臨床整形外科46巻4号

2011年04月発行

論述

腰部脊柱管狭窄の診断に対する立位伸展負荷試験の有用性―歩行負荷試験との比較―前向きコホート研究

著者： 髙橋直人¹² 菊地臣一¹ 矢吹省司¹ 大谷晃司¹ 紺野慎一¹

所属機関： ¹福島県立医科大学医学部整形外科 ²総合南東北病院整形外科

ページ範囲：P.333 - P.340

　立位伸展負荷試験前後での自覚症状と身体所見の変化を検討した．さらに，歩行負荷試験に伴う変化と比較することで立位伸展負荷試験の有用性を検討した．その結果，立位伸展負荷試験は，歩行負荷試験と同程度に，神経障害型式などの病態把握や安静時には顕著化されていない責任高位を明らかにするために有用であることが判明した．

参考文献

1) Baker A, Collins, Tanya AP, et al:Doppler study of porcine cauda equina blood flow:The effect of electrical stimulation of the rootlets during single and double site, low pressure compression of the cauda equina. Spine 20:660-664, 1995

2) Blau JN, Logue V:The natural history of intermittent claudication of the cauda equina, a long term follow-up study. Brain 101:211-222, 1978

3) Ito T, Ohtori S, Hata, K:Rho kinase inhibitor improves motor dysfunction and hypoalgesia in a rat model of lumbar spinal canal stenosis. Spine 32:2070-2075, 2007

4) Iwamoto H, Kuwahara H, Matsuda H:Production of chronic compression of the cauda equina in rats for use in studies of lumbar spinal canal stenosis. Spine 20:2750-2757, 1995

5) Iwamoto H, Matsuda H, Noriage A:Lumbar spinal canal stenosis examined electrophysiologically in a rat model of chronic cauda equina compression. Spine 22:2636-2640, 1997

6) Jellinger K, Neumayer E:Claudication of the spinal cord and cauda equina. Handbook of Clinical Neurology. Elsevier, Holland, Amsterdam, pp507-547, 1972

7) Katz J, Dalgas M, Stucki G:Degenerative lumbar spinal stenosis. Diagnostic value of the history and physical examination. Arthritis Rheum 38:1236-1241, 1995

8) 菊地臣一，星加一郎，松井達也，他：腰椎疾患における神経性間欠跛行―第1報　分類と責任高位・部位診断．整形外科37：1429-1439，1986

9) 菊地臣一，松井達也，星加一郎，他：腰椎疾患における神経性間欠跛行―第2報　治療成績．整形外科38：15-23，1987

10) Kikuchi S, Hasue M:Combined contrast studies in lumbar spine diseases. Myelography (peridurography) and nerve root infiltration. Spine 13:1327-1331, 1988

11) Kobayashi S, Yoshizawa H, Hachiya Y:Vasogenic edema induced by compression injury to the spinal nerve root:Distribution of intravenously injected protein tracers and gadolinium-enhanced magnetic resonance imaging. Spine 18:1410-1424, 1993

12) 小林利男，菊地臣一：腰仙椎神経の皮膚髄節固有域選択的神経根ブロックによる検討．整・災外33：1131-35，1990

13) Konno S, Olmarker K, Kikuchi S:Intermittent cauda equina compression. An experimental study of the porcine cauda equina with analyses of nerve impulse conduction properties. Spine 20:1223-1226, 1995

14) Konno S, Kikuchi S, Tanaka Y, et al:A diagnostic support tool for lumbar spinal stenosis:a self-administered, self-reported history questionnaire. BMC Musculoskeletal Disorders 8:102, 2007

15) Olmarker K, Horn S, Rosenqvist AR:Experimental nerve root compression:A model of acute, graded compression of the porcine cauda equina and an analysis of neural and vascular anatomy. Spine 16:61-69, 1991

16) Ooi Y, Mita F, Satoh Y:Myeloscopic study on lumbar spinal canal stenosis with special reference to intermittent claudication. Spine 15:544-549, 1990

17) Sato K, Kikuchi S:Clinical analysis of two-level compression of the cauda equina and the nerve roots in lumbar spinal canal stenosis. Spine 22:1898-1903, 1997

18) Sato K, Konno S, Yabuki, S:A Model for acute, chronic, and delayed graded compression of the dog cauda equina:Neurophysiologic and histologic changes induced by acute, graded compression. Spine 20:2386-2391, 1995

19) Sekiguchi M, Konno S, Anzai H:Nerve vasculature changes induced by serotonin under chronic cauda equina compression. Spine 27:1634-1639, 2002

20) Shimokawa H, Aarhus LL, Vanhoutte PM:Porcine coronary arteries with regenerated endothelium have a reduced endothelium-dependent responsiveness to aggregating platelets and serotonin. Circ Res 61:256-270, 1987

21) Takahashi K, Miyazaki T, Takino T, et al:Epidural pressure measurements:Relationship between epidural pressure and posture in patients with lumbar spinal stenosis. Spine 20:650-653, 1995

22) 高山文治，菊地臣一，紺野慎一・他：腰部脊柱管狭窄の診断に対する歩行負荷試験―有効性の検討．日脊会誌15：383，2004

23) 高山文治，菊地臣一，紺野慎一・他：腰部脊柱管狭窄の診断に対する歩行負荷試験の有効性の検討．臨整外45：587-595，2010

24) Yamaguchi K, Murakami M, Takahashi K:Behavioral and morphologic studies of the chronically compressed cauda equina:experimental model of lumbar spinal stenosis in the rat. Spine 24:845-53, 1999

25) 渡部　徹，菊地臣一：腰仙部神経根による支配筋および深部反射弓の検討―選択的神経根ブロックによる検討．日整会誌67：264，1993

26) Wilson CB:Significance of the small lumber spinal canal;cauda equina compression syndrome due to spondylosis. J Neurosurg 31:499-506, 1969