第5腰椎椎体切除(Gaines法)およびIntrasacral fixation (Jackson法)により整復固定した脊椎下垂症の1例

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Spondyloptosis is defined as the most severe form of L5 spondylolisthesis, one that causes vertical descent of the entire vertebral body of L5 below the end plate of S1. The treatment of this complicated deformity still remains controversial. We will report about a case of spondyloptosis for whom two staged surgeries, transperitoneral L5 resection and reduction of L4 onto S1 by intrasacral fixation, were performed. A 25-year-old female, who had been diagnosed with grade 3 spondylolisthesis since she was 7 years old. The lumbosacral fixation had been recommended but she refused. At the time of admission, she complainted of lower back pain, gait disturbance, pain and numbness in her both legs, incontinence of bladder and abnormal body appearance due to the slipping of the L5. Plain radiograph showed spondyloptosis. MR imaging revealed marked canal stenosis at the S1 level. Surgery was performed in two stages. At first, the L5 vertebral body was totally resected through transperitoneal approach. During the second procedure, posterior segments of the L5 were resected through posterior approach to facilitate reduction of the L4 to the sacrum. The lumbosacral spine was stabilized using two mesh cages and was fixed by intrasacral fixation technique. After the operation, improvements in pain, neurological symptoms and cosmetic appearance were achieved. Alignment in the sagittal plain was restored. At the time of 18 months follow up, redisplacement did not occur and bony fusion was obtained.
日本脊髄外科学会の論文

第5腰椎椎体切除(Gaines法)およびIntrasacral fixation (Jackson法)により整復固定した脊椎下垂症の1例

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