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医者の男

頚椎ヘルニアに手術が必要な場合と問題点

医師

頚椎ヘルニアは一般的には安静にすること(保存療法)で治療することが多いと言えます。しかし、頚椎ヘルニアの症状が好転しない場合には、ケースによっては手術を受けることも必要となります。

頚椎ヘルニアの場合に手術を受けることが必要な場合とは具体的にはどのような場合なのでしょうか。また、手術を受けるに際してはどのような点に注意することが必要と言えるのでしょうか。

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頚椎ヘルニアのメカニズムと手術の必要がある場合について

医師

頚椎ヘルニアとは、頸部(くび)の椎間板が飛び出てしまって神経を圧迫している状態を言います。本来、ヘルニアとは飛び出るという程度の意味合いであり、頚椎ヘルニアは首の椎間板が本来あるべき場所から飛び出てしまって神経を刺激している状態をいいます。

神経が圧迫されている状態ですので、頚椎ヘルニアとなると首や肩などが非常に痛みます。(また程度が進めばしびれなども生じます)これが頚椎ヘルニアのメカニズムです。

頚椎ヘルニアに対しては、一般的にはあまり手術をすることは少ないということができます。頚椎ヘルニアに対して行われる治療法は手術よりも保存療法と呼ばれる治療法が主流です。

保存療法とは頚椎ヘルニアの幹部を安静な状態に保つという治療法です。これにより頚椎ヘルニアの8割程度は数ヶ月で痛みが治まると言われます。頚椎ヘルニアで手術をすることは基本的には少ないということができます。

しかし、保存療法を継続しても痛みなどの症状が好転しない場合、あるいは頚椎ヘルニアの症状がかえって悪化しているような場合には手術の必要性が生じることとなります。頚椎ヘルニアに対して手術は、いわば最後の手段ということができる治療法と言えます。

頚椎ヘルニアに対する手術療法

では、頚椎ヘルニアに対してはどのような手術が実施されるのでしょうか。
一般的には、頚椎ヘルニアに対する手術としては頚椎前方到達法と呼ばれる手術法が取られることになります。

これは、全身麻酔で頸部右側の皮膚を切り開き、気管と食道を寄せながら頚椎に到達して頚椎を削り取るという手術法です。

手術はおおむね3時間程度で実施されます。その後、2週間程度の期間入院して退院をします。手術後、歩行の問題などがある場合には通院してリハビリテーションをすることにもなります。

手術の安全性は?

頚椎ヘルニアの手術は、ある程度手術の方式がかたまっていますのであまり心配はないということができますが、やはり手術というと不安を感じるものです。

頚椎ヘルニアに対する手術は手術用顕微鏡を用いて拡大して行うなど安全性には配慮されていますが、やはり手術である以上いくつかの合併症が生じ得る可能性はあります。

頚椎ヘルニアの手術から生じ得る合併症としては、例えば、創部から感染症が発症してしまうこと、手術後に血腫が出来てしまい脊髄が圧迫されること(四肢が麻痺してしまう恐れがあります)などがあります。

手術である以上、可能性は低いもののこれらの合併症のリスクは受け入れて手術を受ける必要があります。

なお、もちろん、非常に低い可能性ではありますが医師による手術の技術的なミス(いわゆる医療過誤)の可能性もゼロとは言えません。しかし、その可能性は現在の医療水準では極めて低いものです。気にしたい点はやはり手術による合併症の可能性と言えるでしょう。

費用についての問題

また頚椎ヘルニアの手術を受けるにあたっては費用という面も問題となります。頚椎ヘルニアに対する手術自体は高額医療の対象として10万円程度となりますが、入院費などで結局は30万円程度の費用はかかってしまいます。また、お仕事をされている方の場合にはお仕事を休むことによる収入減(いわゆる逸失利益)が問題となるでしょう。

これらの点については任意で加入している保険適用(入院保険など)可能性と症状の程度も考えて決断されることが必要と言えるでしょう。一般に日常生活が困難な程度に頚椎ヘルニアの症状がひどくなってしまった場合には手術を検討する必要があると言えます。

なお、頚椎ヘルニアについては、切開をしないレーザーを用いた手術もあります。この場合、1時間程度で手術は終わりますが、自由診療として全額自己負担となります。

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まとめ:頚椎ヘルニアと手術についてのまとめ

以上、本文で述べました頚椎ヘルニアに対する手術についてのポイントをまとめますと以下のようになります。

  • 頚椎ヘルニアに対して手術をする必要性は、保存療法によっても効果が現れない場合やかえって症状が悪化してしまっているような場合です。このような場合に手術を検討することになります
  • 頚椎ヘルニアに対する手術は3時間程度の切開手術を行い、手術後は2週間程度の入院をすることになります。退院後も歩行困難などの症状があればリハビリを行うことになります
  • 頚椎ヘルニアの手術を受けるにあたっては可能性は低いものの感染症などによる合併症のリスクは負担する必要があります。また、費用が30万円程度かかってしまい、やや支出がかさんでしまうことにも注意が必要といえます

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