A case of arthroglyposis multiplex congenita with bilateral flexion contracture of the knees was reported. A girl with flexion contractures of her knees and hips and equinovarus deformities of her both feet underwent operative procedures including distal femoral extension osteotomy with shortening of the femur and anterior tendon transfer of the hamstrings on both knees. At twenty-two months after the operation, she was able to walk alone with short leg braces and crutches.
In order to investigate the pathophysiology of anticonvulsant induced osteopenia, circulating levels of bone γ-carboxyglutamic acid containing protein (BGP) and urinary excretion of BGP were measured in sixteen childlen on chronic anticonvulsant therapy and twelve control children. Using microdensitometry analysis, osteopenia was found in 25% of the anticonvulsant therapy group, but was not observed in the control group. Serum levels of BGP and Al-P were significantly increased in the anticonvulsant group compared to those in control group (P<0.05, P<0.01), respectively. Urinary excretion of BGP and Hydroxyproline showed a increasing tendency in the anticonvulsant group, but it was not statistically significant. There was no significant difference in serum levels of Vit D metabolites, PTH, calcitonin, Ca, P or urinary excretion of Ca, P between the two groups. It is suggested, therefore, that increasing BGP levels in children receiving anticonvulsant therapy is responsible in part for the occurrence of anticonvulsant induced osteopenia.
Osteomalacia is caused by distal renal tubular acidosis (distal RTA). And, secondary distal RTA is attended with autoimmunodisease. Recently, a lot of reports suggest that autoimmunodisease should be accompanied with HTLV-I infection. We report one case, a patient with Sjogren syndrome, distal RTA, osteomalacia, and positive HTLV-I antibody. We suggest sequence of these events.
A case of vitamin D resistant osteomalacia was reported. A 22-year-old man, who complained of back pain, gait disturbance and polyarthralgia, was admitted to our hospital on 7 Jan, 1986. The patient was diagnosed as vitamin D resistant osteomalacia based on clinical and laboratory findings. By treatment with 1-α-OH-D3 [Alfarol] and NaH2Po42H2O (Sodium Dihydrogenphosphate Dihydrate), the subjective and clinical findings were improved. Two interesting findings were seen in this case. The one is the radiological finding of the sacro-iliacal joint. In the a-p view of the pelvis the sacro-iliacal joint was not seen as if the joint was fused and the part of the pelvis consisted of one bone. The joint was not seen also in the oblique view of the joint. But CT examination revealed that the joint was present. Change of the plane of the joint due to deformity of the posterior part of the pelvis and osteomalacia were the causes of failure to describe the joint notwithstanding the oblique view was examined. The other is the histological findings of the iliac bone. In spite of distinct improvement of clinical and laboratory findings by the treatment, histological findings after 5 months were same as that before the treatment.
A case of tumoral calcinosis in a 47-year-old female patient being treated by long term hemodialysis for 7 years was reported. The calcinosis developed from the lower neck to inner and outer aspects of the left scapula. The contents of calcinosis were confirmed by Roentgen analysis as hydro-oxyapatite, and the histological and electron microscopic findings were presented.
Fracture of the first rib is generally uncommon. Particularly, stress fracture of the first rib is rare. We report three cases of fracture of the first rib. Fracture in the first case was caused by the repeated stress of push-up. Fractures in the second and third cases were caused by extensive indirect trauma.
Acromioclavicular subluxation is treated conservatively, but there is controversy as to whether complete dislocation should be treated surgically. Many surgical procedures have been devised for the treatment of acromioclavicular dislocation. Repair of the coracoclavicular ligament and fixation of the acromioclavicular joint have been accomplished with a variety of materials, including fascial suture, transfar of ligament or tendon, screws and wire. However, these techniques have frequently failed because of breaking or stretching, with recurrence of the dislocation. Since 1971 we have treated Type 3 acromioclavicular dislocation in 18 patients (Dewar modified method; 5 cases, Neviaser method; 2 cases, Weaver modified method; 3 cases, K-wire fixation; 8 cases). We have evaluated 18 patients by Kawabe's criteria (1. Pain, 2. ROM, 3. Muscle Power and Fatigue, 4. Deformity, 5. ADL). The surgical techniques, results and criteria for the assessment of clinical results of acromioclavicular dislocation repair are discussed.
