高齢者腰部椎間板ヘルニアの臨床的検討

抄録

1991 cases of lumbar disc herniation were surgically treated over the past 16 years. Of these, We investigated 79 patients who were aged over 60 years (4.1%). (1) Clinical symptoms and physical signs:
Symptoms tended to be more severe than in younger patients. 23% were unable to walk because of severe leg pain. Intermittent claudication was found in 55%, motor weakness in 46%, sensory disturbance in 51%, recto-vesical dysfunction in 9% and foot drop in 8%.
(2) Operative findings:
Sequestration was present in 49%, extrusion (mostly massive) in 34% and proliferation of facet joints in 67%.
From these results, in cases with severe leg pain, positive SLRT and drop attacks which appeared acutely a sequestrated disc herniation was the most comman cause. Postoperative course was more satisfactory than any other ages. Average improvement rate with JOA score (Hirabayashi) was 72.3% in 36 cases over a period of 3 years after surgery.