Neurological Surgery 脳神経外科45巻9号

2017年09月発行

総説

腰椎固定術の変遷と進化—腰椎手術を始める「あなた」に知っておいてもらいたいこと

著者： 水野正喜¹ 倉石慶太¹ 鈴木秀謙¹

所属機関： ¹三重大学大学院脳神経外科

ページ範囲：P.759 - P.769

Ⅰ．はじめに
　人類の背骨（脊椎）の中で，腰椎は前後屈，側屈，回旋などの動きに関与する運動器であるとともに，起立，歩行などの姿勢を安定化させる支持組織として重要な役割を担っている．常に負荷を受ける状態におかれ，経時的に変性が生じる部位であるため，平均寿命が延びている現代では，腰椎変性疾患の有病率は増加している．
　そのため，腰痛や下肢痛，歩行障害などの神経症状を有する症例に対して，有効で確実な治療方法を選択して対応する能力を身につけることは，脳神経外科医として必須と考える．特に腰椎の不安定性や高度変形を要する患者に対する外科治療は，多数の選択肢から各症例に最適な手技を選択することが重要となる．ここでは，腰椎手術手技のうち，腰椎固定術について，その歴史や手技の発展，今後の展望について解説する．

参考文献

1) Asamoto S：Neurosurgeons in Japan are exclusively brain surgeons. World Neurosurg 99：145-149, 2017

2) Baker JF, Errico TJ, Kim Y, Razi A：Degenerative spondylolisthesis：contemporary review of the role of interbody fusion. Eur J Orthop Surg Traumatol 27：169-180, 2017

3) Brantigan JW, Steffee AD, Geiger JM：A carbon fiber implant to aid interbody lumbar fusion. Mechanical testing. Spine（Phila Pa 1976）16（6 Suppl）：S277-282, 1991

4) Brantigan JW, Steffee AD：A carbon fiber implant to aid interbody lumbar fusion. Two-year clinical results in the first 26 patients. Spine（Phila Pa 1976）18：2106-2107, 1993

5) Cloward RB：The treatment of ruptured lumbar intervertebral disc by vertebral body fusion. Ⅲ. Method of use of banked bone. Ann Surg 136：987-992, 1952

6) Cloward RB：The treatment of ruptured lumbar intervertebral discs by vertebral body fusion. I. Indications, operative technique, after care. J Neurosurg 10：154-168, 1953

7) Dhall SS, Choudhri TF, Eck JC, Groff MW, Ghogawala Z, Watters WC 3rd, Dailey AT, Resnick DK, Sharan A, Mummaneni PV, Wang JC, Kaiser MG：Guideline update for the performance of fusion procedures for degenerative disease of the lumbar spine. Part 5：correlation between radiographic outcome and function. J Neurosurg Spine 21：31-36, 2014

8) Eck JC, Sharan A, Ghogawala Z, Resnick DK, Watters WC 3rd, Mummaneni PV, Dailey AT, Choudhri TF, Groff MW, Wang JC, Dhall SS, Kaiser MG：Guideline update for the performance of fusion procedures for degenerative disease of the lumbar spine. Part 7：lumbar fusion for intractable low-back pain without stenosis or spondylolisthesis. J Neurosurg Spine 21：42-47, 2014

9) Epstein NE：Non-neurological major complications of extreme lateral and related lumbar interbody fusion techniques. Surg Neurol Int 7（Suppl 25）：S656-659, 2016

10) Fischer CR, Hanson G, Eller M, Lehman RA：A systematic review of treatment strategies for degenerative lumbar spine fusion surgery in patients with osteoporosis. Geriatr Orthop Surg Rehabil 7：188-196, 2016

11) Foley KT, Gupta SK：Percutaneous pedicle screw fixation of the lumbar spine：preliminary clinical results. J Neurosurg 97（1 Suppl）：7-12, 2002

12) Goodrich JA, Volcan IJ：eXtreme Lateral Interbody Fusion（XLIF). Quality Medical Publishing, St Louis, 2013

13) Groff MW：Guideline update for the performance of fusion procedures for degenerative disease of the lumbar spine. J Neurosurg Spine 21：1, 2014

14) Joseph JR, Smith BW, Liu X, Park P：Current applications of robotics in spine surgery：a systematic review of the literature. Neurosurg Focus 42：E2, 2017

