척추관 협착증의 수술적 치료

Abstract

Spinal stenosis is a fairly common low back disorder characterized by the narrowing spinal canal and compression of neural element with resultant leg pain and/or intermittent claudication. The usual cause of the spinal stenosis is the degenerative changes of the spine, so symptoms of this disease get worse as the patients get older. Our surgical indications include: 1) when the patient cannot walk more than 200-300 meters due to neurogenic intermittent claudication and/or 2) when the nerve root palsy is noted. From January 1996 to December 1998, there were 86 cases of spinal stenosis who underwent surgery. Of them, 9 cases were excluded due to loss of follow up or other causes, and 77cases were included in this study, who have been followed more than 6 months after surgery. Method of operation at first half of the series was bilateral laminotomy and medial facetectomy in most cases. But low back pain with buttock, thigh pain due to facet joint syndrome was common residual symptoms, so I added the procedure of posterior instrumentation and lateral fusion for decompression. We had analyzed symptoms and results of operation according to Kirkaldy-Willis' criteria. Of the 77 cases, results were graded as excellent or good in 69 cases(88.3%), and fair or poor in 9 cases(11.7%). The result of decompression with instrumentation and fusion was better (91.7% Excellent or Good results) than that of decompression procedure only (82.8% Good or Excellent results). The problem in fusion group was the bone graft site pain. But this pain was self-limited in most cases or was controllable by medication or local steroid injection in some cases. Fusion was achieved in 72.7% of cases, which was interpreted by simple X-ray.