In order to elucidate whether the fibrinolytic system is involved in the pathogenesis of osteonecrosis, the author examined the fibrinolytic activity of human femoral heads suffering from aseptic osteonecrosis. The animal experiment was also carried out by giving high dose of steroid hormone to adult dogs every day of 3 to 13 weeks duration and the fibrinolytic activity of femoral heads was also examined for the study of the hormonal effect. Results: 1) The fibrinolytic activity in bone marrow of a femoral head can definitely be inhibited by t-AMCHA. Hence the related fibrinolytic enzymes are at least plasminogen and its activators. 2) In case of an aseptic necrosis of a femoral head, there is a significant difference of fibrinolytic activity in and out of the necrotic zone. However in case of rheumatoid arthritis and osteoarthritis the fibrinolytic activity is not significantly different in and out of the weight bearing zone. 3) Low fibrinolytic activity in the subchondral and central necrotic areas in the necrotic zone may suggest poor vascularization and far advanced necrosis in these areas, while relatively strong activity in either side of the necrotic zone near the sclerotic boundary may indicate higher vascularization and active repair process in these areas. 4) Animal experiment with dogs showed no significant difference in the fibrinolytic activity of the femoral head between the steroid treated and the control group. 5) From this study no definite evidence was obtained, that the fibrinolytic system is related to initiate the process of osteonecrosis, but it definitely participates in the repair process of osteonecrosis.
Tumoral calcinosis is a well established but rare clinical entity. It was first described in 1889, and since then, scattered reports have been present in the literatures from many parts of the world. The patient reported here is a 55-year-old male who has developed a solitary tumor with local pain on the ischial tuberosity. There had been no preceding trauma and no significant illness of note. Physical examination revealed a firm, hard mass on the ischial tuberosity. There was no limitation of motion. Laboratory studies revealed that the serum phosphate level remained in the normal range but the serum calcium level remained slightly elevated. The serum parathyroid hormone level and renal function studies were within normal limits. Radiographs showed multinodular, calcified soft tissue masses on the left ischial tuberosity. Pathological findings are also characteristic. We resected the tumor and then found that its main composition was hydroxyapatite by X-ray diffraction study.
Arthroscopy under spinal anethesia seems to be too much effort for diagnostic purposes only. We carried out arthroscopy as outpatient examination under local anesthesia in 128 knees. Preparation, technique, complication and problems of this procedure are disscussed. Some patients felt pain on arthroscopy but the patients tolerated arthroscopy well. No severe complication was encounted. It was convinced that accuracy is not diminished by performing arthroscopic examinations under local anesthesia on outpatient. Outpatient arthroscopy is useful to try for early diagnosis and therapy.
A prospective study of repaired peripheral meniscus tears in nine patients and conservative treatment in five patients was carried out from June 1986 to October 1987. All patients had arthroscopically proved peripheral tears of the meniscus. We repaired the fresh meniscal ruptures in 7 cases and old ruptures in 2 cases. At a mean follow-up of 15 months, 13 patients had clinically apparent healing of the meniscal tears.
Postoperative results of 59 menisci in 58 cases treated by arthroscopic partial meniscectomy were reported. The follow up period ranged from 3 to 43 months (mean, 13 months). Ninety-four percent had excellent and good results subjectively. Clinical scores by Kurosawa knee scoreing scale were 7.5; 8.4 in the non-osteoarthritic knees and 7 in the osteoarthritic knees. Twenty-eight cases among the 58 had osteoarthritic changes and the results of their subjective estimation and the clinical score were almost good. We thought that arthroscopic partial meniscectomy should be considered even for old patients, if chosen with care.
Sixty cases of arthoroscopic examination and arthroscopic surgery in children under 14 years were reviewed. Arthroscopy was found to be useful in 83% of children. Arthroscopic surgery was especially useful for children with knee meniscus lesions. Post-operative prolonged knee joint effusion was experienced as complication of arthroscopic surgery in children in six cases. Five of six cases had discoid meniscus lesions.
We experienced 3 cases of impingement of the infrapatellar fat pad in the patellofemoral joint after direct injury to the knee. The impingement was confirmed by arthroscopy. At extended position, the fat pad was impinged in the patellofemoral joint, however, at flexed position the impingement disappeared. At arthroscopy we used lateral suprapatellar pouch approach and saline was deflated from the knee joint for observation under biological condition. All cases received conservative therapy. Case 1 received casting with the knee in 30° flexion for 1 week. Case 2 received physical therapy as an in-patient. Case 3 received steroid injection to the infrapatellar fat pad and casting with the knee in 30° flexion for 1 week. In every case, symptom disappeared.
