臨床整形外科51巻8号

2016年08月発行

誌上シンポジウム 脊椎診療ガイドライン—特徴と導入効果

頚椎後縦靱帯骨化症診療ガイドライン

著者： 岩﨑幹季¹

所属機関： ¹大阪労災病院整形外科

ページ範囲：P.709 - P.714

診断：後縦靱帯骨化を頚椎に画像上確認でき，それによる臨床症状が出現している場合を頚椎後縦靱帯骨化症(OPLL)と診断する．CTで初めて視認できる後縦靱帯の小骨化巣は，診断要件としての後縦靱帯骨化とはしない．

疫学・病因：OPLLは中年男性に多い．後縦靱帯骨化の発生には遺伝的背景が関係しているものの，遺伝様式は断定されていない．OPLLは全身の骨化傾向の強い症例が多く，胸椎後縦靱帯骨化や胸椎黄色靱帯骨化を合併しやすい．脊髄障害の機転については，骨化の程度と神経麻痺の程度は必ずしも相関しないが，骨化占拠率が50％を超えると脊髄症状発症の危険が高い．

治療：手術方法としては前方法と後方法があり，両者に明らかな手術成績の差はないが，骨化占拠率が高い症例は後方除圧単独では成績不良となる危険性が高い．

参考文献

1）日本整形外科学会診療ガイドライン委員会，頚椎後縦靱帯骨化症ガイドライン策定委員会，厚生労働省特定疾患対策研究事業「脊柱靱帯骨化症に関する研究」班(編)：頚椎後縦靱帯骨化症診療ガイドライン，南江堂　2005．

2）日本整形外科学会，日本脊椎脊髄病学会(監)，日本整形外科学会診療ガイドライン委員会，頚椎後縦靱帯骨化症診療ガイドライン策定委員会(編)：頚椎後縦靱帯骨化症診療ガイドライン．改訂第2版，南江堂，2011．

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