The fate of free fat grafts used in spinal decompression surgery to prevent epidural fibrosis was evaluated by CT scanning. A follow-up study was perfonmed on thirteen cases. The free fat grafts were obtained from the subcutaneous layer of fat of the back. The grafts were used to cover the dural sac. Results were excellent in six, good in five, and fair in two cases. In one case, the second operation for recurrence of the tumor demonstrated survival of the fat graft and apparent prevention of scar formation. The free fat grafts were effective to prevent the postoperative dural scar formation.
We reviewed 644 patients who had been examined by myelography retrospectively. The incidence of side effect was lower with iotrolan and iohexol than with metrizamide. But confusion, tremor or convulsion occurred in 3 of 189 patients examined with iotrolan, all being investigated for cervical region by lumbar puncture. We concluded that iotrolan and iohexol were safe agents for myelography.
Thermographic analyses before and after operation were studied in 30 patients with root compression syndrome. Of these, 12 patients had cervical radiculopathy, and 18 patients had lumbar disc herniation. All of patients were diagnosed the single level lesion by clinical findings, myelogram, and MRI findings. The accordance rate of thermotome with clinlcal symptome and MRI findings was investigated. The manifestation of thermographic cold area coincided with the pain-distribution on the surface in most cases. The degree of compression in dural tube on MRI correlated with appearance rate of cold area on thermogram. However, the degree of temparature of the thermographic cold area didn't correlate with the MRI findings. The asymmetric thermographic cold area was reduced or disappeared by the decompression surgery. Therefore, thermographical examination is useful to evaluate the result of surgical treatment and follow-up study.
Spinal evoked potentials by median nerve stimulation were recorded on the cervical dura over the dorsal column in adult cats. The basic wave form consisted of two negative potentials. Alterations in these potentials produced by compression injury to the cervical cord and roots were described. The rusults were as follows. 1. The median nerve in a cat mainly arises from C7 and C8. 2. The compression injury to the cervical cord and roots elicits latency delay and positive potentials.
One of the problems in patients of imcomplete cervical cord injury is limb pain. We treated three cases with lumbar sympathetic ganglion block. The first case was a 61-year-old man with right leg dull pain. After the block, he became better. The second case was a 41-year-old man with left leg pain and coldness. After the block he became better. The third case was a 77-year-old man with left leg paresthesia. The effect of blocd was fair. We considered the reason that the block was imperfect, and the complaint was not pain. From now, we will treat the patient who had lower limb pain by lumbar sympathetic ganglion block.
Two cases of traction injury of the brachial plexus have been reported herein. They had the complications of Brown-Séquard syndrome below the T2 myelomere. It is supposed that these two pathological states have come down on the first case almost at once. On the other hand, Brown-Séquard syndrome appeared on the second case 3days after injury. Existence of the hematoma in the neural canal was negrected by radiographical studies. These cases are not common, and the causes of these complicated phenomena are unsolved.
We have experienced a case of intraspinal epide rmoeid cyst. A 10-year-old man had been suffuring from the painful attack of both thighs repeatedly. Myelogram and MRI showed an intradural tumor of L2-3 region. The tumor was removed and proved to be epidermoid cyst. He has no pain after operation.
A Case of spinal archnoid cyst is reported. Our case is a 38-year-old man who had no complaint but showed an atrophy of quadriceps and hypesthesia of thigh. MRI showed the mass lesion behind the CSF space, and at enhanced-MRI with Gadolinium-DTPA, the lesion was not enhanced, therefore, was diagnosed as cystic lesion, MRI, myelography and CTM have been shown to be very useful tools in the diagnosis of a spinal archnoid cyst.
We report a case of congenital extradural arachnoid cyst. Computed tomographic myelography and magnetic resonance (MR) were complementary, and both correctly charactarized the cystic nature of the lesion. Surgical removal of the cyst and obliteration of the communication led to improvement in neurological symptoms.
