高齢者の腰椎変性疾患に対する手術法
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Purpose : Some elderly people, suffering from numbness or pain in their lower limbs, gait disturbance and so on, are restricted in their daily life. We undertook operations for these elderly patients over eighty years old with degenerative lumbar spine disease and acquired excellent results. Operative methods and outcomes are reported. Materials and methods : 623 patients of degenerative lumbar spine disease were surgically treated in Inazawa City Hospital. 36 (5%) out of those 623 were performed on patients aged over eighty years. There were twenty-eight lumbar canal stenoses, six lumbar disc herniations, and two superior facet syndromes. Symptoms were; numbness or pain in the lower extremities in twenty-nine, and intermittent claudication in sixteen. Unilateral lumbar fenestration was considered at first as the operative approach for degenerative lumbar disease and bilateral lumbar fenestration was carried out for the patients with bilateral radiculopathy. Central lumbar fenestration was also selected for patients with severe lumbar degeneration. Moreover, if necessary, lumbar fixation was added to lumbar fenestration. Result : Operative approach was chosen as central lumbar fenestration in seventeen, unilateral lumbar fenestration in seventeen, and bilateral lumbar fenestration in two. In six cases instrumentation was used for lumbar fixation. Intermittent claudication improved in all cases. However numbness or pain in the lower extremities was not improved in three patients, so a second operation was performed for them. After the second operation, their symptoms improved. Conclusion : The purpose of the operations for elderly patients with degenerative lumbar spine disease was to improve the restrictive symptoms in their daily life. Operation was limited, only to the levels presenting symptoms, and can not be decided only with radiographic findings. In operative approach, central lumbar fenestration had advantages in the safety of the procedure and appropriate operative decompression for degenerative lumbar spine. Even if lumbar fixation was needed, a less invasive method had to be chosen.
- 日本脊髄外科学会の論文
- 2005-09-30
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