Dysplasia epiphysealis hemimelica is a developmental affection of the skeleton that is characterised by unilateral, asymmetrical abnormal proliferation of cartilage. The disorder is associated with endochondral ossification in an epiphysis or tarsal bone or, exceptionally in a carpal bone. The purpose of this paper is to report on a patient with the disease involving the scaphoid.
Ochronosis is now the recognised consequence of alkaptonuria, one of the inbone error of metabolism, and melanin-like pigment is deposited in connective tissue. The desease leads to progressive joint disability after middle age. We have treated a case of ochronotic arthropathy presented rapid destructive change in the right hip joint, leading to severe disability within about 7 months after onset.
We treated an unusual case of osteopetrosis with pathological fractures of the lumbar neural arches. A baby girl had been referred to us because of the left brachial plexus palsy on delivery and osteopetrosis had been diagnosed incidentally. When she was eleven, she complained of low back pain without apparent trauma. When she was fourteen, spondylolysis of L4 was diagnosed roentgenographically. Another spondylolysis occurred at L3 one year later, when she had fallen down and hit on her buttock. She has been free from fractures of long bones. In order to examine the healing process of fractures in this patient, CT scans were employed as well as plain films. On CT films, bony callus was well identified, but was not dense enough and was somewhat irregular: bone union was not complete when most fractures were supposed to have healed. In summary, it was suggested that there might be some defects in bone remodeling and that the healing process of bone fractures could be considerably slower in patients with osteopetrosis. CT examination was very useful to follow the healing process of fractures.
In this report, we described clinical and histological findings of a case of pycnodysostosis. The patient was a 49-year-old man and admitted to our hospital for the treatment of the non-union of the left femur after several pathological fractures. He had a typical clinical finding of a pycnodysostosis. Biochemical investigation revealed no abnormality. The X-ray pictures demonstrated a failure of closure on cranial sutures, obliquity of the mandibular angle and defects of the terminal phalanges. Bone histomorphometric analysis of the iliac bone showed the thickening of trabecular bone and elongation of bone resorption and formation period.
Paget's disease of bone is not a rare disease in Japan today that is characterized by bone pain and an abnormal serum alkaline phosphatase concentration. EED is a rare disease that is characterized by chronic skin lesions featuring erythematous plaques or nodules arranged in an acral distribution. We treated a case of Paget's disease of bone associated with EED. The patient was a 55-year-old man who had suffered from low back pain and hip pain for twelve years and from erythematous lesions on joints of extremities for ten years. Paget's disease of bone was diagnosed by bone biopsy. Roentgenograms showed right femoral neck fracture. Treatment with eel calcitonin decreased bone pain. The fracture was treated by femoral head replacement. EED was diagnosed by skin biopsy at the department of Dermatology of our hospital and was treated by DDS. This patient had an IgA gammopathy. We concluded that the IgA gammopathy was not derived from neoplastic changes of Paget's disease of bone that is myeloma, but from secondary change of EED.
The Fanconi syndrome is a proximal renal tubular defect manifested in its complete form by phosphate diabetes, generalized aminoaciduria and renal glucosuria. The patient was a 46-year-old female with Fanconi syndrome, who had pseudo-fractures and muscle weakness. However, the symptoms were relieved by treatment with 1.25 dihydroxyvitamin D and phosphate.
A 7-year-old boy with tumor-induced hypophosphatemic rickets is presented. Treatment with orall α(OH)D3 administration (0.75 to 15μg/day) failed to alleviate the rickets. After removal of a benign osteoblastoma, the level of 1α, 25(OH)2D increased and the serum phosphorus level became normal. There after, clinical and roentgenographic features improved, and the rickets was cured.
