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Youichirou Ishida, Shinya Kawai, Akira Matsuoka, Katsumi Nakamura, Tos ...
1990 Volume 39 Issue 1 Pages
224-227
Published: October 25, 1990
Released on J-STAGE: February 25, 2010
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To determine the induction mechanism of OPLL, using cultured cells derived from the human posterior longitudinal ligament of the spine, the ossification group and the non-ossification group were compared morphologically and biochemically.
The result seems to suggest that the non-ossification group consists chiefly of fibroblast-like cells, while the ossification group consists chiefly of osteogenic undifferentiated mesenchymal cells. The pathogenesis of OPLL is considered as follows. In the ossification group, the posterior longitudinal ligament is composed of high osteogenic potential cells, with a resulting general tendency of systemic ossification.
This systemic ligamentous ossifaication factor is a primary cause of OPLL. When localized anatomical stress and/or abnormalities of hormone and bone metabolism stimulate this ligament, which is in a high osteogenic activity, this may result in initial ossification which may develop into pathological OPLL.
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Atsuhiko Wakisaka, Shinya Kawai, Kenji Kido, Yasushi Tanekubo, Hiroyas ...
1990 Volume 39 Issue 1 Pages
228-230
Published: October 25, 1990
Released on J-STAGE: February 25, 2010
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Histological Feature of Ossification of the posterior longitudinal ligament of spine (OPLL) was studied using undecalcified grinded sections. All specimen were obtained from patients with OPLL, who had already done double bone labelling. The specimens were observed by light, polarized, and fluoro-microscopies.
Tetracycline bone labelling was found at the level of vertebral edge in OPLL. but little bone labelling was found in the middle part of OPLL.
Mineral apposition rate (MAR), which was calculated from double labelled width, was compared among ilium, vetebra, rib, and OPLL. The patients with OPLL were deviled into two groups; the OPLL group, which showed symptom due to OPLL, and the CSM+OPLL group, which showed symtom due to cervical spondylosis, not OPLL. In both groups, MAR in vertebra was higher than that in ilium. But MAR in OPLL was changeable. In OPLL group, MAR in OPLL was higher than that of ilium, vertebra, and rib. In CSM+OPLL group, MAR in OPLL was same to that of vertebra.
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Takatomo Mine, Shinya Kawai, Hirotsugu Oda, Toshihiko Taguchi, Hiroshi ...
1990 Volume 39 Issue 1 Pages
231-233
Published: October 25, 1990
Released on J-STAGE: February 25, 2010
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The supraspinous ligaments, which were taken during surgery, were observed by means of SEM and TEM in order to clarify ossification process of the ligament. The fibrils of the supraspinous ligaments were 900-2000A in diameter and were almost parallel. Closer to the ossification, various changes were observed such as thinness and branching of fibrils, bridging between fibrils, irregular network of fibrils and deposits of granular substance.
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Noburo Hashimoto, Takafumi Nakamura, Yuuichi Maeda, Kazuyuki Takeshita ...
1990 Volume 39 Issue 1 Pages
234-236
Published: October 25, 1990
Released on J-STAGE: February 25, 2010
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Diagnosis by MRI was analyzed in 15 patients with OPLL of the cervical region. As a result we found that MRI could diagnose OPLL in 9 of 15 patients (60%). This rate was inferior to those by plain radiographs (86.7%), tomogram (100%) and CT (100%). There was a strong relationship in the possibility of diagnosis by MRI to the efficacious AP canal diameter of the cervical spine. Even in the cervical spine with less than 9mm of the AP canal diameter, the image of spinal cord compression appeared in MRI.
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Shinpei Miyazaki, Kensei Nagata, Toru Takamatsu, Masashi Sagara, Akio ...
1990 Volume 39 Issue 1 Pages
237-242
Published: October 25, 1990
Released on J-STAGE: February 25, 2010
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MRI findings of 41 patients with cervical OPLL were investigated. The 41 patients consisted of 28 males and 13 females with a mean age of 59 years (range, from 43 to 80 years). According to the morphological classification of OPLL, 12 patients had continuous type, 13 had mixed type, and 16 had segmental type. The ratio of spinal canal narrowness by OPLL was measured on roentgenograms and compared with the MRI findings. Spinal cord compression on T1-weighted sagittal images was little demonstrated in the patients with a narrowing ratio of less than 30%. Dural tube compression on T2-weighted images was not seen in the patients with a narrowing ratio of less than 20%. T2-weighted axial image was a most sensitive method for demonstrating OPLL. Degenerative changes of disc on MR image were frequently observed at the level of OPLL; 100% of segmental type, 93% of continuous type and of mixed type.
