臨床整形外科44巻11号

2009年11月発行

臨床経験

新しい胸椎再建手術：経椎間孔進入胸椎椎体間固定術Transforaminal Thoracic Interbody Fusion（TTIF）

著者： 町野正明¹ 湯川泰紹¹ 伊藤圭吾¹ 中島宏彰¹ 加藤文彦¹

所属機関： ¹労働者健康福祉機構中部労災病院整形外科

ページ範囲：P.1119 - P.1124

　経椎間孔進入椎体間固定術は，後方から片側の椎間関節を切除しforaminal zoneからアプローチするため，硬膜管外縁と神経根を直視下に確認でき，除圧に対する有効性は高い．硬膜の牽引を必要としないため神経合併症が少ない．また後方のみでの椎間板操作と椎体間骨移植により前方支柱再建が可能である．今回われわれは，腰椎でのtransforaminal interbody lumbar fusion(TLIF)を応用し，胸椎病変に対しtransforaminal thoracic interbody fusion(TTIF)を施行し，良好な治療成績を得た．今回の検討から本術式は，後方除圧固定と片側性の前方除圧，そして椎体間固定による強固な再建が可能であり，また術後早期離床も可能で骨癒合も良好であった．今後胸椎の除圧再建術の有用な選択肢となりうると考える．

参考文献

1) Blume HG:Unilateral posterior lumbar interbody fusion:simplified dowel technique. Clin Orthop 193:75-84, 1985

2) Cloward RB:The treatment of ruptured lumbar intervertebral disc by vertebral body. Ann Surg 136:987-992, 1952

3) Cloward RB:The treatment of ruptured lumbar intervertebral disc by vertebral body. J Neurosurg 10:154-168, 1953

4) Fisher CG, Sahajpal V, Keynan O, et al:Accuracy and safety of pedicle screw fixation in thoracic spine trauma. J Neurosurg Spine 5:520-526, 2006

5) Hackenberg L, Halm H, Bullmann V, et al:Transforaminal lumbar interbody fusion:a safe technique with satisfactory three to five year results. Eur Spine J 29:E65-70, 2004

6) Harms J, Jeszenszky D, Stolze D, et al:True spondylolisthesis reduction and more segmental fusion in spondylolisthesis. In. Bridwell KH, Dewald RL (ed). The Text Book of Spinal Surgery. 2nd ed. Lippincott-Raven, Philadelphia:1337-1347, 1997

7) Harris BM, Hilibrand AS, Savas PE, et al:Transforaminal lumbar interbody fusion:the effect of various instrumentation techniques on the flexibility of the lumbar spine. Spine 29:E65-70, 2004

8) Jaslow IA:Intercorporal bone graft in spinal fusion after disc removal. Surg Gyn Obst 82:215, 1946

9) Karapinar L, Erel N, Ozturk H, et al:Pedicle screw placement with a free hand technique in thoracolumbar spine:is it safe? J Spinal Disord Tech 21:63-67, 2008

10) Kim YJ, Lenke LG, Bridwell KH, et al:Free hand pedicle screw placement in the thoracic spine:Is it safe? Spine 29:333-342, 2004

11) Lowe TG, Tahernia AD, O'Brien MF, et al:Unilateral transforaminal posterior lumbar interbody fusion (TLIF):indications, technique, and 2-year results. J Spinal Disord Tech 15:31-38, 2002

12) McAfee PC, Bohlman HH, Ohio C, et al:Anterior decompression of traumatic thoracolumbar fractures with incomplete neurological deficit using a retroperitoneal approach. J Bone Joint Surg Am 67:89-104, 1985

13) McCormack T, Karaikovic E, Gaines RW, et al:The load sharing classification of spine fractures. Spine 19:1741-1744, 1994

14) Potter BK, Freedman BA, Verwiebe EG, et al:Transforaminal lumbar interbody fusion:clinical and radiographic results and complications in 100 consecutive patients. J Spinal Disord Tech 18:337-346, 2005

15) Rosenberg WS, Mummaneni PV:Transforaminal lumbar interbody fusion:technique, complications, and early results. Neurosurgery 48:569-574, 2001

16) Salehi SA, Tawk R, Ganju A, et al:Image-guided spine surgery. Transforaminal lumbar interbody fusion:surgical technique and results in 24 patients. Neurosurgery 54:368-374, 2004

17) Taneichi H, Suda K, Kajino T, et al:Unilateral transforaminal lumbar interbody fusion and bilateral anterior-column fixation with two Brantigan I/F cages per level:clinical outcomes during a minimum 2-year follow-up period. J Neurosurg Spine 4:198-205, 2006

18) Tezeren G, Kuru I:Posterior fixation of thoracolumbar burst fracture:short-segment pedicle fixation versus long-segment instrumentation. J Spinal Disord T 18:485-488, 2005