A 52-year-old man was admitted with medial neck fracture of the right femur. This fracture occurred when he stood up from a sitting position. He had a peculiar short stature.: 140cm in height; 59kg in weight with bilateral bow legs. Laboratory examinations showed hypophosphatemia with normocalcemia, increased level of serum alkalinephosphatase and normal levels of PTH, 25(OH)D3, and 1, 25(OH)2D3. Radiological findings showed Looser's zone in the subtrochanteric region of the right femur, osteoarthritic changes in many joints and exostotic bone proliferations at the site of ligamentous and tendinous insertions. The architecture of cancellous bone was atrophic with a coarse trabecular pattern. Histological examination showed the increase of osteoid. Therefore he was diagnosed as an untreated adult case of hypophosphatemic vit. D resistant rickets. We guess that the cause of this pathological fracture is weakness of the bone and increase of the shearing force on the femoral neck due to varus deformity of the femur. Failure of intestinal phosphate absorption may play a role in hypophosphatemia in this case.
Thirty-seven Cases with chronic low back pain were treated by developing the abdominal muscles exercise. They were classfied into two groups. Eighteen cases (A) who could sit up from 25 to 30 times with the hands clasped behind the head and knees flexed, showed improvement of the low back pain (71.2%), the leg pain (52.9%) and the constipation (75%). The other group (B) that could sit up less than 25 times, also showed improvement but it was less than that of the former group.
Twelve subjects (6 cases of and 6 cases of Achilles' tendon rupture anterior. talofibular ligament rupture) were studied on the muscle power of the femur with a Cybex II dynamometer (Lumex Inc., New York) at four weeks and eight weeks of postoperative muscle training. The muscle power reduction of the knee extensors was greater than that of the knee flexors. Probably the greater distribution of type II (FT) fibers of the knee extensors may affect this muscle power reduction.
The Jewett type thoraco-lumbo-sacral orthosis has been used in patients with vertebral compression fracture. It provides a three-point pressure system consisting of posteriorly directed forces from the sternal pad and the pubic pad, and an anteriorly directed force from the thoraco-lumbar pad. But it is always recognized that the pubic area is insufficiently fixed by the pubic pad. Therefore it will not do well enough for thoraco-lumbar flexion control. For the purpose of making this better, we developed a rapidly constructable thoraco-lumbar flexion control orthosis. The orthosis has a triangular upright and the location of the pubic pad is transferred to the areas of bilateral anterior superior iliac spines, and we clinically applied our orthosis. Our orthosis has good adjustability, comfortable wearing and excellent thoraco-lumbar flexion control. Taking negative cast model or measurement is not needed for the orthosis.
In the last one year, we have prescribed upper extremity orthoses for 31 cases. For 21 out of 31 cases, the orthoses were completed by the orthotic manufacturer. Usually it takes one week to two weeks to complete them, and we sometimes miss a proper chance of treatment. So, we have developed a rapidly constructable wrist-hand orthosis. The futures of the orthosis are as follows. 1) It is easy to be constructed by a doctor in charge. 2) It can be indicated to various diseases of wrist and hand involvement. 3) Either dynamic or static orthosis can be completed within a short period of time.
Ankle sprain is considered to be a frequently encountered daily life with increasing population in athletes. Our newly devised ankle brace keeps the same merit and supplements the demerit of usual supporters and taping in conservative treatment. The functional evaluation was carried out both by stress radiogram in static condition and by our original method of gait analysis in dynamic condition. We obtained a good result from our ankle brace which was efficient for conservative treatment of ankle sprain.
Though wheelchair marathon seems to be one of the hardest sports in paraplegic people, it has become more popular. An evaluation of daily exercise by one of the elite wheelchair racer (T-8 Paraplegia, 33 Y/O) in international races was made successively according to his daily exercise menu which was vigorous. The subject's data were compared with other elite paraplegic racers and controls. There were overall superiority in items related with aerobic capacity. His maximum oxygen consumption seemed to be 44.44ml/kg/min. He could tolerate the heavy load of 35.43ml/kg/min continuously. Though there are lots of factors which limit physical fitness, this sport is safe and aerobic in essence. It is important for sedentary prone paraplegics to participate in these events that will match establishing quality of life of paraplegics.
