This is to reaccess the levels of the cervical spine operated for myelopathy in cervical osteochondrosis. For this purpose this study was restricted to 66 patients to whom anterior interbody fuion was carried out with myelographic investigations performed in both pre- and post operation. Of 66, 59 patients had had slight or mild abnormal myelographic findings before operation seen in the non-operative intervertebral space, except in 3 patients the findings got improved and in 9 worsened. Worsened findings were seen at the level adjacent to the level of fusion, especially at C4-5. Malalignment of the cervical spine after surgery is considered mainly to be the reason to make the level worsened, but this does not always correlate with the clinical results. Careful attention must be taken to the level of C4-5. When it has mild abnormal findings in myelography, the level of C4-5 is advisable to be operated from the view point of post-operative myelography.
Since Tsukimoto has reported in 1960, this disease has found by many clinicians. Clinical feature and therapy are almost established, but etiology is unknown. We referred to epidermiological and clinical examination. We have chosen 107 cases with ossification of posterior longitudinal ligament in Kumamoto University Hospital and associated hospitals, and investigated about their occupation, physique, age, roentgenogram, additionally the incidence of this disease compared with diabetic and another patients over fifty years old. We operated for 13 cases of these patients, the result was improved in 4. The change of ossification postoperatively was observed in 10 among 13.
Since 1974, twenty three patients with the ossification of the posterior longitudinal ligament (OPLL) in the dorsal and lumbar spine have been seen in our clinic. Sixteen cases of them were associated with OPLL in the cervical region, and fourteen cases had the ossification of the yellow ligament, in the lower dorsal region. Myelopathy had developed in nine cases, most of them were obese, and showed difficulties in walking, sensory disturbances and hyperactive tendon jerks in the lower extremities. Decompressive laminectomy was operated on seven out of nine myelopathic patients with good results.
Conservative treatment for thoracic outlet syndrome had been performed on 56 cases for 5 years (Jan. 1972-Dec. 1976). In this report we analyzed clinical status in 40 cases of these patients who were able to be followed up. Clinical evaluation are classified as excellent 5 cases (13%), good 12 (30), fair 10 (25) and poor 13 (32). This results were poor than that of surgical treatment. Subjective symptoms of upper limbs seem to be improved more than that of scapular regions as results of surgical treatment. Subjective symptomes seem to be improved, compared with objective symptome.
Six cases of surgically treated thoracic outlet syndrome have been reported in this paper. Five cases out of the six had had resected the first rib through axillary approach and one had the tenotomy of the pectoralis minor muscle. Five cases showed good recovery. On arteriography, most frequent site of compression lesicon was located in subclavian artery in the costoclavicular space in Wright's position. On radiological examination, congenital anomaly, the pseudarthrosis of the first rib was found in two cases.
Anterior half of spinal canal of thoracic region can be exposed by wide resection of the rib and extrapleural anterior approach associated with the excision of posterior part of vertebral bodies. This paper reports typical thoracic myelopathy treated by this procedure for the purpose of the decompression. Case 1. 26 years old woman. Tuberculous Spondylitis of C6 to Th 4. Anterior approach to the cervical spine and costo-transversectomy to the upper thoracic spine (Th 2, 3, 4) was carried out to expose the affected vertebral bodies which compressed the spinal cord. The excision of the vertebral bodies and complete recovery of venous system. Case 2. 53 years old woman Ossification of posterior longitudinal ligament and ligament Flavum in cervical, thoracic and lumbar region. Myelogram revealed complete block of contrast media in Th 6 to Th 9 level where the ossification of posterior longitudinal ligament was predominant. Excision of the rib of 15cm and extrapleural approach permitted the excision of posterior half of the bodies and the resection of ligament flavum. Case 3. 38 years old man Metastatic extradural tumor of the upper thoracic region. The extirpation of the tumor was insufficiently done by the posterior approach. On the second steps, anterior residural tumor was well exposed by anterior extrapleural approach with resection of the rib and excision of posterior half of the body.
