臨床整形外科55巻6号

2020年06月発行

症例報告

腰椎すべり症に対しXLIF^®による間接除圧効果が得られず再手術を要した1例

著者： 池尻正樹¹ 重松英樹¹ 田中誠人¹ 川崎佐智子¹ 須賀佑磨¹ 山本雄介¹ 田中康仁¹

所属機関： ¹奈良県立医科大学整形外科

ページ範囲：P.761 - P.765

　症例は71歳女性．L4変性すべり症に対して他院でExtreme lateral interbody fusion(XLIF)®を施行され，腰痛と下肢痛が残存し当院を受診した．直接除圧と後側方固定術でサルベージ手術を行った．XLIFによる間接除圧(indirect decompression：IDD)は広く普及しているが，除圧不足で追加手術を要した報告も散見される．本症例は骨性外側陥凹狭窄とケージの沈降を認めていた．過去の報告によると，骨性外側陥凹狭窄はIDD不良因子であり，また高さ12mm以上のケージとケージの椎体前方1/5設置は終板損傷のリスクが高い．IDD効果を得るには術前の画像評価とケージ設置位置が重要である．

参考文献

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11) 鳥越一郎，新井嘉容．LLIFにおける術中終板損傷．脊椎脊髄2017；30(10)：933-40．

12) Marchi L, Abdala N, Oliveira L, et al. Radiographic and clinical evaluation of cage subsidence after stand-alone lateral interbody fusion. J Neurosurg Spine 2013;19(1):110-8.

13) Park SJ, Lee CS, Chung SS, et al. The ideal cage position for achieving both indirect neural decompression and segmental angle restoration in lateral lumber interbody fusion (LLIF). Clin Spine Surg 2017;30(6):784-90.

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