低侵襲手術の観点より見たLumbar Alligator Spinal Systemとspacerを用いた後方腰椎固定術の臨床経験

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Compared with the simple decompression procedures, lumbar fixation procedures are essentially invasive. Spinal instrumentation is used for fixation in degenerative lumbar disease cases. But there is a considerable debate with regard to whether instrumentation is needed or not and if needed, which procedure should be performed. It is possible to accomplish the firm lumbar fixation using pedicle screws (PS), but the procedure is invasive. Intraoperative nerve root injury or paraspinal muscle damage is sometimes reported as one of the complication of PS fixation. The aim of this paper is to clarify the invasiveness of posterior lumbar interbody fusion (PLIF) using interbody spacers and a Lumbar Alligator Spinal System (LA) which is a kind of a clamping plate for the spinous process. A total of 17 patients underwent PLIF for single level spondylolisthesis in our institute from 2002 to 2004. Stand-alone PLIF was carried out in 4 patients, PLIF with PS in 10 patients, and PLIF with LA in 3 patients. We compared the duration of surgery, volume of blood loss, procedure-related complications, postoperative neurological findings, and postoperative hospitalization among 3 techniques. A LA was employed in 1 patient age more than 80 years and in 2 patients with osteoporosis. In the LA group, the duration of the surgery was significantly shortened in comparison to the PS group. In the LA and stand-alone PLIF group, the volume of blood loss was significantly lower than that in the PS group. After surgery, there was no neurological deterioration in any patient in LA group, and the main preoperative symptoms, such as lumbago and intermittent claudication, improved in all patients. In this study the fixation with LA was appreciated to be safer and less invasive method than PS. For the case which need the less invasive procedure such as aged people and the case who has osteoporosis, it is a useful fixation method for PLIF instead of the PS fixation.
日本脊髄外科学会の論文
2006-09-30

低侵襲手術の観点より見たLumbar Alligator Spinal Systemとspacerを用いた後方腰椎固定術の臨床経験

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