Computerized transaxial tomography (CT) has proved to be one of the most useful and reliable methods of detecting intracranial pathology. An investigation was undertaken to determine the application of this scanning technique to lumbar spine area. We have studied the horizontal sections made through a lumbar spine removed at pathological anatomy. Pathology of lumbar spine and cauda equina are well within the reach of this new diagnostic methodology and furthermore by utilizing contrast agent. There is no doubt that as the new technique is developed, CT will contribute significant information in the transverse planes.
Transfemoral epidural venography was performed on fourteen cases of lumbar canal stenosis. The results are as follows. 1) On thirteen cases the intrapedicular and ascending veins did not come into view. 2) On a case an extradural tumor rich in vessels was found with this method. 3) Ischemia in the vertebral body was suggested by the examination.
The instability of lumbal vertebrae is classified into three types; Type A-an excess tilting movement of the vertebral body, Type B-an anterior or posterior displacement of the vertebral body and Type C-a combination of Type A and Type B instability. X-ray films of 18 patients with instability of the lumbal vertebrae were traced and compared with those of 6 or 7 years ago. The results were as follows: 1) The development and progression of Type B imstability were anatomicaly related to the sagital plane facet, as well as, Type A to the oblique plane facet. 2) Osteoarthrotic changes of the intervertebral joint increased in almost all cases of Type B instability during 6 or 7 years, but in Type A instability OA changes were observed only in the cases with increased instability. 3) The pedicle-facet angle had no relationship with the increasing of the vertebral instability.
Lumbar intervertebral disc lesion occurs rarely in childhood. Its clinical pictures differ from those usually seen in abults. 1) Only twelve patients (6.9%) of our series of 173 patients who had been operated on for protruded intervertebral discs were aged from thirteen to eighteen years. 2) Most patients had complained of pain in the low back and the leg. In objective findings, there were marked limitation of straight leg raising and forward bending of the body, but sensory disturbances, muscle atrophy and weakness had not been noted in this group. 3) In the operative findings, midline protrusion was more frequently seen in this group than in the adult group. 4) In our experience, the most patients had not been relieved without operation. 5) The results of the operative treatment were gratifying. But, the spasm of hamstring tends to remain during a few years aftre operation.
This paper reports a case of 42 year man with severe spondylolisthesis treated by 3 step-operation using Harrington instrumentation with the excellent result. The operative procedure consists of 1) the reduction of the olisthesis by Harrington instrumentation and the posterolateral spondylodesis at the lumbosacral level by posterior approach. 3) removal of Harrington apparatus as soon as the fusion is obtained. Pelvic traction or active extention exercise of the spine should be indicated to avoid the risk of neurological complications by the stress of violent operative reduction.
A mass survey of scoliosis was performed on about 6, 429 school children in Yamaguchi City fro mAugust 1976 to January 1977. Children 9 to 15 years of of age were examined by orthopaedists. Of the 6, 429 children examined, 772 were examined for their malposture, and Radiographs were obtained on 717 of them. The overall incidence of scoliosis was 9.3%, or 601 children, and of these 147 (2.3%) were in structural scoliosis, and 139 (2.2%) were in 10 degree or greater curvature by the Cobb method. The sex incidence was three females to one male. 368 (5.7%) had a scoliosis of 10 degree or more. The greatest curve pattern was thoracic type with 55 children (38%) effected. Doublecu rvature was second with 30 children (20%) children effected.
Melorheostosis is a rare systemic bone disease which is characterized roentogeno graphically by hyperostosis and clinically by pain, deformities and limitation of motion of various degree. Its etiology remains obscure in spite of several hypothesis. This report concerns a fourty-eight years female of the disease, complained of pain and palpable defotimy of right radius. Histological examination showed extremely dense bone and derangement of Haversien systemes. By bone scanning with 99mTc pyrophosphate, high accumulation of it located on right forearm. The possibility of existence of the imflammation was discussed.
