Neurological Surgery 脳神経外科43巻5号

2015年05月発行

研究

変性すべり症に対する減圧術単独の長期成績—不安定性例も含めて

著者： 佐々木修¹ 中村公彦¹ 梨本岳雄¹ 山下慎也¹ 矢島直樹¹ 鈴木健司¹ 斎藤明彦¹

所属機関： ¹新潟市民病院脳神経外科

ページ範囲：P.419 - P.427

Ⅰ．はじめに
　腰椎疾患の病態や治療法を考える上でinstabilityの有無は重要な因子であり，減圧術を行うにあたっては固定術の併用を示唆する所見ともされている^{1,3,7,8,11,15,23)}．また，術後のinstabilityの発生は予後不良の兆候とされている⁹⁾．しかしながら，instabilityについては臨床上もX線撮影上も明確な定義はなく，その意義についても議論が多い^11,16,21,24)．筆者らは，変性すべり症を伴う腰部脊柱管狭窄症例に構造を極力温存するless invasive surgery（開窓術）を行った場合，固定術を併用せずとも術後すべりは悪化せず，長期的に良好な成績が維持されることを報告した²⁰⁾．しかし，instabilityを合併する症例にみられる問題点については未検討であった．そこで，今回はすべり症のみならずinstabilityを有する例に固定術を併用せずに減圧術単独で手術を行った場合，術後すべりやinstabilityが悪化し，臨床症状や手術成績が悪化する危険性はないのかといった点を中心にretrospectiveな検討を行った．

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