Fractures of the scapula are relatively uncommon. According to Jinnaka, it accounts for only 1% of all fractures. We report 16 cases of the scapular fractures experienced in the last 8 years together with some literature discussions. The cases consisted of 13 males and 3 females and their ages ranged from 19 to 80 years (mean, 49 years). Tumbles and falls accounted for 88% of the causes of injury and traffic accidents accounted for more than 60% of the causes. The fractures occurred at a total of 23 sites. They were the neck (8 cases), the trunk (6 cases), the acromion (5 cases), the glenoid (2 cases), the coracoid process (1 case) and the scapular spine (1 case). Associated injuries were present in 63% of the cases and many cases of costal fracture and head trauma were observed. 13 cases were treated conservatively and 3 cases operatively. Prognosis was generally good in most cases, but 31% of the cases had some complaints. This is considered to be attributable to changes in the balanced scapular structure and impairment of the inherent coordination between muscles and scapula due to the fracture.
As clinicians are well aware, hemiplegia is often accompanied by shoulder subluxation. But in spastic cases, reduction of subluxation have been seen in their walking. We analyzed factors affecting this phenomenon by using EMG. There were 6 women and 12 men, 7 being hemiplegic on the right, 10 on the left and 1 normal. We classfied the function of upper extremity (U/E) in hemiplegic patients into 6 degrees by using Brunnstrom's scale. As a result, the following findings of EMG in hemiplegic patients were seen. 1) High potential amplitude elicited from biceps brachii was seen in lower stage (in II-IV stage of Brunnstrom's scale). 2) Supraspinatus played a role in reduction of shoulder subluxation more largery as increasing the functional stage of shoulder. This fact was seen from II stage of Brunnstrom's scale. And at last, Supraspinatus participated largely. 3) Deltoideus played a role only in higher stage (in IV-V stage). These findings suggest that flexion synergy of U/E may participate in the reduction of shoulder subluxation in hemiplegic patients.
All patients suffering from a painful contractured shoulder should be treated conservatively at first, but in cases which do not improve in a reasonable time, surgical treatment should be selected. For the last twelve years, 85 patient have been operated on in our hospital. Follow-up study was carried out in 34 cases. According to the point system of Wolfgang, 94.4% of them had good or excellent results.
It is considered that neither the accurate pathology nor the adequate treatment of unstable shoulder have established yet. As For the treatment of unstable shoulder in the past ten years in our hospital, Gallie's op., pectoralis major transfer, pectoralis minor transfer, bone graft, Neer's inferior capsular shift and Glenoid osteotomy have been performed. We investigated the prognosis of the operated cases and studied the future view for the treatment of unstable shoulder.
Rotator cuff tear is a very common and quite important disease, because functional disturbance is almost always due to the problem of rotator cuff. We reported the results of surgery which were performed on the patients with rotator cuff tear. Total number of patients who underwent the operation from June in 1985 to March in 1987 was 43. Nineteen cases of more than six months follow-up after operation were evaluated in Wolfgang's criterie. The purpose of this paper is to report the technique of repair of tears of the rotator cuff.
The results of 14 operative repaires and 11 non-operative treatments of the rotator cuff were reviewed retrospectively. The results of treatments were assessed according to Neer's criteria. An item of anatomy (10 units) was omitted from the criteria. Therefore, full score became 90 points: (35 points for pain, 30 for function and 25 for range of motion.) The average point was 76.2 in the group of operative repairs which was higer than that (67.2) in the conservative group. Four cases of the operative group, however, showed poor results, whereas, four cases of the conservative group showed good results. We discussed on the results of these conservative and operative treatments.
