1997 年 11 巻 1 号 p. 1-12
Described are the basic concepts of diagnosing and surgically treating cervical and lumbar spondylosis. Stenotic lesions of the central canal in the cervical spine result in myelopathy and in the lumbar intermittent claudication occurs. That of the nerve root canal results in radiculopathy. Pathological impingement on the nerve tissue is classified into orthostatic and dynamic compressions. Orthostatic factor is due to degenerated disc, osteophyte, hypertrophic facet joints and yellow ligament. Dynamic change of the spinal canal concomitant with physiological posture change contributes to these impingement. Pathological instability of the spine enhances the above dynamic compression. CT with myelography is the most reliable diagnostic method to diagnose cervical and lumbar spondylosis, since this provides precise information about both the anatomical and pathological status of a bony and/or a soft tissue involvements. MRI provides three-dimensional images of neural tissue entrapment and information on intervertebral disc degeneration. Our basic surgical procedures for spondylosis are removal of static compressing components and fusion for instability. We treated cervical spondylosis with osteophytectomy and interbody fusion. Long postoperative follow-up results evaluated by the Neurosurgical Cervical Spine Scale (NCSS) up to 7-20 years have shown 74% recovery from myelopathy and 84% of patients returned to the previous social activities. For lumbar spondylosis a laminectomy was done for a central spinal stenosis, a medial facetectomy for a lateral recess stenosis and a facetectomy for a foraminal stenosis. In view of possible post-operative instability, we do a bilateral partial laminectomy for central spinal stenosis, which is a limited interlaminar decompressive procedure. We usually avoids discectomy unless disc extrusion presented. Posterolateral fusion is performed for some cases given a facetectomy. Our follow-up results show 94% recovery of intermittent claudication.