A case of concurrent diastematomyelia and syringomyelia in a 6-year-old girl was presented. She had hypertrichosis and dimple in the lumbosacral region. X-ray and CT myelography demonstrated spina bifida, low placed conus, tight filum terminale, and diastematomyelia. In addition to these abnormalities, MR imaging demonstrated syringomyelia that was not detected by other radiographic studies. Because embryopathologically, diastematomyelia and syringomyelia may occur simultaneously, the possibility of syringomyelia should be carefully evaluated in patients with diastematomyelia. And MR imaging will be an excellent tool to deliniate the presence of syringomyelia as well as other associated abnormalities.
We report two cases of thoracic spinal cord herniation. Case I: A 45-year-old male complained of increasing gait disturbance. CTM and MRI showed displacement of the spinal cord to the abdominal side at the T5 vertebral level. He was treated with surgical correction of the spinal cord which had herniated into a defect of dura mater. Postoperatively, he gave almost complete healing. Case II: A 43-year-old female developed Brown-Sequared Syndrome. Myelography, CTM and MRI showed shift of the spinal cord to the right side at T5-6 vertebral level. She was treated with correction of the spinal cord which incarcerated into a cavity due to arachinoiditis. Postoperatively, her neurological status became stable.
A case of meningioma with the ossification which is continuing with the thoracic vertebral body is reported here. A seventy-nine-year old woman consulted our hospital, complaining of the gait disturbance and paresthesia in the lower extremities. MRI showed evidence of extramedullary mass at T2-3. A myelogram showed a “cap” shaped block at the same block, suggesting an intradural extramedullary tumor. Then a laminectomy and excision of tumor was performed. Pathological diagnosis of the specimen was psammomatous meningioma. The tumor, about 0.8cm×1.0cm in size, had the ossification continuing with the thoracic vertebral body. The meningioma is famous for the characteristic which produces bone or calcification. Reports of the meningioma with the ossification are sometimes seen. However, as seen in our case, a bone-infiltrating meningioma is very rare.
We report a case of tabetic arthropathy of the thoracic and lumbar spine with paraplegia and retention of urine. The patient is a 61-year-old man who underwent decompression of the spinal canal from L3-5 two times in 1982 and 1984. On admission in April 1989, the diagnosis was made by the characteristic X-ray findings of Th8, 9 and L3, 4, 5, Argyll Robertson pupils, absence of both ankle and knee jerks, loss of deep tendon sensation and blood Wassermann reaction. He had been treated with decompression of the spinal canal from Th8-9 and L3-5 in April, then 2 months later, because of instability of the lumbar spine, he was treated with anterior fusion from L3-4 and wiring.
Hand-Schüller-Christian Disease is usually diagnosed in children and young adults. An unusual case of Hand-schüller-Christian disease with severe pulmonary involvement in a middle aged man was reported. A 48 years old man complaining of gait disturbance came to our clinic in June 1988. He had noticed polydipsia and polyuria since 1980, but worked as a taxi driver. He had noticed the onset of pain in both knees in Oct. 1986 and subsequently became incapaciated and was able to move only with assistance. Roentgenograms showed symmetrical sclerosis involving metaphysis and diaphysis of the proximal ulna, proximal humerus and distal femur. There were osteolytic lesion in the sclerotic area in the proximal tibia, femur and acetabular region of the left pelvis and pathologic supracondylar fracture of the both femurs. He voiced 10 liters of urine with a specific gravity less than 1.002. Open biopsy of the tibia revealed numerous foamy histiocytes in a fibrotic bed. The patient is under the treatment with Prednisolone, Desmo pressin and training with cruch gait.
It is well known that the careful control and therapy are needed in fracture patients with diabetes mellitus (DM). 88 fracture cases with DM were treated for the last 7 year; 29 were treated conservatively and 59 were operated. We compared the change of blood suger before and after operation to see the influence of DM on the surgical treatment. It was found that the condition of DM of most cases could be controlled well after operation except 2 cases. It is concluded that active operative treatment should be done as soon as possible, if the diabetes control would be done enough after operation.
In this paper we described the patients who had not only chronic renal failure but also bone and joint diseases developed during the maintenance hemodialysis. We performed surgical treatment in more than 200 cases undergoing hemodialysis. So we reported our cases concerning the complications after surgery and compared those with nondialysis patients. All of the patients who had had osteosynthesis, osteotomy or arthrodesis healed without problems, and no difference was found between the dialysis and nondialysis patients. The complications after surgery in the prosthetic implantation group were infection and loosening. They occurred higher in incidence in the dialysis group than in the nondialysis group. Roentgenogtams revealed the bone cysts in various joints. The deposition of beta-2-microglobulin amyloid was detected in the substance of the bone cysts by histological study. It has been suggested that these bone cysts may cause pathological fracture or osteoarthritis.