Recently, attention has been paid to arthroscopic examination and arthroscopic surgery for shoulder disorders. We have carried out arthroscopic examination of the shoulder since 1981 and performed arthroscopic surgery on fourteen shoulders since 1986. They are seven shoulders in five cases of rheumatoid arthritis (RA), five shoulders in four cases of rupture of rotator cuff (RRC), and two shoulders in one case of labrum tear. Surgery was performed on all cases with patient under general anesthesia. Arthroscopic examination was performed prior to arthroscopic surgery through both the anterior and posterior approaches with the addition of subacromial approach when necessary. After the findings of the disorders were well known, arthroscopic surgery was performed. Cases of RA and RRC were elderly people with severe pain of the shoulder joint. Pain in these cases was decreased by intracapsular anesthesia with findings in arthrography showing synovitis. Joint lavage, synovectomy and joint débridement were performed under arthroscopy. Severe pain was relieved in all cases except one case with subacromial bursitis of RA. The case with labrum tear had locking phenomenon and intracapsular pain. In this case, the injured labrum was partially resected so as not to injure the glenohumeral ligament. After surgery, all complaints in this case disappeared.
Prostheses are often applied to the hip and knee joints. Total shoulder prostheses are divided into two types: constrained and unconstrained types. We have developed the Fukudai-type total shoulder prosthesis since 1980 and have applied it clinically since 1984. The range of motion of this type of prosthesis is 120 degrees. We report 3 cases who underwent replacement with the Fukudai-type total shoulder prostheses.
A 57-year-old diabetic female presented with heel ulcerations of the weight-bearing area and the lateral side. She had previously undergone a left below knee amputation. At operation, surrounding tissue of the ulcers was excised and a combined flap composed of flexor digitorum brevis muscle and abductor digiti minimi muscle was elevated and transferred with free skin graft over the flap. Though the transferred muscle flap survived in its entirety, the skin graft over the muscle resulted in total necrosis. Then, the necrosed skin graft was debrided and this defect was covered with split-thickness skin graft. The wound healed without any complications.
Ossification of the Achilles tendon is an unusual condition. We have seen one case of ossification of the Achilles tendon which was symptomatic and associated with Osgood-Schlatter disease and calcaneal spur. This case was successfully treated by excision of ossific mass in the Achilles tendon.
There are many types of malleolar fractures of the ankle. Among them a Salter-Harris type III fracture of the antero-lateral part of the distal tibial epiphysis, so-called Tillaux fracture, is rare. We reported a case of a 15-year-old male who suffered a Tillaux fracture and whose ankle had a lateral instability and an abnormal mobility to anterior side.
A rare case of a thirteen-year-old man with the right two-fragment triplane distal tibial epiphyseal fracture was reported. The use of tomograms and CT-scans to determine the diagnosis and accuracy of reduction was quite important. This fracture was suspected to occur with a supination external rotation injury involving the diastasis of the antero-lateral epiphyseal plate, the fibular fracture, and no ligament rupture. This fracture was considered to be a good indication for open reduction because it was possible to fix without injury of the epiphyseal plate.
Manual reduction of intra-articular fracture of the calcaneus had been thought to be impossible and unrealistic. However, I developed a new method of manual reduction by utilizing the tension of the ligaments around the calcaneus. If was published in Clin. Orthop. (177, 104-111, 1983). The following is the manipulation procedure in brief. The patient is placed in a prone position with the knee at 90°. An assistant holds the thigh, and the surgeon compresses the affected heel with interlocked hands. The calcaneal tuberosity is repeatedly squeezed upward with strong traction and quick side to side bending. This method is gaining wide acceptance in Japan and elsewhere. We believe that this method should be the first choice for treatment of calcaneal fractures.
High tibial osteotomy is commonly performed for osteoarthritis of the knee. At dome osteotomy, we use curved chisel. We evaluated the results in thirty-two patients (thirty-seven knees) who had had a dome osteotomy. The operations were performed between 1982 and 1986. The mean length of follow-up was 2.8 years. The best results were achieved when postoperative femorotibial angle was 162 to 176 degrees. We found a slight tendency for progression of degenerative changes in the tibiofemoral compartments. In two-third of the knees, femorotibial angle was slightly increased during follow-up (average 3.8 degree).
