2001 年 15 巻 1 号 p. 7-14
Anterolateral partial vertebrectomy, a new operative technique which involves drilling into the anterolateral part of the vertebral bodies, enables radical resection of the lesion, without any fusion. The cervical spine, however, could possibly become instable because of excessive resection to get a wider operative field. The authors describe the operative technique and emphasize that the approach should be made as laterally as possible to preserve postoperative vertebral stability. The patient is placed in a supine position, with the head in slight extension and rotation to the contralateral side. Supporting pads are placed at the contralateral side, providing for contralateral rotation of the operative table. Longus colli muscles are exposed through the routine anteromedial approach. The medial half of the ipsilateral longus colli muscle is excised for as many levels as required, and the lateral half is dissected from the vertebral bodies and reflected laterally with strings to expose the lateral wall of the vertebral bodies. The drilling is started at the anterolateral aspect of the vertebral bodies within the dissected area of the longus colli muscle. The drilling is extended obliquely toward the opposite side. The osteophytes or the ossification of the posterior longitudinal ligament are resected and the vertebral canal is opened widely, thus preserving more than half of the vertebral bodies. Postoperatively, all patients are asked to wear a soft collar for 4 weeks. The surgery was performed in 16 cases. The duration of postoperative follow-up ranged from 3 to 15 months, with an average period of 12 months. All of them except two improved neurologically. The cervical alignment was preserved in all patients.