45 cases of anterior cruciate ligament rupture were evaluated on anteromedial rotatory instability (AMRI) and the effect of anterior cruciate ligament reconstruction, 8 were acute and others were old injuries. The incidence of AMRI was 69% (31 cases). 32 cases had medial meniscus tears and AMRI was severe in the cases of peripheral tears. The grade three ruptures of the medial collateral ligament was seen in two cases and in them AMRI was severe. All cases underwent reconstruction of anterior cruciate ligament with Leeds-Keio artificial ligament by the arthroscopic method. Medial meniscus tears were treated with the meniscal suture in 14 cases, subtotal meniscectomy in 8 cases and the partial meniscectomy in 10 cases. Medial collateral ligament ruptures were reconstructed in the cases of more than grade three. The results of each operative method were successful, and AMRI was noted in 4 cases postoperatively. But in these cases there were no disability related to AMRI.
Six ACL deficient knees reconstructed by the Dacron artificial ligament were followed-up after more than six months from the operation. All cases had remain of the instability and recovery to daily living early. We think that the use of the Dacron artificial ligament is indicated in the patient of the daily activity level.
Many reports have been recently published on various orthopedic complications in patients undergoing periodic haemodialysis. We studied clinical symptoms, range of motion and radiographic findings of their 62 knee joints in patients with haemodialysis, and measured parathyroid hormone and β2-microglobulin in plasma of 31 cases. A large proportion of long time haemodialysis cases had a limitation on range of motion and abnormal radiographic findings in the knee joint. There was some relation between length of time on haemodialysis and value of parathyroid hormone and β2-microglobulin. It is suggested that a long-term haemodialysis might cause a weakness and non-flexibility with tendon, ligament, muscle and joint and abnormal radiographic findings.
This is a follow-up study of surgically treated dislocation of the 14 knees (9 habitual, 4 permanent, and one recurrent dislocation) in 9 patients. The average follow-up period of nine habitual dislocations was 4 years and 9 months. The results were satisfactory in all regardless of surgical procedures (dynamic semitendinous tendon transfer, medial displacement of the tibial tuberosity etc). The follow-up periods of four permanent dislocations were more than six years. These were treated by dynamic transfer of the semitendinous tendon (Uesaki's procedure). The results were satisfactory in two knees, redislocation in one knee (hypochondroplasia), and progression of osteoarthritic change of the P-F joint in one knee (spondylometaphyseal dysplasia, SMD). The follow-up period of one recurrent dislocation (left knee of SMD patient) was 6 years and 5 months. Osteoarthritic changes of the P-F joint progressed slightly. In conclusion, the dynamic semitendinous tendon transfer (Uesaki's procedure) is effective to keep the patella in functional position in the treatment of all types of patellar dislocation.
Meniscectomy, the commonest performed in orthopaedic surgery, and lateral release and a modified Hauser's operation were used for treatment of reccurrent dislocation of patella. 17 patients (18 knees) of meniscal injury and 8 patients (9 knees) of reccurrent dislocation of patella were treated by operation. Those were traced for the purpose of long-term follow-up. Many of excised menisci were lateral discoid type and young patients with lateral discoid type showed good results. In reccurrent dislocation of patella, the patients with growth plates were treated by lateral release and those who have no growth plate were treated by Hauser's procedure. The results treated by Hauser's procedure were good and the group treated by lateral release showed reccurrence of dislocation of patella.
We evaluated rotational abnormalities of the osteoarthritic knee joints by observing a contact area of the tibia with the femur from the view of single standing lateral roentgenogram of the knee. If contact area was in anterior third of the medial tibial plateau, tibia was considered to be internally rotated, if in middle third, neutral, and if in posterior third, externally rotated. Results showed that 55 knees were internally rotated type, 56 neutral type, and 3 externally rotated type. Three knees with externally rotated type had much severer varus deformity and flexion contracture than the other types.