Pycnodysostosis is a rare hereditary bone abnormality charactarized by increased bone density, short stature, hypoplasia of the mandible, dysplasia of skull bones, partial aplasia of the terminal phalanges, and increased tendency toward pathological fractures. Recently we encountered a case of pycnodysostosis, a twenty-five-year-old female, associated with closed femoral-shaft fracture.
A 1-year-old male patient with infantile digital fibromatosis was reported. The lesion had been noticed at dorsum of right 2nd toe since 1-month-old and it was excised at 4-month. Later reexcision was performed at 10-month. The lesion consisted of intra-dermal fibromatous proliferation with many eosinophilic round inclusions, 7-8μ in diameter in fibroblast. By electron microscopy, the intracytoplasmic inclusions had no limitting membrane and composed of aggregates of fine fibrilar substances without any virus-like particle.
Adamantinoma of long bones is a rare primary bone tumor. In 1913, Fischer first used the term “Adamantinoma” to describe a long bone tumor which histologically resembled tumor of the same name in the jaw. As the primary treatment, en bloc excision has most often been attempted because of the slow growth of this tumor. In this paper, two cases of adamantinoma of long bone are described. Case 1: The patient was a 35 year-old woman who had noted a generalized swelling in her left leg 7 years previously. In September, 1976, segmental resection and deep frozen massive bone grafting were performed. Case 2: The patient was a 30 year-old woman who experienced pain in the right thigh 4 years previously. In October, 1976, en bloc resection and autogenous bone grafting were performed. Microscopic examination showed adamantinoma.
The so-colled Adamantinoma of limb bone is a very rare osteogenic tumor, Originally described by Fischer in 1913, We experienced this tumor by a chance. Case Report: A male, Factory Warker, fifty three years old, He complained the pain of the left leg. Roentgenograph showed multi-cystic appearing lesion with out periosteal reaction in the middle portion of the left Tibia. Bone syntigraphy, arteriography and biopsy of the tumor were done. We diagnosed Adamantinoma of the Tibia by the examination of pathologic tissue. Therapy was block resection including periosteum and transplantation of freeze-bone there. Nine months after the operation, bone agglutination is incomplete, the patient walks with crutchs. There is no metastasis to the lung, to the regional lymphnode.
Recently we have experienced a case of non-ossifying fibroma in the fibula. According to the Bone Tumor Resistry in Japan, the non-ossifying fibroma arises almost in lower femur and upper tibia, and it is rare that the non-ossifying fibroma occurs in fibula. Case; A girl of twelve complained pain in left knee after running. There was a history of trauma. Radiographs revealed a cystic lesion in the left upper fibula. At the time of examination, there was no redness and no venous dilatation, but there was tenderness on pressure over the affected area. At surgery the lesion was located in the marrow. The lesional tissue had a soft consistency. The color of the lesional tissue was gray. Micro-examination of the tissue demonstrated fibrous connective-tissue cells in a whorled pattern. There were small giant cells sporadically.
The cases with the tumor in the lumbogluteal region were presented. Case 1; A man, 61 years old, with the bilateral gluteal tumors arising extensively from the sacrum was histlogically diagnosed as chordoma. Case 2; A woman, 59 years old, with the huge tumor from the sacrococcyx was diagnosed as chordoma. Case 3; A man, 57 years old, with the osteolytic and invasive tumors was also diagnosed as chordoma. Case 4; A man, 60 years old, with the soft tissue tumor destroying the right iliosacral joint was diagnosed as fibrosarcoma. Case 5; A woman, 69 years old, with the big tumor in the lumbosacral region which was probably originated from the nerve tissue resting after the excision of myelomenin-gocele was diagnosed as neurofiroma. Case 6; A woman, 64 years old, with the painfull tumor originating from the right trunk of sciatic nerve was diagnosed as malignant Schwannoma. Case 7; A woman, 35 years old, with huge tumor arising from the right gluteal muscle and compressing the sciatic nerve was diagnosed as leiomyosarcoma. Case 1, 2, 3, and 6 died from extensive metastasis in spite of the treatment of radical excision and postoperative radiation. All cases complained of the intolerable lumbogluteal pain and radiating leg pain. The end stadium of the dead cases was miserable. Difficulty in the treatment for the sites and the expansive destruction of the tumor in these case was discussed. Furthermore, the differential diagnosis of the tumor was histologically discussed.
