頚椎後縦靭帯骨化症に対する外科的治療 : 自家椎体使用による前方除圧固定術の手術成績(<特集>頚椎 OPLL)

Abstract

The authors describe the results of surgical treatment for ossification of the posterior longitudinal ligament of the cervical spine. This series consisted of 50 patients who underwent anterior decompression with anterior cervical fusion using bone grafts obtained from cervical vertebral bodies, and 5 patients who underwent expansive laminoplasty or laminectomy as a method of posterior decompression. Twelve out of 50 patients were operated for anterior cervical fusion at one level, 29 at two levels and 9 at three levels. The patients were out of bed within one day postoperatively with a soft collar for two months. In all patients, the symptoms improved postoperatively. Postoperative X-ray films showed solid bone fusion in all patients with anterior cervical fusion at a mean follow up time of 2 years and nine months (range 6 months to 6 years and one month). Anterior angulation was found in one out of nine patients (11%) with three-level fusions. Concerning the method of operation, the authors think that anterior decompression and fusion should be applied to cases of ossification of up to three consecutive vertebrae with either one level fusion or two level fusions. Posterior decompression is applied in cases in which anterior decompression is not indicative. If necessary, a two-stage combined decompression is recommended.