High tibial osteotomy (HTO) is one of the common surgical procedures used to correct axial malalignment and pathomechanics of the knee. But it is not easy to decide the correct angle of osteotomy. We have noticed that lateral joint opening angle (LJOA) in standing position changes after HTO. LJOA is the angle made between the line connecting bilateral condyles and that connecting bilateral tibial plateaus in antero-posterior roentgenogram. The purpose of this study is to determine the factors which effect the change of LJOA. The results indicate that LJOA of preoperative standing position is 3.6 degrees larger than that of the postoperative standing position. The size of change of LJOA in standing position has relation to the size of preoperative LJOA in standing position. And LJOA of postoperative standing position is almost equal to that of preoperative supine position. This suggests that the correct angle in HTO had better been determined in the preoperative X-ray film of supine position, especially in the case which has large LJOA in preoperative standing position.
We evaluated the effect of ventralization of the tibial tuberosity in 34 patients (42 joints) who underwent hight tibial osteotomy (interlocking wedge osteotomy). An effective ventralization of the tibial tuberosity was not obtained in the majority of patients due to posterior displacement of the proximal fragment and the increase in the ratio of tibial posterior displacement was correlated with postoperative decrease in tibial posterior declining angle. It was considered that the decrease in the angle resulted in correction of flexion contracture at the time of surgery. In high tibial osteotomy, the decrease of tibial posterior declining angle results in decrease of the effective ventralization. If ventralization of distal fragment is not performed in the case combined patello-femoral arthrosis, pressure of the joint may increase and develop patello-femoral arthrosis.
The subjects were 18 cases (21 knee joints) of osteoarthritis in our clinic between 1986 and 1987. Age at surgery ranged from 37 to 73, with an average of 56 years old. Surgical technique was mainly shaving of ulcerated articular cartilage. After surgery, pain and hydrops were improved in many cases, but radiographically, in 7 cases (33.3%), progress of osteoarthitis was observed.
We performed Lord's osteotomy on 36 patients (42 knees) for treatment of the patellofemoral joint disorders between 1983 and 1987 and followed them up for post-operative ex-amination for periods from six months to four years and 10 months, or one year and 11 months on the average. The results of examinations as evaluated by grading according to the Cox's criteria were as follows: excellent in 16 knees (38.1%); good in 25 knees (59.5%); and fair in 1 knee (2.4%). The surgical procedure employed was deemed highly useful because it permitted ventralization and medialization of the tibial tubercle to be performed at the same time without the need for bone graft.
We had used the Kinematic Knee System for the total knee replacement since 1980, and have changed to the Whiteside Ortholoc Total Knee System since 1986. Nineteen knees using Kinematic system were followed up for an average of 4.6 years after surgery, and 21 knees using the Whiteside system for an average of 1.4 years. Using the criteria described by three universities, the clinical results were evaluated. After surgery the score obtained was 67.1±9.9 points by the Kinematic system, and 76.1±7.4 points by the Whiteside system. Statistically there was no difference between the two. Roentgenographical results showed that the Whiteside system had been inserted more precisely than the Kinematic system.
The results of 29 total knee arthroplasties (21 patients) that have been performed in the last 3 years were evaluated. 21 patients were followed for an average of 19 months. At the time of the review, all but one patient were free of pain or mildly painful. Although the results are satisfactory, the follow-up period is short. So we must follow each case for a longer time. In this report we compared two different types (Kinematic and Miller/Galante) of cut instruments. Cut instruments of M/G allow us to establish proper alignment without difficulty. We consider that instruments of M/G are more precise.
Twenty patients (twenty-four knees) were treated by continuous passive motion (CPM) in the postoperative rehabilitation of total knee replacement. Twelve patients (fifteen knees) were OA and eight patients (nine knees) were RA. These patients were divided into three groups according to CPM method. Group A (five patients, six knees) were treated by CPM from the day of operation, Group B (seven patients, nine knees) were from the next day, Group C (eight patients, nine knees) were from two days after. As control, sixteen patients were used as a non-CPM group (Group D). Transition of range of motion (ROM), volume of postoperative bleeding, wound condition and pain were compared among these four groups. CPM group were superior to non-CPM group in ROM, pain and wound condition, however, in the group treated by CPM from the day of operation, there was tendency of increase in postoperative bleeding volume.