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Takayoshi Ueta, Keiichiro Shiba, Masaaki Katsuki, Kenzo Shirasawa, Tet ...
1990 Volume 39 Issue 1 Pages
243-245
Published: October 25, 1990
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MRI studies of fifty-two cases with OPLL in the cervical spine showed some interesting facts. Firstly, twenty-five percents of these cases had iso-or high signal intensity in the area of the OPLL, which indicated the pre-OPLL stage. Then, MRI could show us the change of the spinal cord between pre-operation and post-operation. The volume of the spinal cord is usually increased by posterior decompressive laminectomy than by anterior operation. However, some cases were observed in which the volume did not increase sufficiently or did not increase at all (atrophic type) or increased too much on the contrary. Finally, in OPLL with spinal cord injury, low intensity area in the spinal cord was observed at the edge of the OPLL. It suggested that a dynamic factor was more important than a static factor such as a narrow canal.
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Ayumu Terada, Kouichi Ookubo, Takashi Sakou, Eiji Taketomi, Kazunori Y ...
1990 Volume 39 Issue 1 Pages
246-248
Published: October 25, 1990
Released on J-STAGE: February 25, 2010
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15 patients with ossification of the posterior longitudinal ligament (OPLL) in the cervical spine were examined with 3 dimensional computed tomography (CT). During 3 dimensional CT examinations, 3 different types of ossification were observed. Radiologically continuous type and continuous region of mixed type ossification were semicylindric or semi-spindle shaped that were associated with large width and thickness laterally. Radiologically segmental type and segmental region of mixed type ossification were thin semi-cylindric shape that were localized in the center of posterior aspect of the vertebral body.
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Yukio Kinjo, Tomohiro Nakasone, Takesi Nisihira, Isao Gushiken, Kunio ...
1990 Volume 39 Issue 1 Pages
249-254
Published: October 25, 1990
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We performed clinical and radiological evaluation of double open door laminoplasty by longitudinal splitting of the spinous process on 20 patients (13 males, 7 females) with ossification of the posterior longitudinal ligament.
1. Mean recovery rate by Hirabayasi's method was 67.6%.
2. There was no significant difference of postoperative range of motion of the cervical spine between two groups; one group of the patients operated from C2 to C7 and the other from C3-C7.
3. The distance between the posterior margin of the vertebral body and the posterior edge of the cord was measured at the level maximally occupied by ossification using postoperative CT-myelography. One case with tethering effect showed the longest distance.
4. The case with tethering effect showed the root stretching and clarification sign which we stressed as an important radiological one in the postoperative myelography and CT-myelography.
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Tadashi Egawa, Kunio Tomonaga, Yasushi Nakamura, Mamoru Kitagawa, Masa ...
1990 Volume 39 Issue 1 Pages
255-258
Published: October 25, 1990
Released on J-STAGE: February 25, 2010
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Postoperative clinical results were evaluated in 42 patients (33 males and 9 females) with O. P. L. L. in cervical spine. The mean follow-up period was 5 years and 5 months. The mean age of the patients at operation was 56 (36-73) years. Twenty-six (61.9%) patients were treated by the method of enlargement of spinal canal (reported by Hirabayashi and Miyazaki), 9 patients by extirpation of ossification area by anterior approach, and 7 patients by laminectomy. Thus, 34 (92.8%) of the 42 patients obtained good and excellent results. This clinical outcome correlated with trauma and severity of the preoperative symptoms.
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Masakuni Naruo, Eiichi Koyanagi, Misao Urakado, [in Japanese], Kiyosi ...
1990 Volume 39 Issue 1 Pages
259-263
Published: October 25, 1990
Released on J-STAGE: February 25, 2010
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66 cases of ossification of the posterior longitudinal ligament of the cervical spine have been surgically treated for the past 12 years. Of these, 44 cases followed over 3 years were studied clinically, and 20 cases followed over 5 years after operation were roentgenologically investigated.