Six cases including 3 giant cell tumors and 3 chondrosarcomas were operated on by wide en bloc resection and reconstruction using massive bone graft in 4 cases, long-stem endoprosthesis and bone cement in each one case. All cases were completely reconstituted without recurrence after the follow-up periods ranging from 3 months to 2 years. Operative indication and the post operative clinical courses were presented with case reports.
Amputation is indicated for bone and soft tissue sarcoma of limbs. Wide excision, however, may be possible in a case, which seems to be cured by such operative method. In this article we reported local recurrence and functional disorders of 18 cases, which were treated by wide excision. 18 cases include soft tissue sarcoma (11 cases), osteogenic sarcoma (3 cases), and desmoid. (4 cases). The rate of local recurrence was 2 of 18 cases (11%), and pulmonary metastasis without local recurrence occured in 3 cases (17%).
Case. A male aged 38 was admitted, complaining of pain of the right knee joint. The past history and family history were irrelevant. On examination McMurray click and Apley griding test were positive. Tear of the medial meniscus of the right knee joint was found on the arthrogram. Urinalysis, blood count and blood chemistry were normal. After extirpation of meniscus tumor was found in the joint space. Pathologically the tumor was diagnosed nodular tenosynovitis.
A 34-year-old woman felt the strain on the left thigh and noticed the mass a month later, which was man's fist sized, non-pulsatile and resilient hard. There were not found tumor stain or afferent and efferent arteries at angiogram. The extirpation of the tumor, localized in the vastus intermedius, was performed. Pathological diagnosis was true aneurysm, because sectioning of the tumor revealed the continuity of the arterial wall filled with the laminated thrombi.
Malignant soft tissue tumors in Japan were reviewed in collaboration with the specialists of orthopedics and pathology. The files of 695 patients with soft tissue sarcoma were registered and classified as: liposarcoma 155 cases (22.3%), rhabdomyosarcoma 118 (17.0%), neurogenic sarcoma 55 (7.9%), fibrosarcoma 52 (7.5%), leiomyosarcoma 51 (7.3%), angiosarcoma 48 (6.9%), synovial sarcoma 31 (4.5%), dermatofibrosarcoma protuberans 26 (3.7%), alveolar soft part sarcoma 12 (1.7%) and malignant fibrous histiocytoma 9 (1.3%). Suspected cases were 70 (10.1%), and unclassified were 54 (7.8%). Angiosarcoma, dermatofibrosarcoma protuberans and malignant fibrous histiocytoma tend to occur more frequently in males, neurogenic sarcoma in females. The highest average age was 48.8 years of liposarcomas, the lowest 21.7 years of rhabdomyosarcomas, 65% of which occured under 10 years of age. The lower extremity was most often involved in liposarcoma, leiomyosarcoma and synovial sarcoma. Wide resection or amputation with chemotherapy and irradiation were common in the management of the tumor. But, 5-years survival rates were as follows: liposarcoma 64%, fibrosarcoma 59%, leiomyosarcoma 50%, neurogenic sarcoma 44%, synovial sarcoma 30% and angiosarcoma 32%. The survival of rhabdomyosarcoma was only 21%.