Bone mineral density (BMD) in the second metacarpal bone was measured by Digital Image Processing method (DIP) in 146 female patients with senile osteoporosis. There was a significant correlation between age and the BMD, and also a correlation between BMD and the jidai index, which evaluated the degree of bone atrophy of the lumbar spine. The fracture and deformity of the spine with osteoporosis was showed to depend on the degree of BMD of the second metacarpal bone. When the BMD increased more than 2.1mm Al., the spine might not have the danger of the fracture and deformity. We showed that the DIP method was a useful parameter in osteoporosis.
In 161 persons (over 70 years old) with complaining of lumbago, bone mineral density (BMD) was meaured at the lumbar spine by DEXA (QDR 1000). In 87 cases-54% (8 men-23.5% and 79 women-62.2%) X-ray findings of lumbar and thoracic spines showed at least one vertebral fracture due to osteoporosis. We concluded that when BMD decreased to less than 0.7g/cm2, the risk of osteoporotic vertebral fractures escalates rapidly.
Thirty-three magnetic resonance images of the cases under the age of twenty-five years were evaluated. Two groups were compared; one was a control in which eleven were imaged because of the sprain of the low back, and the other was a symptomatic group in which twenty-two sustained low back pain. There were two major findings in the NMR images: low intensity in the nucleus and posterior protrusion of the disc materials, which were observed more often in the cases of the symptomatic group than in the control group. Close relationship between posterior disc protrusion and clinical manifestation of low back pain was suspected. Multi-leveled abnormalities were specially noted in the symptomatic cases. Existence of Schmorl's nodules had no clinical meaning and no relation with changes of the discs on the NMR images.
MR images of 43 cases with lumbar disc herniation were evaluated. MRI was carried out by Siemens' Magnetom (1.5T). T2 weighted image demonstrated alteration of signal intensity in the discs best clearly. T1 value, T2 value and ρ density were calculated on each disc grouped it in three parts: anterior, middle and posterior one third. In the discs with normal signal intensity, T1 value was longest in the middle, and T2 value also was longest in the middle. However, ρ density was longest in the posterior. In herniated discs, the anterior showed the shortest T2 value and a similarity of long T2 value was found in from the middle to the posterior contained herniated disc mass. These findings were significant in diagnosis of lumbar disc herniation on MRI.
Thirty-two patients with lumber canal stenosis were studied by comparing MRI with myelography. In the ability of diagnosis MRI and myelography were almost equal. The results in this study proved well the value of MRI. The sagittal diameter of the dural tube less than 5mm by midsaggital MRI suggested complete block on myelography.
Neurogenic claudication caused by exercise but relieved by rest is usually reliable symptom of lumbar spinal canal stenosis. 12 patients with lumbar canal stenosis were studied. They ranged in age from 64 to 85 years (mean, 74.5). There were 7 men and 5 women. These 12 patients were evaluated with treadmill exercise testing and spinal cord evoked potential after electrical stimulation to the tibial nerve trunks, caudal epidural anesthesia. In all of 12 patients, both electrical stimulation to the tibial nerve trunks and caudal epidural anesthesia significantly prolonged onset time of claudication. In 10 of 12 patients, the amplitudes in spinal cord evoked potential significantly decreased after treadmill exercising and recovered in 5 minutes.
Lumbar disc herniation in teenagers may show a tear at the ring apophysis which may show spurformation. This ring apophysis tear may occur not only in teenagers but also in cases of adults showing lumbar disc herniation. Accordingly, Vertebral spur generated after lumbar disc herniation in teenagers and adults and posterior vertebral spur in lumbar spinal stenosis were compared by the type of spur in order to investigate the etiology or cause of posterior vertebral spur in each case. 1) Bony spur generated after lumbar disc herniation in teenagers and adults and vertebral spur generated at posterior site of the lumbar vertebra in cases of lumbar spinal stenosis cannot be discriminated morphologically. 2) The etiology of posterior vertebral spur in adult cases was considered to be associated greatly with lumbar disc herniation.