The results were as follows:
1) According to the JOA Score, excellent and good cases accounted for 100% in the auterior approach (18 cases), 90.4% in the posterior approach (21 cases) and 60% in reoperated cases (5 cases).
2) Factors influencing postoperative results.
In cases with duration of symptoms over 5 years, score under 6 points due to JOA, and narrow canal rate in antero-posterior diameter over 70%, postoperative results were mostly unsatisfactory.
3) Roentgenological investigation.
Progression of ossification with aging was encountered in 25% at long axis and 5% at thickness.
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Yutaka Itou, Shinya Kawai, Kouzou Sunago, Minoru Saika, Tosihiko Taguc ...
1990 Volume 39 Issue 1 Pages
264-266
Published: October 25, 1990
Released on J-STAGE: February 25, 2010
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The operative results of aged patients with cervical myelopathy due to ossification of the posterior longitudinal ligament were studied. Twenty-nine cases consisting of 25 males and 4 females were included. Their ages ranged from 65 to 81 years (average; 68.2 years old) at the time of operation. The evaluation of their overall results at the time of discharge using the JOA score system showed that their scores were lower than those of non-aged patients, because of the long duration of myelopathy. However, aged patients had the same reversibility of damaged cervical cord as non-aged patients. Based on our follow-up results, we propose that the operative therapy of aged patients with the desease must be hurried if the cervical myelopaty is distinct.
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Toshihiko Taguchi, Shinya Kawai, Hirotugu Oda, Kouzou Sunago, Fujio Ka ...
1990 Volume 39 Issue 1 Pages
267-269
Published: October 25, 1990
Released on J-STAGE: February 25, 2010
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The purpose of this paper is to describe the factors which infulence the postoprative long-term follow-up results of ossification of cervical posterior longitudinal ligament (OPLL).
In this paper, 115 patients were studied. There were 85 males and 30 females. The mean age of this group of patients was 55 years with a range from 28 to 81 years. The duration of follow-up varied from 1 year to 17 years, the average being 6 years and 11 months. We performed multivariate analysis to evaluate the weight of various factors: age, sex, duration of symptom, trauma, type of ossification, dysfunction of extrimities, sensory disturbance, dysfunction of bladder, antero-posterior diameter of cervical canal and so on.
The main results found in this study were as follows:
1) The factors which infulence the postoperaive results were, in order of weight, onset by trauma, age, dysfunction of the bladder, duration of symptom.
2) But duration of symptom in OPLL is not so important as in cervical spondylotic myelopathy (CSM).
These results showed that spinal cord in OPLL is compressed statically and not dynamically compared with in CSM. Because of this, symptomatic OPLL has high posibility of irreversible change in spinal cord and we have to decide carefully the timing of operation for this condition.
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Takayoshi Ueta, Keiichiro Shiba, Masaaki Katsuki, Kenzo Shirasawa, Tet ...
1990 Volume 39 Issue 1 Pages
270-272
Published: October 25, 1990
Released on J-STAGE: February 25, 2010
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Postoperative evaluation was performed on fifty-two patients with the ossification of the posterior longitudinal ligament (OPLL) after decompressive laminectomy or anterior decompression and fusion. OPLLs with cervical cord trauma showed poor results, thus these cases had better be excluded.
Twenty-one cases with posterior approach gained 48.4% recovery rate, and eigteen cases with anterior approach 51.7%.
In severe narrow cases (narrow ratio>40%), posterior decompressive laminectomy was performed on eighteen cases and anterior decompression under microscopy on four cases.
Four anterior cases gained 58.5% recovery rate, whereas 18 posterior cases 48.7%.
Anterior resection of OPLL and fusion was a good procedure for compressive myelo pathy due to OPLL, especially cases with kyphosis or cases with locally located big OPLL.
In order to perform this operation safely, it is essential to use the microscopy during operation.
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Minoru Saika, Hideo Watanabe, Kazuyuki Moriyama, Akihiko Asami, Hideo ...