The results of 49 dome osteotomies have been reviewed at a mean length of follow-up of 30.1 months (range, 6 to 63 monthes). Ninety-two percent had an excellent and good result subjectively and 89.5 percent clinically. In our studies the tibio-femoral angle to 10 to 15 degrees of genu valgum produced the best results. We suspected that ventralization of distal tibia caused the delayed union or decrease in tibial plateau angle.
Thirty-seven knees in 28 patients with osteoarthritis were teated by high tibial osteotomy with median open wedge and ventralization of the tibial tuberosity, and the excellent results were obtained. The operative procedures were presented with interesting cases, in which intraarticular loose bodies were absorbed and loose marginal spurs were united to the tibia.
A follow-up study of open wedge and closing wedge high tibial osteotomy was reported. 24 knees were treated by the former method, and 25 knees by the latter. Average follow-up period was five years and nine months in the former method, and two years and one month in the latter. Although the postoperative clinical scores showed no significant differences between these two methods, the results of the closing wedge osteotomy had more relationship to the postoperative radiological changes in FTA and compartmental sclerosis than those of open wedge osteotomy.
We evaluated the results in sixty-eight patients (eighty-one knees) who had a high tibial osteotomy for medial compartment osteoarthritis. The operations were performed between 1977 and 1986. The mean length of follow-up was 3.4 years (range, one to nine years). The osteotomy methods included closing wedge osteotomy (forty knees), dome osteotomy (forty knees), and interlocking wedge osteotomy (one knee). Sixty-three knees (77.8%) had satisfactory results, twelve knees (14.8%) had no improvement and six knees (7.4%) had poor results. The causes of non-improvement and poor results were recurrence of varus deformity, under-correction, over-correction and advanced radiographic grading of tibiofemoral osteoarthritis before operation. The patient's age at the time of osteotomy and alignment obtained by osteotomy did not necessarily correlate the results.
We evaluated thirty-two knees after the interlocking wedge osteotomy for varus deformity. The operations were performed between 1981 and 1986 at the Saiseikai Yahata Hospital. The mean length of follow-up was 25 months (range, 7 to 65 months). No untoward technical difficulties were encountered at surgery. Early bone union was noted in all of the cases and none of the cases developed nonunion or delayed union. Ninety-four per cent of the patients had a good result. No result was a failure. In this procedure, contact area and stability at the osteotomy site are increased by an interlocking effect of the cortices and the stress under the patella is reduced by an anterior advancement of the tibial tubercle.
We evaluated the results in 48 knees in 43 patients who had had a high tibial osteotomy for medial osteoarthritis. The mean length of follow up was 4 years and 3 months (range, 1 to 8.5 years). Out of 48 knees, 32 knees in 29 patients were thoroghly examined by us both clinically and radiologically. The satisfactory results were obtained in the 24 knees that had been positioned in 165 to 175 degrees of FTA and in this group, neither diminution of clinical score nor recurrence of varus deformity were observed.
We evaluated the results in thirty-eight patients (forty-six knees) who had had a high tibial osteotomy for unicompartmental osteoarthritis. The operations were performed between 1972 and 1985. Most of the good results were in corrected knees in which the femoro-tibial angle (FTA) is between 163 and 172 degrees. The success of high tibial osteotomy depends upon not only accurate operative technique but also proper prediction of the correcting angle based upon X-rays taken in the exact antero-posterior standing position prior to surgery. Failure to obtain accurate preoperative FTA results in overcorrection or undercorrection. Therefore it is important to note in preoperative drawing that the FTA based upon standing X-rays changes according to knee rotation and flexion.
Forty patients (51 joints) who underwent high tibial osteotomy were evaluated after a follow-up period ranging from one year and one month to 4 years and 3 months with the average being 2 years and 11 months. Union was easily achieved and trouble due to antero-medial displacement of the distal fragment was not seen in all patients. Satisfactory results were obtained in the majority of patients, but unsatisfactory results were obtained in 7 patients (9 joints), who required the use of intraarticular injections or analgesics even one year after operation. Of these 7 patients with poor results, 4 patients (6 cases) resulted from undercorrection due to inaccurate osteotomy, one patient from medial meniscus lesion and another patient from patello-femoral osteoarthritis changes. But there were no known causes in one patient. Reoperations were performed in 3 patients (total knee replacement, arthroscopic medial meniscectomy, ventralization of tibial tuberosity). Accurate osteotomy is most important to obtain good result in high tibial osteotomy, but it is not easy to perform accurate osteotomy in the procedure of wedge osteotomy, therefore likewise in this operative procedure, it is necessary to make and use a useful osteotomy guide.
