高齢者に対する自家椎体骨を用いた前方固定術の有用性

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Technical difficulty in anterior cervical fusion for elder patients is attributable to narrowing of intervertebral spaces and fusion problems due to osteoporosis of both donor grafts and recipient sites. These problems could be resolved by the use of the method of anterior cervical fusion using autologous vertebral grafts. A retrospective comparative analysis was done in 14 patients elder than 70 (the elder age group) and 46 patients younger than 70 (the younger age group) who underwent anterior cervical fusion using vertebral grafts obtained from the fusion site in our institutes. An average follow-up period was 33 months (range 6 to 55 months). Sufficient decompression of the anterior cervical pathology was performed successfully via a wider operative field. The symptoms and neurological score improved significantly without any new deficits in all patients except for a 50-year-old man with a three-level fusion who needed reoperation for further decompression. Although the preoperative Neurosurgical Cervical Spine Scale (NCSS) was significantly worse in the elder age group, the improvement rate was as good as that in the younger age group (77±5.8% vs. 88±2.8%). No major graft complications such as graft extrusion or pseudoarthrosis occurred. No graft fracture was noted in the elder age group, while it was noted in five patients in the younger age group. Cervical alignment was preserved in all the cases in the elder age group, while five patients in the younger age group showed kyphotic changes. Although the method was technically demanding, it was useful in elder patients because of major advantages such as a wider operative field, excellent graft fusion in osteoporotic patients, and no need for an additional incision to obtain autogenous bone graft, which factor allowed early mobilization.
日本脊髄外科学会の論文
1999-03-31

高齢者に対する自家椎体骨を用いた前方固定術の有用性

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