頚椎疾患における spinal instrumentation の手術手技

抄録

Surgical management of cervical injuries has been drastically changing for the last decade with the advent of refined instruments which are compatible with magnetic resonance (MR) imaging. The usage of spinal instrumentation can be extended to cervical spondylosis and ossification of the posterior longitudinal ligament (OPLL) with or without instability, rheumatoid arthritis and spinal tumors. However its surgical indication is often controversial and operative techniques are demanding high skills. Anterior plating system such as "Synthes" and "Orion" are relatively easy to use and very effective in flextion or burst injury which requires anterior decompression and fixation. This can be also used in cervical spondylolisthesis and in some cases of anterior approach for cervical OPLL. Posterior lateral mass plate system such as "Universal" and "Axis" is quite useful in cases with lamina fractures and unstable cervical stenosis due to spondylosis or OPLL which require multilevel laminoplasty and fixation. Transarticular screw fixation along with midline C1-C2 fixation with cable and graft provides solid internal fixation in atlantoaxial dislocation due to odontoid fracture, rheumatoid arthritis and congenial anomalies. But great care has to be taken to avoid injury to the vertebral arteries and the neural structures. In conclusion spinal instrumentation is a very effective method in internal fixation for unstable cervical spine, facilitating early ambulation and rehabilitation, if one can select good indications and master surgical skills.