For the subjects of 37 cases of degenerative lumbar spinal canal stenosis, the following studies were made. By comparative review of form lateral view in posture with clinical symptoms of patients, survey was made on how the posture is related to the development of symptom of lumbar spinal canal stenosis. As a result, the most remarkable item was the decrease in the curved angle of both thoracic kyphosis and lumbar lordosis with the progress of lumbar spinal canal stenosis. There were many cases showing the flat and straight extended thoracic and lumbar spine.
Scoliotic change of the lumbar spine due to lumbar disc herniation is regarded as the sciatic scoliosis. It is generally believed that the shape of the curve is oriented as to keep the nerve root away from the herniated disc. In our study of 40 cases with lumbar disc herniation, the curves were observed in 14. In 11 out of the 14 cases with scoliosis (79%), the convex side corresponeded with the side of the herniation, and after operation the curve subsided. Therefore, we consider that most of the shape of the curve is decided whether the herniation is at the right or left side.
Eight cases of lumbar disorders with drop foot were investigated to determine the level of injured nerve roots and to estimate factors of clinical results. These cases consisted of four cases of lumbar disc herniation, one case fo lumbar canal stenosis, one case of OPLL, one case of idiopathic extra-dural hematoma, and one case of others. The results found in this study were as follows: 1) L5 root injury was involved in all cases. 2) Cauda equina and/or multiple roots injuries were noted in all cases. 3) Cases who had bladder paralysis and/or severe weakness of tibialis anterior muscle did not improve their drop feet.
Love's method was carried out for lumbar intervertebral disc herniation. Fifty-six patients were evaluated by J. O. A. Score, roentgenograms and MRI. These cases consisted of 32 males and 24 females. The age range was from 12 to 56 with an average of 31.6 years. The mean follow-up period was 4 years and 7 months, ranging from 1 year to 9 years and 6 months. The rate of improvement in the J. O. A. Score was 86.4% at the L4/5 interval, and 78.9% for L5/S1, for an average improvement of 87.7% overall. While there was tendency for increased postoperative lumbar mobility and advancing disc space narrowing, no significant correlation was recognized between the rate of improvemant and roentgenographical changes. We obtained satisfactory results from Love's method for intervertebral disc herniation, however, as disc material still remains in situ. Careful longterm follow-up will be necessary before the final results are known.
We have been preferred to the conservative therapy on the lumbar disc herniation. Recently, patients often hope to return to their works as soon as possible, even if they select operative methods. We have operated on 248 patients of lumbar disc heniation by modified Casper's method using microscopy since 1985. Using microscopy, we can operate safely under well-lighted field. Casper reported that this method has ablemish of taking long period in operation. We shortened the operative time by modifying the operative procedures. So we can finish operation in less than 30 minites. Our postoperative managements are as follows; 1) the patient is permitted only to move on the bed during the first week after opration; 2) the patient is permitted to walk only on a plain floor during the second week; 3) William's exercise is started after 2 weeks postoperatively; and 4) the patient is permitted to leave the hospital after 3 weeks postoperatively.
Eighteen patients of herniated lumbar disc were treated with microlumbar discectomy in 1989, and were compared with 20 patients treated with Love's nucleotomy. Using this method, intraoperative bleeding decreased to 69 grams, and the postoperative period for ambulation has averaged 2.2 days and postoperative stay 9.4 days, which were far shorter than the period with Love's nucleotomy. The mean operatig time was 83 minutes, and the improvement rate by JOA score was 81.3%, which were almost the same as those with Love's nucleotomy. Microlumbar discectomy seems to have good application for the first operating intracanal hernia with clear laterality from the disc wihtout so much degeneration or instability.