1990 Volume 39 Issue 1 Pages
273-275
Published: October 25, 1990
Released on J-STAGE: February 25, 2010
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137 cases of cervical myelopathy due to OPLL which consisted of 100 males and 37 females were studied. Their ages ranged from 28 to 81 years old (average; 56 years old) at the time of operation. The follow-up periods were more than 1 year and up to 17 years (average; 7 years).
Their overall results were satisfactory: that is, excellent and good results were obtained in 77% of the cases at the time of discharge, and in 73% at the time of follow-up study.
Based on our follw-up study of each operative method, we propose that laminoplasty be chosen first for continuous and combined OPLL, and that anterior approach be limited for segmental and localized OPLL without canal stenosis.
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Yoshihiro Usui, Masami Ozaki, Fumitaka Furuta, Satoshi Yoshimura, Kous ...
1990 Volume 39 Issue 1 Pages
276-280
Published: October 25, 1990
Released on J-STAGE: February 25, 2010
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We studied long-turm results of treatment of ischial decubitus ulcers and had the conclusion as follows. Many cases of ischial decubitus ulcers had recurrence and a prevention of the recurrence was difficult, even if a good cushion was constructed by using a muscle flap.
It seemed that a recurrence rate was diminished by partial resection of the ischial tubercle.
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Tarou Kodama, Masakuni Naruo, Eiichi Koyanagi, Misao Urakado, Mutuo Sh ...
1990 Volume 39 Issue 1 Pages
281-284
Published: October 25, 1990
Released on J-STAGE: February 25, 2010
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Cervical orthoses is important for the postopereative treatment of the cervical disorder. A Newly designed cervical orthoses, N-type cervical orthoses, has been developed for 5 years. It is characteristic of the N-type cervical orthoses that it is supported by frontal, suboccipital region, mastoid process and thorax without supporting mandibula.
The availability of the N-type cervical orthoses is as follows;
1) Alignment can be changed at will by posterior adjustable dual hinge.
2) It can be easily taken off because frontal solid cuff is inlaid design and truncal jacket is fixed by magic tape.
3) It allows the patient to eat and talk easily because no mandibular support is necessary.
4) It is lighter than other orthoses (700gr).
As a result of measurement of stability with the N-type cervical orthoses by radiography and photography, range of motion was 13.2° in flexion and extension, 7.6°, in bending, 8.3° in rotation, and rate of control was, 77.4% in flexion, and extension 74.8% in bending and 87.1% in rotation.
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Kazuo Kaneko, Shinya Kawai, Akira Matsuoka, Kazuo Nakata, Yasunori Fuc ...
1990 Volume 39 Issue 1 Pages
285-287
Published: October 25, 1990
Released on J-STAGE: February 25, 2010
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We attempted to record spinal evoked potentials epidurally stimulating intercostal nerve in cats and man.
The first negative potential (N1) conducted mainly in dorsal tract, and its spinal conduction velocity was about 50m/s in cats.
The amplitude of the first component was not significantly altered by the frequency of stimulation up to 50Hz in cats and man.
The peak latency of the first component recording from cervical epidural space was delayed (range, 0.64-1.0ms) acording to stimulating intercostal nerve more caudally in man.
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Masaru Higo, Shyougo Harada, Tokutarou Nagayama, Kouji Inaba, Nobuhiko ...
1990 Volume 39 Issue 1 Pages
288-291
Published: October 25, 1990
Released on J-STAGE: February 25, 2010
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One hundred patients with Down syndrome, between one and fifteen years old, were evaluated for instability of the cervical spine at the atlanto-axial joint. Roentgenologically, the odontoid process was considered normal in ninty-seven patients, and abnormal in three patients. The mean atlanto-dens interval in ninty-seven patients with normal odontoid process was 2.5±1.0mm in flexion and 1.2±0.8mm in extension. Six patients (six per cent) exhibited abnormal intervals (4.5mm or more) during flexion. Of these patients, three patients had the slightly ligamentous atlanto-axial joint instability, another three patients who had the atlanto-axial instability with the osseous malformation of the odontoid process showed narrowing of antero-posterior diameter of the atlas and the cervical spinal canal in atlanto-axial level. One patient with abnormal odontoid process had any symptoms and signs of spinal cord compression at examination.
