The epidemiology of low back pain disorder is not yet popular in Japan. When we consider its best treatment, we should know its prevalence, rate and its natural course of the disease. Therefore we started to seek the general picture of the low back pain around us. Our survey was conducted in our orthopedic out-patient clinic in 1978.
Results are as follows;
Seventy % of out-patient experienced low back pain, but its course is self-limiting and 93% of them healed within 1 month. 20% of them were so severely disabled, that required them restraint from work.
The over-weighted one had more severe pain than the underweighted.
The older the person, the more people get troubled, contributing 33% disabled over the group of 7 decade.
The patients above 4 decade required more treatment than the younger, and they pre-ferred acupuncture and massage than the ordinary treatment.

View full abstract

We reviewed back pain patients treated with epidural block or facet block who visited our clinic from 1977 to 1979. And we concluded as follows:
(1) Epidural block has good indication for patients suffering from low back pain with sciatica.
(2) Facet block is indicated for patients who complained back pain worsened on body movement.
(3) Both epidural block and facet block have some beneficial effect for patient with chronic back pain.

View full abstract

One hundred and seven cases of the lumbar spine diseases treated with the surgical procedures at our hospital in last 3.5 yrs were as following : disc herniation 56, spinal canal stenosis 32, discopathy 3, spondylolysis 9, spondylolisthesis 2, spinal tumor 2, tuberculosis of spine 1, discitis 1, extradural abscess 1.
Among them, we investigated about the operative indication, the operative methods and the prognosis of the disc herniation and the spinal canal stenosis.

View full abstract

Since Mixter and Barrinitially reported on the surgical treatment of lumbar disc herni-ation in 1934, numerous basic and clinical studies have been done. The operative treatment for the lumbar disc hernia has been improved from initial laminectomy, osteoplastic hem-ilaminectomy to partial laminectomy (Love's method and modified Love's method). Among numerous improved methods, Love's method has been considered to be the most excellent method with minimal operative removal of bone and has prevalently been used. However, there have been only a few reports on the postoperative treatment and rehabilitation after the Love's method. It can be said that there are many varieties in the method of postoper-ative treatment, period of bed rest and ambulation.
Since 1975, we have established a program of the postoperative treatment and applied it on 111 cases of the operated patients. The purpose of this program is to obtain early ambulation and early discharge from the hospital within 2 weeks after the surgery, as re-ported by Crenshaw.
This program was based mainly on our clinical experience more than 300 cases of oper-ative treatment of disc hernia. The details of this program are as follows: (1) Urination was done through the catheter which was set preoperatively and kept open at desire to water. The catheter was removed within 24 hours postoperatively. (2) The cast bed was not used. The, patient was put in supine position on the bed, knees and hips with slight flexion. Elevation exercise of the lower extremities was initiated on the operated day. (3) Change of body position was started one day after the surgery. (4) Standing and ambu-lation with assistant or walker were started 2 or 3 days after the surgery. (5) Heat to the lower back was applied after the removal of the suture. (6) Discharge from the hospi-tal was in 2 weeks. (7) Deskwork was permitted after one month of the surgery. Return to the heavy work was permitted in 2 months.
The results obtained by the application of this program were as follows: ambulation was at 4.1 days (on average)postoperatively: hospitalization for 18.4 days: returnto the deskwork in 34.1 days, to heavy work in 63.8 days.
Postoperative follow-up was done mainly on evaluation of lumbago, pain in the lower limbs, SLR test, sensory disturbances and muscle atrophy. Short term follow-up was in one month after surgery, long term follow-up after one year.
Lumbago and discomfort in the lower back remained in 25% of the operated patients, which was almost the same results as other reporters. Other symptoms were relieved completely by the surgery. There was no instability of the operated lumbar columns, except for one case with discitis. The operation was highly appreciated by the operated patients.

View full abstract

Lumbar myelographies with Dirax were carried out for total of 80 patients during the period from April 1977 to September 1979.
Various aspects of the side effects during or after examination were observed. Mye-lographic findings were investigated in 72 cases of lumbar disc herniation. The side effects: 1) These were observed in 41.3 per cent among 80 cases. The most common. side effect was ache or heavy sensation of the head. The next commonest were neck pain, nausea and vomiting. 2) When Dirax was occupied higher than the middle level of L₁ vertebra, frequency of the side effects tend to increase, though major side effect was not encountered. 3) The side effects such as convulsive seizures or fibrillation were not ob-served in our cases.
Myelographic findings: 1) Dirax is convenient to observe radiculogram. Radiculogram of L₅ and S₁ nerves could be obtained in 94.1 per cent among 80 cases. 2) Findings by oblique views were most reliable to determine level diagnosis of lumbar disc herniation, though it was difficult to obtain good images. 3) Dirax had the advantage of detecting existance of double disc herniation, lateral type of herniation and prolapsed nucleus immigrated to lateral side. 4) Correct level diagnosis of lumbar disc herniation was obtained in 93.1 per cent among 72 cases.

