分離症を伴う50才以上の腰部脊柱管狭窄症に対する治療

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In the treatment of lytic spondylolisthesis wide decompression and fusion are usually performed. However, lumbar fusion is invasive and has a high risk, especially in the advanced. In this report the patients with lumbar spinal stenosis and pars defect have been reviewed clinically and radiologically to determine whether the fusion is needed or not. A total 24 patients more than fifty-year-old with an average of 64.7- year-old were reviewed. The mean follow-up time was 34.4 months. The spondylolysis was seen at L4 in 6 cases, L5 in 13, L3+L4 in 1, L4+5 in 3, and L3+L4+L5 in 1. Out of these 24 patients spondylolisthesis was shown in 19 patients. In L4 spondylolysis spinal stenosis was seen at L3/4 in 2, L4/5 in 3, and L3/4+L4/5 in 1. In L5 spondylolysis stenosis was shown at L3/4 in 1, at L4/5 in 8, L3/4+L4/5 in 3, and L5/S1 in 1. In six patients treated with laminectomy, pedicle screw fixation, and posterolateral fusion, two showed good, and four fair. Radicular pain continued in two patients and low back pain persisted in two. Two patients developed new stenosis at the proximal segments and required second operation. In 12 patients with fenestration procedures alone, three patients exhibited excellent, and nine good. The surgical outcomes were neither related to the degree of olisthesis nor to the age of patients. Follow up radiographs showed no progression of slippage. These results seem to suggest that lumbar fusion is not necessary in the treatment of lumbar spinal stenosis with pars defect, especially in patients more than fifty-year-old.
日本脊髄外科学会の論文
2004-03-31

分離症を伴う50才以上の腰部脊柱管狭窄症に対する治療

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