A case of familial spastic paraplegia (FSP) was reported. The patient was a 47-year-old male having a long clinical course since an adolescent time when he first had difficulties in walking. The neurological features were compatible with FSP on account of familiality, spastic paraplegia, negative cerebellar sign, negative sensory disturbance and normal intelligency. For adduction deformity of the hip adductor tenotomy and neurectomy of the anterior branch of the obturator nerve was carried out, and for the equinovarus deformity of the foot the lengthening of the tendo calcaneus by White's technique. Magnetic resonance imaging (MRI) revealed the decrease of the anteroposterior diameter of the thoracic spinal cord, which might correspond to the demyelinization of the lateral spinal cord.
The chronic skin fistula in the face is a common problem in head and neck surgery. The differential diagnosis includes skin infections, pyogenic granuloma and basal or squamous cell carcinoma. The possibility of skin fistula from a chronically infected tooth is often overlooked. In this time, we report three cases of external dental fistula.
The patient was a seventy-year-old woman, who was admitted in our department for the purpose of treatment for her posttraumatic gangrene of the left first toe. On admitting examination, we did not find anything unual, but accentuation of erythrosedimentation-ratio and ascention of value of fibrinogen. We amputated the gangrened first toe. Although we intended to follow her, she had not visited. After one year, we amputated her second toe which showed a gangrene at that time. Afterwards we followed her attentively. About 2 months later, we noticed precipitation in her plasma and found purpura and ulceration at the periphery of the extremities. As a result of the detailed examination, we realized that she suffered from cryoglobulinemia. This disease must be differentiated without fail when we see a gangrened toe.
We reported one case of intractable decubitus ulcer probably due to the decrease of Blood Coagulation Factor XIII (FXIII) in this paper. The patient was a 19-year-old girl who had been injured in the traffic accident and followed by quadriplegia. She had been treated with anterior fusion for cervical cord injury. After surgery, she had developed decubitus ulcer in the sacral region. Radical operations were carried out several times for the ulcer in other hospital, but it was not cured. Poor nutrition, wound infection and the decrease of FXIII were found in this case. Especially, FXIII remarkably decreased to below 40%. We treated this case with IVH, musclocutaneous flap and tansfusion of lyophilized human bloon coagulation factor XIII concentrate. The result was succesful. We thought that FXIII had contributed to this result.
Despite emphasis on prevention, pressure sores continue to occur and prevent these patients from functioning in society. It is important to evaluate the extent of the lesion correctly and to make treatment programs. We have managed sacral, trochanteric and ischial pressure sores by the use of musculocutaneous flap. A total of 12 musculocutaneous transpositions have been done for the last 4 years. This experience will be reviewed.
0.5% bupivacaine was used for spinal anesthesia. 45 patients who underwent surgery of the femoral neck fracture were studied using a dose of 2.5ml. Hypotension occurred more slightly in spinal anesthesia with bupivacaine than in epidural anesthesia. No significant side effect was noted. It was found that bupivacaine provided satisfactory spinal anesthesia for surgery on aged patients.
We investigated one hundred two patients who had lower limb surgery under spinal anesthesia between April, 1986 and March, 1987. Of these patients, sixty-four patients were anesthetized with 0.5% bupivacaine and thirty-eight patients with dibucaine. The results showed that the duration of anesthesia was long and hemodynamics was stable with 0.5% bupivacaine. We consider that 0.5% bupivacaine is useful for old patients, debilitated patients and cases who need a long duration of anesthesia.
The method of antibiotic prescription with use of a tounigaet was evaluated. Intravenous bolus injection of one gram of CMX was given, then venous and intraosseous concentration of the same agent were measured at 30 and 60 minutes respectively. Intraosseous concentrations were higher when a tourniquet was applied than when it was not. A highest value was obtained when the tourniquet was applied ten minutes after intravenous injection. In cases of operations that need tourniquet use, it is a reasonable method that the antibiotic should be given intravenously 10 minutes before tourniquet application.