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Minoru Katayama, Sekio Tominaga, Keiji Ohuchi, Takashi Toyoumi, Ichiro ...
1990 Volume 39 Issue 1 Pages
292-297
Published: October 25, 1990
Released on J-STAGE: February 25, 2010
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86 patients with rheumatoid arthritis (RA) were studied to clarify the radiological progression of the cervical spine. The number of patients without radiological changes decreased from 60 at the time of initial examination to 45 at the final examination in an average duration of 14 years and 3 months. The radiological changes occurred more likely in the upper cervical spine than in the middle or lower cervical spine. Atlanto-axial subluxation was one of the characteristic early features of RA, which was detected in 8.1% of the patients, increased over 10 years period markedly and found in 48% of the patients in the 3rd decade of RA. Odontoid erosion was also the most common radiological change detected in early RA and the change increased in the 3rd and 4th decades of RA.
In the middle or lower cervical spine, disc narrowing had a significant increase in the 3rd decade of RA. Subaxial subluxation increased gradually in frequency with increased disease duration. Apophyseal erosions also showed a tendency to increase gradually with increasing duration of the disease.
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Toshinori Nakao, Hideo Watanabe, Minoru Saika, Akihiko Asami, Muneyosh ...
1990 Volume 39 Issue 1 Pages
298-300
Published: October 25, 1990
Released on J-STAGE: February 25, 2010
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We examined the relation of segmental signs and neurological localization in 11 patients of cervical soft disc herniation with myelopathy. We showed the index of neurological localization. We think that diagnosis of the level of lesion can be presumed by the index of neurological localization with MRI, if segmental signs are taken exactly.
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Hiroshi Itoh, Takashi Sako, Yoshiyuki Morizono, Kazutaka Wakimaru, Yas ...
1990 Volume 39 Issue 1 Pages
301-304
Published: October 25, 1990
Released on J-STAGE: February 25, 2010
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In order to know the useful index in the level diagnosis of the cervical myelopathy, preoperative neurological findings were analyzed in 21 patients who underwent effective operations of single level of anterior decompression and fusion for cervical myelopathy.
Initial site of numbness, tendon reflex, Hoffmann's sign and sensory disturbance were thought to be useful findings in the diagnosis of the localization of the vertebral level. On the other hand, muscle weakness was too complex to be used for the level diagnosis of myelopathy.
Sensory disturbance reflected the impaired spinal cord of about one spinal segment below the impaired vertebral disc level.
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Hideo Nishikawa, Hideo Watanabe, Minoru Saika, Kazuyuki Moriyama, Shin ...
1990 Volume 39 Issue 1 Pages
305-307
Published: October 25, 1990
Released on J-STAGE: February 25, 2010
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We studied 6 cases of severe cervical spondylotic myelopathy which consisted of 5 males and 1 females.
Their ages at the time of operation ranged from 59 to 78 years old and average was 68 years old.
All cases under went operative treatment. The clinical results were evaluated using J. O. A. score of cervical myelopathy and the change of activities of daily living such as eating, standing and walking.
After operation J. O. A. score was not improved remarkably. But ADL was improved in all cases and no case became worse.
The surgical treatment will be indicated for the severe cervical spondylotic myelopathy in order to improve the ADL and prevent the worsening of the symptom of each case.
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Tsukasa Kondo, Mitsuhiro Sumi, Kenji Kumagai, Masayuki Kondo, Takayosh ...
1990 Volume 39 Issue 1 Pages
308-312
Published: October 25, 1990
Released on J-STAGE: February 25, 2010
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Since 1978 eight cases of tuberculous Spondylitis were operated by the curettage and anterior spinal fusion, in which the additional Luque SSI was applied to one case. Before the operations only one case showed kyphotic deformity which was more than 10 degrees. Although in one case a fracture of the grafted bone occurred, all cases finally showed stable bone union and almost satisfactory results. In order to get firm stability of the anteriorly grafted bone, 7cm in length, the additional Luque SSI was applied to the case with L2, 3 tuberculosis who had chronic renal failure. This case could ambulate early and showed good course. We guess that the additional posterior instrumentation is effective in the case with a general complication which demands early mobilization and who needs a long fusion.