High-tibial osteotomy is one of the most valuable methods of treatment for osteoarthritis of the knee. The results of barrel-vault osteotomy were investigated. The results of 35 osteotomies have been reviewed from 10 to 66 months (average of 29.7 months). Postoperative gait pain, hydrops, range of motion, and X-ray findings were compared with preoperative states. The results were evaluated with Maquet's criteria; 26 (74.3%) excellent, 4 (11.5%) good and 5 (14.3%) fair results. Gait pain and hydrops were remarkably reduced at the time follow-up, but range of motion was almost unchanged. Although there were some factors influencing the results, femorotibial angle, mechanical axis and α-angle had relatively wide range (p<0.05). Tibial angle was closely related (p<0.01).
It is well-known that the femorotibial angle of 165° to 170° is desirable to get good results from HTO. In this study, we followed up 46 joints of 36 cases (average age, 62 years) for 8 to 112 months (average, 43 months), and FTA was 165°-175° in 40 joints at the follow-up investigation. Results were scored by the knee-rating scale of the Japan Knee Joint society. Excellent results (over 80 point) were obtained in 21 knees, good (70-79) in 6, and poor in 13 (under 69 points). Then 29 joints of this group were analyzed with arthroscopic evaluation of lateral compartments. 16 joints with normal cartilage had 88.6 point on an average, 6 joints with deep cartilage erosion 71.6, 3 joints with cartilage erosion down to subchondral bone were 69.3 and 4 joints of subchondral bone exposed were 67.2. Arthroscopic evaluation of lateral compartment is useful to decide indication of HTO.
We reviewed 189 cases who had HTO operations for varus gonarthrosis. We discussed pitfalls of HTO and divided these into 1) patient selection, 2) operative technique and 3) complication. We prefer HTO to TKR for patients under 60 years of age who are active, even if their knees show osteoarthritic changes in lateral FTJ or PFJ. We experienced 10 cases of pseudoarthrosis postoperatively. We discussed causes and prevention of non-union
Thirty-two osteoarthritic knees were evaluated by clinical and radiological examination after an minimum follow-up of two years. The average age of the patients at the time of surgery was 66.6 years (range, 54 to 79 years). We have believed that the alignment in coronal plane obtained by osteotomy is one of the most important factors in determining the results. Based on this study, we believe that the alignment in sagittal plane and the laxity of the knee joint are also important factors in determining the result.
Fifteen cases with ruptures of musculotendinous juncture of the medial head of the gastrocnemius muscle which occurred during sports activities were studied. Of these cases, 7 were males and 8 were females. The mean age was 36 years and 6 months with ages ranging from 15 to 56. Six of these cases were involved in track-and-field events, three in volleyball, two in softball, two in badminton, one in judo and one in recreational game. Prodromic symptoms such as dull aching of the affected leg were seen in 8 cases. All cases were injured in a position of the ankle joint in dorsiflexion with the knee joint in extension. Conservative treatments resulted in a satisfactory recovery of their activities of daily living in all cases. The results indicated that prophylactic stretching is of value for preventing this injury, especially in middle-aged players.
Rugby football is a very hard body contact sport, so players are injured very frequently. To comprehend the fact of injuries and disorders of rugby football players, we sent out questionnaire to players in high school. Results showed that 115 of 144 players suffered injuries and that 54 had disorders in playing rugby football. They injured more frequently on tackling or on being tackled. The shoulder lesions in upper limb and the ankle lesion in lower limb were seen frequently. We emphasize that warming up, cooling down and a day-off of practice are very important to prevent ruggers from disorders in rugby football.
