腰椎変性疾患再手術例の検討

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タイトル別名
  • Study of Reoperation for Lumbar Diseases

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The primary operation for lumbar canal stenosis, including herniation of lumbar vertebral discs, is a comparatively easy procedure. However, when reoperation is required the procedure is very much complicated by granulation tissue round the circumference of the operated site causing adhesion with the lumbar dural sac and root. The author analyzes cases of lumbar canal stenosis and disc herniation requiring reoperation and the methods employed. From April 1996 to December 2002, reopration for restenosis was required in 67 cases out of a total of 817 operations for lumbar canal stenosis and disc herniation. Patients comprised 35 males and 32 females, with an average age at reoperation of 64.3 yr. In 39 cases, the site of reoperation was the same as for the primary operation, but in the other 28 patients involvement of the adjacent lumbar levels had occurred. The reoperative approach was basically the same as for the primary procedure. In cases with instability of the lumbar vertebrae, the author used mechanical lumbar vertebral fixation was necessary with decompression and, in cases without instability, performed only a trumpet-shaped vertebrae laminoplasty. The improvement rate was 72.8%. For restenosis between lumbar vertebrae at a level similar to the primary procedure, in 7 patients spinal column expansion alone was performed, and in 32 patients vertebral fixation using a device was employed. Concerning the causes of restenosis at the same level, there were many case of recurrent lumbar disk herniation with an average age at reoperation of 54.2 yr. The overall improvement rate was 81.4%, however there was a significant difference between improvement in the group in whom a fixation device was used (88.1%) and those in whom a device was not used (50.8%). In conclusion, the author strongly advises the lumbar fixation is necessary when reoperation is required for restenosis at the same level of the primary procedure.

収録刊行物

  • 脊髄外科

    脊髄外科 17 (2), 139-146, 2003

    日本脊髄外科学会

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