脊髄外科
Online ISSN : 1880-9359
Print ISSN : 0914-6024
ISSN-L : 0914-6024
脊髄症を呈した頚椎後縦靭帯骨化に対する前方除圧術の工夫特に神経損傷に対する工夫(<特集>頚椎 OPLL)
小島 精和賀 志郎久保 和親中村 文明阪井田 博司水野 正喜
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1997 年 11 巻 1 号 p. 33-38

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Cervical ossification of the posterior longitudinal ligament (OPLL) is one of the well-known causes of myelopathy and radiculomyelopathy. The choice of surgical procedures including laminectomy, laminoplasty, anterior fusion, and anterior decompression with fusion, remains controversial. We choose anterior vertebrectomy and fusion for multilevel OPLL, because we believe that cervical cord and root compression caused by the lesions located in the anterior spinal canal must be completely relieved and this can be achieved better via the anterior approach. Postoperative neurological complication, especially fifth cervicalradiculopathy has been reported after multilevel vertebrectomy for cervical OPLL. One explanation for this complication includes the factor of traction and its influence following on the cervical roots caused by anterior shifting of the spinal cord following wide decompression. However, we ourselves do not think that the spinal cord could shift so pathologically as to result in traction on the cervical roots after removal of anterior pathology such as OPLL. This conviction has led us to change the width of vertebractomy. Before December, 1992, 46 patients underwent multilevel vertebrectomy for cervical OPLL, and the width of the anterior decompression was 12 to 14 mm. Since January, 1993, 18 patients have had multilevel vertebrectomy for cervial OPLL, and the width of the anterior decompression was 14 to 20 mm (average 16.4 mm). In our former series, 4 patients (8.7%) suffered C5 radiculopathy and 37 patients (80%) got good results. In our later series, the incidence of postoperative radiculopathy was 0 and 18 patients (100%) got good results. In conclusion, from our small experience of vertebrecotmy in these two series, the greater width of the anterior decompression most likely reduces the incidence of neural tissue complication and results in better outcome.

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© 1997 日本脊髄外科学会
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