腰部脊柱管狭窄症の観血的治療経験

Abstract

Low back pain accompanied with degenerative lumbar spine is an important problem as well as cauda equina syndrome for lumbar spinal canal stenosis. The purpose of the surgical intervention is to decompress the neural stractures without spoiling stability of the lumbar spine. In point of this purpose, Wedge's osteotomy is one of the ideal methods for laminectomy. Multiple fenestration at the narrow interlaminar segments is a new method.We treated nineteen cases of the lumbar spinal canal stenosis surgically from 1982 o 1986 in our hospital. Central laminectomy was done in one case, Modified Wedge's osteotomy in eleven cases, multiple fenestration in five cases, anterior interbody fusion in two cases. Posterior spinal fusion was done in three cases of laminectomy, and in all cases of multiple fenestration. Harrignton distraction rod was employed in two cases, Harrignton compression rod in one case, and L-type rod in two cases.Good results were obtained concerning involvement of the cauda equina. But one case accompanied with cervical spondylotic myelopathy and one case with thoracic spinal cord tumor developed left paraparesis as sequelae due to spinal cord involvement. Low back pain was deteriorated postoperatively in two cases of laminectomy without fusion.One was a case of degenerative spondylolisthesis. In another one, postoperative stress ulcar occurred and long period of rest in bed was required.Instrumentation gave stability to the spinal column immediately after surgery and was able to make postoperative care easy.