Incomplete Brown-Séquard Syndromeを呈した頸・胸椎後縦靱帯骨化の手術例

抄録

This report deals with a case with a myelopathy of Brown-Séquard type due to ossification of the posterior longitudinal ligament (OPLL) in the cervico-thoracic spine. The patient, 59-year-old male was admitted on February 1, 1977, with complaints of disturbance of gait, girdle pain in the chest, cold dysesthesia of the left half of trunk below papilla, with progressive aggravation for the last two years. Neurological examination revealed weakness of the right leg with pyramidal tract signs, hypesthesia to pin-prick, and temperature on the left leg below Li with cold dysesthesia and impaired vibration sense on both legs. X-ray examinations showed the OPLL from C6 down to Th4 vertebral bodies and myelographic block at the level of C6-7; blocked mainly on the right side of the spinal cannal. (Fig. 1, 2). Decompressive laminectomy from Th 1 upto CS and bilateral facetectomy at C6-7 disclosed an extradural osseous bulge on the right side of the spinal canal most marked at level of Th 1 to C7, compressing the dural tube from right lateral to the midline with distortion of the tube away from the right. The exposed cord at this level showed marked atrophy; almost 1/2 of normal diameter. No intradural pathology noted. Dentatotomy was added. Following closure of the dura, the osseous bulge was drilled away. Postoperatively, the girdle chest pain disappeared on the next morning, cold dysesthesia improved for 50%, hypesthesia to pain and temperature for 80%. With 11 months' follow-up, the patient showed good recovery of muscle strength of legs; walking by himself and running by bicycle. The clinical course, X-ray examinations and surgical exploration revealed the OPLL as the sole cause of this syndrome in this case.