Since 1983 we have used cementless T. H. R. (JIAT) in severe osteoarthritis of the hip joint. We reviewed the results of 29 T. H. R. in 27 patients (average age, 63.7 years) who required autogenous grafting with bone from the femoral head for acetabular deficiency. Roentgenographically bone grafts appeared to have united without evidence of resorption, to be communicated by bone trabeculae within an average period of 2.2 months, and to be remodeled within an average period of 6.3 months. 99mTc-MDP scintimetry was performed after operation, and bone graft uptake ratio was markedly decreased within an average period of 16 weeks. We suggested that bone graft was reconstructed within 16 weeks.
Seven cases of total hip replacement for highly dislocated hip were followed up for an average of 3 years and 4 months. All of them revealed clinical improvement in pain and walking ability. Unfortunately, one of them underwent revisional operation 6 years after THR because of loosening. Although total hip replacement is sometimes chosen as a treatment for highly dislocated hip, it is important that those patients should be the old aged and the socket of total hip replacement should be set at the level of the original acetabulum.
A special review, with the aim of identifying the incidence and the factors of the dislocation of Charnley low-friction arthroplasty, was undertaken. From 1971 to 1986, 304 arthroplasties have been performed at Nagasaki University and followed over 2 years. Dislocation is defined as displacement of the head of the femoral prosthesis out of the prosthetic socket on radiography except the dislocation owing to the loosening of the socket or stem. Dislocation occurred in 8 of 304 hips (2.6%): 2 occurred during 3 weeks, 1 at 3 months, and 5 from 4 months to 180 months. Two of these were traumatic dislocations. In 5 hips, there were inadequate deepening and placement of the acetabular component at operation. In 3 hips, there were varus position of the femoral component, but those varus angles were below 5 degrees. In one hip, there was loss of neck length due to resorption of the femoral calcar. Two dislocations were related to muscle atrophy due to prolonged bedrest and other 2 dislocations were related to scarring from severe trauma or previous surgery. Only one patient showed complete bony union of the trochanteric osteotomy in dislocated cases, whereas 5 of 7 patients showed complete detachment of trochanter. Factors contributing to dislocation were inadequate orientations of prosthetic socket and loss of normal tissue tension as a result of muscle atrophy and defective bony union of trochanteric osteotomy.
Twelve prosthetic hip and knee replacements (eight bipolar endoprosthetic replacements, three conventional total hip replacements, and one hemiarthroplasty of the knee) were implanted between 1978 and 1988 in eleven patients who underwent hemodialysis for chronic renal insufficiency. Five replacements (three conventional total hip replacements, one bipolar endoprosthetic replacement, and one hemiarthroplasty of the knee) in four patients had a failure due to the loosening of the component. In these four patients, the median age at operation was 51 years and the average length of follow-up was 6 years. One of these patients died of infection in both loosened total hip replacements seven years and four months after the operation.
One case was a 54-year-old woman who had secondary osteoarthritis in the left hip, which was replaced with a Harris Galante-type prosthesis without cement. After eighteen months, a revision arthroplasty was carried out because radiographs showed bone resorption and loosening. Another case was a thirty-year-old female. The right hip with aseptic necrosis of femoral head was replaced with an English Conversion Head. After four years, radiographs showed that inner head was dislocated from outer head. It compelled us to carry out revision arthroplasty. In both cases, intraoperative cultures were negative for infection. The soft tissues adjacent to the companents were dark. On histological examination, the metal particles of groundup debris were intra- or extracellular. They produced a marked mononuclear histiocytic response.
In order to know the factors that influenced the progression of the clear zone in the acetabular side, we investigated 106 hips which were followed up for 5 years or more after Charnley THR. The progression of the acetabular clear zone didn't correlate with the sex, operative age, socket angle, acetabular cementing technique, acetabular anchoring, and the location of the socket if it was original acetabular location. But if it was osteonecrosis as the primary disease, the acetabular clear zone had wrong course compared with osteoarthrosis. The patient's general osteoporosis correlated with the progression of the acetabular clear zone. Concerning the bilateral THR, both acetabular clear zone took same courses. These suggest that the general factors have more correlation with the progression of the acetabular clear zone than the locational factors.
We treated 134 cases of femoral neck fracture between 1983-1985 in our department. The age range was 60-97 years, (mean age, 77.8 years). Generally, early surgical treatment is recommended for femoral neck fracture. We compared the postoperative results and complications of such fractures in the elderly during long-term hospitalization with those of other types of patients. Most of the patients had many complications, especially senile dementia, and the resultant gait ability was not favorable when compared with other types of patients.