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Shunichi Rikimaru, Keiichiro Shiba, Masaaki Katsuki, Takayoshi Ueta, K ...
1990 Volume 39 Issue 1 Pages
313-317
Published: October 25, 1990
Released on J-STAGE: February 25, 2010
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This is a clinical study of the surgical treatment of tuberculous spondylitis in the past ten years. In principle, radical debridement and anterior spinal fusion with bone grafting has been done in our center; but as circumstances demand, posterior fixation with instrumentation was combined. We consider that the combined surgical method is effective for the facilitation of bone fusion and the stabilization of anterior spinal fusion in cases of more than 3 vertebral bodies involved, for the maintenance of corrected angle in cases of high degree kyphosis, and for the early start of rehabilitation in cases of paresis.
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Hideo Baba, Nobuyuki Ito, Masao Eto, Toru Hirano, Masahiro Wada
1990 Volume 39 Issue 1 Pages
318-322
Published: October 25, 1990
Released on J-STAGE: February 25, 2010
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We report a rare case of chordoma which occurred at cervical spine. A 84-year-old man had a numbness in upper extremities from 1986. Gradually he had difficulty of defecation, dysuria and gait disturbance. Plain X-rays of the cervical spine showed structural damage to the posterior side of the C4 body due to the tumor. Myelography demonstrated a complete block at C3-C4 level.
A tumor of the cervical spine was suspected. Then in February 1987 the tumor resection and replacement of a vertebral body with ceramic implant were carried out. After surgery, the gait ability of the patient improved quite well.
Pathological diagnosis obtained was the metastasis of parathyroid tumor. According to this diagnosis, resection of parathyroid was performed but there was no malignancy.
Because the gait disturbance appeared again, the second surgery was carried out to replace the implant in the end of 1988. The pathological diagnosis obtained this time was chordoma. Now the patient is ambulating quite well.
Chordoma is a rare tumor which arises from foetal notochordal rests. It accounts for about 0.8 percent of all primary bone tumors. It occurs mostly at the sacrococcygeal and cranial areas, but it is seldom found in the cervical spine. Generally 45-49 percent in the sacrococcygeal, 36-39 percent in the cranial, 14-18 percent in the spinal areas. Cervical chordoma presents formidable problems in diagnosis.
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Osamu Akiho, Shinya Kawai, Koichiro Ihara, Tsuneo Nakahara, Ichiro Ash ...
1990 Volume 39 Issue 1 Pages
323-325
Published: October 25, 1990
Released on J-STAGE: February 25, 2010
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In the follow-up study of 101 patients with metastatic spine tumor, the survival from the time when metastases were identified was analyzed. The median survival was 12 months. The survival was significantly short in patients whose cancers were metastasized from the stomach or liver, whose ages were less than 40 years old and who had liver or lung metastases. On the other hand, the patients whose bone metastases were localized in the limieid site had significantly longer survival.
Although the grade of paralysis, the surgery of the spine and radiographic findings of bone metastases were supposed to influence the survival, there was no stastistical evidence.
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Kunio Sasaki, Keisuke Matsuo, Takuya Tamaru, Atsushi Shimizu, Koichi W ...
1990 Volume 39 Issue 1 Pages
326-330
Published: October 25, 1990
Released on J-STAGE: February 25, 2010
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We operated on 7 cases with metastatic tumor of the spine. There were 6 males and one female. Mean age was 59 years old (42-78yrs). Primary lesions were kidney in three cases, lung in two, breast and esophagus in each one case. Levels of metastasis were cervical in one case, thoracic in four and lumbosacral in two cases. All suffered from pain and 5 cases were paralized. Several operative methods were done. Spinal instrumentation with bone cement was performed in 6 cases. Improvemnt of paralysis and pain were studied. All cases showed improvement but duration was variable in cases. Indication and purpose of operative treatment were discussed.
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Hiroyasu Ichimoto, Shinya Kawai, Hirotugu Oda, Toshihiko Taguchi, Kats ...
1990 Volume 39 Issue 1 Pages
331-332
Published: October 25, 1990
Released on J-STAGE: February 25, 2010
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Pathogenesis of ossification of cervical posterior longitudinal ligament (OPLL) has not been well clarified yet.