Symptomatic spinal arachnoidal ossification is an extremely rare condition of unknown etiology, especially at the lower lumbar and sacral region. We experienced a case of 38-year-old man with this condition occuring after myelography and discography. Preoperatively the useful available diagnostic tool was computed axial tomography. The removed tissues were histologically true ossification without inflammatory cell infiltration in our case, and so almost in the literatures. Therefore we emphasized that the ossification of the spinal arachnoid was more adequate term than the ossificating arachnoiditis. Although the ossification was removed attentively, postoperatively the patient experienced urinary retention and weakness of plantar flexion of the ankle. And so the exploration shoud be carried out carefully because of the adhesion between the cauda equina and the ossification such as periradicular, or cylinder, or ring type. Additionally the literatures were reviewed about the predisposing factor, etiology, diagnosis and treatment of the ossification and calcification.
Since the first discription of intrathecally prolapsed disc by Dan dy (1942), the papers have been rarely reported. We have experienced intradural disc prolapse in two cases out of 1556 cases with surgical in tervention for the lumbar disc herniation. 86 cases found in litera tures were reviewed. Intrathecally prolapsed disc on the average acc ounted for about 0.2% according to literatures. Intradural disc prolapse was mostly encountered at the L4/5 disc level, and more frequently localized at the upper lumbar disc (L1/2-L3/4) levels than commonly experienced herniation. The first patient in this series was difficult to be differentiated from cauda equina tumor in myelogram and magnetic resonance imaging. Because intradural herniated disc in the first case was enhanced with Gd-DTPA. But retrospectively, iso-intensity lesion in intradural space was mostly valuable as the diagnostic examination. The second patient showed the myelogram like a massive epidural disc prolapse. That is, the myelogram of both patients revealed a regularly marginated manifestation, this feature was different from the previously reported cases. And the second case was found at an uncommon L5/S disc level postoperatively. Anterior dura mater had fastly adhered with posterior longitudinal ligament in these two cases.
A case of intradural rupture of a lumbar intervertebral disc at L4/5 is reported, and the literature is reviewed. These patients usually have neurologic deficits more severe than those found in the much more common extradural disc herniations. The pathogenesis of this condition is uncertain, but the common factor allowing intradural disc herniation is probably dense adhesions between the dura and the posterior longitudinal ligament. Intradural disc herniations should be included in the differential diagnosis of lumbar intradural lesions causing nerve root or cauda equina compression, since preoperative roentgenographic diagnosis is quite difficult.
Case Reports A 61-year-old man with left lumbar pain and left lower limb pain was pointed out to have an abnormal shadow in the spinal canal on CT-scan. Simple X-P view in the lumbal spine revealed vacuum phenome non in L3-4 intervertebral disc. Myelography revealed the defect of the left L4 root at the supe rior aspect of the L4 vertebral body. Plain-CT revealed low density lesion in the spinal canal at the same level. Discography and CTD revealed the continuance between interv ertebral disc and cystic tissue. We confirmed cystic tissue surrouded by the thick capsule and the presence of the gas collection in it at the operation. We did disectomy and vertebral body fusion via the posterior approach to prevent a relapse. The patient was in good condition after the operation.
We analyzed 11 cases of extracanal lumbar nerve root entrapment. MRI and selective radiculography were the most effective examinations. We thought that the osteoplastic laminectomy was the best approach to these lesions.
Fifteen patients who underwent Electrosurgical Lumbar Medial Branch Neurotomy had been followed 4 to 36 months, and the degrees of pain releif were evaluated by JOA score. Neurotomy was performed using a electrosurgical unit and evoked EMG at lumbar PVM was monitored at the same time to make sure of the denervation. Following the neurotomy, 9 patients showed increase and 4 patients decrease in their scores. And one patient showed no score changing. It was considered that among 5 patients who showed no improvement, there were 2 patients who had psychological, pain, 2 patients had multiple focuses and 1 patient had another origin of pain.
We have had experience in treating 18 cases of Chance type fractures. The dominant feature of this fracture is a horizontal fracture involving the posterior element with little or no compression of the vertebral body. In our cases, 4 cases had bony fragments retropulsed from posterior wall. These may be classified to burst fracture. Two cases had rotation and displacement of the vertebral body. These may be classified to fracture dislocation. Surgical treatment with transpedicular fixation was done in 9 cases. For cases with burst fracture, combined anterior decompression and fusion was done.