39 patients over 80 years old with femoral neck fracture were examined. They were classified into four groups on admission and again at the follow-up. The average hospitalization time was one hundred and twenty-two days. Many patients had cardio-vascular diseases, senile dementia, anemia or lung diseases. Pneumonia and heart failure were important as post-operative complications. At one-year follow-up, 9 patients were found to be dead. 58% of the surviving patients had maintained their pre-fracture level of activity compared with 72% of the patients under 80 years old. Medical complications and senile dementia caused deterioration of their activity levels.
We operated 11 cases with femoral neck fracture with hemiplegia during 1983-1988 and surveyed the methods and the results of their treatment. Results of treatment of intracapsular and extracapsular femoral neck fractures with hemiplegia, although there is a little decrease in walking ability, are good. Indication of compression hip screw for intracapsular femoral neck fracture in patients with hemiplegia is low, If operation is done, more carefull guidance is necessary in aftercare. There are no problems in operative met hods of ext capsular femoral neck fracture with hemiplegia. Active operative treatment shoud be done on the patients with femoral neck fracture even if they are hemiplegic.
One hundred thirty patients with trochanteric fractures of the femur were treated with Ender pins. Distal ends of the pins were buried into intramedullary area. Only two cases required the secondary operation due to the distal migration of the pins. It is our impression that the buried method of Ender pins is very useful for elderly patients.
233 cases with trochanteric femoral fracture were treated by a few operative methods (Jewett nail, Ender nailing, Compression hip screw and others'). 78 cases had stable type fracture and 155 cases unstable, 23 per cent of 101 cases treated with Jewett nail osteosynthesis had fracture complication, particularly penetration of the nail in unstable type. 12 cases with Ender nailing (38%) had severe sliding of the nail and varus deformity of the femoral neck in IVand Vtype. In Vtype, 3 cases with Compression hip screw (23%) had shortening of the femoral neck but they had few complications in ADL. We find the Compression hip screw osteosynthesis suitable for the treatment of trochanteric femoral fracture also of the unstable type.
Twelve patients of femoral neck fracture treated by captured hip screw were reviewd. Postoperatively, eleven patients obtained union and good weight bearing. Because titanium alloy is solid and operative technique is easy, captured hip screw is useful for treatment of femoral neck fracture of aged patients.
The therapeutic results of using a titanium alloy captured hip screw in cases of external fractures of the femoral neck were studied. The subjects were eight males and 22 females, a total of 30 with an average age of 78.8. According to Evans' classification, the fractures were the stable type in 21 cases and the unstable type in nine cases. The average operating time was 56 minutes and the average hemorrhagic volume was 80ml which were not inferior to those of other methods of osteosynthesis. Loading of the hip was started in the 3rd week postoperatively on the average, and bone union was confirmed after 10.5 weeks on the average in all cases. One case of protrusion of the lag screw in the joint and one case of breaking of the fixation material were observed as postoperative complications, but these were both technical errors, and it was considered that good results can be obtained if care is taken concerning reduction of the eversion position of the fracture, correct insertion of the lag screw and accurate joining of the hip screw and plate.
Clinical history from the onset to one year and two months after operation of slipped capital femoral epiphysis in an adult male patient aged 27 years was reported. The slipping of the femoral head occurred suddenly one week after the onset of pain in the left hip which was operated on by multiple pinning. While the clinical course was favourable, degenerative changes developed in the femoral head approximately one year after operation. Hypothyroidism was revealed by the hemanalysis and Tc scan, and the biopsy of the coexistent arthropathy of the elbow joint demonstrated the villous hypertrophy of synovial membrane and the degenerative changes in articular cartilage.
The purpose of this paper was to determine the factors in the operative procedure that contributed to a successful outcome and assess the clinical results. Three patients who had undergone Pauwels' valgus osteotomy with Blount plate were reviewed after a mean follow-up of 5.3 years. The average age at operation was 42 years. In all cases radiographical and clinical results have been satisfactorily achieved. There were no complications at the last examination such as late segmental collapse and occurrence of osteoarthritis of the hip or the knee. It seems to be most important that approximalety 15 degrees between the horizon and fracture-line should be postoperatively maintained in order to decrease a shearing force of the hip joint.
