隣接２椎間の腰部脊柱管狭窄症に対する片側進入両側脊柱管除圧術の手術成績
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Microscopic bilateral spinal decompression through unilateral laminotomy is a minimally invasive surgical technique for treating lumbar canal stenosis. This technique can accomplish decompression of the thecal sac and bilateral nerve roots without injury to the supra-/inter-spinous ligament complex or contralateral paraspinal muscles. Subsequently, this technique can prevent postoperative pain derived from muscle injury, and allows patients to begin postoperative body exercises earlier resulting in a more prompt return to society. We consider that the superiority of this strategy is particularly apparent in the treatment of patients with multilevel lumbar canal stenosis. In the present study, ten patients with adjacent two-disc-level lumbar canal stenosis were treated by this technique. Surgical outcomes were evaluated by the Japan Orthopedic Association score (JOA score), a Visual Analogue Scale (VAS), lengths of postoperative hospital stay, the period of time to return to work after operations, and by the patients' satisfaction of their operation. The JOA scores ranged from 6 to 23 points (mean, 14.3 points) preoperatively, with improvements resulting in postoperative scores ranging from 23 to 28 points (mean, 24.9 points). The preoperative VAS scores ranged from 6 to 10 (mean, 8.3), and were postoperatively reduced, ranging from 0 to 3 (mean, 1.3). The postoperative hospital stay ranged from 4 to 38 days (mean, 16.4 days). Seven of the patients were unemployed preoperatively, while the remaining three had jobs and returned to work between 8 and 12 days after their operations. None of the patients answered "border-line" or "unacceptable" when they evaluated their operations; five patients answered "very good", and the other five answered "good". In conclusion, we consider microscopic bilateral spinal decompression through unilateral laminotomy to provide an excellent surgical outcome and an early return to society for patients with multilevel lumbar canal stenosis.
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