View full abstract

Usually we must treat many patients with low back disorders, complaining of lumbago, buttock pain and sciatica. In spite of classification of these pains into myofasciogenic pain, facetogenic pain, discogenic pain and so on, we have not yet had proper explanation of occurrence of these pains. To localize the precise level of the lesion which caused pain, myelography has been used until now but recently peridurography, facetography, selective lumbar radiculography and block, and discography are often utilized, so the localization of the lesion is more cleary defined.
Since 1974 we have been performing facetography, radiculography, discography and myelography on these patients. And the following is deduced from the comparative study of these ancillary diagnostic aids. Facetography and block (performed on 70 cases):
Indication 1. acute low back pain with limitation of mobility of the spine only
2. chronic buttock pain, thigh pain with no neurological deficit, which is aggravated with physical exertion
3. unilateral low back pain, buttock pain, thigh pain with limited extension of the spine
In the patients over fourty, marked degenerative facetogram was often seen and block was very effective.
Discography (110 cases):
As for L₅/s disk herniation discography is more useful than myelography diagnostically.
Discography can demonstrate asymptomatic disk.
A few cases had marked relief of pain or numbness after undergoing this procedure.
Discitis occurred in four cases.
Selective lumbar radiculography and block (63 cases):
1. this is more useful to determine the localization of the lesion in cases with poor postoperative result, with difficulties in localizing the lesion and with extreme lateral disk herniation.
2. this is very effective as therapeutic aid in case with severe radicular pain.

View full abstract

Among the 813 cases of radical sciatica in the five years from 1974 through 1978, 144 cases or 17.7% were treated as in-patients. In spite of various types of maintenance thera-py, surgery was performed in only 23 cases or 2.8%.
When the prognosis of the maintenance therapy and surgery groups was compared, it was found that there were no major differences between the two groups with respect to such factors as daily activities and recurrences.

View full abstract

K. S., a fourteen-years-old boy Y. I., a thirteen-yeas-old boy had suddenly felt severe pain in the right groin while running at high speed. Both of them could walk without assistance, but with limping.
Roentgenologic examinations of their pelvic bones disclosed fractures of the anterior inferior spine of the right ilium, respectively. This small fragments displaced inferiorly, and slightly laterally and the shapes were almost the same as ones of apophysis of the opposite iliums. Therefore the lesions were considered to be avulsion fractures of non-fured apophysis in adolescent.
Surgical treatment was performed on both patients. A bony mass attached to the direct head of the rectus fernoris separated from the iliac bone. The fragments were reset by a screw.
The symptoms subsided completely several weeks after the operations.
Although we have only come across about 30 cases of this fracture in medical literature of Japan, it may be more common than those reported. One of the reasons may be that they do not come under medical care due to the fact that the symptoms are relatively slight.

View full abstract

Three cases of cervical osteomyelitis, in which one case evolved spinal cord com-pression syndrome, were successively encountered from 1975 to 1978.
All 3 cases were treated with anterior curettage and bone transplantation under chemo-therapy and were discharged within 3 months postoperatively in all 3.

View full abstract

A 60-years-old male had been suffering from rheumatoid arthritis since 1969. In 1977, the patient had gangrene in his left toes while he was receiving corticosteroid therapy. And then, the lisfranc joint amputation was performed. Histologic examination revealed pe-ripheral arteritis in the amputated tissues. Seven months later he died due to interstitial pneumonia, pleurisy and myocarditis. At autopsy, diffuse generalized arteritis in many organs was found. The deposition of γA, γM, γG and C₃ was noted in lung, kidney and skin tissues by immunofluoresence method. These findings suggest some intrinsic role of immune complexes in the pathogenesis of vascular lesions of malignant rheumatoid arthritis. Necrotic changes of crycoarytenoid joint that had caused dysphagia and speech disturbance was found. Autoptical findings in the neck muscle showed also localized myositis. There have been very few reports about malignant rheumatoid arthritis complicated with myositis.

View full abstract

A 59-yrs-old female patient was first seen 7 years ago with the diagnosis of classical rheumatoid arthritis. She had been under our care with undulating symptoms as other R. A. until she abruptly developed Sjögren's syndrome and later peripheral polyneuropathy involving the V th cranial nerve region.
She is now on the regimen of rehabilitation again with us without any sign of improve-ment. The serological study and medical care have been carried out.

View full abstract

Often there are cases of tumors developing on jaw, requiring resection of the man-dibula, in which cases, because of the specific conditions in the jaw and oral cavity, dysmasesia and destruction of facial aestheticism are problems that call for application of reconstructive operations.
Recently we had a 31-years-old lady of ossifying fibroma in the left lower region.
We conducted on her an operation for the continuous mandibular diseases, together with autogenous particulate cancellous bone and marrow grafting from ilium as well as an immediate reconstructive operation by a bridgebuilding plate and achieved a satisfactory re-sult functionally as well as in form.

View full abstract

Eight cases with anterior interosseous nerve paresis were reviewed to clarify the cause, symptoms, and the method of treatment for this condition. Six of eight cases had some trivial trauma of the arm before the onset of symptoms. Two had no causative factors.
The involved muscles were;flexor pollicis longus m. (F. p.1.)alone in two cases, F. p. 1. and flexor digitorum profundus of index (F. d. p.) in three, F. p. 1., F. d. p. and pronator teres m. in two, F. p.1., F. d. p. and flexor digitorum superficialis m. of index in one. In two cases, numbness over the forearm or the hand was noted.
Five cases were followed for one to six years. Three cases with conservative treatment showed one good and two poor result. The results of two cases with surgical method were one good and another poor.
The conclusions are;
1. The disease is mostly due to traumatic neuritis.
2. The symptoms have some variation probably because of anatomical variance of the nerve and the muscles.
3. The conservative treatment is not necessarily reliable.
Therefore, when the sign of recovery does not appear after two or three months of conservative treatment, surgical procedure is recommended.

View full abstract