The purpose of this paper is to evalute calcium metabolism in patients with OPLL, using the bone mineral analyzer (single photon absorption technique).
Bone mineral contents were examined in 27 cases of OPLL. There were 15 males and 12 females, and their mean age was 52 years with a range from 42 to 74.
107 healthy people, 51 males and 56 females, were selected as a cotrol group, matching the averageage as much as possible.
Results were as follows:
The bone mineral content tends to be higher in the group of OPLL, compared with the control group, and it was significantly higher if only the asymptmatic patients were selected.
The period of myelopathy could sffect the bone mineral contents.
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Hideki Sonoda, Mitsuyoshi Oda, Mani Azuma, Kenichi Yamashiro, Kiminori ...
1990 Volume 39 Issue 1 Pages
333-335
Published: October 25, 1990
Released on J-STAGE: February 25, 2010
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Two cases of phrenic nerve palsy in an ossification of posterior longitudinal ligament (OPLL) were admitted and underwent operations on cervical spine. A 57-year-old man had been performed cervical laminoplasty (C
2-C
7). A month after surgery, he was weaned from artificial respirator, and gained vital capacity by 1, 230ml, and %vc, 36.6%. Seven months post-Operation he was discharged on his feet.
A 55-year-old woman had been operated (C
2-C
7) on due to left phrenic palsy and myelopathy in OPLL. Three months after surgery the neurological deficits were almost fully recovered.
Cervical X-ray films of Both cases revealed the peak of OPLL to be on the third cervical spine and the myelogram showed block at C
2-3 level. In case of upper cervical OPLL, we need an attention to phrenic nerve palsy.
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Akira Iwaki, Takashi Naono, Masahiko Ono, Tetsuro Isayama, Naoyuki Mat ...
1990 Volume 39 Issue 1 Pages
336-338
Published: October 25, 1990
Released on J-STAGE: February 25, 2010
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In the past, as a posterior decompression surgery for OPLL, Iaminectomy was perfomed. Howerver, postoperative follow-up was made difficult by such negative factors as instability of the operated part, abnormal alignment, scar formation, etc. Therefore, to counteract these negative results, a variety of Iaminoplasty are being tried in recent years. We have performed Iaminoplasty both by the Kirita and Hirabayashi methods at our hospital since 1983, and we hereby report our evaluation of the operative results and the postoperative complications.
With the Hirabayashi method, we observed the limitation of the range of movement in the posterior flexion. We could observe no difference in the improvement rate of the clinical condition when using different operative techniques. Postoperatively, we had no case where OPLL's growth could be clearly observed.
In case of the unilateral existence of ossifications with a high rate of stenosis, we thought it was necessary to practice sufficient caution at the time of operation in order to prevent complications.
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Kouichi Tashiro, Naoya Tajima, Kouichi Matsumoto, Toshimasa Kuroki, Ta ...
1990 Volume 39 Issue 1 Pages
339-343
Published: October 25, 1990
Released on J-STAGE: February 25, 2010
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Between 1984 and 1989, 14 patients with a diagnosis of cervical OPLL were treated by Hirabayashi's laminoplasty method in our institution. There were 12 men and 2 women, between the ages of 42 and 74 years (mean, 58.7 years). These patients were followed for 4 to 68 months. The duration of the interval between the initial occurrence of symptoms and operation ranged from one to 120 months (mean, 28.1 months).
We studied as to clinical results and the morphologic changes. Results were as follows.
1) Clinical results showed 59.6% according to the improvement rate of Hirabayashi's method.
2) Postoperative cervical antero-posterior movement decreased to below a half of preoperative movement.
3) Cervical alignment showed a tendency to be straight, but there was no instability nor deformity.
4) There was a possible correlation between lost angular anteroposterior movement after operation and clinical results.
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Shin Tanaka, Itushi Baba, Akihisa Ishida, Tadayoshi Sumida, Koichiro N ...
