WHITE CROSSは、歯科・医療現場で働く方を対象に、良質な歯科医療情報の提供を目的とした会員制サイトです。



PubMedの提供する医学論文データベースを日本語で検索できます。AI(Deep Learning)を活用した機械翻訳エンジンにより、精度高く日本語へ翻訳された論文をご参照いただけます。
J Neurosurg Spine.2020 Mar;:1-8. 2020.1.SPINE191152. doi: 10.3171/2020.1.SPINE191152.Epub 2020-03-20.


Short-term outcome of lamina-sparing decompression in thoracolumbar spinal tuberculosis.

  • Gagandeep Yadav
  • Pankaj Kandwal
  • Shobha S Arora
PMID: 32197241 DOI: 10.3171/2020.1.SPINE191152.




OBJECTIVE: The authors sought to assess the outcomes of lamina-sparing decompression using a posterior-only approach in patients with thoracolumbar spinal tuberculosis (TB). In patients with spinal TB with paraplegia, anterior decompression yields excellent results because it allows direct access to the diseased part of the vertebra, but the anterior approach has related morbidities. Posterior and posterolateral decompression mitigate approach-related morbidities; however, these approaches destabilize the already diseased segment. Lamina-sparing decompression through a posterior-only approach is a modification of posterolateral and anterolateral decompression that allows simultaneous decompression and instrumentation while preserving the posterior healthy bony structure as much as possible.


脊髄結核患者35名がラミナを温存した減圧とインスツルメンテーションを受けた。奏功は、機能評価には視覚アナログスケール(VAS)とOswestry Disability Index(ODI)、神経学的評価には米国脊髄損傷協会(ASIA)の障害等級、手術成績評価には出血量と手術期間、前弯矯正を測定するためのコブ角を使用して決定された。

METHODS: Thirty-five patients with spinal TB underwent lamina-sparing decompression and instrumentation. Outcomes were determined by using a visual analog scale (VAS) and the Oswestry Disability Index (ODI) for functional assessment, the American Spinal Injury Association (ASIA) impairment grade for neurological assessment, blood loss and duration of surgery for surgical outcome assessment, and Cobb angles to measure kyphosis correction.


平均年齢35.8±18.7歳(範囲4~69歳)の35名(男性12名、女性23名)がラミナ温存減圧術を受けた。背側8名、背腰部7名、腰部7名、多巣性連続性9名、多巣性非連続性脊椎結核4名;傍脊椎Pott's spine(結核性脊椎二十二指腸炎)33名、中枢型2名であった。術前の平均Cobb角は28.4°±14.9°(範囲0°~60°)、術後のCobb角は16.3°±11.3°(44°~-15°)であった。フォローアップの16ヶ月間に1.6°±1.5°(0°~5°)の損失があった。平均出血量は526±316(範囲130~1200)mlであった。手術時間は228±79.14分(範囲60~320)であった。平均的な椎体インストルメントのレベルは、患部近位で0.97±0.8(範囲0-4)、患部遠位で1.25±0.75(範囲0-3)の椎体であった。術直後の神経学的回復は、27人中23人(85.1%)の患者に見られた。全ての患者は16ヶ月後の最終フォローアップ時には回復していた。術前ODIスコアは76.4±17.9(範囲32-100)から6.74±17.2(0-60)に改善した。術前のVASスコアは7.48±1.16(6-10)から0.47±1.94(0-8)に改善した。手術部位の感染は2名に発生し、1名の患者は術中硬膜断裂を起こしたが修復に成功した。1名の患者は3ヶ月目にインプラントの緩みを発症したが、これは延長インスツルメンテーションにより管理された。

RESULTS: In total, 35 patients (12 men and 23 women) with an average age of 35.8 ± 18.7 (range 4-69) years underwent lamina-sparing decompression. Eight patients had dorsal, 7 had dorsolumbar, 7 had lumbar, 9 had multifocal contiguous, and 4 patients had multifocal noncontiguous spinal TB; 33 patients had paradiscal Pott's spine (tuberculous spondylodiscitis), and 2 had central-type disease. The average preoperative Cobb angle was 28.4° ± 14.9° (range 0°-60°) and the postoperative Cobb angle was 16.3° ± 11.3° (44° to -15°). There was loss of 1.6° ± 1.5° (0°-5°) during 16 months of follow-up. Average blood loss was 526 ± 316 (range 130-1200) ml. Duration of surgery was 228 ± 79.14 (range 60-320) minutes. Level of vertebral instrumentation on average was 0.97 ± 0.8 (range 0-4) vertebra proximal and 1.25 ± 0.75 (0-3) distal to the diseased segment. Neurological recovery during the immediate postoperative period occurred in 23 of 27 patients (85.1%). All patients had recovered at the final follow-up at 16 months. The preoperative ODI score improved from 76.4 ± 17.9 (range 32-100) to 6.74 ± 17.2 (0-60) at 16 months. The preoperative VAS score improved from 7.48 ± 1.16 (6-10) to 0.47 ± 1.94 (0-8). Surgical site infection occurred in 2 patients, and 1 patient had an intraoperative dural tear that was successfully repaired. One patient developed implant loosening at 3 months, which was managed by extended instrumentation.



CONCLUSIONS: To achieve stability, lamina-sparing decompression allows fixation of lower numbers of vertebrae proximal and distal to the diseased segment. This method has a fair outcome in terms of kyphosis correction, good functional and neurological recovery, shorter surgical duration than conventional methods, and less blood loss.