腰椎椎間板ヘルニアに対する術後成績の検討

抄録

341 operated cases of lumbar disc hernia were analyzed. Cases of pure hernia were 87%, those with lumbar canal stenoses were 13%. The average age was 50.3 years-old and the male to female ratio was almost 2 to 1.
The indication of surgery should be analyzed first, according to the patient's neurological status, complaints and the duration of leg pain. It also can be determined by examining the evidence of the findings of radiological images of neural compression. However, it may be also indicated, in consideration of the psychiatric aspects, excluding neurological degenerative diseases.
In deciding the surgical plan, (whether it is limited to minimum surgery, or extended to the wide laminectomy), the surgeon should consider the following points; whether the patient is of working age or not, and whether his labor is physical work or not, for example.
One of the other important points of surgical strategy is to make a change as promptly as possible from minimum laminotomy to the wide laminectomy, when the case of a large size hernia is accompanied with a severely narrow canal. This is in order to protect the nerve root, at the same time, as aiming for the maximum removal of the herniated tissue. Nevertheless, the rate of recurrence could not be decreased more than 2∼3%.
The investigation of preoperative risk factors brings a decrease in the percentage of complications, such as, brain or heart vascular disorders, Exceptions would be postoperative infections or hematomas.