15) 久保田基夫，高橋敏行，上田茂雄，佐々木　学，水野正喜：腰椎変性側弯症の外科治療．脊髄外科31：42-52, 2017

16) Luk KD, Chen L, Lu WW：A stronger bicortical sacral pedicle screw fixation through the s1 endplate：an in vitro cyclic loading and pull-out force evaluation. Spine（Phila Pa 1976）30：525-529, 2005

17) Matsukawa K, Yato Y, Imabayashi H, Hosogane N, Asazuma T, Nemoto K：Biomechanical evaluation of cross trajectory technique for pedicle screw insertion：combined use of traditional trajectory and cortical bone trajectory. Orthop Surg 7：317-323, 2015

18) 宮本和寿：腰椎椎間板ヘルニアに対する前方固定術の長期経過に関する検討．日整会誌65：1179-1190, 1991

19) 水野正喜，花北順哉，諏訪英行，名村尚武，大塚俊之，朝日　稔：腰部脊柱管狭窄症に対する手術治療成績：8年間，164例の手術治療成績．脊椎脊髄7：309-315, 1994

20) Mizuno M, Kuraishi K, Umeda Y, Sano T, Tsuji M, Suzuki H：Midline lumbar fusion with cortical bone trajectory screw. Neurol Med Chir（Tokyo）54：716-721, 2014

21) 水野正喜，倉石慶太，鈴木秀謙：腰椎固定術の基礎と低侵襲手技の発展．脳外誌26：353-361, 2017

22) Moran JM, Berg WS, Berry JL, Geiger JM, Steffee AD：Transpedicular screw fixation. J Orthop Res 7：107-114, 1989

23) Mummaneni PV, Dhall SS, Eck JC, Groff MW, Ghogawala Z, Watters WC 3rd, Dailey AT, Resnick DK, Choudhri TF, Sharan A, Wang JC, Kaiser MG：Guideline update for the performance of fusion procedures for degenerative disease of the lumbar spine. Part 11：interbody techniques for lumbar fusion. J Neurosurg Spine 21：67-74, 2014

24) O'Brien JR, Matteini L, Yu WD, Kebaish KM：Feasibility of minimally invasive sacropelvic fixation：percutaneous S2 alar iliac fixation. Spine（Phila Pa 1976）35：460-464, 2010

25) Ray CD：Threaded titanium cages for lumbar interbody fusions. Spine（Phila Pa 1976）22：667-679, 1997

26) Resnick DK, Watters WC 3rd, Sharan A, Mummaneni PV, Dailey AT, Wang JC, Choudhri TF, Eck JC, Ghogawala Z, Groff MW, Dhall SS, Kaiser MG：Guideline update for the performance of fusion procedures for degenerative disease of the lumbar spine. Part 9：lumbar fusion for stenosis with spondylolisthesis. J Neurosurg Spine 21：54-61, 2014

27) Rosenberg WS, Mummaneni PV：Transforaminal lumbar interbody fusion：technique, complications, and early results. Neurosurgery 48：569-575, 2001

28) Santoni BG, Hynes RA, McGilvray KC, Rodriguez-Canessa G, Lyons AS, Henson MA, Womack WJ, Puttlitz CM：Cortical bone trajectory for lumbar pedicle screws. Spine J 9：366-373, 2009

29) Schwab F, Ungar B, Blondel B, Buchowski J, Coe J, Deinlein D, DeWald C, Mehdian H, Shaffrey C, Tribus C, Lafage V：Scoliosis Research Society-Schwab adult spinal deformity classification：a validation study. Spine（Phila Pa 1976）37：1077-1082, 2012

30) Steffee AD, Biscup RS, Sitkowski DJ：Segmental spine plates with pedicle screw fixation. A new internal fixation device for disorders of the lumbar and thoracolumbar spine. Clin Orthop Relat Res 203：45-53, 1986

31) Watkins MB：Posterolateral fusion of the lumbar and lumbosacral spine. J Bone Joint Surg Am 35-A（4）：1014-1018, 1953

32) Wiesner L, Kothe R, Schulitz KP, Rüther W：Clinical evaluation and computed tomography scan analysis of screw tracts after percutaneous insertion of pedicle screws in the lumbar spine. Spine（Phila Pa 1976）25：615-621, 2000