Spinal Epidural Abscess (SEA) is a rare infectious disease and often misleading to a delayed diagnosis. This delay may be disastrous, and result in permanent neurologic dysfunction or death. We evaluated SEA with spondylitis using MR Imaging by Field Echo method (TR 400, TE 23, Flip Angle 15°) occasionally. The appearance of MR imaging shows 1) high intensity which corresponds with abscess and inflammation, 2) decrease of high intensity which represents restoration of inflammation, and 3) low intensity which represents the sclerotic change of parainflammatory area. MR Imaging by Field Echo method is useful for the diagnosis of SEA.
Pyarthrosis of the knee was treated in 11 patients by arthroscopic lavage and debridement. There were 4 men and 7 women patients whose ages raged from 8 months to 80 years. Staphylococcus aureus was cultured in 5 knees. Four patients were caused by the injection of steroids. There were no recurrences. Arthroscopy can aid in establishing the diagnosis and implementing the appropriate treatment when a septic knee is suspected.
A 78-year-old man complaining of the left knee pain was admitted to our hospital in January 1989. The patient experienced knee pain, swelling and local heat. Physical examination revealed tenderness, swelling local heat, bollotment, and varus deformity in the knee joint. Radiographs demonstrated joint narrowing, spurring formation, and sclerotic changes of subchondral bone in the knee joint. Antibody to human T cell leukemia virus, measured by indirect immunofluorescence, was positive in the serum (1: 4096), in the synovial fluid (1: 2048), and in the spinal fluid (1: 32). The atypical lymphocytes compatible with ATL-like cell were observed in synovial fluid. The surgical treatment was managed with synovectomy and unicompartmental prosthetic total knee replacement. The synovial proliferation was observed. The histology of synovium by hematoxyrin and eosin staining demonstrated villous proliferation, no lining cells, and no lymphoid cell infiltration.
In this report, we present a case who suffered from synovial osteochondromatosis in the subacromial bursa which, to our knowledge, has never been reported in Japan, and regained early return to sporting activities by arthroscopic treatment. The patient was a 40-year-old male who had shoulder pain during and/or after playing volleyball over a 10-year period and had increased pain, limited shoulder motion and disturbance of daily living since one month ago. From physical examination and radiographs, synovial osteochondromatosis in the subacromial bursa and impingement syndrome of the shoulder was diagnosed, and arthroscopic synovectomy and removal of loose bodies was performed. Postoperatively, passive motion was started on the first day after the operation and he has returned to full sports activity, playing volleyball without pain since 8 weeks postoperative.
Ruputur of long head of biceps tendon was known to occur rarely in a young adult. We report one case of the injury in a young soft-ball pitcher. Our case was a 21 years old male. He was a pitcher of a soft-ball team and he began Windmill throw from 13 years old without proper direction. At the acceleration phase of the normal pitching form, long head of biceps tendon is not extensed hard and not pressed hard to bicipital groove. The pitcher that was not directed proper from, the tendon was extensed and pressed hard to bicipital groove. So the tendon in a young adult becomes weak and ruputures with slight force. We thought that orthopedists should understand characters of each sport.
We treated 4 cases of rupture of the biceps tendon. Durations between injury and operetion was 2, 3, 4 and 6 weeks in each case. We concluded that we had to reconstruct the biceps tendon by 6 weeks after injury on the basis of the operative findings.
Most of tears of the rotator cuff of the shoulder can be repaired by McLaughlin's operation. But it is sometimes difficult to close the defect, so, many methods of repair were reported. In two patients with massive tear of the rotator cuff, we used a Leeds-Keio artificial ligament to close the defect. A good functional result was obtained in these cases.
It seems that anterior acromioplasty described by Neer in 1972 has been accepted widely as a successful procedure for impingement syndromes in the shoulder especially in older individuals. We have also met with excellent results following the Neer procedure. In this report we reviewed four shoulders of three patients which were reoperated on in accordance with Neer in our hospital more than six months before because of persistent impingement in spite of the previous one or two operations in other institutions and found following three points deserving of emphasis through the findings at the operation, reconfirming the effectiveness of the Neer procedure. 1) To minimize a damage to the function of the deltoid muscle, it is imperative that it should be detached or devided through an optimum approach and restored anatomically. 2) It should be recognized that the degenerated AC joint is an important contributor to rotator cuff impingement and that the anterior acromioplasty of Neer is not limited only to the coracoacromial arch when the AC joint is degenerated. 3) In younger patients with impingement, it is important to realize that it may be a continuum of some type of instabilities and that the impingement should never be surgically repaired without repairing the primary instability, if present.
