[脊柱管狭窄症:広範な疾患か、あるいは単なる放射線学的診断か?]

Julia Luckow1,2, Klaus-Dieter Schaser3,4, Rainer Sabatowski5

  • 1UniversitätsCentrum für Orthopädie, Unfall- & Plastische Chirurgie, Universitätsklinikum Carl Gustav Carus Dresden, Fetscherstr. 74, 01307, Dresden, Deutschland. julia.luckow@ukdd.de.

Schmerz (Berlin, Germany)
|January 16, 2026
PubMed

腰部脊柱管狭窄症は主に65歳以上の高齢者に発症し、間欠性跛行などの典型的な症状を伴うことが多い。稀な先天性要因を除き、通常は椎間板突出、椎間関節変性、靭帯肥厚などの加齢に伴う変化により二次的に発症する。典型的な臨床症状に加え、2方向からの立位単純X線写真および磁気共鳴画像法(MRI)が診断の決定打となる。重大な神経学的欠損のない患者に対しては、まず保存的治療を行うべきである。保存的アプローチで軽減できない疼痛、神経学的欠損、および保存的治療が無効な場合には、外科的治療の適応が正当化される。可能な限り、低侵襲な除圧術を目指すべきである。臨床的に有意な不安定性、狭窄、またはアライメント異常がある場合には、固定術が必要となることがある。

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