Thirty patients with surgically proved lumbar disc herniation and 25 with surgically proved LCS (lateral stenosis type) were studied retrospectively. Lumbar lateral recess morphometry (depth of the lateral recess, interfacetal diameter and interpedicular diameter) for CT-Myelography (CTM) was performed at the levels of L3/4, L4/5 and L5/S. In the patients with LCS, depth of the lateral recess is narrow, which may tend to result in an entrapment of the nerve root at the peripheral portion of the canal and lateral recess. Also degeneration and hypertrophy of a superior articular facet may tend to progress with aging.
We determine the size of the dural sac of the lumbar spine by measuring the sectional area. The area of lumbar canal stenosis is below 90mm2. According to this indicator, eighteen cases of lumbar canal stenosis (LCS) and eleven cases of spondylosis (OAS) are investigated. The average ages are sixty-one in LCS and seventy-four in OAS. Other morphological investigations by CT revealed no difference between LCS and OAS. We conclude that the symptoms of LCS mainly depends on the dynamic factors and spinal instability.
Lumbar lateral canal stenosis is a narrowing of the lumbar lateral canal. Lateral canal is a part of the nerve canal which runs from medial edge of the superior articular process to the foramen. This is usually acquired. We made nerve root infiltration and block for 19 cases who were diagnosed as lateral canal stenosis by clinical and radio-logic presentations. Nerve root block and a lasting effect on 5 cases, but did not have a much effect on cases which showed complete block of nerve root infiltration. There were not significant differences in clinical and physical presentations between effective and non-effective cases.
Laminectomy was performed in forty-four patients with lumbar canal stenosis between 1968 and 1985. Scoliosis was found in twenty patients before operation and in twenty-one patients after operation. After operation, scoliosis disappeared in four patients, progressed in four patients and appeared in five patients. Nine patients whose scoliosis progressed and appeared showed poor results.
The operative methods that we have adopted for lumbar canal stenosis include 1) unroofing, 2) osteoplastic hemipartial laminectomy, 3) osteoplastic bilateral partial laminectomy, and 4) enlargement of the lumbar canal. Stenotic areas are determined by myelogram, CT scan and nerve root block. If the area is localized at the disc level, we make choice of unroofing or osteoplastic partial laminectomy. But enlargement of the lumbar canal is indicated in more severe cases that show wide stenotic area both cephalad and caudad over the disc level. This method was carried out in forty-seven cases. The results were classified as excellent or good in 85%. Enlargement of the lumbar canal is one of the most useful and recommendable method for lumbar canal stenosis.
The records of twenty-seven patients who were older than fifty-five years old were analysed with reference to subjective and objective findings, and A. D. L. after partial facetectomy. The mean follow-up period was 1.6 years. The total evaluation after treatment was excellent in eighteen, good in eight, and fair in one case.
Fifty-five patients with lumbar canal stenosis who underwent posterior spinal decompression with or without P-L spinal fusion were reviewed to investigate clinically and radiographycally. Twenty-four patients were female and 31 were male. The mean age was 52.8 years (range, 23-73). The average follow-up time was 2.4 years (range, 0.5-6.4). Forty-seven patients were treated with decompression and spinal fusion, and 8 patients were treated with decompression alone without spinal fusion. The postoperative results were evaluated wity JOA score. Regarding radiographycal approach, we measured the angle displacement and horizontal displacement using Dupuis' method. The mean preoperative JOA score was 12.5 points and the mean postoperative JOA score was 23.0 points. The recovery rate was 63.6%. High incidence of poor results were noted in postoperative group. Forty-three patients (92%) had a good union of the graft bone and four patients (8%) were found to have pseudoarthrosis on follow-up roentgenographic evaluation. It does not appear that the P-L spinal fusion induces instability of other lumbar spine. The concomitant spinal fusion should be routinely employed to patients with extensive spinal decompression.