Ultrasonography of the shoulder joint was investigated in 30 patients who had been suspected rotator cuff tear. In 26 patients, the sonographic fihdings were correlated with arthrography (sensitivity, 86%). The sonographic appearance of the rotator coff tear, be could be classified into three, categories as thinning (15 patients), invisualization (8 patients), and discontinuity (3 patients) of the rotator cuff. Based on these results, ultrasonography is comparable with arthrography for evaluation of the rotator cuff, so we think that ultrasonography can be used as the intial imaging test for the rotator cuff tear.
L. J. clein and T. R. swift reported Droopy Shoulder Syndrome (DSS). The patients with DSS had various symptoms and signs. And they demonstrated that the second thoracic spinal body of these patients, was visible in the lateral view of cervical spine X-rays. In this report we studied the relation between the symptoms of DSS and the visibility of the second thoracic spinal body in cervical spine X-rays. Therefore, we examined the lateral view of cervical spine X-rays in 500 cases that came to our department with various disorders between 1988 and middle of 1989. In 52 cases, 10.4% of the total, we could see the second thoracic spinal body. So we did make inquiries about the symptoms of DSS to these cases, and got 42 answers from them. 15 cases of the 42 (36%) had the symptoms of DSS, but other cases had no symptons. We think this rate is very high. But we had had some patients with DSS whose second spinal body were not visible. Because of these results we think the visibility of the second spinal body in cervical spine X-rays is only one of the signs of DSS. And 11 of the 15 cases, who had the symptoms of DSS, were diagnosed as TOS. Therefore, we should have a doubt about combined DSS in female patients with TOS.
There are few reports to discuss the prognosis of the inferior instability of the shoulder. The purpose of this study is to compare the results of natural course and those of the pectoralis major transfer for the inferior instabilty. From 1975 to 1988, 48 patients were diagnosed as inferior instability of the shoulder and were followed from 2 to 11 years. According to the complaints, 19 patients were observed as natural course (natural group) and 29 patients (34 shoulders) were operated on (operated group), and there was no difference in the degree of instability between the two groups. All patients except two did not improve the inferior instability at their follow-up consultations (average, 4.3 years) in the natural group. And the two patients who were followed for 9.9 years and 11 years respectively, showed no instability. But the number of the patients who complain the feeling of subluxation were decreased among the natural group. The average instability of the operated group were improved from 38% to 16%. Four patients among the natural group and ten patints among the operated group did not complain at the follow-up. The number of patients who complained the shoulder stiffness were increased among the operated group at the follow-up. There were no osteoathrotic changes in the natural group. These results suggested that the operative indication should be made carefully for the patients who complain the shoulder stiffness and the feeling of subluxation of the shoulder.
We investigated abnormality in the position of ipsilateral scapulae, compared with contralateral scapulae, in 106 patients with disorders of the shoulder. Its abnormal position was recognized in 45 percent of all patients, and there was no difference of the frequency in each disease. In 53 postoperative patients, cases with its abnormal position had a tendency to have a low activity in daily living and a low points in the J. O. A. score. The present study suggests that abnormal position of the scapulae shows low capaity in function of the shoulder.
SSEPs were applied to 16 cases suspected of having thoracic outlet syndrome. SSEPs were measured before operation, after excision of the serratus anterior and resection of the first rib, and in three months after the operation. Neurological TOS group indicated an increase in the N9 (1-2) conduction time before operation and the shortening in the N9 (1-2) conduction time after the first rib resection and in three months after the operation. Vascular TOS group indicated the normal range in the N9 (1-2) conduction time before and after operation.
We evaluated the accuracy and reliability of the Camino and Millar systems using our closed circuit system to determine whether they can be useful for measurement of intramuscular pressure. Both catheters as well as wick catheter reflected the mercury pressure precisely and were considered to be applicable for measurement of intramuscular pressure. These catheters were found to be simple in the technique and very useful for long-term measurements of compartment pressure or continuous measurements during exercise.