Thirty-four patients with rheumatoid arthritis who had failed to response to gold therapy were treated with D-penicillamine (Metalcaptase). Initial dose of 100 to 200mg per day was increased by 100mg in every two or four weeks, and the minimum dose which showed a effective response was maintained. In 65per cent of the patients, decreasing of duration of morning stiffness, articular index and increasing of grip strength were observed. Erythrocyte sedimentation rate decreased significantly in 82% of them after treatment. Side effects including skin rush pruritus, gastro-intestinal distress, edema, dizziness or proteinuria thrombopenia developed in 18 cases (52.9%).
Resection arthroplasties of the metatarso-phalangeal joints for the correction of the multiple deformities of the forefoot in rheumatoid arthritis were performed in seven feet of four paients. One foot was treated by the procedure of Clayton, and six feet were Kates, Kessel & Kay. There were recurrence of hallux valgus in one case, and ankylosis of the metatarsophalangeal joint of the great toe in another case. The results of the operation were satisfactory for the patients because of relief of pain. Most patients have been able to wear ordinary shoes.
The correlation between ADL and the roentgenographical findings of the elbow joint was examined in 60 patients with RA involving some of the shoulder, elbow, and wrist joint. Of these patients, thirteen showed no symptoms of the elbow joint and forty-seven some symptoms of this joint. 1) When roentgenographical changes were classified by the method of Larsen, groups B and C presented a high systemic activity. 2) The frequency of involvement in the elbow joint was parallel with that in the wrist joint. The severer the changes of the elbow joint, the higher the frequency of involvement in any other joint. 3) The ROM of the elbow joint was reduced in accordance with the progress in destruction of the joint. The disturbance of the upper limbs in ADL seemed to be closely related to the restriction of pronation and supination.
We treated the equinovarus deformity of cerebral palsy by the heel gait cast method and its results were followed up on thirty cases (forty-three feet). This method is useful to inhibit the spasticity, to obtain the ankle function and to prevent recurrence. But the active exercise was needed to participate into the balance reaction of dorsiflexion of the ankle in standing position. The mechanism of inhibition of spasticity in heel gait cast method were considered as follows. 1. Inhibition of spasticity of the sural muscle due to slow stretching. 2. Facilitation of dorsiflexion reflex due to heel gait and heel standing. 3. Facilitation of tibialis anterior due to heel standing.
Purpose: The change of operative and therapeutic procedures as well as the long-term prognosis for equinus deformity due to cerebral palsy were investigated by means of questionnaire and medical examination so as to help future treatment. Method: A total of 103 patients or 175 cases have undergone operation for equinus deformity due to cerebral palsy from 1954 when this clinic was established through 1976. The methods employed included Stoffel operation, classical Z procedure, Baker technique, Vulpius technique, and White technique. Study was made mostly on long-term prognosis for the cases with the lapse of half a year to the maximum of 21 years after operation. In the questionnaire, gait ability was classified into seven degrees of (a) no limit, (b) 2km, (c) 1km, (d) 500m, (e) 50m, (f) a little and (g) unable. Inquiry was also made for the bending posture at walking down hill and the after operation and at present. Those who had not received medical examination for the past several years were examined to confirm the present status. Result: Among those with long postoperative lapse, heel-toe gait was hardly observed and toe-heel gait or stamp gait was common. A durative follow up was deemed advisable.
The authors have evaluated the foot deformity in 147 children with cerebral palsy hospitalized in crippled children hospital roentogenographically and clinically. 1) Of 269 feet of 147 patient of all types of cerebral palsy, the deformity most frequently observed was equinovalgus, which was seen in 59per cent. Normal feet were only in 17per cent. 2) Equinovarus was seen especially in the group of spastic hemiplegia: 40per cent. It was thought to be the result of less weight bearing by affected limbs. 3) Equinovalgus was seen in the group of para-and quadriplegia. It appeared in about 70per cent of feet in each age grous. 4) In roentogenological mesurement, deformed feet revealed the change in MTR angle and talo-1st metatarsal angle.