Cefamandole (CMD) is a new semisynthetic derivative of cephalosporin. The serum levels of CMD were measured with the bioassay method in the venous blood and in the drainage tube after 12 hip operations. CMD was administered by the injection at a dose of 2 grams. The mean peak serum level in venous blood was 101.52μg/ml at 30 minutes after injection, and thereafter the mean level was decreased rapidly to 45.59μg/ml at one hour and 17.2μg/ml at 2 hours. But the mean peak serum level in drainage tube was 41.56μg/ml at one hour and 41.50μg/ml at 2 hours, and thereafter the mean level was decreased gradually to 33.25μg/ml at 3 hours and 24.5μg/ml at 4 hours. The time required for an operation and bleeding during operations showed no influence on the serum levels of CMD. But the aged patients showed higher serum level of CMD in venous blood.
The condition of bony or fibrous ankylosis of the phalangeal joint was designated “symphalangism” by Gushing in 1915. It is inherited as an autosomal dominant phenotype. It is usually bilateral. It is implied that the precartilaginous antagen of the consecutive phalanges of each digit are not separeted from one another in prenatal life. We reported 3 cases in a family with tarsal coalition, and discussed pathogenesis of the symphalangism.
We experienced a rare case with contraction of Extensor Carpi Radialis Longus and Brevis muscles. A 26-year-old man was admitted due to extension contracture of the left wrist joint and revealed a cord-like resistant at the dorso-radial side of the left forearm. We performed prolongation of these muscles. At operation, these fascia were thickened and remarkably strained. Postoperative wrist movement was improved. Histological findings of these fascia showed hyperplasia of collagen fibers which were similar to tendon. No recurrence has been found one year and three months after surgery.
Intraosseous ganglion of the capitate bone is a rare condition. We have encountered a patient with an intraosseous ganglion of the capitate bone of the wrist. A 54-year-old man had suffered from localized pain associated with a plantar-flexion of his right wrist since one year before at which time he got a bruise. The radiographs of the wrist showed a roundto-oval radiolucent defect in the middle portion of the capitate with a sclerotic border. An operation was carried out for the purpose of both diagnosis and treatment. Curettage was performed, removing typical ganglionic fluid and the cyst was packed with the iliac bone graft. The histological diagnosis was intraosseous ganglion and his symptoms resolved six months after operation.
Recently, we experienced two cases of subcutaneous ruptures of the flexor tendons at the little fingers. These were treated with end to end suture and tendon transfer, respectively. The rupture site and mechanism of disease issue were discussed.
The fracture of the hook of the hamate is very rare. In Japan, about thirty cases have been reported. In most literatures, it is discussed on the mechanism of the injury, complications, and radiologic examination, but few discussion of the comparision with conservative and operative treatment is done. We experienced four cases, in which three were treated with excision of a fragment, and one case conservatively. Their follow-up period ranged from five to nineteen months. In operated cases, the recovery periods to occupation or sport were three weeks to three months and pain was free in all cases. Otherwise in the conservative case, pain disappeared after eighteen weeks but no bony uion was obtained in the roentgenogram during a follow-up period of eight months. Compared with conservative treatment, operative treatment has many advantages that early and certain functional recovery can be obtained, so that we recommend the operative treatment.
Ninety cases (one handred and sixteen digits) of metacarpal fractures were followed-up from 2 months to 13 years and 6 months with an average length of 2 years and 3 months. We analysed 48 cases of operative treatment and 42 cases of conservative one, 22 open fractures and 68 closed fractures. The injuries were found most frequently in the little finger. Good results were recognized in 80 per cent of base fractures, 60 per cent of neck fractures, and 58 per cent of shaft fractures. On the other hand, open fractures, tendon injuries, joint injuries, and long immobilization of fractures, tended to cause poor results. K-wire (transverse) fixation of multiple fractures gave good results.
We report 9 cases of jocked MP joint of the index finger, of which 5 were treated by surgical exploration. Roentgenographically all showed osteophyte, generally called volar lip, on the palmar aspect of the metacarpal head. The volar lip was composed more of the cartilage than the bone. The size of the volar lip was defined clearly by sonogram. In all cases with surgery, the volar lip was related to a locking of the MP joint. We considered that removal of the volar lip was important in surgical treatment.
