臨床整形外科58巻9号

2023年09月発行

特集 脊椎内視鏡下手術の進化・深化 展望：痛みを視る

Modic Changeの痛みを視る—Modic Changeによる慢性腰痛に対する全内視鏡下手術の臨床成績と術中鏡視所見

著者： 杉浦宏祐¹ 西良浩一¹

所属機関： ¹徳島大学大学院医歯薬学研究部運動機能外科学

ページ範囲：P.1161 - P.1166

Modic changeによる腰痛に対する保存療法は効果が乏しく治療に難渋することも珍しくない．一般的には椎体間固定術が選択されるが，若年者や活動性の高い患者に対しては椎間可動性が温存される低侵襲な手術が理想的であり，全内視鏡下に椎間板内の洗浄と変性椎間板の郭清，椎体終板の焼灼手術(FEDC)が開発された．術後早期より除痛が期待でき，特に椎間板造影にて再現痛が確認できる症例は良好な成績が期待できる．Modic changeの部位を全内視鏡で確認すると変色椎間板，および発赤し易出血性の椎体終板が確認でき，終板への病的な血管新生に伴う炎症物質の流入がModic changeによる腰痛の一因と考えられた．

参考文献

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