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歩く女性
歩く女性

腰椎間板ヘルニアの手術で日帰りで終えられる方法

歩く女性

腰椎間板ヘルニアの治療法には保存療法や手術療法などさまざまな方法があります。軽度であれば保存療法で治療が行われ、すぐに手術が行われるということはありません。しかし、緊急を要する場合や保存療法では症状の改善が見られない場合には、手術という方法がとられることがあります。

腰椎間板ヘルニアの手術の中にも、日帰りで終えられる方法もありますので紹介します。症状によっては日帰りでは難しいということもありますが、仕事の都合などで手術にあまり日数をとれないという時には日帰りの手術という選択を医師と相談してみてはいかがでしょうか。

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腰椎間板ヘルニアとは?

腰痛

腰骨には5つの腰椎と1つの仙骨、それぞれの骨の間にある椎間板というクッションからできています。椎間板は外側部分を線維輪、中には髄核があります。髄核の後ろの方には脊柱管という管が腰骨の中にあり、神経の通り道となっています。しかし、椎間板の中身である髄核が後ろに飛び出て、神経を圧迫することがあり、これが腰椎間板ヘルニアという状態です。神経が圧迫されると炎症が起きて、痛みやしびれ、麻痺などの症状を起こします。

腰椎間板ヘルニアの手術方法

腰椎間板ヘルニアへの手術方法には、大きく2通りの方法があります。1つは椎間板をとって上下の骨を癒合させる方法で、もう1つはヘルニアと髄核のみをとる方法です。

日帰りで行える腰椎間板ヘルニアの手術方法

日帰りで行える腰椎間板ヘルニアの手術方法は、ヘルニアと髄核のみをとる手術です。その中でもいくつか手術方法がありますので紹介します。

①経皮的レーザー椎間板減圧術

椎間板の中央に針を刺し、その中を通してガラス繊維を入れて、先からレーザー光線を照射して椎間板の中央部を焼灼して神経を圧迫しているヘルニアの圧迫力を低下させるという方法です。レーザー自体に消炎鎮痛効果があるとも言われています。この方法は、椎間板を元の状態に戻すものではありませんので、仙骨ブロックなど手術以外の治療法を試みた後、効果が不十分な場合のみ行います。

薬や理学療法、ブロック療法などと、手術の中間に位置する中間療法として、レーザーによる経皮的髄核減圧術が行われます。手術に比べると適応は狭いですが、十数分のレーザー照射で治療が可能です。

局所麻酔で行い、状態によって日帰り~1泊で終えることができます。術後の回復も早く、日常生活や仕事への復帰が早期に行えるのがメリットとして挙げられます。また、針の穴程度の傷しかありませんので、傷跡が目立ちません。

ただし、健康保険が適応できませんので、費用が約35万円ほどかかります。

②経皮的椎間板破砕・摘出術

経皮的椎間板破砕・摘出術は、傷口が非常に小さく、日帰りや1泊2日で早期に社会復帰できる最先端の手術方法です。X線透視を行いながら椎間板に針を刺し、針の先端のワイヤーを椎間板内で広げます。広げたワイヤーを回転させてヘルニアを砕きながら吸引します。椎間板内に空洞ができることでヘルニアを縮小するという方法です。針穴で行う手術としては、最も効果があると言われています。レーザーよりも再発が少なく、治療成績がよいとも言われています。

手術の特徴としては、皮膚切開を行わないで髄核を取り出すことができます。また、傷口が非常に小さく、注射のような傷跡で絆創膏でふさぎます。
局所麻酔で行うことができ、日帰り~1泊で終えることができます。ただし、健康保険が適応できず、約60万円の費用がかかります。

レーザーによる手術のメリット

腰痛がひどくて毎日つらい、ヘルニアで手足がしびれるのに、治療が効かないという方で、切開手術を受けるほどではないが腰椎間板ヘルニアを治したいときに有効です。レーザーの手術は検査入院も不要ですから、多くの場合が日帰りが可能です。この他にもレーザーによる手術のメリットがあります。

まず、出血しないということがあります。レーザーファイバーを身体に刺す方法ですから、メスを用いる切開手術のような出血がありません。また、身体への負担が軽いということも言えます。局所麻酔が使われますので、身体の負担が少なく、高血圧や喘息、糖尿病などの疾患がある方でも施術が可能です。治療時間は10~30分程度と短く、完治のスピードも速いです。1時間程度の安静時間を病院で過ごせば帰宅できます。

まとめ:保存療法でも効果がない時には日帰りの手術を相談してみよう

マッサージや薬物療法などでは抜本的に痛みの元をなくすことはできません。しかし、切開手術をするほどでもないという症状で、メスを入れることに抵抗があるという方には日帰りの手術が適していると言えます。担当の医師と相談して手術方法を決めるようにしましょう。

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