Since April 1986, continuous passive motion device (CPM-device) has been used for postoperative rehabilitation of the hand in our clinic. During the last six years, 29 MP joints in 10 cases were operated on for the release of extension contracture, and 24 joints in 8 cases were evaluated after the operation. Of these 8 cases, 4 cases (7 joints) were applied CPM-device immediately after the operation for 7 to 16 days, whereas 4 cases (17 joints) were started rehabilitation after removal of K-wires which were used for the fixation in intrinsic plus position during 16 to 26 days. CPM group showed an improvement of the ROM, both in flexion and extension of the MP joints. But, immobilized group showed a slight improvement with a shift of the ROM to flexion site.
Six patients have been studied after trapoeziometacarpal total joint replacement with Caffenière's type implant using a metal metacarpal component and a polyethylene trapezium component cemented to bone with polymethyl me-thacrylate. Upon examination after 2 years to 4 years and 10 months (mean 44 months), all patients were completely relieved of pain. Abduction was improved in 5 hands. Grip strength was improved in 6 hands and pinch strength in 4 hands. There have been no cases of implant fracture or dislocation, but all cases demonstrated “sink in” of the proximal socket into the trapezium, which have not produced any serious complication and symptoms.
The distal radial fractures historically has been treated by closed reduction and plaster immobilization. But it is difficult to align the fracture fragments and to maintain the reduction. We reported distal radial fractures treated by Ace Colles' fixators in seven patients. All patients were satisfied with the results.
The authors studied residual pain at the processus styloideus ulnae after 41 radius end fractures. There was no tenderness at the processus styloideus in the case who had not sustained fracture of the processus styloideus. Concerning to the symptom, there was no relationship between the cases of union and the cases of non-union. There was no tenderness at the processus styloideus in the case who had no fracture of the processus styloideus. Over a half number of cases who had puls variant over 3mm of the ulnae had pain on the processus styloideus ulnae.
The recognition of carpal instability as a clinical entity is relatively recent. The relationship between Kienböck's disease and volarflexed intercalated segment instability of the wrist is a matter of controversy. In the wrists of thirty-one patients with Kienböck's disease, fourteen patients treated surgically by means of shortening of the radius and seventeen patients treated conservatively, a roentgenographic analysis was carried out. Carpal height ratio, carpal ulnar distance ratio, Stahl's index, capitolunate angle, radiolunate angle, radioscaphoid angle and scapholunate angle were measured. From these studies, it was concluded that the collapse of the lunate allows proximal migration of the capitate and volarflexed intercalated segment instability pattern (VISI pattern), and that shortening of the radius can be considered to be an effective treatment of Kienböck's disease.
Limited wrist arthrodesis was carried out in ten cases including Kienböck's disease, malunited intra-articular fracture of the distal radius and fracture-dislocation of the wrist. Scaphoid-Trapezium-Trapezoid fusion for Kienböck's disease resulted in decreased wrist pain and increased grip strength in three of four cases. Three of four cases of radiolunate fusion were improved but by intercarpal fusion for fracture dislocation of the wrist, clinical symptoms were not improved. In Kienböck's disease, the results of STT fusion and radiolunate fusion were inferior to those of radius osteotomy for Kienböck's disease of the same stage. For fracture-dislocation of the wrist, proximal row carpectomy was considered to be a more favorable method than intercarpal fusion.
Lesions of the ulnar nerves as a complication of fracture of the distal radius and ulna are uncommon even if well known. Three cases of this condition are presented. Case 1 was a 57-year-old woman. There was a Colles' fracture of her left wrist and paresthesia in the area of the distribusion of the median and ulnar nerves. Six months after injury, neulolysis of the median and ulnar nerves was done. Although the median nerve was recovered gradually, the ulnar nerve had not returned. Eight months after the first surgery, neulolysis and resection of the ulnar head was performed. Six months later the ulnar nerve function was recovered. Case 2 was a 45-year-old man who had open fracture of the distal radius and ulna, and had paresthesia in the area of the distribution of the median and ulnar nerves. Four months after injury, osteosynthesis and neulolysis of the median and ulnar nerves was performed. Both nerves were found to be tethered at the fracture level. Six months after operation, the median and ulnar nerve functions were recovered. Case 3 was a 36-year-old man who had distal ulnar fracture and paresthesia in the area of distribution of the ulnar nerve. Four months after injury, osteosynthesis and neulolysis was performed. Two months later, the ulnar nerve function was recovered.