A preliminary study was made on the evaluating system of motor function in the cervical myelopathy. The elements of the system include evaluation of fine motion, isolation of fingers, grasping, and pinch; speed of motion; and 88 questions about ability of ADL usage of hands. A total of 20 evaluations on 15 myelopathy cases were made and analized in order to determine the system was sensitive to disability of the hand or not. The authors suspect that the evaluating system has good sensitivity and potential easy applicability.
We have experienced 10 cases of cervical spondylosis with muscle weakness. These were thought to be the dissociated motor loss syndrome reported by Keegan, or cervical spondylotic amyotrophy by Sofue. We operated 7 cases of them and reported the results. In one case we have found the dissociated motor loss due to soft disc hernia.
In order to investigate the mortality of cervical spondylosis, 203 patients who were operated with cervical spondylosis were studied. 180 patients were alive and 23 patients were dead. Death ages ranged from 48 to 83 and an average was 66.7. 168 patients who were alive in 1975 and known to be dead or alive in 1985 were analyzed to obtain standard mortality ratio. Observed deaths were 16, expected deaths were 16.2 and standard mortality ratio was 0.99. It means that there was little difference in mortality between patients and general people. But comparing two groups, patients who were alive over 80 y. o. (group I) and died at less than 70 y. o. (group II), postoperative J. O. A. score tended to be low in group I. It is suggested that ADL associates with mortality of cervical spondylosis.
We studied serious 108 cases less than 10 points of JOA score of cervical spondylotic myelopathy to clarify the characteristic of these serious cases and to differentiate between the cases with and without good results. We almost obtained good postoperative results in acute worsening-types, but in chronic worsening-types, those were inferior to the former. We confirmed again that it is important to diagnose earlier and to start the therapy at the proper time.
Two cases of continuous type of OPLL and one case of segmental type of OPLL were autopsied and histologically studied. Characteristic findings were as follows: 1. In OPLL, the ossification initiates near the posterior border and edge of the vertebral body, and thickens toward the superficial layer of the posterior longitudinal ligament. In the axial ossifying point of the continuous type of OPLL, various directions of ossification, including axial direction and from superficial to deep direction, are recognized. 2. Degeneration and posterior protrusion of the intervertebral disc are more evident in the segmental type of OPLL than in the continuous type of OPLL. However, other factors such as age and history of disc herniation should be considered. 3. Endochondral ossification process is predominant in the ossifying point, and membranous ossification process is focally noticed.
The purpose of this paper is to predict the prognosis in cervical spondylotic myelopathy (CSM). Multivariate analysis to evaluate the weight of various factors which influence the postoperative results of CSM. The subjects were 251 patients with CSM. We performed the method of discriminant analysis of quantification theory type 1 and multiple regression analysis using 10 parameters. Following results were obtained. 1. The factors which influence the postoperative results were, in order of weight, the duration of symptoms, function of the lower limb movement, sensory of the body, the anteroposterior diameter of cervical canal, bladder disfunction, function of the upper limb movement and age. 2. Multiple correlation coefficients were 0.78 on the methods of discriminant analysis of quantification theory type 1, 0.73 on multiple regression analysis. On the base of this results, most cases with CSM will be able to predict the prognosis.
Since 1983 operative treatment was performed in 57 patients (47 males, 10 females) of cervical myelopathy by means of cervical spinal canal enlargement, which consist of 42 cervical spondylotic myelopathy, 12 cervical ossification of posterior longitudinal ligament and 3 cervical spinal cord injury. Their ages at the time of operation ranged from 25 to 79 years old and the average was 57 years old. The clinical results were evaluated using J. O. A. score of cervical myelopathy and recovery rates of Hirabayashi's method. The preoperative average was 7.9 points, and it was improved up to 13.6 points postoperatively. The average recovery rate was 64.0%. After operation cervical instability was seen in 3 cases. In two of them cervical physiological lordosis disappeared preoperatively. The enlargement breadth of cervical spinal canal in the sagital diameter was not correlated with the clinical results. The clinical results were much influenced by the factors of age and duration of history. Cervical spinal canal enlargement (by Hirabayashi's method) is a very valuable and safe procedure for cervical myelopathy.