1990 Volume 39 Issue 1 Pages
344-348
Published: October 25, 1990
Released on J-STAGE: February 25, 2010
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Since 1980, operative treatment was performed on 49 patients of OPLL associated with cervical myelopathy by means of laminoplasty (42 cases), laminectomy (2 cases) and anterior decompression (5 cases). The clinical results were evaluated using J. O. A. score of cervical myelopathy and recovery rate of Hirabayashi's method. The preoperative average was 10.8 points, and it was improved up to 14.0 points postoperatively. The recovery rate was 50.7%. The duration of myelopathy and age at the operation etc were the factors for affecting the results of operation. Radiological progression of OPLL was seen in 36.7%, but these radiological changes didn't affects the results. We have usually used surgical microscope in laminoplasty (modified Ito's method), so that we have had no neurological problems.
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Katsumasa Fujikawa
1990 Volume 39 Issue 1 Pages
349-358
Published: October 25, 1990
Released on J-STAGE: February 25, 2010
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Reports are to be made on the results of manual treatments upon ten cases of scoliosis, two of which showed the maximum Cobb angle of 23°.
Manual treatments have proved to be superior to conservative therapies such as tractions, exercises, braces and plaster-casts, from the real proofs of curing so faster during comparatively short time in growing ages (from 8 to 18 years of ages).
The successful results in four adults with manual treatments on therapy have proved to be available upon adults.
Two eminent aspects can be seen on the clients; one is the stiffened muscles on the depressed side, and the other is the rotation of the vertebrae.
Upon these two aspects, manual treatments have worked most positively, on which in detail my paper is presented.
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A compative study between Harrington instrumentation (H. I) and Harrington segmental spinal instrumentaion (H. S. S. I.)
Yoshihiro Kohashi, Kenichiro Shibata, Masayoshi Oga, Kazuo Hayashi, Yo ...
1990 Volume 39 Issue 1 Pages
359-362
Published: October 25, 1990
Released on J-STAGE: February 25, 2010
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We retrospectively reviewed the records of posterior arthrodesis for idiopathic scoliosis. Thirty patients had one stage posterior spinal arthr-odesis between 1971 and 1988 using one of types of instrumentation; a Harrington distraction rod, Harrington distraction and compression rods, Harrington distraction and compression rods with a device for transverse traction and a Harrington distraction rod with sublaminar wires.
H. S. S. I. provides usefulness for rigid fixation and correction of scoliotic deformities compared with the conventional H. I..
But no significant difference was found among another three groups.
The use of a straight Harrington rod reduced normal thoracic Kyphosis, but the use of bending Harrington rod and S. S. I corrected thoracic hypoky-phosis.
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Toyoko Asami, Hideo Watanabe, Minoru Saika, Ryuji Kitajima, Toshinori ...
1990 Volume 39 Issue 1 Pages
363-365
Published: October 25, 1990
Released on J-STAGE: February 25, 2010
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Prospective study of scoliosis was investigated in 60 cases of severe cerebral palsy. Of them, 29 cases were men and 31 cases were women, ranging in age from 10 to 61 years old (mean; 34 years). The results were as follows;
1. The incidence of scoliosis in cerebral palsy was very high (62%).
2. During school age of children and adolescent, curves of scoliosis increased rapidly.
3. The incidence and severity of scoliosis were more remarkable in cases of non-ambulatory patient.
4. It is concluded that treatment of scoliosis in cerebral palsy should be started as early as possible.
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Mutsuaki Kai, Kunio Sasaki, Keisuke Matsuo, Takuya Tamaru, Atsushi Sim ...
1990 Volume 39 Issue 1 Pages
366-370
Published: October 25, 1990
Released on J-STAGE: February 25, 2010
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Paralytic spinal deformities associated with myelomeningocele present several difficulties in the treatment.
Eleven years old boy suffered from paralytic lordoscoliosis with spina bifida below L5. Preoperative scoliosis was 124 degrees, pelvic lumber angle 33 degrees and sacral inclination 60 degrees.
Tow-stage operation was done. First, anterior release and fusion by use of Zielke instrumentation was performed. Second, Luque instrumentation by Galvestone technique and Harrington instrumentation was done.
During operations, small vertebrae and weakened body around the apex were main problemes fou instrumantation.
One year afer the operation bony union was achieved. Finally, scoliosis was corrected 40% (75 degrees), pelvic lumbar angle 45% (18 degrees) and sacral inclination was 11 degrees. He gained balanced appearance of his back and could sit well.
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