，頚髄損傷の内訳では，骨損傷のない頚髄損傷が56％に達した．高齢社会の到来に伴って，頚椎症などの脊柱管狭窄を有する高齢者が，転倒などの比較的軽微な外傷で，このような骨損傷のない頚髄損傷を示す症例が増えてきており，その対策と治療は重要な課題となっている．

　脊髄損傷治療に関する高いレベルのエビデンスは少なく，特に外科治療の適応や有効性は議論が分かれている．近年のインスツルメンテーションの開発と進歩によって，脊椎の骨折・脱臼による不安定性脊柱に対しては，積極的な外科治療が行われる傾向にある．損傷した脊髄そのものに対する治療薬は，1990年代初頭にステロイドの大量投与の有効性が多施設臨床試験の結果として報告されて以来，臨床応用に到達した新しい薬剤は開発されていない．ステロイド大量療法についても，合併症の問題や有効性を疑問視する報告も相次いでいる．現在，脊髄損傷に対する新しい治療として，低体温療法，電気刺激，移植治療など，薬物治療以外でもさまざまな臨床研究が行われている．その多くはphase ⅠあるいはⅡであり，今後の検証が必要である．本稿では，主に頚椎レベルの脊椎・脊髄損傷の診断と治療に関する基本事項と，脊髄損傷に対する臨床研究の最近の知見に関して解説する．

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