腰部脊柱管狭窄症に対する一側進入両側黄色靭帯切除術の治療成績

抄録

  Object : Unilateral partial hemilaminectomy with bilateral ligamentectomy (UPBILIT) is one of the less invasive procedures for treating lumbar spinal stenosis. Optionally, this decompression technique can also be combined with inter-spinous process fixation (+F) for those patients with minimum instability. In this study, the surgical results of single-level UPBILIT were retrospectively evaluated.

  Methods : We conducted an analysis of data obtained in a consecutive series of 60 patients treated with single-level UPBILIT or UPBILIT+F over a 4-year period (April 2003-March 2007). Clinical outcome was measured using the Japan Orthopedic Association (JOA) score and JOA recovery rates. Prognostic factor and complicated cases were also evaluated.

  Results : Forty patients had undergone UPBILIT and twenty patients with spinal instability had undergone UPBILIT+F. On an average of 24.2 months postoperatively, 54 of 60 patients (90%) experienced clinical benefit. The JOA score significantly improved from 14.6 to 21.0 (p<0.0005) with an average JOA recovery rate of 44.9%. Longer duration of disease correlated with the fair outcome group.Two patients (3.3%) experienced dural tear intraoperatively, and postoperative complications occurred in 4 patients (6.7%).

  Conclusions : The favorable recovery rate and the low incidence of complication indicated that UPBILIT can be a useful decompression surgery for lumbar spinal stenosis. In addition, the procedure, by using inter-spinous process fixation, can also manage those patients with minimum spinal instability.