Clinical evaluation of French window laminoplasty for twenty-seven patients with myelopathy due to OPLL in cervical spine was analysed. The average age at surgery was 56 years old and average follow-up period 4.5 years. Neurological recovery was evaluated by The Japanese Orthopedic Association score. The preoperative score ranged from 5 to 15 points, the mean being 9.8. The postoperative score ranged from 1 to 17 points, the mean being 13.1. The average recovery rate was 55.2%. The duration of myelopathy and age at the operation were the factors for affecting the results of operation. Roentogenologically, three of 27 patients showed postoperative mild kyphotic deformity. Mobility of the cervical spine was reduced considerably. However, these roentgenologic changes did not affect the results. French window laminoplasty is a useful procedure for the treatment of the myelopathy due to OPLL in cervical spine.
Amongst the out-patients in recent two years, we found one hundred eighty Lumbosacral trasitional Vertebrae. These cases were classfied into four groups according to Jinnaka. Type IT was the most frequent, being observed in 86 cases (47.8%), followed by Type IV in 49 cases (27.2%), and Type III in 29 cases (16.1%). In patients younger than 23 years old, the hypermobile discs were found at the level just above the transition in Type II, III and IV. This may be a cause of increased of degenerative disc disease.
A series of 190 patients (91 men, 99 women) with the fifth lumbar spondylolysis were examined clinically and radiographically on two occasions. one with only lysis and the another with lysis and olisthesis. The symptomatical differences were not particularly evident between the two groups subjectively and objectively. The lumbar index and the S-H angle were shown to be prognostic values for the development of vertebral slipping.
Clinical study was performed on 40 cases of surgically treated spondylolysis with adjacent disc lesion and spinal canal stenosis. In these cases, appropriate approach must be selected for each of cases. Operative methods which we performed for adjacent disc lesion group were as follows: (1) anterior interbody fusion for adjacent disc and affected disc, (2) anterior interbody fusion for adjacent disc and bone graft in the lytic portion, (3) anterior interbody fusion for adjacent disc and disectomy for affected disc, (4) laminectomy and posterolateral fusion for multiple lesions, and (5) Love's method for adjacent disc. On the other hand, operative methods for spinal canal stenosis group were as follows: (1) laminectomy only, (2) laminectomy and posterolateral fusion, (3) laminectomy and anterior interbody fusion for affected disc, and (4) fenestration operation for multiple lesions. They were followed more than one year after surgery. Postoperative improving rate more than 80% by J. O. A. score was noted in 76% of adjacent disc lesion group and 62.5% of spinal canal stenosis group.
We report a few cases of compression of dorsal root ganglia. The dorsal root ganglion normally lies within the lateral portion of the intervertebral foramen and is not directly compressed by a bulging disc prolapse or a bony spur which may compromise the nerve root. This ganglion contains cell bodies of first-order sensory neurons. The chemical response to mechanical deformation of the dorsal root ganglion may hold significance for some of the unknowns in the etiology of low-back pain.
Subjective symptom, neurological signs and skin temperature of lower limbs were examined in 20 patients with intermittent claudication of cauda equina before and after excercise test. In 15 patients (75%), increased neurological signs were observed. Straight leg raising was restricted in 5 patients, sensory deficit were increased in 12 patients and 9 patients became worser in weakness of lower limbs. These alternations tended to be provoked in agreement with lesions, so excercise test appeared to assist in level diagnosis. Many patients had cold area in the affected limb and it was suggested that the increase of cold area caused by walking correlates that of sensory deficit.
Fourty-eight patients with lumbar spinal canal stenosis surgically treated after 1975 were reviewed. Patients were placed in the following categories: degenerative stenosis without olisthesis (22), degenerative spondylolisthesis (14), combined (7), and post-operative (5). Twenty-four patients were treated with wide laminectomy, eleven with wide fenestration, five with wide laminectomy and fusion, six with wide fenestration and fusion, and two with fusion only. Results were judged to be good in 16 patients, fair in 25, and poor in 7. The patients who showed instability on the preoperative radiographs needed spinal fusion in addition to decompressive procedure.
The purpose of this paper is to describe two things. One is to analize lumbar radicular pain by response of nerve root infiltration clinically and espesially to describe false negative and false positive response. The other is to discuss the mechanism of action of nerve root infiltration experimentally, using rabbits. Based on our clinical and experimental studies, it can be concluded that there is a pathogenesis, so-called “arachnoid villi insufficiency” in clinical cases with false negative response of nerve root infiltration, and spinal arachnoid villi has great importance on mechanism and site of action of nerve root infiltration.