腰椎椎間板ヘルニアに対する経皮的椎間板摘出術 : 術後成績に関与する因子について ヨウツイ ツイカンバン ヘルニア ニ タイスル ケイヒテキ ツイカンバン テキシュツジュツ : ジュツゴ セイセキ ニ カンヨ スル インシ ニツイテ Percutaneous discectomy for lumbar disc herniation : Factors that may affect the clinical results
腰椎椎間板ヘルニアに対する経皮的椎間板摘出術 : 術後成績に関与する因子について
ヨウツイ ツイカンバン ヘルニア ニ タイスル ケイヒテキ ツイカンバン テキシュツジュツ : ジュツゴ セイセキ ニ カンヨ スル インシ ニツイテ
Percutaneous discectomy for lumbar disc herniation : Factors that may affect the clinical results
The traditional surgical treatment for lumbar disc herniation has been discectomy by the posterior approach. However, postoperative complications such as delayed vertebral in stability, epidural fibrosis an d adhesive myelomeningitis sometimes occur in a fcw cases making the sugical result less disirable. Recently, instead of the conventional surgery of discectomy, a new method of percutaneous discectomy has been employed with excellent results. This procedure is simple, safe and only slightly in vasive since it causes no direct damage to the dura or nerve roots. For this technique, we developed a nucleotome probe with a rotating electric shaver (3mm in diameter). In this study, the therapeutic results of this procedure and factors that may affect the results were evaluated. The subjects were 119 patients (124 discs) with disc herniation who had not been relieved of sciatica in spite of conservative treatments. They consisted of 79 males and 40 females aged 12-66 years (mean, 31.6 years) and were followed up for 2-13 months (mean, 6.1 months) after operation. The intervertebral levels involved were T12-Ll, Ll-L2, and L2-L3 in 1 each. L3-L4 in 9, L4-L5 in 63, and L5-S1 in 49. The postoperative results were evaluated according to Macnab's criteria, and the treatment was considered to have been effective when the evaluation was "excellent" or "good". The results were "excellent" in 38, "good" in 56, " fair" in 10, and "poor" in 13, with a percent efficacy of 79.8%. The symptoms were alleviated during or immediately after operation in some patients but more often reduced or resolved about 1 week after operation. No particular postoperative complications were noted. Among the sex, age, level of the affected disc, herniation type, degree of disc degeneration, pain reproducibility during discography, amount of the disc resected, duration of illness, and preoperative severity, which were evaluated as possible factors affecting the operative results, the degree of disc degeneration, level of the affected disc, and herniation type are considered to have some effects on the operative results. The results were less satisfactory when disc degeneration was severe than absent or mild, when the level of the lesion was L5-S1 than L3-L4 or L4-L5, and when herniation was the extrusion type than the protrusion or prolapse type. In 57 paticets who were available for preoperative and postoperative MRI, the degree of disc protrusion was reduced postoperatively in 54%, the reduction being 2 mm or more in 8, 0-2mm in 23, but none in 28. The treatment was effective in all 8 patients in whom protruded disc was reduced by 2mm or more. From these results, reduction of the protrudcd disc would effect the direct decompression of the nerve root and relieve pain.
医歯学総合研究科博士論文(医学) ; 学位取得日: 平成3年11月6日