A follow-up study was performed on ninety cases that were followed for more than one year after operation. The age at the time of operation ranged from 29 years to 77 years old with an average age being 53.1 years old. A tracing period was an interval in nine-eight months from one year and an average tracing period was four years and one month. According to an international classification, the results of ninety cases were excellent in 55, good in 23, fair in 7 and poor in 5. The results of many cases of the combined and the spondylolitic spondylolithesis were satisfactory. Althongh intermittent claudication improved in almost all cases, low back pain and pain or numbness of the legs still remained in about half of the cases.
A total of 46 patients with lumbar spinal canal stenosis were followed up, to evaluate the results of Surgical treatment. Thirty-two cases were degenerative type, 12 cases were combined type and 2 cases postoperative type. Eleven cases had unsatisfactory clinical results, which were suspected to have been caused by lumbar disc instability, complication of cervical spondylotic myelopathy, congenital anomaly of nerve roots, intraoperative injury of dura mata or cauda equina, hypertrophy of the articular facets and osteophyte formation of the posterior edge of the vertebral body.
Forty-seven patients with lumbar canal stenosis operated were examined by questionaire. Their follow-up period ranged from 5 to 12 years with an average of 8.8 years. The excellent and good results were obtained in 77% of the cases. The results appeared to be correlated with their age, evaluation points, activities of daily living, sensory disturbance, muscle power loss, preoperative ambulatory distance and their follow-up period.
Clinical features of lumbar canal stenosis were studied in 319 cases of our clinic in the last five years. There were 210 male and 109 female. The age varied from 22 to 88 (60.4 years on an average). Most of the patients were of degenerative type. Subjective symptoms were various, but mainly low back pain (89%), intermittent claudication and leg pain, and dysfunction was found in 29%. As the objective signs, Lasegue's sign and femoral stretching test were positive in 27% and 31% respectively, and sensory deficit in the leg and sensory deficit in more than 50%. Epidural block was effective in 58% of the patients for relief of low back pain and intermittent claudication.
In order to evaluate imaging method for diagnosing degenerative lumbar canal stenosis, fiftynine patients who underwent surgical decompression were reviewed. Myelography was more reliable than CTM, MRI. CTM was superior to myelography and MRI in delineation of the anterior and posterior elements, and surrounding nervous structures. MRI was the imaging method of choice in follow-up of out-patients and postoperative patients. It was also useful in evaluating nonvisualized vertebral levels caudad to a complete block on myelography.
Degenerative lumbar canal stenosis is a major pathological factor of aged patients with lumbago and leg symptoms. From June, 1979 to June, 1986, 16 patients were operated on. They all suffered from intermittent claudication. Wide laminectomy was done in 9 patients and partial laminectomy in 7 patients. Twelve patients were underwent posterolateral fusion. Meticulous preoperative assessment was essential for this disease. Computed tomography was useful for showing the narrowed area in transverse plane. Radiculography gave us benefit to assess the pathological level in patients with unilateral symptoms. Instability and lumbar kyphosis were main problems due to residual lumbar pain. In cases with multilevel myelographic abnormality, we preferred decompression by partial laminectomy with medial facetectomy in narrowed levels. In cases with complete block or combined ossification of ligamentum fiavum, wide laminectomy should be done.
768 cases of lumbar canal stenosis were surgically treated for the past 10 years. 321 cases of these operated cases were degenerative lumbar canal stenosis. About 116 cases passed over 5 years after operation and answered enqete (containing 72 consulted cases). Clinical symptoms and signs, operative findings, postoperative evaluation and roentgenologic changes were mainly investigated. The results were as follows: 1) Clinical symptoms and signs: Unilateral leg pain (72%), cauda equina claudication (49%), limited motion in extension (71%), leg pain in extension (71%), muscle weakness (49%) and hypoactive or absent ATR (49%) were found in high frequency. 2) Postoperative results: “Excellent” and “Good” cases accounted for 72%. In cases of duration of symptom over 3 years, operated at 60 years of age, at postoperative results tended to be poor 8 years after operation. 3) Roentgenologic study was performed on 25 cases of wide laminectomy without fusion. In these cases, anterior displacement was found in 20% of L4+5 level laminectomy, and 66.7% of L3+4+5 level laminectomy, but correlation between displacement and postoperative results was not encountered.