神経病性脊椎症に対する脊椎後方固定術の２例

Abstract

We present 2 cases of neuropathic spinal arthropathy treated by spinal fusion. 1 case involved a 39-year-old female with a history of congenital insensitivity to pain and a neuropathic spine who suffered progressive neurological compromise secondary to the L4-5 lesion. Radiograph revealed spondylolisthesis at L4 with severe destructive changes at L5. She underwent laminectomy at L3-5 with posterior spinal fusion using titanium instrumentation and a bone graft from L4 to the sacrum. Although follow-up radiograph confirmed progressive instability in the screw and rod, her motor loss and sensory disturbance gradually improved after the operation. The other case involved a 53-year-old male with complete T12 paraplegia due to traffic accident 25 years ago. At that time skeletal injuries to the spine included burst fractures in T12 and L1. The spine has decompressed and later fused posteriorly from T12 to L1 after the injury. Follow-up radiographs confirmed disc space narrowing, facet arthropathy, and destruction in the vertebral body with severe instability at L4-5. Recently he underwent posterior spinal fusion using ISOLA stainless instrumentation with a bone graft from L2 to the iliac bone. Postoperative radiographs showed good maintenance of the position and alignment of the instrumentation with no progression of arthropathy. We concluded that successful arthrodesis was achieved not only by rigid fusion using instrumentation but also by sufficient postoperative bracing.