The axillary nerve palsy in the quadrilateral space is rare in the various regions of the shoulder joint. Although the commonest type of the axillary nerve palsy occurs following shoulder dislocation on humeral fracture, another from is seen after blunt trauma to the shoulder region without associated fracture or dislocation. We treated operatively 8 patients with the axillary nerve palsy associated with the shoulder injuries. The average age was 37 years (range, 19 to 55). A case of them showed guadrilateral space syndrome reported by Bateman. Electromyographical findings showed fibrillation potentials and positive sharp wave in the deltoid muscle at rest in 2 patients and no motor unit potentials at voluntary contraction in all of them. Neurolysis of the axillary nerve was carried out in all of them about 3 months after injuries. The recovery of the injured nerve very fast as shown by electromyographycal display. Good results were obtained in 6 patients. Restriction of the arm elevation remained in only 2 patients who were complicated with rotator cuff injury and frozen shoulder.
We analyzed electrodiagnostic data for carpal tunnel syndrome. In addition to motor nerve terminal latency, many data were analyzed. By analysing mixed nerve action potential at the forearm portion, we found retrograde degeneration in many patients.
We studied twenty-two hands of carpal tunnel sydrome and ten of them (45.5%) had suboptimal results. Seven of them were lack of pseudoneuroma at operation. The reasons for suboptimal results were associated conditions, such as cervical spondylosis, diabetus mellitus, contracture of scar formation, previous fracture of the distal radius and digital nerve injury at operation.
Between 1977 and 1986, nine patients with an isolated ring avulsion injury were seen in the Orthopaedic Surgery Division of Hiroshima University School of Medicine. Eight fingers were reconstructed by use of microsurgical anastmosis. Five have been successfully revascularized, and useful motion and sense of the digits have been obtained. Three were treated by secondary amputation due to the necrosis of the digits and one by primary amputation. Micosurgical revascularization has been particularly useful in salvaging incomplete ring avulsion injuries with insufficient vascular flow. Although complete ring avulsion injuries in general are thought to be poor candidates for microsurgical repair, these should be treated by replantation, in which it would be often necessary to shorten bone or use vein grafts.
The reconstruction of injured fingers is often difficult when the bone, nerve and vessel of fingers are exposed. For the reconstruction of such fingers, we have used a venous skin graft obtained from the arm. This method was performed on 14 cases. The youngest patient was 10 years old at the time of operation, the oldest being 62, and the average age was 36.4. The follow-up period varied from 2 years and 8 months to 10 months. The flap survived in all 14 cases. The largest flap of the 14 cases is 8.0cm×3.0cm in size. For 3 cases we have covered the skin defect of two fingers with a venous skin graft. The grafted skin was rich in elasticity and flexibility.
Vascularized fibular graft with skin was used in six patients who had extensive bone and skin defect in the lower leg with osteomyelitis and pseudoarthrosis. Follow up ranged from 14 to 52 months (mean, 30 months). In one case we used musculo-cutaneous flap with fibular bone as the treatment of the patient with extensive bone and skin defect in the lower leg. The results were all excellent and the period of the bone union ranged from 6 months to 10 months (mean, 7.3 months).
