脊髄外科
Online ISSN : 1880-9359
Print ISSN : 0914-6024
ISSN-L : 0914-6024
原著
腰部脊柱管狭窄症に対する顕微鏡下棘突起縦割式腰椎椎弓切除術の周術期合併症の検討
妹尾 誠佐藤 司森 大輔西谷 幹雄大竹 安史
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2015 年 29 巻 3 号 p. 304-309

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  Objective : To investigate the incidence of perioperative complications associated with lumbar laminectomy performed microscopically using the spinous process-splitting technique for degenerative lumbar canal stenosis.
  Methods : We retrospectively reviewed 250 consecutive patients (131 men and 119 women ; mean age 68.4 years, range 44-90 years) treated at our institute between 2006 and 2014. To assess the risk factors for unintended dural tear, which is the most common complication, we analyzed patient characteristics and surgeons’ experience. We also reviewed all the video records of the cases with incidental durotomy to identify dangerous locations and causative maneuvers for dural tear.
  Results : Of the 250 patients, 35 (14%) had more than one complication during surgery or within three months after surgery.
  Unintended dural tear occurred in 20 cases (8%). Moreover, we observed the following complications : two nerve root injuries, two wrong-level surgeries, one postoperative hematoma, six postoperative CSF collection, and four surgical site infections ; however, there was no severe deficit or mortality. There was no significant difference in age, sex, and number of treated levels between the patients with and without dural tear. Moreover, the surgeon’s experience did not markedly influence the incidence of dural tear. Dural tear frequently occurred during detaching or punching procedures at the medial aspect of the zygapophysial joint.
  Conclusion : The overall complication rate of microscopic lumbar laminectomy for degenerative lumbar canal stenosis was 14%, with no permanent deficit and mortality. The incidence of dural tear (8%) was the highest of all the complications. Great care should be taken to avoid dural tear, especially when using a dissector or Kerrison punch at the medial aspect of the facet joint.

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© 2015 日本脊髄外科学会
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