The aims of this paper, carried out in dogs, are to develop the surgical techniques involved in transplantation of the knee, and to study the effects of the immunosuppressnat drugs, cyclosporin, on the fate of allografts taken from unrelated animals. The survival and structure of the grafts were evaluated by serial radiological examinations and radioactive bone scans and by repeated biopsy. The growth of donor and recipient bones were assessed by tetracycline labelling and their structure and viability by histological examination. In vascularized autografts as a pilot study, three months after operation, 4 animals showed apparently normal joints and only minor atrophy of their thigh muscles. By contrast all 3 dogs with allografts rejected the graft within the first 5 days had to be sacrified. In the final group, 3 dogs were given vascularized allogtafts and administration of cyclosporin started at the time of operation and continued for 3 months. At 3 months after grafting, all dogs showed bony union and a constant and active uptake of radioactive tracer in the graft. Histologically, the grafts showed viable chondrocytes and osteocytes, and active turn-over of the bone until withdrawl of cyclosporin. After withdrawl of cyclosporin, the grafts were rejected rapidly.
A case of Down's syndrome with atlantoaxial subluxation was reported. He was a 21-year-old male and had a wry neck. Hyperreflexia and pathological reflex in upper extremities were revealed but other neurological examinations were not performed because he was severely retarded. Cervical X-ray showed atlantoaxial subluxation with the ADI being 7mm (neutral position) and an unstable spine. It was hard to keep the patient at rest because of his mental retardation. He was treated with posterior fusion using rectangular rod. Bony fusion was obtained by 3 months. Since this procedure provides strong internal fixation, it allows early initiation of rehabilitation by the use of simple cervical splints and is advantageous for bone union.
Type II odontoid fracture classified by Anderson was treated by internal screw fixation using a small cancellous screw. This method, which was introduced by Nakanishi in 1980, has several advantages: 1. Loss of rotation at C1, C2 junction did not occur; 2. Rigid external fixation was not necessary; 3. Early mobilization of a patient was allowed; 4. Good bony union was obtained. Thus, this method may be the treatment of first choice for fresh fracture of the odontoid process.
The treatment for odontoid fracture have been mainly conservative. The methods of conservative treatment are skull traction, Minerva Jacket, and recently Halo-Vest. But the results of conservative treatment for odontoid fracture were poor. There have been so many pseudoarthrosis by these methods. The average rate of pseudoarthrosis was 26.2%. Nakanishi reported five cases of odontoid fracture which were treated from anteriorly by using a cancellous bone screw. He got good results by this method. We operated on two cases of odontoid fracture with the same method. The result was excellent.
Posterior atlanto-axial fusion was used to treat 14 patients with upper cervical disorders. Among the above patients, post-surgical range of rotation (ROR) of 11 patients were measured. Follow-up period ranged from 1 to 11 years (average, 6yrs and 2ms). The average of range rotation in the operated group was decreased by 35.2% compared with that of the control group. Nevertheless, two patients in the operated group had almost normal ROR. It is suggested that the compensation of middle or lower cervical facets can contribut to ROR of the neck.
Postoperative extradural pseudocyst is the subject of this paper. Out of 348 cases of spinal surgery, which consists of 125 cervical, 41 thoracic and 182 lumbar spines, there were 6 cases of postoperative extradural pseudocyst in our clinic. The cysts were all found in the cervical region. Three cases of the pseudocyst were noted, after dural incision which was done in 9 cases, and other three cases were after posterior decompression of the spinal cord without dural incision. Three cases were symptomatic. One case had myelopathy, which improved by excision of the cyst. Other two cases showed meningitis-like symptoms, which also improved by conservative treatment.
Common clinical course of cervical myelopathy (CM) is chronic. But there are some cases with so called “sudden onset type CM”, which shows rapid progression without the history of trauma or OPLL. We reported 12 cases of sudden onset type CM treated by surgery. They were evaluated by plain lateral X-ray views and the Japanese Orthopedic Association Score before and after treatment. And they were compared with 49 popular chronic cases treated by surgery. The results of this paper showed that; 1) There was little disturbance of activity of the daily life before the onset. And each case had severe symptoms of CM with sudden onset in an activity of daily life; 2) The older cases had more severe symptoms than chronic cases. But the result of the surgical treatment is better than the chronic cases; 3) All of the 12 cases had cervical spinal canal stenosis with the minimal anteroposterior diameter of the canal being less than 12mm. We thought that it is the base of the sudden onset type CM.